Objective To study the clinical effect of the treatment of patients with bronchial dilation in the treatment of patients with the combination.MethodsWenzhou Hospital of integrated traditional Chinese and Western Medicine in March 2013~July 2015 diagnosed and treated with bronchial dilation and infection of 72 cases of elderly patients, according to the random number table method is divided into the study group and the control group, each group of 36 people.Two groups were given conventional intervention of bronchial dilation.The control group in the conventional intervention based on the given first cell risperidone sulbactam sodium and ambroxol intravenous injection treatment.The study group in the control group on the basis of the implementation of the whole treatment plan based on bronchial alveolar lavage and local administration of rice.Compared with the two groups, the main symptoms and signs of the total improvement time, blood gas indicators before and after treatment.ResultsThe study group cough sputum, fever and chest X-ray shadow the significant remission time were significantly faster than that of the control group (P<0.05).After treatment, two groups above the index of blood gas analysis were group than before treatment significantly improved (P<0.05) study group on each index improved significantly better than the control group (P<0.05).ConclusionAged bronchiectasis infection patients given according to for etimicin plus bronchoalveolar lavage can be more significant to promote the improvement of patients with respiratory symptoms and signs, curb inflammation.At the same time, the index of blood gas and respiratory function in patients with more significant.

Objective To study and establish the quantitative analysis method for verbascoside ,luteolin and apigenin in Siphono-stegia chinensis by HPLC .Methods HPLC was performed on Kromasil C18 (4 .6 mm × 250 mm ,5 μm) ,the mobile phase consisted of acetonitrile and water(containing 0 .1% phosphoric acid) at a flow rate of 1 .0 mL/min .The column temperature was set at 35℃ ,and the eluate was detected at 340 nm .Results Quantitative analysis of HPLC showed that the linear ranges of verbascoside , luteolin and apigenin were 0 .197 6~1 .482 μg (r=0 .999 8) ,0 .100 8~0 .756 μg (r=0 .999 7) ,0 .043 2~0 .324 μg (r=0 .999 7) respectively .The average recovery of verbascoside ,luteolin and apigenin were 99 .7% (RSD= 2 .0% ) ,99 .5% (RSD = 2 .3% ) , 99 .4% (RSD=2 .2% ) respectively .Conclusion The method is accurate ,feasible and reliable ,therefore it′s available for the quality control of Siphonostegia chinensis .

Objective To investigate the relationship between the expression of trannsient receptor potential vanilloid 1 (TRPV1) and the severity of airway remodeling in elderly patients with chronic obstructive pulmonary disease(COPD).Methods According to airflow obstruction severity,totally 100 cases of elderly patients with COPD were divided into chronic obstructive pulmonary disease Global Initiative(gold) grade 1 in 23 cases,24 cases of grade GOLD2,GOLD3 27 cases,GOLD4 26 cases,respectively.The TRPV1 concentrations in induced sputum supernatant and serum from each level of elderly patients with COPD as well as in 50 cases of healthy old people were analyzed.Results TRPV1 concentrations in serum and induced sputum in the COPD group was significantly increased compared with the healthy elderly group[(9.94±2.91)μg/L vs.(3.68±0.46)μg/L,(3.29± 1.32)μg/L vs.(0.70 ± 0.30)μg/L] (P ＜ 0.01).The serum and induced sputum TRPV1 concentrations in the mutual pairwise comparison between the elderly COPD patients with all levels had statistical difference (P ＜ 0.01).Conclusion The expression of TRPV1 protein become increased with the severity of airway remodeling in elderly patients with chronic obstructive pulmonary disease.

Objective To explore etiological factors, clinical characteristic and diagnosis of acute recurrent pancreatitis (ARP). Methods Clinical data of 68 patients with ARP from Jan. 2003 to Dec. 2009 were reviewed retrospectively. Results Among 532 acute pancreatitis (AP) cases, 68 were diagnosed as ARP ( 12.8% ). The majority of ARP patients were male, amounting 76.5% of the total. The average age of ARP patients was 45.6 years. Cholelithiasis, hyperlipemia and alcohol were the most frequent factors causing ARP. Among the 68 ARP cases, 58 cases were mild (85.3%) and 10 cases were severe ( 14. 7% ). 54 cases underwent surgery or endoscopic treatment (79.4%) while 14 cases underwent non-operative treatment (20.6%). As a result, 66 cases were cured or improved and 2 cases with severe ARP died. Conclusion The key to reduce recurrent rate of ARP is to find out the causes of recurrence and then treat the diseases accordingly.

