Objective To investigate the possibility of reserving uterus during severe postpartum hemorrhage. MethodsA retrospective analysis was conducted on the clinical data of 138 cases of severe postpartum hemorrhage (blood loss ≥2000 ml) from January 1, 2003 to December 31, 2009. Results Among 138 cases of severe postpartum hemorrhage, uterine atony (n= 60, 43. 38 ％ ) was the first cause and the second was placental factor (n= 55, 39.86 ％). The blood loss varied from 2000 ml to 10 000 ml and the mean level was about (3004± 1473) ml. The volume of blood transfusion for these patients varied from 800 ml to 7200 ml. Among these patients, the blood loss of 108 cases reserved uteri was from 2000 ml to 7500 ml, with the average of (2564±932) ml； while for 30 cases performed with hysterectomy, the blood loss was about 2500 to 10 000 ml averagly (4653± 1857) ml (t=8. 57, P=0.00). These patients were divided into two groups according to time series. Twelve cases of hysterectomy were performed during 2003to 2005, and the hysterectomy rate was 0. 47‰; 18 cases of hysterectomy were performed during 2006 to 2009, and the hysterectomy rate was 0. 36‰. The average blood loss of the above two groups was (3783±861) ml and (5233±2124) ml respectively (t=2. 234, P=0. 034). Among all the cases with blood loss ≥ 3000 ml, uteri were reserved in 24 cases with the average blood loss of (3818 ± 1284) ml； while hysterectomy were performed in 27 cases with average blood loss of (4900 ± 1789) rnl (t = 2. 453, P =0. 018). The time for blood loss to 3000 ml in the two groups was (160±129) min and (100±67) min,respectively, and the difference was significant (t=2. 113, P = 0.04).The uteri of six cases with postpartum hemorrhage over 4000 ml were successfully reserved, and average bleeding amount was 5570 ml.Two patients among the 138 women died of amniotic fluid embolism.The perinatal mortality rate was 3. 73％.ConclusionsThe postpartum hemorrhage volume and velocity is the key point to decide whether to reserve the uterus or not.For the population with high risk factors,prophylaxis treatment with prostaglandins should be initiated to reduce the bleeding volume.Uterine packing might be an effective treatment to stop postpartum hemorrhage, especially for those bleeding due to placenta previa.

This study was aimed to reveal the effector mechanisms of Chinese medicine aconite, ginseng, astragalus and dried ginger on the intervention of adriamycin (ADR) cardiotoxicity model rats. The analysis was made on the interactive relationship between aconite and ginseng, astragalus as well as dried ginger. A total of 72 rats were randomly divided into nine groups. There were eight rats in each group. Except the normal group, rats in each group were intraperitoneally injected with 2.5 mg·kg-1 of ADR according to their body weights. The injection was given once a week and continued for four weeks. The total dosage was 10 mg·kg-1. In the aconite, dried ginger group, the intragastric administration dosage of herbal decoction was 1.75 g·kg-1. The decoction dosage in the gin-seng, astragalus group was 0.875 g·kg-1. The decoction dosage in the Shenfu, Qifu group was 2.625 g·kg-1. The decoction dosage in the Jiangfu group was 3.5 g·kg-1. The intragastric administration was given once a day and continued for four weeks. Indexes such as superoxide dismutase (SOD), cardiac troponins (cTn), cytochrome C (CytC), myocardial mitochondria of Bax, Bcl 2, caspase-3, caspase-9 were detected. The colligation score was calculated associating with the close index. One-way ANOVA was given on different indexes and colligation indi-cators among different drug groups and the factorial design variance analysis was given to reveal the drug interac-tions. The results showed that compared with the normal group there were statistical significances among different indexes in the model group (P < 0.05). Aconite, ginseng, astragalus, dried ginger had varying degrees of impact on different indicators. There were statistical significances on the interaction between aconite and ginseng, astra-galus, dried ginger (except Bax). It was concluded that herbal medicine aconite, ginseng, astragalus, dried ginger had certain protective effect to the heart of ADR model rats. The combination of aconite and ginseng, astragalus, dried ginger can enhance the effect compared with a single herb.

The development of clinical microbiology laboratory is an essential part in promoting the development of clinical microbiology and the basis rational use of antimicrobial agents.Under the circumstances of national specific rectification of antimicrobials,clinical microbiology laboratory should focus on self-buildup and improvement.The development of clinical microbiology laboratory should focus on development of both software and hardware capabilities for lab examination and diagnosis in an all-round way,enhance the antimicrobial susceptibility surveillance,and emphasize and communication and cooperation between laboratory and other departments e.g.clinical departments,pharmacy department and nosocomial surveillance and control office,making concept translation from past ‘paramedical department' to a ‘platform department',contribute its due share to the rational uses of antimicrobial agents.

