Objective To evaluate the therapeutic effect of silver ion dressings combined with hydro gel in treatment of diabetic foot by using Meta-analysis.Methods The Cochrane Library,EMbase and domestic main databases were searched,the quality of included studies which screened by certain standards was evaluated.The Review Manager 5.0 software was taken for analysis.Results Totally 11 studies were included,containing 765 patients with diabetic foot.The Meta-analysis showed that there were significant differences between two groups in treatment efficiency,granulation tissue growth time and basic healing time.But the epithelial formation time showed no significant difference between two groups.Conclusions Silver ion dressings combined with hydro gel in treatment of diabetic foot was effective.However,the quality and quantity of most studies included in this review are low,studies of higher quality and quantity are needed to confirm the results in the future.

Unplanned extubation (UEX) is defined as premature removal of the indwelling catheter tube by a patient (deliberate unplanned extubations) or by staff during nursing and medical care (accidental extubations). UEX, either deliberate or accidental, can cause severe damage of patients, with the increasing of hospital costs and medical disputes. Identifying high-risk patients is the key point of reducing UEX. This review conclude risk assessment tools reported for UEX.

Objective To evaluate the therapeutic effect of intravenously use of ambroxol in treatment of mechanical ventilator patients.Methods Meta-analysis was used.The Cochrane Library,PubMed,Elsevier (ScienceDirect),OVID series medical databases and domestic main databases were searched,the quality of included studies was evaluated by certain standards.The Review Manager 5.0 software was used for analysis.Results 14 studies were included,1 184 mechanical ventilation patients were involved.The Meta-analysis showed that there were significant differences between two groups in blood gas analysis,airway resistance and pressure and lung compliance.However,there were no differences between two groups in expectorant effect and VAP incidence.Conclusions Intravenously use of ambroxol in treatment of mechanical ventilator patients was effective.A large multi-center sample of high-quality clinical studies is needed to confirm the results.

Objective To evaluate the role of using non-invasive ventilation with bi-level positive airway pressure (BiPAP) in order to reduce the need of re-intubation in pediatric patients with respiratory failure after cardiac surgery. Method From January 2007 to December 2007, 25 patients aged from three months to 11 years with median 2.3 years operated on for cardiac surgery with respiratory insufficiency after extubation and re-intubation indicated were enrolled in this study. They were put on non-invasive nasal (mask) BiPAP ventilation before re-intubation. The arterial blood gas, A-aDO2 and PaO2/FiO2 were measured. In addition, clinical data including heart rate, respiratory rate, and the product of heart rate and systolic pressure were recorded before and after BiPAP. The software SPSSD 13.0 was used to process by ANOVA test for statistical analysis. Meanwhile, the outcome of these patients was analyzed. Results Twenty-five patients with 30 episodes of respiratory insufficiency were treated with BiPAP ventilation with median duration of 1.96 days ranged from 0.03 to 12 days. Of these respiratory failure episodes, 25 ones (83.3%) could be controlled by BiPAP and the needs of re-intubation were avoided. Five episodes of respiratory failure in 4 patients could not be quelled and the endo-tracheal tubes were inserted in these patients. All patients were saved with a median of mechanical ventilation duration of 3.4 days and ICU stay of 10.6 days. No major complications were observed. The heart rate, respiratory rate and the rate-pressure product were decreased significantly one hour after BiPAP (P < 0.05 all). Meanwhile, patients showed rapid improvement of oxygenation. The pH, SpO>2 and PaO2/FiO2 were increased significantly and A-aDO2 was decreased significantly (P < 0.05 all). The PaCO2, was decreased significantly four hours after BiPAP (P < 0.05). Conclusions Non-invasive nasal mask BiPAP can be used safely and effectively in children after cardiac surgery to improve oxygenation/ventilation, decreasing the work of breathing. It may be particularly useful in patients with high risk of re-intubation.

Objective To discuss the function and advantages of ultrasound technology in various factors in the diagnosis of vertebral artery stenosis lesions.Methods The objective data of ultrasonography were selected in 60 patients (120 vertebral arteries) with paroxysmal,reversible vertigo and headache as the chief complaint,the internal relations were summarized and analyzed.Results In the subjects of study,the vertebral artery stenosis for 38.2％,vertebral artery course tortuosity changer accounted for 33.3％,congenital abnormal development accounted for 9.8％,mixed cause 18.6％,dominant etiology was vertebral artery sclerosis and vertebral artery tortuosity change.Conclusion Ultrasound technology has important value of clinical application in the reasons diagnosis of vertebral artery stenosis disease,it can help extend clinical diagnosis.

