Objective To analyze the pregnancy outcomes and measures to prevention and cure for pregnancy women with pulmonary hypertension.Methods Clinical data of 40 women with pulmonary hypertension were analyzed and they were divided into three groups on the basis of Doppler transthoracic echocardiography detections.Results(1)The proportions of rheumatic heart disease and congenital heart disease were 22.64% and 45.38%;8 cases appeared with the perinatal heart disease and 5 cases' hearts structure were normal.(2)49 cases applied cesarean section and 2 delivery naturally.2 women were induction of labour in second trimester.In midrange and severity groups,prematurity and small gestational age were significently higher than those of gentle group.(3)3 women died of congestive heart failure and pulmonary embolism.6 women were treated by SICU and physician because of serious illness.Conclusion Women with midrange and severely pulmonary hypertension should avoid pregnancy.Pregnant women with pulmonary hypertension needed monitor closely and being treated with pulmonary vasodilator added decoagulant would improve outcomes of mather and infant.

Objective To establish the procedural pain nursing care protocols to improve the management of perioperative pain in elderly patients after total knee replacement,as well as to relief postoperative pain,and promote the rehabilitation.Methods 82 patients were randomly divided into the control group (45 cases) and the intervention group (37 cases).The control group was controlled by usual care,and the intervention group was offered with the standardized pain nursing care.The scores for postoperative pain,the satisfaction for analgesia,the complications associated with analgesia and the injection rate of Dolantin at 24,48,72h postoperatively were compared between two groups.Results The score for postoperative pain at rest in the intervention group was significantly lower than that in the control group at 24 h postoperatively,but there was no statistical difference at 48 h and 72 h postoperatively.Pain scores during passive activity at 24,48h,and 72h postoperatively were significantly lower in the intervention group when compared with that of the control group.The rates of side effects at 24,48,72h postoperatively in the intervention group were significantly lower than those in the control group.The injection rate of Dolantin in the control group were significantly higher than that in the intervention group.The score for both analgesia and life satisfactory in the intervention group was significantly higher than that in the intervention group at 24,48,72h postoperatively.Conclusions Procedural pain nursing care can reduce the pestoperative pain,complications and the injection rate of Dolantin in patients after total knee replacement.It can also improve elderly patients' satisfaction of analgesia and promote early recovery of their joint function.

Purpose:To study the changes of t-PA ?u-PA expression and fibrinolysis molecular mark ers in patients with gastric or intestinal cancer in order to elucidate their cl inical significance. Methods:The plasma levels of t-PA ?u-PA ?u-PAR and PAP were measured by ELISA . Gen e transcription of t-PA?u-PA mRNA were detected by Real-time RT-PCR. Results:The plasma levels of u-PA?u-PAR and PAP were elevated in gastric or intestina l cancer patients ,while u-PA was markedly elevated in patients with local infi ltration?lymph node involvement or distal metastasis. u-PA mRNA was higher and t-PA was lower in gastric or intestinal cancer compared to normal tissue. Conclusions:Hyperfibrinolysis was an important factor related with m etastasis potential of gastric or intestinal cancer. t-PA may be a character of well differentiated tissue.

Objective To explore the curative effect and indication in coverage of the thumb soft tissue defect by five kinds of minute flaps. Methods From January 1998 to March 2003, 52 cases with skin and soft tissue defect of the thumb were treated by five different kinds of flaps: 5 underwent the wrapping flap with nail from the big toe, 15 with the reversible thumb dorso-ulnar artery island flap, 10 with the thenar flap, 8 with the lateral digital island flap, 14 with the index finger dorsal island flap. There were 40 males and 12 females, aged from 17 to 35 years (average, 25 years). The maximum area of the repair flap was 5.0 cm?2.5 cm, and the minimum area was 2.0 cm?1.5 cm. Results All flaps survived. After 6 to 36 months postoperative follow-up, with an average of 20 months. The blood supply and texture of the flaps were excellent, their outer aspect and function were satisfactory. Among 46 cases of flaps with their proper or connecting nerves, the average distance of the two-point discrimination was 5.8 mm in the wrapping flap with nail from the big toe, 8.5 mm in the reversible thumb dorso-ulnar artery island flap, 7.0 mm in the thenar flap, 6.2 mm in the lateral digital island flap, 8.8 mm in the index finger dorsal island flap. Of the 6 cases that the nerves were not connected, the healed flaps had only the pain and touch sensation, the two-point discrimination was poorly recovered. Conclusion The five kinds of flaps are safe and reliable for repairing thumb soft tissue defect, among which the wrapping flap with nail from the big toe and the lateral digital island flap have the advantage of the best sensation recovery, the reversible thumb dorso-ulnar artery island flap and the thenar flap are easy to perform with minimum damage. Better curative effect can be obtained by choosing different flaps according to the site of tissue defect.

