Objective To investigate the effect of different doses of dexmedetomidine on myocardial injury (in perioperative peri‐od) on cardiopulmonary bypass (CPB) in patients with rheumatic heart valve replacement surgery .Methods Patients undertook rheumatic heart valve replacement surgery with mitral stenosis were divided into three groups (n=20) in randomized and double‐blind method :control group (group C) ,dexmedetomidine 0 .3 μg/kg group (DEX1 group) ,dexmedetomidine 0 .6 μg/kg group (DEX2 group) .Central venous blood was drawn respectively before anesthesia induction (T0 ) ,2h after CPB (T1 ) ,24 h after CPB (T2 ) ,48 h after CPB (T3 ) ,72 h after CPB (T4 ) .Plasma muscle calcium protein I (cTnI) and creatine kinase (CreatineKinase MB , CK‐MB) were measured and mean arterial pressure and heart rate were recorded at each time point .Furthermore ,extubation time , ICU stay ,postoperative inotropic score 24 h after operation ,drainage 24 h after operation ,cardio auto‐resuscitation rates and ad‐verse cardiovascular events were recorded .Results Compared with T0 ,HR was significantly lower in the T1 time point in DEX2 group .Compared with group C ,HR ,plasma CK‐MB ,inotropic score 24 h after operation and cardiovascular adverse events was sig‐nificantly reduced in the T1 time points in DEX1 group (P<0 .05) ,but the heart auto‐resuscitation rate did not significantly im‐proved .HR at T1 ,plasma CK‐MB values at T1 and T2 ,and plasma cTnI values at T2 -T4 were significantly reduced ;the heart re‐suscitation significantly increased ,myocardial contraction power ratings 24 h after operation and the incidence of cardiovascular e‐vents was significantly lower in DEX2 group (P<0 .05) .The extubation time ,ICU stay time and drainage 24 h after operation did not change significantly in both groups .Conclusion Dexmedetomidine has a protective effect on perioperative myocardial injury in patients with rheumatic heart valve replacement surgery ,and the effect would be better when the dexmedetomidine was infused at 0 .6 μg · kg -1 · h-1 after a loading dose of 0 .6 μg/Kg continuously .

Objective To observe the therapeutic effects of different doses of recombinant human tumor necrosis factor-receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc) on rheumatoid arthritis (RA). Methods Seventy-six patients with RA were randomly divided into rhTNFR:Fc treatment group A (n=22; rhTNFR:Fc 25 mg, twice/week and methotrexate 10 mg/week), rhTNFR:Fc treatment group B (n=24; rhTNFR:Fc 12.5mg, twice/week and methotrexate 10 mg/week) and control group (n=30; methotrexate 10 mg/week). Joint function related parameters including number of swollen joints, number of tenderness, pain degree, time of morning stiffness, Health Assessment Questionnaire (HAQ) score, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor were detected before and 2, 4, 6, 8, 12, 16 and 24 weeks after treatment in all the patients. After being treated for 3 months, the changes of joint function related paramters were evaluated and compared among groups. ACR20, ACR50 and ACR70 criteria were employed to evaluate the therapeutic effects. Results There was no significant difference in joint function related parameters among three groups before treatment (P＞0.05), while those improved significantly after treatment for 3 months (P<0.05), with more favorable results in rhTNFR:Fc treatment group A and B than in control group (P<0.05). The percent of patients with ACR50 in rhTNFR:Fc treatment group A was significantly higher than that in rhTNFR:Fc treatment group B 2 and 4 weeks after treatment (P<0.05), while there was no significant difference in total effect between these two groups 8, 12, 16 and 24 weeks after treatment(P＞0.05). Conclusion Small dose of rhTNFR:Fc in combination with methotrexate may yield effective and economical results for treatment of RA.

