Objective To investigate the application of nasal jejunal tube and nasogastric tube of two different catheter ways in improving the severe craniocerebral injury and the low temperature condition and the role of early enteral nutrition support and compare the difference between its curative effect.Methods A total of 120 patients with severe craniocerebral injury underwent normal and low temperature treatment were selected,and they were divided into nasal jejunal tube enteral nutrition(nasal jejunal tube group,60 cases)and nasogastric tube enteral nutrition(nasogastric tube group,60 cases)by simple random sampling.After implement nasogastric tube and nasal jejunal tube,normal pressure using enteral nutrition elemental diet and/or enteral nutrition multi polymerization agent produced the best nutrient solution implementation of early enteral nutrition support,two groups of subjects under the condition of bowel function exists,within 48 h starting enteral nutrition,compared two groups of various nutrition indicators as well as adverse reactions and complications,and Glasgow Coma Scale(GCS)score,Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ)score,etc.Results The patients with severe craniocerebral injury after early nutrition,the various nutrition indicators had improved in two groups.The rise extent of triceps skinfold thickness,arm muscle circumference,serum albumin,prealbumin,transferrin,hemoglobin and other indicators in nasal jejunal tube group was higher than that in nasogastric tube group on the 14th,28th day after admission,and there was significant difference(P ＜ 0.05).The incidence of diarrhea,bloating,vomiting,and stomach contents reflux retention in nasal jejunal tube group was lower than that in nasogastric tube group [5.0％(3/60)vs.18.3％(11/60),10.0％(6/60)vs.21.7％(13/60),5.0％(3/60)vs.21.7％(13/60),15.0％(9/60)vs.16.7％(10/60),11.7％(7/60)vs.48.3％(29/60),8.3％(5/60)vs.21.7％(13/60)],and there was significant difference(P ＜ 0.05).The incidence of complications in nasal jejunal tube group was lower than that in nasogastric tube group [16.7％(10/60)vs.76.7％(46/60)],and there was significant difference(P ＜0.05).The changes of GCS score,APACHE score in nasal jejunal tube group was more obvious than that in nasogastric tube group,and there was significant difference(P ＜ 0.05).Conclusions Early nasal jejunal tube enteral nutrition for the severe craniocerebral injury after the low temperature condition in clinical enteral nutrition implementation is feasible and reasonable,compared with a nasogastric tube feeding,can obviously reduce the complications of enteral nutrition and reach goals earlier nutritional therapy,can improve the prognosis.

Objective To analyze rick factors for postoperative recurrence of spontaneous pneumothorax surgery. Methods The clinic characteristics of 1128 patients who received spontaneous pneumothorax surgery in Tianjin Chest Hospital were collected from January 2009 to March 2015. The relationship between clinic characteristics and the pulmonary bullae was analyzed. Logistic regression analysis was used to assess factors affecting the postoperative relapse of spontaneous pneumothorax. Results The pulmonary bullae were found in 877 patients of 1128 during the operation. The incidence of pulmonary bullae was significantly high in patients with age below 25 years compared with patients over 25 years (P<0.05). The duration of surgery was significantly longer in patients with pulmonary bullae compared with that of patients without pulmonary bullae (P<0.05). Postoperative recurrence occurred in 21 cases, with a recurrence rate of 1.86%. Logistic regression analysis showed that pulmonary bullae, pleurodesis without pleura friction, delayed drainage duration (> 3 d) were independent risk factors of postoperative recurrence for spontaneous pneumothorax (P<0.05). Conclusion Pulmonary bullae, pleurodesis without pleura friction and delayed drainage duration are risk factors of postoperative recurrence for spontaneous pneumothorax, which should be paid more attention in clinic.

