Objective To explore the value of procalcitonin (PCT)and lipopolysaccharide (LPS)in identifying pathogens and evaluating therapeutic efficacy of hospital-acquired pneumonia (HAP).Methods A total of 110 HAP patients were enrolled in a prospective study,patients were divided into gram-negative bacterial infected HAP group (G- infected group,n=50),gram-positive bacterial infected HAP group (G+ infected group,n=30),and control group (nontypical pathogen or virus infected group,n =30).Serum levels of PCT,LPS and C-reactive protein (CRP)of patients were dynamically detected,receiver operating characteristic (ROC)curve and area under the curve (AUC)were adopted to assess the value of PCT and LPS in predicting pathogenic bacteria causing HAP. Results PCT and LPS levels of G - infected group were (3.43 ±1 .15)ng/mL and (0.20 ±0.08)EU/mL respec-tively,which were higher than G+ infected group ([0.42±0.12]ng/mL and [0.05±0.02]EU/mL respectively)and control group([0.14±0.08]ng/mL and [0.02 ±0.01 ]EU/mL respectively)(all P <0.05 ).Levels of PCT and CRP of G- infected group before and after therapy were both significantly different ([3.43±1 .15]ng/mL vs [0.63 ±0.22]ng/mL,[47.26±30.35]mg/L vs [9.21 ±6.54]mg/L,respectively)(both P <0.01).The levels of PCT, LPS,and CRP in moderate and severe patients were all significantly higher than mild patients ([5.43±1 .05]ng/mL vs [0.72±0.32]ng/mL,[0.33±0.07]EU/mL vs [0.09 ±0.04]EU/mL,[57.46 ±20.15 ]mg/L vs [8.25 ± 5.24]mg/L,respectively)(all P <0.05).Sensitivity and specificity of combined detection of PCT and LPS in dif-ferentiating gram-negative bacteria infected VAP from gram-positive bacteria infected VAP were 95.83% and 96.15% respectively,AUC was 0.95.Conclusion PCT and LPS have certain value in identifying pathogens of HAP,combined detection of PCT and LPS can increase specificity in identifying HAP type,and assess the efficacy of antimicrobial therapy in accordance with the dynamic change.

0.05). PetCO 2 was a reliable index reflecting PaCO 2. There was a significant difference between PetCO 2 and PaCO 2 in the Group Ⅲ (P

OBJECTIVE： To determine the gentamycin sulphate,ephedrine hydrochloride and dexamethasone sodium phosphate in nasal drops without need of separation.METHODS： Gentamycin was determined via the dihydrolutidine derivatives produced by Hantzsh reaction using UV-spectrophotometry.The detecting wavelengths was 330nm.A dual-wavelength spectrophotometry was used for determination of ephedrine hydrochloride and dexamethasone sodium phosphate.The detecting wavelengths were 256.5nm and 241.6nm and the reference wavelengths were 228.4nm and 266.4nm for ephedrine hydrochloride and dexamethasone sodium phosphate,respectively.RESULTS： The average recovery rates of gentamycin sulphate,ephedrine hydrochloride and dexamethasone sodium phosphate were 100.74％ (CV=0.2％ ,r=0.9 999,n=5),100.15％ (CV=0.66％ ,r=0.9 997,n=5)and 99.46％ (CV=0.35,r=0.9 996,n=5)respectively.CONCLUSION： This method is simple,rapid,accurate and stable and suitable for rapid quality control of compound gentamycin sulphate nasal drops.

Objective To compare the effect oropivacaine combined with fentanyl or sufentanil in labor anal-gesia.Methods 116 cases of maternal birth in obstetrics and gynecology were selected.According to the random number table method,116 cases of parturients were randomly divided into observation group (58 cases,received ropiv-acaine and sufentanil analgesia)and control group (received ropivacaine and fentanyl).In two groups of maternal anesthesia before induction (T0 ),used the drug after 30min(T1 ),60min(T2 ),180min(T3 )detection of the mean arterial pressure (MAP)and heart rate (HR),and digital evaluation table Rating Scale (NRS).The complications of maternal and infant in the two groups were recorded,the change of the mode of delivery and the Apgar score of neo-nates in the two groups were analyzed.Results There were no significant differences in the levels of MAP and HR between the two groups in T0-T3 (tMAP =0.123,1.078,0.212,0.047;P =0.903,0.283,0.832,0.963;tHR =0.033, 0.289,0.288,0.036;P =0.974,0.773,0.774,0.972).The NRS scores in T1 -T3 of the two groups were significantly lower than those in the T0;the T1 -T3 scores of the observation group were (2.21 ±0.36 )points,(1.78 ± 0.24)points,(1.83 ±0.25)points,which were significantly lower than (3.61 ±0.75)points,(3.22 ±0.12)points, (2.84 ±0.26)points of the control group(t =12.816,40.871,21.325,P =0.000,0.000,0.000).In the observation group,there was 0 case (0.00%)had cardiac arrhythmia,the control group had 4 cases (6.90%),and the differ-ence was statistically significant(χ2 =4.143,P =0.042).Two groups of labor analgesia,the way of delivery and birth of the newborn after birth,1min,5min of Apgar score were compared,the differences were not statistically significant (χ2 =0.703,t =0.631,1.149,P =0.402,0.530,0.253).Conclusion Ropivacaine combined with sufentanil or fentanyl in analgesia have no effect in childbirth and maternal vital signs and neonatal,and have good analgesic effect, but ropivacaine combined with sufentanil has stronger analgesic effect,higher safety.

