Objective To build the steady framework of the nasal tip by using caudal septal advancement technique to obtain the permanent nasorostral configuration.Methods From Oct 2009 to Apr 2011,the caudal septal advancement technique was used to reconstruct the septum to make the septal anterior angel and the caudal septal margin reach the anticipated height and length of the tip,then medial crus and the vault of the lower lateral cartilage were sutured to the caudal septum to form the steady supporting structure of the nasal tip.Results 3-16 months follow-up in 26 cases showed that 2 cases appeared the staircase deformity in the junction of the bone and the cartilage in the dorsum,but the nasorostral configuration was good.3 cases whose tip and columella were deviated before the operation appeared the deviation again after 3 months but the nasorostral configuration was better than before.The other 21 cases were good.Conclusions It is a available method of using caudal septal advancement technique to form the steady nasorostral configuration.

OBJECTIVE:To provide the reference for the set-up of precautions against flu pandemic in China.METHO_DS:RNA of influenza viruses isolated from flu children in flu seasons between 2003 and 2005 in Beijing was extracted and amplification of M2 gene fragments associated with ion channel were performed by one step reverse transcription–polymerase chain reaction(RT-PCR).The sequencing of amino acid was determined,and its bioinformation was analyzed with software,then the positions of amino acid for resistance to amantadine were detected.RESULTS:20 of 31 isolated strains were resistant to amantadine,the percentage of which was 66.7%.CONCLUSION:The monitoring of drug resistance to flu viruses should be strengthened in China.

Objective:To investigate the thoughts and the methods of clinical pharmacists in the individual continuous renal re-placement therapy ( CRRT) anticoagulation treatment for severe patients. Methods:Clinical pharmacists participated in the CRRT anti-coagulation treatment for one patient with severe thrombocytopenia after aortic dissection surgery. Clinical pharmacists analyzed the cau-ses of thrombocytopenia and the coagulation function of the patient to exclude heparin-induced thrombocytopenia, and developed the treatment of supplementing platelets and regional citrate anticoagulation as the way of CRRT. Results:Three days after the treatment, the patient was changed to the general ward with normal renal function. Conclusion:Clinical pharmacists should participate in clinical treatment comprehensively and perform individual treatment for patients in order to ensure the effect and safety of medication.

Objective To conclude nursing experience of second anastomotic leakage after radical gastric cancer surgery. Methods The present study compared the differences of clinical symptoms between these two anastomotic leakages, and found a way to detect latent anastomotic leakage with an unobvious abdominal sign accurately and opportunely. The study also intervened in the patient′s observation, psychological condition, peritoneal irrigation and nutritional support after surgery. Results The patients were discharged from the hospital after cured with well controlled condition. Conclusions In order to make an early detection and treatment of the second anastomotic leakage, nurses should not only observe the abdominal sign, but also observe the systematic poisoning and concomitant symptoms.

10.3969/j.issn.2095-4344.2013.23.019

Objective To evaluate the effects of limited fluid resuscitation on septic shock caused by myocardial injury . Methods 60 severe traumatic sepsis and septic shock patients were randomly divided into study group and control group ,with 30 cases in each group ,the control group was given active fluid resuscitation ,maintain the mean arterial pressure (MAP) in 70 mm Hg ;the study group were treated with limited fluid resuscitation ,namely when MAP rose to a slow infusion rate 50-60 mm Hg ,we restrict the amount of fluid ,maintain MAP at about 50 mm Hg ,observe and record the two groups of patients hemodynam-ics index ,APACHE Ⅱ score and heart function index ,and compared serum cTnI ,NT proBNP and CRP in the two groups .Results (1)In study group the infusion volume before admission was (258 ± 105)mL ,preoperative was (558 ± 226)mL ;in the control group that of before admission was (816 ± 422)mL ,preoperative was (1 668 ± 780) mL (P<0 .05) .The mortality rate in study group was 13 .3% ,the mortality in control group rate was 26 .7% (P<0 .05) .(2) the HR and blood lactic acid levels in two groups decreased significantly after treatment ,MAP and CVP increased significantly (P<0 .05);there were no significant differences in hemodynamic parameters (P>0 .05) .(3)After the treatment APACHEⅡscore of the two groups was significantly decreased ,car-diac output ,stroke volume and left ventricular ejection fraction significantly increased in control group ,the study group were better than control group (P<0 .05) .(4) The plasma cTnI ,NT proBNP ,CRP levels of the two groups significantly decreased after treat-ment (P<0 .05) ,plasma cTnI ,NT proBNP and CRP levels of research group were significantly lower than that of control group (P<0 .05) .Conclusion Limited fluid resuscitation can maintain hemodynamic ,reduce the interference on the internal environment ,re-duce myocardial injury ,and improve the success rate of treatment .

