Objective To evaluate the value of high sensitive troponin I (hs-TnI) combined with the Global Registry of A-cute Coronary Events (GRACE) 2 .0 score in the prediction of death risk in the patients with acute coronary syndrome (ACS) . Methods The hs-TnI levels and GRACE2 .0 scores at admission in 347 ACS patients treated in the hospital from December 2015 to December 2016 were retrospectively analyzed .The follow up was performed for observing the effect of hs-TnI level and GRACE2 . 0 score on the short term (30 d) mortality rate of cardiovascular diseases .And the Kapian-Meier survival curve analysis was also used to analyze the effects of hs-TnI level and GRACE2 .0 score on the short term mortality rate of cardiovascular diseases .Results In this study ,the average value of hs-TnI level in the death group was (7 .5 ± 5 .6)μg/L ,which was significantly higher than (1 .2 ± 2 .9)μg/L in the survival group (P<0 .01) .The short term cardiovascular morality rate in ACS patients was positively cor-related with the hs-TnI level (P<0 .01) .The effect of hs-TnI level on short term cardiovascular morality rate in ACS patients was analyzed by the Kapian-Meier survival curve ,the patients with hs-TnI >0 .014 μg/L had significantly poor short term prognosis (Log rank 62 .81 ,P<0 .01);the GRACE2 .0 score showed positive correlation with the 30 d cardiovascular morality in ACS pa-tients(P<0 .01) ,the short term survival rate in the patients with extremely high risk ACS was significantly decreased (Log rank 116.56,P<0.001).Buttheareaunderthesurvivalcurve(AUC)ofhs-TnIwas0.079(95% CI:0.75-0.83,P<0.01),andAUCof GRACE2 .0 score was 0 .81(95% CI:0 .79-0 .84 ,P<0 .01) .In the comparison between them ,the predictive value of GRACE2 .0 risk score was slightly higher than that of hs-TnI .Therefore ,the combination of hs-TnI and GRACE risk score could increase the value for predicting recent cardiovascular morality in ACS patients [AUC=0 .84(0 .81-0 .91)] .Conclusion hs-TnI combined with GRACE2 .0 score has an important prediction value in short term cardiovascular death risk in ACS patients .

Based on the analysis of definition and the causes of excessive medical treatment, this paper discus-ses the harm of excessive medical treatment concretely, including increased health care costs, the waste of medical resources, worsening doctor-patient conflicts that influence the development of holistic medicine. And in the per-spective of ethics, professional spirit and the humanistic quality, it puts forward the prevention and countermeasures to solve the problem of excessive medical treatment.

Objective To explore the feeling and experience of the nursing undergraduate students in the simulation training for the doctor-nurse cooperation emergency before their internship,in order to provide reference for making excellent teaching and practical plan of emergency nursing.Methods Using phenomenology method,the experience records of thirty-six nursing students were collected.The experience was recorded by Colaizzi method.Results Five themes were summarized by Colaizzi method:preliminary acquaintance of doctor-nurse cooperation; reflection on division of labor cooperation; scan self-ability; focus on interpersonal communication;comprehension of emergency characteristics.Conclusions Simulation training for doctor-nurse cooperation emergency can give nursing students' opportunity of cooperative learning; Simulation training for doctor-nurse cooperation emergency can arouse nursing students' interest of active learning; Simulation training for doctor-nurse cooperation emergency can develop nursing students'habit of reflective learning;Simulation training for doctor-nurse cooperation emergency can improve nursing students' ability of integrative learnng.

