Objective To explore the effect of high positive end-expiratory pressure (PEEP) for the treatment of neurological pulmonary edema (NPE) in patients undergoing mechanical ventilation,and to look for the best mechanical ventilation strategy to improve the prognosis.Methods A prospective study was conducted,and 120 patients with NEP admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangxi Traditional Chinese Medical University from January 2010 to August 2013 were enrolled and divided into two groups according to random number table (n=60 in each group).The patients in two groups were given empiric treatment for the disease,and they underwent mechanical ventilation.In the normal PEEP group PEEP was 3-10 cmH2O (1 cmH2O =0.098 kPa),and in the high PEEP group PEEP was 11-30 cmH2O,and all the rest parameters were the same.Clinical indices before and 7 days after treatment,and 28-day morality rate were compared between two groups.Results The 28-day morality rate in high PEEP group was obviously lower than that in the normal PEEP group [25.0％ (15/60) vs.65.0％ (39/60),x2=6.465,P=0.011].The clinical signs in both groups were improved after treatment.Compared with the normal PEEP group,the clinical indices in high PEEP group were more significantly improved.There were significant differences in body temperature (℃ 37.4 ± 0.5 vs.38.5 ± 0.6),respiratory rate (times/min 18.3 ± 3.1 vs.23.3 ±3.5),heart rate (beats/min 94.7 ±8.5 vs.113.5 ±8.0),white blood cell count [WBC (× 109/L) 12.5 ±2.1 vs.17.1 ± 1.7],acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (15.6 ± 3.2 vs.19.8 ± 3.7),Glasgow coma score (GCS 12.5 ± 2.1 vs.8.5 ± 2.9),gastrointestinal dysfunction score (3.9 ± 3.0 vs.3.6 ± 2.4),oxygenation index [PaO2/FiO2 (mmHg,1 mmHg=0.133 kPa) 196.5 ± 45.1 vs.134.1 ± 22.3],serum creatinine [SCr (μmol/L) 86.5 ± 35.6 vs.98.5 ± 37.7],total bilirubin [TBil (μmol/L) 39.7 ± 23.5 vs.41.5 ± 16.2],C-reacting protein [CRP (mmol/L) 53.7 ± 21.4 vs.108.4 ± 26.3],prothrombin time [PT (s) 15.0 ± 2.1 vs.20.4 ± 2.2],activated partial thromboplastin time [APTT (s):37.3 ±4.9 vs.56.7 ± 13.6],international normalized ratio (INR 2.52 ±0.64 vs.4.01 ±0.77),extra vascular lung water index [EVLWI (mL/kg) 7.53 ± 1.21 vs.15.85 ±3.41],pulmonary vascular permeability index (PVPI 6.07 ± 0.89 vs.9.47 ± 1.26),mean arterial pressure [MAP (mmHg) 87.3 ± 10.9 vs.98.7 ± 13.6],cardiac output [CO (L/min) 7.15 ± 1.42 vs.5.65 ± 1.82],systemic vascular resistance index [SVRI (KP) 112.4 ± 9.5 vs.136.5 ± 11.9],and blood lactate (mmol/L:2.53 ± 1.23 vs.5.81 ± 2.17) between high PEEP group and normal PEEP group (P＜0.05 or P＜0.01).Conclusion Prognosis can be improved in NPE patients with the use of high PEEP in mechanical ventilation.

Objective To investigate the effects of dexmedetomidine preconditioning on ischemia-reperfusion(I/R) injury to isolated rat hearts.Methods Twenty-four male Wistar rats weighing 230-260 g were anesthetized with intraperitoneal 10％ chloral hydrate 400 mg/kg and heparin 500 IU/kg.Their hearts were excised and perfnsed in a Langendorff apparatus with K-H solution saturated with 95％O2-5％CO2 at 37 ℃.Twenty-four isolated rat hearts were randomly divided into 3 groups after 10 min of equilibration(n =8 each):group I/R,dexmedetomidine 0.23,2.30 ng/ml preconditioning group (groups D I,D Ⅱ ).In group I/R,the hearts were perfused continuously for another 30 min.In groups D Ⅰ and D Ⅱ,the hearts were perfused with K-H solution containing dexmedetomidine 0.23,2.30 ng/ml for 20 min followed by 10 min washout before ischemia.All hearts were subjected to 30 min of global ischemia followed by 120 min of reperfusion with K-H solution.The activities of creatine kinase(CK) and lactate dehydrogenase(LDH) in coronary effluent were measured at the end of 10 min equilibration(balance),and at 5,30,60 and 120 min of reperfusion.Myocardial tissues were obtained at the end of reperfusion for determination of the activity of SOD and the content of MDA.Results Compared with group I/R,the CK and LDH activities in coronary effluent and MDA content in myocardium were significantly decreased,the SOD activity was significantly increased in groups D I and D Ⅱ ( P ＜ 0.05).Compared with group D Ⅰ,the CK and LDH activities in coronary effluent and MDA content in myocardium were significantly decreased,the SOD activity was significantly in group DⅡ ( P ＜ 0.05).Conclusion Dexmedetomidine preconditioning can attenuate myocardial I/R injury in a concentration-dependent manner in rats.

