The trial of two-way referral enrolled 26 patients with hypertension, including 20 cases of refractory hypertension, 3 new cases and 3 cases of secondary hypertension, the average length of follow-up was 22 d (10-35 d). The family physicians in Huaihaizhong Road Community Health Service Center communicated with specialists in the medical center (Ruijin hospital), appointments were made and medical information and other materials were sent in advance. When investigations and adjustment of medication were made, and the blood pressure was under control, patients were referred back to the community. This two-way referral system promoted the information exchanges between two side, doctors got prior knowledge about patients' condition and would spend more time with the patients; and patients' feeling of satisfaction and compliance of the treatment were increased. From our experiences, we suggest that the therapeutic regime made by the medical center should be feasible to the community, and more convenience should be given to the referred patients, so that the effectiveness and efficiency of the two-way referral can be further improved.

Complex intracranial aneurysms refer to huge aneurysm, wide-necked aneurysm, fusiform aneurysm, microaneurysm, dissecting aneurysm and pseudoaneurysm.Endovascular interventional therapy is one of the safe and effective methods for intracranial aneurysms. However, the treatment is still limited by the morphology and is challenged by the recurrence for most of the complex intracranial aneurysms. The article reviews the treatment progress of complex intracranial aneurysms.

Objective To investigate the efficacy of flupentixol and melitracen(Deanxit) in treatment of non-erosive reflux disease(NERD) and non-responding to proton pump inhibitor. Methods Fifty eight NERD pa-tients were randomly divided into two groups, the treatment group (n = 29) and control group (n = 29). Patients in control group were given esomeprazole 40 mg qd. Patients in the treatment group were given the same drug plus Deanxit 1 Tab qd. The clinical effect was evaluated and scored by Hemihon Anxiety Rating Scale (HAMA) after 4 weeks. Results The total efficacy rate of the treatment group was higher than control group (P < 0.01),and HAMA was lower in the treatment group than in control group (P < 0.01). Conclusions Adjuvant treatment of Deanxit combined with esomeprazole is effective to NERD patients who did not respond to proton pump inhibitor, can greatly improve anxious disorders.

Objective To study the main infectious bacteria and their drug-resistance after liver tra nsplantation. Methods K-B method was used to detect the susceptibility of agents of the main bacteria after liver transplantation. ESBLs and AmpC ?-lactamase among the main negati ve bacillus were detected by three-dimensional tests. ?-lactamase and Van gen e among Enterococcus were dectected by standard agar dilution susceptibility tes ts and Nitrocefin respectively. Results Among the main Gram-negative bacteria in 55 cases of infection following liver transplantation, the ratio of resistance to 4 or more antibiotic were all beyond 40% . The detectable rate of ESBLs and AmpC ?-lactamases in Enterobacter cloacae and Escherichia coli was 32.4% and 36.8% , and 33.8% and 10.5% re spectively. Moreover, the detectable rate of both ESBLs and AmpC ?-lactamases in Enterobacter cloacae and Escherich ia coli was 24.3% and 7.0% repectively. 8.8% and 11.1% produced ?-lactamases in Enterococcus faec alis and Enterococcusfaecium, with the ratio of resistance to Vancomycin being 11.2% and 18.5% respectively. Conclusions The primary pathogens have the high and multiple resistance to antimicrobial aft er liver transplantation. ESBLs and AmpC ?-lactamases were the main two factor s of drug-resistance among Gram-negative bacillus. we should pay much attentio n to the high detectble rate of Enterococcus which are resistant to Vancomycin a fter liver transplantation.

Objective To study the therapeutic effect of pinaverium bromid and oryz-aspergillus enzyme and pancreatin tablet on patients with bile duct Ⅲ of sphincter of Oddi dysfunction (SOD) after cholecystectomy.Methods 72 patients who had a diagnosis consistent with bile duct Ⅲ of SOD seen from February 2010 to February 2013 in our hospital were randomly divided into the control group and the treatment group.Patients in the control group were given pinaverium bromid for 3 months while patients in the treatment group were,in addition to pinaverium bromid,given oryz-aspergillus enzyme and pancreatin tablet.Relief of abdominal pain,abdominal distention and recurrence of the above symptoms after drug withdrawal were studied.Results The scores on abdominal pain in the treatment group before and after treatment were 7.5 ± 1.1 and 3.0 ± 1.6 (P ＜ 0.05) while the scores in the control group were 7.4 ± 1.1 and 5.0 ± 1.4 (P ＜ 0.05),respectively.Alleviation of abdominal pain in the treatment group was superior to the control group (P ＜ 0.05).The scores on abdominal distention in the treatment group before and after treatment were 5.4 ± 0.6 and 1.6 ± 0.5 (P ＜ 0.05) while the scores in the control group were 5.2 ± 0.5 and 4.7 ± 0.8 (P ＞ 0.05),respectively.Alleviation of abdominal distention in the treatment group was superior to the control group (P ＜0.05).The scores of abdominal pain and distention in half year after 3 months' therapy in the treatment group were 3.1 ± 1.7 and 1.7 ± 1.1,respectively,which obviously were lower than the control group (5.4 ± 1.4 and 5.0 ± 0.6,P ＜ 0.05).Conclusions Pinaverium bromid and oryz-aspergillus enzyme and pancreatin tablet could effectively alleviate abdominal pain and distention in patients with bile duct Ⅲ of SOD after cholecystectomy and the recurrence rates of symptoms were significantly lower.