Objective To evaluate the efficacy and safety of etanercept in treatment of ankylosing spondylitis. MethodsEighty-six patients were randomized into experiment group and control group (n=43). Patients in experiment group were treated with non-steroidal antiinflammatory drugs (NSAIDs) and etanercept (25 mg, twice/week, subcutaneous injection in the upper arm), and those in control group were managed with NSAIDs and sulfasalazine. Reexaminations were performed after treatment for 3 months, and the prevalence of low back pain, time of morning stiffness, Bath ankylosing spondylitis disease activity index(BASDAI), Bath ankylosing spondylitis functional index(BASFI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were analysed, and the prevalence of adverse effects was observed. ResultsCompared with those at administration, the prevalences of low back pain significantly reduced (P<0.05 or P<0.01), the time of morning stiffness significantly decreased (P<0.05), BASDAI and BASFI significantly improved, and ESR and CRP significantly decreased 3 months after treatment in both groups (P<0.05). After treatment for three months, the clinical parameters in experiment group were more favourable than those in control group (P<0.05). There was no significant difference in the prevalence of adverse effects between two groups (P>0.05). Conclusion Etanercept has favourable short-term therapeutic effects on ankylosing spondylitis with minor adverse effects.

Objective To study the incidence of pelvic adhesions in endometriosis(EM) and the relationship between pelvic adhesions and pain symptoms. Methods The incidence of pelvic adhesions, dysmenorrhea, chronic pelvic pain, dyspareunia, dyschizia in 480 patients with EM were studied retrospectively to evaluate the correlation between pelvic adhesions and the degree of pain symptoms. In accordance with the revised American Fertility Society classification (r-AFS), it was observed that 155 cases were in Stage Ⅰ,33 cases were in stage Ⅱ,108 cases were in stage Ⅲ and 184 were cases in stage Ⅳ. Results (1) Among 480 cases with EM, 72.3% (347/480) of patients have pelvic adhesions simultaneously, of which 25.2% (39/155) patients were in Stage Ⅰ, 78.8% (26/33) patients were in Stage Ⅱ, 90.7% (98/108) patients were in Stage Ⅲ and 100.0% (184/184) patients were in Stage Ⅳ. It was found that positive correlation existed between the degree of pelvic adhesions and clinical staging of EM(rs=0.870,P<0.01).(2) 61.0%(293/480) of patients presented dysmenorrhoea, of which the percentages of mild, moderate and severe dysmenorrhea were 52.2%(153/293), 26.6%(78/293), 21.2% (62/293), respectively. The rate of patients presenting chronic pelvic pain (CPP), dyspareunia and dyschezia were 23.8% (114/480), 15.4% (74/480) and 7.1% (34/480), respectively. (3) Ovarian adhesions was positively correlated with dysmenorrhea and CPP(rs=0.367 and 0.267,P<0.01). Adhesion of the bottom and posterior wall of uterus was positively correlated with dysmenorrhea and CPP (rs=0.336, 0.164,P<0.01); adhesions of fallopian tubes were positively correlated with dysmenorrhea, CPP and dyschezia (rs=0.283, 0.225 and 0.159, P<0.01). Adhesions of rectum was positively correlated with dysmenorrhea (rs=0.101,P<0.05). In addition to dyspareunia, the degree of pelvic adhesions was positively correlated with dysmenorrhea, CPP and dyschezia (rs=0.470, 0.273, 0.132, P<0.01). Conclusion Pelvic adhesions are characteristic lesions of endometriosis, the site and degree pelvic adhesions are closely correlated with pain symptoms.

Post-traumatic stress disorder (PTSD) is a mental disorder characterized by hyperarousal, flashback and avoidance behavior after experiencing traumatic events. This article reviews the diagnostic criteria, pathogenesis and treatment options of this disease.