Objective To investigate the size and diversification of peripheral nerve measured by high frequency ultrasound in di-abetic peripheral neuropathy patient .Methods The endings of the medial branch of deep peripheral nerves(DPN) were interrogated by high frequency ultrasound and nerve electrophysiology ,and the nerve conduction characters were studied in a cohort of 150 clini-cally diagnosed diabetic peripheral neuropathy patients and a control group of 100 healthy volunteers .At the sametime these cases underwent electrophysiological examination .Results Distinct echoic appearances were consistently detected between the DPN nerves of diabetic peripheral neuropathy patients and healthy volunteers .The sensitivity rate of high frequency ultrasound and nerve electrophysiological examination in diagnosis of diabetic peripheral neuropathy were 91 .33% and 74 .67% ,and the specificity rate were 91% and 82% .Conclusion High frequency ultrasound may play a role in the diagnosis of diabetic peripheral neuropathy .

Objective To investigate the expression of granulocyte-macrophage colony-stimulating factor (GM-CSF) and its associated mechanism during the wound healing. Methods The animal model with the full-thickness skin injury was used in the study. Fifty male mice were involved in the study and divided randomly into control group (n = 25) and GM-CSF group (n = 25). Each group had five time points (5 mice per time point). All the mice received full-thickness skin defect (1 cm × 1 cm) through the panniculus camosus on the midline of the back near the neck after anesthesia. Recombinant human granulocyte-macrophage colony stimulating factor (RhGM-CSF) gel (10 μg/cm2) were applied in the GM-CSF group and gel matrix without RhGM-CSF applied in the control group. The wound healing time and rate were observed at days 3, 5, 7, 10 and 14 after injury. The wound specimens were collected to detect the histopathological change. The microvessel density of the wound was counted based on the results of CD31 immunohistochemistry. RT-PCR was employed to detect the expression changes of GMCSF, platelet-derived growth factor (PDGF) , vascular endothelial growth factor ( VEGF) and stromal cell derived factor-1 (SDF-1). Results RT-PCR results showed that the gene expression of GM-CSF reached the peak at day 3 after injury (P＜0. 01) and kept the high level at days 3-10 after injury (P＜ 0. 05) , followed by a sharp decrease to a normal level at day 14 after wound. The wound healing time was average (2.4 ±0. 3) days earlier than the control mice after application of rhGM-CSF, with significant increase of the wound healing rate during 7-14 days after injury ( P ＜ 0. 05 ). In the GM-CSF group, the early histology of trauma wound showed a small number of neutrophils, obvious epithelial cell proliferation in the wound margin, marked hyperplasia of the granulation tissue, high cell density with quantity of spindle-shaped and oval-shaped cells and increased number of new blood vessels. The microvessel density was also increased significantly (P ＜ 0. 05) at days 7-14 after injury. The gene expressions of VEGF and SDF-1 were significantly increased at day 7 and day 10 respectively after injury (P＜0.05) and the gene expression of pro-healing factor PDGF was significantly increased in every time point (at days 5, 7 and 10,P＜0.05;at day 14,P＜0.01). Conclusion GM-CSF expresses highly in the early stage after injury and can promote the wound healing, when the mechanism may relate to the up-regulated expressions of pro-angiogenic factors and pro-healing growth factors.

Objective: To evaluate the effects of percutaneous balloon pulmonary valvuloplasty ( PBPV) for pulmonary valve stenosis (PS) by single-balloon, double-balloon and Inoue-balloon methods. Methods: PBPV was performed in 42 patients with PS. The systolic right ventricular pressure (SRVP) , systolic right ventricular outflow pressure and systolic pulmonary arterial pressure ( SPAP) were contrasted before and after the procedure. Systolic transpulmonary valve pressure gradient (TVPG) and total pressure gradient from right ventricular to pulmonary arterial after the procedure were compared among the three gropes. Results:SRVP, SRVOP were decreased from (14. 69?6. 01 )kPa, (12. 16?3. 48)kPa to (8.14?5.26)kPa, (5.39?2.21)kPa and PAP increased from (1.57?0.56)cm to (17. 16? 2.16)cm after PBPV, respectively. TVPGs were (2. 40?2. 05) kPa, (3. 29?2. 25 ) kPa, (2.52? 1.95)kPa and TPGs were (2. 40?2. 05)kPa, (4.98?4.26)kPa, (6.16?6.93)kPa, (5.65?4.75) kPa after PBPV by single balloon, double balloon and Inoue balloon methods, respectively. During the follow-up period (2. 5?1. 6) years, bloodflow velocity at pulmonary valve measured by supersonic Doppler decreased from (2. 38?1. 89) m/s immediately after PBPV to (2.22?1. 96) m/s, further TVPG decreasing was indicated. Conclusion: The short and long term results of PBPV for PS by each of the three methods were excellent. Inoue balloon may be the first choice for elder children and adults, while for younger children, single balloon method may be preferred. Double balloon method can be remained as the second choice when Inoue method failed.

