Objective To evaluate the effects of conventional mechanical ventilation (CMV) and mechanical ventilation with ideal PEEP and permissive hypercapnia (PHY + PEEPi) on expression of ?-defensin-2 (HBD-2) gene and protein in ventilator-associated pneumonia (VAP). Methods Forty-eight male SD rats weighing 280-320 g were randomly divided into 2 groups: (1) CMV group (VT = 12 ml? kg-1 , RR = 70bpm, FiO2 = 1.0) (n = 24) and (2) PHY + PEEPi group (VT =6 ml?kg-1 , RR = 90bpm, PEEP = 0.2 kPa, FiO2 = 1,0) (n = 24) . The animals were anesthetized with intraperitoneal 20% urethane 1 ml?100 g-1 , tracheotomized and mechanically ventilated. After being ventilated for 24 h P. aeruginosa (3 ? 108 CFU/ml) 0.2 ml was introduced into trachea to induce pulmonary infection. Three animals were sacrificed at following intervals: before and 1.5 h, 3h,6h,12h,3d and 5 d after introduction of P. aeruginosa. Lung tissaes were obtained from middle and lower lobes of left lung for microscopic examination and determination of expression of mRNA of HBD-2 by RT-PCR and HBD-2 protein level by Western blot analysis. Right lung was lavaged and broncho-alveolar lavage fluid (BALF) was collected for bacteriological examination. Results There were significantly more severe pathological changes in the lung in CMV group as compared with PHY + PEEPi group. In CMV group the levels of up-regulation of HBD-2 mRNA and protein expression were significantly lower after 3h than those in PHY + PEEPi group. The positive rate of blood and BALF bacterial culture was also higher in CMV group. The survival rate of PHY + PEEPi group was 76% , significantly higher than that of CMV group (40% ) ( P

Objective To evaluate the value of the 7-joint ultrasound score (US7) in treatment of rheumatoid arthritis (RA) with Chinese and western medicine.Methods A total of 160 RA patients were divided into 2 groups based on different methods of treatment,including Yi Shen Qing Luo (YSQL) group and western medicine group.The patients were examined by grey scale ultrasound (GSUS) and power Doppler ultrasound (PDUS) with US7 at baseline and after 3 and 6 months later.There were 7 related joints and 5 single factors for scoring in US7 system.The joints included the wrist joints,the second/third metacarpophalangeal joints (MCP Ⅱ/Ⅲ),the second/third proximal interphalangeal joints (PIP Ⅱ / Ⅲ) and the second/fifth metatarsophalangeal joints (MTP Ⅱ/Ⅴ).And the factors included synovitis of GSUS,synovitis of PDUS,myotenositis/tenosynovitis of GSUS,myotenositis/tenosynovitis of PDUS and bone erosion (ES).Meanwhile,the laboratory index included C-reactive protein (C-RP) and erythrocyte sedimentation rate (ESR) were examined.And the clinical indexes as disease activity score in 28 joints (DAS28) were evaluated.Results The statistical differences of synovitis of GSUS,synovitis of PDUS,myotenositis/tenosynovitis of GSUS and myotenositis/tenosynovitis of PDUS scores in US7 system were found in both 2 groups at baseline,3 months and 6 months after treatment (all P＜0.01).There was no statistical difference of ES before and after treatment in all cases (P＞0.05).The factors of US7 were positively correlated with DAS28,C-RP and ESR in different extent.Condusion US7 is a viable tool for examining patients with RA.

