Objective To investigate the early predictive indexes of curative effect of acute respiratory failure(AFR) treated with noninvasive bilevel positive airway pressure(BiPAP) ventilation.Methods Sixty-eight patients with AFR were treated with BiPAP ventilation.According to the therapeutic outcome,patients were divided into success group and failure group,and the distributions of ages,acute physiology and chronic health evaluation(APACHEⅡ) score,consciousness level as well as arterial blood gas(ABG) measurement before and after the treatment with BiPAP ventilation were compared between the two groups.Results There was statistical difference in the ABG levels of pH and PaCO_2 after 1 hour's treatment with BiPAP ventilation(P0.05).Conclusion The levels of pH and PaCO_2 after 1 hour's treatment with BiPAP ventilation are valuable markers for curative effects in early stadge.If the levels of pH and PaCO_2 fail to improve,the treatment with intubation may be necessary.

[Objective]To study the stability function of Luschka Joint(LJ) of lower cervical spine.[Method]C_(3、4) and C_(5、6) as a funtional spinal unit(FSU) were taken from 16 fresh adult cadavers and randomly divided into experimental group,its LJ was cut out and in control group,LJ was maintained.The FSU of C_(3、4) and C_(5、6)was loaded and tested on the AG-10 AT automatic electronic versatile machine in normal,flexion ≤10? and extension ≤7.5? positions.Data of sigattal horizontal displacement(SHD),rotational angulation(RA) and coronary laterral displacement(CLD) were collected,counted and 3-dimesionally analyzed by computer.[Result]The SHD,RA and CLD of FSU experimental group were significantly different with that of control group(P

Objective To summarize the experiences in the diagnosis and treatment of delayed rupture of spleen.Methods The clinical data of 26 patients with traumatic delayed rupture of spleen who were admitted to the Dachang Hospital from January 2005 to December 2013 were analyzed retrospectively.The medical history,clinical presentation,results of laboratory examinations were analyzed,and the splenic trauma was graded.Surgical procedures were selected according to the condition,severity of the splenic trauma and time of injury.Patients were followed up via outpatient examination or telephone interview till June 2014.Results Twenty-six patients had the history of injury of the left hypochodriac region,and were accompanied by slight abdominal pain and a short period of pain alleviation,and then pain in all regions of the abdomen at postoperative hour 48.All thepatients had pale face,tenderness,rebound tenderness or tonus.The pulse above 100 per minute was observed in 20 patients,and 15 patients had blood pressure under 90/60 mmHg (1 mmHg =0.133 kPa).The level of hemoglobin under 5 g/L was observed in 3 patients,and 5-10 g/L in 21 patients.All the 26 patients received abdominal paracantesis,non-coagulating blood was extracted in 25 patients.Twenty-six patients received B ultrasonography,and 24 had splenic rupture.Nineteen patients received computed tomography (CT),and 19 had splenic rupture.Ten patients had type Ⅰ splenic rupture,12 had type Ⅱ splenic rupture,3 had type Ⅲ splenic rupture and 1 had type Ⅳ splenic rupture.All the 26 patients received operation,including 2 received suture of the ruptured spleen,2 received resection of the lower part of the spleen,9 received total splenic resection,and 13 received total splenic resection + autogeneous transplantation of greater omentum.Two patients died of hemorrhagic shock intraoperatively,and the other 24 patients were cured.The operation time and volume of hemoperitoneum were (90 ± 15)minutes and (1 500 ± 700) mL,respectively.Twenty-four patients received blood transfusion,with the volume of transfused blood of 1 200 mL.The mean duration of hospital stay was 16.7 days.Two patients had complications after the operation,which were left pleural effusion and splenic fossa effusion,and they were cured by symptomatic treatment.No infection or other complications were observed.All the 24 patients were followed up for 6-108 months (median,46 months).One patient died of myocardial infarction at postoperative year 5,and the other 23 patients survived.Conclusions B sonography and computed tomography are important methods for the treatment of delayed rupture of spleen.Traumatic delayed rupture of spleen should be considered when the patient had symptoms including history of injury of the left hypochondriac region,the course of abdominal pain,abdominal pain alleviation,abdominal pain recurrence,time for abdominal pain alleviation longer than 48 hours,interperitoneal hemorrhage and the signs of splenic rupture indicated by B ultrasonography and computed tomography.The indication of spleen-preservation surgery or splenectomy for patients with delayed rupture of spleen should be strictly controlled and optimal surgical procedure should be designed according to the condition of the patient.

