Objective To investigate the risk factors and microbial causes related to the pathogenesis of ventilator-associated pneumonia(VAP).Methods Totaly 138 intubated newborn infants for longer than 48 hours in Ningbo Women and Children's Hospital were studied,who were divided into VAP group (56 cases)and non VAP group(82 cases).Microbial causes of VAP were analyzed.Results Malnutrition,repeated tracheal intubation,repeated endotracheal suctioning,indwelling tube,posture,hyaline membrane disease,gestational age,birth weight,duration of intubation,duration of hospitalization were independent risk factors for ventilator-associated pneumonia(P<0.05).Klebsiella pneumoniae,pseudomonas aeruginosa,acinetobacter species and enterobacter cloacae were the main pathogenic bacteria of VAP.Conclusion Shortening of mechanical ventilation duration,avoiding repeated tracheal intubation and indwelling tube usage,semi-fowler positioning can lower the incidence of VAP.Pathogenic bacteria control is essential for VAP.

Objective To describe the methods of treatment of fresh and old fractures of the elbow joint with internal fixation.Methods Ten cases of fracture of the elbow with complete records were reviewed; 9 of them were male and 1 female; 6 of them were Han people and 4 Tibetans. The average age was 31 years. Four cases had open fractures and 6 had closed fractures. Among the cases of open fractures, 3 were treated with routine debridement and internal fixation of the fragments or internal fixation plus advanced skin flaps. One was treated as closed fractures after wound healing. The 6 cases of closed fractures were treated with a single tension band wiring, tension band and screw fixation, or screw fixation. Results The mean duration of the follow up was 8 months. Fracture healing was seen at 3－ 4 months. The range of motion of fresh fractures of the elbow and forearm was  4.2° － 144.2° . The old fracture cases had the range of motion of  31.3° － 115° without restriction in pronation and supination. Conclusion The intra articular fracture of elbow joint must be treated with early surgery to attain anatomical reduction with firm internal fixation. Early functional exercise is also important for the recovery.

Based on clinical features of refractory diseases and clinical practice experience for many years,the author expounded the therapeutic strategies from establishing individualized system of differentiation treatment,treatment strategies of refractory diseases,and the key for medication,and emphasized individual concerned therapy,separating primary and secondary treatment and grasping the physiological state to treat pathological changes.Thus complicated and changeable diseases can be treated clinically.

Objective To explore the diagnosis and treatment for the incision cesarean section scar pregnancy(CSP).Methods The clinical data of 34 patients with CSP admitted were retrospectively analyzed,and analyzed the methods of diagnosis and treatment of CSP.Results Our results showed that 9 cases after treatment with mifepristone combined with suction palace obtained success,2 cases of bleeding assisted with balloon compression;8 cases after mifepristone combined hysteroscopy under suction palace treatment obtained success,1 case was failed and transfer to laparotomy.Mifepristone combined with transvaginal lesion resection of scar pregnancy was succeed in 9 cases,2 cases were failed,of which 1 case was bleeding more and transfer to laparotomy,1 case was confirmed remaining during a review after half a month open.7 cases were succeed in the transabdominal lesion resection of pregnancy (3 cases of transit);without hysterectomy;3 cases were turn to the superior hospital for treatment of intervention.The statistical results showed that no statistical significant difference was obtained among the scores of different age, length of hospital stay, hospital expenses and rescue of shock in different teams of surgery.For the haemorrhage amount, the bleeding was at least in hysteroscopy group, and was at most in abdominal resection of lesions group (rescue of shock was on the high side).Conclusion Uterine scar pregnancy is a relatively rare and dangerous clinical special type of ectopic pregnancy, early diagnosis and appropriate therapeutic strategy are important.The mifepristone combined with suction palace and resection of the pregnancy lesions are safe and effective method for treatment.

