To investigate the characteristics of acute respiratory distress syndrome(ARDS)in the casualties of a great earthquake in Wenchuan China on May 12,2008.Records of the hospitalized patients in ICU injured in the earthquakes were examined retrospectively.Among the total of 153 critical patients injured in the earthquake,52(34.0%)had ARDS.Among these 52 patients with ARDS,24(46.2%)had multiple organ dysfunction syndrome(MODS).9(17.3%)patients with ARDS dead.Approximate 34.0% of the casualties of a great earthquake in ICU had ARDS,MODS is a common associated conditions in these patients,infection phy a great role in these patients.

Objective To study the sensitivity and reliability of rat skin anaphylactoid test method, detect and evaluate the anaphylactoid reaction of traditional Chinese medecine injection. Methods The condition of rat skin anaphylactoid test was optimized by studying the influencing factors of sensitivity and reliability of test with C48/80 as a tool drug, Tween80, endotoxin, China cobra toxin, trichosanthin injection, Tanreqing injection and Xuesaitong injection were investigated. Results The best conditions of rat skin anaphylactoid test was as follows:intrademal inject the drug with insulin syringe, 50-100μL per point, immediately inject 0.5%Evans blue dye 1 mL though caudal vein, 15 min later, kill the rat by carotid artery bleeding, clip dorsal skin to do the test. With this method, Tween80, endotoxin, China cobra toxin and trichosanthin injection all can induce blue stain in rat skin. Tanreqing injection showed no blue stain at the clinical dose. Xuesaitong injection although can induce blue stain in rat skin at the clinical dose, but the results cannot exclude the interference of its pharmacological function. Conclusion The method is simple with short test cycle, less dose of test drug, high detection sensitivity and good reproducibility, but some drug can show false positive result due to its own property.

Objective:To explore the effect of tectorigenin on myocardial fibrosis(MF) in the rats and clarify the related mechanism,and to provide reference for its clinical application. Methods:Sixty Wistar rats were randomly divided into normal control group,model group,positive drug (capropril) control group, and low,middle,high doses of tectorigenin groups(n=10).Except normal control group, the rats in other groups were used to construct MF models by subcutaneous injection of 5 mg·kg -1·d -1 isoproterenol (Iso) for 7 d.The rats in tectorigenin groups and captopril group were intragastricly administrated with different doses of tectorigenin (25,50,100 mg·kg-1·d-1)and captopril(10 mg·kg -1·d -1) from the second day after modeling for consecutive 28 d.Bl-420E+ biological function experiment system was used to detect the heart function;Heart mass index (HMI) and left ventricular mass index (LVMI) were measured after experiment.UV detection was used to measure the levels of malondialdehyde (MDA) and the activities of superoxide dismutase (SOD) in myocardial tissue.Microplate reader was used to measure the activities of lactic dehydrogenase(LDH) and creatine kinase(CK) and the levels of nitric oxide (NO)in serum.ELISA were used to detect the levels of collagen typeⅠ(ColⅠ) and collagen type Ⅲ (Col Ⅲ) in myocardium tissue of the rats.The pathological changes of myocardium tissue of the rats in various groups were observed by HE staining.Results:Compared with normal control group,the HR of rats in model groups was increased,and the left ventricular systolic pressure (LVSP) was decreased(P<0.01);the HMI and LVMI were increased(P<0.05),the levels of MDA in left ventricular myocardial tissue was increased(P<0.01),and the activity of SOD was decreased,the levels of serum ColⅠ,Col Ⅲ and the activities of LDH , CK were also increased(P<0.01);the level of NO in serum was decreased(P<0.01).Compared with model groups, the HR were decreased,LVSP were increased, and HMI and LVMI of the rats in different doses of tectorigenin groups were decreased in a dose-dependent manner;the levels of MDA were reduced;the activities of SOD were increased in myocardium tissue,and the CK activities and the ColⅠ and ColⅢ levels were decreased(P<0.05 or P<0.01);the LDH activities in middle and high doses of tectorgenin groups were decreased(P<0.01);and the levels of NO in serum in different doses of tectorigenin groups were significantly increased(P<0.05 or P<0.01) .Conclusion:Tectorigenin could inhibit the MF induced by Iso in the rats, and its mechanism may be related to antioxidation,scavenging free radical and inhibition of collagen synthesis.

