Objective To compare the effect of methotrexate combined with laparoscopic surgery on pregnancy outcome of patients with tubal pregnancy treated with conservative treatment.Methods 96 patients who were diagnosed of tubal pregnancy,fertility requirements and no clinical data given birth were analyzed retrospectively.Depending on the method of treatment was divided into 46 cases of methotrexate and laparoscopic group of 50 patients.Postoperative intrauterine pregnancy,ectopic pregnancy and secondary infertility situation again were compared.Results Laparoscopic group in intrauterine pregnancy rate was 70.0％,which was significantly higher than that in the methotrexate group(47.8％),and the difference was statistically significant(x2 =13.229,P ＜ 0.05) ;laparoscopic ectopic pregnancy rate was 14.0％ against 17.4％ with methotrexate group,the difference was not statistically significant(x2 =2.037,P ＞ 0.05) ; methotrexate group was 34.8％ of secondary infertility was significantly higher than thatin the laparoscopic group (16.0％),the difference was statistically significant (x2 =12.784,P ＜ 0.05).Conclusion Laparoscopic surgery after conservative treatment of tubal repregnancy outcome is better than methotrexate.

Objective To explore and classify the subjective opinions of nurses on whistle- blowing, and identify the subjective characteristics of each type. Methods This study applied Q -methodology, protocols which could determinate subjective opinions of nurses on histle-blowing were set up and underwent interview investigation, data of the interviews went through Q-factor analysis. Results Most nurses had a positive attitude toward whistle - blowing because it could prevent any nursing activity not based on expertise and professional ethics from causing disadvantages for patients. At the same time, however, they requested the creation of a legal framework in which whistle-blowing was done in a way to increase trust among colleagues. Meanwhile, some nurses showed resistance to whistle - blowing. Conclusions Whether whistle - blowing can reach its aims depends on nurses' attitude toward it. Most Korean nurses support whistle-blowing. Nursing activity not based on expertise and professional ethics and causing disadvantages for patients can be avoided if a legal framework is established for whistle-blowing.

OBJECTIVE:To discuss the use of allopurinol for the reduction of serum uric acid level in patients with chronic kidney disease complicating hyperuricacidemia so as to delay the progression of chronic renal disease.METHODS:A total of 47 patients with chronic kidney disease complicating hyperuricacidemia were randomly divided into treatment group and control group:the treatment group was given allopurinol 100～200mg?d-1 in addition to the antihypertensive therapy as adopted in the control group or the common therapy for 12 months.RESULTS:As compared with the control group,serum creatinine level was lower and the rate of renal function deterioration was significantly decreased in the treatment group(P

Clinical studies show that the factors that impact the quality of life (QOL) in patients with lung cancer are comprehensive.Physiological factors include breathing difficulties,cancer-related fatigue.Depression,anxiety and other psychological factors also play a major role.Social and family support is also crucial to improve the QOL in patients with lung cancer.

Objective To determine the factors influencing the indication for tracheostomy following cervical spinal cord injury.Methods A retrospective study was performed to analyze the 118 patients who had been treated for cervical fracture/dislocation along with cervical spinal cord injury from July 2004 to June 2014 and whose abbreviated injury scale score (AISS) was lower than 3.They were 96 men and 22 women,19 to 68 years of age (average,45.2 years).The patients were divided into a tracheostomy group (n ＝ 28) and a non-tracheostomy group (n =90).The 2 groups were compared in terms of gender,age,presence or absence of complete spinal cord injury at admission,injured segment,injury mechanism,smoking history,injury severity score (ISS),motor AISS,systolic pressure at admission,hospital stay,and ICU stay to determine the factors influencing allocation of tracheostomy.Results Compared with the non-tracheostomy group,the tracheostomy group had a higher rate of complete spinal cord injury at admission,a higher rate of smoking,a higher ISS at admission,a lower motor AISS,and longer hospital and ICU stay,with statistically significant differences (P ＜ 0.05).There were no significant differences between the 2 groups in gender,age,injured segment,injury mechanism,or systolic pressure at admission (P ＞ 0.05).Increased severity of cervical spinal cord injury was associated with significantly decreased motor AISA,increased rate of tracheostomy and increased ISS (P ＜ 0.05).Conclusion The influencing factors for indication of tracheostomy after cervical spinal cord injury are complete cervical spinal cord injury irrespective of the level of injury,ISS,motor AISS,and history of smoking.

Objective To explore the risk factors for hospital acquired pneumonia (HAP) in patients with neural-intensive care unit (NICU).Methods The clinical data were analyzed retrospectively for 207 patients in NICU ≥ 5 d,to determine possible risk factors with HAP.Results The incidence of HAP was 14.01％(29/207).Correlation analysis showed that old age,disturbance of consciousness,dysphagia,vomiting,low pre albumin,NICU residence time ≥ 30 d,indwelling nasogastric tube,the use of the acid-blocking drugs,tracheal intubation,tracheal incision,mechanical ventilation and deep bronchoscopic suctioning were the related factors of HAP (P ＜ 0.05 or ＜ 0.01),but blood glucose,sedative drugs were unrelated with HAP (P ＞ 0.05).Conclusion There is a high incidence of NICU in patients with HAP,taking comprehensive measures actively,reduce risk factors,can effectively control the occurrence of HAP in NICU.

