Objective To explore the clinical efficacy and safety of ropivacaine for combined spinal-epidural anesthesia(CSE).Methods 40 patients,who intended to undergo elective lower limb or perineum surgery,were randomly divided into two groups,each with 20 cases,ropivacaine were used in treatment group,while bupivacaine in control group the differences of feeling,motor block and recovery time,as well as their side effect in the two groups were compared.Results The maximum of spread time of anesthesia and the recovery time,and side effect in treatment group were similar to those in control group.The onset time of motor block and the peak time of motor block were longer in treatment group than that in control group,the maximum modified Bromage scale in treatment group was lower than that in control group(P

Objective To understand the distribution of nosocomial infection pathogens and drug - resistance in intensive care unit of our hospital for providing the guidance of clinical rational administration and preventing the hospital infection. Methods Pathogenic bacteria were isolated from the patients who suffered from nosocomial infection in intensive care unit from January of 2008 to December of 2008. They were tested by microbe VITEK and drug - sensitive reagent. Rate of drug resistance of the pathogenic bacteria was analyzed. Results Gram - negative bacilli( G- ) accounted for 47.67% of the isolated pathogenic bacteria,and most were Acinetobacter baumannii (21.65%) , Pscudomonas aeruginosa( 8.00% ) , Stenotropham onasm altophilia(6.33% ) and Klebsiella pneumoniae (4.00%). Grampositive cocci ( G~+ ) accounted for 9.56 % , and most were Staphylococcus aureus (5.56%) and Enterococcus faecium ( 1.44 % ). The rnycetes occupied the 42. 78% of the pathogens. The main pathogenic bacteria were Candida albicans (24. 44% ) and Candida albicans ( 10.89% ). The rate of drug resistance of Gram - negative bacilli( G~- ) was high as a whole,while the rate of mycetes was low. Conclusion Enhance monitoring on pathogenic bacteria distribution and drug resistance analyses of nosocomial infection in ICU could benefit for the guide of clinical rational administration and depressing multidrug - resistant bacteria.

0.05),but decrease of BP in groupⅠandⅡhad conspicuous difference compared with groupⅢ(P

Objective: To investigate the clinical effect of knee arthroscopy combined with celecoxib in the treatment of elderly patients with knee osteoarthritis. Methods: According to the random table method, 62 elderly patients with knee osteoarthritis admitted to the Third People's Hospital of Zhuji from October 2016 to October 2018 were divided into control group (31 cases) and observation group (31 cases) according to the digital table.The control group was treated with knee arthroscopic debridement, while the observation group was orally given celecoxib on the basis of the control group.Both two groups were treated for 12 weeks.The curative effect of the two groups was compared, and the changes of WOMAC scale score, knee joint active flexion and extension and inflammatory factors before and after treatment were compared. Results: The excellent and good rate of the observation group (83.88%) was higher than that of the control group (51.62%) (χ²=7.381, P<0.05). After treatment, the scores of stiffness[(3.56±0.38)points], difficulty in daily activities[(27.38±7.19)points]and pain[(7.94±2.45)points] in the observation group were lower than those in the control group[(5.81±0.76)points, (38.98±5.42)points and (11.36±1.87)points](t=10.182, 14.743, 6.178, all P<0.05). After treatment, the knee joint active flexion and extension in the observation group[(91.24±7.86)°] was higher than that in the control group[(83.42±7.39)°](t=4.036, P<0.05). After treatment, the serum levels of IL-1beta[(16.58±4.25)ng/L], TNF-α[(183.25±24.15)ng/L]and IL-6[(9.98±2.43) ng/L] in the observation group were lower than those in the control group[(26.31±5.47)ng/L, (219.82±29.96)ng/L and (14.52±4.35)ng/L](t=7.821, 5.291, 5.073, all P<0.05). Conclusion Knee arthroscopy combined with celecoxib has good clinical effect on elderly patients with knee osteoarthritis.It can improve knee function, alleviate inflammation and improve active knee flexion and extension.

To explore the application of protein fingerprint technique and differential diagnosis in bacteriological negative pulmonary tuberculosis and pneumonia ,60 patients with bacteriological negative pulmonary tuberculosis ,60 patients with pneumonia ,and 60 healthy volunteers were selected from known clinical cases .Surface strengthening laser desorption ioniza-tion time of flight mass spectrometry (SELDI ToF Ms) and protein chip technology were applied to detect serum proteins ,and analyze their protein peaks by Ciphergen protein chip 3 .1 .1 software .Comparison of the serum protein fingerprinting data from the pool of 180 patients and healthy volunteers showed significant difference in 5 protein peaks (1 028 .49 ,4 796 .56 ,7 564 .77 , 8 048 .02 ,and 11 526 .75 m/z) identified between pulmonary tuberculosis and pneumonia (P<0 .01) .The total effective rate of the 5 protein peaks as a diagnosis model for differential diagnosis of bacteriological negative pulmonary tuberculosis and pneumonia was 84 .2% (101/120) ,the specificity was 82 .5% (52/63) ,the sensitivity was 85 .9% (49/57) ,the positive pre-dictive value was 86 .7% (52/60) ,and the negative predictive value was 81 .7% (49/60) .The total effective rate of the diagno-sis model for differential diagnosis of bacteriological negative pulmonary tuberculosis ,pneumonia and healthy volunteers was 89 .4% (161/180) .The specificity was 100% (60/60) ,the sensitivity was 84 .2% (101/120) ,the positive predictive value was 100% (101/101) ,and the negative predictive value was 75 .9% (60/79) .Protein fingerprinting technology is advanta-geous of being a simple method ,quick detection ,and requires less amount of sample .It is an effective means to screening the tuberculosis specific markers .We found the good diagnosis model through the detection of serum protein by protein fingerprint-ing technology .

