Study on therapeutic effect of Cefoselis sulfate versus Cefepime on stroke-associated pneumonia in elderly patients / 中华老年医学杂志

Objective To explore the therapeutic effect of Cefoselis sulfate and Cefepime on the stroke-associated pneumonia in elderly patients.Methods 96 cases of stroke-associated pneumonia with positive pathogen were divided into two groups treated with Cefoselis versus Cefepime respectively.Body temperature,leukocyte count,arterial partial oxygen pressure,the serum level of C-reactive protein (CRP) and bacterial clearance rate were observed before and after the treatment.The cefoselis sulfate group (n =48) or the cefepime group (n =48) was treated with 2.0 g Cefoselis sulfate or 2.0 g Cefepime every 12 hours for 7 to 10 days.Results In post-treatment versus pretreatment,both two groups showed that clinical symptoms and inflammatory indicators were improved,and the patient's body temperature,white blood cell count and neutrophil cell count,hs-CRP and arterial partial oxygen pressure were significantly decreased (all P＜0.05).Arterial partial oxygen pressure was better in post-versus pre-treatment (P＜0.05).The total effective rate was 87.5％ in Cefoselis sulfate group and 83.3％ in cefepime group (P ＞ 0.05).The bacterial clearance rate was higher (89.6％) in Cefoselis sulfate groups than in cefepime groups (67.9％) (P＜0.05).In posttreatments of Cefoselis sulfate groups versus Cefepime groups,white blood cell count and neutrophil cell count,hs-CRP and arterial partial oxygen pressure showed no statistically significant differences (all P ＞ 0.05).Conclusions Compared with Cefepime,Cefoselis has the similar anti-infection efficacy in the treatment of stroke-associated pneumonia.While,the bacterial clearance rate and the total effective rate are better in cefoselis group than in Cefepime group.

Acute hypotensive episodes prediction based on non-linear chaotic analysis / 生物医学工程学杂志

In intensive care units (ICU) , the occurrence of acute hypotensive episodes (AHE) is the key problem for the clinical research and it is meaningful for clinical care if we can use appropriate computational technologies to predict the AHE. In this study, based on the records of patients in ICU from the MIMIC II clinical data, the chaos signal analysis method was applied to the time series of mean artery pressure, and then the patient's Lyapunov exponent curve was drawn ultimately. The research showed that a curve mutation appeared before AHE symptoms took place. This is powerful and clear basis for AHE determination. It is also expected that this study may offer a reference to research of AHE theory and clinical application.

Advances in research of animal models of hyperuricemia combined with abdominal obesity / 中国实验动物学报

Hyperuricemia is closely associated with abdominal obesity .The prevalence of hyperuricemia combined with abdominal obesity has been increased significantly in recent years , along with the improvement of daily life and the changes in dietary structure .The state of hyperuricemia combined with abdominal obesity is most harmful , and becomes a common and high risk metabolic disease .Animal model with hyperuricemia combined with abdominal obesity is very impor-tant for the research of pathomechanism and treatment of this disease .

Clinical cases discussion:fever-hemoptysis-chest pain-pleural effusion / 中华老年医学杂志

This report presented a male patient aged 69 years,who was admitted into our hospital for fever,hemoptysis and chest pain.Chest X-Ray showed shadows on the right lung and pleural thickening.The effect of broad spectrum antibiotic therapy was poor.With the disease progressed,pleural effusion appeared on the right side.Blood culture showed methicillin-resistant staphylococcus aureus.Pleural effusion tests indicated pyothorax,but the effects of closed chest drainage and sensitive antibiotic therapy were poor.After disentangling with open thoracic exploration,the right middle lobe was resected and the right lung lobe pathology showed Wegener granulomatosis.His blood antineutrophil cytoplasmic autoantibodies was negative.The paranasal sinus CT scan and renal function showed no abnormalities.The definitive diagnosis was pulmonary limited Wegener granulomatosis.

Clinical Study of Transurethral Bladder Micro URSL Joint Puncture and Drainage Treatment for Pediatric Calculus of Lower Urinary Tract / 昆明医科大学学报

Objective To investigate the clinical efficacy of the urethra URSL combined with micro-puncture and drainage treatment for pediatric calculus of lower urinary tract. Methods From January 2003 to January 2013, 66 cases with pediatric urinary tract calculi in our hospital were randomly equally divided into experimental group and control group. The experimental group was treated with transurethral bladder micro URSL combined puncture and drainage treatment, and the control group was given a simple transurethral URSL method of treatment. The operative time, postoperative urine turned clear time,pulling stone clearance after catheter time,postoperative hospital stay and the incidence of postoperative urethral stricture were observed and recorded. In addition, these data were compared between the two groups. Results The operations of two groups have successfully completed. The mean operative time, postoperative urine turned clear time, pull out the catheter stone clearance after time and postoperative hospital stay of control group was 30.2±2.45 minutes,2.5±0.5 days,2.1±0.8 days and 4.0±0. 5 days, respectively. Patients were followed up 1 year after operation, and 1 case of urethral stricture occurred. However, the mean operative time, postoperative urine turned clear time, pull out the catheter stone clearance after time and postoperative hospital stay of the test group was 20.36±2.35 minutes,1.5±0.7 days,1.1±0.25 days and 3.1±0.3 days,respectively,with no urethral stricture case occurred. There were significant differences between the two groups ( <0.05) . Conclusion Transurethral bladder URSL micro puncture and drainage combined with transurethral ureteroscopy lithotripsy treatment for children with lower urinary tract calculi has better efficacy and safety. It could shorter operative time, postoperative urine turned clear time, the gravel discharge time and average hospitalization time, reduce the incidence of postoperative secondary urethral stricture.

