Objective To study the clinical efficacy of amiodarone combined with metoprolol in the treatment of arrhythmia.Methods100 cases of patients with coronary heart disease arrhythmia treated in our hospital from August 2015 to September 2016 were selected as the research object in this study.They were randomly divided into the control group and the experimental group, each group had a total of 50 cases.Patients in the control group were treated with conventional arrhythmia treatment, and the experimental group was treated with amiodarone combined with metoprolol on the basis of conventional treatment.Comparative analysis of the experimental group and the control group of patients with clinical therapeutic effect index.ResultsAfter the corresponding treatment, the experimental group of 50 patients, the therapeutic effect of 18 cases were invalid, 12 cases were effective, 20 cases were markedly effective, the total effective number of cases to 32 cases, the effective rate was 64.0%.In the control group of 50 patients, 29 patients were invalid, and the effective rate was effective in all of the 8 patients.The effective rate of the treatment was effective in all of the 13 patients, with a total effective rate of 42.0%.Therefore, the effective rate of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05).The diastolic blood pressure, systolic blood pressure and heart rate in the experimental group were significantly better than those in the control group (P<0.05).There was no significant difference between the experimental group and the control group in the incidence of adverse reactions, which was not statistically significant.ConclusionAmiodarone Combined with metoprolol for treatment of arrhythmia is better, more widely used, can improve the treatment efficiency to a great extent, the treatment of high safety, with further clinical promotion and application.

OBJECTIVETo investigate the possible differences in antimicrobial resistance of Escherichia coli isolated from different samples in children.

METHODSSix hundred and twenty-nine samples from urine, sputum, blood and secretion were collected from June 2004 to May 2009 for bacterial identification by VITEK-32 automatic system and antimicrobial susceptibility tests by Kirby-Bauer method. The drug resistance rate of Escherichia coli isolated from different samples was compared.

RESULTSTwo hundred and sixty strains of Escherichia coli were isolated , and 108 of which were from urine , 64 from sputum, 54 from secretion and 23 from blood. ESBLs were detected in 96 (36.9%) of the 260 isolates, AmpC enzymes in 32 (12.3%), and ESBLs+AmpC in 8 (3.1%). The ESBLs positive rate of Escherichia coli isolates from sputum was significantly higher than that from other samples (P<0.05). The antimicrobial resistance rate of Escherichia coli strains from different samples to amoxicillin/clavulanic acid, ticarcillin/clavulanic acid, piperacillin, cefotaxime, cefuroxime, cefepime, gentamicin, cotrimoxazole, and nitrofurantoin was different. The resistance rate of the strains from sputum samples was higher than that from the other samples (P<0.05).

CONCLUSIONSEscherichia coli isolated from different samples have different antimicrobial resistance rates in children, so the selection of antibiotics for infections confirmed by bacterial cultures from different samples should based on drug sensitivity results.

Adolescent ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Escherichia coli ; drug effects ; enzymology ; isolation & purification ; Female ; Humans ; Male ; beta-Lactamases ; analysis

Objective To understand demonstration methods and ultrasonographic features of left and right atrial appendages in normal fetuses.Methods 200 consecutive normal fetuses during gestation age 19-28 weeks from November 2011 through April 2012 entered the study.Ultrasonographic features and the demonstrated rates of atrial appendages at different incidence angle of ultrasonography and different gestational weeks were recorded and calculated,respectively.Results Atrial appendages of normal fetuses can be demonstrated on atrial appendages plane,which was little lower the view of parasternal great artery short axis.The display rate of left,right and left-right atrial appendages was 92％,68％,65.5％,respectively.When ultrasound beam entranced into chest from the right side,the display rate of left-right atrial appendages was highest(94.3％).The best time to observe atrial appendages was 22 to 24 week of pregnancy.The majority of left atrial appendages were fingerlike hook shapes,with narrower bases and longer bodys,and the endocardial surfaces were relatively smooth.Sometimes with incisures on external edges.Whereas the majority of right atrial appendages were obtuse-angled triangle shapes,with broad bases and shallower bodys.On endocardial surface the pectinate muscles were often seen,which looked like serrated echoes,sometimes prominent taenia sagittalis were noted in right atrial appendages.Conclusions Atrial appendages of normal fetuses can be demonstrated using two-dimensional ultrasonography on atrial appendages plane.The demonstrated rates of atrial appendages were different according to different incidence angle of ultrasonography and gestational weeks.There were some differences in ultrasonographic features between left and right atrial appendages,which is very helpful in determinating atrial situs.

