Objective To explore the effects of bed side painless fiberoptic bronchoscopy for bronchoalveolar lavage (BAL) under chest computed tomography (CT) guidance and mechanical ventilation in the patients with severe pulmonary infection (SPI).Methods A total of 131 cases of SPI undermechanical ventilation support were randomly (random number) divided into CT group (C group),chest Xray examination group (X group) and without radiological examination group (N group).The bronchoalveolar lavage (BAL) by using painless fiberoptic bronchoscopy with invasive mechanical ventilation was carried out in patients of these three groups.Vital signs and variables of respiratory mechanics ofpatients were monitored before and 1 h,2 h,and 4 h after BAL and the time consumed for BAL was simultaneous recorded.Meanwhile,infection related biomarkers on the 3rd d and 5thd after BAL,positive detection rate of pathogenic bacteria,the time of invasive mechanical ventilation used during BAL and total duration of mechanical ventilation support were measured.Results During BAL and at 10 min after BAL,heart rate and respiratory rate of C group and X group were lower than those of N group (P ＜ 0.05),however,there was no significant difference in SBP and DBP among groups (P ＞ 0.05).One and two hours after BAL,peak inspiratory pressure (PIP),work of breathing ventilation (WOBvent) and airway resistance (RAW) in C group and X group were lower than those in N group,therefore,dynamic compliance (Cdyn) in C and X groups was better than that in N group (P ＜0.05).Four hours after BAL.Cdyn in C group and X group was better than that in N group (P ＜ 0.05),But there were no significant differences in PIP,WOBvent and RAW among groups (P ＞ 0.05).BAL time (BAL-t) in C group (16.81 ±2.62) min was shorter than that in X group (20.12 ± 3.81) min and N group (23.69 ± 2.76) min,(P ＜ 0.05).Three and five days after BAL,core body temperature,WBC and procalcitonin (PCT) in C and X group were lower than those in N group (P ＜0.05),and those in C group was lower than those in X group (P ＜0.05).Pathogenic micro-organism detection rate in C group (80.55％,29/36) was higher than that in X group (72.09％,31/43) and N group (59.65％,34/57) (P ＜ 0.05).Total mechanical ventilation time (MV-t) in C group (114.36 ± 38.39) h was shorter than that in X group (132.07 ± 42.51) h and N group (165.28 ± 67.28) h (P ＜ 0.05).Conclusions BAL by using painless fiberoptic bronchoscopy under chest CT guidance can effectively reduce the stress on patients with severe pulmonary infection supported with mechanical ventilation,decrease airway hyper-reactivity,shorten the BAL time,ICU stay and duration of mechanical ventilation,facilitate drainage of lung infection exudates and pathogen detection rate and improve efficacy of comprehensive treatment.

Tobacco smoking is a global healthcare problem that poses a substantial and costly health burden. Nicotine is the major constituent responsible for the addiction to tobacco. Current strategies helping tobacco smokers have limited utility in increasing rates of smoking cessation, consequently indicating the need for alternative therapies. A novel therapeutic method is vaccination against nicotine. Nicotine vaccine can generate specific antibodies that can sequester nicotine from cigarette smoke in the blood, and prevent its access to the brain and minimize positive reinforcing effects, which may help smokers to stop smoking. The vaccine will have great potential for the treatment of nicotine addiction and for relapse prevention. Here we will review the current status of vaccines against nicotine addiction and discuss the problems associated with the development of nicotine vaccines.

As a kind of service trade,medicine needs humane service.The best way to construct harmonious relationship between hospitals and patients is humane service.Humane service should consider that the service's target is patients,the weakness of human nature,the difference of humanity and the mentality of self-defend.Five key elements should be possessed in humane service: reliability,assurance,tangibility,empathy and responsiveness.

Objective To observe and compare the operation ,short-term therapeutic effect and long-term therapeutic effect be-tween painless gastrostomy under endoscopy and nasal-jejunal catheterization as well as to explore their clinical feasibility and clini-cal application .Methods 81 cases of patients with severe acute pancreatitis in the hospital ICU from May 2012 to September 2013 , were divided into gastrostomy jejunostomy group(43 cases)and nasojejunal feeding group(38 cases) .The operation time ,gastroin-testinal nutrition tube inner curvature ,removal rateetc were observed to calculate the success rate .Contrast ratio ,plugging rate and catheter related infection rate and several indexes were observed to evaluate the therapeutic effect of two groups of short-term infec-tion ofincision .long-term calculation of two groups with tube ,comfort score and nutritional indexes to evaluate the therapeutic effect index .Results The operation time ,the digestive tract inside area rate ,nutrition tube removal ,catheter related pulmonary infection rate ,average indwelling catheter time ,comfort ,nutrition index of the two groups had statistically significant (P<0 .05) ,plugging rate ,wound infection rate had no statistically significant (P>0 .05) .Conclusion With fewer complications and longer tube time , painless gastrostomy under endoscopy is safe ,simple and feasible ,which is easily accepted by patients .

Objective To explore an UPLC method for simultaneous content determination of the five nucleosides (cytidine, uridine, adenine, thymidine and adenosine) in Hedyotis diffusa and its adulterants; To compare the content differences.Methods The analysis was performed on a BEH C18 column (2.1 mm×50 mm, 1.7 μm) by UPLC eluted with acetonitrile and water in gradient mode. The flow rate was 0.5 mL/min; the detection wavelength was set at 254 nm; the column temperature was set at 30℃.Results Five nucleosides have good linear relationship, precision, stability, and repeatability according to the requirements of the methodology determination. The recoveries were among 98.7%–101.5%. Five nucleosides in Hedyotis diffusa and its adulterants from different areas were determined by the UPLC method.Conclusion The method is certified to be simple, rapid, accurate and reliable, which can be used for the determination of nucleosides in Hedyotis diffusa and its adulterants.

