Objective To investigate the impacts of Xuebijing injection on systemic inflammatory response and immune function of patients with acute exacerbation of severe chronic obstructive pulmonary disease (AECOPD). Methods A prospective randomized controlled trial (RCT) was conducted. Forty patients with severe AECOPD were divided into control group and Xuebijing group in accordance with the random number table, each group 20 cases. Both groups were treated by routine conventional basic therapy of severe AECOPD including anti-infection, phlegm-expelling formula, bronchodilators and mechanical ventilation, etc, while in Xuebijing group, intravenous drip of Xuebijing (100 mg, twice a day for 5 days) was additionally used. The changes of data of arterial blood gas analysis, blood routine examination, C-reactive protein (CRP), procalcitonin (PCT), immune function, and acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score before and after therapy were observed and compared between the two groups. The length of stay in hospital, duration of mechanical ventilation, and prognosis were also compared between the two groups. Besides, according to the difference in APACHE Ⅱ score, all the patients were divided into APACHEⅡscore≥15 score group (18 cases) and APACHEⅡscore<15 score group (22 cases), and the immune function were compared between the two groups. Results ①The immune function was descended and disordered in patients with severe AECOPD. Compared with the < 15 score group, the expressions of CD45+, CD3+, CD4+, CD4+/CD8+ ratio, B-lymphocyte, natural killer cell (NK cell) in ≥ 15 score group were significantly lowered [CD45+(×106/L):663.92±100.61 vs. 1 289.92±169.38, CD3+(×106/L):342.05±108.93 vs. 882.37±172.56, CD4+(×106/L):205.96±63.97 vs. 486.24±108.64, CD4+/CD8+ratio:0.76±0.49 vs. 1.32±0.57, B-lymphocyte (×106/L):124.77±32.72 vs. 166.06±48.02, NK cells (×106/L): 186.47±39.57 vs. 243.51±44.72, all P < 0.05]. There was no statistically significant difference in the expression of CD8+ between the ≥ 15 score group and < 15 score group (P > 0.05). ② Compared with those before therapy, the pH value, oxygenation index, arterial partial pressure of carbon dioxide (PaCO2), white blood cell count (WBC), CRP, PCT were significantly improved after therapy in both control and Xuebijing groups. Compared with those in the control group, WBC, CRP, PCT were significantly lowered in Xuebijing group [WBC (×109/L): 10.29±3.83 vs. 12.69±3.42, CRP (mg/L): 9.06±4.19 vs. 15.26±4.22, PCT (ng/L): 0.18±0.21 vs. 0.42±0.24, all P < 0.05]. There were no statistically significant differences in pH value, oxygenation index and PaCO2 between two groups (all P>0.05). The degrees of improvement of CD45+, CD3+, CD4+, CD8+ and CD4+/CD8+ ratio were more remarkable in Xuebijing group after treatment than those in control group [CD45+ (×106/L): 1 079.38±153.86 vs. 1 015.63±157.11, CD3+ (×106/L): 652.05±100.05 vs. 596.81±106.85, CD4+ (×106/L): 358.92±67.53 vs. 329.99±72.61, CD8+ (×106/L): 205.73±35.19 vs. 230.41±39.74, CD4+/CD8+ratio: 2.16±0.63 vs. 1.52±0.54, all P < 0.05]. The B-lymphocyte and NK cell before treatment and after treatment showed no statistical significant differences between the two groups (all P > 0.05). Compared with the control group, the duration of mechanical ventilation (hours: 56.25±22.87 vs. 69.45±26.59) and the length of stay in hospital (days: 11.00±0.74 vs. 14.00±2.06) were shortened, and APACHE Ⅱ score was significantly lowered in Xuebijing group (8.21±2.97 vs. 12.08±3.12, P < 0.05). The numbers of multiple organ failure and dead patients in Xuebijing group were less than those of control group, but no statistical significant differences were found (both P > 0.05). Conclusion Xuebijing injection for treatment of patients with severe AECOPD can ameliorate inflammatory response, improve immune function, shorten the duration of mechanical ventilation and the length of stay in hospital, and decrease the risk of death.

Objective To understand the clinical distribution and drug resistance situation of112 strains of Acinetobacter Bau-mannii isolated from the patients′sputum samples in cerebral surgery ICU in order to provide the basis for the rational use of anti-bacterial drugs in clinical therapy.Methods 112 strains of Acinetobacter Baumannii were performed the retrospective analysis.The VITEK2-Compact automatic microbiological analyzer was adopted to conduct the bacterial identification and the drug susceptibility test and the K-B method was combined as the supplement control.The Whonet 5.6 software was used for conducting the statistical analysis.Results Among 112 strains of Acinetobacter baumannii,75 strains(67.0%)were multi-drug resistant,8 strains(7.1%) were pan-resistant.The antimicrobial susceptibility tests showed that the resistant rates of Acinetobacter baumannii to mezlocillin, piperacillin and nitrofurantoin reached up to 100%.Acinetobacter Baumannii had the lower resistant rate to polymyxin B (2.7%), the resistant rates to minomycin and ceperazone/sulbactam were 4.5% and 10.7% respectively.Conclusion The drug resistance phenomena of Acinetobacter Baumannii in the cerebral surgery department ICU is serious.Minomycin,polymyxin B and ceperazone/sulbactam have the better antibacterial activities to clinically isolated Acinetobacter Baumannii and may be the alternative drugs for therapy.Clinic should strengthen the monitoring and rationally use the antibacterial drugs.

