Objective To investigate the agitation effect of dexmedetomidine in the operation of radical hysterectomy by general anesthesia in patients.Methods 68 cases in this study who were under the operation of radical hysterectomy by general anesthesia in our hospital were selected, and randomly divided into the group A and the group B, 34 cases in each group.Group A received dexmedetomidine after tracheal intubation, and group B received physiological saline as the measurement of group A, hemodynamic and inflammatory factors were measured at different time points in anesthesia, the corresponding indexes and the degree of emergence delirium were compared.Results Compared with T1 , levels of HR and MAP increased, levels of SpO2 decreased at T3 and T4 in group B, levels of CRP, TNF-αincreased at T2 , T3 , T4 , T5 in group B, levels of CRP, TNF-αincreased at T3 , T4 , T5 in group A(P<0.05), and compared with the group A, levels of HR and MAP were higher at T3 and T4, levels of SpO2 were lower,levels of CRP, TNF-αwere higher at T2, T3, T4, T5in group B(P<0.05).The cough response score and agitation score in group B were higher than group A, and sedation score was lower than group A ( P <0.05 ) , the grade of emergence delirium in group A was better than group B ( P <0.05 ) . Conclusion Dexmedetomidine in the operation of radical hysterectomy by general anesthesia could reduce the emergence of agitation occurred, inhibit extubation reaction, but would not extend the anesthesia recovery time.

Objective To investigate the relationship between mental status and some physical indicators,so as to identify the influencing factors of anxiety and depression in health check-up populations.Methods A total of 3885 health check-up adults enrolled in this investigation.Self-rating anxiety scale (SAS),self-rating depression scale (SDS),and Symptom Checklist 90 (SCL90) were used to evaluate mental health of the participants.Physical indicators,including body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),serum free three iodine armour gland original acid (FT5),serum free thyroxine (FT4),and thyroid-stimulating hormone (TSH),were retrospectively reviewed.Pearson correlation analysis was used to assess the relationship between mental health and physical signs,and the Logistic regression analysis was performed to confirm the influencing factors of anxiety and depression.Results Increased prevalence of anxiety and depression was found in females or those with lower education level.For the health check-up populations,anxiety and depression were negatively correlated to BMI,SBP,DBP,LDL-C,FT3 and FT4.In Logistic regression analysis,LDL-C,FT3 and FT4 were related to SDS score,while SBP,FT3,and FT4 were related to SAS score.Conclusion Our data suggest that emotion could be affected by gender and education level; SBP,LDL-C,FT3,and FT4 may be protective factors of anxiety and depression.

Objective To studythe efficacy of levosimendan in treating refractory heart failure complicating severe renal in sufficiency.Methods Sixty-seven cases of refractory heart failure complicating severe renal insufficiency in the internal medicine department of our hospital were randomly divided into the levosimendan treatment group(L group,n=33)and dopamine treatment group(D group,n=34).The changes of N-terminal pro-B-type natriuretic peptide(NT-pro-BNP),left ventricular ejection fraction (LVEF)and glomerular filtration rate(GFR)before treatment and on 1,3,7,30 d after treatment were compared between the two groups and analyzed.Results Before the treatment,there were no statistically significant differences in the baseline indicators between the two groups(P＞0.05).The group L:the NT-pro-BNP level on 1,3,7 d after treatment was decreased significantly(P＜ 0.05),LVEF on 3,7 d was significantly increased compared with th baseline(P＜0.05)and GFR on 1,3,7,30 d was significantly increased compared with the baseline(P＜0.05).The group D:the NT-pro-BNP level on 7 d of treatment was significantly decreased(P＜0.05),LVEF on 7 d of treatment was significantly increased compared with the baseline(P＜0.05),and no statistically significant changes were observed in GFR on 1,3,7,30 d(P＞0.05).After treatment,NT-pro-BNP,LVEF and GFR significant level values in the group L were better than those in the group D.Conclusion Levosimendan is superior to dopamine in improving heart and renal function for the patients with refractory heart failure complicating severe renal insufficiency.