Objective To investigate the effect of vaccum-assisted closure(VAC)on the expression of C-ski and Smad3 in the human wound margin tissue and to explore their significance in triggering the wound healing.MethodsFourteen patients,9 males and 5 females with chronic wound admitted in our department from April 2007 to April 2009 were enrolled into the study after signed an informed consent,and the full-thickness skin defects were collected before treatment,and 1,4 or 7 d after treatment.Immunohistochemistry(IHC)was carried out to detect the expressions of C-ski and Smad3,and RT-PCR was used to determine their mRNA expressions of C-ski and Smad3.ResultsIHC results showed that there existed little C-ski in the wound margin tissue before treatment,and after treatment,it were gradually increased.Compared with before treatment group,the differences in 4 and 7 d after treatment were markedly significant(P0.05).Compared with above groups,the differences in 4 and 7 d after treatment groups were markedly significant(P

Objective To get more diagnostic informa ti on from the acute cerebral infarct, We used1HMRS and TCD to investigate the r elationship between the metabolites in the infarct, the infarct volume, blood f low velocity and blood flow to the infarct, and the clinical neurologic deficit. MethodsFifteen patients with acute cerebral infarct underwent1HMRS and TCD examinations. Clinical neurologic deficit score was c ollected from every patient record at the time of the1HMRS and TCD study. Inf arct volume (V/ml) was determined with machine software automatically. A PRESS a cquisition was used for1HMRS. The peak areas of N,Lac,Cr,Cho in the lesi on region were compared with those in the contralateral side. TCD was performed for measuring Vs, Vm of encephalic blood vessels on both sides, and the responsi ble cerebral blood flow was estimated by Vs. ResultsT here were significant decrease of N,Cr,Vm and ECBF in the lesion region when c ompared with the contralateral side( P

Aim To study protective effects of aFGF on rats' renal tubular epithelial cells injured by gentamicin in vitro.Methods After renal cortice were grounded,filtered and digested with 0.25%trypsin,renal tubular epithelial cells were cultured.The injury models of epithelial cells of renal tubules were established by gentamicin and then the protective roles of aFGF in injured renal tubular epithelial cells were observed.Results ① By observing the morphology of the epithelial cells and comparing GM group with control group,CAT、SOD、Na~+,K~+-ATP enzyme activities decreased,while NAG activity and MDA level increased(P

OBJECTIVE: To investigate the protective effects of fibronectin (Fn) on vascular endothelial cells. METHODS: Block reticuloendothelial system model compound with injury of tail vein and femur fractures in rats were used. The level of plasma Fn and surface Fn of peritoneal macrophage cells, the numbers of circulating endothelial cells and the injured tail vein were observed. RESULTS: Fn increased the level of plasma Fn and peritoneal macrophage cells surface Fn,but decreased the number of circulating endothelial cells after infusing Fn 1.7 mg/10 g before injury. Under the scanning electron microscope, only a local focus injury to vascular endothelial cells in the rats was observed after Fn was infused, but a piecemeal injury and detachment of vascular endothelial cells were observed in rats without giving Fn. CONCLUSIONS: Fn has obvious protective effects on vascular endothelial cells in rats.