Congenital adrenal hyperplasia(CAH) is a family of autosomal recessive disorders.The most frequent form of the disease is steroid 21-hydroxylase deficiency,which accounts for more than 90％ of all cases of CAH.In the pathogenesis of CAH,the cortisol synthesis impairement leads to excessive ACTH secretion of the adrenal glands,which ultimately results in adrenal hyperplasia and androgen overproduction.CAH causes signs of androgen excess including ambiguous genitalia in newborn females and rapid postnatal growth in both sexes.In the most severesalt wasting form of CAH,concomitant aldosterone deficiency may lead to salt wasting with life-threatening adrenal crises.Newborn screening,especially in males,reduces morbidity and mortality from adrenal crises.Glucocorticoid replacement remains the cornerstone of treatment.However,how to make a suitable therapeutic regimen of CAH is still a challenge to the pediatric clinician.

Objective To investigate the effect and prognosis of intensive insulin therapy on cerebral infarction combined with hyperglycemia.Methods Seventy cases of cerebral infarction combined with hyperglycemia were divided into two groups by random number table method.Thirty-five cases in control group,were treated with insulin,and the blood glucose was controlled ＜ 11.1 mmol/L; 35 cases in intensive group,were treated by insulin pump,and the blood glucose was controlled in 4.4-8.3 mmol/L.The degree of neurological damage and improvement of daily life in two groups before and after treatment was compared by National Institutes of Health Stroke Scale(NIHSS) and modified Rankin Scale(mRS) scores.Insulin dosage,the time for reaching the standard,incidence of hypoglycemia,pulmonary infection rate and fatality rate was recorded in two groups.Results The NIHSS and mRS scores between two groups before treatment had no statistical significance (P ＞ 0.05),and after 30 d treatment,the NIHSS and mRS scores in control group [(8.29 ±2.74),(2.96 ±0.74) scores] and intensive group [(6.83 ±3.16),(2.02 ±0.62) scores] were obviously improved compared with those before treatment,and the improvement in intensive group was better than that in control group (P＜ 0.05).In intensive group,the insulin dosage and the time for reaching the standard was less than that in control group [(36.40 ± 6.91) U/d vs.(51.70 ± 9.86) U/d,(4.30 ± 0.87)d vs.(6.60 ± 1.24) d],incidence of hypoglycemia and fatality rate was lower than that in control group[5.7％ (2/35) vs.25.7％ (9/35),0 vs.8.6％ (3/35)],the difference was statisticly significant (P ＜ 0.05),but the pulmonary infection rate between two groups had no statisticly difference (P ＞ 0.05).Conclusion The curative effect of intensive insulin therapy on cerebral infarction combined with hyperglycemia is better,and is helpful to the neural functional recovery.

It's known that ICU patients is in critical condition and might deteriorate rapidly,so it's important for them to get appropriate nutritional support in order to recover.We must make proper nutrition treatment plan for patients according to their different nutritional condition and potential risk.Nutritional risk screening can not only assess the nutritional status of children,is more likely to predict its potential nutritional risk,to guide nutritional support treatment plan,and ultimately improve the prognosis.Looking out for comprehensive,simple,fast,and easy nutritional risk screening tools as soon as possible and appropriate nutrition risk screening is significantly for growth and development as well as prognosis of ICU patients.

Objective To evaluate the levels of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP),high sensitive C-reactive protein (hs-CRP) and the correlation in the patients with actue coronary syndrome (ACS).Methods One hundred and eight patients with ACS as ACS group,while 84 healthy controls as control group.ACS group included non-ST-segment elevation myocardial infarction (NSTEMI) group (37 cases),ST-segment elevation myocardial infarction (STEMI) group (35 cases),unstable angina(UA) group(36 cases).Recorded and compared the levels of NT-proBNP and hs-CRP in two groups,and the correlation was analyzed.Results The levels of NT-proBNP and hs-CRP in ACS group were significantly higher than those in control group [(1264.8 ±671.8) ng/L vs.(337.0 ± 10.6) ng/L,(15.42 ± 8.03) mg/L vs.(6.92 ± 0.59) mg/L,P ＜ 0.05].The correlation between hs-CRP and NT-proBNP level was positive in ACS (r =0.46,P ＜ 0.05).The levels of NT-proBNP in NSTEMI group,STEMI group,UA group,control group,differences among groups were statistically significant (P ＜ 0.05).The levels of hs-CRP in NSTEMI group,STEMI group,UA group were significantly higher than those in control group (P ＜ 0.05).There was no statistically significant difference in the levels of NT-proBNP between STEMI group and UA group (P ＞0.05).And the levels of NT-proBNP and hs-CRP increased with the increasing of coronary artery lesion counts,the differences among groups were statistically significant (P ＜0.05).Conclusion ACS can be early diagnosed through combined detection of NT-proBNP and hs-CRP,and NT-proBNP and hs-CRP can be used as important makers to evaluate prognosis and risk stratification.