ObjectiveToobserve the regulating effect of acupuncture at Fengchi (GB20) and extraordinary points on tumor necrosis factor (TNF)-aand endothelin (ET) in hypertension.MethodTotally 150 patients with hypertension were randomized into two groups at a ratio of 1:1.In the control group, 75 subjects were intervened by acupuncture at bilateral Fengchi; in the treatment group, 75 subjects were intervened by acupuncture at bilateral Fengchi plus extraordinary points. The needles were manipulated once every 10 min duringthe 30-min session. The treatment was given once per day, 2 weeks as a treatment course. ResultDuring the intervention, the TNF-aand ET contents were decreased significantly in the treatment group (P<0.05); the TNF-aand ET contents were also decreased in the control group but without statistical significance (P>0.05). After 1 treatment course, the TNF-aand ET contents were decreased significantly in the treatment group (P<0.05); the TNF-aand ET contents were insignificantly decreased in the control group (P>0.05); there was a significant difference in comparing the TNF-aand ET contents between the two groups (P<0.05). There were also significant differences in comparing the TNF-aand ET contents inhypertension of various degrees between the two groups (P<0.01). The results showed that the TNF-aand ET contents in patients intervened by acupuncture at Fengchiand extraordinary points were lower than that in those intervened by acupuncture at Fengchialone, i.e. combination of Fengchi and extraordinary points produces a significant effect on regulating TNF-aand ET contents.Conclusion Acupuncture at Fengchi and extraordinary points can produce a more significant effect than acupuncture at Fengchi alone on regulating TNF-aand ET in patients with hypertension.

Objective To investigate the role and significance of miRNA-21 in the pathogenesis and development of inflammatory bowel disease (IBD).Methods The expressions of microRNA-21 (miRNA-21) in colonic mucosa and peripheral blood CD4+T cells were analyzed by fluorescence quantitative polymerase chain reaction (PCR) in 26 patients with active Crohn's disease (CD), 23 patients with active ulcerative colitis (UC) and 19 healthy controls.The relative expression amount of miRNA-21 in colonic mucosal and peripheral blood CD4+ T cells in 11 patients with CD was compared before and after infliximab (IFX) treatment, and its correlation with tumor necrosis factor (TNF)-α was analyzed.t-test was performed for comparison between groups.The correlation between miRNA-21 expression in peripheral blood CD4+ T cells and serum TNF-α was analyzed by Spearman correlation analysis.Results The expression of miRNA-21 in colonic mucosa of CD patients and UC patients was 4.720 ± 0.397 and 4.993±-0.415, respectively, which were both higher than that of healthy control group (1.101±-0.284),and the differences were statistically significant (t =7.657 and 8.356, both P＜0.01).The expression of miRNA-21 in peripheral blood CD4+ T cells of CD patients and UC patients was 3.254 ± 0.323 and 3.450±0.311, which were both higher than that of healthy control group (0.891 ±0.220), and the differences were statistically significant (t=6.007 and 7.098, both P＜0.01).After 12 weeks of IFX treatment, simple endoscopic score for Crohn's disease (SES-CD) of CD patients was 8.019 ± 0.349,which was lower than that before treatment (21.502 ± 1.185), and the difference was statistically significant (t=10.910, P＜0.01).The serum TNF-α level was 61.570±6.252, which was lower than that before treatment (173.500 ± 12.670), and the difference was statistically significant (t=7.926, P＜0.01).The results of correlation analysis indicated that serum TNF-α level was positively correlated with miRNA-21 expression in peripheral blood CD4+ T cells (r =0.780 4, P ＜ 0.01).Conclusions The increasing of miRNA-21 expression in IBD was closely correlated with the serum TNF-α level and severity of inflammation.miRNA-21 might be a new target for IBD treatment.

Objective To investigate the genotype ,distribution and drug resistance of 24 multi-drug resistant Escherichia coli i-solates from the patients in the hospital 24 cases of multi-drug resistant genotyping and resistance ,the distribution of its depart-ments in the hospital ,to provide basis for rational use of antibiotics in clinical patients .Methods By MIC method to analyze antimi-crobial susceptibility of Escherichia coli ,Enterobacter Genetics adopt consistent between repetitive sequences (ERIC)-polymerase chain reaction (PCR) screening carried out the multi-drug resistant Escherichia coli genotyping .Results Statistics showed that the hospital were isolated 24 strains were divided into two types A and B2 type genotype .Distribution is 10 in respiratory ,6 in urology , 5 in ICU (B2 type 3) ,3 in hematology and oncology (B2 type 1) .Drug susceptibility results of 4 type B2 ,for cefoxitin ,ceftazidime , amikacin ,ticarcillin + clavulanic acid are all manifestations of resistance .24 strains of Escherichia coli ,amoxicillin ,cephalothin , gentamicin ,ticarcillin ,piperacillin resistance rate reached more than 70% .Conclusion B2-type strain showed multidrug resistance , pathogenicity strong ,and mainly in the ICU and hematology and oncology ,the use of antibiotics should be based on reasonable ad-justments in patients infected with different genotypes of Escherichia coli .