Objective To observe the clinical curative effect of BudesonideNasal Spray plus Gelomyrtol Forte for acute secretory otitis media.Methods 80 Patients (108ears) and 60 patients (74ears) were treated by BudesonideNasal Spray be bound to Gelomyrtol Forte and Cefaclor Dispersible Tablets res pectively. After 10 days, observe the two groups’s clinical curative effect for acute secretory otitis media.Results The of treatment’s group efficient rate is 99.07, Cefaclor Dispersible Tablets 87.84, and the difference is (?2 =10.68 P0.05), and mild adverse reactions will be disappeared after stoping drugs. Conclusion The of BudesonideNasal Spray puls Gelomyrtol Forte is better than that of Cefaclor Dispersible Tablets for acute secretory otitis media. The mild adverse reaction is the same between the two groups.

AIM: To investigate the clinical effects of phacoemulsification and surgical techeniques in small pupil cataract after filtering operation of glaucoma.
METHODS: Thirty-six cases ( 36 eyes ) of small pupil cataract after filtering operation of glaucoma were underwent phacoemulsification combined with foldable intraocular lens implantation. Postoperative visual acuity, intraocular pressure filtration bleb and complications were observed. The follow-up time was 3mo.
RESULTS: The preoperative uncorrected visual acuity (UCVA) or best-corrected visual acuity ( BCVA) ≤0. 3 were in all patients. Postoperativerly, the UCVA or BCVA≥0. 3 after 1wk and 3mo were achieved in 23 eyes (63.89%) and 34 eyes (94. 44%). BCVA was <0. 3 in 2 eyes ( 5. 56%) including optic nerve atrophy of one eye and diabetic retinopathy of one eye. All patients were kept the level of normal intraocular pressure and completed filtering bleb, there were no serious complications.
CONCLUSION: Phacoemulsification in small pupil cataract after filtering operation of glaucoma was complex, and reasonable application of operation skills can still achieve better clinical results. The main factor of affecting the visual acuity is pre-existing retinal optic neuropathy.

Objective To investigate the effects of Panax notoginseng saponins(PNS) on penile erection in rats with diabetes-as-sociated erectile dysfunction (ED) .Methods Ninety male Sprague-Dawley rats were established diabetic rats by injecting streptozo-tocin(STZ) ,and observing erectile phenomenon by injecting apomorphine .After 4 weeks of PNS treatment (low-dose ,medium-dose , high-dose group) ,erectile function in each group was assessed by intracavernous pressure (ICP) and mean arterial pressure(MAP) measurement .The level of nitric oxide(NO)and cyclic guanosine monophosphate(cGMP)in cavernous tissue were detected .Immu-nohistochemical staining and TUNEL were performed for detecting endothelial nitric oxide synthase (eNOS) and apoptosis ,respec-tively .Results ICP and ICP/MAP ratio were significantly increased in medium-dose and high-dose PNS treated groups compared with the diabetic untreated group(P<0 .05) .Compared with the diabetic untreated group ,the expression of eNOS and the levels of NO and cGMP were increased in medium-dose and high-dose PNS treated groups(P<0 .05) .The apoptosis ratecorpus of caverno-sum in 3 PNS treatment groups significantly decreased than the diabetic untreated group (P<0 .05) .Conclusion PNS can recovery the endothelial cell function in corpus cavernosum by adjusting the NO/cGMP pathway and controlling the accumulation of AGEs , and may be used for improving in diabetic ED rats .

Objective:To explore the breakthrough points of pharmaceutical care in the anti-infection treatment by clinical phar-macists. Methods:Using the pharmaceutical care carried out by clinical pharmacists in the treatment of infected patients as the exam-ple, the breakthrough points of pharmaceutical care in the anti-infection treatment by clinical pharmacists were discussed. Results:Clinical pharmacists should be in accordance with the specific clinical conditions to find out such breakthrough points of pharmaceutical care as judging the indications of antibacterial drugs use, assisting in the development of drug therapeutic regimens ( including the choice of species, dosage and solvent, the optimization of PK/PD parameters and the infusion speed) , paying close attention to bacteri-al culture, concerning on drug interactions, monitoring adverse drug reactions and efficacy, providing patient medication education and so on. Conclusion:Clinical pharmacists can participate in anti-infection treatment and carry out individual pharmaceutical care to en-sure the safety and efficacy of drugs.

