Objective To investigate the influence of combined kinetotherapy with non-drug sleep on delirium in patients with mechanical ventilation. Methods 107 cases with acute exacerbation of chronic obstructive pulmonary diseases (COPD) respiratory failure and mechanical ventilation were randomly divided into the treatment group of 54 cases, and the control group of 53 cases. Two groups of patients were given conventional treatment, the treatment group while giving to kinetotherapy and non-drug sleep:an eye mask earplugs at night. Observe the difference of the incidence of delirium, duration of delirium, number of days of mechanical ventilation, case fatality rate. Results The incidence of delirium in the treatment group was 59.3%(32/54), while that was 77.4%(41/53) in the control group, the difference was significant, χ2=4.042,P=0.044. The duration of delirium in treatment group was (1.75 ± 1.05) d, while that was (2.56 ± 1.25) d in the control group, the difference was significant, t=-2.955, P=0.004. The number of days of mechanical ventilation in treatment group was (6.41 ± 2.84) d, while in the control group was (8.68 ± 3.85) d, the difference between the two groups was significant, t=-3.478,P=0.001. The case fatality rate in treatment group was 5.6%(3/54), while in the control group was,11.3%(6/53) , the difference between the two groups was no significant, P=0.283. Conclusions Kinetotherapy cooperate with non-drug sleep can reduce the incidence of delirium, duration of delirium and number of days of mechanical ventilation in patients with mechanical ventilation. This method are simple and it is worth spreading.

Objective To study the relationship between white blood cell(WBC) count and cardiac events in acute ST-elevation myocardial infarction(STEMI) patients treated with reperfusion in the early stage. Methods Two hundred and thirty-five patients with acute STEMI were divided into two groups:percutaneous coronary intervention group (PCI group, 97 patients) and thrombosis therapy group (138 patients). WBC count and cardiac events of the two groups before and after treatment (3 h and the second day and the third day) were recorded and compared. Results The level of WBC count had no changes in two groups before and after treatment in first 3 h (P>0.05) , while the level of WBC count was significantly decreased, and the level of WBC count was significantly lower in PCI group than that in thrombosis therapy group (P<0.05). The rate of no cardiac events and two cardiac events in two groups has no significant differences (P > 0.05). The rate of one cardiac events in PCI group was significantly higher than that in thrombosis therapy group (P<0.05). The rate of three cardiac events in PCI group was significantly lower than that in thrombosis therapy group (P<0.05). WBC count had a positive correlation with cardiac events rate (r = 0.231, P < 0.05). Conclusions Primary percutaneous coronary intervention decreases WBC count and cardiac events rate. In patients with acute myocardial infarction, level of WBC count has positive relationship with cardiac events.

Objective To explore the relationship between superior vena cava-jugular vein oxygen saturation-differential value (ScVO2-SjVO2) and injury severity and prognosis in patients suffered from severe traumatic brain injury,finding out the chnical value.Methods Forty-three patients with severe tranmatic brain injury were selected and divided into two groups according to Glasgow Coma Scale (GCS) score,19 cases were enrolled in GCS 3-5 scores group;24 cases in GCS 6-8 scores group;20 contemporaneous cases in control group had conscious and without traumatic brain injury.The changes of ScVO2-SjVO2 at 0,12,24,48 h after admission of ICU among the groups were observed.In addition according to the degree of change in ScVO2-SjVO2,12 cases were enrolled in ScVO2-SjVO2 ＜ 0.05 group;14 cases in ScVO2-SjVO2 0.05-0.15 group; 17 cases in ScVO2-SjVO2 ＞ 0.15 group.The GCS score and mortality rate in patients after brain injury 28 d among groups were observed.Results GCS 3-5 scores group compared with control group,ScVO2-SjVO2 reduced significantly at 0,12,24,48 h after admission of ICU (-0.071 ±0.032 vs.0.093 ±0.049,-0.097 ±0.052 vs.0.081 ±0.052,-0.035 ±0.031 vs.0.089 ± 0.059,0.036 ± 0.033 vs.0.081 ± 0.064),there were significant differences (P ＜ 0.01).GCS 6-8 scores group compared with control group,ScVO2-SjVO2 dramatically increased at 0,12,24 h after admission of ICU(0.173 ± 0.043,0.158 ± 0.067,0.123 ± 0.073),there were significant differences (P ＜ 0.01 or ＜ 0.05).ScVO2-SjVO2 ＜0.05 group and ScVO2-SjVO2 ＞0.15 group compared with ScVO2-SjVO2 0.05-0.15group,the mortality rate significantly increased,the mortality rate were 8/12,4/17,1/14,respectively,there were significant differences (P ＜0.01).ScVO2-SjVO2 ＜0.05 group and ScVO2-SjVO2 ＞0.15 group compared with ScVO2-SjVO2 0.05-0.15 group,GCS score decreased significantly[(4.17 ± 1.34),(5.88 ±1.35) scores vs.(6.86 ± 1.35) scores],and there was significant difference (P ＜0.01 or ＜0.05).Conclusions When ScVO2-SjVO2 ＜ 0.05,the difference is negatively related to the deg~e of brain injury.When ScVO2-SjVO2 ＞0.15,the difference is positively related to the degree of brain injury;ScVO2-SjVO2 can assess injury severity objectively in patients who suffered from severe traumatic brain injury,and it also expresses the rate of cerebral oxygen metabolism.It can provide a basis for treatment accurately and timely,and judgment prognosis.