Objective To systematically evaluate the efficacy of high-flow nasal cannulae oxygen (HFNC) in patients with respiratory failure.Methods Computerized PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP, Wanfang Database up to March 31st, 2017, all published available randomized controlled trials (RCTs) or cohort studies about HFNC therapy for patients with respiratory failure were searched. The control group was treated with face mask oxygen therapy (FM) or non-invasive positive pressure ventilation (NIPPV), while the experimental group was treated with HFNC. The main outcomemeasurements included endotracheal intubation rate, patient comfort, and the secondary outcome was in-hospital mortality. The quality of the literature was completed by two professionally trained evidence-based medical students, and meta-analysis was performed on quality-compliant literature. Funnel plot was used to analyze the publication bias.Results A total of 17 articles were enrolled including 15 RCTs and 2 cohort studies. There were 3909 patients enrolled, 1907 patients in HFNC group, and 2002 in control group (1068 patients with FM, and 934 with NIPPV). Meta-analysis showed that HFNC had a significant advantage over FM in reducing the tracheal intubation rate of patients with respiratory failure [odds ratio (OR) = 0.51, 95% confidence interval (95%CI) = 0.29-0.89,P = 0.02], but there was no significant difference as compared with that of NIPPV (OR = 0.80, 95%CI = 0.54-1.17,P = 0.25). It was shown by pooled analysis of two subgroups that compared with FM/NIPPV, HFNC had a significant advantage in reducing tracheal intubation rate in patients with respiratory failure (pooledOR = 0.66, 95%CI = 0.47-0.94, P = 0.02). Compared with FM, patients with respiratory failure were more likely to receive HFNC for comfort [standardized mean difference (SMD) = -0.41, 95%CI = -0.56 to -0.26,P < 0.00001]. There was no significant difference in hospital mortality between HFNC and FM (OR = 0.82, 95%CI = 0.55-1.24,P = 0.35) or NIPPV (OR = 0.66, 95%CI = 0.37-1.17, P = 0.16). The results of pooled analysis of two subgroups were still unchanged (pooledOR = 0.75, 95%CI = 0.54-1.05, P = 0.09). It was shown by the funnel analysis that there was a bias in the study of tracheal intubation rate in the literature, while the bias of patient comfort and hospital mortality was low.Conclusions Compared with FM, HFNC could reduce the rate of tracheal intubation in patients with respiratory failure, but no difference was found as compared with NIPPV. Compared with FM, HFNC made patients more comfortable, and it was easier to be accepted and tolerated. However, there was no difference in hospital mortality among FM, NIPPV, and HFNC.

Objective To investigate the clinical value in changes of serum glutamic acid decarboxylase antibody (GAD-Ab) ,islet cell antibodies(ICA) ,insulin autoantibodies (IAA) and high-sensitivity C-reactive protein (hs-CRP) and renal function in elderly type 2 diabetic patients .Methods 122 cases of endocrine inpatient in our hospital had been diagnosed with type 2 diabetes were chosen from January 2012 to December 2012 .They were divided into islet autoimmunity antibody positive group (n=21) and islet autoimmunity antibody negative group (n=101) according to the antibody test results ,Fasting C-peptide(FCP) ,2-hour postprandial C-peptide(2 h CP) ,glycosylated hemoglobin(HbA1c) ,high-sensitivity-CRP(hs-CRP) and renal function[urea (UREA) ,creatinine (Cr) ,microalbuminuria(urinary mALB) ,urinary β2-microglobulin (urinary β2-MG)]were detected .Test results were statistically analyzed and compared .Results At least one Islet autoimmune antibodies were found in 21 cases of 122 elderly patients with type 2 diabetes .The positive rate was 17 .21% .GAD-Ab was detected positive in 14 cases(11 .47% ) ,ICA was detected positive in 10 ca-ses(8 .19% ) ,IAA was detected positive in 1 case(0 .82% ) ,Two antibodies were detected positive together in 4 patients(3 .27% ) , Three antibodies were not detected positive together .The levels of hs-CRP ,UREA and Cr in Islet autoantibodies positive group were higher then in islet autoimmunity antibody negative group ,the difference was statistically significant (P<0 .05) .The levels of FCP ,2 h CP ,HbA1c ,urinary mALB and urinary β2-MG in both group ,the difference was not statistically significant (P>0 .05) . Conclusion Chronic inflammation and the appearance of islet autoantibodies are closely related to the damage of islet cell function . It has a higher value in monitoring complications and efficacy through understanding islet autoantibodies ,inflammation and changes in renal function in elderly type 2 diabetes .