Based on clinical features of refractory diseases and clinical practice experience for many years,the author expounded the therapeutic strategies from establishing individualized system of differentiation treatment,treatment strategies of refractory diseases,and the key for medication,and emphasized individual concerned therapy,separating primary and secondary treatment and grasping the physiological state to treat pathological changes.Thus complicated and changeable diseases can be treated clinically.

Anti-Bacterial Agents ; therapeutic use ; Emergencies ; Enterocolitis, Necrotizing ; diagnosis ; epidemiology ; etiology ; prevention & control ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; epidemiology ; etiology ; prevention & control ; Infant, Very Low Birth Weight ; Infection Control ; Intensive Care Units, Neonatal ; Premature Birth ; prevention & control ; Risk Factors

Brain Injuries ; surgery ; Female ; Humans ; Hypoxia-Ischemia, Brain ; surgery ; Infant, Newborn ; Male ; Neural Stem Cells ; cytology ; transplantation

Microorganisms can affect the development of body immune system.Intestinal flora regulate immune function by promoting the intestinal immune system development,inducing T cell differentiation to avoid or reduce the incidence of immune-related diseases.Allergic diseases are related with the body's immune system hypoplasia and imperfect immune regulation mechanism.The immune system can be affected by intestinal flora,and the distribution of flora in the body between children with allergies and healthy children are significantly different,indicating that the occurrence of allergic diseases are associated with intestinal microflora.Studies have reported probiotic are helpful to the prevention and treatment of allergic disease,providing a new way for the prevention and treatment of allergic diseases.

A magnitude of 8.0 earthquake struck on Wenchuan on May 12, 2008. Until July 1, 1393 injured persons had been admitted to Deyang People's Hospital. Of all injured persons, 32 were diagnosed with abdominal injury, including 18 men and 14 women. All the abdominal injuries were closed injury, and multiple abdominal viscera were involved in the abdominal injuries after the earthquake. Careful examination is crucial in preventing missed diagnosis. The incidences of the liver and spleen injuries were significantly higher than that of the intestine, and the reason may be that the liver and spleen are the parenchymal viscera. Diagnostic abdominocentesis can timely diagnose the parenchymal viscera with severe blood loss. Diagnostic peritoneal lavage combined with selective CT scan can timely diagnose the abdominal injuries with comparatively low cost.

Objective To investigate the association between thyroid autoimmunity (TAI) and miscarriage.Methods A systematic review of both case-control and cohort studies on the association between TAI and miscarriage published before March 2009 was performed.All the literatures were abstracted based on the defined selection criteria by two independent investigators.Publication bias was tested by funnel plot.The odd ratios of case-control studies and relative risks of cohort studies were pooled respectively,depending on the result of heterogeneity test among the individual studies.The software Review Manager (version 4.3.1) was used for meta analysis.Results Electronic search yielded 23 articles,4 of which were reviews and were excluded.The remaining 19 clinical studies met the selection criteria,of which 7 were case-control studies and 12 cohort studies.A clear association between the presence of thyroid autoantibodies (TA) and miscarriage was found with a pooled odds ratio of 2.72 (95% CI 1.27-5.80,P = 0.01) in 7 case-control studies,and a pooled relative risk of 2.41 (95% CI 1.96-2.96,P＜0.01) in 12 cohort studies.Women with TA were found to have slightly older age (age difference,1.29 years,95% CI 0.43-2.16,P = 0.003) and raised TSH levels (TSH difference,0.61 mIU/L,95% CI 0.51-0.71,P＜0.01) compared with those without TA.Conclusion TAI is significantly associated with miscarriage,which can be interpreted as the direct involvement of TA.Alternatively,the association can be partially explained by the slightly older age in women with TA compared with those without.A third possibility is mild thyroid failure,as TSH levels in TA-positive but euthyroid women are higher than in TA-negative women.