Objective To explore the clinical effect of laparoscopy combined with choledochoscopy on choledocholithiasis.Methods Totally 134 elderly patients with choledocholithiasis were treated in our hospital from Jan 2013 to Dec 2014, who were randomly divided into observation group and control group (n=67 for each), treated with laparoscopy combined with choledochoscopy, and traditional surgery, respectively.The operation time, bleeding volume, exhaust time, in-hospital stay, complications and residual stones rate were compared between the two groups.Results The operation time was higher in observation group than in control group [(124.6±21.2) min vs.(94.7± 17.9) min, t=8.821, P＜0.001].The bleeding volume were less in observation group than in control group[(43.8±10.4) ml vs.(113.5±37.6) ml, t=14.624, P＜0.001].The exhaust time and in hospital time were decreased in observation group than in control group[(27.6 ±5.5) h vs.(43.4±8.1) h, (7.4±2.4) d vs.(10.3±2.8) d, t=13.209 and 6.437, P＜0.001 for both].The incidences of postoperative pain and other complications were lower in observation group than in control group [6.0％ vs.28.4％, 16.4％ vs.43.3％, x2=11.810and 11.547, P=0.001 for all].Conclusions The laparoscopy combined with choledochoscopy has advantages to minimize the surgical injury, reduce the bleeding volume and promote the postoperative recovery in treating choledocholithiasis in elderly patients.

Objective: To investigate the value of serum hepcidin in assessment of liver inflammation activity among patients with chronic hepatitis B ( CHB ), so as to provide insights into the assessment of liver inflammation activity among CHB patients. Methods: A total of 79 CHB patients who were admitted to the Affiliated Hospital of Hangzhou Normal University were selected as the experimental group, while 40 healthy volunteers were randomly sampled as controls. Subjects'demographic data, liver function tests and iron metabolism parameters were collected from medical records, and serum hepcidin was measured using enzyme-linked immunosorbent assay ( ELISA ). In addition, ultrasound-guided liver biopsy was performed in CHB patients, and mild and moderate-to-severe CHB were classified according to liver inflammation activity and degree of liver fibrosis. Serum hepcidin levels were compared between the experimental and control groups and between patients with mild and moderate-to-severe CHB. The value of serum hepcidin in assessment of liver inflammation activity was examined among CHB patients using the receiver operating characteristic ( ROC ) curve analysis. Results: Subjects in the experimental group included 54 men ( 68.35% ) and had a mean age of ( 39.06±10.67 ) years, while the controls included 24 men (60.00%) and had a mean age of ( 42.43±11.44 ) years. Lower hepcidin levels were measured in the experimental group than in the control group [( 11.70±5.64 ) vs. ( 17.82±3.63 ) μg/L; P<0.05 ]. There were 54 patients with mild CHB ( 68.35% ) and 25 cases with moderate-to-severe CHB ( 31.65% ), and lower hepcidin levels were detected in patients with moderate-to-severe CHB than in those with mild CHB [ ( 6.92±2.21 ) vs. ( 13.95±5.36 ) μg/L; P<0.05 ]. The area under the ROC curve, optimal cut-off, sensitivity and specificity of serum hepcidin were 0.903 ( P<0.05 ), 10.365 μg/L, 100.0% and 72.2% for assessment of moderate-to-severe CHB, respectively. Conclusion Serum hepcidin is feasible to evaluate the liver inflammatory activity among patients with CHB.

Objective To observe the bone density, serum osteoprotegerin (OPG) level,relevant parameters of bone metabolism and sex hormones in elderly men with osteoporosis before and after treatment with oral Fosamax for 3 years. Methods The serum OPG level was compared between 72 randomly selected elderly male patients with osteoporosis and age-matched healthy controls. The bone density, serum OPG level, sex hormones, serum calcium and phosphorus,parathyroid hormone (PTH), osteoealein and urine type Ⅰ collegen crosslinked N-telopeptides (NTX),urine calcium and cretinine were tested in all elderly male patients with osteoporosis before and after 3 years of oral Fosamax treatment. The role of OPG in anti-osteoporotic therapy was studied by comparison of the parameters tested during the course of treatment. Results The serum levels of OPG osteoealcin, PTH and urine NTX were obviously higher in elderly men with osteoporosis than in healthy controls [(10.56±2.56) pmol/L vs. (8.91±2.20) pmol/L, (9.544±4.40) g/L vs. (6.774±2.87)rig/L, (70.39±35.58) ng/L vs. (47.11±21.80) ng/L, (72.06±9.78) nmol/L vs. (63.36±14.61)nmol/L, all P<0.05]. After treatment with oral Fosamax , the bone density was significantly increased. However, serum levels of OPG[(8.23±2.96)pmol/L], osteocalcinE(6.18±2.27)μg/L],PTH[(40.46±14.43) ng/L] and urine NTX[(64.83±11.40) nmol/L] were significantly decreased after treatment (all P<0.05). Spearman analysis showed that the improvement of bone density after treatment was closely associated with serum OPG level. Conclusions Serum OPG level in elderly patients with osteoporosis is much higher than that in control group. The improvement in bone density after treatment is associated with the decrease in OPG level. Bone density and relevant parameters of bone metabolism can be improved in elderly male patients with osteoporosis by using oral Fosamax.