Objective To investigate the causes of repeated operations in patients with biliary diseases.Methods The clinical data of 265 patients who received repeated operations at the Jinshan Branch of Shanghai Sixth People's Hospital from January 2005 to June 2011 were retrospectively analyzed.The causes of repeated operations were analyzed. The first reoperation aimed at removing the calculi completely,repairing the injured biliary ducts and managing malignant tumors. The primary surgical procesures of the first reoperation included choledochotomy + T tube drainage,choledochotomy + Roux-en-Y choledochojejunostomy,endoscopic retrograde cholangiopancreatography + endoscopic sphincterotomy,choledochotomy + hepatectomy + T tube drainage or Rouxen-Y choledochojejunostomy,choledochotomy + biliary-endo-drainage,end-to-end anastomosis of bile duct + T tube drainage,radical or palliative resection of tumor,endoscopic biliary stent drainage or exploratory laparotomy.The second and multiple reoperations aimed at reconstructing the passage for biliary drainage. All data were analyzed using the chi-square test.Results A total of 69.8％ (120/172) of patients who had recurrent or retained calculi received first reoperation,which was significantly higher than 31.2％ ( 29/93 ) of those who received second or multiple reoperations (x2 =36.51,P ＜ 0.05 ).A total of 58.1％ (54/93) of patients who had benign stenosis of bilioenteric anastomosis received multiple reoperations,which was significantly higher than 4.1％ (7/172) than those who received first reoperation (x2 ＝ 99.32,P ＜ 0.05 ).Of the 265 patients,46 had complications.The incidence of complications of patients who receive first reoperation was 10.5％ ( 18/172),which was significantly lower than 30.1％ (28/93) of patients who received second or multiple reoperations ( x2 =13.61,P ＜ 0.05 ).Six patients died of hemorrhagic shock or multiple organ syndrome dysfunction postoperatively.The mortality rates for patients who received first reoperation and second or multiple reoperations were 1.7％(3/172) and 3.2％ (3/93),respectively,with no significant difference ( x2 ＝ 0.59,P ＞ 0.05 ).Conclusions The causes for reoperation of biliary disease are muhifactorial.Full assessment of the status of biliary diseases and ample preperation preoperatively,careful operation and precise and rational selection of operative procedures are keys to decrease the reoperative rates and perioperative complications.

Objective To investigate the distribution of biliary bacteriology and their sensitivity to antibiotics in patients with biliary tract infection in Jinshan area in recent 3 years.Methods Bile specimens collected from 367 patients with cholelithiasis between June 2006 and June 2009 were cultured and tested for drug sensitivity to aerobic bacteria.The results were statistically analyzed.Results One hundred and fifty-six bacterial strains were found in 142 (38.7%) bile specimens including gram negative strains (97,62.2%),gram positive strains (51,32.7% ),and fungal strains (8,5.1%).Enterococcus (17.9%) was major pathogen and follwed by Escherichia coli (12.8%),staphylococcus (11.5%),Klebsiella pneumoniae (8.3%),Pseudomonas aeruginosa (7.7%).Whereas the mixed infection was found in 26 (18.3%) specimens.The positive rate of bacterial infection was 53.1% in patients over 60 years of age (X2=8.36,P<0.01 ) and 47.1% in patients with acute biliary infection(X2=4.68,P<0.05).The drug susceptibility revealed that gram negative strains had low resistance to Meropenem (7.5 %),and followed by Imipenem (8.8 %),Cefoperazone +Sulbactam (19.7%),Amikacin (21.9%) and Tazobactam+Piperacillin (TZP,25.3%),but they were highly resistant to Ampicillin,Quinolones and some third generation of Cephalosporins (>50% ).In gram positive strains,none was resistant to Vancomycin,11.3% to fosfomycin and 11.6% to chloromycetin.They were highly resistant to Penicillins,Ampicillin and Cefazollin (>40%).ConclusionsEnterococcus,Escherichia coli,Sstaphylococcus and Klebsiella pneumoniae are commonly seen pathogens in biliary tract infection in Jinshan area.Use of Sulperazone or TZP plus Amikacin and metronidazole is recommended.Imipenem and Vancomycins may be second choice in treatment of severe biliary infection and refractory infection.

Objective To evaluate the clinical outcomes of split fractures of humeral greater tuberosity treated by our self-designed new type of anatomical locking plate.Methods From September 2012 to February 2017,23 patients were treated for acute split fracture of the humeral greater tuberosity using our self-designed new type of anatomical locking plate.They were 13 males and 10 females with a mean age of 52.8 years (range,from 25 to 81 years).Of them,6 were beyond 60 years old, 12 had comminuted fracture,10 were complicated with glenohumeral dislocation,and 12 with rotator cuff tear.The patients were evaluated clinically with Constant-Murley score,visual analog scale (VAS),range of motion and complications at the last follow-ups.Results This series were followed up for 12 to 30 months (mean,23.2 months).All the fractures healed after an average time of 10.6 weeks (range,from 8 to 12 weeks).Their mean Constant-Murley Score was 92.1 points (range,from 70 to 100 points),giving an excellent and good rate of 95.7％ (22/23);their VAS scores averaged 0.8 points (range,from 0 to 4 points).Their forward flexion averaged 160.6°,abduction 157.8°,external rotation 46.4°,and internal rotation up to the T11 level,respectively.Their complications rate was 17.4％ (4/23).One case of axillary nerve injury,one case of relapse of glenohumeral dislocation at sports,and 2 cases of stiff shoulder were observed.Conclusion Split fractures of the humeral greater tuberosity can be successfully treated with our new type of anatomical locking plate which serves as a new alternative treatment.

