Objective In order to explore practical values of the revised Duck criteria for diagnosis and treatment of pediatric infective endocarditis(IE).Methods Seventy-three children′s cases diagnosed and treatmented as IE complicated with congenital heart defects in the past 22 years were collected to make retrospective analysis according to the Duck criteria.Results In 73 patients,a definite diagnosis of IE was made in 37 patients(51%),16(43%) of which proved by the pathologic lesions during the operations.Eight patients(22%) met two major criteria,13 patients(35%) met one major and more than 3 minor criteria.36 patients(49%) were diagnosed as possible IE.Forty-five patients(62%) were cured using antibiotic therapy.Sixteen cases(21%) were failure in antibiotic treatment,of whom 16 patients were operated by cutting off the detection of vegetation and repairing the heart malformation.Tweleve cases(17%) were died,one of which was died after the operation.Conclusions IE is still a significant complication of congenital heart disease.Duck criteria is relative rigid in sensitivity,but it is high in specificity.When the vegetation isn′t large enough in shape,revised Duck criteria is difficult to(diagnose) early.The surgery treatment is optimistic.To combine the medicine with surgery can contributed to decrease mortality rate.

Objective To investigate the effects of ulinastatin on pulmonary and hepatorenal function of elderly patients undergoing resection of esophageal cancer. Methods The clinical data of 40 elderly patients with esophageal cancer who had been admitted to Southwest Hospital from January 2005 to January 2008 were retrospectively analyzed. All the patients were randomly divided into control group (n = 20) and ulinastatin group (n = 20) according to random number table. Patients were administered with total parenteral nutrition, and patients in ulinaslatin group were additionally instilled with 4×10~5 U/d of ulinastatin. The levels of PaO_2, PaCO_2, PaO_2/FiO_2, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (Tbil), blood urea nitrogen, creatinine and uric acid were detected preoperatively and at postoperative day 2 and day 6. All the data were analyzed by t-test and chi-square test. Results The levels of PaO_2 and PaO_2/FiO_2 were (87.3±4.2) mm Hg (1 mm Hg =0.133 kPa) and (416±20)mm Hg in ulinastatin group, which were significantly higher than (79.0±4.3)mm Hg and (376±20)mm Hg in control group (t =6.2, 6.2, P <0.05). The levels of ALT, AST and Tbil were (23±7)U/L, (38±8)U/L and (13.4±3.0) μmol/L in ulinastatin group, and (39±8) U/L, (50±9) U/L and (24.5±6.0) μmol/L in control group, with significant difference between the 2 groups (t = 7.0, 4.4, 7.6, P < 0.05). The levels of uric acid, blood urea nitrogen and creatinine were (279±84) μmol/L, (4.1±1.7) mmol/L and (66±12) μmol/L in ulinastatin group, and (386±67)μmol/L, ( 8.9±2.7) mmol/L and (95±38) μmol/L in control group, with significant difference between the 2 groups (t = 4.4, 6.4, 3.3, P < 0.05). The recurrence of complications in ulinastatin group was significantly lower than that in control group (χ~2 = 4.8, P <0.05). Conclusion Postoperative supplementation of ulinastatin and total parenteral nutrition is helpful in improving the pulmonary and hepatorenal function of elderly patients undergoing resection of esophageal cancer.

