Objective To evaluate the effects of early tracheotomy and delay tracheotomy on the prognosis of patients with severe craniocerebral injury.Methods Data of randomized controlled test (RCT) of early tracheotomy on the prognosis of the patients with severe craniocerebral injury were retrieved by using Conchrane Library,PubMed,Embase,OVID,CBM,CNKI,Wanfang and VIPdatahase.The retrievaled time was limited from their building to March 2016,and all the index of the obtained references was accessed.Two researchers independently screened the literature in accordance with the established criteria for inclusion or exclusion.The incidence of VAP,mechanical ventilation time and ICU length of hospital stay,mortality were considered as evaluation indexes.The methodology quality of the included references was evaluated,and the Meta-analysis was performed by using Review Manager 5.3 software.Results Finally,4 randomized controlled studies (RCT) were enrolled,including 220 patients.Meta-analysis results showed that:early tracheotomy did not have any effects on VAP incidence rate (P=0.15) and fatality rate (P=0.20) of the patients with severe craniocerebral injury,there was not any statistically difference;but there was a statistically difference between the mechanical ventilation (P =0.01) and ICU hospitalization time (P =0.05).Conclusion Early tracheostomy could not significantly reduce the incidence of VAP and fatality rate of the patients with severe craniocerebral injury,but it can reduce the mechanical ventilation time and ICU hospitalization time.

Objective To study the clinical application value of aspirator and electrocautery in dissecting Calot′s triangle in laparoscopic cholecystectomy(LC).Methods All patients underwent LC were divided into group A and group B according the detaching way in the operation.The Calot′s triangle were detached by electrocautery as group A and by aspirator as group B.Operative time,hemorrhage and complication between two groups were compared.Results The mean operative time was(28.5?7.6) minutes in group A and(21.1?4.3) minutes in group B.The mean hemorrhage was(13.9?(4.7)) ml in group A and(8.8?2.5) ml in group B.The complication of bile duct injury occurred in 2 cases in group A.No complication was found during or after surgery in group B.All patients were cured.Conclusion Aspirator and electrocautery are both suitable for skeletonizing the cystic duct and cystic artery in LC.

OBJECTIVE: To observe the effects of Huanglian Jiedu Decoction (HLJDD), a traditional Chinese compound herbal medicine, on p85 mRNA and protein expressions of phosphatidylinositol-3-kinase (PI-3K) in target tissues (skeletal muscular and adipose tissues) in rats with type 2 diabetes mellitus (T2DM) and to investigate the molecular mechanism of HLJDD in treating T2DM. METHODS: The male Wistar rats were injected with streptozotocin (STZ) 30 mg/kg through tail vein, and fed with high-fat and high-caloric diets to induce T2DM. Then the rats were randomly divided into untreated group, aspirin-treated group and HLJDD group, and treated correspondingly. Meanwhile, a group of normal animals without any treatment was set up for normal control group. Ten weeks later, serum fasting blood glucose (FBG), serum fasting insulin (FINS) and oral glucose tolerance test (OGTT) were routinely determined. The expressions of PI-3K p85 mRNA and protein in skeletal muscle and adipose tissue were determined with RT-PCR and Western blotting before and after insulin treatment. RESULTS: Compared with the untreated group, the FBG and OGTT levels in T2DM rats treated with HLJDD decreased significantly (P<0.05). The FINS in HLJDD group was lower than that in the normal control group (P<0.05), but was not significantly different from that in the untreated group. The PI-3K p85 mRNA and protein expressions in HLJDD group obviously increased, as compared with those in the untreated group. CONCLUSION: The effect of HLJDD in treating T2DM was probably associated with its improvement of PI-3K p85 mRNA and protein expressions in skeletal muscle and adipose tissue of the T2DM rats.

ABSTRACT:Objective To investigate the clinical features of seronegative rheumatoid arthritis (RA)in western China and its outcomes after one-year treatment with disease modifying anti-rheumatoid drugs (DMARDs) so as to provide evidence for effective therapy.Methods We made a retrospective analysis of 240 RA patients treated in our department from May 2013 to June 2014.We compared the 47 seropositive and 25 seronegative RA patients in clinical features,laboratory parameters and outcomes after one-year DMARDs medication.Results The percentage of seronegative RA was 10.4% (25/240).The number of swollen small joints was significantly smaller in seronegative RA group (P<0 .0 1 ).Compared with those in seropositive RA,the level of hemoglobin was lower,the level of platelets was higher,and the level of alkaline phosphatase was lower in seronegative RA (P<0 .0 5 ).The remission rate was higher in seronegative RA group than in seropositive RA group after one-year DMARDs administration (P<0.05).Conclusion Seronegative RA is not rare in clinic.Even though seronegative RA patients often present fewer swollen small joints, it is difficult to distinguish between seronegative and seropositve RA just based on the clinical features.Besides,hematological damage is more severe in some patients with seronegative RA.Only after one-year treatment with DMARDs,the remission rate is higher in seronegative RA patients than in seropositve RA ones.

Objective To explore the value of contrast-enhanced ultrasound(CEUS) in diagnosis of placental accrete,placental increta and placental percreta. Methods Twenty suspected patients of placental accrete, placental increta and placental percreta were examined with CEUS after routine ultrasound examination. Sono Vue was injected intravenously as bolus and a real time CEUS was performed to observe the characteristics. Results Comparison of 15 CEUS cases with uterine curettage, 8 cases had a clear relationship between the residual disease of the uterine cavity and uterine wall,7 cases had a thin thickness (2-4 mm) between the residual disease of the uterine cavity and uterine wall. Five of the 20 cases performed cesarean cesion,3 cases of the uterine serosa of placenta affixing part were very thin,incomplete and rough, demonstrating placenta increta and placenta percreta, 1 case of uterine rupture showed non-invasiveness between uterine wall and uterine serosa,and 1 case of placenta increta pathologically proven, initially suspected gestational trophoblastic disease by the CEUS. Conclusions CEUS provides an important diagnostic message for placental accrete, placental increta and placental percreta by showing the different characteristics of the perfusion image.