Objective: To investigate the association between the left atrial appendage (LAA) volume and atrial fibrillation (AF) recurrence after radiofrequency catheter ablation. Methods: We prospectively enrolled sixty-two patients with AF (40 cases with paroxysmal AF, 22 cases with persistent AF) who successfully underwent a first AF catheter ablation and had performed contrast-enhanced cardiac computed tomography (CT) prior to the procedure to measure LAA volumes in our hospital from January 2012 to August 2015. Circumferential pulmonary vein isolation was performed under the guidance of three-dimension mapping system (CARTO system). Linear ablation or ablation of complex fractioned atrial electrograms was also undertaken if necessary. All patients were followed up at the 3rd, 6th and 12th months after ablation by 24-hour ambulatory Holter monitoring, and were divided into the non-recurrence group (n=42) and the AF recurrence group (n=20). Univariate and multivariate Cox proportional hazards regression analysis were used to assess the factors related to AF recurrence. The receiver operating characteristic (ROC) curve was calculated to assess the best cut-off value of LAA volume to predict AF recurrence. Kaplan-Meier method was used to evaluate the rate of freedom from AF recurrence. Results: Mean LAA volume in all patients was (9.5±3.6)ml. AF recurrence occurred in 20 patients (32%) during the follow-up period. The LAA volume was significantly larger in the AF recurrence group than in the non-recurrence group ((11.5±3.8)ml vs. (8.3±3.1)ml, P=0.002). In the univariate regression analysis, LAA volume (HR=1.36, 95%CI 1.14-1.82, P<0.001), persistent AF (HR=4.43, 95%CI 1.52-12.06, P<0.001) and hypertension (HR=1.61, 95%CI 1.13-2.04, P=0.041) were risk factors of AF recurrence. However, multivariate regression analysis revealed that LAA volume (HR=1.32, 95%CI 1.12-1.51, P<0.001) and persistent AF (HR=4.22, 95% CI 1.48-11.05, P<0.001) were independent predictors for AF recurrence after ablation. The receiver operating characteristic (ROC) curve analysis revealed that a LAA volume >8.80 ml was associated with AF recurrence after ablation (sensitivity: 94% and specificity: 66%, area under the curve=0.76). Kaplan-Meier analysis showed a lower rate free from AF recurrence in the group with LAA volume >8.80 ml (P<0.001). Conclusion Larger LAA volume is associated with AF recurrence after catheter ablation in patients with AF. A LAA volume greater than 8.80 ml could be used to predict AF recurrence after ablation.

OBJECTIVETo investigate clinical and epidemiological characteristics of hospitalized severe acute respiratory illnesses (SARI) patients under 15 years old registered by sentinel hospitals at 10 cities and risk factors analysis of severe illness.

METHODSThe objects of this study were 2 937 SARI patients under 15 years old registered by sentinel surveillance in internal wards, pediatrics wards and intensive care units (ICU) of 10 sentinel hospitals in 10 cities during the period from December 2009 to June 2014. We also collected case report form (CRF) of them and their throat swabs for influenza testing. The inclusion criteria was hospitalized patients who were admitted by surveillance departments, registered by SARI surveillance system, under 15 years old, meeting SARI case definition and with complete CRF. Rank-sum test was used to compare the difference of age, the duration including from onset to admission, hospital stay and from onset to discharging/death between mild illness and severe illness. Chi-square test was used to compare the difference of demographic characteristics, influenza psoitive rate, vaccination rate of influenza, chronic medical conditions and clinical characteristics between mild illness and severe illness. Logistic regression was used to analysis risk factors associated with severe illness by two stratifications from SARI surveillance protocol (< 2 years old and ≥ 2 years old).

RESULTSAmong 2 937 SARI patients under 15 years old, 97.7% (2 872/2 937) was mild illnesses, and 2.3% (65/2 937) was severe illnesses. 78.8% (2 315/2 937) was under 5 years old. The median ages of severe illness and mild illness were 0.4 and 2.0 years old (U = -6.23, P < 0.001). The proportions of severe illness and mild illness with at least one chronic medical condition were 32.3% (21/65) and 8.4% (240/2 872) (χ² = 45.03, P < 0.001). The positive rate of influenza virus was 6.5% (190/2 937), which was 6.5% (186/2 858) for mild illness and 6.2% (4/65) for severe illness (χ² = 0.08, P = 0.961). The proportion of seasonal influenza vaccination was 1.5% (42/2 853), which was 1.5% (42/2 788) for mild illness and higher than that for severe illness (0) (χ² = 6.09, P = 0.048). For under 2 years old patients, age < 11 months and with at least one chronic medical condition were risk factors for severe SARI illness, and the risk for SARI patients who was 12-23 months and without medical condition was 14.71 (5.35-40.44) and 5.61 (2.96-10.63). For ≥ 2 years old patients, age, with at least one chronic medical condition and seasonal influenza vaccination history have no association with severe illness, OR (95% CI) was 0.92 (0.80-1.05), 0.67 (0.09-5.05) and 0.85 (0.31-2.35), respectively.

CONCLUSIONMost of SARI patients registered by 10 urban sentinel hospitals were patients under 5 years old. Age < 11 months and with at least chronic medical conditions were possible risk factors of severe illness of SARI patients.

Adolescent ; Child ; Child, Preschool ; China ; Chronic Disease ; Cities ; Hospitalization ; Hospitals ; Humans ; Infant ; Influenza, Human ; Orthomyxoviridae ; Respiratory Tract Diseases ; Risk Factors ; Sentinel Surveillance ; Vaccination