OBJECTIVE To evaluate the value of blood lactic acid in elder pneumonia patients and indicate its relation with the classification of peverity of patients.METHODS Seventy-five elder patients with pneumonia and 50 younger patients were divided into sepsis group and no sepsis group.The sepsis group was divided into MODS and non-MODS sub groups.The level of blood lactic acid,CRP and PaO2 in them were measured.RESULTS The incidence of sepsis was remarkably higher in the elder pneumonia patients group than in the younger one.There was a significent difference of the blood lactic acid between them((1.74?0.33)mmol/L vs(1.35?0.66)mmol/L,P

Objective To investigate the clinical and pdysomnographic characteristics and related factors of obstructive sleep apnea hypopnea syndrome (OSAHS) in elderly patients. Methods The 163 elderly patients with OSAHS confirmed by polysomnography were classified into obesity group and non-obesity group according to body mass index (BMI). All cases were grouped into mild,moderate and severe groups according to the apnea hypopnea index (AHI) and night SaO2. The 190non-elderly OSAHS patients were as control group at the same time. The clinical and polysomnographic characteristics were recorded and analyzed. Results (1)The proportion of obesity in OSAHS patients was 79. 1%, there was significant difference between the elderly-obesity group and non-elderly-obesity group (70.3% vs. 83.6%, P＜0.05). (2)The proportions of moderate and severe OSAHS patients were lower in elderly group than in non-elderly group. There were significant differences in AHI, the lowest arterial O2 saturation (LSaO2) and % TRT SaO2 ＜90% between the two groups (all P＜0.05). (3)The sleep architecture disturbance was significantly severer in elderly group than in non-elderly group. The percentages of non-rapid eye movementsleep (NREM sleep)stage Ⅲ-Ⅳ sleep were significantly decreased, and the arousal was significantly increased. (4) The syndrome of OSAHS in elderly group was untypical and the clinical complication was increased.Conclusions The elderly OSAHS patients are less severe than non-elderly group, but the elderly patients have worse sleep architecture disturbance and more complications such as hypertension and other cardiovascular diseases.

Objective.To probe into the influence of Jiannao Anshen Capsule of Miao medicine on the behavioral performance,content of cytokine interleukin-1 (IL-1),neuroendocrine hormone melatonin (MT) and monoamine neurotransmitter 5-hydroxytryptamine (5-HT) of rats with sleep deprival.Methods All of the 60 rats were evenly and randomly divided into 5 groups:the normal control group,model control group,estazolam group,Zaoren Anshen group,and Jiannao Anshen of Miao medicine group,respectively.Every group had 12 rats.Sleep deprivation rat model was established by intraperitoneal injection of para-chlorophenyla lanice (PCPA).After successful modeling,the rats were intragastrically administrated with corresponding medicines.The contents of serum 5-HT,IL-1 and MT and the contents of 5-HT,MT in brain tissue were determined.Results Behavioral score,the contents of 5-HT,MT and IL-1 in serum and the contents of 5-HT,MT in brain tissue in insomnia rats caused by PCPA were significantly decreased as compared with normal control group (P ＜ 0.05).In the Jiannao Anshen group,estazolam group and Zaoren Anshen group,the behavioral score,the content of 5-HT,MT and IL-1 in serum and the content of 5-HT and MT in brain tissue of insomnia rats were significantly increased as compared with model control group (P ＜ 0.05).The behavioral score,the content of 5-HT,MT and IL-1 in serum and the content of 5-HT and MT in brain tissue of insomnia rats were not statistically significant different among Jiannao Anshen group,estazolam group and Zaoren Anshen group (P ＞ 0.05).Conclusion Jiannao Anshen capsule of Miao medicine could obviously improve the sleep quality of rats with sleep deprival.The mechanism may be related to improving the content of IL-1,MT and 5-HT.

Objective To explore the MRI characterisitics of primary dilated cardiomyopathy and isolated left ventricular non-compaction.Methods The patients who were diagnosed as primary dilated cardiomyopathy (n=18) and isolated left ventricular non-compaction (n=10) were enrolled,and the MRI was performed.The thickness of non-compaction myocardium (NC),compaction myocardium (C) in end-diastole,the feature of movement of myocardium,the number of non-compaction segment,the fraction shortening of non-compaction and the distribution were compared.Results Totally 823 segments were analyzed in primary dilated cardiomyopathy,in which 124 segments were non-compaction myocardium;397 segments were analyzed in isolated left ventricular non-compaction,in which 115 segments were non-compaction myocardium.The NC,NC/C,NC/(NC+C),and the fraction shortening of the isolated left ventricular non-compaction patients were higher than those of primary dilated cardiomyopathy patients (all P＜0.05).The features of distribution showed that the apical segment was mostly involved,and the basal segment was less involved or hardly involved.The anterior and lateral segments were more involved in the free wall,the septal was less involved.Conclusion The MRI characteristics of primary dilated cardiomyopathy and isolated left ventricular non-compaction are different,especially in the distribution,non compacted segments,NC and NC/C,which is important for diagnosis and differential diagnosis of the two diseases.

