Objective To determine the relationship between the rennin-angiotensin-aldosterone systems(RAAS)and left atrial structure remodeling in patients with rheumatic mitral stenosis.Methods The patients with rheumatic mitral stenosis were divided into two groups according to atrial fibrillation:sinus rhythm group(SR group,n=25)and atrial fibrillation group(AF group,n=30).17 normal subjects were selected as normal control group(NC).The plasma concentration of renin,angiotonin Ⅱ(Ang Ⅱ)and aldosterone(Ald)were measured by radioimmunoassay(RIA).Results The average value of the left atrial diameter in AF group was significantly greater than that of both SR group and NC group,increased by 16.9%[(57.71±8.07)mm vs.(48.48±5.05)mm,P＜0.01)]and 87.8%(57.71±8.07 mm vs.30.18±2.85 mm,P＜0.01)respectively.Compared with NC group,the left atrial diameter of SR group was also significantly greater,elevated by 60.6%[(48.48±5.05)mm vs.(30.18±2.85)mm,P＜0.01)].The level of plasma rennin activity(PRA),Ang Ⅱ and Aid in AF and SR patients was significantly higher than those of NC subjects(P＜0.01),and compared with SR patients,the level of those in AF patients was also significantly increased(P＜0.01,P＜0.05).Pearson correlation analysis revealed a positive correlation between the plasma level of PRA,Ang Ⅱ or Ald and the value of the left atrial diameter(r=0.277,0.485,0.431,P＜0.05,P＜0.01,P＜0.01).Multiple liner stepwise regression analysis showed that plasma Ang Ⅱ and Ald were the important risk factors that affected left atrial diameter in patients with rheumatic mitral stenosis(Bate=0.362,0.261,P＜0.01,P＜0.05).Conclusion Patients with rheumatic mitral stenosis are characterized by the activation of circulating RAAS,and the plasma Ang Ⅱ and Ald may contribute to left atrial structure remodeling.

Objective To observe the clinical efficacy of intermediate care in patients with after acute stroke.Methods Six hundred cases patients with after acute stroke were divided into experimental group with 301 cases and control groups with 299 cases according to the opinions of patient and family members.The experimental group was given intermediate care for 2 weeks.The control group was given the basic treatment of cerebral infarction.Activities of Daily Living (ADL) score,fall risk score and geriatric depression scale (GDS) were compared between the two groups at the time of entry,2 weeks after treatment,6 months and 12 months of follow-up.Results There were no significant differences in terms of ADL score,fall risk score and GDS between the two groups at the time of entry(P＞0.05).Compared with at the time of entry,ADL score and fall risk score were decreased of two group after 2 weeks after treatment,6 months and 12 months of follow-up(P ＜0.05),and ADL score and fall risk score of the experimental group both were lower than of the control group after 2 weeks after treatment,6 months and 12 months of follow-up(P＜0.05).Compared with at the time of entry and 2 weeks after treatment,GDS of two groups both were decreased 6 months and 12 months of follow-up (P ＜0.05),but there was no significant difference between the two groups in different time periods(P ＞0.05).Conclusion Intermediate care has a significant effect on improving the activities of daily living and reducing the risk of falls in patients with after acute stroke,and can reduce the GDS score.

Proteomics is a new field of research in the post-genomic era,which aims at the expression and functional study of proteins in cells,tissues and organisms.It analyses the vital changes of pathological and physiological processes of life by examining proteins.It can detect low-abundance or low molecular weight proteins and polypeptides which contain rich information about diagnosis,treatment and prognosis of diseases,leading to important breakthrough in the field of basic and clinical researches.It has achieved great progress and displayed a promising future in orthopedic researches.This article reviews the development,the present status of proteomic research and its application in orthopedics.

