BACKGROUND: Mild hypothermia can protect cerebral cell from injury induced by ischemia, however, whether it can protect cerebral function after cerebral resuscitation or not?OBJECTIVE: To investigate the differences between neural functional outcome and living self-care ability of patients after 3-month cerebral resuscitation with mild hypothermia technique compared with normal temperature technique.DESIGN: Randomized control study.SETTING: Emergency Center of Gulou Hospital Affiliated to Medical College of Nanjing University.PARTICIPANTS: Totally 16 patients rescued with cardiopulmonary resuscitation were selected from Gulou Hospital of Nanjing between February and October 2002. All patients had systemic lesion and intoxication, and were treated with cardiopulmonary resuscitation because of heartbeat and respiratory arrest. There were 10 males and 6 females aged 27-57 years.According to the application of mild hypothermia or not, 16 cases were divided randomly into normal temperature group and mild hypothermia group with 8 in each group.METHODS: After cardio-pulmonary resuscitation, patients in mild hypothermia group were treated with medicine + caput ice cap + electronic ice blanket method to reduce the temperature. The temperature of brain was kept at 32 to 34 ℃ for 72 hours. Patients in normal temperature group were treated at the room temperature.MAIN OUTCOME MEASURES: ① Blood-oxygen saturation, blood pH value, intracranial pressure, mean arterial pressure and Glascow Coma Scale of patients were measured on the third and seventh day after resuscitation. ② After 3-month resuscitation, Glascow Coma Scale was followed:85-100 points as functional independency, 74-84 as moderate disability,10-50 as severe disability and ＜ 10 as vegetative slate; meanwhile, living self-care ability was measured with Bathel index of 10 items in total. Every item was scored from 0 to 15 points with 100 in total, and ＜ 60 was determined as unable self-care.RESULTS: Totally 16 patients entered the final analysis. ① On the third day, mean cerebral temperature and intracranial pressure in the mild hypothermia group were lower than those in the normal temperature group [(33.1±0.26)℃, (37.4±18)℃; 15.7 mm Hg, 19.1 mm Hg, P=0.027, 0.043]. The two groups were similar in the Score of blood-oxygen saturation, blood pH value, mean arterial pressure and Glascow Coma Scale (P ＞ 0.05). ② On the seventh day, Glascow Coma Scale in the mild hypothermia group was higher than that in the normal temperature group [(9.1±1.4), (11.2±1.6) points,P=0.032]. ③ After 3 months, Glascow Coma Scale and Barthel index in the mild hypothermia group were higher than those in the normal temperature group [(12.9±1.75), (9.9±1.9) points; (86±6), (52±12) points, P ＜ 0.05-0.01].CONCLUSION: Mild hypothermia can decrease intracranial pressure during the early cerebral resuscitation, is especially effective in the recovery of long-term neural function and activity of daily living, and has remarkable protecting effect on cerebral function.

Objective To study the clinical value of serum procalcitonin(PCT)in early diagnosis of systemic bacterial infection.Methods 57 suspected bacterial infectious patients in our hospital were selected as observation group,and another 57 healthy subjects were selected as control group.Patients in the observation group were divided into sepsis group (A group,19 cases),local bacterial infection group (B group,19 cases)and bacterial infectious SIRS group (C group,19 cases)according to ACCP/SCCM consensus conference and their clinical manifestations. The serum PCT levels in the 4 groups were detected and compared.Results There was no statistically significant differences in general situation (age,sex,height,weight and body mass index (BMI),etc.)between the two groups (P >0.05).After admission,the PCT level in the observation group was obviously higher than that in the control group,the level of PCT was the highest in group A,and the difference was statistically significant(F =94.88,P <0.001).24h,3d,7d and 10d after admission,there was no statistically significant difference in PCT level in control group(P >0.05);the PCT level in the observation group was gradually decreased,the level of PCT in A group was still higher than that in the other three groups,and the differences were statistically significant(F =62.40,P <0.001;F =65.00,P <0.001;F =58.84,P <0.001;F =63.05,P <0.001).Conclusion Serum PCT has a certain advan-tage in sensitivity and specificity,it can reflect the severity of disease,it also has certain clinical significance in judging the development and prognosis of disease.Therefore,it can be considered as one of the first choice for clinical detection of bacterial infection.

Objective To explore the real burden experience and feelings of the caregivers of patients with advanced pancreatic cancer in the process of care. Methods Totally 9 caregivers of patients with advanced pancreatic cancer were selected and investigated by in-depth interviews. Results Five major themes were found:Psychological burden,Physiological burden,Lack of knowledge, emotion, and economic support system,Challenges to personal life. Conclusions The caregivers of patients with advanced pancreatic bear the burden in Psychology, Physiology and personal life,and lack of emotional, economic and social support to different degrees at the same time. Doctors and nurses should pay attention to the caregivers, help them solve the difficulties, and provide scientific and effective nursing intervention.