Objective To evaluate the value of sonourethrography in the diagnosis of dysuria after bipolar transurethral plasmakinetic prostatectomy. Methods Sixty male patients with dysuria after bipolar transurethral plasmakinetic prostatectomy underwent sonourethrography and re-operation.The clinical data of these patients were reviewed. Results The sonourethrographic findings were similar with the operative findings in 57 cases.In the 60 cases,there were 11 cases with bladder neck closure,10 cases with bladder neck stricture,30 cases with urethral stricture (16 located at membranous urethra,12 located at pars cavernosa urethra and 2 in external orifice of urethra),5 cases with prostate remnant,1 case with calculi in prostatic urethra,2 cases with dysfunction of detrusor of bladder and 1 case with flap of internal urethral orifice,Conclusions Sonourethrography could be a reliable diagnostic method for dysuria after bipolar transurethral plasmakinetic prostatectomy.It may be helpful for clinical treatment.

Objective To investigate the effects of sequential blood purification on cardiac function in patients with acute organophosphorus pesticide poisoning (AOPP),and to analyze its application value.Methods Forty-five patients with severe AOPP and toxic myocarditis were researched and randomly divided into two groups.Sequential blood purification included hemoperfusion(HP) and continuous veno-venous hemofiltration (CVVH).In treatment group,23 patients were treated with HP + CVVH on the basis of the conventional therapy.Twenty-two patients of control group received the conventional therapy with HP.The differences of two groups on left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP) were compared before treatment and at 24,48 and 72 h after treatment.Results Before treatment,the levels of LVEF and BNP in treatment group were (47.7 ± 9.8)％ and (511.3 ± 285.3) ng/L,in control group were (47.3 ± 10.2)％ and (535.4 ± 303.9) ng/L,and there were no significant differences (P ＞ 0.05).The levels of LVEF at each time point after treatment in treatment group were significantly higher than those of control group:(52.7 ± 7.3) ％ vs.(47.8 ± 8.4)％,(55.2 ± 5.2)％ vs.(50.6 ± 7.1)％,(60.7 ± 6.3)％ vs.(53.3 ± 5.2)％,and the levels of BNP in treatment group were significantly lower than those of control group:(320.7 ± 181.8) ng/L vs.(496.7 ±268.9) ng/L,(252.7 ±113.8) ng/L vs.(384.3 ±167.5) ng/L,(122.4 ±66.7) ng/L vs.(294.8 ± 121.8) ng/L,there were significant differences between two groups (P＜ 0.05 or ＜ 0.01).In treatment group,the levels of LVEF at 24,48 and 72 h after treatment were significantly increased:(52.7 ± 7.3)％,(55.2 ± 5.2)％,(60.7 ± 6.3)％ vs.(47.7 ± 9.8)％,and the levels of BNP were significantly decreased:(320.7 ± 181.8),(252.7 ± 113.8),(122.4 ±66.7) ng/L vs.(511.3 ±285.3) ng/L,there were significant differences (P ＜ 0.01).In control group,the levels of LVEF and BNP at 24 h after treatment were (47.8 ± 8.4)％ and (496.7 ± 268.9) ng/L,before treatment were (47.3 ± 10.2)％ and (535.4 ± 303.9) ng/L,and there were no significant differences (P ＞ 0.05);the levels of LVEF at 48 and 72 h after treatment were significantly increased:(50.6 ± 7.1)％,(53.3 ± 5.2)％ vs.(47.3 ± 10.2)％,the levels of BNP were significantly decreased:(384.3 ± 167.5),(294.8 ± 121.8) ng/L vs.(535.4 ± 303.9) ng/L,and there were significantl differences (P ＜ 0.05 or ＜ 0.01).Conclusion Sequential blood purification treatment of AOPP can reduce myocardial injury and improve the cardiac function.

