Objective To investigate the clinical effect of rhubarb combined with smecta in the treatment of acute organophosphorus pesticide poisoning (AOPP).Methods Seventy-six patients with severe AOPP admitted in the Emergency Centre of Heze Municiple Hospital in Shandong Province from June 2011 to June 2014 were enrolled in this study. They were divided into observation group and control group by the random number table method, 38 cases in each group. The comprehensive routine treatment of gastric lavage to thoroughly clear the gastric content, appropriate application of penehyclidine and atropine for detoxication, pralidoxime chloride, etc. were given to the two groups. On the basis of the above conventional treatment, the observation group was treated with rhubarb 30 g for catharsis and smecta 30 g for adsorption once in every 4 hours, two drugs applied alternately for 48 hours, while the control group was treated with 33% magnesium sulfate 60 mL for catharsis and bleaching clay 200 g for adsorption once in every 4 hours, two drugs applied alternately for 48 hours. The treatment effect, dosage, incidence of complication and case fatality rate in both groups were observed.Results The first defecation time (hours: 5.8±3.7 vs. 9.4±4.6), gastrointestinal function recovery time (hours: 21.7±6.1 vs. 25.2±8.3), atropinization time (minutes: 51.8±23.9 vs. 68.5±20.1), conscious recovery time (days: 2.3±1.2 vs. 3.6±1.9), the time of cholinesterase (ChE) activity returning to more than 50% (days: 4.7±2.3 vs. 6.1±2.9) and the length of stay in hospital (days: 9.2±4.9 vs. 12.3±6.9) were obviously shorter in the observation group than those of the control group (P < 0.05 orP < 0.01); the used dosage of atropine (mg: 234.3±37.1 vs. 265.7±31.4) and penehyclidine (mg: 19.2±14.3 vs. 36.7±25.4) and the incidence of adverse reactions of poisoning rebound [7.9% (3/38) vs. 31.6% (12/38)], intermediate syndrome [2.6% (1/38) vs. 18.4% (7/38)], delayed neuropathy [0 (0/38) vs. 15.8% (6/38)] in the observation group were significantly lower than those of the control group (P < 0.05 orP < 0.01). No death occurred in both groups.Conclusion At present, the combination of smecta and rhubarb is a relatively good method of catharsis and adsorption to completely clear the gastrointestinal toxic residues inside the patients with AOPP, and it can reduce the amount of drugs used, the incidence of complications and the duration of hospital stay.

Objective To observe the effect of lactobacillus vaginal capsules and Kangfuxin liquid in the treatment of senile vaginitis and the influence on vaginal environment,thus to guide rational and effective treatment. Methods 80 patients with senile vaginitis were randomly divided into observation group and control group.40 cases in the control group were given ornidazole suppository,40 cases in the observation group were given lactobacillus vagi-nal capsules and Kangfuxin liquid on the basis of the control group.Both two groups had been treated for 7d.The symptoms and signs were observed before and after treatment.The vaginal secretions were taken for measuring vaginal lactobacilli by smear method.The pH in vaginal was detected,adverse events were recorded.All the patients were fol-lowed up for six months,the recurrence was observed.Results The total effective rate,the recurrence rate of 2 months after treatment,the recurrence rate of 4 months after treatment,the recurrence rate of 6 months after treat-ment of the observation group and control group were 97.5% vs 75.0%,0.0% vs 10.0%,2.5% vs 17.5% and 2.5% vs 22.5%,the differences were statistically significant(χ2 =4.211,5.000,7.314,all P <0.05).The improve-ment of genital itching,increased vaginal discharge,dysuria,vaginal congestion in the observation group were better than the control group(χ2 =5.00,4.872,5.475,5.333,all P <0.05).The pH values of vagina in the observation group and control group were (4.4 ±1.8),(5.5 ±2.1),there was statistically significant difference(t =5.386,P <0.01).The vaginal lactobacilli positive rate of the control group after treatment was 57.5%(23 /40),which of the observation group was 87.5% (35 /40 ),the difference was statistically significant (χ2 =9.028,P <0.01 ). Conclusion The method contained lactobacillus vaginal capsules and Kangfuxin liquid can balance the vaginal envi-ronment,improve symptoms and signs,reduce the rate of disease recurrence.