Objective: To observe the clinical efficacy of long-snake moxibustion plus Western medicine for chronic heart failure due to heart-kidney yang deficiency.Methods: A total of 80 patients were randomized into a control group and an observation group, with 40 cases in each group. The control group was treated with routine Western medicine, and the observation group was treated with long-snake moxibustion therapy on the basis of routine Western medicine. Left ventricular ejection fraction (LVEF), stroke volume (SV) and left ventricular end-diastolic diameter (LVEDd) were measured before and after treatment, and the heart function was assessed. The serum brain natriuretic peptide (BNP) level was measured, the 6 min walking distance was recorded, and the Minnesota living with heart failure questionnaire (MLHFQ) was assessed and scored. The serum galectin-3 (Gal-3) and soluble growth stimulation expressed gene 2 (sST2) protein levels were measured. Clinical efficacy was evaluated after treatment. Results: The total effective rate of the observation group was higher than that of the control group, and the difference between the two groups was statistically significant (P<0.05). After treatment, LVEF and LVEDd in both groups were significantly improved (all P<0.05), and LVEF, SV and LVEDd in the observation group were superior to those in the control group (all P<0.05). The heart function classification in both groups were improved after treatment (both P<0.05), and the heart function classification in the observation group was superior to that in the control group (P<0.05). The serum BNP level in both groups decreased (both P<0.05), and the serum BNP level in the observation group was lower than that in the control group (P<0.05). The 6 min walking distance and MLHFQ scores in both groups were improved (all P<0.05), and the 6 min walking distance and MLHFQ score in the observation group were superior to those in the control group (both P<0.05). The serum Gal-3 and sST2 levels in the observation group decreased significantly (both P<0.05), and all lower than those in the control group (both P<0.05). Conclusion: Long-snake moxibustion plus Western medicine has significant efficacy in treating chronic heart failure due to heart-kidney yang deficiency; it can improve heart function, reduce the serum BNP level, and improve the exercise endurance and quality of life in the patients. This may be related to the down-regulation of serum Gal-3 and sST2 levels.

Objective To investigate the effect of excessive fluoride,aluminum on Zn,Fe,Ca,Mg,Cuin rat blood.Methods Forty eight SD rats were randomly divided into 4 groups matched with their weights:control group,high aluminum group,high fluorine group and high fluorine-aluminum group.Aluminum content in their drinking water was 0,90,0,90 mg/L respectively.Fluorine content of their feed was 5.2,5.2,106.0,106.0 mg/kg and aluminum Was 6.8,6.8,19.7,19.7 mg/kg respectively.90 days later,the level of blood Zn,Fe,Ca,Mg, Cu Was detected by the atomic absorption spectrometry.Results Compared among these groups,Zn,Fe,Mg and Cu content of the whole blood had significant difierences(F=46.25,14.74,6.10,2.93,P<0.05),while Ca content of the whole blood did not significantly change(F=2.81.P>0.05).Factorial analysis showed that excessive intake of aluminum could significantly decreased Zn,Fe,Mg content of the blood(F=42.66,5.41,7.04,P<0.05)and excessive intake of fluorine could significantly decreased Zn,Fe,Mg,Cu content of the blood(F=64.50,37.90,9.75,6.74, P<0.05).The coexistence offluorine and Muminum had interaction to the level of Zn(F=31.59,P<0.05)and did not obviously interact with other elements(F=0.91,1.63,1.51.0.00,P>0.05).Compared with the control group [(131.30 ±13.86)μmol/L,(10.24 ±1.02),(1.71 ±0.19)mmol/L,(20.43 ±4.42)μmol/L],Zn content in the high aluminum group[(90.84±9.98)μmol/L]decreased significantly(P<0.05),so did Zn,Fe,Mg content in tlle high fluorine group[(85.85 ±10.92)μmol/L,(8.49 ±0.68),(1.52 ±0.13)mmol/L],the difference being statistically significant(P<0.05)0Zn,Fe,Mg,Cu content in the high fluorine-aluminum group,being(82.82 ±11.00)μmol/L, (8.16±0.45),(1.46±0.09)mmoL/L,(15.69±2.38)μmol/L,respectively,all decreased signitlcarIdy(P<0.05). Compared with the high aluminum group[(9.43±1.09)mmol/L],Fe content of the high fluorine aluminum group[(8.16±0.45)mmol/L]decreased significantly(P<0.05).Conclusions Excessive fluoride can cause blood zn, Fe,Mg,Cu decline,so can excessive aluminum.Combination of excessive fluofine and aiuminum has 8ignificant synergic effect on the level of Zn but have rio influence on Ca.