Objective To explore the constitution characteristics of patients with uterine fibroids.MethodsA total of 413 patients with uterine fibroids (patient group) and 413 healthy women (control group) were enrolled in this case-control study. All the participants were required to fill in a questionnaire on Chinese Medicine constitution.The frequency and percentage of indicators were calculated,and analysis of variance and Chi-square test were used to find difference between the two groups.Results The incidence of Qi-stagnation constitution in the patient group was higher than that in the control group (x2 =8.209,P ＜ 0.05 ). The incidence of menstrual abnormalities was increased in patients with constitution of Phlegm-dampness and Dampness-heat,Qi-stagnation and Blood-stasis.The detection rate of hypertension of the patient group was also significantly increased.ConclusionThe most common constitution of patients with uterine fibroid is Oi-stagnation.

Objective To investigate the relationship between the coagulation system status and the pulmonary hemorrhage in children with severe hand,foot and mouth disease(HFMD)and approach the clinical significance of early detection of coagulation function. Methods By prospective case design method,89 cases with HFMD admitted to Department of Critical Care Medicine of Hebei Provincial Children Hospital from July 2010 to July 2012 were enrolled. The children were divided into severe group(46 cases)and critical group(43 cases)according to the severity of disease,and the children in critical group were subdivided into survivor group(26 cases)and non-survivor group (17 cases). Forty-four healthy children with the same age and in the same period were served as healthy control group. The blood of children was collected immediately after admission for determination of blood routine, prothrombin time(PT),thrombin time(TT),activated partial thrombin time(APTT),fibrinogen(Fg),and D-dimer (DD). Results There were no significant differences in PT,TT,APTT and Fg among severe group,critical group and health control group(all P>0.05). The blood platelets count(PLT)in severe group and critical group was significantly lower than that in health control group(×109/L:245±130,237±156 vs. 389±120),while the DD was significantly higher than that in healthy control group(mg/L:0.34±0.67,0.41±0.08 vs. 0.24±0.13),and the DD in critical group was obviously higher than that in severe group(all P<0.05). The mortality rate in critical group was 39.5%,and there were no significant differences in PT,APTT,Fg,TT and PLT between survivor group and non-survivor group(all P>0.05),but the DD in non-survivor group was significantly lower than that in survivor group(mg/L:0.60±0.09 vs. 0.12±0.09,P<0.05). Conclusions In children with severe or critical HFMD, the coagulation factor and blood platelet were in a state of mobilization,mild consumption state with the existence of fibrinolytic inhibition,but without systemic bleeding tendency,therefore it is in a compensatory stage of disseminated intravascular coagulation(DIC),not the mechanism of pulmonary hemorrhage. The monitor of DD has its clinical significance in evaluations of the disease situation and its prognosis.

Acute intermittent porphyria(AIP) is a rare inherited metabolic disease that can cause severe and fatal acute attacks. This article shares the treatment and management of a severe AIP patient. It is proposed that (1) avoiding incentives is essential; (2) emotional problems easily overlooked should be paid attention; (3) long-term follow-up and patient education can improve the prognosis. The patient underwent renal biopsy during the remission period. We found a red-brown-yellow-white refractive index crystal under a polarized light microscope that had not been reported in the previous literature, which was speculated to be a porphyrin crystal.