ObjectiveTo observe the clinical efficacy ofelectroacupunctureplustopical laser treatmentin treating hyperplasia of mammary glands.MethodFifty-eight patients with hyperplasia of mammary glands were randomized into a treatment group of 30 cases and a control group of 28 cases. The treatment group was intervened byelectroacupunctureplustopical laser treatment, while the controlgroup was by oral administration of Ru Zeng Ning tablets. The intervention began from 15 d prior to the menstrual period. After 3 successive treatment courses, the clinical efficacies were compared, and the efficacies in treating three different patterns of mammary glands hyperplasia were also compared, i.e. qi-stagnation due to liver depression, accumulation of phlegm and stagnation, and imbalance of the Thoroughfare and Conception Vessels.ResultAccording to the comprehensive efficacy evaluation, the total effective rate was 86.7% in the treatment group versus 57.1% in the control group, and the difference was statistically significant (P<0.05). The efficacy of the treatment group in treating the pattern of qi-stagnation due to liver depression was significantly higher than that in of the control group (P<0.05); there were no significant differences in comparing the efficacies in treating the types of accumulation of phlegm and stagnation and imbalance of the Thoroughfare and Conception Vessels between the two groups (P>0.05).ConclusionElectroacupunctureplustopical laser treatmentis effective in treating hyperplasia of mammary glands, especially for the type of qi-stagnation due to liver depression.

Objective: To analyze the influencing factors of whole blood colloid osmotic pressure (COP) and predict reference range of plasma protein for safe COP to guide clinical infusion of protein in critically ill patients. Methods: Physical data and blood gas analysis of 405 patients were collected. hTe patients were divided into 2 groups by COP: group A (COP≤18 mmHg) and group B (COP>18 mmHg). The serum proteins including total protein (TP), albumin (Alb), globumin (Glb) and ifbrinogen (FIB) were detected. Results: APACHE II of group B was signiifcantly lower than that of group A (P<0.05). hTe survival rate, TP, Alb, Glb and FIB of group B were significantly higher than these of group A (P<0.05).Standardized regression coeffcient of Alb, Glb and FIB was 0.518,0.283 and 0.113 (P<0.05); the 95% reference range of 4 types of protein level in group B: Alb>23.3 g/L,Glb 12.6-37.6 g/L and FIB 1.3-8.7 g/L; 5 reformed equations were made. Conclusion: The main influencing factors of COP include Alb, Glb and FIB. We can use the reference range of 4 types of protein level to guide the clinical management of protein agents, and reformed equations can be used to preliminarily forecast COP in critically ill patients.

Viral encephalitis is infectious diseases caused by many kinds virus which infects the brain and produces a series of clinical manifestations,it is an common disease in children.Rhabdomyolysis is a sort of syndrome characterized by striated muscle necrosis and the release of intracellular muscle constituents into the circulation,most notably high level of creatine phosphokinase and myoglobin,and myoglobi-nuria,which is often complicated with acute renal failure.It was reported that rhabdomyolysis could be associated with many viral encephalidities,the clinician should pay attention to this condition because it was not rare especially,when hematuria appearred in the course of viral encephalidities,serum creatine phosphate kinase,serum and urine myohemoglobin should be detected to identify whether rhabdomyolysis was existed.Once the diagnosis was confirmed,it should be treated with fluid administration and basification in order to avoid acute renal failure,and to improve prognosis on these patients.This study reviewed the literature on viral encephalidities and rhabdomyolysis.

Objective To observe the central nervous system(CNS)damage in children with mycoplasma pneumoniae pneumonia(MPP)and explore its mechanism.Methods A total of 325 cases of MPP were selected to investigate the incidence of CNS damage,and the levels of IL-8,IL-18 and soluble interleukin-2 receptor(sIL-2R)in both serum and cerebrospinal fluid(CSF)were detected in those patients with CNS complications.Children with viral encephalitis at hospital during the same period were taken as control group.Use SPSS 12.0 software to analyze the data.Results There were 22 cases(6.8%)of MPP who had CNS complications,presented mainly with fever,vomiting,headache and convulsion.The levels of IL-8,IL-18 and sIL-2R were higher in MPP patients who had CNS complications than those in control group,especially the level of IL-18 and sIL-2R in CSF(Pa

Doctor′s license for multi-sited service is an important part of hierarchical diagnosis.Aiming at the requirements and management in Guangdong medical reform, this essay clarified the situation and restriction factors when Doctor′s license for multi-sited service was carried out and gave some suggestions under the current conditions.