Objective To explore the therapeutic effect on the prevention of eccyesis by optimizing fallopian tube to be pregnant.Methods Three hundred and seventy-nine patients with infertility were divided into two groups:control group with 187 patients received the combined optimized treatment,and study group with 192 patients received the combined optimized treatment and optimizing fallopian tube to be pregnant.All patients received the hysterosalpingography uterosalpingography(HSU)whik the patients of the study group received the ultraphonic monitor for the.dominant follicle besides for 6 ovulatory cycle.Results There were intrauterine gestation 59 patients(31.55%,59/187),eccyesis 20 patients(10.70%,20/187)and infertility 108 patients(57.75%,108/187)in control group while there were intrauterine gestation 83 patients(43.23%,83/192),eccyesis 10 patients(5.21%,10/192)and infertility 99 patients (51.56%,99/192)in study group.The intrauterine gestation rate in study group was higher than that in control group(P<0.05),and the eccyesis rate was lower than that in control group(P<0.05).But there was no significant difference in the infertility rate between two groups(P＞0.05).The eccyesis rate in fallopian tube unsmooth was higher than that in salpingemphraxis and fallopian tube canalization respectively[12.59%(18/143),2.63%(2/76),2.70%(2/74),P<0.05].Conclusion Selecting the optimizing fallopian tube by HSU and monitoring the dominant follicle by ultraphonic to guide pregnancy can let the dominant follicle grow and conceive in the optimizing fallopian tIlbe,and this treatment can raise the intrauterine gestation rate and decrease the cause of eccyesis.

Objective To investigate the prevalence of aac(6')-Ib-cr in clinical isolates of Klebsiella pneumoniae.Methods A total of 337 isolates of Klebsiella pneumoniae were isolated from clinical specimens in our hospital from Jan,2006 to Sep,2007.Gentamycin,amikacin or tobramicin was used to screen the isolated with aac(6')-Ib-cr.aac(6')-Ib and class 1 interase gene(intl1)was determined by PcR All PCR products of aac(6')-Ib were sequenced for determination of aac(6')-Ib-cr. MICs of antibiotics were determined by agar dilution method.The ESBLs-producing isolates were determined by the CLSI-recommended confirmatory tests.Conjugation test was used to detect the transfer of plasmid.Results Of the 337 clinical isolates of Klebsiella pneumoniae,64(19.0%),28(8.3%)and 55(16.3%)isolates were resistant to gentamycin,amikacin and tobramycin,respectively.Among 64 gentamycin-resistant isolates,24(37.5%)were positive for aac(6')-Ib-cr,including 13 ciprofloxacin-resistant isolates and 11 ciprofloxacinsusceptible isolates.The prevalence of aac(6')-Ib-cr in ciprofloxacin-resistant and-susceptible isolates were 54.2%(13/24)and 27.5%(11/40).The positive rates of ESBLs and intl1 in the 24 isolates carrying aac(6')-Ib-cr were 79.2%(19/24)and 91.7%(22/24).Plasmids carrying aac(6')-Ib-cr of 13 isolates were successfully transferred to E.coli J53.Plasmids of all transconjugants were positive for aac(6')-Ib-cr and intl1.All transconjugants were ESBL producing strains.Conclusions aac(6')-Ib-cr exists widely in clinical isolates of Klebsiella pneumoniae.aac(6')-Ib-cr and ESBL gene usually coexist in a selftransmissible conjugative plasmid by class 1 integron.

Objective To investigate the prevalence and molecular epidemiology of clinical isolates of plasmid-mediated 16S rRNA methylases-producing Klebsiella pneumoniae. Methods From January 2006 and September 2007, 337 non-replicate clinical isolates of Klebsiella pneumoniae were consecutively collected from inpatients in a teaching hospital in Wenzhou, China. All of the isolates were identified by the automated microbiology systems. MICs of amikacin, gentamicin and tobramycin were determined by agar dilution method. The isolates were investigated for the presence of ESBLs by the CLSI-recommended confirmatory tests. PCR was used to detect 16S rRNA methylase genes, ESBL genes and class Ⅰ integrase gene. The homology of these isolates was analyzed by pulse-field gel electrophoresis (PFGE). Results Sixty-four ( 19. 0% ), 28 ( 8. 3% ) and 55 ( 16. 3% ) of 337 isolates were resistant to gentamicin, amikacin and tobramycin, respectively. Twenty-one (6. 2% ) isolates carried 16S rRNA methylase genes (3 for armA, 13 for rmtB, 5 for both armA and rmtB) and high-level resistant to gentamicin, amikacin and tobramycin ( MICs ≥256 mg/L). Nineteen of 21 isolates with 16S rRNA methylase genes were ESBL producers, blaCTX-M-14-like, blaCTX-M-like and blaSHV-12-like were predominant genotypes of ESBLs. The plasmids of 13 isolates were transferred into the recipients E. co/iJ53. PCR and sequence analysis revealed that blaCTX-M-14-like,blaCTX-M-15-like and blaSHV-12-like were co-transferred with the armA or the rmtB to the recipients. All transconjugants harbored intll and blaTEN-1. Of the 21 isolates, 14 patterns were obtained by PFGE. Conclusion Both horizontal gene transfer and clonal spread were responsible for the dissemination of the rmtB or the armA gene in Klebsiella pneumoniae.

