OBJECTIVE:To explore the effects of the early use of heparin on the prognosis related indicators of patients with acute respiratory distress syndrome(ARDS). METHODS:Data of 86 ARDS patients were retrospectively analyzed and divided in-to observation group(45 cases)and control group(41 cases)by whether the early use of heparin. Control group received invasive mechanical ventilation,using end-expiratory pressure(PEEP)ventilation method,enteral nutrition support,nasogastric enteral nu-trition suspension 35-40 kcal/(kg·d);patients with combined infection were given Sodium ceftizoxime for injection 2 g,adding in-to 0.9% Sodium chloride injection 100 mL by intravenously infused,twice a day. Observation group was additionally given Hepa-rin sodium injection 6250 units by continuous intravenously pumped. They were treated for 14 d. The cumulative incidence of dis-seminated intravascular coagulation(DIC),and D-dimer,platelet count(PLT)before treatment and after 3,7,14 d of treatment, IL-6,IL-8,IL-10,TNF-α levels before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RE-SULTS:The cumulative incidence of DIC in observation group was significantly lower than control group,with statistical signifi-cance(P<0.05). Before treatment,there were no significant differences in the D-dimer,PLT,IL-6,IL-8,IL-10,TNF-α levels, with no statistical significance (P>0.05). After treatment,D-dimer,IL-6,IL-8 and TNF-α levels in 2 groups were significantly higher than before,while observation group was significantly lower than control group;PLT in 2 groups was significantly lower than before,while observaton group was higher than control group,with statistical significance (P<0.05). There was no signifi-cant difference in the IL-10 level in 2 groups before and after treatment (P>0.05). And there were no obvious adverse reactions during treatment. CONCLUSIONS:Based on conventional treatment,early use of heparin can significantly decrease the DIC rick for ARDS patients,which can improve coagulation disorders,reduce inflammatory response,and dose not increase the incidence of adverse reactions.

OBJECTIVE:To observe the efficacy and safety of amikacin different administrations in the treatment of ventila-tor-associated pneumonia. METHODS:Data of 109 patients with ventilator-associated pneumonia were divided into observation group (58 cases) and control group (51 cases) based on different administrations. All patients received 3.0 g Ceftriaxone sodium for injection,adding into 100 ml 0.9% Sodium chloride injection,intravenously,once every 12 h. Based on it,control group re-ceived 7.5 mg/kg Amikacin sulfate injection,once a day. Observation group received 7.5 mg/kg Amikacin sulfate injection,adding into 20 ml 0.45% Sodium chloride injection,aerosol inhalation,twice a day. The treatment course for both groups was 7 d. Clini-cal pulmonary infection score (CPIS),alanine aminotransferase (ALT),serum creatinine (Cr),oxygenation index (PaO2/FiO2), IL-10,IL-6,C-reactive protein(CRP),tumor necrosis factor(TNF)-α,cumulative mortality after 3 months of treatment and the incidence of adverse reactions before and after treatment in 2 groups were observed. RESULTS:Before treatment,there were no significant differences in the CPIS score,ALT,Cr,PaO2/FiO2,IL-10,IL-6,CRP and TNF-α levels in 2 groups(P>0.05). After treatment,CPIS score,TNF-α,IL-6 and CRP levels in 2 groups were significantly lower than before,observation group was low-er than control group,the difference was statistically significant(P<0.05),and there was no significant difference in IL-10 before and after treatment in 2 groups(P>0.05). PaO2/FiO2 in observation group and ALT,Cr and PaO2/FiO2 in control group were signif-icantly higher than before,PaO2/FiO2 in observation group was higher than control group,ALT and Cr were significantly lower than control group,the differences were statistically significant(P<0.05). The cumulative mortality after 3 months of treatment in observation group was significantly lower than control group,the difference was statistically significant(P<0.05). And there were no severe adverse reactions during treatment. CONCLUSIONS:The efficacy of amikacin by aerosol inhalation is superior to by in-travenous infusion in the treatment of ventilator-associated pneumonia,it can effectively reduce inflammatory cytokine levels and mortality rate,do not increase the incidence of adverse reactions.