Objective To compare the safety and short-term efficacy of thulium laser resection of the prostate (TMLRP) and bipolar transurethral plasmakinetic prostatectomy (TUPKP) for the treatment of benign prostatic hyperplasia (BPH) patients.Methods A total of 100 patients diagnosed with BPH were randomly divided into 2 groups:TMLRP group (50 cases) and TUPKP group (50 cases).There was no significant difference of preoperative variables such as age,prostate volume,PSA,IPSS,Qmax and PVR between the two groups (P＞0.05).The perioperative parameters and therapeutic effects were recorded and compared between the two groups.Results Comparison between TMLRP group and TUPKP group included:operating time ((61.2±24.2) min versus (30.1±15.9) min),catheterization time ((1.8±0.4) d versus (3.2±0.6) d)and postoperative hospital stay ((3.3±0.8) d versus (4.1±1.3) d).Significant differences in these parameters were found between the two groups(P＜0.05).Compared with TUPKP group,the blood loss and postoperative bladder irrigation were significantly less in TMLRP group.One month postoperatively,there were 4 cases of urethral stricture in TUPKP group.Three months postoperatively,IPSS,QOL,Qmax and PVR were significantly improved in both groups (P＜0.01),but no significant difference detected between the 2 groups (P＜0.05).Conclusions TMLRP is superior to TUPKP in term of safety and tolerability (decreased blood loss,complication rate and short recovery time),and as efficacious as TUPKP in efficacy.Compared with TUPKP,operating time were significantly longer in TMLRP group

Objective To investigate the effects of β-blockers on cardiac protection and hemodynamic in patients with septic shock. Methods A prospective randomized controlled trial was conducted. Forty-one patients with septic shock in accordance with early goal directed treatment and met the target within 6 hours,and admitted to intensive care unit (ICU)of Affiliated Huxi Hospital of Jining Medical College from January 2012 to January 2014 were enrolled. The patients were divided into treatment group (n=21)and control group (n=20)by random number table. The patients in both groups were given the standard treatment,esmolol was giving to patients in treatment group in order to control the heart rate (HR)below 100 bpm within 2 hours,and the patients in control group only received standard treatment. The changes in hemodynamic parameters〔mean arterial pressure(MAP),central venous pressure(CVP), HR,cardiac index(CI),stroke volume index(SVI),systemic vascular resistance(SVRI),global end diastolic volume index(GEDVI)〕,biochemistry metabolic of tissue〔central venous oxygen saturation(ScvO2),lactic acid(Lac)〕,and cardiac markers 〔troponin I (cTnI)〕before and 12,24,48,72 hours after the treatment were recorded. Results①Before treatment,the hemodynamic parameters,tissue metabolism index and cTnI had no significant differences in both groups (all P>0.05).②The hemodynamic parameters after treatment in the control group showed no significant difference compared with that before treatment. HR and CI in the treatment group were gradually declined after treatment,SVRI and GEDVI were gradually increased. There were significant differences in HR,CI,SVRI,and GEDVI between treatment group and control group from 12 hours on〔HR(bpm):93±4 vs. 118±13,CI (L·min-1·m-2):3.3 ±0.8 vs. 4.5 ±0.6,SVRI (kPa·s·L-1·m-2):159.2 ±27.4 vs. 130.5 ±24.2,GEDVI(mL/m2):668 ±148 vs. 588 ±103,P<0.05 or P<0.01〕. MAP,CVP and SVI in the treatment group showed no significant changes. ③Lac after treatment in both groups was decreased slowly,Lac (mmol/L)at 12 hours after treatment was significantly decreased compared with that before treatment (control group:8.8 ±3.2 vs. 9.8 ±3.4,treatment group:9.5±3.1 vs. 10.5±4.1,both P<0.05). The Lac of control group and treatment group were 2.5±1.2 and 2.7±1.1 at 72 hours after treatment,and there was no significant difference between two groups (all P>0.05). The ScvO2 was not decreased in both groups.④Compared with before treatment,cTnI in the control group was gradually increased,peaked at 72 hours,and that in the treatment group was gradually increased,peaked at 24 hours and then gradually declined. Compared with control group,the cTnI (μg/L)in the treatment group was decreased significantly at 24,48,72 hours (1.15 ±0.57 vs. 1.74 ±0.77,0.93 ±0.52 vs. 2.15 ±1.23,0.52 ±0.36 vs. 2.39 ±1.17,all P<0.01). Conclusionsβ-blockers (esmolol) can improve cardiac function and myocardial compliance,reduce the myocardial injury in patients with sepsis shock. Although β-blockers can decrease cardiac output,it has no influence on the circulation function and tissue perfusion.