AIM: To validate the alternations of flow velocity patterns in the infarct-related artery (IRA) during no-reflow phenomenon in a canine model of acute myocardial ischemia and reperfusion by transthoracic Doppler echocardiography (TTDE) combined with myocardial contrast echocardiography (MCE) by means of administration of Albunex. METHODS: Nineteen dogs first underwent 60 min myocardial ischemia and then followed by 60 min,120 min and 180 min reperfusion ( n = 6, 6 and 7, respectively). The perfusion defect area determined by MCE at 60 min myocardial ischemia was regarded as risk area (RAMCE). The perfusion defect area defined by MCE after reperfusion was considered as no-reflow area (NRAMCE). The ratio between NRAMCE and RAMCE ≥ 25 %was regarded as the development of no-reflow phenomenon and the ratio of NRAMCE to RAMCE＜25% was considered as the myocardial reflow. The coronary flow velocity parameters in IRA were determined through TTDE. RESULTS: Two dogs died during experiment and the remaining seventeen dogs completed throughout the procedure.There were seven dogs in reflow group and ten dogs in noreflow group. No significant difference was present in reflow group between at baseline and at 60 min reperfusion in systolic peak velocity (PVs), systolic velocity time integral (VT Is), corrected systolic flow duration (cFDs),diastolic peak velocity (PVd), diastolic velocity time integral (VT Id), corrected diastolic flow duration (cFDd),diastolic deceleration rate (DDR), corrected diastolic deceleration duration (cDDD) (P＞0.05), however, a significant difference was found in no-reflow group between at baseline and at 60 min reperfusion in PVs,VTIs, cFDs, PVd, VTId and cFDd (P＜0.05). The most marked alterations during diastolic phase were the increase of DDR and reduction of cDDD. CONCLUSION: The impaired microvasculature may profoundly affect the coronary flow velocity pattern in the IRA. The increase in microvascular resistance and decrease in coronary perfused pressure can contribute to the changes.Transthoracic Doppler echocardiography combined with MCE has the capability of noninvasive assessment of coronary flow velocity pattern in the IRA during no-reflow phenomenon.

Objective To explore the value of CD+4T lymphocyte count in laboratory diagnosis of AIDS complicated with pulmonary tuberculosis.Methods Forty-three patients with acute tuberculosis were selected as the subjects.Among them,14 patients had typical tuberculosis(X-ray or chest CT),29 cases were atypical tuberculosis(X-ray or chest CT).43 patients were examined by CD+4T lymphocyte count,sputum smear tuberculosis acid-fast bacilli test and T-SPOT.TB(interferon-γ release test),and the results of various methods were compared.Results The The number of CD+4T lymphocytes in patients with typical pulmonary tuberculosis was (151.26±59.47)/μL,and that in atypical pulmonary tuberculosis was (69.11±19.65)/μL,the difference was statistically significant(t=5.124,P<0.05);and with the reduction of CD+4T lymphocytes,AIDS patients showed more atypical pulmonary tuberculosis.The positive detection rates of CD+4T lymphocyte count,T-SPOT.TB and sputum smear were 86.05%,16.28% and 51.16% respectively.The positive rate of combined detection of three methods(90.70%) was significantly higher,the differences were statistically significant(x2=5.123,6.023,7.125,all P<0.05).Conclusion CD+4T lymphocyte count is of great value in the laboratory diagnosis of AIDS complicated with tuberculosis,and it is worthy to be widely carried out in clinical practice.

Objective To explore the effects of Tongfu Huayu Daotan Decoction (通化阏导痰汤)on the serum concentration of S-100β protein, neuron-specific enolase(NSE) and Prognosis in patients with severe craniocerebral injury.Methods Sixty patients with severe craniocerebral injury were randomly divided into a a'eatment group and a control group.The treated group was treated with Tongfu Huayu Daotan Decoction plus conventional treatments including dehydration,antibiotics, organ functional support, nerve nutrition, prevention of complication, etc.; the control group was treated with conventional treatments alone. The concentration of serum S-100β protein and neuron-specific enolase(NSE) in plasma at admission and at24, 36, 72huors, and 5, 7 days after treatment were determined respectively; the Glasgow outcome scale (GOS)and neurological deficits scoring at 2weeks and 4weeks after hospitalization were compared to observe the efficacy of the patients. Results The concentration of serum S-100β protein and neuron-specific enolase (NSE) in plasma at previous treatment and at 24, 36 hours after the treatment had no statistical difference in the two groups(P＞0.05 ), The concentration of serum S-100β protein and neuron-specific enolase (NSE) in plasma at 72huors, 5 and 7 days after the treatment in the Tongfu Huayu Daotan Decoction group were lower than those in the control group, the differences being significant (P＜0.01). The Glasgow outcome scale (GOS) and neurological deficits scoring at 2weeks and 4weeks after the treatment in the Tongfu Huayu Daotan Decoction group were significantly nigher than those in the control group, the differences being significant (P＜0.01) .Conclusion Tongfu Huayu Daotan Decoction can alleviate the plasma concentrations of S-100β protein and neuron-specific enolase (NSE) in patients with severe craniocerebral injury and markedly improve the clinical therapeutic effects. Combined Tongfu Huayu Daotan Decoction and western medicine can significantly reduce mortality and improve the Glasgow outcome scale (GOS), neurological deficits scoring and therapeutic effect.

