Objective To systemically analyze the effect of continuous aspiration of subglottic suction (CASS) on the incidence of ventilator-associated pneumonia (VAP) and other outcomes in mechanical ventilated patients.Methods PubMed,Cochrane Library,Ovid,EBSCOhost,ScienceDirect,Google scholar,CNKI,CBM and Wanfang Database were searched for the RCTs about the effect of CASS on the outcomes of mechanical ventilated patients from July 1994 to July 2014,and the relevant journals were also hand-searched.Data were extracted independently by two reviewers.Meta analysis was conducted using RevMan 5.1 software.Results Data extracted from 7 RCTs with a total of 1 566 patients were analyzed.The risks of developing clinically diagnosed VAP were significantly lower among the patients receiving CASS [RR =0.54,95％ CI(0.43,0.65),P＜0.01],episodes of VAP occurred later in patients receiving CASS [MD=3.52,95％CI(1.98,5.06),P＜0.01],the duration of mechanical ventilation [MD=-2.03,95％CI(-2.23,-1.73),P＜0.01]and length of ICU stay were reduced [MD=-2.99,95％CI(-3.75,-2.23),P＜0.01],while no significant differences were detected between the two groups regarding the mortality rate [RR=0.98,95％CI (0.80,1.20),P＞0.05].Conclusion This study proved that the CASS did have effect in reducing the incidence of VAP,but it is limited by lack of enough RCTs with high quality.Large sample of high quality RCTs is necessary to examine the wider applicability of CASS.

Objective To describe the burden of caregivers of children with asthma,and to provide reference for the development of family care support program.Methods Qualitative research was used to carry out semi-structured interviews with 13 caregivers of children with asthma in the pediatric outpatient of the First Affiliated Hospital of Guangzhou Medical University.The data collected were analyzed with Colaizzi 7-step analysis method.Results The carcgiver burden was classified into 4 themes,including time and energy exhaustion,heavy economic burden,insufficient knowledge of care and negative emotions.Conclusions The burden of caregivers of children with asthma has a relatively great impact on the daily work and life,even the physical and mental health.Care workers should be concerned about the status of caregiver burden and provide targeted interventions,which could help caregiver adapt to their roles,maintain and promote the health of children patients and their families.

Objective To evaluate the therapeutic effects of ultrasound biomicroscopy (UBM) assisted intraocular lens suspension surgery with one loop suturing for residual lens capsule aphakia.Methods Fifty aphakia patients (50 eyes) with residual lens capsular equal or greater than 180 degrees were chosen.The patients were randomly divided into 2 groups and underwent intraocular lens suspension surgery with one loop suturing:Trial group (25 cases,25 eyes) selected suture site according to the preoperative UBM results,and control group (25 cases,25 eyes) selected the suture site according to the clinical experience.The uncorrected visual acuity (UCVA),astigmatism at preoperative and postoperative 1 week,1 month and 3 months were observed,the eccentric and tilt value of the lens were calculated by UBM measurement at 3 month after operation,and the postoperative complications of the two groups were observed.Results UCVA at each time point after operation were higher than that before operation,and gradually increased with time.There was no significant difference between the two groups at 1 week before and after the operation of UCVA (P ＞ 0.05).At 1 month and 3 months after operation,UCVA in trial group were significantly higher than those of control group (all P ＜ 0.05).The astigmatism value at 1 week after operation in two groups was higher than that before operation and gradually decreased with time.The astigmatism value in trial group at 1 month and 3 months after operation had no significant difference with that of preoperative (P ＞ 0.05),while the astigmatism value in control group increased (all P ＜ 0.05).The astigmatism values had no significant difference between the two groups before and 1 week after operation (all P ＞0.05),which were significantly lower in trial group at 1 month and 3 months after operation (all P ＜ 0.05).Three months after surgery,the proportion of lens accurately implanted in the ciliary sulcus was significantly higher than control group (P ＜ 0.01),the eccentric and tilt values of the lens in trial group were significantly less than control group (P ＜ 0.01).No serious complication was observed in all patients.Conclusion UBM assisted intraocular lens suspension surgery with one loop suturing can significantly improve the postoperative visual quality,safety and lens stability,which can be used as a routine preoperative examination of intraocular lens suspension surgery.In addition,UBM provides an alternative method for the calculation of the eccentricity and tile value of the intraocular lens after the implantation of the intraocular lens.

Objective To evaluate the effectiveness of clinical pathways for pediatric asthma.Methods The literatures on the application of clinical pathways for pediatric asthma were collected in the databases such as PubMed,Cochrane Library,Ovid,ScienceDirect,EBSCOhost,CNKI,Wanfang and CBM while a manual search was added.The search was performed from 1980 to 2014.Two reviewers independently screened references,extracted data and assessed the risk of bias.Data was pooled and analyzed by using Revman 5.2 version.Results Eleven studies involving 2 207 participants from nearly 1 048 relevant studies met the inclusion criteria.1 174 participants were in the clinical pathway group while the other 1 033 participants were in the control group.Meta-analysis result showed that patients with asthma in a clinical pathway had a shorter length of stay,less medical cost,reduced rate of emergency room visits,and improved health education.However,clinical pathway did not appear to reduce readmission.Conclusions Clinical pathway can significandy reduce the length of hospital stay,cost,rate of emergency room visits and improve health education.

Resident standardization training is an important means of clinical physician training in our country. Critical care medicine has important status in the training process. It is the important link to ensure the quality of resident standardization training. Residents should grasp the identification and early detection of critical ill patients. Residents should also get the ability of general basic management for critical condition and the doctor-patient communication ability. In practice, we have explored the training mode of standardized training of resident doctors in critical care medicine by developing detailed training outline, a variety of teaching methods and emphasizing the cultivation of clinical work ability.

