Objective To compare the effect of methotrexate combined with laparoscopic surgery on pregnancy outcome of patients with tubal pregnancy treated with conservative treatment.Methods 96 patients who were diagnosed of tubal pregnancy,fertility requirements and no clinical data given birth were analyzed retrospectively.Depending on the method of treatment was divided into 46 cases of methotrexate and laparoscopic group of 50 patients.Postoperative intrauterine pregnancy,ectopic pregnancy and secondary infertility situation again were compared.Results Laparoscopic group in intrauterine pregnancy rate was 70.0％,which was significantly higher than that in the methotrexate group(47.8％),and the difference was statistically significant(x2 =13.229,P ＜ 0.05) ;laparoscopic ectopic pregnancy rate was 14.0％ against 17.4％ with methotrexate group,the difference was not statistically significant(x2 =2.037,P ＞ 0.05) ; methotrexate group was 34.8％ of secondary infertility was significantly higher than thatin the laparoscopic group (16.0％),the difference was statistically significant (x2 =12.784,P ＜ 0.05).Conclusion Laparoscopic surgery after conservative treatment of tubal repregnancy outcome is better than methotrexate.

OBJECTIVE:To discuss the use of allopurinol for the reduction of serum uric acid level in patients with chronic kidney disease complicating hyperuricacidemia so as to delay the progression of chronic renal disease.METHODS:A total of 47 patients with chronic kidney disease complicating hyperuricacidemia were randomly divided into treatment group and control group:the treatment group was given allopurinol 100～200mg?d-1 in addition to the antihypertensive therapy as adopted in the control group or the common therapy for 12 months.RESULTS:As compared with the control group,serum creatinine level was lower and the rate of renal function deterioration was significantly decreased in the treatment group(P

Objective To explore and classify the subjective opinions of nurses on whistle- blowing, and identify the subjective characteristics of each type. Methods This study applied Q -methodology, protocols which could determinate subjective opinions of nurses on histle-blowing were set up and underwent interview investigation, data of the interviews went through Q-factor analysis. Results Most nurses had a positive attitude toward whistle - blowing because it could prevent any nursing activity not based on expertise and professional ethics from causing disadvantages for patients. At the same time, however, they requested the creation of a legal framework in which whistle-blowing was done in a way to increase trust among colleagues. Meanwhile, some nurses showed resistance to whistle - blowing. Conclusions Whether whistle - blowing can reach its aims depends on nurses' attitude toward it. Most Korean nurses support whistle-blowing. Nursing activity not based on expertise and professional ethics and causing disadvantages for patients can be avoided if a legal framework is established for whistle-blowing.

Objective: Our purpose was to study the concentration of soluble tumor necrosis factor receptor-Ⅰ(sTNFR-Ⅰ) in the serum of patients with acute tuberculosis. Methods: The levels of soluble TNFR-Ⅰ in serum were measured in 11 patients with acute tuberculosis. Concentration of sTNFR-Ⅰ were measured by using enzyme-linked immunological binding assay. Results: In patients with acute tuberculosis, especially severe tuberculosis, serum levels of sTNFR-Ⅰ increased significantly (P<0.01), compared with those of control. After antituberculosis therapy, serum levels of sTNFR-Ⅰin patients with acute tuberculosis decreased by various degrees. Conclusion: Measurements of sTNFR-Ⅰ in serum of patients with acute tuberculosis could be an important index in the judgement of the outcome of the disease.

BACKGROUND:Methylene blue can hinder abnormal pain conduction via the sensory nerve, and its mechanism is to block bradykinin-induced hyperalgesia and eliminate pain caused by local tissue inflammation.
OBJECTIVE:To observe the influence of methylene blue solution on the lumbar spinal cord and spinal ganglia function of rats, and to investigate whether methylene blue is safe for treating discogenic low back pain.
METHODTotal y 120 Wistar rats were randomly divided into five groupthree experimental groups, a saline control group and a blank control group, n=24 in each group. Lumbar segmental dura was exposed in rats. In the three experimental groups, 0.2, 1, and 2 mL methylene blue were injected epidural y, respectively. The saline control group was subjected to the epidural injection of 1 mL saline. In the blank control group, there was no treatment. Six rats from each group were selected randomly and perfused at 30 minutes, 2 hours, 24 hours, 72 hours after injection, respectively. Then, the corresponding segments of the spinal cord and ganglions were removed. Hematoxylin eosin staining was used for comparing histological and structural changes under light microscope.
RESULTS AND CONCLUSION:Hematoxylin-eosin staining showed that at 30 minutes, 2 hours, 24 hours and 72 hours after injection of methylene blue, the spinal dorsal side exhibited the structural integrity, clear boundaries between the white matter and gray matter, dense nerve fibers in the white matter, and round or oval nuclei of glial cells among fibers;dense nerve fibers in the posterior horn of gray matter;light-colored neuronal nuclei with prominent nucleoli;a bundle of nerve fibers among cellpopulations. There was no significant change in tissue structure of lumbar spinal cord and spinal ganglia between the experimental groups and the saline control group or between the experimental groups and the blank control group. Thus, the epidural injection of 1%methylene blue has no significant effect on the spinal cord and spinal nerve structures.