Objective: This study was designed to identify the influence of age and comorbidity on the treatment strategies and survival time of the elderly patients(≥70 years) with advanced (stage III B or IV) non-small cell lung cancer (NSCLC). Methods: The clinical characteristics, treatment strategies and survival features of 127 elderly patients with a good performance status (PS≤1) were retrospectively analyzed. They were diagnosed as NSCLC and received chemotherapy in our oncological department between January 2005 and December 2005. These patients were stratified by age into two groups: 70-74 years group and ≥75 years group; and divided into three groups based on the degree of comorbidity: no comorbidity (0), mild comorbidity (1-2) and severe comorbidity (≥3) groups. Their relationship with clinical features, treatment strategies, and survival time was analyzed. Results: More than 50% patients in 70-74 years group (51.2%) were treated with cisplatin-based combination therapy, while only 20.6% patients in ≥75 years group received cisplatin-based combination therapy (P=0.003). There were 37.0% patients in the severe comorbidity group received palliative radiotherapy, which was significantly higher than that of the no or moderate comorbidity groups (21.7% and 11.7%, P=0.014). In 70-74 years group and ≥75 years group, the 1-year survival rate was 41.4% and 35.3% (log-rank, P=0.319). In no, mild and severe comorbidity group, the 1-year survival rate was 53.5%, 41.3%, and 20.8%, respectively (log-rank, P=0.071). In univariate and multivariate COX model analyses, age and mild comorbidity did not increase the risk of survival, but severe comorbidity was an independent risk factor for the survival of elderly patients with NSCLC; the relative risk ratio (95% confidence interval) was 2.09 (1.06-4.15) and 2.56 (1.18-5.76) (P=0.034 and 0.023). Conclusions: Different treatment strategies should be given to elderly patients with advanced NSCLC according to the age or the degree of comorbidity. Severe comorbidity is an independent risk factor for survival of elderly patients with advanced NSCLC.

Objective: To observe the influence of ischemia-reperfusion (I/R) on hepatoma growth and on the expression of genes associated with tumor metastasis and recurrence (VEGF and MMP-9) in the adjacent tissues of cancer in nude mice. Methods: BALB/c nude mouse model bearing Hep3B-tumor in the liver was established and the model mice were evenly randomly into 5 groups: sham group and ischemia/reperfusion 1 h, 6 h, 5 d, and 7 d groups (n = 8). I/R models were established by blocking porta hepatic; the sham group underwent the same treatment as the I/R model group except for blocking of porta hepatic. ALT and AST were detected in I/R 1 h and 6 h groups. Real-time-PCR was employed to detect the change of VEGF and MMP-9 in the adjacent tissues of cancer and the results were compared with that of the control group (n = 6). Histopathological changes of liver were studied by H-E staining and necrotic areas were calculated in I/R 5 d and 7 d groups (n = 6). The remnant tumor bearing mice were sacrificed 2 weeks after I/R to measure the volume and mass of the tumors. Results: Two weeks later, the tumor volume and mass in I/R group were increased compared with those in the sham group ([209.6 ± 25.74] mm3 vs [330.6±32.01] mm3, [0.214±0.036] g vs [0.374±0.045 g, P<0.01). Levels of ALT and AST were significantly elevated in I/R 1 h and 6 h groups compared with those in the sham group (P<0.01). H-E staining showed that the infiltration of inflammatory cells around the tumors and the areas of necrosis became more prominent 5 days after I/R compared with the sham operation group (P<0.05). The necrosis area was reduced 7 days after I/R compared with 5 days after I/R (P<0.05); however, the necrosis area was replaced by invasion of tumor cells (P<0.05). It was found that the expression of VEGF and MMP-9 mRNA was higher in the adjacent tissues of cancer after I/R than that in the sham group (P<0.01), and the expression of the 2 was correlated with each other (r = 0.418, P<0.01). Conclusion: I/R induced by blocking porta hepatic can accelerate tumor cell growth and promote expression of VEGF and MMP-9 in the adjacent tissues of cancer.

Objective To explore the distribution of high-arsenic water in Shaanxi Province in order to provide theoretical basis for the control of arsenism.Methods The contents of arsenic of 4042 water sampled from 1898 nature villages in 12 counties were assessed using semi-quantitative reagent-knit,and the water samples of Shanyang County,the targeted area,was quantified using quantitative atomic fluorescent speemetry.Results The contents of arsenic of 6 water samples in 2 villages exceeded 0.05 mg/L,accounting for 0.15%(6/4042),were 0.46,0.53,0.63,0.69,0.74,1.53 mg/L,respestively,and located in Shanyang County.A crowd of 1146 exposed to hish asenic water.among whom 555 were children.Conclusions Arsenic in drink water in Shanyang County in Shaanxi Province is higher than the standard,to which a large number of people are exposed,water-improving and defluoridotion must be carried out as soon as possible,reduces harm of high arsenic.