Objective To explore the effects of early glucocorticoids (GC) therapy on the outcome of patients with acute respiratory distress syndrome (ARDS). Methods The clinical data of all ARDS patients admitted from January 2008 to December 2011 in Chengdu Military General Hospital of Chinese PLA were retrospectively analyzed. The adult patients whose diagnosis was in accord to the Berlin ARDS diagnostic criteria published in 2012 were enrolled, and based on whether using glucocorticoid or not, they were divided into GC group and non-GC group. All the patients in GC group received low dosage of intravenous GC within 48 hours after the onset of ARDS, including different kinds of GC, methylprednisolone, dexamethasone and hydrocortisone (hydrocortisone dosage < 5 mg·kg-1·d-1, the dosage of former two kinds of GC being converted to that of hydrocortisone), and the therapeutic course of the two groups was 7 to 21 days. The patients in non-GC group received no GC therapy after the occurrence of ARDS. The duration of mechanical ventilation, the length of intensive care unit (ICU) stay and totally in hospital, medical cost and 28-day survival rate were compared between the two groups. Results One hundred and seventeen patients with ARDS were collected, including 56 cases (47.86%) in GC group and 61 cases (52.14%) in non-GC group. The duration of mechanical ventilation in GC group was significantly shorter than that in non-GC group [days:0 (0, 2.50) vs. 2.00 (0, 2.50), Z=2.015, P=0.044]. The 28-day survival rate in GC group was significantly higher than that in non-GC group [71.43%(40/56) vs. 50.82%(31/61),χ2=5.198, P=0.023]. There were no significant differences in the length of ICU stay [days:7.50 (2.00, 11.00) vs. 4.00 (1.00, 9.00), Z=1.879, P=0.060] and stay totally in hospital [days:16.00 (10.00, 27.75) vs. 15.00 (7.00, 28.00), Z=0.592, P=0.552] between GC group and non-GC group. However, the medical cost in non-GC group was significant lower than that in GC group [10 thousand Chinese yuan:3.15 (1.51, 5.78) vs. 4.39 (1.66, 10.88), Z=2.204, P=0.028]. Conclusion The early GC therapy may improve the outcome of patients with ARDS, especially beneficial to the 28-day survival rate.

Objective To study the efficacy of movement imagination combined with biofeedback for stroke patients with upper extremity dysfunction. MethodsEighty stroke survivors were recruited and randomly divided into a movement imagination group ( n =40) and a movement imagination combined with biofeedback group ( n =40).Their EMG mean values during wrist dorsiflexion were amplified and calculated.Fugl-Meyer upper extremity function scores (FMAs) and the modified Barthl index (MBI) were recorded before and after 6 weeks of treatment.ResultsAfter 6 weeks of treatment the two groups had significantly higher mean EMG values,FMA scores and MBI scores,but the effects in the combination group were significantly better than those in the simple movement imagination group. ConclusionMovement imagination can be made more effective by combining it with biofeedback for promoting the recovery of stroke patients with upper extremity dysfunction.

Objective:To investigate the clinic effect of r-MHT and hematoma aspiration on the traumatic intracerebral hematoma.Methods:89 cases with traumatic intracerebral hematoma were given hematoma aspiration,47 of them were given r-MHT and hematoma aspiration,the clinic effect on the 1st,7th,14th day after treatment were evaluated by NIHSS,the hematoma volume before treatment on the 1st,7th,14th day after treatment were counted by Dotian formula.Results:The effective rate of treatment group was 93.6％,which was significantly higher than that of the control group (P＜0.05).The NIHSS score of treatment group was significantly higher than that of the control group(P＜0.05) on the 1 st day,1st,2nd week after treatment (P＜0.05).Conclusion:r-MHT and hematoma aspiration couldn effectively reduce the brain damage,improve the patient's neurological fumction in treating traumatic intracerebral hematoma.

ObjectiveTo evaluate the feasibility of constructing tissue engineering cardiac patch with photooxidationfixed acellular bovine pericardium.MethodsFresh bovine pericardia were treated by dye-mediated photooxidation after decellularization.Some of them were seeded with bone marrow stromal cells(MSCs) isolated from male SD rats to construct cardiac patches.Myocardial infarction(MI) model was made in female SD rats by left anterior descending coronary ligation(LAD).One week later, the confirmed MI rats were divided into three groups randomly, group MI (n = 15)without any treatment; group P (n = 18) with photooxidated pericardia implantation ; group P + C (n = 18) with seeded pericardia implantation.A sham group (n = 10) was also performed with opening and closing chest twice only.The heart were explanted at 2 or 4 weeks after implantation, and examined histologically and immunohistochemically.The heart function was evaluated by echocardiography at 4 weeks before excising the rats.ResultsThere were no cells or cell debris remained in bovine pericardium tissue.The fiber structure became condensed after photooxidation.The seeded cells formed a continuous layer on the surface of the tissue.The pericardial degradation level and newly formed microvessel density were larger in group P + C than in group P after 2 [ (13.7 ±5.2)个/mm2 vs (7.1 ±3.1)个/mm2, P＜0.05]and4 [(22.6 ±4.9)个/mrn2 vs (14.1 ±5.3)个/mm2, P＜0.05]weeks.Four weeks after transplantation, cardiac echocardiography showed left ventricular ejection fraction(LVEF) was lower in group MI (44.8 ± 4.4) ％ and group P (48.4 ± 5.0) ％ compared with group P + C (49.3 ± 4.8) ％, left ventricular fractional shorterning(LVFS) was lower in group MI (18.0 ± 2.2) ％ and group P (19.8 ± 2.5) ％ compared with group P + C (20.4 ±2.5) ％, the difference between P + C and MI was significant.ConclusionTransplantation of the tissue engineered bovine pericardial patches with dye-mediated photooxidation can improve heart function in MI rats.This kind of patches demonstrates a promising prospect in the future.