Clinical efficacy of ambroxol treatment on acute stroke-associated pneumonia / 中华老年医学杂志

Objective To observe the clinical effects of ambroxol on acute stroke-associated pneumonia (SAP).Methods From July 2011 to December 2012,a total of 82 patients with strokeassociated pneumonia (SAP) admitted to our hospital were selected and randomly divided into ambroxol group (n=43,treated with ambroxol in combination with antibiotic therapy) and control group (n =39,treated with antibiotic therapy).The defervescence time,hospitalization time,antibiotic use time,C-reactive protein level,blood oxygen partial pressure,bacterial clearance rate and the total effective rate were compared between the two groups.Results The defervescence time,hospitalization time,antibiotic use time were shorter in ambroxol group than in control group [(3.1 ± 0.8)d vs.(3.8±1.1)d,(11.7±3.7)d vs.(13.6±4.9)d,(5.4±1.7)dvs.(6.6±2.1)d,t=18.60,22.80,23.50,P=0.014,0.008,0.011,repectively].Bacterial clearance rate and the total effective rate were higher in ambroxol group than in control group [90.7％ vs.74.4％,93.0％ vs.74.4％,x2 =3.86,5.34,P=0.05,0.02].There were no significant differences in changes of C-reactive protein level and blood oxygen partial pressure between two groups before and after treatment (all P＞0.05).Conclusions Ambroxol is an effective treatment for acute stroke associated pneumonia,which can shorten antibiotic use time and duration of symptoms and remove bacteria effectively.

Clinical Observation on Endoscopic Treatment of Ureteral Calculi Acute Obstruction with Urinary Extravasation / 昆明医科大学学报

Objective To investigate the feasibility and safety of endoscopic treatment of ureteral calculi acute obstruction with urinary extravasation. Methods 56 patients with ureteral calculi acute obstruction and urinary extravasation were randomly divided into two groups:the treatment group and the control group,28 cases in each group. Patients in the treatment group were given URSL or percutaneous nephrostomy drainage, and the secondary fistula was given URSL stone clearance treatment. Patients in control group were given traditional ureterolithotomy treatment. The stone clearance rate, the average recovery time after surgery, postoperative wound infection rate and the abnormal rate of postoperative albumin were observed in two groups. Results In the treatment group,28 patients had no residual stones with mean postoperative recovery time of (5.2 1.3) days,postoperative fever was found in 3 cases,obvious abnormal postoperative albumin in 3 cases. In the control group,residual stones were found in 3 cases,the average recovery time after surgery was (7.9 2.6) days,postoperative fever was found in 10 cases, and obvious abnormal postoperative albumin in 11 cases. There were statistically significant differences in stone clearance rate, the average recovery time after surgery, postoperative wound infection rate and the abnormal rate of postoperative albumin between two groups (P<0.05) . Conclusion Endoscopic treatment of ureteral calculi acute obstruction and urinary extravasation has advantages including better efficacy, less trauma, less complications and quicker recovery.

Effects of continuons blood purification on patients with severe acute pancreatitis / 中华急诊医学杂志

ObjectiveTo explore the therapeutic effect of continuous veno-venous hemofiltration (CVVH) on the treatment of severe acute pancreatitis (SAP).MethodsAll data about forty-five patients with SAP admitted to the intensive care unit (ICU) from June 2005 through June 2010 were reviewed.These 45 patients were randomly (random number ) divided into routine treatment group (n =22 )and comprehensive treatment group ( n =23 ).In control group,patients were rapidly given with a suffficient liquid support,vasoactive drug to increase organ perfusion,trypsin secretion inhibitor,broad-spectrum antibiotics,enteral nutrition with intestine membrane protective agent in early stage.In the comprehensive treatment group,patients received CVVH integrated with routine treatment.On admission and 72 h posttreatment,the scores of acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) and multiple organ dysfunction syndrome (MODS),and the results of standard bettery of biochemistry tests indcluding blood urea nitrogen (BUN),serum cratinine (Scr),total bilirubin (TBIL),alanine aminotransferase (ALT),amylase (AMS),C-reactive protein (CRP),TNF-α,IL-6,IL-8 were observed.Time of mechanical ventilation support,length of ICU stay,and survival rate were compared between two groups.ResultsOn admission between the two groups,no statistical significance was seen in the APACHE Ⅱ and MODS score,BUN,Scr,TBIL,ALT,AMS,CRP,TNF-α,IL-6,IL-8 (P ＞ 0.05).But APACHE Ⅱ and MODS score were decreased significantly in comprehensive treatment group than in the routine treatment group,as well as the the level of BUN,Scr,TBIL,ALT,AMS,TNF-α,IL-6,IL-8 and CRP after 72h post-treatment (P＜0.05 ).In routine treatment group and comprehensive treatment group,the time of respirator intervention and length of stay in ICU were (7.6±3.4) d vs.(11.5±4.7) d,(12.3±7.8) dvs.(17.6±9.2) d respectively,the statistical significance was shown ( P ＜ 0.05 ).Compared to the comprehensive treatment group ( 86.96％ ),the survival rate ( 59.09％ ) were lower in routine treatment group ( P ＜ 0.05 ).ConclusionsCVVH combined with routine treatment,which can remove inflammatory agents and toxins,maintain homoeostasis,and improve oxygenation,is effective in treatment of SAP and can improve patient survival rate.