Objective To explore the clinical value of transnasal high volume oxygen therapy in the treatment of patients with acute heart failure.Methods From January 2016 to January 2018,61 cases with acute heart failure in Huxi Hospital Affiliated to Jining Medical College were selected.The patients were randomly divided into control group and treatment group according to the digital table,31 cases in the control group and 30 cases in the treatment group.The two groups were routinely given control of fluid volume,analgesia,strong heart,diuresis,vasodilator,anti-platelet aggregation,camp support and so on.The control group was given conventional oxygen therapy,and the treatment group was treated with high flow oxygen through nose.Before treatment and 12h,24h,48h,72h after treatment,the left ventricular ejection fraction (LVEF),oxygen index (PaO2/FiO2),serum lactic acid (Lac),B type sodium and titanium (BNP) in serum,and the application rate of non-invasive mechanical ventilation and invasive mechanical ventilation in 7d were observed in the two groups.Results Compared with the control group,the LVEF of the treatment group in each time point increased [(35.58 ± 3.64) ％ vs.(37.77 ± 3.76) ％,(37.87 ± 3.58) ％ vs.(40.07 ±3.36)％,(44.94 ±3.19)％ vs.(46.83 ±3.21)％,(47.55 ±3.45％)％ vs.(40.07 ±3.36％)％,t =-2.308,-2.466,-2.316,-2.487,all P ＜ 0.05].The PaO2/FiO2 of the treatment group increased significantly at each time point after treatment [(177.39 ± 10.62) mmHg vs.(184.17 ± 10.49) mmHg,(188.00 ± 11.72) mmHg vs.(198.57 ± 18.47) mmHg,(204.06 ± 17.69) mmHg vs.(221.40 ± 23.80) mmHg,(265.23 ± 34.51) mmHg vs.(290.37 ± 26.72) mmHg,t =-2.507,-2.678,-3.236,-3.174,all P ＜ 0.05].The BNP level of the treatment group decreased significantly at each time point after treatment [(2 462.90 ± 288.00) ng/mL vs.(2 264.53 ± 366.44) ng/mL,(1 646.61 ± 377.19) ng/mL vs.(1 474.07 ± 214.03) ng/mL,(991.94 ± 242.95) ng/mL vs.(811.90 ±258.67) ng/mL,(653.77 ± 147.671) ng/mL vs.(526.47 ± 127.87) ng/mL,t =2.355,2.187,2.803,3.594,all P ＜ 0.05].The Lac level of the treatment group decreased significantly at 12h and 24h after treatment [(5.05 ± 0.69) mmol/L vs.(4.55 ± 0.80) mmol/L,(3.68 ± 0.89) mmol/L vs.(3.13 ± 0.77) mmol/L,t =2.610,2.601,all P ＜ 0.05],but there were no statistically significant differences between the two groups at 48h and 72h after treatment [(1.62 ± 0.65) mmol/L vs.(1.53 ± 0.65) mmol/L,(1.36 ± 0.64) mmol/L vs.(1.26 ± 0.46) mmol/L,all P ＞ 0.05].In the control group and the treatment group,the incidence rates of non-invasive mechanical ventilation in 7d were 35.48％ (11/31),13.33％ (4/30),respetively,the difference was statistically significant (x2 =4.034,P ＜ 0.05).In the control group and the treatment group,the incidence rates of invasive mechanical ventilation in 7d were 12.90％ (4/31),3.33％ (1/30),respetively,the difference was statistically significant (x2 =4.957,P ＜ 0.05).Conclusion Nasal high flow oxygen therapy has better clinical effect on patients with acute heart failure.It is a more active treatment measure,and is worthy of clinical application.

