Objective To investigate the effect of reformative ventilation method (head-high leg-low 30°-declivate prone position ) in the ventilation of acute respiratory distress syndrome ( ARDS ) patients, and compared with normal prone position ventilation. Methods Forty-four patients of ARDS underwent ventilation were divided into prone position group (22 cases) and reformative prone position group (22cases) by random digits talle. Continuous 30° semireclining position was kept in normal time. The patients of the two groups underwent different prone position ventilation 4 hours every day,and indexes of hemodynamics and respiration before,during and after prone position ventilation were recorded and analyzed. Results After prone position ventilation, oxygenation index of two groups improved similarly (P ＞ 0.05 ). In prone position group, lung compliance decreased [2 h, ( 25.6 ± 5.8 ) ml/cm H2O ( 1 cm H2O = 0.098 kPa) vs. ( 37.2 ± 20.5 )ml/cm H2O] ,average airway pressure increased [2 h, ( 18.5 ± 3.9) cm H2O vs. ( 15.6 ± 5.3 )cm H2O] ,heart rate increased [2 h, ( 112.0 ± 16.2 ) beats/min vs. ( 102.0 ± 11.3 ) beats/min], mean arterial blood pressure decreased [2 h, (86.0 ± 6.7) mm Hg ( 1 mm Hg = 0.133 kPa) vs. (93.5 ± 7.5 ) mm Hg] ,central venous pressure increased[2 h, ( 15.5 ± 3.3 ) cm H2O vs. ( 12.6 ± 4.3 ) cm H2O]. These changes persistently existed during prone position ventilation (P ＜ 0.05 ),and they disappeared in 1 hour when recovered to 30 °semireclining position. Conclusion Reformative prone position ventilation not only has same effect on improving oxygenation index, but also obviates adverse effect on lung compliance and hemodynamics.

Objective To investigate the therapy efficiency and complication prevention in patients undergoing radiofrequency current catheter ablation combined with multiple X-ray projecting angles.Methods Two hundred and six atrioventricular nodal reentrant tachycardia (AVNRT) patients were involved in this study. The distance between the tip of His and the ostium of coronary sinus were measured under different X-ray projecting angles respectively, including posterior anterior (PA), right anterior oblique 30° (RAO 30° ) and left anterior oblique 45° (LAO 45° ) in each patient, and mapping was proceeding under the corresponding X-ray projecting angles with the longest distance. The distance between ablating catheter and His was confirmed again before powering by the other two X-ray projecting angles. Results The longest distance between the tip of His and the ostium of coronary sinus were obtained in 66,75 and 65 patients under PA,RAO 30° and LAO 45° respectively(P＞ 0.05 ),and the data were (2.94 ± 0.87), (2.98 ± 0.76)and (2.91 ± 0.52) cm(P＞ 0.05). Transient first or second degree of atrioventricular blocking was observed in 4 cases among 22 high risk patients in which the powering sites were above the medium level of the distance between the tip of His and the ostium of coronary sinus under three kinds of X-ray projecting angles obviously.However,only 1 case was observed in other 184 patients(P＜ 0.01 ). All patients were cured successfully and no permanent atrioventricular blocking occurred. Conclusion Radiofrequency current catheter ablation combined with multiple X-ray projecting angles is helpful to increasing the successful rate and preventing complication in ablating therapy.

Objective To analyze the clinical pathology features of light-chain amyloidosis associated renal disease,and investigate the survival influential factors. Method From January 1998 to March 2009,25 patients with light-chain amyloidosis associated renal disease were reviewed and followed up.Results Of the 25 patients with light-chain amyloidosis associated renal disease,median age was 57(37-69) years old and lamda light-chain predominated (88% ,22/25). Heavy proteinuria and nephrotic syndrome with peripheral edema were typical clinical presentations. Renal biopsy showed that amyloid deposition of light-chain amyloidosis associated renal disease involved the glomeruh mostly, with mesangial area widening. Median survival of all patients was 24.4 months after diagnosis. The estimated 1,2,3 year survival rate was (65 ± 10 )%, (46 ± 12 )% and (15 ± 12 )% respectively. There was significant difference in median survival between the two groups (24.7 months in the group of 14 patients with isolated kidney affected,16.4 months in the group of 11 patients with kidney and other organs involved,P = 0.03). By univariate analysis, kidney associated with other organs amyloidosis and renal dysfunction were relevant to prognosis (P ＜ 0.05) and heart involvement was probably relevant (P = 0.06),whereas sex,age,plasma cell ratio,serum albumin level and hemoglobin level had no relation(P＞ 0.05 ). Multivariate analysis revealed that renal dysfunction at the time of diagnosis was a significant and independent prognostic factor for survival (P ＜0.05). Conclusions Renal dysfunction at the time of diagnosis is the best predictor of survival. The presence of amyloidosis in organs other than the kidney, such as advanced cardiac amyloidosis, predicts a poor survival.