OBJECTIVE:To explore the effects of xingnaojing combined with naloxone on related indexes of patients with he-patic encephalopathy. METHODS:In retrospective analysis,76 patients with hepatic encephalopathy were divided into control group(40 cases)and observation group(36 cases)according to drug use. Based on routine treatment,control group was additional-ly given Naloxone injection 1 mg added into 10% Glucose solution 100 mL intravenously twice a day. Observation group was addi-tionally given Xingnaojing injection 20 mL added into 0.9% Sodium chloride injection 250 mL intravenously once a day on the ba-sis of control group. Treatment courses of 2 groups lasted for 2 weeks. HDS score,MMSE score,the levels of blood ammonia,β-endorphin,CRP,IL-6 and TNF-α,the occurrence of ADR were observed in 2 groups before and after treatment. RESULTS:Af-ter treatment,HDS score and MMSE score of 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group;the levels of blood ammonia,β-endorphin,IL-6,CRP and TNF-α in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,with statis-tical significance(P<0.05). There was no statistical significance in the level of IL-10 between 2 groups before and after treatment (P>0.05). There was no statistical significantly in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on routine treatment,Xingnaojing combined with naloxone can significantly improve cognitive function for patients with hepatic en-cephalopathy and reduce peripheral blood neurotoxin and inflammatory factor,moreover,do not increase the incidence of ADR.

Objective To study the toxicity of fosthiazate feeding for 90 days in rats, and to determine the maximal non-effective dose of fosthiazate , in order to provide the reference dose for safety in production and chronic toxicity experiment.Methods A total of 80 SD rats ( half female and half male ) were randomly divided into 4 groups, respectively:0.8 mg/kg· bw· d group, 4.0 mg/kg· bw· d group, 20.0 mg/kg· bw· d group, and normal control group .The rats were sacrificed to determine the indices including serum biochemical parameters , body weight , routine urine test and organ coefficients after the end of the experiment , and the results were statistically analyzed .Results In the high dose group, the body weight gain was slowed in male and female rats .The TG and CHE in the high dose group of male rats and the TP, ALB, CREA, GLU, and CHE in the high dose group of female rats were significantly lower than those of normal control group.The ALP in the high dose group of female rats was higher than that of the normal control group .The positive rates of BIL, SG, and PRO in both male and female rats had significant differences compared with those of normal control group.The organ coefficients of brain , lung, kidney, adrenal, and testis of male rats, and the organ coefficients of brain , lung, and kidney of female rats in the high dose group were significantly higher than those of the normal control group .The ovaries and uterus in the female rats of high dose group were significantly lower than those of normal control group ( P<0.05,P<0.01).Conclusions The oral dose of fosthiazate at 4.0 mg/kg· bw· d fed for 90 days and above cause toxic effects on rats , and its maximal non-effect dose of long-term intake of low-dose fosthiazate on rats is 4 mg/kg· bw· d.

BACKGROUND:Source of bone for autografting,allografting and xenografting is insufficient.Moreover,immunoreaction,infection and re-fracture occur sometimes.As artificial bone substitute.calcium sulfate and calcium phosphate ate widely used in clinic.OBJECTIVE:To compare the curative effect between calcium sulfate(Stirnulan pellets)and calcium phosphate(Bio-Lu bioceramics)as bone substitutions in traumatic fractures.DESIGN.TIME AND SETTING:Randomized controlled observation was performed at the Department of Orthopedics,Beijing Xiyuan Hospital.China Academy of Chinese Medical Science between October 2004 and October 2007.PARTICIPANTS:Fifry patients with bone trauma-induced bone defect who needed bone grafting were selected and randomly divided into two groups:calcium sulfate(n=24)and calcium phosphate(n=26).METHODS:Besides internal fixation(steel-wire,plate)and external fixation(plaster,external frisket),all Cases were filled with bone substitutes.The grafted bone mass was on basis of standards of grafting:generally 3-5mL for Barton fracture and calcaneus fracture.the maximum 10 mL.MAIN OUTCOME MEASURES:Bone substitute usage,resorption time.fracture status and bone callus.RESULTS:All fractures that were filled with bone substitutes were healed well.No abnormal reaction occurred in calcium sulfate group.Two cases with calcium phosphate exhibited effusion in local soft tissue and healed by changing dressing.During the follow-up of 6 months(range 4-12 months),the bone substitutes were absorbed completely.The absorptivity of Stimulan pellets was 80%within 2 mortths and 100%within 3 months.faster than Bio.iu bioceramics(70%within 4-6months:90%within 7-12 mortths).CONCLUSION:The advantages of calcium sulfate and phosphate as bone substitutes are safety.convenience,and few side effects with good filling effect and well fractures healing.Moreover,the calcium sulfate powder(Stimulan)exhibits stronger supporting for bone defect area after soliditication,and faster degradation than calcium phosphate

Objective] To find a rapid method for diagnosing Acanthamoeba keratitis and identifing Acanthamoeba . [Methods] 10% potassium hydroxide(KOH) wet mount preparations, Acanthamoeba culture, inverted phase contrast microscopy,and pathological examination using H.E. staining and PAS staining. [Results]Using corneal scrapings and corneal materials obtained from surgery,7 cases and 5 cases of Acanthamoeba keratitis were diagnosed by 10% KOH wet mount preparations. 6 strains of Acanthamoeba were isolated in corneal materials of 6 cases by protozoa culture method. The cysts, trophozoites and pseudopods on the trophozoites of Acanthamoeba were directly observed under the inverted phase contrast microscope. The cysts and trophozoites of Acanthamoeba were seen by H.E. staining and PAS staining with 20 h. [Conclusion] Acanthamoeba keratitis could be rapidly diagnosed by 10% KOH wet mount preparations and inverted phase contrast microscopy. Acanthamoeba organisms could be directly observed and identified under inverted phase contrast microscope.

