Extracorporeal Membrane Oxygenation ; Female ; Heart Failure ; therapy ; Humans ; Infant ; Postoperative Period ; Respiratory Insufficiency ; therapy ; Twins, Conjoined

Objective To study the therapeutic and protective effect of low tidal volume(LTV) ventilation in children with acute respiratory failure.Methods Forty-eight patients with respiratory failure were enrolled in our study.The patients were suffered from severe infection,trauma or after major operation.Besides general treatments,they were all given ventilation with LTV.Blood gas,ventilation parameters and complications related to ventilation were also measured.Results No significant difference was found between the patients with high tidal volume(HTV) and those with LTV in the results of improving respiratory acidosis.But the incidence of(ventilated-)induced lung injury(VILI) was lower in LTV patients.Conclusion LTV ventilation is preferable for children with acute respiratory failure and beneficial for alleviation of VILI.

Object To optimize the apheresis procedure of mononuclear cells from bone marrow for different clinical treatments. Methods Bone marrow mononuclear cells were separated from bone marrow using COBE Spectra apheresis system. Cell morphology, cell counts, positive expression of CD34, CD133 and CD271 were detected, and the obtaining percent of total nuclear cells and mononuclear cells were calculated. The relationships between cell-morphology and CD34, CD133 and CD271, were also analyzed. Results 1)The positive expression of CD271 was correlated with monocytes before and after apheresis (P

Background The alteration of dominance eye is associated with visual quality in patients with age-related cataract or after cataract-surgery.However,the study on the relationship of dominance eye shift with vision following cataract-surgery is lack.Objective This study was to observe the influence of age-related cataract and cataract surgery on ocular dominance in the elderly.Methods A serial cases-observational study was designed.Eighty-seven patients with age-related cataract were collected from December 2011 to April 2012 in Affiliated Eye Hospital of Wenzhou Medical University,and phacoemulsification combined with intraocular lens (IOL) implantation was performed in all the patients.The patients were grouped into binocular vision difference (best corrected distance vision) ≥2 lines group (42 patients) and ≤ 1 line group (45 patients) on the standard logarithmic visual acuity chart.The frequency and shift of dominant eye were determined by card-hole method or thumb method before operation and 1 day,1 week,1 month and 3 months after operation.The difference in the frequencies of dominant eye between before and after operation was analyzed with MecNmar test.Results The median of best corrected distance vision (LogMAR) was 0.40 (0.00-1.40) in preoperation and 0.00 (-0.08-0.30) in postoperation,with significant difference between them (Z=-9.481,P =0.000).In the binocular vision difference ≥ 2 lines group,the dominant eyes were 24 in the right eyes and 18 in the left eyes.The milder cataractous eyes were identified as dominant eyes in 33 (78.57％) patients and heavier cataractous eyes were determined as dominant eyes in 9 (21.43％) patients before operation.However,the right eye was evidenced as dominant eye in 31 patients and the left eye was in 11 patients after operation.In the 42 patients,dominant eye shifted from the left eyes to the right eyes in 10 patients and from the right eyes to the left eyes in 3 patients,and 4 patients presented an unstable change binocularly.In 45 patients of the binocular vision difference ≤ 1 line group,the dominant eyes were the right eyes in 27 patients and the left eyes in 18 eyes in preoperation ; while after operation,dominant eye altered form the left eyes to the right eyes in 3 patients and form the right eyes to the left eyes in 1 patient,and unstable change occurred in 5 patients.There were no significant differences in the frequency of dominant eyes between before and after operation both the two groups (group A:P =0.092 ; group B:P =0.727).Conclusions Age-related cataract impact on eye dominance.Dominance eye may occur alteration binocularly following cataract surgery,which is one of causes of visual discomfort.

This study was aimed to observe the tongue image characteristics at different renal function stages among 157 chronic kidney disease (CKD) patients. Tongue images of 157 CKD cases and 30 healthy people were recorded with the instrument designed by Shanghai University of Traditional Chinese Medicine. Parameters of the tongue image were compared among different renal function stages. The results showed that compared with the control group, there were obvious decreasing on the R and L indexes in groups of different renal function stages (P < 0.05). Compared with the control group, there were obvious decreasing on the G and B indexes in groups of CKD1, CKD2, CKD3 and CKD4 stages (P < 0.05). Compared to CKD4 stage, there were obvious decreasing on the R, G, B, L indexes from group of CKD1 and CKD2 stage (P< 0.05). Compared with the group of CKD5 stage, there were obvious decreasing in the group of CKD1, CKD2, and CKD3 (P< 0.05). Compared with the control group, the cracking index was obvi-ous increased in 5 stages (P < 0.05). There was obvious difference in the greasy index between the group of CKD5 stage and the control group (P< 0.05). Compared with the control group, there was obvious difference in the peeling index from the group of CKD3, CKD 4, CKD5 stage (P < 0.05). Along the decreasing of renal function, compared with the group of CKD5 stage, there was obvious decreasing on the greasy index and peeling index in the group of CKD1 and CKD2 (P< 0.05). It was concluded that Chinese medicine tongue and face diagnosis instrument can pro-vide certain objective evidence for the clinical diagnosis of CKD.