Objective To explore the diagnostic and clinical application value of combined detection of C-reactive protein (CRP),serum prealbumin (PA) and white blood cell (WBC) count in neonatal infectious diseases.Methods A total of 187 fullterm newborns were collected in this study,including 92 newborns of bacterial infection as the infection group and 95 newborns of non-infection diseases as non-infection group.The abnormal rates of CRP,PA and WBC in the two groups were measured;the sensitivity,specificity,false positive rate and false negative rate were compared between the single detection and combined detection of WBC,PA,CRP;the changes of the three indexes in the infection group were compared between before and after treatment.Results The abnormal rates of CRP,PA and WBC in the infection group were significantly higher than those in the non-bacterial infection diseases group (P＜0.05).The sensitivity and specificity of combined detection of CRP+ PA + WBC were higher than those of single detection of CRP,PA and WBC;after treatment,the level of CRP in the infection group was significantly decreased,the level of PA was significantly increased and the WBC count returned to normal(P＜0.05).Conclusion The combined detection of CRP,PA and WBC has an important clinical value in the early diagnosis of neonatal bacterial infection.

Objective To observe the effect of intermediate care on recurrence factors and recurrence rate of elderly patients with cerebral infarction.Methods Five Hundred and ninety-eight cases of acute cerebral stroke were divided into two groups,301 cases in the experimental group and 297 cases in the control group.After the acute stage,patients in the experimental group was included into the intermediate care unit.The experimental group was given comprehensive evaluation and multidisciplinary management,including the combination of traditional Chinese and Western medicine treatment,rehabilitation training and physical therapy,medication guidance,nursing and health education.After the acute stage of the disease,the control group patients were in the general ward.The course of treatment was 2 weeks.At baseline(t0),second weeks(t1),sixth months(t2)and twelfth months(t3),the blood pressure(SBP,DBP),fasting blood-glucose(FBG),blood lipid(TC,TG,LDL),serum homocysteine(Hcy)level and the recurrence rate of cerebral infarction in all two groups were observed.Results SBP at t1,t2 and t3 was lower than that at t0 in the experimental group,and the difference was statistically significant(P＜0.05).SBP in the experimental group at t2 and t3 was lower than that in the control group.There was significant difference between the experimental group and the control group(P＜0.05).DBP at t2 and t3 was lower than that at t0 in the experimental group,and the difference was statistically significant(P＜0.05).DP in the experimental group at t2 and t3 was lower than that in the control group.There was significant difference between the experimental group and the control group(P＜0.05).FBG at t1((5.34±0.76)mmol/L),t2(5.86±1.05)mmol/L)and t3(5.62±0.89)mmol/L)were lower than that at t0((7.27±2.34)mmol/L),and the difference was statistically significant(P＜0.05).FBG in the experimental group at t2 and t3 were lower than that in the control group((6.85±0.92)mmol/L,(6.36±1.03)mmol/L).There was significant difference between two groups(P＜0.05).TC at t1((4.86±0.85)mmol/L),t2((4.21±0.76)mmol/L)and t3((3.95±0.64)mmol/L)were lower than that at t0((5.56±1.06)mmol/L),and the difference was statistically significant(P＜0.05).TC in the experimental group at t2 and t3 was lower than that in the control group((5.06±0.93)mmol/L,(4.84±0.76)mmol/L).There was significant difference between two groups(P＜0.05).TG at t3((1.48±0.26)mmol/L)was lower than that at t0((1.86±1.31)mmol/L),and the difference was statistically significant(P＜0.05).TG in the experimental group at t3 was lower than that in the control group((1.71±0.66)mmol/L).There was significant difference between two groups(P＜0.05).LDL at t1((3.76±0.92)mmol/L),t2((3.09±0.62)mmol/L)and t3((2.59±0.51)mmol/L)were lower than that at t0((4.59±1.45)mmol/L),and the difference was statistically significant(P＜0.05).LDL in the experimental group at t2and t3 was lower than that in the control group((4.09±0.75)mmol/L,(4.12±0.64)mmol/L).There was significant difference between two groups(P＜0.05).Hcy at t1((14.16±3.17)μmol/L),t2((10.37±2.59)μmol/L)and t3((10.10±1.86)μmol/L)were lower than that at t0((23.62±5.62)μmol/L),and the difference was statistically significant(P＜0.05).Hcy in the experimental group at t2and t3 was lower than that in the control group((18.52±3.64)μmol/L,(16.37±2.75)μmol/L).There was significant difference between two groups(P＜0.05).The recurrence rate of cerebral infarction within 1 years was 4.7％(14/301)and 7.1％(21/297)in the experimental group and the control group.There was a decreasing tendency,but no statistical significance(P=0.208).Conclusion The intermediate care may affect the blood pressure,FBG,blood lipids,serum Hcy levels in elderly patients with cerebral infarction,so as to reduce the recurrence rate of cerebral infarction.