Objective To discuss bilateral percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) using inside and outside intravertebral vacuum cleft (IVC) respectively with bone cement injection for the treatment of Kümmell disease.Methods From January 2008 to October 2015,16 cases of Kümmell disease patients were treated with bilateral PVP or PKP with inside and outside IVC perfusion of bone cement respectively.Of 16 cases,6 were male and 10 were female,aged from 63 to 94 years,with a disease duration from 2 to 15 months.The bone mineral density of every patient was measured by dual-energy X-rayabsorptiometry.The T value ranged from-4.3 to-2.6.Fractures located from T10 to L4,including 2 cases of multiple fractures.Postoperative X-ray was used to observe the vertebral bone cement leakage and anterior height changes of affected vertebrae.Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate pain status and functional activity.Results All cases were followed up for 12-96 months.Cement leakage occurred in 4 patients without nerve complications.The anterior height of affected vertebrae before operation,2 d after operation and at the last follow-up was (50.3 ± 8.3)％,(67.1 ± 8.1)％ and (65.2 ± 6.4)％.The anterior height of affected vertebrae 2 d after operation and at the last follow-up were significantly improved compared with those before operation (P ＜ 0.05),but there were no significant differences between 2 d after operation and at the last follow-up (P ＞ 0.05).The scores of VAS before operation,2 d after operation and at the last followup was (8.63-± 1.23),(2.56 ± 3.48) and (1.38 ± 0.92) scores,and the scores of ODI was (82.1 ± 6.7)％,(28.5 ± 7.3)％ and (22.1 ± 8.2)％.The scores of VAS and ODI 2 d after operation and at the last follow-up were significantly decreased compared with those before operation (P ＜ 0.05),but there were no significant difference between 2 d after operation and at the last follow-up (P ＞ 0.05).There was no postoperative in situ or adjacent vertebral fracture.Conclusions Using internal and external IVC bone cement injection for treatment of Kümmell disease has a good clinical curative effect.It can effectively relieve back pain symptoms,reduce intraoperative and postoperative bone cement leakage and recurrent adjacent or in situ vertebral fracture.

Objective To compare the effect of anterior and superior reconstruction plate internal fixation in treatment of middle clavicular fractures in the old patients.Methods Thirty-nine old patients with middle clavicular fractures received anterior and superior reconstruction plate internal fixation treatment,respectively.There were 19 males and 20 females at average age of 66.7 years.The operation time,intraoperative blood loss and healing time were observed and compared in two groups.According to the Constant scoring system,shoulder functional evaluation was made at half a year after operation and the latest follow-up.Results All the patients were followed up for 10-32 months (average 18.7 months).Of the two groups,there was no statistical significance in aspects of healing time and Constant score at half a year after operation and the latest follow-up ( P ＞0.05 ).The complication of superior reconstruction plate internal fixation group was significant higher than that of anterior reconstruction plate internal fixation group,while the anterior reconstruction plate internal fixation group had shorter operation time and less intraoperative blood loss in comparison with the superior reconstruction plate internal fixation group ( P ＜ 0.05).Conclusion As for the middle clavicular fractures in the old patients,both anterior and superior reconstruction plate internal fixation can obtain satisfactory curative effect.With shorter operation time,less intraoperative bleeding and less complications,anterior reconstruction plate internal fixation is a much reliable treatment for middle clavicle fractures in the old patients and deserves wider application.

Objectives To summarize the diagnosis and treatment of cardiomyopathy caused by inborn errors of metabo-lism (IEM). Methods The retrospective study included 11 cases diagnosed as metabolic cardiomyopathy through tandem mass spectrometry, activity of serum enzyme, detection of urine mucopolysaccharide and gene analysis from 2012 to 2013. Six cases were diagnosed as primary carnitine deficiency (PCD). Four cases were diagnosed as glycogen storage disease (GSD) and only 1 case was diagnosed as mucopolysaccharidosis. Six PCD cases received carnitine supplementation and anti-heart failure thera-py and received follow-up for 2-10 months. Other 5 cases received supportive treatment and follow-up. Results Patients with PCD recovered soon after treatment but other 5 cases have died within 5 months. Conclusion IEM is an important cause of chil-dren cardiomyopathy which varied in clinical manifestation, diagnosis, treatment and prognosis of different kinds of metabolic cardiomyopathy. Early diagnosis and treatment could be lifesaving for cardiomyopathy caused by IEM.