Objective To explore the expression and significance of vascular endothelial growth factor (VEGF),tissue polypeptide specificity antigen (TPS) and tumor type M2 pyruvate kinase (TuM2-PK) before and after interventional therapy in lung cancer (LC).Methods Sixty cases of LC treated by interventional treatment in our hospital from January 2013 to January 2015 were analyzed.The levels of VEGF,TPS and TuM2-PK on preoperative 1 d,postoperative 1,3,7,14,28 d were detected by enzyme-linked immunosorbent assay(ELISA).The change of VEGF,TPS and TuM2-PK levels in the patients with different treatment outcomes was observed.Contemporaneous 40 individuals undergoing healthy physical examination served as the healthy control group.Results The levels of VEGF,TPS,TuM2-PK on preoperative 1d,postoperative 3,7,14,28 d had statistical differences between the observation group and control group (P<0.05,P<0.01).Compared with pre-treatment,the levels of VEGF,TPS and TuM2-PK in partial remission patients were significantly improved,which in the patients with stable and progressive condition,the levels of VEGF,TPS and TuM2-PK were significantly increased (P<0.05).Conclusion The levels of VEGF,TPS and TuM2-PK are significantly elevated before and after interventional treatment in LC patients,moreover the worse the therapeutic efficacy,the higher the levels of VEGF,TPS and TuM2-PK,which can be used as the detection indexes of LC interventional treatment.

15 cases of diaphragmatic traumatic hernia were reported. The majority of patients were young people. The location of lesion was on the left in 14 cases and one on the right. There were 8 close and 7 open cases. The size of the rupture on the diaphragm was from 3 to 15cm. The importance of earlier diagnosis and treatment were also discussed.

Objective To investigate the effect of electroacupuncture plus functional exercise in patients with olecranon comminuted fracture.Method Seventy-sevenpatients with olecranon comminuted fracture were enrolled as the subjects and allocated, using a random numbertable, to a control group (38cases) and a treatment group (39 cases).The control group received routine rehabilitation such as postoperative functional exercise and the treatment group, electroacupuncture in addition.Inthe two groups of patients, the pain score was recorded at one,sevenand fourteen days after the surgery; elbow joint activity was examined at two days and two months after the surgery; the elbow function score was recorded at six months after the surgery.Result There was no statistically significant difference in the pain score between the twogroupsat one day after the surgery (P>0.05).Thepain score was lower in the treatment group than in the control group atsevenand fourteen days after the surgery (P<0.05).There was no statistically significant difference in elbow jointactivity between the two groupsat two days after the surgery (P>0.05). Elbow joint activity was larger in the treatment group than in the control group at two months after the surgery (P<0.05).The elbow HSS score was higher in the treatment group than in the control group at six months after the surgery (P<0.05).Conclusion Electroacupuncture plus functional exercise can effectively decrease the pain score and increase elbow joint activity and the elbow function score in patients with olecranon comminuted fracture.It has greater value in clinical application.

Thyroid-associated ophthalmopathy(TAO)is an organ specific autoimmune disorder affecting the life quality of patients.Glucocorticoids have been applied for many years in the treatment of TAO,though the side effects are the major concern.Recently,intravenous methylprednisolone pulse therapy is a novel and effective method for TAO treatment.Nevertheless this new strategy needs to be modified,and attention should be paid to the indications and contraindications in order to prevent liver damage when high dose methylprednisolone is applied.

OBJECTIVE: To establish the HPLC method for the determination of spironolactone tablets. METHODS: The determination was performed on Agilent C18 column with mobile phase of acetonitrile-water (50 ∶ 50) and detection wavelength of 238 nm. RESULTS: The linear range of spironolactone were within 5.023 1 ?g?mL-1～75.347 1 ?g?mL-1 (r=1.000 0) with an average recovery of 100.23% (RSD=0.53%). CONCLUSION: The method is reproducible, simple and convenient for the quality control of spironolactone tablets.

No significant difference in peak amplitude, duration, latency and wave integral between A-DRP and CDP-P_1 was electrophysiologically observed in control and capsaicin-treated adult rats which had been injected at birth with capsaicin(50mg/kg,s.c.), when the sural nerves were stimulated. However, the most of C-DRP and CDP-P_2 lack. These were consistent with the changs of peripheral action potentials. The above results suggest that PAD on myelinated primary afferent fibres produced by incoming volleys in the larger afferent is not affected by a lifelong loss of Group Ⅳ afferent, but the afferent responses of amall fibres disapear.