Objective A survey was conducted to learn the status of award winning for science and technology achievement among the medical institutions ranked level 2 and above in Sichuan province,to learn the research capacity in such medical institutions,and to provide the basis for research management and health decision.Methods Questionnaire survey was carried out among 555 hospitals ranked level 2 and above in Sichuan province,information on award winning for science and technology achievement during 2010 -2012 was collected and analyzed.Results Only 33％ of those medical institutions were awarded for their achievement in research with total number of 882 awards in three years:300,266,and 316 awards were obtained in 2010,2011 and 2012,respectively.Conclusions In the medical organization of Sichuan province,the number of awards of scientific and technological achievements showed no significant increase with an volatility state,and the overall level of award need to be improved.Awarded Research areas were mainly on clinical research-based,especially on surgery department.Most award winning hospitals are level 3,and the general hospitals win more award than specialized hospitals;furthermore,hospitals located in different regions are quite different in terms of award winning.

OBJECTIVEThis study aims to explore the method that uses primary tumor contralateral facial artery musculocutaneous (FAMM) flap to reconstruct defects of the tongue and floor of mouth.

METHODSSix cases were selected for the use of primary tumor contralateral FAMM flap to reconstruct tongue and floor of mouth defects after tumor resection.

RESULTSThe FAMM flap of the six cases had a long pedicle that could reach the contralateral tongue and floor of mouth. All flaps were intact until post-operation. All patients experienced post-operation complications, such as temporary facial tension and limited mouth opening, which improved after 3 months. Half a year later, the flaps still did not show signs of shrinking.

CONCLUSIONFeatures of the primary tumor contralateral FAMM flap include the tissue-like material provided for reconstructing tongue or floor of mouth defects, easy acquisition, and high survival rate with minimal donor site morbidity. As such, it is an ideal material for repairing tongue and floor of mouth defects.

Objective To investigate the clinical effect of nicorandil for treatment of patients with acute respiratory distress syndrome (ARDS).Methods A prospective randomized controlled trial was conducted. A total of 40 cases of patients with ARDS admitted to Department of Critical Care Medicine of Guizhou Provincial People's Hospital from October 2012 to October 2014 were enrolled, and they were randomly divided into two groups, 20 cases in each group. The two groups were treated with routine western medicine after admission. On this basis, the observation group was given nicorandil 10 mg, while the control group was given warm boiled water 10 mL, through gastric tubes 3 times a day, the therapeutic course being consecutive 5 days in both groups. The length of stay in intensive care unit (ICU), duration of mechanical ventilation after treatment, oxygenation index (OI), alveolo-arterial oxygen partial pressure difference (PA-aO2), positive end-expiratory pressure (PEEP), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Glasgow coma score (GCS) before and after treatment, the predicted death rate (PDR) and 28-day mortality were compared between the two groups. The predicitive factors for 28-day mortality were screened by binary logistic analysis.Results The length of stay in ICU and duration of mechanical ventilation of control group were longer than those of observation group, but the difference was not statistically significant [ICU length of stay (day): 14.55±12.71 vs. 9.15±6.00, duration of mechanical ventilation (day): 13.25±12.27 vs. 7.75±5.32, bothP > 0.05]. After treatment, the GCS was higher than that before treatment in control group and observation group (11.95±3.98 vs. 10.75±4.89, 12.95±3.67 vs. 12.20±4.56), while APACHE Ⅱ score, PDR and PEEP were all lower than those before treatment [APACHE Ⅱ: 21.05±8.58 vs. 24.90±5.63, 18.70±11.21 vs. 26.65±7.67; PDR: (47.71±29.49)% vs. (61.00±23.29)%, (36.79±18.49)% vs. (56.12±18.16)%; PEEP (cmH2O, 1 cmH2O = 0.098 kPa): 4.40±3.14 vs. 5.75±2.59, 3.80±2.55 vs. 7.55±3.32], but there were no statistically significant differences between the two groups before and after treatment (allP > 0.05). After treatment, the OI was significantly higher and the PA-aO2 was significantly lower than those before treatment in the two groups, and the degrees of improvement of the observation group were more remarkable than those of the control group [OI (mmHg, 1 mmHg = 0.133 kPa): 224.72±85.12 vs. 141.37±45.82, PA-aO2 (mmHg): 132.60±46.64 vs. 204.30±121.2, bothP < 0.05]. The 28-day mortality of observation group was lower than that of control group, but no statistically significant difference was seen [15% (3/20) vs. 25% (5/20),χ2 = 0.156,P > 0.05). Binary logistic regression analyses showed that the PA-aO2 [odds ratio (OR) = 0.958,P = 0.013, 95% confidence interval (95%CI) = 0.927 - 0.991], APACHE Ⅱ score (OR = 0.882,P = 0.010, 95CI = 0.803 - 0.970), GCS (OR = 1.399, P = 0.004, 95%CI = 1.111 - 1.761) and PDR (OR = 0.907,P = 0.002, 95%CI = 0.853 - 0.965) after treatment were the independent predictors of 28-day mortality.Conclusion Nicorandil can significantly improve oxygenation, but cannot reduce 28-day mortality in patients with ARDS.