Objective To analyze the effect of blood glucose control level on prognosis in cerebral infarction with stress hyperglycemia.Methods Ninety-two cases of new cerebral infarction within 24 h with stress hyperglycemia were divided into control group (46 cases) and observation group (46 cases).The blood glucose was controlled in 4.0-6.0 mmol/L in control group and 6.1-8.3 mmol/L in observation group.The hypoglycemia rate,infection rate,fatality rate,NIHSS score and Barthel score was observed in two groups.Results In control group,there were 14 cases cured,19 cases significantly improved,12 cases improved and 1 case invalid,while in observation group,there were 11,17,15,3 cases respectively,and the difference was not statisticly significant (P ＞ 0.05).The hypoglycemia rate,infection rate,fatality rate was 19.6％(9/46),10.9％(5/46) and 2.2％(1/46) respectively in control group,while in observation group was 4.3％ (2/46),15.2％ (7/46) and 4.3％ (2/46) respectively.The hypoglycemia rate was different between two groups(P ＜ 0.05),but the infection rate and fatality rate was not statistic difference between two groups(P ＞0.05).The NIHSS and Barthel score was not different between two groups before treatment (P ＞ 0.05).In control group the NIHSS after 1 week and 30 days after treatment and Barthel score 30 days after treatment was (15.47 ± 7.78),(9.85 ± 6.47),(67.18 ± 20.24) scores respectively,in observed group was (16.01 ±7.49),(10.17 ±5.84),(65.82 ± 19.93) scores respectively,which was improved compared with that pretreatment,but there was no significant difference between two groups(P ＞ 0.05).Conclusion The blood glucose controlled in 6.1-8.3 mmol/L does not increase the infection rate and fatality rate,but can reduce the hypoglycemia rate and promote neural function recovery in cerebral infarction with stress hyperglycemia.

Objective To analyze the significance of higher vocational nursing students participating in opening professional social practice,and to explore the effective way of combining social practice with professional learning and clinical practice.Methods After completing the opening professional social practice in summer,the reflection diaries of 30 nursing students were analyzed and the concerns were refined.Questionnaire survey about self assessment of comprehensive effect of the practice of nursing students were conducted.Results Nursing operation and soft skills were mostly concerned by nursing students' in opening professional social practice.Vocational learning,occupation of responsibility,and the occupation ability were improved by practical activities.Conclusions Nursing students who participate in opening professional social practice before clinical work,can re-understand the professional learning,adapt and integrate themselves into clinical practice through the perception of clinical nursing work.

Autistic disorder is a severe neuropsychiatric disease and abnormal development in early childhood.The main clinical manifestations of autistic disorder are social interaction,language and behavior barriers.Currently,the incidence trend has showed increased year by year,the pathogenesis of autism has also been considerable development.This paper reviews the latest developments in autism,make excitatory/inhibitory neurotransmitter imbalances,nicotinamide metabolism and HPA axis dysfunction is the main pathogenesis of autism.

Objective To study the related risk factors and comparison between adenomyosis and uterine myoma in order to find the same and different ways of preventing adenomyosis and uterine myoma.Methods Clinical data of 200 cases of adenomyosis and 200 cases of uterine myoma were retrospectively analyzed.Results There was no significant difference in the incidence of different ages between adenomyosis and uterine myoma (P ＞ 0.05).There were significant differences in A blood type,family history,dysmenorrhea and using intrauterine device between adenomyosis and uterine myoma (85 cases vs.56 cases,9 cases vs.36 cases,163 cases vs.71 cases,104 cases vs.79 cases,P ＜ 0.05),but there was no significant difference in occupation,education,previous gynaecopathia inflammatory disease,age of menarche,menstrual cycle,menstruation,infertility,the first gestational age,parity,abortion numbers between adenomyosis and uterine myoma (P ＞ 0.05).Conclusions The adenomyosis and uterine myoma may be associated with the stimulation by high level of female hormone.Compared with uterine myoma,adenomyosis seems to be related to A blood type,dysmenorrhea and using intrauterine device.