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Objective:To discuss how to avoid the occurrence of adverse events and provides basis for improving the extracorporeal membrane oxygenation (ECMO) transport safety management to formulate the corresponding preventive measures through analyzing the causes and characteristics of adverse events in transport of ECMO.Methods:By using a self-designed ECMO transport observation table to collect data, with a retrospective study of adverse events in patients with ECMO transport in ECMO center of Beijing Chaoyang Hospital from January 2013 to June 2017, carrying out classification and analysis according to the causes of adverse events and the potential risks of the patients, thus put forward the feasible preventive measures.Results:There were 53 cases of ECMO transport in study period, with 18 cases (33.96%) of adverse events, among which the incidence of adverse events in inner-hospital transport was 34.21% (13/38) and that in inter-hospital transport was 33.33% (5/15). There was no patient died in ECMO transport. In the adverse events of ECMO transport, the main causes were related to transport staff, transport equipment and patient, which accounting for 1/3 of each. Among them, the most prominent was 4 cases (22.22%) of equipment lacking and 3 cases of battery and power supply (16.67%). In classification according to the risk degree of patients, 6 cases (33.33%) of third grade risk were found.Conclusions:It is safe and feasible to carry out ECMO transport in inner-hospital transport and inter-hospital transport based on ECMO transport team and transport process of this hospital. However the unexpected events of high risk or crisis of life is inevitable in ECMO transport. Through standardized training for ECMO team, with full assessment before transport, by the use of ECMO checklist and strict implementation of various transport processes and specifications, the incidence of adverse events in ECMO transport may be reduced.
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Objective@#To investigate the early diagnosis method of pulmonary embolism in patients with skin and soft tissue defects after trauma.@*Methods@#From January 2011 to July 2014, 5 patients with skin and soft tissue defects and pulmonary embolism after trauma were admitted to Department of Plastic Surgery and Burns of the Affiliated Drum Tower Hospital of Nanjing University Medical School, including 4 males and 1 female, aged 26-68 years. The medical records of the 5 patients were retrospectively analyzed. Hierarchical screening of patients with suspected pulmonary embolism was performed after admission for 4-45 days. Computed tomography pulmonary angiography (CTPA) was performed immediately in 2 patients who had hemodynamic disorder and were able to tolerate CTPA, and pulmonary embolism was confirmed. Clinical risk assessment was conducted for the other 3 patients who had no obvious hemodynamic disorder and only had clinical manifestations of pulmonary embolism such as chest tightness and dyspnea. Among the 3 patients, two of them were assessed as high risk possibility by clinical risk assessment and diagnosed with pulmonary embolism by CTPA immediately. The other one patient′s clinical risk assessment was moderate risk possibility, but D-dimer was positive, and the patient was diagnosed with pulmonary embolism by CTPA immediately. Wound exudation of all patients was collected within 1 week after admission for microbial culture, and wound debridement and skin grafting were performed according to the wound condition. The color Doppler ultrasonography of blood vessel on lower extremity was performed to determine deep venous thrombosis of lower extremity after appearance of symptoms of pulmonary embolism. The patient was immediately given urokinase or recombinant tissue plasminogen activator by intravenous infusion for thrombolysis after definite diagnosis of pulmonary embolism. The activated partial thromboplastin time (APTT) was monitored after treatment, and standardized anticoagulation began when APTT was equal to or lower than 70 seconds. The treatment results of patients, D-dimer measurement value, bed time before definite diagnosis of pulmonary embolism, number of patients underwent wound debridement during hospitalization, definite diagnosis time of pulmonary embolism after wound debridement, and number of patients with deep venous thrombosis of lower extremity and wound infection were recorded.@*Results@#Wounds with skin and soft tissue defects of all patients were completely healed, all skin grafts survived well, pulmonary embolism recovered well after timely treatment, and the trunk and branches of involved pulmonary artery recovered blood supply. The course of disease ranged from 1 month to 3 months. The measurement value of D-dimer was 2.4-31.7 mg/L, and the measurement values of D-dimer of 4 patients were equal to or higher than 5.0 mg/L. The bed time before definite diagnosis of pulmonary embolism was 4-46 days, with an average of 23.2 days. Four patients underwent wound debridement during hospitalization. The definite diagnosis time of pulmonary embolism after the wound debridement was 14-40 days, with an average of 20.5 days. Four patients were diagnosed with deep venous thrombosis of lower extremity. All patients had wound infection, and the bacteria causing wound infection included Pseudomonas aeruginosa of 2 cases, Staphylococcus aureus of 2 cases, and Enterococcus faecalis of 1 case.