Objective To review our experiences of diagnostic methods and surgical treatment of the left superior vena cava (LSVC) draining into the left atrium.Methods Nineteen patients with LSVC draining into the left atrium were diagnosed and treated surgically from February 1998 to January 2012.All the cases were combined with other congenital heart diseases including patent ductus arteriosus,ventricular septal defect,atrial septal defect,single atrium,triatriatum,partial endocardial cushion defect,anomalous pulmonary venous drainage,right ventricle outflow stenosis,pulmonary valve stenosis,tetralogy of Fallot,double outlet right ventricle,complete endocardial cushion defect,tricuspid atresia.The patients were diagnosed through different methods including echocartiographic examination,cardiac catheterization,computer tomography,and explored during the operation,even postoperatively.All were treated surgically with four techniques including simple ligation to the LSVC,including ligation during a redo procedure; intra atrial rerouting to drainage the flow from the LSVC to the right atrium,atrial septum reconstruction to make the outlet of the LSVC lying in the right side of the patched atrial septal,and bidirectional Glenn shunt to get a physiological result.Results No mortality postoperatively.All the cases were uneventful postoperatively.And the main postoperative course was related only to the main diagnosis of congenital heart disease,not to the left superior vena cava draining into the left atrium.The echo examination result was satisfied before the discharge.The early and long term follow-up(1-11 years) results are excellent,no arrhythmia,no cardiac deficits after echo examination,including stenosis obstruction and residual shunt.No death.Conclusion The diagnostic methods of the LSVC draining into the left atrium are difficult,the only way to make the diagnosis clearly enough before the operation is depending on improving of more and more comprehending to this rare cardiac anomaly,by the pediatric cardiologists,the sinologist,the intensive care unit,and the pediatric cardiae surgeons.The choice of different surgical treatment is depending on the diagnosis and the findings during the operations,and the results are excellent after a suitable choice made.

Objective To discuss and analyze effect of biotype common handle (short handle) prosthesis in treating aged patients with femoral intertrochanteric fracture.Methods A retrospective analysis was carried out on 321 patients,among which 280 (102 males and 178 females,at age of 72-98years,average 82.5 years) obtained follow-up.According to a new fracture classification method (Piansui Classification),the typeⅠ a fracture was found in 65 cases and type Ⅰ b in 215.Most patients were combined with medical diseases,and after related medical collaborative treatment,standard biotype common handle prosthesis (artificial bipolar femoral head) replacement was applied to all patients.Early rehabilitation exercise was performed postoperatively.Results All the 321 patients lived through perioperative period successively,with no death in hospitalization.Meanwhile,postoperative complications were all cured in hospitalization.The patients could take out-of-bed activity at 1-3 weeks after operation.All 280 patients could take care of themselves at 12-46 months (average 28 months) of follow-up.According to Harris score,the results were excellent in 129 cases,good in 121,fair in 22 and poor in eight,with excellence rate of 89.3％.Conclusion Biotype common handle artificial femoral head replacement is an effective method to allow early ambulation,reduce complications and improve quality of life in treatment of intertrochanteric fractures in the elderly.