Objective To observe the curative effect of electro-acupuncture combined with rehabilitation training to shorten the period of flaccid paralysis after cerebral infarction.Methods 78 victims were divided into treatment group and control group at random. The treatment group received electro-acupuncture combined with rehabilitation training, and the control group received rehabilitation training only. Muscular tension was evaluated on the 15th day and 30th day after admission according to the modified Ashworth spasm rating scale.Results The number of flaccid paralysis victims in the treatment group is significantly less than that in the control group (P＜0.05) on the 15th day and 30th day after treatment.Conclusion Electro-acupuncture combined with rehabilitation training can shorten the period of flaccid paralysis after cerebral infarction significantly.

Objective To study the clinical effects of Ditan Xingnao Chengqi soup for treatment of patients with sepsis brain dysfunction. Methods Sixty-two cases of sepsis brain dysfunction were divided into treatment group(32 cases)and control group(30 cases)according to random digits table. Both groups received general clinical treatment,while the treatment group additionally accepted Ditan Xingnao Chengqi soup through nasal feeding. The changes of C-reactive protein(CRP)of two groups before treatment and after treatment for 12,24,48,72 hours and 1 week were observed. Besides,the Glasgow Outcome Scale(GOS)was used to assess the curative effect of two groups, and its clinical significance was judged. Meanwhile,the hospitalization costs,the times staying in hospital and total effective rates of the two groups after treatment were observed. In addition,cost-effectiveness analysis was carried out. Results With the extension of therapeutic time,the levels of CRP(mg/L)in the two groups were reduced effectively in comparison with those before treatment,and the change was more obvious in the treatment group;after treatment for 24 hours,the difference in the level of CRP between the two groups began to be statistically significant(106.5±22.3 vs. 201.6±25.4,P<0.05). The GOS of two groups after treatment had been increased markedly in comparison to that before treatment,and the change was more obvious in treatment group(72 hours:10.34±0.76 vs. 7.34±0.48,1 week:13.16±0.86 vs. 9.56±0.64,both P<0.05). Hospitalization costs(yuan)of treatment group in intensive care unit (ICU)was lower than that in control group(43276.16±1844.23 vs. 51347.75±2011.06,P<0.05),and the duration of staying(day)in ICU of treatment group was shorter than that in control group(15.11±2.25 vs. 20.30±2.97,P<0.05). The total effective rate of treatment group was higher than that of control group,but the difference had no statistical significance(87.5%vs. 60.0%,P>0.05).The ratio of cose effectiveness analysis in treatment group was smaller than that of control group(497.42 vs. 855.80,P<0.05). Conclusions Ditan Xingnao Chengqi soup has a relatively good effect on antagonizing inflammatory factors,controlling excessive inflammatory response and improving disturbance of consciousness. The early intervention with this agent for a patient with sepsis cognitive impairment can control the disease situation,improve the patient's prognosis and reduce his or her hospitalization costs.

Objective To evaluate the clinical application of COBIO XS automated urine sediment analyzer for screening urinary tract infection(UTI) .Methods Midstream urine samples were collected from 182 patients with suspected UTI .White blood cell counts(WBC) and bacteria counts(BACT) were determined by COBIO XS automated urine sediment analyzer .By comparing with quantitative urine culture as the golden standard of UTI .The area under the ROC curve(AUC) was constructed to evaluate the dis‐criminative power of variables to predict UTI .Results The positive rate of urine culture was 30 .8% .The isolated rate of Esche‐richia coli ,Enterococcus species and proteus species were 53 .6% ,16 .1% ,10 .7% ,respectively .ROC curve analysis showed that AUC was 0 .808(95% CI 0 .710-0 .867) for WBC and 0 .899(95% CI 0 .797 -0 .923) for BACT .The best cutoff value for WBC was 50/μL ,sensitivity was 89 .0% ,specificity was 83 .8% ,positive predictive value was 86 .3% and negative predictive value was 93 .7% .The best cutoff value for BACT was 110/μL ,sensitivity was 82 .5% ,specificity was 85 .6% ,positive predictive value was 78 .5% and negative predictive value was 88 .0% .Conclusion COBIO XS analyzer is adopted to conduct rapid and reliable a screen‐ing tool for UTI .