@*Conclusions@#In the diagnosis process of pulmonary embolism in patients with skin and soft tissue defects after trauma, D-dimer positive, long-term bed rest, experiencing operation during hospitalization, and with deep vein thrombosis and wound infection can be regarded as the key points for diagnosis. When a patient has clinical symptoms of pulmonary embolism and the above conditions, the clinician should promptly perform hierarchical screening, select the corresponding examination to confirm pulmonary embolism, and immediately perform thrombolysis for the patient with pulmonary embolism according to the patient′s tolerance, thereby improving patient survival rate.
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Objective To explore the therapeutic effect of different doses of botulinum toxin A injections on bromhidrosis.Methods A total of 200 cases were divided into mild-to-moderate group (N=100) and severe group (N=100) based on the grade of bromhidrosis,and each group was further divided into two groups:low dose group (50 cases) were treated by botulinum toxin A injections (100 U) and high dose group (50 cases) were treated with 200 U for bilateral axillary.The total effective rate and recurrence rate in both groups were compared.Results In the mild to moderate group,after treatment for 3 months,the total effective rate of both groups had no statistical difference (P＞ 0.05),and the same with recurrence rate in 6 months follow-up (P＞0.05).In the severe group,after treatment for 3 months,the total effective rate of the high dose group (82％) was significantly higher than that of the low dose group (64％),with statistical significance (x2 =4.110,P＜0.05).After 6 months follow-up,recurrence rate in the high dose group (22％) was significantly lower than that of the low dose group (46％),with statistical significance (x2 =6.417,P ＜ 0.05).Conclusions A suitable dose of botulinum toxin A can be selected based on the severity of bromhidrosis,which is a individualized therapy for cost savings and might have potential benefits for patients with osmidrosis.
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OBJECTIVE:To investigate improvement effect of external administration of water extract from Eriocarpous Glochidion on chronic dermatitis-eczema model mice, and to provide reference for developing new dermatological drug. METHODS:A total of 60 mice were randomly divided into blank group (distilled water), model group (distilled water), compound triamcinolone acetonide acetate group (positive control group, original liquid) , high-concentration, medium-concentration and low-concentration groups of water extract from Eriocarpous Glochidion(2.0,1.0,0.5 g/mL,calculated by crude drug),10 mice in each group. Except for blank group,other groups were given 2,4-dinitrochlorobenzene to induce chronic dermatitis-eczema model. Since the third day of the experiment,two sides of right ears of the mice were given relevant medicine twice at 7:00 and 15:00,15 μL each time,for consecutive 12 d. In the tenth,thirteenth,sixteenth day of the experiment,the difference of thickness of right ears of the mice was calculated(the difference value before experiment),the times of scratching in ear of mice were recorded within 30 min. In sixteenth day of the experiment,ear swelling degree of mice was determined,and thymus index and spleen index in mice were calculated. Optical microscope was used to observe the pathological changes of ear tissues of mice. RESULTS:Compared with blank group,the difference of thickness of right ears,ear swelling degree,spleen index and scratching times were increased significantly in model group(P<0.05 or P<0.01). The epidermis of the ear tissue was thickened,the cell proliferation was obvious,and cavernous edema was found in the epidermis. Compared with model group,other indexes in were decreased significantly,except that the difference value of thickness of right ears in sixteenth day of the experiment,scratching times in ninth and fifteenth day of the experiment were decreased slightly in low-concentration group of water extract from Eriocarpous Glochidion and the thymus index and spleen index in medium-concentration, low-concentration groups of water extract from Eriocarpous Glochidion (P<0.05 or P<0.01). The pathological changes of ear tissue were improved in administration groups to certain extent. CONCLUSIONS:External administration of water extract of Eriocarpous Glochidion has good improvement effect against chronic dermatitis-eczema in mice, which is worthy of further development and investigation.