OBJECTIVE：To provide refere nce f or the quality control and evaluation of rice-wine processed Coptidis Rhizoma decoction piece. METHODS ：Taking 17 batches of rice-wine processed Coptidis Rhizoma decoction piece from different manufacturers as samples ，HPLC method was adopted to determine the contents of 4 kinds of alkaloids as epiberberine ，coptisine， palmatine and berberine. The compound weights of epiberberine ，berberine，palmatine and berberine were calculated by the subjective and objective combination weighting method （AHP combined with variation coefficient ）. Then the quality evaluation method was used to evaluate the quality of decoction pieces combined with the appearance of decoction pieces and the contents of 4 alkaloids. The percent mass constant was calculated and the grade of rice-wine processed Coptidis Rhizoma decoction piece was classified. RESULTS ：According to the results of content determination of 4 kinds of alkaloids ，among 17 batches of samples ，a total of 13 batches of samples met the requirements of 2015 edition of Chinese Pharmacopoeia （part Ⅳ）. Mass constants of 13 batches of qualified samples were 10.03-26.96，and the percent mass constants were 37.20％-100％. If the percent mass constant ≥ 80％ of the sample was listed as the first-class product ，the sample with the percent mass constant between 50％-＜80％ was classified as the second-class product ，and the rest was listed as the third-class product ，therefore the quality constant of first-class product was ≥21.57，that of second-class product was 13.48-＜21.57，and that of third-class product was ＜13.48. According to the grading standard ，3 batches of 13 batches of qualified samples are classified as first-class products ，6 batches are classified as second-class products ，4 batches are classified as third-class products. CONCLUSIONS ：The established subjective and objective combination weighting method and quality constant method can more scientifically and reasonably classify rice-wine processed Coptidis Rhizoma decoction piece.

Objective: The aim of this study was to compare the efficacy and safety of metformin/thiazolidinediones (TZDs) / glucagon-like peptide 1 (GLP-1) analogs (triple therapy) with conventional glucose-lowering therapy(conventional therapy) for patients with type 2 diabetes and metabolic syndrome. Methods: A prospective randomized-controlled 26-week study was carried out. A total of 82 patients with type 2 diabetes and metabolic syndrome were randomized to receive either triple therapy protocal or just conventional therapy, altogether with 41 cases in each group. Results: HbA_1C value was significantly reduced in triple therapy group versus the conventional therapy group [(2.23±1.75)% vs (1.48±1.59)%, P<0.05]. Values of body mass index, waist circumference, and visceral fat area were significantly reduced in triple therapy group as compared to those of conventional therapy group [(2.50±1.81 vs 0.92±1.82)kg/m², (6.75±4.92 vs 1.66±3.25)cm, (24.10±19.10 vs 10.02±20.10)cm², all P<0.01, respectively]. Control rates of HbA_1C and fasting plasma glucose for triple therapy were higher than those for conventional therapy (both P<0.05). No hypoglycemia occurred in triple therapy group. Subjects receiving triple therapy experienced more frequent gastrointestinal side effects than those in conventional therapy group (18.87% vs 3.92%, P<0.05). The most common side event was mild nausea (90%). Conclusion Combination therapy with metformin/TZDs/GLP-1 analogs had statistically significant advantages in the control of body weight, waist circumference, and visceral fat area in addition to the control of blood glucose over conventional glucose-lowering therapy in our patient cohort, it seems to be an optimized therapeutic regimen for patients with type 2 diabete and metabolic syndrome.

Objective    To investigate the correlation between lung ultrasonography and pulmonary complications after cardiac surgery. Methods    Fifty-two patients after cardiac surgery in our hospital from January to May 2017 were recruited. There were 27 males and 25 females, aged 60.50±10.43 years. Lung ultrasonography was performed by specially trained observers, video data were saved, and lung ultrasound score (LUS) were recorded. The correlation between the LUS and the patients' pulmonary function was evaluated. Results    LUS was 17.80±3.87, which was negatively correlated to the ratio of arterial PO2 to the inspired oxygen fraction (PaO2/FiO2) during examination, without significant difference (r=–0.363, P=0.095), but significantly negatively correlated to PaO2/FiO2 changes 24 hours postoperatively (r=–0.464, P=0.034). Conclusion    The changes of lung ventilation area may occur earlier than the changes of lung function. Bedside LUS is an effective method for clinical monitoring of pulmonary complications.