Recently,alveolar recruitment maneuver is one of effective management of mechanically ventilated patients with acute respiratory distress syndrome.Recruitment maneuvers are widely used in clinical practice to open the lung and prevent lung injury by derecruitment,improving the compliance,increasing PaO2,increasing the PaO2/FiO2 ratio,and reducing the pulmonary shunt fraction,although the evidence is still discussed.This review discussed recruitment maneuvers in pediatric patients with acute respiratory distress syndrome.

The problems in making PowerPoint slides include too many characters in a single slide,too many presentations in a class hour,lacking or impertinently employing of multimedia materials,deficiency in aesthetic feeling,etc.The problems in clinical theoretical teaching aided with PowerPoint include the teacher becoming a commentator for slides,teaching too many contents in a single hour,neglecting traditional teaching aid,etc.The combination of rich medical knowledge,super teaching skills and ability of good taste for slides is the key to make perfectly and use rightly PowerPoint.

Objective:To discuss the clinical value of CT-guided interstitial implantation of125I radioactive particle through the percutaneous puncture in the treatment of central-type lung cancer.Methods: 63 patients with the central-type lung cancer treated in Renmin Hospital of Wuhan University from November 2013 to July 2016 were randomly grouped (31 cases in the control group and 32 cases in the observation group). Patients in the control group were given the treatment of bronchial arterial perfusion with the chemotherapeutic drugs; while patients in the observation group were given the CT-guided interstitial implantation of125I radioactive particle through the percutaneous puncture. The clinical therapeutic effect and complications were observed of the two groups and the quality of life scores before and after the treatment were summarized between two groups as well.Results: The overall effective rate of observation group was 84.38% (27/32) that was higher than 61.29%(19/31) of control group, with statistical difference (x2=4.259,P<0.05); the complication rate of observation group was 9.38% (3/32) that was lower than 12.90% (4/31) of control group, with no statistical difference (x2=0.002,P>0.05); the quality of life score of observation group after the treatment was 84.57±3.27 that was higher than 70.38±3.20 of control group, with statistical difference (t=17.402,P<0.05).Conclusion: CT-guided interstitial implantation of125I radioactive particle through the percutaneous puncture in the treatment of patients with central-type lung cancer has the significant effect, and it can effectively improve the quality of life for patients and have the high degree of safety.

Ubiquitin specific peptidases play important roles in controlling proteasome activity,organogenesis,tumorigenesis and transcriptional regulation.Ubiquitin specific peptidase 9X is able to remove ubiquitin from substrate proteins,so it may effectively regulate the proliferation,adhesion and signal transduction of tumor cells.It is a one of the most important factors in tumor progression.

Objective To explore the value of detecting serum cytokeratin 19 fragmen 21-1 (CYFRA21-1) and squamous cell carcinoma antigen (SCCAg) in the diagnosis of patients with nasopharyngeal carcinoma.Methods 79 patients with nasopharyngeal carcinoma from October 2013 to October 2015 as case group and 145 patients with nasopharyngeal chronic inflammation as control group were collected.The CYFRA21-1 level was detected by the electrochemical luminescence immunoassay and the SCCAg level was detected by the enzymoimmunoassay.Comparisons of diagnostic value of CYFRA21-1 and SCCAg to nasopharyngeal carcinoma were conducted according to pathological diagnosis.Results The serum CYFRA21-1 and SCCAg levels in case group were (12.37±1.65) g/L and (1.65±0.37) ng/ml,and the control group were (4.26±1.99) g/L and (1.22±0.45) ng/ml,with statistically significant differences (t =8.093,P =0.002;t =4.287,P =0.043).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CYFRA21-1 combined with SCCAg in the diagnosis of nasopharyngeal carcinoma were higher than those of CYFRA21-1 and SCCAg respectively,and the difference all were statistically significant (all P ＜ 0.05).Conclusion Detecting serum CYFRA21-1 combined with SCCAg in the diagnosis of nasopharyngeal carcinoma has high sensitivity and good specificity,which can significantly improve the diagnostic accuracy.

OBJECTIVETo investigate the therapeutic effects of manipulative reduction for calcaneal fractures.

METHODSFrom January 2009 to June 2012, 53 cases (60 affected feet) of Sanders type I-IV calcaneal fractures were treated by manipulative reduction and external fixation with cardboard splint,including 45 males and 8 females with an average age of (33.5 +/- 1.54) years old ranging from 18 to 65. The course of disease ranged 0.5 h to 7 d. Before treatment the feet were swelling, ache and activity limitation in evidence, some feet were wide flat deformity, the cortical bone was broken in the imaging examination. All selected cases were evaluated using Creighton-Nebraska health foundation assessment scale for fractures of calcaneus.

RESULTSAll cases were followed up at 12 months after treatment, 13 feet got excellent curative effect, 34 good, 11 moderate and 2 poor.

CONCLUSIONManipulative reduction for Sanders type I-IV calcaneal fractures could get excellent curative effect. Manipulative reduction for calcaneal fractures could avoid surgical trauma while assure high curative effects. Manipulative reduction is not only economical and easy therapy, but also can restore maximum function of the calcaneus with few complications and facilitate early rehabilitation of ankle and joint function.

