Objective To evaluate the efficacy and safety of open occluded coronary artery branch through outside stent balloon expansion technique.Methods A retrospective analysis of 26 patients,26 interventional treat-ment of coronary bifurcation lesions were taken.All patients initially used conventional interventional techniques, branch reserve protection guidewire and main branch stent.When branch occlusion occured during operation and failed again through guidewire,small outer diameter of the balloon branch guidewire which was squeezed could be used to branch opening.The blocked branch opening was expanded outside of the stent,and the balloon was expanded after the guide wire enter into branch again.The main branch/branches kissing balloon inflation or main branch /branch double stenting would be used when necessary.Results Among 26 cases of bifurcation branch occlusion,25 cases successfully completed the outer stent balloon,achieved a branch balloon expansion after reentry guidewire,saved blocked branches and the rate of success was 96.2%,and 6 cases of the main branch and the branch kissing balloon dilatation,2 cases of remedial double stenting.Following -up for 1 -12(5.3 ±6.8)months after operation in 25 cases of patients,there was no death and myocardial infarction and other adverse cardiovascular events.Conclusion Out-side stent balloon expansion technique can improve the success rate of coronary occlusion branch opening,and it have fewer complications and worth of clinical application becasuse of its satisfactory results.

Objective To analyze the current situation of TB control in Hefeng County and probe into the role of medical institutions in TB control. Methods In-depth interviews were conducted with health workers of TB prevention, TB patients and their family members; data on registered TB patients were collected; the current situation of TB control was analyzed and countermeasures were put forward. Results The TB epidemic was pretty serious in Hefeng County, with a high morbidity rate and a low cure rate. According to an epidemiological survey in 1990, the TB morbidity rate in the county was 1000/100000. Conclusion Hefeng County failed to give full play to the role of hospitals in TB control and the treatment of TB patients was separated from their management. Hence the deplorable results of TB control. The following countermeasures were presented: ①giving full play to the role of general hospitals in TB control; and ②perfecting the three-level medical networks of prevention and healthcare.

Objective To explore specimen sampling for microbial culture in ICU patients with documented infections in order to offer clinical evidence for improving the rational use of antibiotics.Methods Patients with documented infection on the first day after admission into ICU and discharged from ICU from July to December 2012 and from July to December 2013 were enrolled in the study.Clinical data including presence or absence of infection,initial antimicrobial therapy,microorganism specimen sampling and culture were retrospectively analyzed.Results Of 841 patients discharged from ICU,443 had evidence of infections and received antimicrobial therapy on the admission day,and only 30 (6.8％) of them had microbiological detection results prior to treatment.There were microbial specimens available at infection sites on the admission day in 369 cases,and 360 cases (97.6％) of them were sampled in the first three days after ICU admission,while only 119 cases (33.1％) were sampled before the first dose of antimicrobial therapy.Specimens sampled were sputum (56.4％) in the majority,followed by the blood (17.4％).Further analysis of 269 infected patients receiving initial broad-spectrum antimicrobial therapy also showed that only 33.5％ cases were sampled before the first dose of broad-spectrum antimicrobial administration.The positive isolation rate of multi-drug resistant isolates including A.baumannii,S.maltophilia and B.cepacia from specimens sampled after first dose of initial broad-spectrum antimicrobial therapy were significantly higher than those sampled before antimicrobial therapy,P ＜ 0.05.There was no significant difference in isolation rate of Staph.aureus and Enterobacteriaceae between samples obtained before and after first dose of initial broad-spectrum antimicrobial therapy.Conclusions Few evidence of pathogenic microorganisms was available before initial antimicrobial therapy in ICU patients.Although sampling rate of microbial specimens is high,the most of them are sampled after the first dose of antimicrobial administration,and the patentially contaminated specimens such as sputum in predominance,obviously decrease the reliability of authentic results obtained from microorganism culture.

Objective To investigate de-escalation of empiric broad-spectrum antibiotics treatment for patients in intensive care unit (ICU).Methods Data of the patients discharged from ICU in the Second Affiliated Hospital of Zhejiang University from July 1 to December 31 of 2012 and from July 1 to December 31 of 2013 were retrospectively reviewed.Patients with initial use of empirical broad-spectrum antibiotics within 3 d after ICU admission were included in the study.Clinical data including status of infection,the initial empiric antimicrobial therapy,pathogens culture and adjustment of antibiotics in 5 days were analyzed.Results A total of 841 patients were discharged from ICU during the study periods and antibiotics were used in 786 (93.5％) patients.Among 786 patients,389 (49.5％) were treated empirically with broad-spectrum antibiotics,but only 269 (69.2％) had evidences of bacterial infections.Of the 389 patients with empiric antibiotics use,de-escalation of antibiotics was applied only in 6 (1.54％) patients within 5 days after the initiation of treatment.In 269 patients with evidence of infection,specimen sampling and culture were performed in 248 (92.2％) patients within 3 days,among which 165 samples were positive,and the clinical isolates were mainly multi-drug resistant gram negative bacilli and colonized bacteria in oropharyngeal cavity.De-escalation was applied only in 4 (1.49％,4/269) patients with evidences of bacterial infections.Conclusion Broad-spectrum antibiotics as initial empiric therapy is common for patients in ICU,however de-escalation of empiric therapy is rarely applied even in patients with positive results in pathogen isolation and culture.