Objective To investigate the predictive factors and prognosis of early intrahepatic recurrence after curative resection of hepatocellular carcinoma(HCC).Methods Clinicopathological dats of 184 HCC patients with intrahepatic recurrence after curative resection were collected.Thirteen clinicopathological factors and prognosis after recurrence were retrospectively analyzed. Results Univariate analysis showed that preoperative scrota alpha-fetoprotein(AFP)>100 ng/ml,tumour size>5 cm,venous invasion and intra-operative blood transfusion were predictive factors of early intrahepatic recurrence,and selum albumin<35 g/L was marginally predictive factor.Multivariate analysis showed that serum AFP>100 ng/ml,tumour size>5 cm and venous invasion were independent predictive factots of early intrahepatic recurrence.The survival of patients suffering from early recurrence was significantly shorter than those with late recurrence.with median survival period of 12 mos vs 18 mos(P=0.012).Conclusion Serum AFP,tumour size and venous invasion were independent predictive factors of early intrahepatic recurrence in HCC patients after radical resection of the primary tumor.Early intrahepatic recurrence implies poor prognosis.

OBJECTIVETo study the arbuscular mycorrhiza and arbuscular mycorrhizal fungi associated with cultivated and wild Pinellia ternata in Guizhou province.

METHODWild and cultivated P. ternata roots were observed through staining and microscopic examination, the arbuscular mycorrhizal fungi spores were isolated through wet thieving according to Gerdemann & Nicolson (1963), the spores were identified following the description of Schenck & Pérez (1988), and some previous publications.

RESULTThe typical arbuscular mycorrhiza (AM) structure was showed according to a research of wild and cultivated P. ternata. In the survey of AM fungi species in the rhizosphere of wild and cultivated P. ternata, 3 genera and 21 species were found, 3 genera and 7 species were identified. 5 species of them belong to Glomus, 1 species belongs to Scutellospora, 1 species belongs to Gigaspora, including Glomus mosseae, G. intraradices, G. melanosporum, G. deserticola, G. aggregatum, Scutellospora castanea, Gigaspora albida, and one of them was a new record, i.e., Scutellospora castanea which was the dominant species in Bijie.

CONCLUSIONThe diversity of AM fungi between wild and cultivated Pinellia ternata was showed on this survey, the fungi associated with wild ones are different form the cultivated ones, such as Gigaspora albida only occurs in cultivated ones, Glomus melanosporum only occurs in wild ones, while Glomus mosseae and Glomus intraradices occur in both wild and cultivated ones, and there were specialization species in Bijie, all these can provide new though for solving degradation problem of cultivated Pinellia ternata.

Biodiversity ; Fungi ; classification ; cytology ; isolation & purification ; Mycorrhizae ; classification ; cytology ; isolation & purification ; Pinellia ; microbiology ; Plant Roots ; microbiology ; Soil Microbiology ; Spores, Fungal ; classification ; cytology ; isolation & purification

Objective To investigate the effect of the second resection for unsuspected gallbladder carcinoma discovered after cholecystectomy.Methods A retrospective clincopathological analysis was conducted for 45 cases of unsuspected gallbladder carcinoma receiving second operation at our hospital from January 2000 to December 2010.Result Of the 45 cases with unsuspected gallbladder carcinoma (33 pT2,12 pT3 ),40 cases received second radical reeection of the liver bed with lymph dissection; the remaining 5 cases received palliative operation.Amongst 45 patients lymph metastasis (4 pT2,6 pT3 ) was found in 10 cases,liver metastasis ( 2 pT2,1 pT3 ) in 3,parietal seeding in 1 ( pT3 ) and distant metastasis ( pT2 ) in one.The 5 patients receiving palliative operation died in 3 ～ 8 months and 40 patients receiving the radical operation achieved long-term survival ( 40.4 ± 2.7 months) after the operation.The effect of second operation which was done within 4 weeks after the first cholecystectomy was better than that of the operation done beyond 4 weeks ( survival time 37.1 ± 2.2 vs 22.4 ± 5.8months).Conclusions Radical resection for unsuspected gallbladder carcinoma discovered after the initial cholecystectomy helps improve prognosis and prolong patients survival time.

Objective To investigate long-term data of dry eye after LASIK in young myopia patients.Methods Young myopia patients were divided into treated group (group A) and control (group B),who were interviewed before surgery and on 1 year,3 years and 5 years after surgery.Their diopters,uncorrected visual acuity (UCVA),tear breakup time test,Schirmer I test and corneal fluorescent staining were taken,then dry eye was diagnosed and OSDI questionnaire were scored.Results The postoperative incidence of dry eye in group A was higher than that before surgery (35.6％) and decreased with time (51.7％,44.9％ and 40.7％,respectively),and there was no significant difference in group B at each time point (P ＞ 0.05).The preoperative incidence of dry eye was equal between two groups (P ＞ 0.05),which were much higher in group A after surgery (all P ＜ 0.05).In group A,the postoperative constituent ratio of mild dry eye was the majority and decreased with time (65.6％,52.8％,41.7％,respectively),while moderate and severe dry eye was increased,especially the latter (6.6％,11.3％ and 16.7％,respectively;P ＜ 0.05).At 5 years after surgery,the UCVA and visual function score in dry eye patients were lower than those of non-dry eye patients (all P ＜ 0.05),while the residual refraction and ocular symptom score were higher than those of dry eye patients (all P ＜ 0.05).Conclusion Dry eye disease may last for a long time and may getting worse after LASIK.Therefore,we should pay more attention to the development of dry eye long after LASIK in young myopic patients.