A total of 20 patients with massive hemorrhage for pelvic fracture, underwent angiographic embolization with gelfoam sponge embolization agents in 3-8 hours after admitted at the Department of Orthopedics, Changhai Affiliated Hospital of Second Military Medical University of Chinese PLA between January 2001 and August 2003 were selected. The patients aged ranged from 18-70 years (mean 43.4-year-old), including 12 male and 8 female. Conduits were inserted into the internal iliac artery embranchment of 8 cases with method of ultraselection, and gelfoam sponge grain and contrast medium were injected together. Conduits combined with gelfoam sponge grain and contrast medium were inserted into 12 cases’ pathic internal iliac artery bole. The whole 20 cases were performed endovascular embolization, and blood pressures turned to normal level after operation gradually without serious complications of embolization. One case died of deterioration after blood pressure stabilization. The result reveals that anglo-graphic embolization with gelfoam sponge embolization agents is a safe, quick and effective method of controlling the severe hemorrhage caused by pelvic fracture.

Resident standardization training system is established in the framework of modern western medicine. With less consideration to the specificity of TCM on the curriculum, teaching mode and other aspects, it is not suitable for the actual requirement of TCM hospital. TCM apprentice education has a long history, is an important form of the traditional education of Chinese medicine. Leading the TCM apprentice education mode into the standardized training of resident physicians, exploring the construction of the teaching model suited to help the masses of TCM college graduates training will play an increasingly important role in training work.

AIM: To evaluate the therapeutic efficacy and safety of heavy silicone oil (HSO), Densiron 68, was used as internal tamponade to treat complex vitreoretinopathy.METHODS: A retrospective study of 30 patients (30 eyes) who underwent vitrectomy and HSO tamponade for complex retinal detachment between January 2015 and January 2016.The best corrected visual acuity (BCVA), intraocular pressure (IOP), retinal reattachment and complications after surgery were observed.RESULTS: There were statistical significances in both the BCVA difference between pre-operation and HSO tamponade, and the BCVA difference between pre-operation and the removal of HSO for 3mo (z=-2.198, P=0.028;z=-2.682, P=0.007).The average intraocular pressure of HSO tamponade group was 20.233±8.007mmHg, and the average intraocular pressure of pre-operation group was 16.067±4.025mmHg, showing significant difference(t=-2.913, P=0.005).Between the pre-operation group and the HSO removed group 14.933±3.423mmHg, there was no significant statistical difference in the analysis of IOP (t=2.635, P=0.430).Anatomical success was achieved in 90% of cases after the removal of HSO.Most common complications were cataract formation and oil emulsification.CONCLUSION: Densiron-68 is a safe and effective tamponade material for the treatment of complex vitreoretinopathy.However, most common complications are cataract formation and oil emulsification.So clinicians should strictly handle indications and usage during the clinical applications.

Objective To study the relationship of intestine permeability with post hepatitis cirrhosis. Methods Serum DAO levels were measured by Holt method and lactulose/mannitol absorption tests were performed in 96 patients (Child A, n =11; Child B, n =37; Child C n =48) with post hepatitis cirrhosis and 49 healthy control subjects to evaluate the intestine structure and function of the patients. Lactulose and mannitol levels in 5 hours urine were determined by gaschromatographic assay. Results DAO activity and lactulose/mannitol ratio were higher in each patient group than those in normal control group (DAO Child A 4.68?0.97, Child B 6.05?1.02, Child C 7.80?1.34 vs 3.98?0.93, P

Objective To evaluate the effectiveness among computed tomography-guided aspiration.minimally invasive microsurgery and conventional craniotomy on patients with intracerebral hemorrhage and their quality of life separately.Then to study the cost-effectiveness of the 3 surgical procedures. Methods One hundred and five patients with intracerebral hemorrhages were randomized into 3 groups:conventional group,stereotactic group and key-hole group.Karnofsky Performance Status Scale was examined 3 months after operation,and the cost of hospitahzation was calculated separately,then the cost-effectiveness was compared using cost-utility analysis. Results Costs of 3 procedures were 9741 yuan,7957 yuan and 13256 yuan separately,and Karnofsky Performance Status Scale were 59.7,63.7 and 50.3 separately.When self-care case was achieved in all conventional group,the stereotactic group and key-hole group need to remedy 51 eases and 10 cases separately.and the total cost was 496819 yuan for stereotactic group and 79575 yuan for key-hole group. Conclusions Minimally invasive microsurgery is optimal treatment for intracerebral hemorrhage.