0.05).There were no statistical difference between the 50 mg IM group and the 75 mg NM group in secondary end-point.Conclusion Maintenance therapy with 50 mg domestic clopidogrel did not increase the 1-year incidence of major adverse cardiac events when compared with standard 75 mg of Plavix therapy.

Objective To explore the strategy of emergency medical rescue of the massive crowd in general hospital during spring festival with snow disaster. Method The clinical data of 20 966 emergency cases were analyzed retrospectively from 22 Jan,2008 to 6 Feb, 2008 with snow disaster, and concerned about the ratio of different diseases, the character of pre-hospital care and the contrast between emergency medical treatment and routine work. Results The accidence of respiratory disease ( 57.3 % ) was followed by gastrointestinal ( 25.5 % ) and trauma (6.2% )during the emergency medical treatment, and surgical trauma, syncope, coma and convulsion were the most common symptoms, also in some conditions, but empties returning was 30.3% . Similar to the above situation, the extremities (56%)and head injury (24%)were most commonly in the hospital emergency department. The incidence of falling accidents was high( 35.7 % ), and two of them were dead due to trauma on died of being trampled, and on the other was electrothermal burn and falling. Conclusions The general hospital is very important in emergency medical treatment, and it should be ready to tackle the emergency disaster, in order to reduce the loss to minimum.

Objective To describe the chnical, neuroimagine, pathological and genetic features in a case with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS)/Leigh overlap syndrome.Methods The ease was a 22-year-old woman with recurrent headache, loss of visual acuity and general seizures over 11 years.MRI demonstrated symmetrical high T2-weighted signals in occipital and parietal lobes, in the late stage of the disease, the above imagine changes on MRJ were also shown in the bilateral basal ganglion and brainstem.She died of status epilepticus at age of 22.Brain autopsy and mitochondrial DNA (mtDNA) analysis were performed in the patient.Results The main neuropathological findings were muhifocal and lamilar spongiform in the cortex of the whole brain, the basal ganglion and middle brain.Gliosis, macrophagie reaction and capillary endothelial proliferation were observed in these areas.All 6 layers of the cortex and subcortical white matter in occipital and parietal lobes were severely affected.GI3513A mutation was found in the gene of mitochondria encoded NADH dehydrogenase subunit 5 (MTNDS).Conclusions MELAS/Leigh overlap syndrome presents the symptoms predominantly affecting the cerebral cortex.Neuroimagines suggested that the lesion initially involves the cerebral cortex and in the late stage implicates the basal ganglion and the brainstem, possibly caused by pathological changes of spongiform with capillary proliferation in these areas.

OBJECTIVE:To provide reference for hospital infection treatment and control. METHODS:The etiological data of Enterococcus isolated from clinical specimens were collected from our hospital during Jan. 2009-Jun. 2017. The drug resistance of commonly used antibiotics and infection related risk factors were analyzed retrospectively. RESULTS:A total of 6252 isolates of Enterococcus were isolated,of which there were 1994 strains of E. faecalis and 3575 strains of E. faecium. The bacteria were mainly isolated from urine(2009 strains),drainage liquids(1538 strains),bile(1168 strains),wound secretions(561 strains), blood (493 strains). The detection rate increased 9.4％ in 2009 to 13.4％ in 2017. Resistance rate of E. faecalis to ampicillin, penicillin and vancomycin showed a wavelike decrease,and E. faecalis showed low resistance rate to vancomycin,teicoplanin, linezolid and tigecycline. Resistance rate of E. faecalis to ciprofloxacin,moxifloxacin and levofloxacin decreased wavily to 2014 but showed a fluctuating upward trend since 2015. Resistance rate of E. faecium to linezolid decreased from 1.9％ in 2009 to 0.2％ in Jun. 2017;resistance rate of E. faecium to vancomycin and teicoplanin continues to fluctuate,but it is still at a low level;resistance rate of E. faecium to tetracycline decreased, but that to high concentration gentamicin increased. There were 43 strains of vancomycin-resistant E. faecium and 8 trains of vancomycin-resistant E. faecalis detected in 51 patients. Resistant rates of vancomycin-resistant E. faecium to linezolid,tigecycline and teicoplanin were 23.3％,0,35.3％,respectively. Resistant rates of vancomycin-resistant E. faecalis to linezolid,tigecycline and teicoplanin were 0. Pearson relationship analysis showed that days in ICU (r=0.225,P<0.01),tracheotomy or intubation (r=0.314,P<0.01),days of antibiotic use (r=0.347,P<0.01),types of antibacterial drugs (r=0.226,P<0.01),use of glucocorticoids (r=0.190,P<0.01),and days of carbapenems use (r=0.173,P<0.05)were positively correlated with vancomycin-resistant E. faecium infection rate and vancomycin-resistant E. faecalis infection rate. CONCLUSIONS:The detection rate of Enterococcus in our hospital is fluctuating upward. E. faecalis and E. faecium were the main types,mainly from urine and drainage fluids. The resistance rate of Enterococcus most of antibiotics shows a downward trend. The resistance rate of E. faecium to high concentration gentamycin is on the rise,while that of E. faecium to linezolid and tetracycline is decreased. The appropriate antibiotics should be selected according to the patient's condition and drug susceptibility results.