Objective To evaluate clinical efficacy of treating femoral intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures using anatomic locking plate.Methods From January 2009 to June 2011,we treated 72 cases of femoral intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures using anatomic locking plate.Sixty-four cases were followed up.There were 50 males and 14 female,with an average age of 42.8 years (range,21-79).All patients suffered from closed femoral unilateral fractures.The interval between injury and surgery was 2 h-16 d (average,4.6 d).All patients were followed up at regular interval.During the follow-up period,clinical and radiographic data were recorded.The clinical efficacy was evaluated with Harris hip function score.Results The mean operative time was 65 min (range,45-120 min); the mean blood loss was 210 ml (range,50-650 ml).All patients began to walk with crutches 3-35 d after surgery.During the follow-up period,no infection,deep vein thrombosis,screwed cut-out and implant failure occurred in all patients.Coxa vara with shortening deformity was noted in 2 cases,solid bone union was found in all the cases.The mean time of fracture healing was 5.2 months (range,3.6-10.5 months).According to Harris hip score,45 cases were classified as excellent,14 as good and 5 as fair,with excellent and good rate being 92.19％ (59/64).Conclusion Anatomic locking plate fixation provides stable fixation,with a high union rate and a minimal complication rate in treatment of intertrochanteric and subtrochanteric fractures combined with femoral shaft fracture.

Taking Suxi Healthcare Center in Yiwu City, Zhejiang province as an example, the paper analyzed the present mission and organizational characteristics of township healthcare centers in China, especially their dual functionality of community public health and primary medicare. Based on such analysis, it designed a matrix-based model for organizational structure and job performance management for such heslthcare centers. The features are as follows. 1) The two dimensions of the matrix structure refer to the departments for medical treatment and the multi-village doctors team in the community, respectively and jointly offering primary medicare and public health services; 2) Jobs are designed based on the organizational structure and functionality. Every job carries out dual Junctions as described and managed by the job description and target responsibility certificate; 3) The job responsibility certificate is a breakdown of the balanced scorecard of the healthcare center, as divided between the departments for medical treatment and the multi-village doctors team; 4) The balanced scorecard of the township healthcare center is designed based on its strategic mission and developing plan. The entire organizational design and management of the center are built on the strategic orientation and logical programmed research.

Objective To evaluate clinical application value of polymerase chain reaction (PCR) detection for bacteria in peritoneal dialysis associated peritonitis (PDAP).Methods Peritoneal dialysis fluid specimens were collected from January 2014 to December 2014 in The First Affiliated Hospital of Anhui Medical University.Conventional bacterial culture and PCR detection were used respectively.According to the bacterial 16S rRNA gene, universal primers were devised and designed, based on reference, the specific primers of 17 kinds of experimental bacteria.Real-time fluorescent PCR (Real-time PCR, qPCR) amplification was implemented.The establishment of standard strain DNA extract was used as positive control;sterile double distilled water was used as negative control.Results (1) The traditional bacterial culture results showed that positive proportion was 26/40 in specimen of 40 cases, gram-positive strains accounting for 18/26.Main species were epidermis staphylococcus (5/26), hemolysis staphylococcus (4/26), escherichia coli (4/26), and streptococcus viridans (3/26).(2) The PCR detection results showed that total positive rate was 33/40 in 40 patients specimens, among which 2 cases of positive samples ended up with no specific strains being detected;the main bacteria strains in PCR were not different from ordinary culture results.(3) With bacterial culture as the gold standard, the detection sensitivity of PCR technology for PDAP pathogenic bacteria was 96.15％ and specificity was 42.86％;the detection positive rate was significantly higher than ordinary culture method.(4) PCR technology for detecting pathogenic bacteria could produce results within 4-6 hours, while reported positive results in the traditional bacterial culture would take (77.88±15.53) hours, which was significantly longer than PCR.Conclusion Compared with traditional bacteria culture method, PCR method is more sensitive, simple, and quick.Bacteria detection using PCR technique is of clinic applied value in PDRP.