Objective To evaluate the dose distribution of target volume and normal tissues with different treatment planning such as three dimensional conformal radiotherapy(3DCRT) ,simplified intensity modulated radiotherapy(sIMRT) ,and intensity modulated radiotherapy (IMRT) for patients with radically resected rectal cancer. Methods Ten male patients with stage Ⅱ and Ⅲ rectal cancer after radical resection (Dixon surgery) were enrolled in this study. 3-field or 5-field 3DCRT,slMRT and 5-field or 7-field IMRT plans were performed for each patient. The dose distributions of target volume and normal tissues,conformal index(CI) and heterogeneous index(HI) were analyzed using the dose-volume histogram(Dvit). The prescription dose was 50 Gy in 25 fractions. Results The CI for PTV of IMRT and sIMRT was superior to 3DCRT. Conversely,the HI for PTV of 3DCRT was superior to sIMRT and IMRT. sIMRT and IMRT can protect the organs at risk better than 3DCRT. The mean of total MU for 3DCRT3f,3DCRT5f, sIMRT, IMRT5f and IMRTT7f was 482±13,504±11,455±42,841±36 and 884±46, respectively. Conclusions Comparing with 3DCRT plans and IMRT plans, sIMRT plan was the optimal plan for clinical practice. All of the three radiotherapy techniques can protect the rectal stump and anal canal well with the prescription dose of 50 Gy.

Objective To analyze the incidence, clinical feature and late complications, and treatment for diabetes ketoacidosis (DKA) in children with type 1 diabetes mellitus.Methods Ninty children with type 1 diabetes mellitus within 10 years were retrospectively reviewed.The onset situation,clinical feature and long-term complication,and treatment of DKA were analized.Results High morbidity was found in 10 to 16 years old children.DKA was often caused by infection; late complications of diabetes mellitus was resulted from interrupted injection of insulin.Conclusions Emergency treatment for DKA may involve the injection of small dose insulin,correction of the disorder of water and electrolysis and regulation of acid-base.The education of patients and parents about diabetes mellitus and long-term injection of insulin are of importance in preventing the complications.

OBJECTIVE To evaluate the clinical efficacy of piperacillin/tazobactam for acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with pulmonary encephalopathy.METHODS Seventy three cases of AECOPD with pulmonary encephalopathy were randomized into piperacillin/tazobactam group and ceftazidime group,and sputum culture was underwent for each case before and after treatment.RESULTS The total efficacy rates and bacterial clean rates in piperacillin/tazobactam group and ceftazidime group were 91.67% and 88.89%,75.68% and 57.89%,respectively,and the differences between the two groups were statistically significant.CONCLUSIONS It suggested that piperacillin/tazobactam be a more effective drug for AECOPD with pulmonary encephalopathy.

Objective To study treatment of massive variceal bleeding secondary to localized pancreatitis-associated portal hypertension (MVBPAPH).Methods A retrospective study on the clinical data of patients with MVBPAPH was carried out.Of 24 patients with MVBPAPH,20 had pancreatic pseudocysts.12 were operated after failure of treatment with endovascular intervention for variceal bleeding (including 10 patients with splenectomy and gastric fundus-body peripheral vessels amputation and 2 patients with pancreatic pseudocystogastrostomy).8 patients underwent partial splenic embolization and left gastroepiploic artery embolization.4 patients directly underwent splenectomy and gastric fundus-body peripheral vessels amputation for variceal bleeding.Results Left pleural effusion developed in 5 patients who underwent arterial embolization.Left pleural effusion and lung infection occurred in 2 patients who underwent operation.All patients recovered well and were discharged home.During the follow-up period of 2 to 72 months,no rebleeding occurred in these patients (including 2 patients had passed little interval melena).Gastroscopy re-examination showed that variceal veins were not found in 18 patients.Variceal veins which were detected in the remaining 6 patients were obviously less severe.Conclusion Individualized treatment should be given to patients with MVBPAPH and according to the specific type of pancreatitis and the onset time of any accompanying pseudocyst.