To investigate the mechanism of JinShuiBao capsule on improving respiratory function and lung tissue pathology in rat pneumoconiosis model. Chronic pneumoconiosis rat model was established by tracheal injection of quartz dust. JinShuiBao was administrated orally by 600 and 300 mg/kg, once daily for 6 months. At the 1st, 3rd and 6th month of administration, 6 rats in each group were taken for hemorheology, vascular endothelial function, immunoinflammatory cytokines and oxidative stress. The results showed that high dose of JinShuiBao had a significant improvement on the plasma viscosity at each time point(P< 0. 05)during the 6-month trial, and partially improved the whole blood viscosity. Both dose of JinShuiBao capsule significantly decreased the levels of serum inflammatory cytokines such as TGF-β, TNF-α and IL-6(P< 0. 05, P< 0. 01), and high dose group could significantly decrease the level of CD4+/CD8+(P< 0. 01). The high dosage of JinShuiBao could obviously reduce the level of serum MDA and increase the activity of SOD(P< 0. 05), and obviously reduced the number of leukocytes in the bronchoalveolar lavage fluid of model rats. In the high-dose group, the levels of ET, NO and PC in bronchoalveolar lavage fluid were significantly improved in all the experimental periods(P< 0. 05, P< 0. 01), while the low-dose group also had a statistically significant improvement at 3 month later. These results suggested that the improvement of JinShuiBao capsule on pneumoconiosis rats involved various mechanism, including blood viscosity, systemic and pulmonary inflammatory response, vascular endothelial injury, and oxidative stress in the whole body and lung fibrosis.

Objective:To investigate the prognosis of intensive care unit(ICU)patients with carbapenem-resistant Klebsiella pneumoniae(CR-KP)infection.Methods:Clinical data of 86 elderly patients with KP infection admitted to our hospital from August 2017 to July 2019 were retrospectively analyzed.All patients were identified by the VITEK system and were tested by using the Kirby-Bauer paper diffusion method for drug susceptibility.Based on the existence of CR-KP, patients were divided into the non-resistance group(n=40)and the resistance group(n=46). The number of ventilator days, ICU days and clinical prognosis were compared between the two groups.Results:Specimens from sputum had the highest rate of KP isolation(46/86, 53.49%), followed by specimens from drainage fluid(16/86, 18.60%), blood(12/86, 13.95%), puncture wound fluid(3/86, 3.50%)and the tip of deep vein catheters(9/86, 10.46%). KP had high drug resistance to meropenem, and the drug-resistance rate was 53.49%(46/86). Compared with the non-resistance group, ventilator days and ICU days increased in the drug-resistance group[(60.75±72.86)d vs.(26.11±41.10)d, (73.41±63.32)d vs.(38.96±50.75)d, t=2.660 and 2.756, P=0.003 and 0.004]. The clinical effectiveness rate was higher in the non-resistance group than in the drug-resistance group(57.50% or 23/40 vs.23.91 % or 11/46, χ2=10.097, P=0.001). Conclusions:ICU patients with CR-KP have a higher number of ventilator days and longer ICU stays than those without CR-KP.In clinical practice, it is necessary to strictly follow the indications for antibiotic use, regularly perform bacterial identification and drug susceptibility tests, and diagnose KP infection as early as possible, in order to provide evidence for clinical diagnosis and treatment.

Objective: This study is to investigate the outcome of unilateral cleft lip repairment using trilobate flap and nasal-labial muscle tension system reconstruction. Methods: From January 2015 to December 2017, 264 children with unilateral cleft lip were performed cheiloplasty. For all the patients, trilobate flap was adopted. The tension lines group among nasal-labial muscles were reconstructed following a three-dimensional pattern. Long-term results were evaluated using postoperative photos. Three measurements were collected, to compare the nasolabial contour on the cleft side and noncleft side. Results: Six to 12 months follow-up was completed in 112 patients. Asymmetry percentage of lip height was (2.98±1.65)%, while nostril width ratio was 1.02±0.05, and nostril height ratio was 0.94±0.04. Aesthetic contour of vermillion and philtrum were satisfied. Conclusions Trilobate flap technique combined with the reconstruction of nasal-labial muscle tension system have reliable effect on unilateral cleft lip repair. With proper application, satisfactory and stable outcomes can be achieved.

