Problems and countermeasures in clinical studies on acupuncture and moxibustion in course of developing / 中国针灸

To explore the problems and countermeasures existing in acupuncture and moxibustion clinical studies, in the perspective of the key steps of

Bibliometric analysis of refractory facial paralysis based on CNKI database / 中国针灸

The current development situation and the hotspot of the relevant research on refractory facial paralysis are explored. The articles on refractory facial paralysis are retrieved from CNKI database. The bibliographic items co-occurrence matrix builder (BICOMB) 2.0 is adopted to extract and analyze statistically literature characteristics and generate the high-frequency keywords matrix. The graphical clustering toolkit (gCLUTO) 1.0 is used to cluster the high-frequency keywords. A total of 750 articles are included, mostly published in

Clinical analysis of hemolytic-uremic syndrome associated with Streptococcus pneumoniae serotype 3 infection in a child / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics of Streptococcus pneumonia-associated hemolytic uremic syndrome (SP-HUS) in children.</p><p><b>METHOD</b>Clinical and laboratory data of a pediatric case of SP-HUS were retrospectively analyzed and the key points of diagnosis and therapy were reviewed.</p><p><b>RESULT</b>An 18-month old girl was admitted with chief complaint of fever and cough for 5 days combined with mild labored breath. Breath sound was found weakened in right lung with lower lobe dullness on percussion. Laboratory tests revealed: WBC 3.7×10(9)/L, Hb 83 g/L, PLT 11×10(9)/L, C-reactive protein (CRP) > 180 mg/L. Morphological study of the RBCs showed marked anisocytosis and schistocytosis. Urinalysis showed 42.66 RBCs per high-power field, occult blood (+++), proteinura (++++). Streptococcus pneumoniae was isolated from blood, pleural fluid and sputum. Serotyping with simplified chessboard system was 3. The direct Coombs test was positive. Serum complement levels (C3 and C4) were depressed at 0.699 g/L, 0.064 g/L, respectively. Chest X-ray showed pleural effusion and infection of the right hemothorax. The computerized tomographic scan of the chest revealed pneumatoceles in the right lower lobe. The diagnosis on admission we considered was SP-HUS. Intravenous antibiotic therapy (vancomycin + cefoperazone/sulbactam) was administered. The renal replacement theraphy was administered to maintain electrolyte and fluid balances and adequate nutrition. Transfusions of washed red blood cells were administered to correct the anemia. One month after admission the patient was good with recovery. Liver and renal function recovered and the pneumonia was resolving, anemia and platelets were corrected. The direct Coombs test turned to be negative. Serum complement levels (C3 and C4) were normal. After 3-month follow-up, no clinical anomalies were detected.</p><p><b>CONCLUSION</b>SP-HUS should be suspected when the following occurs in the context of pneumococcal infections: microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure and a positive Coombs test result. Serotype 3 of SP was associated with HUS.</p>

Function of the present systematic evaluation in establishment of guidance for clinical practice / 中国针灸

<p><b>OBJECTIVE</b>Treatment of insomnia with acupuncture is taken as an example to explore the significance and problems existed in the present systematic evaluation in establishment of guidance for clinical practice.</p><p><b>METHODS</b>Fifteen articles on systematic evaluation of both English and Chinese were retrieved and studied carefully, their basic information was analyzed. Through study on the establishing process of the guidance of clinical practice, researches were focused on the possible significance of the articles to the guidance as well as the notes in the reuse of those articles since problem still existed.</p><p><b>RESULTS</b>It is held that the systematic evaluation has great significance on the establishment of the guidance from the aspects of applicable people, recommended standards of diagnosis and therapeutic evaluation, extended recommendation and methodology. Great importance should also be attached to the direct application of the research result and understanding of the evaluation result. The data should be rechecked when necessary.</p><p><b>CONCLUSION</b>Great guiding function can be found on the systematic evaluation of articles to the guidance. Moreover, if information needed to be taken into a full play, specific analysis should also be done on the concrete research targets.</p>

Study on the best solution of immediate analgesia of acupuncture for migraine / 中国针灸