Objective To compare the effect of different concentrations of ropivacaine in epidural analgesia of childbirth.Methods According to the digital table,300 cases of our hospital childbirth puerpera were randomly divided into A,B,C three groups.A group was given 0.125％ ropivacaine compound fentanyl analgesia,B group was given 0.1％ ropivacaine compound fentanyl analgesia,group C was not required analgesia childbirth.The childbirth of three groups was observed.Results In group A,the labor time was (261.38 ± 19.87) min,postpartum 2h blood loss was (241.03 ± 34.57) mL.In group B,the labor time was (260.09 ± 19.69) mnin,postpartum 2h blood loss was (238.66 ± 35.01) mL.In group C,the labor time was (270.46 ± 20.86) min,postpartum 2h blood loss was (251.75 ± 36.79) mL.Statistical analysis showed that there was no significant difference (t =0.472,1.035 ; all P ＞ 0.05).In group A,the fetal heart rate was (142.34 ±21.57)times/min,neonatal Apgar score was (9.77 ± 0.21),and umbilical artery blood pH value was (7.27 ± 0.06).In group B,fetal heart rate was (145.21 ± 21.49) times/min,neonatal Apgar score was (9.79 ± 0.20),and umbilical artery blood pH value was (7.26 ± 0.08) ; Fetal heart rate of group C was (143.78 ±22.01)times/min,neonatal Apgar score was (9.64 ±0.24),and umbilical artery blood pH value was (7.28 ± 0.07).The differences among three groups were not statistically significant (t =0.763,0.360,0.114,all P＞ 0.05).Analgesic effect time of group A was (12.13 ± 1.76) min,pain score was (1.03 ±0.46) points,analgesic harem duration was (22.39 ± 3.21) s,analgesic harem time interval was (3.26 ± 1.49) min,the cesareandelivery rate was 8.00％.In group B,the analgesic effect time was (12.04 ± 1.69mnin),pain score was (1.01 ± 0.52) points,analgesic harem duration was (21.04 ± 3.18) s,analgesic harem time interval was (3.4.9 ±1.51)min,the cesarean delivery rate was 9.00％ ; Duration of the analgesic effect of group C was (16.77 ±16.77) min,pain score was (3.76 ± 1.23) points,analgesic harem duration was (26.98 ± 5.87) s,analgesic harem time interval was (2.65 ± 0.75) min,the cesarean delivery rate was 48.00％.The differences between groups were statistically significant (chi square or t =6.148,8.522,5.749,4.095,61.316 ;P ＜ 0.05).Conclusion Application of 0.1％ ropivacaine compound fentanyl anesthesia can effectively relieve patients'pain,shorten labor and reduce postpartum 2h blood loss,impact less on contractions at the same time,reduce the incidence of cesarean delivery,has no influence on the neonate,which is worth popularization and application in clinic.

Objective To evaluate the effect of collagen shield delivering fluconazole eye drops made by centrifugal method on treating fungal keratitis of rabbit eyes.Methods Using centrifugal method to make corneal collagen shield,after soaked with fluconazole eye drops,the collagen shields were used to treat fungal keratitis of rabbit eyes.Results The healing focus time of collagen shield delivering fluconazole eye drops group was average 11 days,the healing focus time of only delivering fluconazole eye drops group was average 18 days.The cure rate and effective rate of 2 groups were 78.94%,63.15% and 92.10%,78.94%,there were significance between 2 groups(P<0.05).Conclusion It was innovation for corneal collagen shield delivering fluconazole eye drops made by centrifugal method to cure fungal keratitis,which had broad development foreground.

To explore the experience in teaching of interns in orthopedic,we put emphasis on the knowledge teaching of medical ethics and medical dispute in addition to the teaching of expertise of orthopedic.

ObjectiveTo discuss the clinical diagnosis and treatment of multiple endocrine neoplasia ( MEN ) 2A, and report the mutation of the RET proto-oncogene in a pedigree of three patients with MEN 2A.MethodsBilateral adrenalectomy was performed on two of the three patients with hypertension and bilateral adrenal-conserving adrenal pheochromocytoma resection was performed on the other patient. All three patients were treated by total thyroidectomy and neck lymphadenectomy. Twelve family members were recruited to the study. Peripheral blood was collected and total genomic DNA was prepared for polymerase chain reaction (PCR). PCR products of exon 10 and exon 11 of the RET proto-oncogene were purified and a direct DNA sequence analysis was performed.ResultsThe pathological diagnosis of the specimens was bilateral adrenal pheochromocytoma and medullary thyroid carcinoma in all the three patients. There was no tumor recurrence or distant metastasis after 1.5 - 5 years of follow-up. A missense mutation of TGC (Cys)to CGC (Arg) at codon 634 in exon 11 of the RET proto-oncogene was detected in all three patients. Genetic screening identified two mutation carriers in the other members of this pedigree.ConclusionGenetic mutation screening and surgical intervention may be helpful to the members of high-risk families.

Objective To compare the effect of repairing large perimembranous ventricular septal defect (VSD) with a new continuous stitching and two classical methods. Methods From January 2005 to January 2008,321 cases with VSD were operated. All the cases were divided into 3 groups according to operational way, with discontinuous stitching in group A (70 cases), continuous stitching in group B(116 cases),new continuous stitching in group C (135 cases). All the patients were total corrected with hypothermic cardiopulmonary bypass. Results Group C had the shortest cardiopulmonary bypass and aortic cross-clamp times [(48 ± 36) min and (26 ± 18) min]among the three groups (P < 0.05). Group C had not residual shunt and incidence rate was lowest among the three groups (P < 0.05). Temporary second degree auriculo-ventricular bolck (AVB) was found in the early stage and no third degree AVB among the three groups. Tricuspid regurgitation was higher in group A,but there was no significant difference between group B and group C. Follow-up was completed in a duration of 1-3 years and all the cases had a good health after discharged. Conclusions The new continuous stitching method has short eardiopulmonary bypass and aortic cross-clamp times. It has fewer residual shunt than other two classical methods and has no evidence of higher AVB occurrence.