Considering the fact that the critical medical education was relatively backward, and the basic medical education was out of touch with clinical practice, this study, combined with the complexity, uncertainty and comprehensiveness of critical care medicine , puts forward the concept of critical care medicine holistic medicine in clinical practice. We try a patient-oriented approach in clinical practice, focusing on the whole, focusing on the interaction relationship among patient and disease and its pathologi-cal and physiology processes, development, complication and prognosis of disease, instead of paying atten-tion only to disease or single organ itself. The purpose of patient-based learning is trying to train medical students and junior residents to form good clinical thinking ability and decision-making ability.

Acupuncture Points ; Acupuncture Therapy ; Chronic Disease ; therapy ; Edema ; therapy ; Heart Failure ; therapy ; Humans ; Male ; Middle Aged

BACKGROUND: Panax notoginseng is an effective medicine for curing gastric mucosal ulcer. There are many clinical reports that Panax notoginseng protects gastric mucosa.OBJECTIVE: To investigate the protective mechanism of Panax notoginseng on the gastric mucosal injury induced by water immersion restraint stress in rats.DESIGN: A randomized controlled animal trial.SETTING: School of Basic Medical Sciences, Daqing Branch of Harbin Medical University.MATERIALS: The study was conducted in the laboratory of Department of Pathophysiology of Harbin Medical University from September 2004 to October 2005. Forty-eight Wistar rats were used, either male or female, weighing 180-230 g.METHODS: The 48 Wistar rats were randomly divided into six groups with 8 rats in each group: normal control group, stress model group, cimetidine treatment group, Panax notoginseng of low, middle and high-dose groups (4, 8, 12 mg/time). In the cimetidine treatment group, cimetidine tablets were grinded into powders, then mixed with distilled water to prepare into suspension (1 tablet:10 mL), which was perfused intragastrically (5 mL), 3 times a day; In the Panax notoginseng groups, the powders in Panax notoginseng capsules were mixed with distilled water to prepare into suspension of corresponding concentrations (0.8, 1.6, 2.4 g/L), then administrated the same as those in the cimetidine treatment group. Stress models in rats were established by means of water immersion restraint stress. The gross and pathohistological changes of gastric mucosa were observed, and the activity of superoxide oxidase (SOD) and contents of malondialdehyde (MDA) and nitric oxide (NO) were determined.MAIN OUTCOME MEASURES:①Gross and pathohistological changes of gastric mucosa;②Changes of MDA and NO contents and SOD activity in the homogenate of gastric mucosa.RESULTS: All the 48 rats were involved in the analysis of results. The gastric mucosal hemorrhage and erosion in the cimetidine treatment group were reduced obviously as compared with those in the stress model group, SOD activity was obviously decreased [(12.61±0.87), (1.03±0.60) mkat/g], whereas the NO content was a little higher [(5.76±1.35), (0.97±0.58) nmol/g]. The MDA content was obviously higher in the stress model group than in the normal control group [(3.10±1.13), (0.09±0.02) μmol/g, P＜0.01]. There were no obvious differences between the Panax notoginseng groups and the cimetidine treatment group except that the NO contents were decreased in the in Panax notoginseng groups.CONCLUSION: Gastric mucosal injury induced by water immersion restraint stress can be significantly protected by Panax notoginseng, which is not dose-dependent. The protective mechanism may be associated with that Panax notoginseng can eliminate the product of oxygen-derived free radicals, and it is not totally the same as that of cimetidine

Objective Analyzing the distribution of 1476 strains of clinical common pathogens and their antimicrobial resistance, provide reference the reasonable use of antimicrobial drugs for clinical.Methods Using BD company PHOEIX-100 Automatic Pathogen Identification to Pathogen identify 1476 strains of pathogens which were got from the various isolated and cultivated samples which were examined from 2009 January to 2010 August and its antibacterial Drug Susceptibility Test, then with WHONET5. 3 system to analyze monitoring data of the pathogen distribution and resistance. Results In 1476 strains of pathogens isolated, gram-negative bacteria had 1206 strains occupying 81.7% ; Gram-positive cocci had 270 stains occupying 18. 3%. The most common detected pathogen were Escherichia coli, Klebsiella pneumoniae,Staphylococcus aureus and Pseudomonas aeruginosa, which accounted for 20. 2% ,17. 5% ,13. 2% ,11.4%.The ESBLs producing E. coli and K. pneumoniae accounted for 65. 9% ,48. 1% ; Also methicillin-resistant S. aureus (MRSA) accounted for 79. 2% and methicillin-resistant coagulase-negative staphylococci (MRCNS) accounted for 68.4%. It isnt found yet that grape genus to vancomycin, nitrofurantoin can resist drug.Gram-negative bacilli to antimicrobial vinyl hydrocarbon mold degree of sensitivity is high. Conclusion The isolated pathogen's resistance of drug is widespread. It is important to guide clinical reasonable use of antibiotics and control infectious pathogens that carry out continuous monitoring of drug resistance.