Objective To investigate the progression of mild cognitive impairment (MCI) to Alzheimer's disease (AD) and the factors influencing the related changes in cognitive ability.Methods Seventy-five subjects with mild cognitive impairment (the MCI group),32 with Alzheimer's disease (the AD group) and 17 others with normal cognition (the NC group) were recruited.The Montreal Cognitive Assessment (MOCA) and the Mini-mental State Examination (MMSE) were used to assess their cognitive ability.At the same time,relevant clinical information such as their general condition and past history of disease were recorded.The subjects were followed up for 20 months on average to evaluate their annual rates of progression (APRs),and logistic regression was used to highlight any influencing factors.Results By the end of the follow-up,9 of the 75 MCI subjects had progressed to AD,with an APR of 5.25％.Thirteen cases had recovered normal cognitive functioning (97.6 per 1,000 person-years).Also,2 cases in the NC group (11.76％) developed MCI (69.1 per 1,000 person-years),but none of them had yet progressed to AD.Both hyperlipidemia and a body mass index (BMI) lower than 24 kg/m2 significantly predicted the deterioration of cognitive functioning.Heart disease was significantly correlated with cognitive improvement,and selfmanagement of cognitive function was also a significant protective factor.Conclusions Patients with MCI are at greater risk of developing AD than normal persons.Prevention and early treatment of hyperlipidemia as well as maintaining a normal BMI may delay the deterioration of cognitive functioning.Self-management of cognitive function can improve cognition.

A systematic review was undertaken, including studies that evaluated the incidence of the blood system adverse events of Tripterygium wilfordii (TWP). Medline, Embase and the Cochrane library were searched for relevant studies, including RCT, cohort studies and case series, of patients treated with TWP published in English and Chinese from inception up until May 25th, 2013 with the keywords including "Tripterygium wilfordii", "toxicity", "reproductive", "side effect", "adverse", "safety" and "tolerability". Relevant information was extracted and the incidence of the blood system adverse events was pooled with MetaAnalyst software. Besides, subgroup and sensitivity analyses were performed based on age, mode of medicine, observation time and disease system. According to inclusion and exclusion criteria, a total of 49 articles were included in the meta-analysis, they were split into 54 researches incorporated in the analysis. There is a large degree of heterogeneity among the studies, so data was analyzed using random-effects model and the summary estimates of incidence of the blood system adverse events was 6.1%. The weighted combined incidence of three major blood system adverse events were white-blood cells decreasing 5.6% (95% CI, 4.3% - 7.3%), hemoglobin decreasing 1.7% (95% CI, 0.5% - 5.0%) and platelet decreasing 1.8% (95% CI, 1.0% - 3.1%), respectively . Sensitivity analyses based on 45 studies with high quality showed the combined value was close to the summary estimate of total 54 studies. The current evidence indicates that the incidence of the blood system adverse events induced by TWP was high; attentions should be paid on to the prevention and treatment of the blood system adverse events.
Blood Cells ; drug effects ; Hemoglobins ; analysis ; Humans ; Tripterygium ; adverse effects

Objective To investigate the causations, management and prevention methods on the complications of hysteroscopic procedures. Methods Retrospective analysis of 36 cases with hysteroscopic complication, focusing on their characteristics and clinical management as well as prevention methods during the ten years from 1993 to 2004. Results Among 36 cases, 11 cases with uterine perforation and incomplete perforation, which happened during the complicated procedures, were treated by both laparoscopy and laparotomy. Five cases with heavy bleeding were encountered because of the deeply injury to the uterine wall and Foley catheter was inserted into uterine cavity and it stopped the bleeding successfully except in one case done by hysterectomy. Three cases with fluid overload syndrome were cured by using diuretic agent and saline infusion. There is no serious consequence in one case with air embolism due to prompt diagnosis and treatment. Four cases with postablation-sterilization syndrome were treated effectively by performing hysterectomy plus single or bilateral salpingectomy, dilating cervical canal as well as resecting adhesions. Twelve cases with adhesion inside uterine cavity followed hysteroscopy were also treated by dilating cervical canal, underwent adhesionlysis and hysterectomy. Conclusions The potential factors causing complications of hysteroscopy include complicated procedures inside uterine cavity, higher pressure of irrigation, deep injury of endometrium as well as incomplete removal of endometrium during hysteroscopic operations. It is the necessary measures to reduce the complications by performing laparoscopy or B ultrasound monitoring simultaneously, standardizing the procedure and strengthening postoperation management.