Objective To study influence on prognosis of children with acute renal injury risk factors and multi factor non conditional logistic regression analysis.Methods 109 cases of AKI children were selected.In accordance with the cure or not,they were divided into cure group (54 cases)and not cured group (55)cases.The two groups of children with the clinical treatment were compared,and the multi factor non conditional logistic regression analysis were carried on.Results Stage Ⅰ and Ⅲ group of the proportion number in the cure group had significantly different than those in the not cured group,the differences were statistically significant (χ2 =6.891,P =0.009,χ2 =7.928,P =0.005).The two groups of children with mechanical ventilation,the presence of oliguria and sepsis or septic shock had significant differences,the differences were statistically significant (χ2 =13.157,P =0.000,χ2 =12.766,P =0.000,χ2 =10.293,P =0.001.The two groups of children Scr and BUN levels contrasting had differences,the differences were statistically significant (t =4.476,P =0.000,t =3.513,P =0.003).In addition,by multivariate logistic regression analysis showed that affect the prognosis of children with acute renal damage independent because respectively for mechanical ventilation (OR =2.237,P =0.000),oliguria (OR =4.247,P =0.000)and sepsis or septic shock (OR =2.146,P =0.000).Conclusion Scr and BUN levels may be the risk factors of children's AKI prognosis,and mechanical ventilation,less urine and sepsis or septic shock are independent risk factors influencing the prognosis of children with AKI.

Diagnosis, Differential ; Humans ; Pneumoconiosis ; diagnosis

Chronic Disease ; Humans ; Male ; Middle Aged ; Mineral Oil ; adverse effects ; Occupational Exposure ; adverse effects ; Pigmentation Disorders ; chemically induced

Thirty five normal esophageal mucosae were observed with electron microscopy. 11 were taken from resected esophageal specimens and 24 were obtained by using fibroendoscope biopsy forceps from normal areas of esophageal mucosae examined endoscopically.Normal esophageal epithelium is divided into basal, prickle and superficial cell layers. The continuous basement membrane separates lamina propria from basal cells. Occasionally a false rupture appears in the obliguely-cut, basement membrane.Intraepithelial lymphocytes and Langerhans cells were found in the basal cell layers and deep in the prickle cell layers. In the cell cytoplasm of one case, a few rod-shaped Langerhans granules with internal periodic substructure were observed. The Langerhans granule measures 250 nm by 50 nm. The results of our observation showed that Langerhans cells were possibly derived from intraepithetial lymphocytes.In the superficial cell layers, a large number of membrane coating granules were identified in pericytoplasm or in the cytoplasmic processes. A few granules were also found in intracellular spaces.Desmosome fields were seen in prickle cell layers. The fields were in the form of labyrinth made up of numerous desmosomes and microvillus processes. No gap junctions were found in the desmosome fields.Twisted thread-like nuclei and indented bizarre nuclei were found in both the prickle cell layers and superficial cell layers. Capillaries with fenestrated endothelium were embedded in the papillae of lamina propria.

The activity of interleukin-2 (IL-2) and expression of interleukin-2 receptor (IL-2 R) were measured in children with acute glomerulonephritis (AGN) in order to detemine the mechanism of the disease Our results showed that the activity of IL-2 in peripheral blood lymphocytes (PBL) of children with AGN was lower than that tof the control group (P

OBJECTIVE:To discuss the role of clinical pharmacists in providing pharmaceutical care in respiratory department.METHODS:The clinical pharmaceutical care provided by clinical pharmacists in respiratory department was analyzed and summarized.RESULTS & CONCLUSION:The pharmaceutical care carried out in respiratory department can help reduce the incidence of medication errors.

Objective To explore the effect and mechanism of montelukast sodium on transforming growth factorβ1 (TGF -β1 )expression in children with asthma.Methods 80 children with asthma were divided into 2 groups.The control group was treated with common medicine,and the observation group was treated with monte-lukast sodium.The clinical effect of two groups was evaluated.The peripheral eosinophile granulocyte(EOS)count of children was measured before and after treatment.Double antibody sandwich enzyme -linked immunosorbent assay (DAS -ELISA)was used to detect the serum levels of TGF -β1 and leukotriene E4 (LTE4)before and after treatment.Results The total effective rate of montelukast sodium group was 95.0%,remarkable effect in 28 cases, 10 cases were effective,and 2 cases failed.The total effective rate of the control group was 82.5%,23 cases had remarkable effect,effective in 10 cases,ineffective in 7 cases.The effective rate of the montelukast sodium group was statistically higher than the control group(χ2 =4.200,P <0.05).After treatment,the peripheral eosinophil count of patients of two groups significantly decreased than before treatment (control group:χ2 =3.251,P <0.05;observation group:χ2 =3.214,P <0.05).There was significant difference between the two groups(χ2 =3.254,P <0.05).Before treatment,serum levels of TGF -1 showed no statistical difference between the two groups (P >0.05).After treat-ment,the levels of serum TGF -1,LTE4 of the observation group decreased more remarkably when compared with the control group (TGF -β1:t =2.06,P <0.05;LTE4:t =2.14,P <0.05).Conclusion Montelukast sodium has good clinical effect on childhood asthma.It can inhibit the expression of TGF -1 in childhood asthma,and its mechanism may be related to eosinophils and the level of LTE4.