Objective To investigate the etiology,clinical characteristics,diagnosis and treatment of female uterine empyema.Methods We retrospectively analyzed the clinical data of 31 patients with uterine empyema in our hospital from January 2003 to December 2015.Results Uterine empyema was caused as a result of occlusion of the cervical canal,Patients had no typical symptoms,four cases had no symptoms (12.90％),twenty-two cases had abdominal pain (70.97％),twenty-seven cases had vaginal discharge (98.09％) and twelve cases had sanguinopurulent material (38.71％),three cases of them had fever (9.70％).Gynecological ultrasound examination was an important diagnostic tool.Dilatation of cervix,discharging purulent material,antibiotics treatment,the cervical adhesions were manually broken down to establish a patent cervical lumen to accommodate a uterine Fleischl catheter,the uterus was lavaged with 0.9％ Nacl solution,metronidazole,gentamicin.The above treatment got a good therapeutic effect.Conclusion Pyometra has atypical symptoms with difficult diagnosis,and develops gradually.Gynecological ultrasound examination has great clinical significance.Full dilatation of cervix,discharging purulent material are the key to the success of conservation treatment and can achieve good results.Combination of endometrial cancer or other malignant tumor patients should take surgery as soon as possible,according to the tolerance ability.

Objective To investigate the therapeutic efficacy of transpupillary thermal therapy (TTT) for age-related macular degeneration (AMD) accompanied with subfoveal choroidal neovascularization (CNV). Methods Fifty-one eyes of 47 patients whose illness had been diagnosed as AMD by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were treated with diode 810 laser. There are 42 eyes of 39 patients had occult CNV and 9 eyes of 8 patients had classic CNV, and the average visual acuity in their fist diagnosis was 0.12. According to the focus size, the diameters of beam spot varied from 0.8, 1.2, 2.0, and 3.0 mm; and the power was 120, 160, 260 and 360mW correspondingly, with the duration of 60 seconds. The follow-up examination was performed once a month after the treatment, and repetitious treatment would be taken once to thrice if necessary. The follow-up period was 3~33 months with the mean of 10 months. Visual acuity, haemorrhage in ocular fundus, absorption of exudation, and the closure of CNV were examined in the follow-up examination. Results No immediate decrement of visual acuity or any other discomforts were found in all of the treated eyes soon after the treatment. The average visual acuity of 51 eyes was 0.16 in the last diagnosis, which remained no change in 68.62%; increased in 23.53% and decreased in 7.84% compared with that in the first diagnosis. The results of FFA and ICCG demonstrated that at the 3rd months after the treatment, the closure rate was 42.86% in occult CNV and 22.22% in classic CNV; and at the 6th month, the closure rate was 73.81% in occult CNV and 66.67% in classic CNV. The results of ophthalmoscopy showed that at the 3rd month after the treatment, partial or complete absorption of hemorrhage and/or exudates with various thickness of organized scarring tissue was found in 42 eyes with occult CNV; decrement of hemorrhage and exudates was observed in 7 out of 9 eyes with classic CNV; and new hemorrhage occurred in 1 eye. At the 6~(th) month, in 27 eyes with occult CNV, new hemorrhage occurred in 3 including 2 eyes with occult CNV, new hemorrhage occurred in 3 including 2 eyes with faster absorption and remaining unchanged for 12 months; in 5 eyes with classic CNV, new hemorrhage occurred in 2, which was absorbed after treated again and remained stable in the 16-month followed-up. In 19 eyes with occult CNV which had been followed up for more than 6 months, hemorrhage disappeared in 5 and new hemorrhage occurred in 5. In the followed-up over 6 months, new hemorrhage occurred in 8 eyes with the recurrent rate of 15.6%. Conclusion TTT is effective for AMD with either classic or occult CNV. In the long-term followed-up, CNV recurs in 15.6% of the treated eyes which may be improved after the further treatment.

Objective To investigate the effect of batroxobin on the blood-retinal barrier (BRB) and vascular endothelial growth factors (VEGF) in diabetic rats. Methods Sixty Sprague-Dawley rats were used to establish diabetic models by intraperitoneal injecting with streptozotocin (60 mg/kg), and were divided into 3 groups: diabetic group (n=20), batroxobin (40 mg/kg) group (n=20) and batroxobin (20 mg/kg) group (n=20). Twenty-five else rats were in control group. All of the rats were executed 7 days later. The function of BRB was observed by Evans blue method. Results concentration of VEGF protein was detected by enzyme-linked immunoabsorbert assay (ELISA). The results of each group were compared. Results The content of BRB leaked into retina was obvious lower in the control group than which in the other 3 diabetic groups(P0.05). The content of Evans blue was lower in the 2 diabetic groups with different dosage of batroxobin than which in the control group (P