Objective To explore the application effect of high quality nursing service in outpatient nursing work, to improve the quality of nursing work. Methods This study selected clinic patients as the research object of high quality nursing before and after 1 month, since June 2014 to carry out high quality nursing activities so far, activitied into the stable period,from September 2014 outpatient treatment of 50 cases as the observation group,high quality nursing January 2014 outpatient treatment of 50 cases as the control group,SAS score,nursing satisfaction were compared be-fore and after treatment in the patients of two groups of cases of outpatient registration and the waiting time, waiting time of auxiliary examination were compared. Results Nursing satisfaction results in the observation group was 98.0%,significantly higher than the control group of 76.0%,the difference was statistically significant between two groups(P<0.05).The observation group cases outpatient registration waiting time less than or equal to 15 min was 92.0%, auxil-iary examination waiting time less than or equal to 15 min was 94.0%,were above 90%,were significantly higher than those in control group,the difference was statistically significant between two groups (P<0.05). Before treatment,SAS score of two groups of patients, there was no significant difference (P>0.05). After treatment, two groups of patients with SAS score decreased significantly(t=8.342,t=7.213,P<0.05),and the SAS score of observation group after treatment was significantly lower than the control group, there were significant differences(P<0.05). Conclusion The development of high quality nursing service in outpatient nursing work is helpful to improve nursing satisfaction, reduce the patient's anxiety,shorten the time of examination,so as to further improve the quality of outpatient nursing work.

Objective To investigate the diagnostic analysis and pathogenic characteristics of bacterial meningitis (BM) in children in Midwest area in China.Methods Clinical and pathogenic data of inpatients with BM were analyzed retrospectively at Xiangya Hospital,Central South University and Children's Hospital of Chongqing Medical University,including age,gender,index of peripheral inflammation,cerebrospinal fluid routine,biochemistry,culture,drug sensitivity and image change.Results In total,446 cases with BM were analyzed in this study.The male-to-female ratios was 1.67:1.00.Peripheral blood detected abnormal ratios of white blood cell (WBC),C reactive protein(CRP)and procalcitonin (PCT) which were 67.7％ (302/446 cases),64.9％ (268/413 cases) and 71.7％ (279/389 cases),respectively.Cerebrospinal fluid detected abnormal ratios of WBC count,glucose and protein,which were 76.5％ (332/434 cases),71.2％ (306/430 cases) and 91.7 ％ (397/433 cases),respectively;79.4％ of the patients revealed abnormal head CT/MRI image.Bacterial culture positive rate was 33.6％ (150/446 cases),and the positive rates of abnormality in peripheral blood WBC,CRP,PCT or cerebrospinal fluid WBC,glucose and protein were 34.9％ (116/332 cases),34.8％ (138/397 cases),36.6％ (112/306 cases),respectively,which were higher than the normal patients,who were 29.4％ (30/102 cases),25.0％ (9/36 cases),21％ (26/124 cases),respectively.The most common pathogenic bacteria were Streptococcus pneumoniae,Escherichia coli and coagulase negative staphylococcus.Infants within one year presented dominantly with infection of Escherichia coli,accounting for 26.6％ (29/109 cases).Children above 1-year-old presented dominantly with Streptococcus pneumoniae,accounting for 61.0％ (25/41 cases).A drug-resistance phenomenon was common among pathogenic bacteria.Conclusion Abnormality in peripheral blood WBC,CRP,PCT or cerebrospinal fluid WBC,glucose and protein,and subdural effusion/empyema can help the early diagnosis and differential diagnosis of BM.The most common pathogenic bacteria in Midwest area of China are Streptococcus pneumoniae,Escherichia coli and coagulase negative staphylococcus,which suggests recommend the application of Streptococcus pneumoniae vaccine.Drug-resistance phenomenon to pathogens is very common.For the treatment strategy,it should be made and adjusted timely according to the drug sensitivity and common hospital antimicrobial spectrum.