Objective To evaluate the role of phosphatidylinositol 3-kinase/protein-serine-threonine kinases (PI3K/Akt) signaling pathway and autophagy in reduction of adriamycin-induced myocardial injury by sevoflurane in the rats.Methods Thirty-six healthy male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 6 groups (n =6 each) using a random number table:control group (group C),adriamycin-induced myocardial injury group (group Dox),sevoflurane group (group Sev),LY294002 inhibitor group (group LY),solvent control group (group dimethyl sulfoxide [DMSO]),and 3-MA inhibitor group (group 3-MA).Adriamycin 4 mg/kg was injected intraperitoneally once a week for 3 weeks in all the groups except group C.The rats were mechanically ventilated for 2 h in C and Dox groups.The rats inhaled 2.4％ sevoflurane for 2 h in group Sev.In group LY,0.3 mg/kg LY294002 was injected via the tail vein at 10 min before anesthesia,and the rats inhaled 2.4％ sevoflurane for 2 h.In group DMSO,the equal volume of DMSO was injected,and the rats inhaled 2.4％ sevoflurane for 2 h.After the blood samples were collected from the heart,the rats were sacrificed,and myocardial specimens were obtained for determination of cardiac troponin Ⅰ (cTnI) concentrations in serum (by enzyme-linked immunosorbent assay),expression of total Akt (t-Akt),phosphorylated Akt (p-Akt),mammalian target of rapamycin (mTOR),phosphorylated mTOR (p-mTOR) and autophagy marker microtubule-associated protein light chain 3 Ⅱ (LC3 Ⅱ) (by Western blot),and cell apoptosis (by TUNEL).Apoptosis index (AI) was calculated.Results Compared with group C,the expression of p-Akt and p-mTOR was significantly down-regulated,and the expression of LC3 Ⅱ,AI,and serum cTnI concentration were significantly increased in the other five groups (P＜ 0.05).Compared with group Dox,the expression of p-Akt and p-mTOR was significantly up-regulated,and the expression of LC3 Ⅱ,AI,and serum cTnI concentration were significantly decreased in group Sev (P＜0.05).Compared with group Sev,the expression of p-Akt and p-mTOR was significantly down-regulated,and the expression of LC3 Ⅱ,AI,and serum cTnI concentration were significantly increased in group LY,and the expression of LC3 Ⅱ was significantly down-regulated,and serum cTnI concentrations were significantly decreased in group 3-MA (P＜0.05).Conclusion Sevoflurane can activate PI3K/Akt signaling pathway and inhibit autophagy,thus reducing adriamycin-induced myocardial injury in rats.

Objective To investigate the relationship between alterations in the corneal innervation observed by laser confocal microscopy and peripheral neuropathy severity in the patients with impaired glucose tolerance (IGT).Methods A total of 70 patients with IGT were consecutively enrolled into the study.Among them,30 patients were diagnosed as peripheral neuropathy (IGT-PN),40 patients without peripheral neuropathy (IGT-NPN).Fifty age-matched healthy subjects were also studied.Corneal subbasal nerves were investigated by laser confocal microscopy.Results Corneal nerve fiber length (17.1 ±4.9) vs (14.0±3.8) mm/mm2; t=13.484,P＜0.05),newe branch density ((53.1 ±18.8) vs (36.2±11.5) mm/mm2 ; t =9.369,P ＜ 0.01) and nerve fibre tortuosity ((2.07 ± 0.76) vs (0.88 ± 0.55) levels,t =12.957,P ＜0.05)were significantly increased in IGT-NPN group when compared with control group,but nerve fibre density had no difference.Nerve fiber length,nerve branch density and nerve fibre density were significantly decreased in IGT-PN group compared with control group and IGT-NPN group,while NFT was significantly increased in IGT-PN group.Conclusions Patients with impaired glucose metabolism show alterations in corneal innervations before diagnosed with diabetes mellitus or peripheral neuropathy.It indicates that corneal confocal microscopy can be used for early diagnosis of diabetic peripheral neuropathy.

Objective To explore the diagnostic value of corneal confocal microscopy in the early small fibre neuropathy (SFN).Methods A total of 45 patients with small fibre neuropathy and 50 age-matched healthy subjects undertook a neurological evaluation,neurological deficits score (NDS),sural nerve conduction velocity,contact heat evoked potential (CHEP) and corneal confocal microscopy (CCM) to quantify small nerve fibre pathology.Four parameters including nerve fiber length (NFL),nerve branch density (NBD),nerve fiber density (NFD) and nerve fibre tortuosity (NFT) were calculated from the observation of corneal confocal microscopy.Results Compared with the control group,significantly decreased NFD and NBD were found in the SFN group [(42.00 ±25.26)/mm2 vs (72.38 ± 14.09) /mm2 ;(31.93 ± 13.21)/mm2 vs (46.24 ± 11.48)/mm2 ; with all P ＜ 0.05],while NFT were significantly increased in the SFN group [(2.48 ±0.87) levels vs (0.88 ±0.56) levels,P ＜0.001].The neurological deficits score was correlated with NFT,NFD and NBD (r =0.782,-0.376,-0.504 ; with all P ＜ 0.001).Conclusion CCM is a new and sensitive noninvasive clinical technique that may be used to detect early small fibre nerve damage in patients with SFN.