AIM: To evaluate the efficacy and safety of multiple vitamin E, C, B facial mask for the patients with acne vulgaris. METHODS: One hundred and seventeen patients aged over 13 a, with acnes mainly sited on the face and an acne severity rating above grade 2 were enrolled in this study. The mask treatment was used once a day with 8 wk as a course.The primary endpoint included the number and the degree of acne lesions including comedoes, papules, pustules and cysts. The secondary endpoint was the overall efficacy evaluation by the physicians. RESULTS:After 8 wk of treatment with multiple vitamin E, C, B facial mask, the mean number of acne lesions:comedoes, papules, pustules and cysts decreased 13 + s 13,10 ± 12, 5 + 7 and 3 + 3, respectively. These changes were statistically significant (P ＜ 0.01 ). The results of overall efficacy evaluation showed that 7 patients '(6.0 % ) symptom was greatly improved, 44 patients '(37.6 % ) symptoms were moderately improved, 56patients'(47.9 % ) symptoms were slightly improved,and 10 patients' symptoms did not change. Among all 117 patients, 59 patients (50.4 % ) showed no adverse reactions, including swelling, redness, itching,burning or scaling. CONCLUSION: Multiple vitamin E, C, B facial mask is efficacious for the treatment of acne and more than half study subjects experienced in none adverse reaction. Multiple vitamin E, C, B facial mask possesses an alternate therapy in acne vulgaris.

Objective To evaluate the effect of chronic alcohol intake on the sedative potency of propofol through investigating the effect of chronic alcohol intake on the half-effective target effect-site concentration ( EC50 )of propofol required for loss of consciousness in patients. Methods Fifty male ASA Ⅰ or Ⅱ patients, aged 25-60 yr, weighing 50-80 kg, scheduled for elective surgery, were divided into 2 groups according to the history of chronic alcoholic intake ( n = 25 each): control group (alcoholic intake per day ＜ 25 g) and chronic alcoholic group (alcoholic intake per day＞45 g, lasting for 2 yr or more). The EC50 and 95% confidence interval (CI)were determined by up-and-down sequential method. The initial target effect-site concentration was 2 μg/nl in chronic alcoholic group and 1.5μg/ml in control group, and the ratio between the two successive concentrations was 1.05. Loss of consciousness was defined as loss of response to verbal command and eyelash stimulation. Results The EC50 of propofol that produced loss of consciousness was 3.92 (95 % CI 3.56-4.63 ) μg/ml in chronic alcoholic group and 2.73 (95%CI 2.26-3.31)μg/ml in control group. The EC50 of propofol was significantly higher in chronic alcoholic group than in control group ( P ＜ 0.05). Conclusion Chronic alcohol intake can increase the EC50 of propofol required to induce loss of consciousness and reduce sedative potency in patients.

Anemia of prematurity is very common in preterm infant.Phlebotomy losses and inadequate production of erythropoietin are the main reasons.Treatment of anemia of prematurity includes delayed umbilical cord clamping at delivery,decreasing phlebotomy losses,use of red cell growth factors such as erythropoietin properly,red blood cell transfusions,which are based on indications and guidelines.In this article we review recent studies in preventing and treating anemia in preterm infants.

Patent ductus arteriosus (PDA)is a common disease among premature neonates and the management of which has always been a challenge to the neonatologists. Early treatment has been advocated as the first-line approach, and drug induced closure is yet the most effective, inexpensive, and convenient method. During the last two decades,indomethacin was often given as conservative treatment, and its closure rate in PDA was approximately 46% ～ 89%. However,indomethacin may increase the number of undesirable or harmful effects including renal damage, intraventricular hemorrhage, necrotizing enterocolitis, and enterobrosis,etc. Recently,ibuprofen is rapidly emerging as a new promising drug for treatment of PDA in preterm infants with closure rate of 73.0% ～95.5%. It is used as standard therapy to close PDA,and it has less influence on the hemodynamics of kidneys, brain and gastrointestinal tract. The surgery is needed in patients with drug treatment failure and cardio-pulmonary function damage.