Expression of matrix metalloproteinase and tissue inhibitor of metalloproteinase in lung tissue of hypercapnia rat model / 中国病理生理杂志

AIM:To study the expression of matrix metalloproteinase-9(MMP-9),matrix metalloproteinase-2(MMP-2) and the tissue inhibitor of metalloproteinase(TIMP-1) in the lung tissue of the hypercapnia rat.METHODS:Forty Wistar rats were randomly divided into a control group (group A,n=20) and hypercapnia group (group B,n=20). Group B received mix gas exposure (6% CO_2,21% O_2,72% N_2) 7 h daily for 4 weeks. The parameters we would examine were as follow:arterial blood gas;the mean pulmonary artery pressure;MMP-2,MMP-9,TIMP-1,and NE activity in lung tissue. Masson pigmentation of elasticity fibre was analyzed by computer image analyzer. Histopathological changes of lung tissue were observed under light microscope. The protein expression of MMP (MMP-2,MMP-9) and TIMP (TIMP-1) in lung tissue were determined by immunocytochemistry.RESULTS:Decompensate respiratory acidosis (pH=7.20±0.04,PaCO_2=7.84±0.15) developed in group B. The mean pulmonary artery pressure were similar between groups B and A (P>0.05). Tissue edema in the lung,endothelial cell damage of the small blood vessels,pulmonary micro thrombus formations and increased pulmonary capillary permeability were observed in group B. NE activity increased significantly (P<0.01). However,no significant change of MMP-2,MMP-9,TIMP-1 activity was found in group B and group A (P>0.05). There was significant decrease in the relative content of elasticity fibre in lung tissue in group B compared to group A (P<0.01). The expression of MMP-2 protein in the lung tissue of group B was lower than that in group A (P<0.01),but the expression of both MMP-9 and TIMP-1 proteins in the lung tissue in group B were higher than those in group A (P<0.01).CONCLUSION:Hypercapnia rat model is successfully reproduced by exposure of animals to the mix gas exposure (6% CO_2,21% O_2,and 72% N_2). The pulmonary artery pressure is not affected by hypercapnia. High concentration of CO_2 causes increase of NE activity and decrease in the relative content of elasticity fibre. High concentration of CO_2 causes the increase of MMP-2 protein expression and decrease in the MMP-9 and TIMP-1 protein expression.

A study on abnormality of coagulation and fibrinolytic system in patients with COPD at acute stage / 中国实用内科杂志

Objective To discuss possible mechanism of chronic obstructive pulmonary disease(COPD)coagulation and fibrinolysis dysfunction.Methods Totally 47 healthy controls(Group A)and 38 cases of AECOPD(Group B)were chosen respectively.The plasma levels of vWF,Factor Ⅹ,TF,TFPI,TM,PC,tPA,PAI-1 and D-dimer were measured by ELISA method,and the blood AT-Ⅲ activity was measured by chromogenic assay.The cases of Group B were measured for RBC,WBC,PLT,PH,PaO2,PaCO2,HCO-3,PT,APTT,FBG,and so on.Results The plasma levels of vWF,TF,Factor Ⅹ,t-PA and D-dimer in Group B were significantly higher than those in Group A while TM and PC were significantly lower in Group B(P

Minimally invasive treatment for multiple calculi in homolateral kidney and ureter / 中国微创外科杂志

Objective To investigate surgical techniques of minimally invasive management for multiple calculi in the kidney and ureter. Methods Combined use of ureteroscopic lithotripsy(URSL) and minimally invasive percutaneous nephrolithotomy(MPCNL) was carried out in 21 patients with multiple calculi in homolateral kidney and ureter between January and October 2005 in this hospital.Results Percutaneous nephrostomy was required before the stone removal in 2 patients with pyonephrosis.Of the remaining 19 patients,all the ureteral calculi were completely removed on one session.And the renal calculi were removed by single session in 13 patients,by secondary percutaneous nephrolithotomy in 3 patients,and by tertiary nephrolithotomy in 2 patients.The combination treatment failed in 1 patient because of stricture of uretero-vesical orifice and a conversion to open surgery was needed.Conclusions Combination use of ureteroscopic lithotripsy and minimally invasive percutaneous nephrolithotomy is effective for the treatment of multiple calculi in homolateral kidney and ureter,offering advantages of minimal invasion,rapid recovery,and few complications.