Objective To observe plasma concentration of adiponectin and high sensitive C reactive protein (HsCRP) in Type 2 diabetes mellitus(T2DM) with/without lower extremities vascular disease,and explore the influences of adiponectin and HsCRP in the genesis and development of them.Methods We selected 115 subjects in our hospital and divided them into 2 groups:normal control group and T2DM group,including simple T2DM and T2DM with diabetic lower extremities vascular disease;in addition,we measured plasma adiponectin and HsCRP with ELISA and scattered radiation turbidimetry for them.Results Plasma adiponectin concentration in the comparing group was higher than T2DM,and the level in simple T2DM patients was higher than the one with lower extremities vascular disease,showing an obviously decreased tendency,and significant differences were detected in plasma adiponectin concentration between groups (P

Objective To analyze the causes of misdiagnosis of aorta diseases for simple inferior limb artery thrombo-embolism,and summarize the clinical experience. Methods Retrospective analysis was made on clinical data of 9 eases misdiagnosed aorta disease,including clinical manifestation,misdiagnosis,improper treatment and final definite diagnosis. Results All 9 cases were misdiagnosed as simple inferior limb thrombo-embolism at first.Three cases were treated with emergent thrombectomy using Fogarty catheter.The correct diagnosis Was achieved by 3-dimensional CT angiography (3DCTA) after operation,and the eitiology of other 6 cases were also pmved as aortic disease by 3DCTA before operation.Among 5 cases of acute aorta dissection with iliac-femoral artery involved,2 cases abandoned surgery with one dying the next day and the other lost to follow-up after being discharged.The other 3 cases were treated with endovascular therapy successfully.One case of abdominal aorta anurysm with mural thrombosis defluxion were treated by aneurysm resection.The other 3 caBes of Leriche syndrome with acute aorta terminal filament thrombosis formation were cured by aortoiliac bypass.The limbs ischemia were improved in all cases without perioperative death.Conclusion Aorta diseases can sometimes lead to acute inferior limb ischemia,mimicking limb artery thrombo-embolism.Preoperative imaging especially 3 DCTA helps to establish correct preoperative diagnosis for a successful treatment.

Objective To investigate the diagnosis and application value of Color Doppler Flow Imaging(CDFI)and Transcranial Doppler(TCD)on blood hemodynamics of carotid artery and cerebral arteries in patients with type 2 diabetes mellitus.Methods Sixty-seven patients with type 2 diabetes mellitus and 53 normal subjects were examined on blood hemodynamics of carotid artery and cerebral arteries by CDFI and TCD,and their ultrasonographic features were recorded and compared.Results Forty-six of 67 patients have atherosclerosis on carotid artery by CDFI,56 of 67 patients have abnormal on cerebral arteries by TCD,there were significant difference between the patients and normal groups(P

Objective To investigate the clinical effect of digital multifunction trauma rinser(DMTR) on wound cleaning .Meth-ods 278 trauma patients from 6 hospitals were divided into groups by hand washing and DMTR .The cleaning time ,the amount of cleaning fluid and the effects of wound cleaning and bacterial clearance and healing were compared between the two groups .Results DMTR save time ,reduced the amount of cleaning fluid ,reduced residual bacteria ,and had better wound healing in patients with large wound area .Conclusion DMTR ,which is worthy of clinical application ,has better effect on cleaning large wounds than the traditional manual debridement w ay .

BACKGROUND:Studies have shown that limited lumbar discectomy can harvest better clinical efficacy, but also face a higher risk of recurrence. In clinic, how to guarantee access to good effect, and meanwhile to reduce the probability of recurrent disc herniation? The annulus repair technology may be an effective way, but it is rarely reported. OBJECTIVE:To investigate the early clinical effects of endoscopic lumbar discectomy associated with annulus repair in the treatment of lumbar disc herniation. METHODS: Totaly 224 patients with lumbar disc herniation who accepted discectomy surgery were selected from the Department of Spinal Surgery, the Third Affiliated Hospital of Southern Medical University from January 2011 to January 2013, including 56 cases of microendoscopic discectomy associated with annulus repair (repair group) and 168 cases of microendoscopic discectomy (control group). Oswestry disability index and visual analog scale scores for lumbago and lower limb pain were recorded before and at 10 days, 3 months, 6 months, 12 months and 18 months after operation. Simultaneously, operative time, blood loss, surgical complications, and postoperative recurrence of lumbar disc herniation were recorded. RESULTS AND CONCLUSION:In the repair group, only 51 patients completed the folow-up, while al the patients in the control group completed the folow-up. There was no difference between the repair and control groups before and after surgery in the Oswestry disability index and visual analog scale scores for lumbago and lower limb pain (P > 0.05), but at 10 days after surgery, the Oswestry disability index and visual analog scale scores for lumbago and lower limb pain were significantly decreased in the repair group (P < 0.05), and this trend continued until the 18th month after surgery. There were no dural tears, disc space infection, hematoma formation in the spinal canal and other serious complications. The recurrence rate was 9.5% in the control group and 3.9% in the repair group. 31.2% of relapsed patients in the control group received the second operation, while on patient in the repair group received reoperation. These findings indicate that microendoscopic discectomy associated with annulus repair can obtain remarkable early clinical results, and effectively reduce the recurrent rate and risk of secondary lumbar disc surgery, which is safe and reliable.