Objectives To analyze the effect of glucocorticoids on acute respiratory distress syndrome (ARDS) in adult patients. Method English and Chinese literature about the glucocorticoids treatment for ARDS were electronically searched. Meta-analysis was performed by Rev Man 5.0 software after the data of qualified studies were included in consistence with the criteria of inclusion and exclusion. Results Eight studies including 679 cases(steroid group 366, control group 313) met the inclusion criteria. Resuhs of meta-analysis showed that there were significant differences( P <0.05), between the steroid group and the control group, in mortality in all cases, mortality in patients treated at early stage, mortality in patients treated with low dose steroids, and PaO_2/FiO_2;the relative risks(RRs)/standardized mean difference(SMDs) and 95% confidence intervals(CIs) are 0.55(0. 34 ～ 0.87), 0.49(0.28 ～ 0.86), 0.46(0.24 ～ 0.88) and 2.99(0.63 ～ 5.34). There were no significant differences in mortality in patients treated during late stage, mortality in patients treated with high dose steroids and number of nosocomial infections(P > 0.05). Conclusions Low-dose glucocorticoids or routine dose glucocorticoids given during early stage can reduce mortality in patients with ARDS; the oxygenation of patients is significantly improved after steroid therapy; incidence of infectious complications is neither increased nor decreased by steroid therapy.

Objective To investigate the application value of low dose high pitch dual source CT angiography technique in diagno-sis of acute aortic dissection.Methods 21 cases of critically ill patients with suspected aortic dissection underwent total aortic angiog-raphy without using ECG by adopting the second generation dual source CT Flash Technology (pitch 3 .2 ,1 0 0 kV and 1 0 0 mAs), using a lower contrast dose (60 mL).Results All subjects accepted as low as possible radiation doses and iodine intake;at the same time,accurate information including aortic intimal tear position,intimal flap,true and false lumen,and lesions involving the range vessel signs and anatomic relationship were received,2 cases of Stanford type A,type B 1 9 cases (2 cases of aortic rupture).Average scan time 2.6 s,average effective radiation dose cm 270 mGy·cm.Conclusion High quality images by using high pitch dual source CT low dose angiography with lower contrast dose provide safe,reliable,real-time screening method for critically ill patients with aor-tic dissection caused by systemic severe compound injury.

BACKGROUNDPulmonary blastoma is a rare primary malignancy of the lung. It is now recognized in two forms: adult type pulmonary blastoma and childhood pleuropulmonary blastoma. The clinical characteristics, diagnosis and treatments of adult type pulmonary blastoma are discussed in this article.

METHODSThe clinical records of 5 patients with adult type pulmonary blastoma admitted in Cancer Center, Sun Yet-sen University from 1964 to 2004 were analyzed and the literature on pulmonary blastoma was reviewed.

RESULTSThree patients were male and two were female with the ages ranged from 22 years old to 70. Their symptoms consisted mainly of cough, hemoptysis and chest pain. The pulmonary blastomas were mainly manifested as a solitary parenchymal mass of the lung on chest radiograph and CT. None of these patients was diognosed by fibrobronchoscopy nor sputum cytology. Three patients underwent lobectomy, one underwent pneumonectomy, and these four patients underwent mediastinal lymph node resection also. The fifth one received wedge resection and postoperative chemotherapy. At the end of follow-up, three patients died and two was alive, and the survival time was from 6 months to 11 years.

CONCLUSIONSPulmonary blastoma is difficult to be diagnosed before operation. Surgery is the best therapeutic choice up to now. It has poor response to radiotherapy and chemotherapy. The prognosis of patient with pulmonary blastoma is variable.

The aim of this study was to determine the differences in phototaxis between Oncomelania hupensis (O .h .) hupensis and O .h .robertsoni as well as four related geographic strains of male and female snails and Schistosoma japonicum-infected and-uninfected snails .Field collection of O . hupensis was performed in S . j aponicum-endemic areas of Xingzi and Yushan counties in Jiangxi Province ,China ,as well as Tianquan and Pengshan counties in Sichuan Province ,China .Infected and uninfected snails were screened using the cercariae escaping method ,with artificial separation of male and female snails . The experiment was carried out in an in-house constructed dark phototaxis experiment box using white light as the main source of light at the most suitable light intensity .Under a light intensity of 1 500 Lux for 30 minutes ,all of the snails from the experimental group showed obvious phototaxis .The statistical analysis showed no significant difference in the phototaxis index between male and female snails ,and there was also no significant difference in the phototaxis index between different geograph-ical strains of the same subspecies of snails .A significant difference in phototaxis was observed between the two subspecies during the 30-minute experimental period :O .h .hupensis displayed a higher phototaxis index than that of O .h .robertsoni , whereas S .japonicum-infected snails showed a lower phototaxis index than that of uninfected snails .A difference in phototaxis was found between different subspecies of O .hupensis and within the same subspecies .All uninfected snails displayed the same phototaxis index .When snails were infected with S .japonicum ,phototaxis reduced .

Objective To summarize the clinical experience of treatment of recurred urinary stone.Methods The patients who needed to be treated again from 1998 to 2002 were reviewed.Results Patients with recurred urinary stone were differentiated by symptom,the causation of recurred stone and operation.Conclusion The pointed step must be adopted based on the clinical character of recurred urinary stone.Preventing against recurred and choosing appropriate method can improve the treatment effect.