Objective: To explore the impact of different atorvastatin doses on platelet function and highreactivity in patients with acute ST-elevation myocardial infarction (STEMI) after emergent percutaneouscoronary intervention (PCI) therapy.
Methods:A total of 120 STEMI patients with emergent PCI therapy were randomly divided into 2 groups:Standard group, the patients received atorvastatin 20 mg/day and Intensive group, the patientsreceived atorvastatin 40 mg/day, all patients were treated for 7 days. n=60 in each group. Blood lipids and biochemistry were examined before PCI and 7 days after atorvastatin treatment respectively;platelet fibrin clot strength induced by ADP (MAADP), AA and ADP induced platelet inhibition rate were measured by thrombelastography (TEG) test.
Results: With 7 days treatment, compared with Standard group, Intensive group showed decreased MAADP (38.40±17.40) mm vs (45.70±14.50) mm, P<0.05. On day 7 of atorvastatin treatment, compared with Standard group, Intensive group had reduced occurrence rate of high ADP reactivity (18.3%vs 31.7%), P<0.05. The occurrence rate of high AA reactivity was similar between 2 groups (13.3%vs 18.3%), P>0.05. The patients were followed-up for 3 months and the end point events including unstable angina, non-fatal MI, in-stent restenosis, in-stent thrombosis, and cardiovascular death or target vessel revascularization were similar between 2 groups, P>0.05.
Conclusion: Early stage and short term administration of high dose atorvastatin could obviously inhibit platelet activity in STEMI patients after emergent PCI;such intensive atorvastatin treatment had no reduction on end point events in 3 months follow-up period.

Objective To investigate the gene mutation in a pedigree with pachyonychia congenita typeⅡ(PC-Ⅱ)and to explore the relationship between the mutation and clinical manifestations.Methods The exon1of K17gene of genomic DNA from peripheral blood was amplified by PCR,and the PCR products were sequenced by automated sequencing system.Results In all the3patients of the pedigree with PC-Ⅱ(2patients presented as delayed-onset PC at4and15-16years of age respectively),the codon92(AAT)of K17gene was mutated as AGT,which caused missense mutation(N92S)in the1A domain of keratin17,but the2unaffected members of the pedigree and50unrelated controls had no such mutation.Conclusions Mutation of N92S in the1A domain of keratin17exists in this pedigree with PC-Ⅱ.Our results indicate that mutation in the1A domain of keratin17can present as delayed-onset pachyonychia congenita.Therefore,the site and type of keratin mutation are not the sole determinant of the age of onset for PC-Ⅱ,there may be other genetic and/or environmental factors that determine the age of onset of PC-Ⅱ.

Objective To evaluate the effect and safety of intravenous (IV) thrombolysis, intra-arterial (IA) thrombolysis and mechanical adjuvant intra- arterial thrombolysis (IA + MA) in treating cardiogenic cerebral embolism. Methods A total of 66 patients with cardiogenic cerebral embolism were randomly divided into IV group (n = 25), IA group (n = 18), IA + MA group (n = 23). The artery recanalization rate, NIHSS score, GCS score, BI excellent rate, symptomatic intracranial hemorrhage rate and mortality after different thrombolytic therapies were determined. The results were compared between each other among the three groups. Results In all three groups both the post-treatment NIHSS score and GCS score were significantly improved when compared with pre-treatment ones (P < 0.05). In IA + MA group the artery recanalization rate was 78.3%(18/23) and the BI excellent rate was 40%(10/25), which were significantly higher than those in IV group (P < 0.05). The symptomatic intracranial hemorrhage rate in IA group was 5.6%(1/18), which was strikingly lower than that in IV group (32%, 8/25). Analysis of the causes showed that the artery recanalization rate in patients with valvular heart disease or cardiac myxoma was rather lower, but the intracranial hemorrhage rate and mortality in these patients were much higher. Conclusion Thrombolytic therapy can improve neurological deficit in cardiogenic cerebral embolism, and the therapeutic effect of mechanical adjuvant intra- arterial thrombolysis is definitely better.