Chronic constipation is a highly debilitating condition, affecting a significant proportion of the commu-nity. Rhei Radix et Rhizoma (rhubarb) is one of the important herbal drugs used in traditional Chinese medicine (TCM) for treating constipation which includes four groups of main active components such as free anthraquinone, conjunc-tive anthraquinone, rhubarb tannin, and rhubarb polysaccharides. However, which one is response for the laxative effect of rhubarb is unknown. Therefore, we proposed a strategy for the effect-guided quality control of TCM based on disease. The effective material for laxative effect of rhubarb was firstly screened based on the constipation model. And different production locations were investigated. Then, the processing was optimized to set up a quality control of rhubarb. It was found that the bioactive component was the conjunctive anthraquinone for the laxative effect. And the raw herb from Liangshan had the best quality compared with those from Pingwu and Beichuan in Sichuan Prov-ince, China. The extraction ethanol volumes to substrate ratio of 10.34, extraction time of 24.25 min and extraction number of 4 were the best conditions for the extraction of conjunctive anthraquinone. Under the optimized condi-tions, the maximum production was 5.455 mg·g-1. This extraction procedure was used as quality control of rhubarb in the treatment of constipation.

Objective To explore the 5,10-methylenetetrahydrofolate reductase (MTHFR) and 5-methyltetrahydro-folate-homocysteine methyltransferase reductase ( MTRR ) gene polymorphisms among the Han women in Zhangjiagang city .Methods A total of 4008 Han women were recruited .Their oral epithelial cells were collected to extract genome DNA in order to detect gene polymorphisms of MTHFR and MTRR using fluorescence quantitative PCR.Then the results were compared with those in other cities in China .Results The genotype frequencies of MTHFR C677T CC, CT and TT among Zhangjiagang women are 32.2%, 49.5%and 18.3%, respectively.The C allele frequency is 64.3%, T allele frequency is 35.7%.The genotype frequencies of MTHFR A1298 C AA, AC and CC are 68.7%,28.7% and 2.5%, respectively .The A allele frequency is 80.8%, C allele frequency is 19.2%.The genotype frequencies of MTRR A66 G AA, AG and GG are 54.4%, 38.5%and 7.1%, respectively . The A allele frequency is 76.3%, G allele frequency is 26.4%.Conclusions The MTHFR, MTRR polymorphism distribution of Han women in Zhangjiagang city is region specific.

Objective To observe the effect of raloxifene, a selective estrogen receptor modulator, on osteoporosis in the osteoprotegerin (OPG) gene knock-out female and male mice. Methods Two groups of OPG gene deficient (OPG-/-) female and male mice, 20 mice in each group, were assigned to raloxifene-treated (3 mg The effect of raloxifene was evaluated by comparing the values of bone mineral density (BMD) , bone strength,histomorphometric measurement and osteoclast number between the raloxifene treated group and placebo group.Results As compared with placebo group osteoporotic manifestations were improved in OPG-/- female mice treated with raloxifene orally. BMD was increased both in lumbar vertebrae (P<0.05) and femurs (P<0.01).Bone strength was measured in femurs by three-point bending test and vertebrae by stress test. Results showed that ultimate load, ultimate stress and Young's modulus were increased both at lumbar and femur bone, suggesting decreased risk of fracture. Tartrate-resistant acid phosphatase, a marker enzyme of osteoclasts, was detected, and the number of osteoclasts declined significantly after the treatment of raloxifene. At the same time, results of histomorphometric measurements indicated that bone trabecular volume was increased and bone formation rate decreased from(8.05±4.02)mm3·mm-2·year-1 to (5.48±1.89)mm3·mm-2· year-1(P＜0.05).These findings were found in the group of OPG-/- female mice treated with reloxifene but not in male mice. Conclusions Raloxifene is effective in treating osteoporosis in female OPG-/- mice, indicating that its action is at least in part independent of OPG gene. But it is ineffective in male OPG-/- mice.