Objective To explore the risk factors for hospital acquired pneumonia (HAP) in patients with neural-intensive care unit (NICU).Methods The clinical data were analyzed retrospectively for 207 patients in NICU ≥ 5 d,to determine possible risk factors with HAP.Results The incidence of HAP was 14.01％(29/207).Correlation analysis showed that old age,disturbance of consciousness,dysphagia,vomiting,low pre albumin,NICU residence time ≥ 30 d,indwelling nasogastric tube,the use of the acid-blocking drugs,tracheal intubation,tracheal incision,mechanical ventilation and deep bronchoscopic suctioning were the related factors of HAP (P ＜ 0.05 or ＜ 0.01),but blood glucose,sedative drugs were unrelated with HAP (P ＞ 0.05).Conclusion There is a high incidence of NICU in patients with HAP,taking comprehensive measures actively,reduce risk factors,can effectively control the occurrence of HAP in NICU.

Clinical studies show that the factors that impact the quality of life (QOL) in patients with lung cancer are comprehensive.Physiological factors include breathing difficulties,cancer-related fatigue.Depression,anxiety and other psychological factors also play a major role.Social and family support is also crucial to improve the QOL in patients with lung cancer.

Macrophage migration-inhibitory factor (MIF) is a cytokine which can promote tumorigenesis.MIF can promote tumorigenesis by directly inducing oncogene transformation,stimulating cell division,as well as indirectly inhibiting tumor apoptosis,promoting its invasiveness and angiogenesis.MIF-targeted biological therapy may become a new therapeutic strategy for malignant tumor.

Objective To characterize clinical features,antimicrobial susceptibility and the outcome of nosocomial Acinetobacter baumannii meningitis.Methods All patients with nosocomial meningitis due to Acinetobacter baumannii in 2nd Affiliated Hospital Medical School of Zhejiang University between January 2010 and October 2011 were retrospectively reviewed.Results During the study period,40 patients of this nosocomial infection were identified,who came from neurosurgery ward (19 cases,47.5％),neurosurgieal intensive care unit (18 cases,45.0％),emergency intensive care unit (2 cases,5.0％) or intensive care unit (1 case,2.5％).All the patients had a history of recent neurosurgical procedures. Fever and disturbance of consciousness were the major manifestations,and cerebrospinal fluid examination showed elevated white blood ceil count and protein,and reduced glucose.All isolated pathogens were resistant to the first line antibiotics.The fatality rate was high. Conclusions The most common risk factor for nosocomial Acinetobacter baumannii meningitis is neurosurgery. Resistance to the first line antibiotics is common among all pathogens isolated.The prognosis of the meningitis is poor.

[Objective] To discuss the therapeutic effect of different methods in the treatment of intertrochanteric femur fracture. [Methods]Totally 118 middle aged or old patients with intertrochanteric femur fracture were fixed with dynamic hip screw (DHS), Gamma nail or PFNA.[Results]Totally 112 cases were followed up, and the average time was 16 months, in those 45 patients were fixed with DHS: 29 were excellent, 11 cases were good, and 5 were poor, and the excellent to good rate was 88.9%; 36 patients were treated with Gamma nail, and the excellent, good, poor results were 28, 2, 1, respectively, and the excellent to good rate was 96.8%; 36 patients were fixed with PFNA, and the excellent, good, poor results were 29, 6, 1, respectively. The differences were significant (P=0.02, analyzed by Logistic regression with SPSS software). The excellent and good superiority of Gamma nail and PFNA were 5.1552 and 2.3726 times compared to DHS, and there was significant differences between the groups.[Conclusion]Surgical treatment of intertrochanteric femur fracture can improve the functional recovery and reduce the complication incidence, and PFNA fixing method can shorten the operative time, reduce the bleeding and the therapeutic effect is reliable, and suitable for old patients combined with osteoporosis.