Background Traditional Chinese medicine (TCM), especially herbal medicine, has been widely used in China and now is also being increasingly used in other countries for the treatment of cardiovascular diseases. Although many studies have demonstrated that certain Chinese herbal products are effective and safe for the treatment of cardiovascular diseases, most of these lack sufficient quality. Therefore, large randomized clinical trials and further scientific research to determine its safety, effectiveness are necessary.QiShen YiQi Dripping Pills (QSYQDP) is a herbal preparation clinically used in the treatment and prevention of coronary artery disease. Preliminary observations have shown its safety and effectiveness. Methods/Design This randomized, controlled trial will recruit 3600 patients with a history of myocardial infarction. Patients will be randomized into two groups by a Centr-Randomized System. One group receives QSYQDP, the other group receive aspirin. This trial protocol will describe eligibility criteria, detailed information on the treatment definition, blinding, endpoints, statistical methods, sample size determination, data management, legal aspects, and the current status of the trial. Discussion This trial is one of the first randomized, controlled clinical trial to evaluate the efficacy and safety of traditional Chinese herbal medicine in the treatment and secondary prevention of coronary artery disease. The results of this study should help to define the role of TCM in modern medical care, as well as to provide the management strategy for CAD patients in China and other countries.

OBJECTIVETo observe the effects of Chinese herbal composition Zengjing Granule (ZJG) on the quality of sperm in the epididymis of infertile rats, and to study its therapeutic mechanisms of improving sperm quality.

METHODSA total of 40 GTW infertile rats were divided into 4 groups of 10 rats each, including an infertility group[GTW 2 mg/(ml.100 g)], a high-dosage group[ZJG 0.67 g/(ml.100 g) + GTW 2 mg/(ml.100 g)], a medium-dosage group[ZJG 0.33 g/(ml.100 g) + GTW 2 mg/(ml.100 g)], a low-dosage group[ZJG 0.17 g/(ml.100 g) + GTW 2 mg/(ml.100 g)], and a normal control group(1% CMC). This study consisted of a 3-week modeling period and a 3-week ZJG period. The changes of sperm quality, the thickness of the epididymal gland canal wall and sexual organ coefficient were detected after 3-week ZJG period.

RESULTSOf the 3 ZJG groups, the sperm density was (59.6 +/- 3.72), (63.3 +/- 5.70) and (69.7 +/- 6.91) x 10(6)/ml, the sperm motility rates were (65.4 +/- 6.33)%, (69.3 +/- 10.96)% and (72.6 +/- 9.61)%, the sperm deformity rates were (52.3 +/- 7.47)%, (46.2 +/- 7.73)% and (33.2 +/- 7.97)% respectively. The ZJG groups showed significant difference from the infertility group (P < 0.05), whose sperm density, motility and deformity were (13.1 +/- 6.81) x 10(6)/ml, (7.6 +/- 5.87)%, and (77.2 +/- 8.75)% respectively. But there was no significant difference between ZJG groups and the normal control group (P > 0.05), whose sperm density, motility and deformity were (75.6 +/- 10.82) x 10(6)/ml, (83.00 +/- 8.02)%, and (8.80 +/- 3.49)% respectively. The thickness of the epididymal gland canal wall was (37.07 +/- 3.38), (37.16 +/- 6.69) and (43.42 +/- 10.23) nm in the three ZJG groups respectively, different from the infertility group[(28.65 +/- 6.96) nm] (P < 0.05) significantly, but not from the normal control group [(45.79 +/- 11.13) nm] (P > 0.05). The ZJG groups showed an increase in the organ coefficient of the epididymal gland canal wall. And these was obvious statistical difference compared with the infertility group (P < 0.05), but no statistical significance compared with the normal control group (P > 0.05).