Objective To investigate the spectrum,diagnosis,time of therapy and management of the congeni-tal heart disease(CHD)in patients with Down′s syndrome(DS).Methods A retrospective report was undertaken of 96 cases in children with DS accompanied by CHD in Department of Pediatric Cardiology,Beijing Anzhen Hospital Af-filiated to Capital Medical University.Data were collected and analyzed about their clinical characteristics,and types of cardiovascular abnormalities,and the important laboratory examinations such as echocardiography and catheterization as well as the procedures of diagnosis and treatments were summarized.Then the interventions,complications and prognosis of different patients were estimated.Results (1)Single congenital heart disease was found in 33 cases (34.38%),a-mong which ventricular septal defect was the most common (14 cases,14.58%),followed by atrioventricular septal de-fect and atrial septal defect (equally,7 cases,7.29%).Multi -cardiovascular abnormalities were discovered in 63 ca-ses,and patent ductus arteriosus turned out to be the most common (42 cases,66.67%).(2)Cat-heterization was car-ried out in 18 cases of serious pulmonary arterial hypertension,and 8 cases were proved resistant pulmonary arterial hy-pertension without operation opportunity.The other 8 cases were estimated as high pulmonary arterial hypertension and medical therapy was suggested before reassessment to reduce surgical risks.(3)Operations were undertaken in 61 ca-ses,among which percutaneous interventional occlusion was performed in 7 cases and surgical interventions were per-formed in 54 patients,in which perioperation complications and death were found in 5 cases and 4 cases,respectively. Conclusions Operation interventions are practicable and most cases recovered well with systematic examinations and assessment in patients with DS and cardiovascular malformations.Early diagnosis and timely interventions are highly suggested.Also close attentions should be paid to follow -up and re -estimation after medical therapy.

Objective To assess the clinical value of MPI with ATP intervention (ATP-MPI) in the diagnosis of coronary heart disease (CHD).Methods To collect published literatures on ATP-MPI studies for the diagnosis of CHD,the PubMed,the Excerpta Medica Database (EMbase),Chinese Biomedical Literature Database (CBMdis),Vip and China National Knowledge Infrastructure (CNKI) databases were searched with computer and manual method since the data were available until to 2014.According to the inclusion and exclusion criteria,the literatures were screened to extract data by two independent evaluators.Meta-analysis was conducted with Stata 12.0 software.Results A total of 11 studies involving 968 patients were included.In patient study,which included 9 literatures and 933 patients,the Se,Sp,LR+,LRand 95％ CI of ATP-MPI diagnosis of CHD were 0.89 (0.82-0.94),0.84 (0.74-091),6.00 (3.25-9.91),0.13 (0.07-0.22),respectively.The diagnostic odds ratio (DOR) was 45.04.The AUC of summary ROC (SROC) curve was 0.94.In the coronary artery study,which included 6 literatures and 1 079 coronary arteries,the Se,Sp,LR+,LR-and 95％ CI of ATP-MPI diagnosis of coronary stenosis were 0.83 (0.71-0.91),0.92 (0.86-0.95),10.00 (5.58-16.99),0.18 (0.09-0.34),respectively.The DOR was 53.24 and the SROC AUC was 0.94.Conclusion ATP-MPI has a significant value in the diagnosis of CHD.

Objective To investigate low density lipoprotein receptor (LDLR)gene mutation in familial hypercholesterolemia (FH) patients. Methods The proband was given clinical diagnosis of homozygous FH based on marked features and blood lipid tests results. After apoB100R3500Q mutation was excluded, the promoter region and all of the 18 exons of LDLR gene were amplified by touch-downpolymerase chain reaction (PCR). The PCR products were analyzed by single-strand conformationalpolymorphism (SSCP). The PCR products with abnormal single strands were sequenced directly. Thesecondary structures of the mutational and wild type proteins were analyzed and compared byANTHEPROT5.0, and then the tertiary structures of the mutant and wild type LDLR were predicted atSWISS MODEL homepage online. Results A homozygous mutation A606T at exon 13 of the patients wasfound by SSCP and confirmed by DNA sequencing. GOR Ⅰ method in ANTHEPROT5.0 indicates that therandom coils and turns would replace some helixes at the mutation site. The online prediction from theSWISS MODEL homepage indicates the backbone structure of the mutant LDLR has no difference from thewild type one. Conclusion The results suggest the A606T mutation of LDLR gene is the cause of the FH inthis pedigree.