Objective To evaluate the predictability of MSCT perfusion in the restorability of renal function of hydronephrotie kidneys with unilateral partial ureteric obstructed rabbit model as to explore a method to predict the restorability of renal function of hydronephrotic kidneys and to investigate the changes of MSCT perfusion parameters during the course of the restore of renal function.Methods Establish a unilateral partial ureteric obstructed rabbits hydronephrotie model.Hydronephrotie rabbits were grouped as control,2,4 and 8 week(G_2w,G_4w and G_8w)after obstruction and the later 3 groups of rabbits were reared for further 4 weeks after the obstruction was released.MSCT perfusion scanning was performed and the specimen was made into histological slices with HE staining.Results BF and BV value of renal cortex and medulla of G_2w after obstruction [(864?32)ml?100 g~(-1)?min~(-1),(19.5?0.9)ml/100 g (cortex ); (182.1?7.5)ml?100g~(-1)?min~(-1),(8.37?0.51)ml/100g(medulla)]was released restored in substance and approached that of control[(899?63)ml?100g~(-1)?min~(-1),(21.6 + 1.4)ml/100 g (cortex);(193.5?16.5 )ml?100g~(-1)?min~(-1),(8.50?0.54 )ml/100 g (medulla)]while there was no significant restore in that of G_4w and G_8w after obstruction[(525?15)ml?100g~(-1)?min~(-1),(12.8? 0.6)ml/100g (G_4 w);(512?10)ml?100g~(-1)?min~(-1),(9.4?1.0)ml/100 g (G_8w)] was released. Histologically,there was a positive correlation between the duration of obstruction and the seriousness of pathologic changes.Conclusion MSCT perfusion can provide information not only morphologically but also about renal perfusion of hydronephrotic kidneys.

Objective To learn the information about the parents' knowledge and inquiry to the nursing participating of the consultant. Methods One hundred and twenty cases of parents were investigated with the self-designed questionnaire. The rates of grade data was accomplished with statistical analysis. Results Knowledge of consultant: 82.5 percent eases parents knew their fight of consultant provided by the hospital. 70.32 percent of parents were satisfied with the nursing consultant for them. Parents of different ages had different ideas about the consultant contents and ranges provided by the doctors and nurses (P < 0.01). Styles of consulting: 67.5 percent of parents wanted to be consulted in prior. 53.33 percent wanted to be consulted at the suitable situation and be informed part of the contents. 78.53 percent wanted to be informed by the nurse in charge of the children. Lines of the consulting contents : the former three ones are as followings, staff of the department, environment, rules and discipline;kinds of the diet;function of the medication, purposes of the tests, items to be care about. Conclusions Parents agreed with the nursing consulting in the practice of medical affairs. More sufficient nursing consultants were needed. Consultant was the basic insure of their informed consents.

Objective To investigate the clinical features of the enterovirus 71 ( EV71 ) infection complicated with pulmonary edema or pulmonary hemorrhage as a fulminant and often fatal illness.Methods The medical records of three cases with EV71 infection were retrospectively reviewed for clinical manifestations, laboratory data, medications, and outcome.Results All the cases were infants and died of the infection. These infants had no skin or mucosal lesions, however, they had sudden onset of cyanosis and tachypnea 1 to 2 days after the onset of the febrile disease with vomiting. All these 3 cases were misdiagnosed and were treated for shock on admission. Pulmonary hemorrhage was not considered in any of the cases on admission. All the cases received tracheal intubation when foamy secretions were discharged from the mouth and nose of the patients and notable cyanosis occurred. After intubation, pink foamy fluid flew out from the endotracheal tube in all the 3 cases. The patients had hyperglycemia and limb weakness, two had tachycardia, and hypertension was found in one case. Chest X-ray showed bilateral or unilateral widespread air space opacity, but the cardiac size and shape were normal. All the patients had leukocytosis. Enterovirus 71 infection was confirmed by detection of specific nucleic acid sequences of the virus from throat swab and tracheal secretions samples and in one case in cerebrospinal fluid.Conclusions Pulmonary edema or pulmonary hemorrhage occurred in the 3 cases with EV71 infection. The initial presentation was nonspecific with fever and vomiting, and sudden appearance of cyanosis, tachypnea, tachycardia, hypertension or hypotension, limb weakness, which may suggest pulmonary edema or hemorrhage. Excessive fluid resuscitation may deteriorate the illness, on the contrary, fluid restriction and inotropic agents, and early intubation with positive pressure mechanical ventilation may be the proper treatment.