<p><b>OBJECTIVE</b>To select the best solution of immediate analgesia of migraine treated with acupuncture.</p><p><b>METHODS</b>Taken 36 cases of migraine in attack stage as research objects, by means of orthogonal experimental design, applying the L9 (3(4)) orthogonal table, the therapeutic effect of immediate analgesia of acupuncture for migraine in attack stage was analyzed in four factors, which were effective acupoints combination, electroacupuncture therapy, auricular therapy and bloodletting therapy, and three levels of each factors. In the test procession, random approaches (stratified random and central random) and blinding experiment (the appraiser blind) were used. The time points of observation were before treatment, and 10, 20 minutes after treatment. Visual Analogue Scale (VAS) was used to evaluate therapeutic effect.</p><p><b>RESULTS</b>Comparing with the headache before treatment, at the time points of 10 and 20 minutes after treatment, the best solution for headache relief was needling therapy (local and distal points and points selection according to the differentiation), auricular electroacupuncture therapy and bloodletting at Taiyang Zimai (Extra) or Taiyang (EX-HN 5)and Ashi points.</p><p><b>CONCLUSION</b>In the attack stage of migraine, by the therapy combined with puncture on local and distal points and the points according to the differentiation, auricular electroacupuncture and bloodletting at Taiyang Zimai or Taiyang (EX-HN 5) and Ashi points, the favorable effects of immediate analgesia are received.</p>

Compilation characteristics and clinical applications of Guideline for Clinical Practice of Acupuncture in the Treatment of Migraine / 中国针灸

Refering to the oversea evidence-based guidelines for migraine, the authors analyze the compilation characteristics of Guideline for Clinical Practice of Acupuncture in the Treatment of Migraine (WHO WPR) (herein after referred to as "Guideline"), and briefly explain the range of application, clinical value and attentions of the Guideline. The methodological characteristics of the Guideline are stated from four aspects: general conditions of the included literature, evaluation standard for literature quality, classification standard for evidence level, and classification standard of recommendation. The characteristics of recommended protocol of the Guideline are stated from three aspects: universality, classification method and content.

Clinical characteristics and antimicrobial resistance of invasive pneumococcal disease in children / 中华儿科杂志

<p><b>OBJECTIVE</b>Streptococcus pneumoniae (SP) is a major causative agent of community-acquired pneumonia. In children older than 2 months, SP is also the most common cause of invasive bacterial infections. Invasive pneumococcal diseases (IPD) have become a severe problem of public health worldwide. The aim of this study was to summarize the clinical characteristics and antimicrobial resistance of IPD in children, and to raise the level of diagnosis and treatment of this disease.</p><p><b>METHOD</b>The clinical data from 55 cases of IPD younger than 12 years old seen from January 2004 to June 2009 in Yuying Children's Hospital Affiliated to Wenzhou Medical College were analyzed retrospectively. Blood, cerebrospinal fluid (CSF), seroperitoneum, mediastinum and soft tissue aspirate specimens were collected from these children, and 64 SP strains were cultured, isolated and confirmed and the antibiotics susceptibility to penicillin and other antibiotics of these strains were assessed.</p><p><b>RESULT</b>The 55 cases of IPD were identified, among whom 32 were male and 23 female, the ratio was 1.39. The ages ranged from 47 days to 12 years. Most (62%) of the cases were aged less than 2 years, and 16% were aged from 2 to 5 years. Overall, 38 (69%) had septicemia, of whom 8 cases were complicated with meningitis, 2 with pneumonia complicated with empyema, 1 had pneumonia complicated with mediastinal abscess and 11 with pneumonia. Nine cases (16%) were diagnosed as meningitis. Seven cases (13%) had hip or neck abscess and 1 case had purulent peritonitis. Thirteen cases (24%) had an underlying disease, including mainly leukemia (31%), followed by congenital heart disease (23%) and head trauma (15%). Three cases (5%) had received a surgical operation; 3 cases (5%) had combined virus infections and 2 cases (4%) had mycoplasma infection. Most (73%) episodes occurred in winter and spring. The main origin of infection was community (89%). Forty of the patients were cured, 12 improved and 3 died (5%). Nine cases (16%) developed neurologic complications. There was a statistically significant differences in the annual detection rate of invasive SP (chi(2) = 33.93, P < 0.01). The incidence of penicillin-intermediate S. pneumoniae (PISP) and penicillin-resistant S. pneumoniae (PRSP) were 30% and 41%, respectively; the resistance to erythromycin and lincomycin were found in as high as 94% and 88% of isolates, respectively; while the resistant rate to chloramphenicol and cefotaxime were low, 26% and 22%, respectively. The multidrug resistance rate was 89%.</p><p><b>CONCLUSION</b>Children aged less than 5 years, especially younger than 2 years are prone to IPD and the underlying diseases are found in 24% of cases; septicemia and meningitis are the common diseases.</p>