Objective To compare the clinical outcomes of transforaminal lumbar interbody fusion (TLIF) through Wiltse approach and posterior midline approach in the treatment of degenerative lumbar spondylolisthesis.Methods A total of 37 patients with degenerative lumbar spondylolisthesis were treated between March 2008 and March 2010,including 23 patients managed by TLIF via posterior midline approach ( posterior midline approach group) and 14 by TLIF via Wiltse approach ( Wiltse approach group).The Japanese Orthopaedic Association (JOA) score and visual ltanalogue scale (VAS) before and after operation,and the interbody fusion condition in both the Wiltse approach group and posterior midline approach group were reviewed and the clinical outcomes of both groups were compared.Results The follow-up lasted for 6-26 months ( mean,15.7 months),during which both groups had obvious relief in clinical symptoms like pain of waist and legs.X-ray photographs showed good spondylolisthesis reduction and interbody fusion,with no loosening or breakage of the internal fixators.The fusion rate of Wiltse approach group and posterior midline approach group at the last follow-up were 86％ and 87％,respectively.The operation time of Wiltse approach group and posterior midline approach group was ( 117.8 +25.6) minutes and ( 128.5 ± 38.7 ) minutes respectively ( P ＞ 0.05 ).The intra-operative blood loss of Wiltse approach group and posterior midline approach group was (203.5 ± 16.4) ml and (284.4 ±27.6) ml respectively (P ＜0.05).Both groups presented significant decrease of JOA score post-opera-tively (P ＜ 0.05).Also,the two groups sbowed significant difference concerning the VAS score in low back pain one week post-operatively (P ＜ 0.05),but no significant difference in terms of VAS score in leg pain at one week after operation (P＜0.05) and VAS score in pain of low back and legs at the final follow-up ( P ＞0.05).Conclusions In the management of lumbar spondylolisthesis,TLIF via Wiltse approach and via posterior midline approach can both achieve satisfactory interbody fusion rate and clinical outcomes,but the Wiltse approach results in relatively less intra-operative blood loss and faster postoperative recovery.

Objective To explore the value of echocardiography in evaluation of pulmonary venous in total anomalous pulmonary venous connection (TAPVC).Methods Fifty-five children with TAPVC were enrolled in the study.The data of echocardiography and CT angiography were retrospectively analyzed and compared with intraoperative findings.Results Totally 55 patients with TAPVC were classified into supra-cardiac type (n=24),cardiac type (n=20),infra-cardiac type (n=7) and mixed type (n=4) according to the sites of drainage of pulmonary venous in echocardiography.In 15 patients with obstruction of pulmonary vertical vein,the sites of obstruction in the supra-cardiac type mostly presented between vertical vein and superior vena cava or innominate vein,and the sites of obstruction in the infra-cardiac presented all between vertical vein and hepatic or portal vein.In 4 patients with pulmonary vein stenosis,3 cases with local pulmonary vein stenosis were all cardiac type,which presented between individual pulmonary vein and common confluence or right atrium;1 patient with diffuse pulmonary vein stenosis was infra-cardiac type.In 9 patients of abnormal individual pulmonary vein,8 cases were not detected by echocardiography,but all were detected by CT angiography.Conclusion Echocardiography is able to make more comprehensive evaluation for the pulmonary venous drainage,obstruction,and proximal stenosis of individual pulmonary vein in TAPVC.CT angiography is superior in evaluation of abnormalities of connection and amount of individual pulmonary vein,and imaging of distal pulmonary vein.

BACKGROUNDPatient trust in physicians, which can be considered a collective good, is necessary for an effective health care system. However, there is a widespread concern that patient trust in physicians is declining under various threats to the physician-patient relationship worldwide. This article aimed to assess patient trust in physicians through a quantitative study in Shanghai, China, and to provide appropriate suggestions for improving the trust in China.

METHODSThe data from a survey conducted in Zhongshan Hospital and Shanghai Tenth People's Hospital, which are two tertiary public hospitals in Shanghai, were used in this study. Patient trust in physicians was the dependent variable. Furthermore, a 10-item scale was used to precisely describe the dependent variable. The demographic characteristics were independent variables of trust in physicians. Binomial logistic regression was employed to analyze the factors associated with the dependent variable, which was divided into two categories on the basis of the responses (1: Strongly agree or agree and 0: Strongly disagree, disagree, or neutral).

RESULTSThis study found that 67% of patients trusted or strongly trusted physicians. The mean score of patient trust in physicians was 35.4 from a total score of 50. Furthermore, patient trust in physicians was significantly correlated with the age, education level, annual income, and health insurance coverage of the patients.

CONCLUSIONSPatient trust in physicians in Shanghai, China is higher than previously reported. Furthermore, the most crucial reason for patient distrust in physicians is the information asymmetry between patients and physicians, which is a natural property of the physician-patient relationship, rather than the so-called for-profit characteristic of physicians or patients' excessive expectations.

Adolescent ; Adult ; Aged ; China ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Physician-Patient Relations ; Trust