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Objective To investigate the expression of glucagon-like peptide-1 receptor (GLP-1R) of skeletal muscle cells and the changes of skeletal muscle microstructure of diabetic rats, and to explore the relationship between the expressions of GLP-1R and insulin resistance in skeletal muscle. Methods Male Wistar rats were divided into two groups, normal glucose tolerance ( NT, n =25 ) , diabetes group ( DM group, n=30), the methods of creating diabetes model were used high-sugar high-fat diet and low-dose in-traperitoneal injection of streptozotocin. Immunohistochemical methods was used to detect the expression of GLP-1R in the muscle cells. The number of GLP-1R positive cells in the muscle of two groups was observed and compared. The relationship was analyzed between the homeostasis model assessment insulin resistance (HOMA-IR) and the number of GLP-1R positive cells. Results ⑴Compared to the NT group, the num-ber of GLP-1R positive cells in muscle of DM group was decreased (P<0. 05); ⑵ Compared to the NT group, HOMA-IR was increased in DM group (P<0. 05);⑶ Pearson correlation analysis showed that the percentage of GLP-1R positive cells expressed in rat skeletal muscle was negatively correlated with HOMA-IR (r= -0. 538, P<0. 01). Conclusions The expression of GLP-1R positive cells was decreased in the skeletal muscle of diabetic rats, insulin resistance increased. Therefore, the expression of GLP-1R on skele-tal muscle cells may promote the development of insulin resistance and diabetes mellitus.
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Objective To explore the aesthetic results of medial upper Iip repair for skin and soft tissue defects using local flap.Methods According to the location and the size of upper lip defect,the modified rhomboid flap of 60 ° above the defect was designed to repair the wound in philtrum;the O-L flap along philtral column to vermilion border was designed to cover the wound close to the peak and lateral to philtral column.Results Twenty-one postoperative patients that underwent pigmented nevus removal (12 female,9 male;ages 16-33 years) had defects in philtrum for 10 cases and close to the peak and philtral column for 11 cases.The diameter of the defect ranged from 0.5 cm to 1.0 cm.All flaps survived primarily without any complications and follow-up was for 1 to 18 months with excellent outcomes in all cases.All patients were satisfied with contour and functions.No pigmented nevus recurrence occurred.Conclusions The flap designed according to the aesthetic principle could be used to repair medial upper lip defect of medium-sized,which not only obtains functional reconstruction,but also satisfies aesthetic results,with aesthetic subunits saved and scar concealed.
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Objective To observe the efficacy and safety of safflower yellow injection in the treatment of sta-ble angina pectoris.Methods 70 patients with stable angina pectoris were selected and divided into observation group and control group by random number table method,35 cases in each group.The observation group used injection of safflower,and the control group used Xuesaitong.The effect was compared between the two groups.Results The total effective rate of the observation group was 94.3%,which was higher than 74.3% of the control group,the differ-ence was statistically significant(χ2 =5.285,P 0.05).Conclusion The injection of safflower yellow pigment in the treatment of stable angina pectoris has high safety.