A Case of Hemodynamically Unstable Bradycardia after Risperidone Overdose

Risperidone is an atypical antipsychotic medication commonly used to treat psychotic illness, such as schizophrenia. It has strong serotonin and dopamine receptor antagonism and antagonist activity at alpha-adrenergic receptors and histamine receptors. An overdose of risperidone can cause tachycardia, hypertension, hypotension, prolonged QT interval, and bradycardia. Risperidone overdose is rare,but life-threatening. Here, we present the rare case of a 33- year-old woman who ingested risperidone overdose for the purposes of suicide, developing hemodynamically unstable bradycardia with trifascicular block, leading to fatality. Lessons from our case report are of urgent consideration for temporary pacemaker insertion, and use of alpha-1 agonist, such as phenylephrine in cases of hemodynamically unstable bradycardia by risperidone overdose. Prompt and appropriate identification and interventions are essential for the successful management of risperidone overdose.

Assessment of Cricoid Pressure Application by Emergency Department Personnel

PURPOSE: To assess the knowledge and the accuracy of cricoid pressure applied by emergency department (ED) personnel. METHODS: A prospective, observational study was conducted for 100 ED personnel (57 doctors, 38 nurses, and 5 EMTs) who participated in emergency airway training courses. Each participant was asked to complete a knowledge survey and the accuracy of cricoid pressure applied was evaluated using the training manikin. Three attempts were measured and a mean value was calculated. Subgroup analysis was also performed for specific variables of interest. RESULTS: Only thirty-four participants (34%) applied adequate cricoid pressure, with all participants who were outside of the target range applying less than the target amount. No statistically significant difference was demonstrated for age, qualifications, years of experience, existence of prior instruction, accuracy in knowledge, or ability to apply cricoid force within the target range. Male participants applied correct cricoid pressure within the target range more often than females (p=0.035, odds ratio=6.987, CI:1.145-42.641). CONCLUSION: Both knowledge and the application of adequate cricoid pressure by ED personnel were inadequate. In particular, females more often applied low cricoid pressure in order to guard against regurgitation than did males. Repeated hands-on training is recommended using adequate methods that integrate the concept of force.

Distribution and Drug Resistance of Pathogenic Bacteria of Urinary Tract Infection in Children / 实用儿科临床杂志

Objective To explore the pathogenic bacteria′s distribution and their drug resistance of urinary tract infection in children.Methods A total of 555 pathogen strains in urinary tract infection for children from inpatients and outpatients from Jan.2005 to Dec 2006 were identified and the drug resistance test was preformed.Results In the 555 strains of bacteria,80.7% were Gram-negative,17.7%were Gram-positive and 1.6%were fungi.Most of Gram-negative bacteria were E.coli,among 300 strains of identified Escherichia,69.3% of them(208 strains) produced extended speetrum ? lactamases(ESBLs);among 41 strains of identified Klebsiella pneumoniae,78.1% of them(32 strains) produced ESBLs.Most of Gram-positive bacteria were Enterococcus,there were 70 strains(12.6%),sensitivity rates of nitrofurantion and vancomycin were 100%.Conclusion Gram-negative is the main infection bacterium in urinary tract infection for children and the most of them are very serious drug resistant.The clinicians should pay more attentions to idstream urin bacteriology culture and choose the suitable antibiotic according to the results of antibiotic susceptibility tests.

Detection of etiologic agents and antibiotic resistance in children with acute lower respiratory tract infection in Wenzhou City / 中国当代儿科杂志