ObjectiveTo observe the effect of Integrated Traditional Chinese and Western Medicine on primary trigeminal neuralgia. Methods126 cases with primary trigeminal neuralgia were divided into treatment group (63 cases) and control group (63 cases), who accepted Integrated Traditional Chinese and Western Medicine and western medicine only. They were assessed with Chinese version McGill Pain Questionnaire before and after treatment, and followed up for 1 year. ResultsThe incidence of cure in treatment group was higher than that of control group (P<0.05), and the relapse was reduced (P<0.05). ConclusionThe Integrated Traditional and Western Medicine is more effective on primary trigeminal neuralgia, and reduce the relapse.

Objective To evaluate the effect of double tractors swing microendoscopic discectomy technique in multi-segmental lumbar disc herniation. Methods From December 2006 to November 2009,153 patients with multi-segmental lumbar disc herniation were treated with double tractors swing microendoscopic discectomy. They included 85 cases of multi-segmental disc herniation, 53 cases of degenerative canal stenosis and 15 cases of lumbar instability. Among them, 2, 3, 4 and 5 fenestrations were performed in 105,33, 13 and 2 cases respectively and interbody fusion was done with "quanhe" inflation cage and screws in 15 cases. The results were evaluated with Macnab scale. Results All the 153 patients were followed from 3to 36 months, with an average of 16 months. The mean operative time was 45, 61, 83 and 110 min for 2,3,4 and 5 fenestrations respectively, with a mean blood loss of 150 ml. And it took extra 92 min to finish interbody fusion. Complications included dural sac tears in 1 case,canda equina slight lesion in 1, superficial incision infection in 1, the formation of deep venous thrombosis in 1, and revision for"quanhe"inflation cage in 1. The mean hospital stay was 10 days. Excellent results were obtained in 117 cases, good in 32 and fair in 4. One hundred and thirty-two patients returned to their work or normal activities in 3 weeks. One hundred and forty-nine cases were satisfied with the therapeutic effect. Conclusion This technique not only can reach adjacent intervertebral space easily but also disperse pressure on the nerve root effectively. This technique can provide thorough decompression and good results.

Objective To evaluate the safety of magnesium borate ore powder (MBOP) as a molluscicide, especially for the arsenic content in the soil samples from the fields used MBOP over more than one year. Method The arsenic in the soil samples was assayed by using the AgDDTC method recommended by the government. Result In all of the soil samples, the arsenic contents did not exceed the national health criterion. However, the arsenic in the MBOP treated soil samples was higher than that in the control one′s. Conclusion The application of MBOP as a molluscicide in the fields does cause some side effects on the environment.

AIM: To explore the relationship between various mitochondrial (mt) DNA tRNA Leu (UUR) and ND1 gene mutations and type 2 diabetes mellitus (T2DM) among Chinese in Hubei Province. METHODS: PCR restriction fragment length polymorphism (PCR-RFLP) analysis was used to screen point mutations of mtDNA ( 3 243, 3 256, 3 290, 3 316, 3 394, 3 421, 3 426, 3 460, 3 593) in 174 T2DM and 207 healthy controls. Then, DNA sequencing, reverse dot blot hybridization and Genchip were used to compare and confirm mutations. All mutations were analyzed by DNASTAR and Antherprot softwares. RESULTS: In diabetic group, there were 5 carriers (2.9%) of 3 316 G→A (Ala→Thr) mutation, 4 (2.3%) of 3 394 T→C (Tyr→His) mutation, 1 (0.6%) of 3 593 T→C(Val→Ala) mutation, and 1 (0.6%) of 3 618 T→C(Phe→Phe) mutation. Among 3 316 (G→A) mutations , there were more than 1 point mutations in 2 cases, one accompanied with 3 256 C→T(Arg→Arg) and 3 688 G→C (Ala→Pro) mutations, another accompanied with 3 606 A→G(Leu→Leu) mutation. 3 606 (A→G), 3 618 (T→C) and 3 688 (G→C) were novel mutations, GenBank accession number is DQ092356. In controls, only 3 316 (G→A) mutation was found in 1 subject (0.5%). There was significant difference between two groups for 3 394 (T→C) mutation frequencies (P