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Objective To find out some ways to solve the problems which are dealing with the clinical application of intrafix.Methods From February to May 2013,324 patients with back blood using intrafix in emergency department were randomly assigned to the experimental group A and the control group A,with 162 patients in each group.The experimental group A used the method of pressing pipe while pulling out the needles when transfusion was over,while the control group A used traditional ways.206 patients who occurred bubbles in the intrafix among the above two groups were divided into the experimental group B and the control group B.The experimental group B got rid of the bubbles using top-down method,the control group B used traditional ways.The effect of withdrawing the needles and exhaustion of bubbles were compared.The least flushing time of remaining liquid using transfusion pipe flushing method was calculated.Results The experimental group A and the experimental group B were better in withdrawing the needles and exhaustion of bubbles compared with those of the control group A and the control group B.Using the method of drop coefficient to calculate the least flushing time can ensure the drug to be transfused into the body thoroughly.Conclusions When transfusion is over,pressing intrafix pipe will have a better result than the traditional way when pulling out the pipe.Top-down method can clearly settle the problem of intrafix pipe,which can not get rid of bubble via traditional way.Flushing pipe and press pipe method can apparently decrease drug waste.
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<p><b>OBJECTIVE</b>To investigate the statement on randomized controlled trials on Wenxin granule for treatment of atrial fibrillation and to judge whether those trials could offer high quality evidence or not, thus improve design level and quality.</p><p><b>METHOD</b>RCTs were searched from home and abroad about atrial fibrillation treated with Wenxin granule, which reported before October, 2010. Jadad scale and CONSORT statement were used.</p><p><b>RESULT</b>There were 66 RCTs retrieved that met inclusion criteria. Using Jadad rating scale, only 2 literatures gain score 4 and 1 literature gains score 3, 54 literatures gain score 2, 7 literatures gain score 1, 2 literatures gain score 0. Only 2 literatures described random number table as the method of grouping. None of the RCTs was reported the allocation concealment. Only 1 literature was used blinding. Fifty-nine literatures were mentioned the lost to follow-up conditions. According to the CONSORT standards, only six literatures (9.1%) mentioned the method of generating the random sequence. Four literatures (6.1%) were quasi-random. Nineteen literatures (28.8%) had inclusion criteria. Six literatures (9.1%) had the follow-up record. Fifty one literatures (77.3%) described the adverse events. None had the estimation of the sample size, intention-to-treat analysis and stratified analysis. None had the ethical approval or informed consent.</p><p><b>CONCLUSION</b>The quality of clinical trials of Wenxin granule in treating atrial fibrillation needs to be improved.</p>
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Humans , Atrial Fibrillation , Drug Therapy , Drugs, Chinese Herbal , Therapeutic Uses , Randomized Controlled Trials as TopicABSTRACT
Objective To explore a new methodology with bilateral rhomboid dermal flaps for surgical treatment of inverted nipple. Methods 36 cases with 64 inverted nipples were involved in this study. Among these cases, 8 of them were evaluated as mild degree, while 19 moderate and 9 severe. In this procedure, the bilateral rhomboid incisions were designed. The rhomboid skin was deepithelialized and two dermal flaps were created. Then these two dermal flaps were filled crosswise through the tunnel beneath the nipple and fixed as supporting. After the operation, the continuous traction of the nipple lasted for one week, and sutured out 10 days later. Results None of these 36 cases appeared nipple blood circulation disorder after operation. Postoperative follow-up for 6 months-3 years showed that the appearance of the nipple was satisfactory. There were no recurrence and sensory disturbance. Conclusions The method introduced in this study is simple, the appearance of nipple is natural and no complication has been found. The incision is larvaceous while the scar is invisible. Meanwhile this method is also benefit for reserving the function of breast-feeding. It is proved to be an ideal method for correcting the inverted nipple.