<p><b>OBJECTIVE</b>The etiology of acute lower respiratory tract infection (LRTI) in children in Wenzhou City remains poorly defined. This study investigated the etiological agents responsible for acute LRTI and patterns of the antibiotic resistant bacterial pathogens in children with acute LRTI from Wenzhou City.</p><p><b>METHODS</b>Lower respiratory tract secretions were obtained from 454 children with acute LRTI (aged 1 month to 10 years, median age 6 months) within 24 hrs after admission for bacterial culture. Meanwhile respiratory viruses were detected by the Direct immunofluorescence (DIF) assay. The K-B method was applied for the drug susceptibility test.</p><p><b>RESULTS</b>Etiological agents were identified in 297 cases out of 454 patients (65.4%. Viral pathogens were identified in 229 cases (50.4%), bacteria in 135 cases (29.7%) and mixed viral-bacterial infections in 67 cases (14.8%). The isolating rate of Respiratory syncytial virus (RSV) was the highest (180 cases, 39.6%) in all of the samples. The isolating rates of other viral pathogens were as follows: Parainfluenza virus 3 type (PIV3) (6.6%), Adenovirus (2.2%), Influenza A (0.9%) and Influenza B (0.7%). Of the 135 strains of bacterial pathogens, 19 kinds of bacterial pathogens were isolated. The predominant isolate was Klebsiella pneumoniae (K. pneumoniae) (9.9%), followed by Escherichia coli (E.coli) (4.4%), Streptococcus pneumoniae (S. pneumoniae) (4.2%) and Staphylococcus aureus (S. aureus) (4.2%). The isolating rates of K. pneumoniae and E.coli with extended-spectrum beta-lactamases strains (ESBLs) positive were 42.2% and 65.0%, respectively. The pathogens isolated of the first 5 places in children with acute LRTI under six months were RSV, K. pneumoniae, PIV3, E.coli and S. aureus in turn. RSV, PIV3, S. pneumoniae, K. pneumoniae and E.coli were found to be the pathogens of the first 5 places in children with acute LRTI between six months and three years. The resistant rates of K. pneumoniae and E.coli to ampicillin were 97.8% and 75.0%, respectively. K. pneumoniae and E.coli with positive ESBLs were resistant to cephalosporin. The resistant rates of S. pneumoniae to erythromycin and penicilin were 100% and 68.4%, respectively. The resistant rates of S. aureus to erythromycin and penicillin were 94.7% and 89.5%, respectively.</p><p><b>CONCLUSIONS</b>RSV is the most common pathogen responsible for acute LRTI in children in Wenzhou City, followed by K. pneumoniae and PIV3. The rate of antibiotic resistance of common bacteria and the isolating rate of Gram-negative bacillus with ESBLs positive are high.</p>

Clinical Analysis of Submerged Patients Treated at an Emergency Medical Center near the Han River

BACKGROUND: There are approximately 2,400 drowning deaths reported every year in Korea, but there are few good reports about submerged patients visiting the emergency room, so this study was designed to investigate the clinical characteristics and outcomes of submerged patients treated at an emergency medical center near the Han river. METHODS: A retrospective review of 123 cases of submerged patients admitted to our emergency medical center over a 5 year period from 1996 to 2000 was conducted. RESULTS: Among the 123 submerged patients, there were 66 males and 57 females, and their mean age was 33.18. The common cause of submersions was a suicide attempt, followed by lack of attention, unknown etiology, and water sports such as swimming. Most of the patients were transported to ER by 119 ambulance. In-hospital CPR was performed on 27(22%) cases. At initial ECG rhythm of these cases, asystole was noted in 25 patients; VF and pulseless electrical activity, respectively, were noted in two others. Prehospital CPR had been performed on all in-hospital CPR cases except 2. Prolonged ROSC after succesful CPR was noted in 13 cases. The mean duration of CPR was 26 minutes. Five patients survived after CPR. Their neurologic outcomes were assessed on CPC(cerebral performance category). Three patients were categorized in CPC1, the other two patients were categorized in CPC3 and CPC4. CONCLUSION: Submerged patient's visits to emergency medical center near the Han river were most frequent in summer for suicide purposes. Drowned patients were more hypothermic than other cardiac arrest cases, and resulted in better outcome even with prolonged arrest time, if they were given appropriate prehospital CPR and aggressive in-hospital resuscitation.

Usefulness of Serum Lactate in the Early Diagnosis of Intestinal Ischemia

BACKGROUND: Intestinal ischemia remains a devastating event despite improvements in clinical recognition and in diagnostic and therapeutic modalities. The ischemic bowel diseases encompass a wide clinical spectrum from mild, reversible disease to severe, irreversible injury. The clinical picture is characterized initially by poorly localized whether an increased serum lactate level is a recognized danger signal marker for intestinal ischemia in patients who present at the emergency department because of abdominal complaints. METHODS: Patients who came to our emergency department with abdominal pain and the risk factors of intestinal ischemia between Apr. 1999 and Nov. 1999 were included in this study. The data analysis included age, sex, final diagnosis, pathogenesis of bowel ischemia, and serum lactate level. RESULTS: The serum lactate level in the intestinal ischemia group was 28.54+/-22.51mg/dl; in non-ischemia group, it was 15.49+/-22.52mg/dl. This difference between the two groups was significatn(p<0.05). An increased serum lactate level had a sensitivity of 88.2% and specificity of 59.2%, a positive likelihood ratio of 4.92, and a negative likelihood ratio of 0.47 as a marker of bowel ischemia. These results do not represent a very meaningful revision of bowel ischemic provability, but may make a small contribution to management of the disease, depending upon their magnitude and the clinical context in which they are applied. CONCLUSION: In patients with abdominal complaints, an increased serum lactate level is usually a useful aid as a diagnostic marker of bowel ischemia.