Objective: To discuss the correlation between the effect of vitamin D treatment and vitamin D binding protein gene polymorphism in elderly patients with stable chronic obstructive pulmonary disease(COPD). Methods: A total of 800 elderly patients with stable COPD admitted to the four Departments of Respiratory Medicine of four Wenzhou Hospitals were enrolled from September 2016 to November 2018.Because of the drop-out during follow-up, there were final 776 patients in our prospective research.According to the GC gene type, patients were divided into the GC1F-1S(n=214), the GC1F-1S(n=168), GC1F-2(n=160), GC1S-1S(n=132), GC1F-2(n=82)and GC2-2 groups(n=44), and each group was randomly divided into control group(n=400)receiving the conventional treatment and the treatment group(n=400)taking vitmain D 0.5 μg/d for 3 months as add-on to the conventional treatment.The lung function and the COPD assessment test(CAT)score before and after the therapy were observed and compared in patients with different GC sub-genotypes. Results: Among the elderly patients enrolled in our research, GC1F-1F genotype was most common, accounting for 26.8%(214 cases), the followings of next order were GC 1F-1S genotype accounting for 21.0%(168 cases), and GC2-2 genotype was most rare, accounting for 5.5%(44 cases). The lung function were improved and the CAT score were reduced in all groups after therapy as compared with pre-treatment(P<0.05). The lung function was better and the CAT score was lower in patients with GC1F-1F, GC1F-1S, GC1F-2, GC1S-1S sub-genotypes(13.77±4.67 vs.15.83±3.73, 15.38±4.45 vs.17.86±3.92, 17.42±3.19 vs.19.46±4.07)than in the corresponding control subgroups after treatment(P<0.05). While, there was no significant difference in the lung function and the CAT score between patients with GC1S-2 and GC2-2 genotypes in control versus treatment subgroups(P>0.05). Conclusions Vitamin D binding protein gene polymorphism is associated with the curative effect of supplement of vitamin D in elderly patients with stable COPD, which has a predictive value for the curative effect of vitamin D supplement.

BACKGROUNDElderly multiple organ dysfunction syndrome (MODS) patients receiving invasive mechanical ventilation have poor prognosis in intensive care units (ICUs). We studied the usefulness of four commonly used severity scores and extrapulmonary factors that affected weaning to predict outcome of such patients.

METHODSClinical data of 197 patients on admission to ICUs (from January 2009 to June 2012) were used retrospectively. The Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Sample Acute Physiological Score (SAPS) II and MODS scores were calculated. All the patients were grouped into survivors and nonsurvivors according to the prognosis. Patients, who weaned from ventilator (n = 154), were subdivided into a successful weaning group and a failed weaning group. The receiver operating characteristic (ROC) curves and Logistic regression was used for prognostic and weaning assessment.

RESULTSBased on the outcomes, the areas under the ROC of APACHE II, APACHE III, SAPS II, and MODS were 0.837, 0.833, 0.824, and 0.837, respectively. The Logistic regression analysis revealed that the odds ratio (OR) of underlying lung diseases, serum albumin and creatinine, and the number of organ failures was 2.374, 0.920, 1.003, and 1.547. APACHE II scores on admission performed excellent (ROC: 0.921) on the weaning assessments.

CONCLUSIONSAPACHE II and MODS systems were marginally better for evaluating the prognosis of elderly MODS patients who received invasive mechanical ventilation. Underlying lung diseases, serum albumin, serum creatinine and the number of organ failures were independent prognostic factors. Using the APACHE II scores on admission before weaning may increase the likelihood of successful weaning. (ClinicalTrial.gov identifier NCT01802983).

Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Multiple Organ Failure ; pathology ; therapy ; Prognosis ; Respiration, Artificial ; methods ; Retrospective Studies

This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
Humans ; China/epidemiology* ; Cross Infection/epidemiology* ; Intensive Care Units/statistics & numerical data* ; Quality Control ; Quality Indicators, Health Care/statistics & numerical data* ; Sepsis/therapy* ; East Asian People/statistics & numerical data*