Objective To understand the abnormal status of alanine aminotransferase (ALT),fasting blood glucose (GLU),to-tal cholesterol (TC)and triglyceride (TG)in urban and rural residents,to provide the basis for making the effective prevention measures,health education and health promotion to community work more targeted and effective.Methods The data of physical ex-amination results of 4 042 residents were analyzed retrospectively,the levels and abnormal rates of ALT,TG,TC,GLU were com-pared between different gender and age.Results Among 4 042 residents,the abnormal rate of male was significant higher than that of female,but the abnormal rates of TG,TC of female were significant higher than those of male(P <0.05).The highest rates of ALT,TG,TC,GLU in male were in 20-<40 years old,40-<60 years old,60-<80 years old,≥80 years old.The highest rates of ALT,TG,TC,GLU in female were in 0-<20 years old,60 -<80 years old,≥ 80 years old,≥80years old.Conclusion The health status of urban and rural residents is not optimistic,the community intervention,health guidance should be strengthened to prevent and control the occurrence and development of diseases and improve the health level of urban and rural residents.

Objective To evaluate the effectiveness of differentiation acupoint massage on the level of blood pressure control and self-efficacy in the elderly with hypertension with yin-deficiency and yangexcess under the model of empowerment education.Methods 80 elderly with hypertension with yin-deficiency and yang-excess were randomly divided into the intervention group and the control group with 40 patients in each group.Both of them received health education of differentiation acupoint massage consisted of 4 weekly sessions.The intervention group received it under the model of empowerment education whilst the other under the model of the general health education.After 4 weeks of sessions,all patients were followed up for 3 months.The blood pressure value was measured before the sessions and 4 weeks and 3 months after the sessions.The scores of self-efficacy was collected before and 3 months later.Results There were significant differences in the blood pressure,self-efficacy between the two groups after the intervention.Conclusions Differentiation acupoint massage under the model of empowerment education can significantly improve patients'self-efficacy and decrease the level of the blood pressure.

Objective:To investigate the influence of string-overalls-suture pancreaticojejunostomy on the incidence of postoperative pancreatic fistula (POPF) in pancreaticoduodenectomy (PD) .Methods:Clinical data of 70 cases receiving PD in the Affiliated Zhongshan Hospital of Dalian University from Jan. 2011 to Dec. 2018 were retrospectively studied. All cases were divided into experimental group and control group according to the different ways of pancreaticojejunostomy. Patients in experimental group received string-overalls-suture pancreaticojejunostomy, and those in control group received pancreatic duct jejunal mucosa pancreaticojejunostomy. The 70 cases were performed by the same team. Operative time and the incidence of postoperative complications between the two groups were compared and analyzed.Results:There was no statistical differences between the two groups in general data and intraoperative observations. The total operative time was (4.28±1.10) hours in the control group and (3.62±0.76) hours in the experimental group. It was significantly different between the two groups ( t=2.942, P=0.004) . There were 7 (28.0%) cases of POPF including 6 cases of grade B, and 1 case of grade C in the control group, and 3 (6.7%) cases of grade B in the experimental group. 6 (24.0%) cases had postoperative bleeding in the control group, 7 (15.6%) cases in the experimental group, 8 (32.0%) cases with abdominal infection in control group, and 8 (17.8%) cases in the experimental group. Delayed gastric emptying occurred in 3 (12.0%) cases in the control group, and 4 (8.9%) cases in the experimental group. It was significantly different for POPF between the two groups (χ 2=4.358, P=0.037) . And there were no significant differences for other postoperative complications between the two groups (all P>0.05) . Conclusion:The string-overalls-suture pancreaticojejunostomy has the advantages of simple and quick manipulation, wide indication, safe and reliable pancreaticojejunostomy, and has certain superiorities in shortening operation times and reducing POPF.