ObjectiveTo investigate the clinical outcome of laparoscopic nephroureterectomy (LUNT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients.Methods We conducted a retrospective analysis on 1130 RT recipients,and 9 patients (0.8％,9/1130) with native upper tract UC were identified. UC was confirmed pathologically in the 9 patients,including 3 cases of unilateral ureter tumor (2 on the right,and 1 on the left),4 cases of unilateral renal pelvis tumor (2 on the right,2 on the left),1 case of bilateral ureter tumor and 1 case of tumor in the right ureter and left kidney.Females predominated (8/9) in the 9 patients with upper tract UC.The patients with left upper urinary tract cancer underwent LUNT using a retroperitoneal approach with a technique of transurethral circumcision of the ureteral orifice.The patients with right upper urinary tract cancer were subjected to nephroureterctomy with ureterectomy and bladder cuff excision by complete laparascopy through a transperitoneal approach. Immunosuppressive protocol conversion from calcineurin inhibitors to sirolimus was performed on all cases. Results In the 9 patients,11 LUNTs were performed successfully without conversion to open surgery.The follow-up period was from 6 to 48 months. One patient died of lung metastasis at 8th month after tumor excision,and 1 patient displayed ductal cancer of the left breast at 7th month after LNUT.Another seven patients showed no evidence of disease during the follow-up period with normal renal function.ConclusionOur present clinical experience suggested that LNUT for the native upper tract cancer in renal transplant recipients is feasible,safe,and effective.

Objective To investigate the characteristics of target motion in esophageal cancer during normal breathing with four-dimensional computed tomography(4DCT). Methods Twenty patients with primary esophageal cancer received respiratory gated 4DCT to obtain the target motion during normal breathing and delineate the gross tumor volume (GTV). The center coordinate and volume of each GTV were measured and recorded to calculate the displacement of the GTV center and the change in volume in different respiratory phases. Results The displacement of the GTV center in each esophageal segment in superior-inferior direction (0.521±0.319 cm) was significantly greater than that in right-left direction (0.169± 0.083 cm) and that in anterior-posterior direction (0.167±0.095 cm)(all P<0.05). The maximum displacement of the GTV center in each direction was significantly different in different esophageal segments(all P<0.05).The displacement of the GTV center in each direction was not entirely consistent in different respiratory phases. The displacement of the GTV center in each direction in T50phase was greatest when T0phase was the reference phase. The volume of GTV had no significant changes at the end of the expiratory phase and the inspiratory phase (P=0.313). Conclusions The displacement of GTV center in each esophageal segment in superior-inferior direction is significantly greater than that in right-left direction and that in anterior-posterior direction and the displacement of GTV center in each direction is significantly different in different esophageal segments. Therefore, all the factors should be considered to develop a reasonable target for precise radiotherapy. For esophageal cancer in cervical and upper chest esophageal segment,it is reasonable to delineate ITV based on the fusion image of the images at the end of inspiratory phase and expiratory phase. The deformation of target volume of the esophageal cancer in the cervical and upper chest esophageal segment is not significant in the respiratory cycle.