Objective To investigate the clinical effect and immunologic function of Moxifloxacin combined with small dose of hormone in the treatment of Ventilator pneumonia in elder.Methods 64 cases of Ventilator pneumonia in our hospital were collected and randomly divided into experiment group and control group, 32 cases each.Two groups were given conventional treatment, the control group received Methylprednisolone Sodium Succinate 1 mg/kg qd, the experiment group was given Methylprednisolone Sodium Succinate 1 mg/kg qd, and Moxifloxacin Hydrochloride and Sodium Chloride Injection 400 mg qd.Two groups of patients were continuous treated for 10 days.After treatment,T lymphocyte subsets, NK cells, white blood cell count, C reactive protein, clinical symptoms disappeared time, mechanical ventilation time, ICU length of stay and mortality rate were compared. Results After treatment, the total effective rate in the experiment group 75% was higher than the control group 50%( P <0.05 ).The levels CD3 +, CD4 +, CD4 +/CD8 +and NK cell in two groups increased(P<0.05), levels of CD8 +decreased(P<0.05),levels of WBC, CPR and PCT decreased in the two groups(P<0.05), and compared with the control group, the levels CD3 +, CD4 +, CD4 +/CD8 +and NK cell in the experiment group were higher(P<0.05), levels of CD8 + were lower(P<0.05),levels of WBC,CPR and PCT were lower(P <0.05), the rales disappeared time, cough disappeared time, fever disappeared time were significantly shorter than the control group(P <0.05), the duration of mechanical ventilation and the length of hospital stay were significantly shorter(P<0.05).Conclusion Moxifloxacin combined with small dose of hormone in the treatment of Ventilator pneumonia in elder was significantly effective, and it can relieve inflammation, prevention of infection control, enhance immune function.

Objectives:To evaluate the clinical significance of different early nutrition support in severe head injured patients. Methods:140 cases(GCS≤8) were randomly divided into 5 groups.From A to E,each one had 28 cases.The patients in group A received early parenteral nutrition(PN) and enteral nutritoin(EN) together;group B received early PN,and EN after 1 week later;group C received PN only for more than 2 weeks;group D received early EN only;group E received traditional delayed EN.The clinical observation and statistical comparison were taken. Results:Severe head injured patients could get nutrition from different ways at early stage.A and B groups had better outcomes,and the blood glucose and nutritional data were superior to those of D,E group( P

Objective To find out the factors affecting the outcome of severe acute respiratory distress syndrome (ARDS) patients treated with extracorporeal membrane oxygenation (ECMO).Methods From November 2008 to September 2010,patients with severe acute respiratory distress syndrome (ARDS) required extracorporeal membrane oxygenation (ECMO) after failure of conventional therapy were retrospectively studied.Patients treated by veno-arterial ECMO,treated by mechanical ventilation for more than l0 days were excluded.All patients were divided into survival group and non-survival group,according to the 28 day survival situation after ECMO treatment.We compared the clinical data of the two groups when transferred to Intensive Care Unit (ICU),before and after ECMO treatment.We used Independent-samples t test and Chi-square tests to find out the factors affecting the results of ECMO treatment in the patients with severe ARDS.Results A total of twenty-five patients were enrolled in the study,of whom 15 patients survived,10 patients died.The results showed that the average age of the survival group is lower than that of non-survival group (49.8 ± 10.5) vs.(59.9 ± 11.5),P =0.044,and the proportion of patients with severe ARDS caused by Influenza A (H1 N1) in the survival group was higher than that of the non-survival group (x2 =4.453,P =0.048).In addition,the duration of mechanical ventilation before ECMO treatment in the survival group was shorter than that in the non-survival group (57.8 ± 8.7) hours vs.(68.3 ±13.7) hours,P =0.013.Conclusions The age,pre-ECMO ventilation duration and the cause of ARDS are the important factors influencing the efficacy of ECMO treatment in the patients with severe ARDS.

OBJECTIVE To study the constituent ratio of the pathogentic bacteria of the newborn omphlitis and their resistance.METHODS The bacteria were identified by ATB-Expression system and antibiotic susceptibility tests.RESULTS Of the specimens in 153 cases,there were 136 positive strains(88.9%).From high to low,Staphylococcus aureus occupied 26.5%,S.epidermidis occupied 16.2%,S.haemolyticus occupied 13.2%,Klebsiella pneumoniae occupied 13.2%,and Escherichia coli occupied 9.6%.Piperacillin/tazobactam,vancomycin,meropenem and imipenem had low drug resistance(2.0%) that doctors could choose the drugs according to pathogenic bacteria.MRSA occupied 13.9%,MRCNS occupied 73.2%.E.coli and K.penumoniae of ESBLs accounted for 21.4% and 44.4%.CONCLUSIONS The main pathogentic bacteria of the newborn omphlitis are S.aureus,S.epidermidis,S.haemolyticus,and K.pneumoniae.Doctors select the antibiotics according to the results of susceptibility test.It is necessary to advise how attend to the newborn in order to decrease the newborn omphlitis.