Objective To evaluate the efficacy of transpupillary thermotherapy(TTT)on three kinds of intraocular benign tumors. Methods Seventeen patients with 3 kinds of intraocular tumors,3 eyes of 3 patients with papillary hemangioma,9 eyes of 9 patients with choroidal hemangioma and 8 eyes of 5 patients with choroidal osteoma were treated with transpupillary thermotherapy.All patients underwent pretreatment ocular examination,including visual acuity,biomicroscopy for anterior segment and fundus examination,fundus fluorescein and indocyanine green angiography,optic coherence tomography,perimetry test,ultrasonography,and CT.TTT was conducted with infrared diode laser at810nm.with power of 360- 1 200 mW; beam diameter of 3 mm or combined 2-5 spots according to the tumor size;the exposure time was 60-80 seconds.The treatment was completed in one session,and another treatment was given 1-3 month later if active leakage demonstrated.The follow-up period was 6-36 months(mean 14.5 month). Results The best corrected visual acuity with Snellen chart on average for papillary hemangioma was 0.17 before TTT and 0.27 after;for choroidal hemangioma was 0.39 before TTT and 0.46 after;for choroidal osteoma was 0.20 before TTT and 0.31 after.Three eyes with papillary hemangioma had operation to release subretinal fluid and intraocular laser coagulation;the tumor remained reddish color with dilated vessels and patches of hemorrhages on the surface.After TTT the color appeared pale yellowish,hemorrhages absorbed,subretinal fluid subsided,and choroidal retinal atrophy disclosed along the lower border of the tumor.In 9 eyes with choroidal hemangioma, the red-light area disappeared, subretinal fluid subsided, and the pigment proliferation in the treatment area was found.Eight eyes with choroidal osteoma had choroidal neovessels and macular hemorrhages;after TTT blood disappeared,subretinal fluid absorbed,and the color of tumor showed pale yellow with dark pigment and thin scar tissue.There was no significant complication associated with TTT. Conclusions Transpupillary thermotherapy is effective on papillary hemangioma,circumscribed choroidal hemangioma and choroidal osteoma either as preliminary or supplementary treatment.

Objective To investigate the predictive value of continuous dynamic monitoring of intrapulmonary shunt (Qs/Qt) in patients with acute respiratory distress syndrome (ARDS).Methods A prospective observational study was conducted.The adult patients with ARDS undergoing mechanical ventilation admitted to intensive care unit (ICU) of Tianjin Third Central Hospital from June 2014 to December 2015 were enrolled.Baseline characteristics,demographic data and relevant physiologic data were recorded.All patients were divided into survivors and non-survivors according to the outcome of patients within 28 days.Artery and mixed venous blood was collected immediately after admission for blood gas analysis,and daily Qs/Qt within 7 days was continuously monitored in ARDS patients.The receiver operating characteristic curve (ROC) was used to evaluate the prognosis accuracy of Qs/Qt.Results In 46 enrolled ARDS patients,20 died,and 26 survived.During the first 7 days of ARDS,the mean Qs/Qt in survivors showed an increasing tendency [(23 ± 6)％,(27 ± 6)％,(28 ± 9)％,respectively,at 1-3 days] and a downtrend tendency from 4 days [(27 ± 5)％,(25 ± 4)％,(19 ± 4)％,(16 ± 2)％,respectively,at 4-7 days].However,a rising tendency of Qs/Qt in non-survivors was found at 1-7 days [(28 ± 7)％,(30 ± 3)％,(33 ± 6)％,(33 ± 11)％,(34 ± 5)％,(33 ± 6)％,(35 ± 6)％,respectively],and Qs/Qt from the 5th day in non-survivors was significantly higher than that in survivors (all P ＜ 0.05).The fluctuation of oxygenation index (PaO2/FiO2) within 1 week in both groups was small,and PaO2/FiO2 (mmHg,1 mmHg =0.133 kPa) at 1-7 days in survivors was 167.37±43.98,180.55±39.90,174.27±35.47,188.64±39.74,252.54±49.22,239.35±25.63,248.93±45.64,respectively,and it was 168.65±35.54,182.31 ± 32.36,159.80 ± 34.39,176.97 ± 31.75,200.69 ± 45.33,185.98 ± 36.47,and 175.43 ± 30.98 in non-survivors respectively.PaO2/FiO2 was significantly lower in non-survivors than survivors from 5 days (all P ＜ 0.05).It was shown by ROC curve that area under ROC curve (AUC) for Qs/Qt evaluating the prognosis on the 5th day was 0.958,and 95％ confidence interval (95％CI) was 0.777-0.999 (P ＜ 0.000 1,Z =13.13).When the cut-off value of Qs/Qt was 28％,sensitivity and specificity were 83.3％ and 90.0％,respectively.AUC for PaO2/FiO2 evaluating the prognosis on the 5th day was 0.790,and 95％CI was 0.577-0.928 (P =0.002 1,Z =3.08).When the cut-off value of PaO2/FiO2 was 223 mmHg,sensitivity and specificity were 69.2％ and 81.8％,respectively.Conclusion Dynamic Qs/Qt surveillance can help physician to analyze the changes of the patient's condition,and it was better than PaO2/FiO2,and can be an important evaluation indicator of prognosis for ARDS patients.