This paper reports the maternal and fetal outcomes of three twin pregnancies with chronic hypertension and obstructive sleep apnea-hypopnea syndrome (OSAHS) who were treated with continuous positive airway pressure (CPAP). All three women with twin pregnancies were diagnosed with chronic hypertension. Furthermore, symptoms such as snoring and apnea assisted the diagnosis of OSAHS through polysomnography monitoring. Case 1 was treated with CPAP at 28 gestational weeks. The blood pressure increased gradually after the first month of CPAP treatment, with an elevated urine protein concentration. At 34 gestational weeks, the pregnant woman underwent a cesarean section due to the development of hemolysis, elevated liver enzymes, and low platelet syndrome. Case 2 was treated with CPAP at 11 gestational weeks, with stable blood pressure throughout the pregnancy, and was delivered through cesarean section at 37 weeks of pregnancy. Case 3 started CPAP at 13 gestational weeks for four months, and increased blood pressure and urine protein were observed. Medication brought the blood pressure down, and urine protein became negative. At 32 gestational weeks, a cesarean section was performed because of premature rupture of the membrane. Her CPAP treatment continued till delivery with good maternal and infant outcomes. The treatment outcomes of the three cases suggest that CPAP may prolong the time of blood pressure rise among twin pregnancies where chronic hypertension and OSAHS coexist, which potentially reduces the occurrence of adverse maternal and infant outcomes.

Objective:To evaluate the changes in vitamins and trace elements in obese patients after laparoscopic sleeve gastrectomy (LSG).Methods:A systematic retrieval of the available literature was performed using Pubmed, Embase, Cochrane library, Web of Science, WanFang data and CNKI databases and studies were selected per predefined eligibility criteria. Statistical analysis was performed using Stata 13.0.Results:A total of 22 studies with 5320 individuals with obesity who underwent LSG were identified as eligible for inclusion. A significant increase was observed in serum 25(OH)D ( SMD = 0.59, 95% CI: 0.16 to 1.03, P = 0.007), phosphorus ( SMD = 0.28, 95% CI: 0.09 to 0.47, P = 0.004) and iron ( SMD = 0.46, 95% CI: 0.31 to 0.61, P < 0.01) after LSG. A significant decrease in serum zinc ( SMD = -0.41, 95% CI: -0.81 to -0.01, P = 0.044) was observed after LSG. But no significant changes in serum calcium ( SMD = 0.11, 95% CI: -0.14 to 0.36, P = 0.385), folate ( SMD = 0.27, 95% CI: -0.08 to 0.62, P = 0.133), vitamin B 12 ( SMD = 0.11, 95% CI: -0.25 to 0.47, P = 0.563) and magnesium ( SMD = 0.53, 95% CI: -0.08 to 1.14, P = 0.09) were observed. Conclusions:The changes of serum nutritional measurements in individuals with obesity who underwent LSG are uncertain. Therefore, it is recommended to monitor the nutritional laboratory values and add supplements when necessary to prevent postoperative malnutrition.

Objective: To summarize the clinical data including manifestations, diagnosis, treatment and prognosis of eosinophilic gastroenteritis (EGE) in children. Methods: A retrospective analysis was performed in 71 patients with pathologically proven EGE at Beijing Children's Hospital Affiliated to Capital Medical University from January 2008 to January 2017. Their clinical manifestations, laboratory and imaging examinations, endoscopic findings, histopathological examinations, and treatment were collected and analyzed. Results: Among 71 EGE cases, 47 (66%) cases were male and 24 (34%) cases were female, and the median age was 9.2 (0.2-16.5) years old. The main clinical manifestations included abdominal pain (76%, 54/71), vomiting (68%, 48/71), anorexia (54%, 38/71), weight loss (38%, 27/71), and diarrhea (37%, 26/71). There were 27 cases (38%) with a history of allergic diseases or family history. The median absolute value of eosinophil in peripheral blood of the 71 patients was 0.4 (0-36.8)×10⁹/L, and 27 cases (38%) showed an increase in eosinophil counts. Serum IgE was measured in 52 patients (104.3 (3.4- 3 000.0)×10³ U/L), and 30 patients (58%) showed an increase in serum IgE. A large number of eosinophils ((41.0±8.5)/HP) were found in 3 patients' ascites. The endoscopic examination of upper gastrointestinal tract revealed hyperemic edema in 62 cases (87%), plaque in 44 cases (62%), erosion in 17 cases (24%) and ulceration in 16 cases (23%). Histopathologically, in 8 cases (11%) the disease involved both stomach and duodeneum, in 21 cases (30%) involved stomach only, and in 37 cases (52%) involved duodeneum only. In addition, in 6 cases (8%) the disease involved esophagus and in 10 cases (14%) involved colorectum. Microscopically, eosinophil counts averaged 67/HP, 33/HP, 40/HP and 38/HP in esophageal, gastric, duodenal and colorectal mucosa respectively. A total of 34 cases were treated with glucocorticoid, and all these patients had alleviation of symptoms, which occurred within 14.9 days on average, but EGE recurred in 11 cases (32%). Conclusions The clinical symptoms and endoscopic findings of EGE are diverse and nonspecific. Histopathological examination of gastrointestinal mucosa is particularly important for the diagnosis. Glucocorticoid treatment is effective, but the patients with EGE are prone to relapse.