Adolescent ; Adult ; Aged ; Calcaneus ; injuries ; surgery ; External Fixators ; Female ; Fractures, Bone ; rehabilitation ; surgery ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Splints

OBJECTIVETo observe the clinical effects of essential hypertension treated with acupuncture at Siguan [Hegu (LI 4) and Taichong (LR 3)], Quchi (LI 11) and Xingjian (LR 2).

METHODSSixty cases of essential hypertension were randomly divided into an acupuncture group and a medication group, 30 cases in each group. Two groups of acupoint, which were (1) Siguan [Hegu (LI 4) and Taichong (LR 3)] and (2) Quchi (LI 11), Xingjian (LR 2), were selected alternatively in the acupuncture group, once everyday. In the medication group, captopril was prescribed for oral administration 25 mg per time, three times per day. Seven days made one session in both groups and totally three sessions were required.

RESULTS(1) After treatment, the blood pressure were decreased significantly in the two groups (all P < 0.01). Compared with the medication group, the diastolic pressure after 14 days, 21 days of treatment in the acupuncture group was decreased significantly (both P < 0.01). (2) In the terms of TCM syndrome score, the improvement of dizziness, soreness and weakness of waist and knees, palpitations was significant in the acupuncture group compared with that in the medication group(all P < 0.05). (3) The acupuncture group had less adverse reactions compared with the control group (P < 0.05).

CONCLUSIONAcupuncture at Hegu (LI4) and Taichong (LR 3), Quchi (LI 11) and Xingjian (LR 2) can effectively decrease blood pressure; the effect of controlling diastolic pressure is better than captopril. It can also improve the symptoms of dizziness, soreness and weakness of waist and knees, and palpitations.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Blood Pressure ; Essential Hypertension ; Female ; Humans ; Hypertension ; physiopathology ; therapy ; Male ; Middle Aged ; Treatment Outcome ; Yin Deficiency ; therapy ; Yin-Yang

Objective: To analyze the influence of long-term swimming training on spatial learning-memory in rats and its relationship with cyclic adenosine monophosphate(cAMP) and cyclic guanosine monophosphate(cGMP) signal transduction pathway. Method: After 3 times adaptable swimming exercises (30min each time), 40 male SD rats were divided into 2 groups: control group (CR, n=20) and exercises, group (TR, n=20). CR group didn't swim, and TR group swam without burden (6 times/week, 60 min each time). After 8 weeks training, 10 rats were selected from both groups respectively for examing of Morris water maze test. Radioimmunoassay was used to measure the levels of cAMP and cGMP in hippocampus and prefrontal cortex of rats. Result: ①Compared with CR group, in TR group learning-memory improved in a certain extent: ②Compared with CR group, in TR group, the level of cAMP in hippocampus enhanced very obviously (P＜0.01), the cAMP/cGMP ratio enhanced obviously (P＜0.05); in prefrontal cortex the levels of cAMP and cAMP/cGMP ratio enhanced obviously (P＜0.05). Conclusion: Swimming training for 8 weeks improved the spatial learning-memory of rats in a certain extent, and elevated the level of cAMP and cAMP/cGMP ratio in hippocampus and prefrontal cortex of rats obviously. It is suggested that exercises might affect learning-memory by cAMP and cGMP signal transduction pathway.

Objective To analyze the value of open tension -free hemiorrhaghy ( OTFH) and laparoscopic totally extraperitoneal prosthesis ( LTEP) repair in patients with bilateral inguinal hernia .Methods A retrospective method was used to compare the clinical data of 115 patients with bilateral hernias , of which 61 cases received LTEP and 54 cases underwent OTFH , from June 2011 to December 2013, in our hospital .Results The mean operative time of LTEP group (88.2 ±15.6 min) was longer than the OTFH group(75.7 ±21.6) min (p<0.05).The dura-tion of hospitalization in LTEP group(2.6 ±1.1) day was shorter than OTFH group(4.2 ±2.1) d (p<0.05).Hos-pitalization expense of LTEP group (12 012.0 ±2 325.2) yuan was higher than the OTFH group (9 291.3 ±2 010.1) yuan (p<0.05).The incision pain by VAS points was gradually decreased in 24 hours, 48 hours, 72 hours after op-eration, and LTEP group was significant lower than OTFH group in the same time point .In LTEP group 3 case had laceration of peritoneum but turn to no other prosthesis , and 2 cases had acute urinary retentions .11 acute urinary re-tentions occurred in OTFH group , and 2 cases had chronic pain in inguinal area and 1 cases of fat liquefaction .No recurrence was found during a follow -up period of 6 to 24 months in both of 2 groups .Conclusion Both LTEP and OTFH are safe and accessible techniques for patients with bilateral inguinal hernia .OTFH is feasible, and has short process and low cost which is suitable for primary hospitals to carry out .OTFH has the advantages of little trauma , faster postoperative recovery and less complications which is worth promoting in future .