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Objective To explore the clinical significance of procalcitonin(PCT)in guiding the optimizing antimi-crobial treatment strategy in ventilator-associated pneumonia(VAP).Methods Sixty patients receiving mechanism ventilation for ≥48 hours in an intensive care unit between November 2011 and April 2013 were randomly divided into control group (n=29)and trail group (n=31),patients in control group stopped antimicrobial use according to guideline,patients in trail group stopped antimicrobial use according to serum procalcitonin level,duration of anti-microbial use and mechanical ventilation between two groups were compared.Results Days of mechanical ventila-tion,length of ICU stay,mortality rates between two groups were not significantly different(all P >0.05);antimi-crobial days in trail group was significantly less than control group([10.70 ±3.78]d vs [13.93 ±3.03 ]d)(t =4.484;P <0.001).Conclusion Serum procalcitonin level plays an important role in the rational use of antimicrobial agents in patient with VAP.
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Objective To investigate the changes of surfactant associated protein A (ST-A) concentration inBALF and its relatiomhips with pulmonary injury after blast injury and blast injury combined with hypoxia. MethodTotally 131 Wistar rats (purchased from animal center of research Institute of Surgery, Daping Hospital, ThirdMilitary Medical University) were randomly divided into four groups: blast injury group ( BI group), blast injurycombined with hypoxia group Ⅰ (BAg Ⅰ group), blast injury combined with hypoxia group Ⅱ (BA Ⅱ group) andnormal control group. After blast injury was made by KST - Ⅰ bio-shock tube, rats of BA Ⅰ and BA Ⅱ groups wereput into hypoxia cabins immediately, where gas mixtures of 12.5% and 10.0% oxygeon were given, respectively.Rats were sacrificed at 1, 3 and 6 hours after injury for gross anatomic examination, light and electron microscopeobservation and lung water determination. The level of SP-A in BALF was detected by Western blot. The data wereprocessed by t test or Chi-square test. Results The respiration increased with shortness of breath and dysphoria inrats of BA Ⅰ and BA Ⅱ groups, and obvious cyanosis on the lips and nose in rats of BA Ⅱ group after blast injury.The lung water in rats of all injury groups was significantly higher than that in normal control group (P<0.05).Gross anatomy changes were mainly pulmonary bleeding and edema. Under light microscope, incrassation of alveo-lar wall, bleeding in alveolar and mesenchyme edema were found. Whereas under electron microscope, breakageof alveolar wall and decrease of lamellar bodies in type Ⅱ cell were observed. All these changes were most obviousin BA Ⅱ group followed by BA Ⅰ and BI groups in severity decling order, with mortality rate of 37.5%, 11.1%and 2.1% respectively at 6 hours (P<0.01). The SP-A level in BALF decreased significantly (P<0.01) andhad a good negative relationship with the lung water after injury (r=0.796, P<0.001 ). Conclusions Blastinjury combined with hypoxia significantly deteriorates the lung injury. More severe and longer hypoxia may resultin more severe lung injury and higher mortality rate. A decrease in SP-A value in BALF shows a good negative re-lationship with the pulmonary edema. The SP-A can be a good indicator for lung injury severity after blast injuryand blast injury combined with hypoxia.
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Objective To investigate the role of suramin in inhibiting the angiogenesis of lung cancer. Methods The protei n expression of VEGF and its receptor fms-like tyrosine kinase(Flt), kinase ins ert domain-containing receptor(KDR) in lung cancer cell A549 and ECV-304 was studied with immunohistochemical technique. The anti-angiogenesis effect of su ramin was evaluated with immunohistochemical technique and cell culture. Results Suramin showed no effect on the production of lung cancer cel ls and their secretion of VEGF. No possitive expression of Flt, KDR in A549 was found in the suramin interfered group and non-interfered group, but VEGF w as e xpressed in both groups. The Flt and KDR expressions in ECV-304 cells were decr eased significantly after the treatment of suramin at 0.25 ng/ml and 2.5 ng/ml r espectively. There was no effect on proliferetion of A549 and ECV-304 after sur amin in terference. Conclusion The mechanism of inhibiting-angiogenes is of suramin is pro bably due to reducing the VEGF receptor expression in vascular endothelial cells and inhibiting the binding of VEGF and its receptors.
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Objective To investigate the operative technique and efficacy of PPH for severe hemorrhoids. Methods The clinical data of 153 cases of severe hemorrhoids treated by PPH, individualized according to size and nature of the piles, concomitant morbidities and conditions at the dentate line, and analysis of the relevance between operative technique and clinical efficacy as well as postoperative complications, were revieuled retropectively. Results All of the prolapsed tissue retracted immediately. Bleeding at the anastomotic site occurred in 49 cases, pulsatile bleeding in 12 cases, all of which were sutured under direct vision with cessation of bleeding. The width of excised-tissue was 2.1~4.6cm(average 3.5cm). The main symptoms of patients on the 1st post-operation day were abdominal distention caused by dysuria, pain, and tenesmus and burning sensation. At followup of 1-40 months, there was no stenosis of stoma, anal incontinence or recurrence of prolapse. After operation, a very satistactory result was achieved in 87 cases, satisfactory in 63 cases and mostly satisfactory in 3 cases. Conclusions In order to achieve ideal results with good retraction of tissues, avoidance of complications and improve patient satisfactory rate, the use of PPH for severe hemorrhords must be individualized and technical skill during operation are important.
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Satisfaction questionnaires for emergency patients were developed in the present study and face to face surveys were conducted. The rate of effective retrieval was 96.8% and the response rate was 96.2%. The ? coefficient for internal consistency was fairly high (0.7099～0.9217) and there was a fairly strong correlation between the various items and the subordinate factors (0.744～0.912, with the exception of B15). A factor analysis indicated that the factor load and structure were basically consistent with the contents of the questionnaire. A statistical analysis showed that the satisfaction questionnaire for emergency patients, which had both credibility and validity, could be used for evaluating emergency patient satisfaction and could provide hospitals with the basis for measuring medical quality.