Objective To build the steady framework of the nasal tip by using caudal septal advancement technique to obtain the permanent nasorostral configuration.Methods From Oct 2009 to Apr 2011,the caudal septal advancement technique was used to reconstruct the septum to make the septal anterior angel and the caudal septal margin reach the anticipated height and length of the tip,then medial crus and the vault of the lower lateral cartilage were sutured to the caudal septum to form the steady supporting structure of the nasal tip.Results 3-16 months follow-up in 26 cases showed that 2 cases appeared the staircase deformity in the junction of the bone and the cartilage in the dorsum,but the nasorostral configuration was good.3 cases whose tip and columella were deviated before the operation appeared the deviation again after 3 months but the nasorostral configuration was better than before.The other 21 cases were good.Conclusions It is a available method of using caudal septal advancement technique to form the steady nasorostral configuration.

OBJECTIVE:To provide the reference for the set-up of precautions against flu pandemic in China.METHO_DS:RNA of influenza viruses isolated from flu children in flu seasons between 2003 and 2005 in Beijing was extracted and amplification of M2 gene fragments associated with ion channel were performed by one step reverse transcription–polymerase chain reaction(RT-PCR).The sequencing of amino acid was determined,and its bioinformation was analyzed with software,then the positions of amino acid for resistance to amantadine were detected.RESULTS:20 of 31 isolated strains were resistant to amantadine,the percentage of which was 66.7%.CONCLUSION:The monitoring of drug resistance to flu viruses should be strengthened in China.

Objective:To investigate the thoughts and the methods of clinical pharmacists in the individual continuous renal re-placement therapy ( CRRT) anticoagulation treatment for severe patients. Methods:Clinical pharmacists participated in the CRRT anti-coagulation treatment for one patient with severe thrombocytopenia after aortic dissection surgery. Clinical pharmacists analyzed the cau-ses of thrombocytopenia and the coagulation function of the patient to exclude heparin-induced thrombocytopenia, and developed the treatment of supplementing platelets and regional citrate anticoagulation as the way of CRRT. Results:Three days after the treatment, the patient was changed to the general ward with normal renal function. Conclusion:Clinical pharmacists should participate in clinical treatment comprehensively and perform individual treatment for patients in order to ensure the effect and safety of medication.

Objective To conclude nursing experience of second anastomotic leakage after radical gastric cancer surgery. Methods The present study compared the differences of clinical symptoms between these two anastomotic leakages, and found a way to detect latent anastomotic leakage with an unobvious abdominal sign accurately and opportunely. The study also intervened in the patient′s observation, psychological condition, peritoneal irrigation and nutritional support after surgery. Results The patients were discharged from the hospital after cured with well controlled condition. Conclusions In order to make an early detection and treatment of the second anastomotic leakage, nurses should not only observe the abdominal sign, but also observe the systematic poisoning and concomitant symptoms.

Considering the fact that the critical medical education was relatively backward, and the basic medical education was out of touch with clinical practice, this study, combined with the complexity, uncertainty and comprehensiveness of critical care medicine , puts forward the concept of critical care medicine holistic medicine in clinical practice. We try a patient-oriented approach in clinical practice, focusing on the whole, focusing on the interaction relationship among patient and disease and its pathologi-cal and physiology processes, development, complication and prognosis of disease, instead of paying atten-tion only to disease or single organ itself. The purpose of patient-based learning is trying to train medical students and junior residents to form good clinical thinking ability and decision-making ability.

10.3969/j.issn.2095-4344.2013.23.019

Objective To evaluate the effects of limited fluid resuscitation on septic shock caused by myocardial injury . Methods 60 severe traumatic sepsis and septic shock patients were randomly divided into study group and control group ,with 30 cases in each group ,the control group was given active fluid resuscitation ,maintain the mean arterial pressure (MAP) in 70 mm Hg ;the study group were treated with limited fluid resuscitation ,namely when MAP rose to a slow infusion rate 50-60 mm Hg ,we restrict the amount of fluid ,maintain MAP at about 50 mm Hg ,observe and record the two groups of patients hemodynam-ics index ,APACHE Ⅱ score and heart function index ,and compared serum cTnI ,NT proBNP and CRP in the two groups .Results (1)In study group the infusion volume before admission was (258 ± 105)mL ,preoperative was (558 ± 226)mL ;in the control group that of before admission was (816 ± 422)mL ,preoperative was (1 668 ± 780) mL (P<0 .05) .The mortality rate in study group was 13 .3% ,the mortality in control group rate was 26 .7% (P<0 .05) .(2) the HR and blood lactic acid levels in two groups decreased significantly after treatment ,MAP and CVP increased significantly (P<0 .05);there were no significant differences in hemodynamic parameters (P>0 .05) .(3)After the treatment APACHEⅡscore of the two groups was significantly decreased ,car-diac output ,stroke volume and left ventricular ejection fraction significantly increased in control group ,the study group were better than control group (P<0 .05) .(4) The plasma cTnI ,NT proBNP ,CRP levels of the two groups significantly decreased after treat-ment (P<0 .05) ,plasma cTnI ,NT proBNP and CRP levels of research group were significantly lower than that of control group (P<0 .05) .Conclusion Limited fluid resuscitation can maintain hemodynamic ,reduce the interference on the internal environment ,re-duce myocardial injury ,and improve the success rate of treatment .

Acupuncture Points ; Acupuncture Therapy ; Chronic Disease ; therapy ; Edema ; therapy ; Heart Failure ; therapy ; Humans ; Male ; Middle Aged

Objective:To investigate the influence of single nucleotide polymorphisms (SNP ) of cytidine deaminase (CDA)in the curative effect of gemcitabine,and to clarify the correlation of CDA SNP with the clinical prognosis of the advanced non-small cell lung cancer (NSCLC)patients.Methods:CDA 79A>C gene was detected by Sequenom Massarray Genotype System among 93 patients with advanced NSCLC who received chemotherapy of gemcitabine.The associations between CDA 79A>C polymorphisms and progression free survival (PFS)and overall survival (OS)were estimated using Kaplan-meier methods and Log-rank test for univariate analysis, and COX proportional hazards model was used for multivariate analysis.Results:There was no significant correlation between the CDA 79A>C SNPs with the clinical and pathological characteristics of NSCLC patients.The median PFS in the patients with wild genotype A/A was 9.3 months, while the median PFS in the patients with mutant genotype A/C and C/C was 11 months;there was no significant difference between them (P=0.061).The median OS in the patients with wild genotype A/A was 2 1.7 months, and the median OS of the patients with mutant genotype was 22.1 months;there was no significant difference between them (P=0.513).Conclusion:CDA 79A>C SNPs can prolong the PFS of the NSCLC patients,but it does not affect the OS of the patients.

Antiplatelet drugs are widely used for various cardiovascular diseases. However, there is no standard for pharmaceutical care of antiplatelet drugs. In the paper, the development and application in antiplatelet drugs of thrombelastography were reviewed to analyze the application value of thrombelastography in effectiveness evaluation of antiplatelet drugs.