Objective:To study the mechanism of the effect of Jiajian-Zhujing Decoction on the expression of VEGF on ARPE-19 cells after AKT transfection. Methods:To prepare the serum and blank serum of Jiajian-Zhujing Decoction and divide ARPE-19 cells into the normal group, model group, blank serum group, medicated serum group, Conbercept group and combined group. Except normal group, this research established AKT transfected cell model. Then cultured the normal group and model group with conventional method, and the blank serum group was cultured with 10% blank serum, the medicated serum group was cultured with 10% medicated serum, the Conbercept group was cultured with 20 μg/ml Conbercept, the combined group was cultured with 10% medicated serum and 20 μg/m Conbercept. The proliferation of ARPE-19 cells in each group was detect by the CCK-8 method. The levels of AKT, mTOR and VEGF mRNA were detected by real-time quantitative PCR. Western blot was used to detect the expression of AKT, mTOR and VEGF. Results:After being cultured for 24, 48 and 72 hours, compared with the model group, the cell proliferation rate in blank serum group, medicated serum group, Conbercept group and combined group significantly decreased ( P<0.05). Compared with the model group, the expression of AKT mRNA (24 h: 3.10 ± 0.48, 1.97 ± 0.14, 1.26 ± 0.24 vs. 4.77 ± 0.68; 48 h: 3.52 ± 0.82, 2.62 ± 0.77, 1.10 ± 0.19 vs. 6.12 ± 1.21), mTOR mRNA (24 h: 3.02 ± 0.26, 2.45 ± 0.75, 1.13 ± 0.15 vs. 4.48 ± 0.80; 48 h: 1.29 ± 0.30, 1.30 ± 0.57, 0.65 ± 0.19 vs. 2.54 ± 0.62), VEGF mRNA (24 h: 3.33 ± 0.62, 2.18 ± 0.20, 1.55 ± 0.28 vs. 5.53 ± 1.02; 48 h: 2.35 ± 0.54, 1.23 ± 0.28, 0.93 ± 0.25 vs. 3.59 ± 0.40), AKT protion (24 h: 0.45 ± 0.09, 0.25 ± 0.05, 0.14 ± 0.04 vs. 0.62 ± 0.04; 48 h: 0.36 ± 0.06, 0.23 ± 0.04, 0.14 ± 0.03 vs. 0.54 ± 0.08), mTOR protion (24 h: 0.35 ± 0.05, 0.24 ± 0.02, 0.18 ± 0.02 vs. 0.52 ± 0.09; 48 h: 0.23 ± 0.04, 0.29 ± 0.04, 0.14 ± 0.03 vs. 0.40 ± 0.10), VEGF protion (24 h: 0.14 ± 0.03, 0.33 ± 0.04, 0.24 ± 0.03 vs. 0.54 ± 0.10; 48 h: 0.24 ± 0.03, 0.17 ± 0.02, 0.11 ± 0.02 vs. 0.42 ± 0.10) significantly decreased ( P<0.05), and the combined group was significantly lower than that of the Conbercept group ( P<0.05). Conclusions:AKT transfection can promote the proliferation of ARPE-19 cells, and Jiajian-Zhujing Decoction can significantly inhibit this proliferation. Jiajian-Zhujing Decoction may inhibit the activity of AKT/mTOR signaling pathway to reduce the expression of VEGF.

Objective:To evaluate the aesthetic outcome of the pretarsal orbicularis-tarsus fixation technique in incisional double eyelid blepharoplasty.Methods:Postoperative results were evaluated from 798 patients who underwent the orbicularis-tarsus fixation blepharoplasty from January 2015 to December 2018. Based on an incisional maneuver, soft tissue was carefully removed to expose the superior edge of tarsus, then the pretarsal orbicularis oculi muscle was anchored on the tarsus. For skin closure, both skin margins, a small bite of subcutaneous tissue and the pretarsal fascia were interruptedly sutured to enhance cicatricial adhesion.Results:All patients successfully underwent double eyelidplasty using this modified technique. The follow-up period ranged from two to forty-six months, with a mean period of twenty months. Ninety-six percent of the patients were satisfied with postoperative outcomes. Twenty-two cases of palpebral fold asymmetry and ten cases of unsatisfactory fold formation near the inner canthus were encountered. However, all the defects had been well improved by minor revisions. No supratarsal crease drooping or disappearing, suture spitting out, scar hypertrophy or crease depression were observed postoperatively.Conclusions:The orbicularis-tarsus fixation method is a reliable technique for double eyelid plasty. It enables high feasibility and long-lasting result, with lower risk of postoperative complications.

China is the country with high incidence of high myopia in the world. High myopia can cause severe vision impairment. So far, there is no effective treatment for high myopia in clinic. Scleral collagen cross-linking surgery has been proven to be effective in preventing animal eye axial elongation
Animals ; Collagen ; Cross-Linking Reagents ; Finite Element Analysis ; Photosensitizing Agents ; Riboflavin ; Sclera