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Objective:To investigate the expressions of tumor stem cell marker CD133 and tumor vascular endothelial cell marker CD105 in lung cancer tissue and their clinical significance.Methods:Streptavidin-biotin-peroxidase complex (SABC)-immunohistochemical staining was used to detect the expression of CD133 and CD105 in 65 cases of lung cancer tissue and 30 specimens of adjacent non-cancerous tissue. The relationship between the expression of CD133/CD105 and tumor size, histological types, differentiation, TNM stage, lymphoid metastasis, and prognosis were analyzed. Results:The positive expression rates of CD133 and CD105 in lung cancer tissues were significantly higher than those in adjacent non cancerous tissues, respectively (69.2% vs 26.7% and 67.7% vs 10.0%, both P0.05). The expression of CD133 was positively correlated with the expression of CD105 in lung cancer tissue with Pearson coefficient r of 0.37 (P<0.05). Postoperative median survival periods of CD133 and CD105-positive group were significantly shorter than the CD133 and CD105-negative groups (37 months vs 66 months,35 months vs 70 months, respectively, both P<0.05). Conclusion:The expression of CD133 and CD105 was associated with lymphoid metastasis and prognosis in patients with lung cancer.Their overexpression implies poor prognosis of lung cancer patients.
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Objective To observe the effect of leflunomide, combined tripterygium glycosides in treatment of nephrotic syndrome. Methods 64 patients with refractory nephrotic syndrome, according to drug using were divided into two groups,34 patients received the conventional therapy plus leflunomide combined tripterygium glycosides,30patients received conventional therapy alone, such as cyclophosphamide and prednisone,effects and follow-up were observed,as well as kidney function, blood lipid changes. Results After 30d treatment,the efficacy were observed. The results showed the efficiency of the observation group were significantly higher than control group. After 1 year followup,the recurrence rate of the observation group was significantly lower than the control group. 24h urine protein in both groups decreased significantly, ALB was higher than before treatment ,TG TCh was significantly lower than before treatment,and different indexes in the treatment group were significantly better than after the reduction and increase the level of the control group(P ＜ 0.05). Conclusion Lellunomide,tripterygium glycosides combined treatment of ne phrotic syndrome had good effect,and recurrence rate was low,and it could improve kidney function,blood fat,it was worthy of wide dissemination and application.
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Cycloheximide (CHX) inhibits protein synthesis in most eukaryotic cells and it is a well-known tool commonly used in biochemical research. In this paper, the antiviral spectrum of CHX against several DNA and RNA viruses have been evaluated. CHX showed strong inhibitory activities against several RNA viruses such as HIV-1, influenza viruses, coxsackie B virus, enterovirus (EV71) and several DNA viruses such as HSV and HCMV. Especially the strong inhibitory activities of CHX against coxsackie B virus and enterovirus caught our attention, since effective drugs available in clinic are limited. The SAR of CHX derivatives also has been discussed in the paper. The hydroxyl group at C-2' and carbonyl group at C-2" of CHX are essential for its antiviral activity. And modification to these groups results its derivatives' antiviral activities reduced or lost.
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Objective To approach the effect of Silkworm Cocoon,Portulaca oleracea on the glucose and lipid metabolism to type 2 Diabetic rats. Methods type 2 diabetic rat models induced by STZ were randomly divided into diabetes model group,Silkworm Cocoon group,Portulaca oleracea group,Silkworm Cocoon+Portulaca oleracea group,and normal contrast group,after eight weeks' intervention,We analyze blood glucose(GLU), triglyeeride(TG), SOD, GSH, MDA, calculate, the indexes of insulin resistance (HOMA-1R). Results compared with diabetes model group, the GLU in Silkworm Cocoon+Portulaca oleracea group decrease 53.3%(P<0.01) : The TG decrease 44.1%(P<0.05). the Homa-IR decrease groups has no statistic difference. Conclusion The mixture group can obviously improve the glucose and lipid metabolism、 relieve insulin resistance、 significantly increase antioxidatian、 decrease the products oflipid peroxide.