BACKGROUND:Class II malocclusion is commonly observed in clinics, with the main manifestation of skeletal malocclusion, and mandibular retrusion is the main reason. Class II malocclusion should be treated early to correct skeletal malformation and improve facial appearance. OBJECTIVE:To compare the biomechanics change in early treatment of Class II division 1 malocclusion with Twin-Block appliance and straight wire appliance combined with face-bow and Class II drawing. METHODS: Thirty patients with malocclusion who were at peak velocity on the growth curve were randomly divided into two groups, with 15 cases in each group. Patients in each group were treated with Twin-Block appliance and straight wire appliance combined face-bow and Class II drawing, respectively. The cephalometric records of al patients were examined before and after the treatments. The acquired data were processed by statistical analysis. RESULTS AND CONCLUSION:After treatment, al molars and cuspid teeth achieved or reached Class I, and ANB angle decreased to normal range. The bone effect of Twin-Block appliance was more significant than straight wire appliance. Using Twin-Block appliance, the length of mandible body and lower face height increased significantly. Experimental findings indicate that, Twin-Block appliance has significant therapeutic effects in treatment of early skeletal Class II division 1 malocclusion patients, who are at peak velocity on the growth curve. With the biomechanical effects, this treatment corrects asymmetrical jaw relation, reconstructs the tissue, and obtains satisfactory lateral facial profile of soft tissues. The therapeutic effect is more obvious for patients with obvious mandibular retrusion, flared upper incisors and upright lower incisors.

Objective To investigate the effects of preconditioning with emulsified isoflurane(eISO)on inflammatory response to myocardial ischemia-reperfusion(I/R)injury in rats.Methods Forty SD rats of both sexes weighing 250-280 g were randomly allocated into 4 groups(n =10 each):groupⅠ sham operation(S);group Ⅱ myocardial I/R + normal saline(NS); group Ⅲ I/R + eISO and group Ⅳ I/R + 30％ intralipid(Ⅱ.)(vehicle for eISO).Myocardial ischemia was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 180 min reperfusion.NS,30％ intralipid and elSO 2 ml/kg were infused iv over 30 min at 30 min before myocardial ischemia in groups Ⅱ,Ⅲ and Ⅳ respectively.The animals were killed at the end of 180 min repeffusion.Their hearts were removed for determination of infarct size and myocardial NF-κB p65 and ICAM-1 expression(by immuno-histochemistry)and plasma concentration of TNF-t(by radioimmunoassay).Results Myocardial I/R induced myocardial infarct and significantly increased plasina TNF-a concentration and myocardial ICAM-1 and NF-κB p65 expression in gro up Ⅱ,Ⅲ and Ⅳ as compared with'sham operation group (Ⅰ).Plasma TNF-a concentration and myocardial ICAM-1 and NF-kB p65 expression were significantly lower in group Ⅲ(eISO)than in group Ⅱ and Ⅳ.Conclusion Down-regulation of myocardial NF-kB and ICAM-1 expression and inhihition of inflammatoy response are involved in the mechanism by which preconditioning with iv elso protects against myocardial I/R injury.

Objective To characterize clinical features,antimicrobial susceptibility and the outcome of nosocomial Acinetobacter baumannii meningitis.Methods All patients with nosocomial meningitis due to Acinetobacter baumannii in 2nd Affiliated Hospital Medical School of Zhejiang University between January 2010 and October 2011 were retrospectively reviewed.Results During the study period,40 patients of this nosocomial infection were identified,who came from neurosurgery ward (19 cases,47.5％),neurosurgieal intensive care unit (18 cases,45.0％),emergency intensive care unit (2 cases,5.0％) or intensive care unit (1 case,2.5％).All the patients had a history of recent neurosurgical procedures. Fever and disturbance of consciousness were the major manifestations,and cerebrospinal fluid examination showed elevated white blood ceil count and protein,and reduced glucose.All isolated pathogens were resistant to the first line antibiotics.The fatality rate was high. Conclusions The most common risk factor for nosocomial Acinetobacter baumannii meningitis is neurosurgery. Resistance to the first line antibiotics is common among all pathogens isolated.The prognosis of the meningitis is poor.

Delayed cerebral vasospasm is the leading cause of death in patients with subarachnoid hemorrhage. A good in vivo animal model of cerebral vasospasm after subarachnoid hemorrhage helps to understand the occurrence, development of this cerebral vasospasm, and the complicated and various pathophysiological mechanisms. It will provide important information for clinical interventions