Objective To investigate the effect of different appropriate modes of weaning from mechanical ventilation (MV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Patients with AECOPD and mechanically ventilated by orotracheal intubation, suitable for continuous positive airway pressure+proportional pressure support (CPAP+PPS) and CPAP+assisted spontaneous breath (ASB) ventilation mode for weaning from MV, admitted to intensive care unit (ICU) of Tianjin Third Central Hospital form January 1st, 2016 to December 31st, 2017 were enrolled. When the patients recovered to spontaneous respiration and down regulation of ventilator support frequency to 10 bpm, they were taken ventilator weaning in CPAP+PPS and CPAP+ASB mode according to the random number table method, respectively. Basic characteristics, ventilator parameters, the incidence of high man-machine confrontation (man-machine confrontation index > 10%) and clinical outcomes (ventilator weaning time, which was defined as the time from randomization to successful weaning from MV, ventilator weaning failure times, the duration of MV, the length of ICU stay and the length of hospital stay) were compared between the two groups. Results Eighty-seven AECOPD patients were selected, 44 in CPAP+ASB group and 43 in CPAP+PPS group. There was no significant difference in gender, age, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure score (SOFA), Glasgow coma score (GCS), Charsen index and the highest arterial blood carbon dioxide partial pressure (PaCO2), the lowest arterial oxygen partial pressure (PaO2) and tidal volume (VT) at the time of onset between the two groups. Compared with CPAP+ASB group, incidence of high man-machine confrontation was significantly decreased in CPAP+PPS group [9.30% (4/43) vs. 27.27% (12/44), P =0.027], and the airway occlusion pressure (P0.1) was significantly decreased [cmH2O (1 cmH2O = 0.098 kPa): 2.21±0.83 vs. 2.63±0.94, P = 0.032], and the failure rate of the first spontaneous breathing trial (SBT) was significantly decreased [6.98% (3/43) vs. 22.73% (10/44), P = 0.039], ventilator weaning time, the length of ICU stay and the length of hospital stay were significantly shortened [ventilator weaning time (hours): 12.73±14.23 vs. 50.64±38.11, the length of ICU stay (hours): 254.53±108.06 vs. 344.93±124.95, the length of hospital stay (days): 18.53±7.59 vs. 26.64±11.22, all P < 0.05]. However, there was no significant difference in PaCO2, duration of MV, ICU mortality and hospital mortality between the two groups. Conclusion Compared with CPAP+ASB ventilation mode, CPAP+PPS ventilation mode can reduce respiratory muscle load, promote respiratory function recovery, and reduce the occurrence of man-machine confrontation, which is beneficial to AECOPD patients taking ventilator weaning, and can significantly shorten the ventilator weaning time of patients and further shorten the hospitalization time.

OBJECTIVE:To establish the quality standard for Gaultheria yunnanensis. METHODS:TLC was adopted for quali-tative identification of samples. Moisture,total ash and acid-insoluble ash were determined. HPLC method was used to determine the content of methyl salicylate. The determination was performed on Eclipse XDB-C18 column with mobile phase consisted of meth-anol-water(62:38,V/V)at the flow rate of 1.0 mL/min. The detection wavelength was set at 307 nm,and column temperature was 30 ℃. The sample size was 10 μL. RESULTS:TLC spots of samples were clear and well separated. The moisture was 8.2%-10.8%,total ash was 0.9%-4.0% and acid-insoluble ash was 0.1%-0.9%. The linear range of methyl salicylate were 0.045-0.73μg(r=0.9999). RSDs of precision,stability and reproducibility tests were no more than 1.0%. The recoveries of meth-yl salicylate were 97.8%-104.3%(RSD=2.6%,n=9). CONCLUSIONS:The established standard can be used for quality control of G. yunnanensis.