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Objective To probe into the best measuring method about observation of efficacy for the infected people by Hp.Methods 4 patients infected by Hp took orally priplicatial drugs,we had their feces measured with HPSA reagent in the fist,the second,the third,the fourth,the fifth,the sixth,the seventh,the thirtieth,the sixtieth,the nin-etieth day and one year,and observed the efficacy.Results The HPSA results of 4 patients were positive in the first and the second days,1 patient had a positive result in the third day,while others were neg-ative,4 patients' resuts were negative from the fourth day to the seventh day,1 patient's result was positive in the thirtieth day,others were negative.4 patients' results were negative in the sixtieth,the ninetieth day and one year.Conclusions Through theraping,4 patients had been cured.Fecal HPSA's measure with ELA method was the best method about monitoring the efficacy after treatment.
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@#ObjectiveTo assess the effect of Duckett and Duplay technique on repairing severe hypospadias.Methods70 cases with severe hypospadias accepted urethraplasty with a penile and scrotal skin tube by Duckett's and Duplay's technique. ResultsThe hypospadias of 65 cases were successfully repaired in one stage, 3 cases complicated urethral fistula,2 caese complicated urethral stenosis with urethral diverticulum, which was significantly improved compared with the scrotal cutaneous island flap techniques(P<0.05). ConclusionDuckett's and Duplay's techniques is a good method in the treatment of severe hypospadias with little complication.
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Objective: To summarize surgery experience and efficiency of laparoscopic excision of choledochal cyst and reconstruction of biliary tract and to analyze the treatments administered during intra and post-operation of the biliary reconstruction. Methods: We enrolled 48 cases of video-guided laparoscopic intraoperative cholangiography, cholecystectomy, choledochocele resection, Roux-en-Y hepaticojejunostomy with an anti-reflux valve from August, 2001 to October, 2003.Their operative procedures and aims were retrospectively analyzed. Results: Forty-four out of 48 patients successfully underwent laparoscopy and recovered soon. Only 4 cases were transformed to open operation. The post-operation complications were found in 4 cases. Conclusion: Video-guided laparoscopic excision of choledochal cyst, biliary tract reconstruction and Roux-en-Y hepaticojejunostomy are an effective method of treatment with advantages of minimal injury, less bleeding, and sooner recovery.
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Objective:To investigate the incidence of anemia in early and middle pregnancy and to provide better medical service to pregnant women.Methods:We included in this study 556 women in early or middle pregnancy received in our hospital in 2007,detected the levels of hemoglobin and analyzed the incidence of anemia in different periods of pregnancy according to the WHO and Chinese national standard.Results:The anemia incidence was 15.83% according to the WHO standard and 1.81% according to the Chinese national standard,significantly higher in the middle period than in the early trimester of pregnancy(P
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Objective To observe the analgesia effects of nitrous oxide inhalation in childbearing. Method Respectively estimate the labor time,delivery type,degrees of labor pain, fetal distress and postpartum hemorrhage condition between analgesia group of 86 cases and control group of 45 cases. Result Compared to control group, the painful extent of delivery process in analgesia group was obvious lightened and childbearing time was decreased. Conclusion BZ Analgesia effects of nitrous oxide inhalation is positive in childbearing and has great value of clinical applying in obstetrics.
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<p><b>BACKGROUND</b>To evaluate the efficacy and toxicity of the FUDR-based regimen in the treatment of advanced non-small cell lung cancer.</p><p><b>METHODS</b>Fifty patients in group A received the L/FUDR-EP regimen, while 42 patients in group B were given the L/FEP regimen. The response and toxicity were evaluated after three courses of treatment.</p><p><b>RESULTS</b>The therapeutic response of group A and group B were 40.0% and 38.1% respectively (P > 0.05). The toxicities such as marrow inhibition, gastrointestinal symptoms, alopecia and local phlebitis were remarkably lower in group A than those of group B (P < 0.01).</p><p><b>CONCLUSIONS</b>The FUDR based regimen is effective to the advanced NSCLC, and its toxicity is lower than 5-FU.</p>