CONCLUSIONSZJG can obviously improve the sperm quality of infertile rats. Its therapeutic mechanisms can be summed up as follows: restoring the thickness of epididymal gland wall, increasing the organ coefficient of testes and epididymis, and hence improving the spermatozoa maturing function of epididymis of infertile rats.

Animals ; Dose-Response Relationship, Drug ; Epididymis ; drug effects ; pathology ; Male ; Medicine, Chinese Traditional ; Rats ; Rats, Sprague-Dawley ; Spermatozoa ; drug effects

OBJECTIVETo observe the efficacy of acupuncture combined with acupoint catgut embedding sequential therapy and medication for mild and moderate ulcerative colitis.

METHODSOne hundred and twenty patients were randomized into an acupuncture and acupoint catgut embedding sequential therapy group (a combination group) and a mesalazine group, 60 cases in each one. Fifty-seven cases in the combination group and 55 cases in the mesalazine group were included into analysis. In the combination group, acupuncture was applied at Tianshu (ST 25), Shangjuxu (ST 37), Quchi (LI 11) during the activity period, and acupoint catgut embedding was applied at Pishu (BL 20), Zusanli (ST 36), Guanyuan (CV 4) during the alleviate period. The patients in the mesalazine group were treated with mesalazine orally. The treatment was given for 12 weeks. The scores of TCM symptoms, colonoscopy, mucosa healing rate were compared before and after treatment in the two groups. The effects, adverse reactions and the recurrent rates during 1-year follow-up were observed.

RESULTSAfter treatment, the scores of TCM symptoms decreased in the two groups (both <0.05), and the result in the combination group was better than that in the mesalazine group (<0.05). The total effective rate in the combination group was 87.7% (50/57), which was better than 70.9% (39/55) in the mesalazine group (<0.05). The colonoscopy scores decreased after treatment in the two groups (both <0.05). There was no significant difference between the two groups on colonoscopy score and mucosal healing rate [50.9% (29/57) vs 34.5% (19/55), both >0.05]. The recurrent rate in the combination group was 8.5% (4/47)，which was lower than 32.4% (11/34) in the mesalazine group (<0.05). No severe adverse reaction was found during the treatment in the two groups.

CONCLUSIONAcupuncture combined with acupoint catgut embedding sequential therapy can improve mild and moderate ulcerative colitis and reduce the recurrent rate.

Acupuncture Points ; Acupuncture Therapy ; Catgut ; Colitis, Ulcerative ; therapy ; Humans

OBJECTIVEOn the basis of western medication, to investigate the effect of electroacupuncture (EA) combined with auricular point sticking therapy for anal pain of mixed hemorrhoid after external excision and internal ligation，so as to explore the method of improving its effect.

METHODSNinety patients of mixed hemorrhoids who received external excision and internal ligation were randomly assigned into an EA group, an auricular point sticking group and a combined group, 30 cases in each one. All the treatment was applied 30 min before surgery. Electroacupuncture was used at Xialiao (BL 34) and Changqiang (GV 1) in the EA group, once a day. The auricular points were bilateral shenmen (TF), pizhixia (AT), jiaogan (AH) and gangmen (HX) in the auricular point sticking group, pressing 3-6 times every day, once 3-5 min. EA and auricular point sticking therapy were applied in the combined group. When the visual analogue scale (VAS) score was above 6, aminophenol dihydrocodeine was applied in the three groups. The scores of anal pain VAS and limb activity at the 4th, 12th, 24th, 48th, 72th hours after operation were compared among the three groups, as well as the maximum scores of VAS in 24 hours (T24max VAS) of 1-3 days after operation, the total dose of aminophenol dihydrocodeine 72 h after operation.

RESULTSThe VAS and limb activity scores at all the time points after operation, the T24max VAS on the 1st, 2nd and 3rd days after operation and the dose of aminophenol dihydrocodeine in the combined group were better than those in the EA and auricular point sticking groups (all <0.05). The VAS and limb activity scores at 4, 12, 24 h after operation and T24max VAS on the 1st day after operation in the EA group were lower than those in the auricularpoint sticking group (all <0.05). The VAS and limb activity scores at 48, 72 h after operation, and the T24max VAS on the 2nd and 3rd days in the auricular point sticking group were lower than those in the EA group (all <0.05).

CONCLUSIONEA combined with auricular point sticking therapy are better than simple EA and auricular point sticking therapy for anal pain of mixed hemorrhoid after external excision and internal ligation. The analgesic effect of EA is rapider, and the effect of auricular point sticking therapy is longer. The combination of the two methods own coordination effect.