Undergraduates in department of laboratory medicine were organized to participate in United Kingdom National External Quality Assessment Schemes. Case discussion was the main form and contents of cases cover the entire clinical biochemical field. One case was given every 20 days and undergraduates must answer in English. All answers would be summarized and reported by one of them. After results being returned, all undergraduates made a retrospective study. The highest score was 1.74 and the lowest score of-0.4, with the median score of 0.67. Time-window score ranged be-tween 0.98 and 0.41. After participating in the case discussion, students improved clinical problem-solving capa-bility, subjective initiative of clinical practice, English level and the team cooperation ability.

Objective To use the method of Meta-analysis to evaluate the effect of the evidencebased nursing in preventing the deep vein thrombosis after orthopaedic surgery,to provide the basis for clinical prevention of DVT.Methods The randomized controlled trials (RCT) on the evidence-based nursing in preventing the DVT were collected using the databases of China National Knowledge Infrastructure (CNKI),Wanfang Periodical Databases,Chinese Science Technology Periodical Databases (VIP) and PubMed and analyzed by RevMan 5.2 software.Results Nine RCTs were included in the study.The results of Meta-analysis revealed that the incidence of the DVT could be effectively prevented by evi-dencebased nursing.Conclusions The evidence-based nursing can reduce the incidence of the DVT after orthopaedic surgery.

Objective To explore the effect of problem-based 1earning (PBL) combined with PICO model in clinical nursing internship teaching.Methods A retrospective case-control study was adopted,133 undergraduate nursing students in grade 2010 were selected as theexperimental group,and 128 undergraduate nursing students in grade 2009 were selected as the control group.The students in the experimental group received a teaching method which combined PBL with PICO model,while the students in the control group received traditional teaching methods.The two groups were evaluated by Objective Structured Clinical Examination (OSCE) and questionnaire survey.Results The OSCE grade and evaluation of teaching method in the experimental group students were higher than the control group,the difference was statistically significant.Conclusions PBL combined with PICO model teaching methods are not only beneficial to cultivate and improve the clinical nursing competency and comprehensive qualities of the nursing students,but also let the students gradually learn and permeate the ideas of any decision made by clinician should be based on the scientific research results,which from the main thought of the evidence-based practice.It can lay a good foundation for going to work in the future,and is also worthy of being popularized and applied in clinical internship teaching of undergraduate nursing students.

Background and purpose:The incidence and mortality of colorectal cancer increased gradually in China, cancer survival rate plays an important role in guiding cancer prevention and treatment.Methods:Data of colorectal cancer cases diagnosed during 2002-2006, follow-up information and death report were from Shanghai Cancer Registry, Life Table and EdererⅡ were used to calculate observed survival (OS) and relative survival (RS), the related demographic characteristics and status were also analyzed to relfect the survival situations of the colorectal cancer survivors in major areas in Shanghai.Results:In this study, 16 682 colon cancer cases and 11 906 rectum cancer cases were included in analysis, 5-year OS rates for colon cancer and rectum cancer were 48.84% and 51.65%, RS rates were 70.50% and 71.31%. Signiifcant difference in survival had been found among the various diagnostic stages, the survival rate in stageⅠ was much higher than those in stageⅢ and stageⅣ. The survival of colorectal cancer patients with different gender, age, tumor histological and residential areas were also found with differences, female was higher than male, age ranged from >44-54 years had the highest survival rates than other age groups. The survival of epithelial tumors was higher than other histologic types in colon cancer, and the survival of non-epithelial tumors was higher than other histologic types in rectum cancer. Over the past 3 decades, the 5-year OS increased dramatically in Shanghai. Conclusion:The level of survival of colorectal cancer in Shanghai is similar with it in developed counties. Colorectal cancer survival rate with different population characteristics may provide suggestions and evidence for further improvement of early screening, diagnosis and treatment.