As a new form of medical practice,narrative medicine has been paid much attention since it was put forward.In the view of "narrative ability",narrative medicine has a strong oriental temperament.In the literature and art tradition of our country,which has existed thousands of years ago,disease and narrative of medicine has always been an important topic.Oriental physician group,represented by Confucian doctor,has the strongest narrative ability.Medical temperament and quality,represented by narrative,can connect the western and eastern medical traditions and medical culture and become the starting point of modern Chinese medical spirit,which combines western medical technology and oriental culture.

Objective To compare the efficacy of arterial stenting with that of traditional B -T shunt for neo-natal pulmonary atresia with intact ventricular septum.Methods Twenty -six cases of neonatal pulmonary atresia with intact ventricular septum were treated at Children′s Hospital of Zhengzhou from December 2005 to December 201 5,aged 3 to 23 days[(8.20 ±4.80)days],and weighted 2.80 -3.88 (3.41 ±0.27)kg.Accompanied with pulmonary hypo-plasia,all these patients were combined with PDA and ASD or PFO.Before operation,the peripheral oxygen saturation was kept in 61 % -75%,averaged at 67%.Among them,1 2 cases underwent arterial catheter stenting,and 1 4 cases re-ceived B -T shunt (including modified B -T shunt and central shunt)ductus ligation.After operation,the oxygen satu-ration in these children was observed,and they were examined by echocardiography and true lateral chest X -ray,blood flow situations in stents and shunts were assessed,and follow -up examinations were conducted in 1 ,3,6 and 1 2 months postoperatively.Results Stents were successfully inserted into these 1 2 cases.After traditional pulmonary shunt,pa-tients′peripheral oxygen saturation was (82.73 ±5.59)%,compared with that of patients after arterial catheter sten-ting (86.1 8 ±3.1 9)%,there was significant difference(t =1 0.71 ,P <0.05).In pulmonary shunt group,2 cases died,1 case died of postoperative heart failure,and the other case was complicated with pulmonary infection and died of respiratory failure;in catheter stent group,1 case was complicated with postoperative supraventricular tachycardia and recovered after drug intervention.For the follow -up examinations 1 ,3,6 and 1 2 months after the operation,1 case of B -T shunt in pulmonary shunt group was improved by central shunt due to slow blood flow,less shunt volume,and ox-ygen saturation decreased to 69%.For the catheter stent group,1 case was improved by stent balloon dilatation due to declined peripheral oxygen saturation 2 months postoperatively,and after the operation,transcutaneous oxygen saturation was improved.No patients died in the catheter stent group.Conclusions In traditional B -T shunts,the operation is extensive,and complications are common,and the recovery turns slowly.Arterial catheter stenting can be used as the preferred method of treatment for one -stage surgical pulmonary atresia with intact ventricular septum to reduce the weakness feasibly and effectively.

" Filial piety" is China's traditional culture.It not only educates the offspring to be grateful and to repay good deeds,but more importantly guides people to take up social responsibilities and obligations.However,there are always contradiction dilemmas between loyalty and filial piety in reality.With the change of the times,this kind of contradiction is getting more prominent.Rethinking the choice of " raising the children but not provi-ding for the elderly" or choosing for helplessness,the causes of which include: the development of medical technol-ogy aggravates the contradiction between the ability and the cost of providing for the elderly,the contradiction be-tween the prolongation of the life of the elderly and the limitation of their children's ability to support them; Chi-na's one-child policy for more than 30 years has weakened the support capacity of the offspring; urban develop-ment leads to population migration and challenges family pension; the instability of family structure affects providing for the elderly; social pension is inadequately prepared and so on.To guarantee intergenerational equity and im-prove people's quality of life,it should advocate the scientific view of providing for the elderly,which must respect the elderly's autonomy,improve and promote the assessment and supervision of basic needs such as living will,hospice care,and medical abandonment.Through carrying out relevant research,it should establish a systematic project of good Chinese-style scientific pension and improve the social pension security system.