In order to determine the pathophysiologic significance of electrocardiographic ventricular hypertrophy in athletes (LVH ath), echocardiographic measurements of left ventricular mass (LVM) were performed on 50 LVH ath. and 50 non-LVH matched ath. They were members of National Teams of track and field, swimming, football and cycling, with an average age of 20.74?3.3 years. Anatomic validation of the method was used for calculation of LVM in this study. Comparisons of LVM were made between LVH ath. and non-LVH ath., and between non-LVH ath. and the untrained:LVM=1.04?[(LVID+PWT+IVST)~3-(LVID)~3]-14Results showed no significant difference of LVM between LVH ath. and non-LVH ath. while LVM of non-LVH ath. were considerably greater than that of the untrained (P

Objective To explore the classification of collateral blood compensation pathways and collateral blood compensation characteristics in patients with common carotid artery occlusive disease.Methods The hemodynamie and imaging data of 20 patients with common carotid artery occlusive disease,admitted to our hospital from May 2016 to September 2018,were collected.The patients were classified according to whether they had internal carotid artery stealing and collateral circulation compensating for collateral flow.Results Internal carotid artery hematoma was found in 11 of the 20 patients;there was collateral circulation in 17 patients,including 10 branches of the anterior communicating artery,9 branches of the posterior communicating artery,11 branches of the posterior cerebral artery-middle cerebral arterial pia anastomosis,and 8 branches of the ocular artery.There were three types of collateral blood compensation pathways to be discovered in the 20 patients with common carotid artery occlusive disease;type Ⅰ (n=3) was the collateral blood compensation pathway with simple internal carotid artery stealing,type Ⅱ (n=8) was the collateral blood compensation pathway with internal carotid artery stealing and collateral circulation,and type Ⅲ (n=9) was the collateral blood compensation pathways with simple collateral circulation.Conclusion In some patients with common carotid artery occlusion,the internal carotid artery stealing route exists in the collateral flow compensation.

Objective To investigate the effects of single i.v. subanesthetic dose of ketamine on heart rate, blood pressure and oxygen saturation for antidepressant treatment. Methods Patients with severe depressive disorder were randomized to ketamine group (n=13) and control group (n=14). Ketamine group received ketamine (0.5mg/kg) single injection whereas control group received saline single injection. Escitalopram (10 mg/d) were orally administered for 4 weeks simultaneously. Comparisons were made on the heart rate, blood pressure and oxygen saturation at baseline, 40 min, 100 min, and 280 min after injection between the two groups. Results The main effects of time but not group were significant for all parameters including heart rate, systolic blood pressure and diastolic blood pressure, (P＜0.05). Interaction of time×group was significant (P＜0.05). All parameters including heart rate (F=16.85, P＜0.01), systolic blood pressure (F=15.82, P＜0.01) and diastolic blood pressure (F=8.63, P＜0.01) with time were significant in ketamine group. The heart rate, systolic blood pressure and diastolic blood pressure in ketamine group were significantly higher at 40 min than at other time points (P＜0.05), while were no significant difference among other time points (P＞0.05). There was no statistical significance of main effect of time, group and interaction of time×group in oxygen saturation between the two groups (P＞0.05). Conclusion Single subanesthetic dose ketamine intravenous drip for antidepressant therapy may cause a transient increase in heart rate and blood pressure.

Objective To study the effect of multi-disciplinary team (MDT) management on the outcome in neonates with omphalocele.Method A retrospective non-randomized controlled clinical study was conducted.Neonates who were diagnosed as omphalocele and admitted to the surgical neonatal intensive care unit of the Guangzhou Women and Children Medical Center from December 2010 to December 2017 were collected.Because MDT was established in December 2014,infants were assigned into non-MDT group and MDT group according to their dates of admission.The characteristics and outcomes between non-MDT group and MDT group were compared using x2,t-test or rank-sum test.Multivariate analysis was performed by Logistic regression.Result A total of 91 neonates were included in the study,50 were in non-MDT group and 41 were in MDT group.The mortality in MDT group (2.4％,1/41) was lower than that in non-MDT group (18.0％,9/50),the difference was statistically significant (P ＜ 0.05).The median time of mechanical ventilation of giant omphalocele in non-MDT group (18.3 hours) was longer than that in MDT group (41.7 hours),the difference was also statistically significant (P ＜ 0.05).After adjusting for the associated confounding risk factors,the risk of death in non-MDT group was 54 times higher than that in MDTgroup (OR=54.19,95％CI2.64 ～1 113.49,P＜0.05).Conclusion There was significant association between the MDT management and the decreased risk of death of omphalocele.

The symptoms of pulmonary nodules are insidious,with inflammatory nodules,inflammatory granuloma,early invasive cancer and lung cancer,and the clinical differential diagnosis is still difficult.Regular CT follow-up observation of most pulmonary nodules provides a"window period"for TCM Intervention in pulmonary nodules.From the aspects of external cold attacking the lung,dense cold and humid geographical environment,cold diet,summer air conditioning,etc.,this paper considers that the soaking of cold pathogenic factors is the basic cause of the formation of pulmonary nodules,and cold phlegm are the basic pathogenesis of pulmonary nodules.The clinical manifestations of cold phlegm in pulmonary nodules are summarized from the two actual situations that can be distinguished from clinical symptoms and no symptoms.It is proposed that Mahuang Fuzi Xixin Decoction and Sanzi Yangqin decoction are the basic formulas,Discussion on the treatment of pulmonary nodules by warming yang and dispelling cold to cure the root cause,eliminating phlegm and softening hard mass to treat the symptoms;Improve the ability of TCM diagnosis and treatment of pulmonary nodules.