10.3969/j.issn.1007-3969.2013.04.003

Objective To investigate the intestinal barrier dysfunction in sepsis and septic shock patients,and to analyze the relationship between infection site and the severity of the disease.Methods A prospective observational research was carried out in 42 sepsis patients,47 septic shock patients and 36 postoperative patients without sepsis as control admitted to Department of Critical Care Medicine of General Hospital of Ningxia Medical University from November 2015 to June 2017.Blood samples were collected from patients on the first day and the third day after admission to the intensive care unit (ICU) to measure D-lactic acid and endotoxin levels of sepsis and septic shock patients by enzymatic method,while the blood sample of control group was just tested on the first day.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score,Sequential Organ Failure Assessment (SOFA) score of patients were recorded on the first day after admission.Sepsis and septic shock patients were divided into intra-abdominal infection group(n=54) and extra-abdominal infection group(n=35).Results (1) Compared with control group,D-lactic acid and endotoxin levels in sepsis patients and septic shock patiems were significantly higher on the first day and third day (all P＜0.01).There were no significant differences in D-lactic acid and endotoxin between sepsis group and septic shock group on the first day (both P＞0.05),but endotoxin level of septic shock group was higher than that in sepsis group(P＜0.05) and there was no significant differences in D-lactic acid level between these two groups (P＞0.05) on the third day.(2) In the intra-abdomen infection group,there were no significant differences in D-lactic acid and entotoxin between sepsis patients and septic shock patients on the first day and the third day after admission (all P＞0.05).(3)There were no significant differences in D-lactic acid and endotoxin between intra-abdominal infection group and extra-abdominal infection group on the first day and the third day after admission(all P＞0.05).Conclusions Sepsis and septic shock patients often have intestinal barrier dysfunction.The dysfunction is correlated with the severity of disease,but there is no relationship with the infective site.Endotoxin is superior to blood D-lactic acid in reflecting the severity of sepsis.

Objective: To understand the characteristics and trends of colorectal cancer incidence and mortality in Lishui residents from 2014 to 2018,so as to provide basis for the development of prevention and treatment measures of colorectal cancer. Methods : The incidence and mortality data of colorectal cancer in Lishui from 2014 to 2018 were collected through the information management system of chronic disease surveillance in Zhejiang Province. The incidence,mortality and annual percentage change(APC)of colorectal cancer were calculated and analyzed in different genders,ages and regions were analyzed. Results: From 2014 to 2018,there were 4 403 new cases of colorectal cancer in Lishui,with the crude and standardized incidence rate of 34.89/100 000 and 20.99/100 000,respectively. There were 2 369 deaths,with a crude mortality rate of 18.77/100 000 and a standardized mortality rate of 10.17 /100 000. The crude incidence rate and crude mortality rate in males were higher than those in females(39.71/100 000 vs. 29.77/100 000,21.31/100 000 vs. 16.08/100 000,both p<0.05). There were no statistically significant differences between urban and rural residents in the crude incidence rate and crude mortality rate(37.24/100 000 vs. 34.44/100 000,19.75/100 000 vs. 18.45/100 000,both p<0.05). The crude incidence rate and crude mortality rate increased with age. The APC of the mortality rate of colorectal cancer among urban residents was 11.31%,showing an increasing trend from 2014 to 2018(p<0.05). Conclusion The incidence and mortality of colorectal cancer are high in Lishui,and the focus groups are men,people aged over 40 years and urban residents.

Objective: To learn the characteristics of gastric cancer incidence and mortality in Lishui from 2014 to 2018，and to provide basis for prevention and control strategies for gastric cancer. Methods: The data of gastric cancer in Lishui from 2014 to 2018 was collected from Zhejiang Chronic Disease Surveillance Information Management System. The incidence and mortality rates of gastric cancer were calculated，and the trend of them was evaluated by annual percentage change（APC）. Results: The crude incidence rate of gastric cancer in Lishui was 44.77/100 000（5 650 cases）and the standardized one was 26.93/100 000. From 2014 to 2018，the incidence rates of gastric cancer showed a decreasing trend（APC=-0.79%，P<0.05）. The crude mortality rate of gastric cancer in Lishui was 25.39/100 000（3 205 cases）and the standardized one was 14.21/100 000. From 2014 to 2018，the mortality rates of gastric cancer were stable（APC=-4.61%，P>0.05）. The standardized incidence and mortality rates of gastric cancer in males were 34.77/100 000 and 18.35/100 000，which were higher than 16.77/100 000 and 8.52/100 000 in females（P<0.05）. The standardized incidence and mortality rates of gastric cancer in rural residents were 46.07/100 000 and 26.11/100 000，which were higher than 38.49/100 000 and 22.02/100 000 in urban residents. The incidence and mortality rates increased with age after 15 years old，and reached the peak at the age group of 80-84 years old. Conclusion The incidence and mortality of gastric cancer in Lishui from 2014 to 2018 were at a high level，which were higher in males than in females and were higher in rural than in urban areas；while the incidence had a downward trend.