Objective To investigate the effect of different treatment on ST-elevation myocardial infarction (STEMI) by evaluating the changes of myocardial collagen metabolism. Methods Forty-one patients with STEMI were divided into drug treatment group (22 cases) and selective percutaneous coronary intervention (PCI) group (19 cases). Meanwhile,47 healthy controls were included in control group. The levels of serum carboxy terminal propeptide of type Ⅰ procollagen (PⅠCP), precollagen Ⅲ ( PC Ⅲ ), matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured by enzyme-linked immunosorbent assay at the 3rd ,6th, 12th, 18th month after STEMI,and compared with those in control group. Results The level of P Ⅰ CP in selective PCI group was significantly lower than that in drug treatment group at the 3rd, 6th month [( 15.08 ± 3.37 ) μ g/L vs. ( 19.78 ± 2.22 ) μ g/L, (23.88 ± 3.33 ) μg/Lvs. ( 30.00 ± 3.14) μ g/L, P ＜ 0.05], but there was no significant difference at the 12th and 18th month (P ＞0.05 ). The level of serum PC Ⅲ in selective PCI group was significantly lower than that in drug treatment group at the 3rd month [(50.70 ±4.83) ng/L vs. (59.91 ±4.64) ng/L,P ＜0.05],and there was no significant difference at others times between drug treatment group and selective PCI group. There was no significant difference in P Ⅰ CP/PC Ⅲ between drug treatment group and selective PCI group in all times(P ＞0.05). Compared with those in control group,the levels of serum MMP-1 in all times were significantly decreased in drug treatment group and selective PCI group(P ＜ 0.05 ), but there was no significant difference between drug treatment group and selective PCI group at same times (P ＞ 0.05). The level of serum TIMP-1was significantly higher in selective PCI group than that in drug treatment group at the 3rd and 6th month [(61.89 ± 11.44) μg/L vs. (52.23 ±4.97)μg/L, (62.85 ±6.31) μg/L vs. (52.97 ±6.43)μg/L,P＜0.05] ,and there was no significant difference in TIMP-1 between drug treatment group and selective PCI group in other times (P＞ 0.05). MMP-1/TIMP-1 in selective PCI group was significantly lower than that in drug treatment group at the 6th month [( 1.53 ± 0.25 )% vs. ( 1.95 ± 0.04)% ,P ＜ 0.05] ,and there was no significant difference in MMP-1/TIMP-1 between drug treatment group and selective PCI group in other times (P ＞0.05). Conclusions Selective PCI can improve myocardial collagen metabolism in patients with STEMI in short term ( ＜ 6 months), but it doesn't appear to be superior to drug treatment in long term (6 - 18 months). Patients with STEMI should enforce drug treatment if they have not been treated with PCI.

Objective To study the significance of the prognosis assessment by acute physiology and chronic health evaluation (APACHE Ⅱ ),sequential organ failure assessment (SOFA) score,clinical pulmonary infection score(CPIS) and multiple organ dysfunction syndrome (MODS) score in the patients of ventilator-associated pneumonia (VAP). Methods The clinical data of 68 cases with VAP in the ICU or RICU were studied. APACHE Ⅱ , SOFA and MODS scores on admission and APACHE Ⅱ , SOFA, CPIS and MODS scores on the first 24-hour of VAP diagnosis were recorded. The area under the receiver operating characteristic curve(AUROC ) and Logistic regression were used to estimate the prognostic ability by the four kinds of scoring systems. Results The APACHE Ⅱ , CPIS, MODS and SOFA scores on the first 24-hour of VAP diagnosis were significantly higher in non-survivors than those in survivors. AUROC of APACHE Ⅱ ,SOFA,MODS and CPIS respectively were 0.80,0.75,0.73,0.71. Logistic regression analysis showed that only APACHE Ⅱ＞ 18 scores on the first 24-hour of VAP diagnosis was an independent predictor of the mortality (OR: 5.7,95% CI: 1.9 - 20.0, P = 0.013). Conclusion The APACHE Ⅱ on the first 24-hour of VAP diagnosis may be a useful index in predicting progress of patients with VAP.

Objective To investigate the value of serum pentraxins-3 (PTX-3) together with triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) as predictor risk factors of future acute coronary syndrome(ACS). Methods One hundred and seventy-one cases of selective coronary angiography from July 2008 to December 2009 were collected and analyzed. According to the situation on admission and coronary angiography, patients were divided into three groups: normal control group (25 cases), stable angina pectoris (SAP) group (23 cases) and ACS group (123 cases). Fasting venous blood was extracted for measuring serum PTX-3 and lipids (TG, HDL-C) in the next morning, and the statistical significanc was analyzed. Results The level of serum PTX-3 and the ratio of TG to HDL-C in ACS group [(6.39 ± 3.01)μ g/L, 2.38 ± 2.00] were significantly higher than those in SAP group[(3.87 ± 2.05 ) μ g/L, 1.70 ± 1.01] and normal control group [(2.90 ± 1.94)μg/L,0.95 ±0.35] (P ＜0.01 or ＜0.05). Conclusion Increased serum PTX-3 levels and ratio of TG to HDL-C in patients are closely related with ACS, both of which increase the accuracy of early diagnosis of ACS.