Objective To investigate the clinical value of the subfascial endoscopic perforator surgery (SEPS) combined the endovenous laser on venous ulcer in lower extremities.Methods Subfascial endoscopic perforator surgery was applied to 32 patients (34 limbs) of varicose veins with venous ulcers,aided by endovenous laser treatment of great saphenous veins and varicose veins.Results All branch limb varicose veins disappear,leg heaviness significantly reduce soreness,leg ulcers were healed up in 2 to 8 weeks after surgery.All patients were followed for 1 year to 5 years,no recurrence of varicose veins and ulcers formed.Conclusion The method of endoscopic perforator surgery combined the endovenous laser for venous ulcer in lower extremities is simple operation,small trauma,quicker recovery,should be widely applied.

Objective:To investigate the clinical manifestations and causative factors of adverse drug reactions following cinepazide mahate injection and provide reference for the safe use of drugs.Method:503 cases treated with cine- pazide maleate in our hospital were retrospectively studied and the results were statistically analyzed by SPSS(versionl 1.0).Result:Of 503 patients,27 cases presented some adverse events with an incidence of 5.4%,and adverse drug reac- tions were found in 11 cases with an incidence of 2.2%.The main adverse drug reactions were nervous,gastrointestinal and dermal reactions.The adverse drug reactions had no relation with sex,but with age of patients and combination use of drugs(P

Objective To evaluate the diagnostic significance of blood cells and electrolyte in preoperative diagnosis and surgical treatment of Cushing's disease (CD).Methods 116 csses of CD and 21 cases of adrenocortical adenoma (ACA) patients pathologically proven adrenocorticotropic hormone (ACTH) adenoma from Jan.2003 to Dec.2010 were enrolled into the study.They were given transsphenoidal surgery (TSS) and laparoscopic resection of adrenal adenoma (LRAA).Patients were divided into remission group ( group A),non-remission group (group B) and ACA group (group C) according to the remission criteria of CD.The preoperative and postoperative level of blood cells and electrolyte were determined.Results TSS treatment improved the abnormal level of blood cells and electrolyte in patients with CD.Group A had significant change in preoperative and postoperative level of blood cells and electrolyte,while group B and group C didn't.Conclusions Compared with the endocrine examination items which need huge expense and harsh conditions,the change of blood cells and electrolyte level is more superior in assessing diagnostic and cruative effects on CD patients.

Objective To investigate the clinical features of internal carotid steal syndrome. Methods The clinical manifestations, CT or MRI, digital subtraction angiography, and blood flow compensation in 6 patients with internal carotid steal syndrome were analyzed. Results Of the 6 patients, 2 had unilateral internal carotid artery stenosis, 4 had severe stenosis (in which 2 were on the left side, 1 was on the right side, and 1 was on both sides). The clinical manifestations of the patients with internal carotid steal syndrome were watershed infarction and transient ischemic attack. Four patients had posterior circulation ischemia and 2 had anterior circulation ischemia. Digital subtraction angiography demonstrated that collateral circulation was established in all the 6 patients. The anterior communicating artery, posterior communicating artery, and pial artery were the common compensatory vessels. Conclusions Internal carotid artery steal syndrome can be presented as anterior or posterior circulation ischemia, and the collateral circulation plays an important role in the compensation.

One patient confirmed as pituitary carcinoma by histopathology was retrospectively analyzed according to the great changes of tumor invasive growth in imaging examine and clinical characters. Clinically,pituitary carcinoma quickly grows,and the growth character of tumor is helpful in the diagnosis. Moreover,the treatment for pituitary carcinoma is different from pituitary adenoma.The rapid progress of pituitary adenoma indicates the possibility of primary carcinoma.More experience should be accumulated for the diagnosis and treatment of the disease.

Objective To study the prevalence of metabolic syndrome (MS) in women with polycystic ovary syndrome (PCOS) ,and to explore the risk factors of MS in young women. Methods The prevalence of MS and its components were evaluated in 348 young women with PCOS and 113 control subjects without PCOS. Results According to the 2005 modified Adult Treatment Panel Ⅲ criteria,MS was found in 27.0% of PCOS women,being significantly higher than 10.6% in the controls(P<0.01). The rates of MS components,except for the triglyceride (TG) level, were all significantly higher in PCOS subjects than those in control subjects ( P < 0. 05 or P < 0.01). However, the difference disappeared after adjustment for age and body mass index ( BMI, P>0. 05). The results of logistic regression analysis revealed that homeostasis model assessment insulin resistance (HOMA-IR)and BMI were the independent predictors of MS( both P<0.01) ,and the presence of PCOS was not the independent risk factor for MS (P>0. 05). Conclusions Obesity and insulin resistance are the independent predictors of MS. PCOS alone does not increase the risk of MS prevalence.