Objective To retrospectively compare analysis of two kinds of surgery which were nerve-sparing radical hysterectomy (NSRH) and the traditional radical hysterectomy (RH) for cervical cancer was done to find out the effect on urinary function in postoperative patients. Methods Among 57cervical cancer with clinical stage Ⅰ B1- Ⅱ A 31 cases treated with NSRH,26 cases treated with RH. The postoperative bladder function of the two methods were evaluated, and postoperative recovery of urinary function and postoperative recurrence of tumor were compared. Results The period of indwelling catheter for the postoperative patients with NSRH was (8.5 ± 3.2) days, obviously less than that for traditional RH patients which was ( 12.8 ± 3.8) days. The difference was statistically significant(P < 0.01 ). And two methods of postoperative patients were alive without tumor recurrence and metastasis after 1-4 years follow-up.Conclusions NSRH is better than traditional RH in remaining pelvic autonomic nervous system and improving the early urinary function of postoperative patients of cervical cancer. Otherwise, it doesn't effect the radical cure of tumor.

Objective To study the state, feature and risk factors of bacterial infection in patients with liver cirrhosis, find out the influence of infection on prognosis, and provide scientific basis for its prevention and treatment. Methods Three hundred and twenty-three patients with liver cirrhosis were analyzed. The number of the patients with infection, the location of infection, clinical feature as well as the kind of pathogenic bacteria were analyzed. Unconditional Logistic regression analysis was used to assess the risk factors of bacterial infection. Results The overall infection rate was 39.94% (129/323),of which community acquired infection rate and nosocomial infection rate were 22.60% (73/323) and 17.34%(56/323) respectively. The most common location of infection in turn were respiratory tract,gastrointestinal tract, urinary tract,biliary tract and abdominal cavity. The main pathogenic bacteria was Gram-negative bacillus, most of which had drug resistance for cefquinome and quinolones. The risk factors related with bacterial infection included liver cancer, Child-Pugh class B and C grade of liver function, gastrointestinal tract bleeding, diabetes mellitus,invasive operations and the length of staying in hospital. Conclusions The incidence rate of infection in patients with liver cirrhosis is higher. Multiple factors are likely to affect the incidence rate of infection in patients with liver cirrhosis.

Objective To investigate the risk factors of hemorrhagic transformation (HT) after cerebral infarction. Methods The clinical and neuroimaging data of 100 patients (gender,age-matched)with cerebral infarction and hemorrhagic transformation from January 2005 to January 2010 were analyzed retrospectively. The following factors were listed for single factor analysis: the history of hypertension, diabetes mellitus,admission blood pressure,blood sugar,infarction size,alcohol,smoking,atrial fibrillation,hypercholesterolemia, combined anticoagulant and antiplatelet aggregation therapy. All the above factors were analyzed by chi-square test or t test, and Logistic regression analysis was used to screen out the related risk factors of HT from the potentially related factors. Results Atrial fibrillation (OR =5.483,95%CI:fibrillation,extensive cerebral infarction,blood sugar,high blood pressure at the beginning of the disease,combined anticoagulant and antiplatelet aggregation therapy are the major risk factors of HT. At the same time, the occurrence of HT is the result of the joint effect of multiple factors and multiple mechanisms.

Objective To observe the effect and safety of low dose milrinone used in patients suffering from refractory heart failure and renal dysfunction. Methods Forty-two patients with refractory heart failure and renal dysfunction were divided into treatment group(21 cases ) and control group(21 cases )by random digits table. All the patients accepted a therapy of cardiac booster, diuretics and vasodilators, and treatment group also accepted the therapy of milrinone [0.375 μ g/( kg· min), 10 mg/d, for 7 days]. And then the symptom, signs, blood pressure, heart rate, heart function and renal function before and after the treatment were observed. Results The total effective rate in treatment group was 85.7%( 18/21 ) ,significantly higher than that in control group [57.1% (12/21)] (P ＜0.05＝. After treatment,the heart rate,systolic blood pressure,diastolic blood pressure,stroke volume,cardiac output and left ventricular ejection fraction in treatment group and control group improved significantly than those before treatment, and these index improved better in treatment group [(79.3 ± 12.4) beats/min vs. (85.4 ± 10.2) beats/min, ( 107.6 ± 15.4)mm Hg ( 1 mm Hg = 0.133 kPa) vs.( 119.1 ± 13.5 ) mm Hg, (60.8 ± 9.4) mm Hg vs. (65.8 ± 8.5 ) mm Hg,(66.3 ± 10.2 ) ml vs. (61.2 ± 9.3 ) ml, (5.3 ± 0.6 ) L/min vs. (4.8 ± 0.9) L/min, (56.6 ± 8.4 )% vs. (48.9 ±7.3)% ,P ＜ 0.05＝. In two groups,there were no statistical difference in renal function. Conclusions Low dose of milrinone can improve the heart function of the patients with refractory heart failure and renal dysfunction and has good renal safety.