Objective To compare the efficacy of different antibiotics strategy,introperitoneal (IP) cefazolin plus third-generation cephalosporin versus IP Vancomycin plus thirdgeneration cephalosporin on peritoneal dialysis (PD)-related peritonitis.Methods All episodes of PD -associated peritonitis happened in prevalent PD patients between January 2008 and December 2012 were recruited from the PD Center of Peking University First Hospital.According to their empiric antibiotics scheme,episodes were divided into group A (where IP cefazolin plus third-generation cephalosporins were administrated) and group B (where IP Vancomycin plus third-generation cephalosporins were administrated).Multivariable logistic regression model was used to explore the influence of different emnpiric antibiotics scheme on peritonitis outcome.Results Patients in Group B had significantly lower level of serum albumin (33.5±6.0 vs 35.3±5.2 g/L) and cholesterol (4.6±1.3 vs 4.9± 1.1 mmol/L) than those in group A.In group A,the percentage of gram-positive bacteria was similar to group B (43.2％ vs 43.3％,P =0.96),but gram-negative bacteria was numerically lower (16.9％ vs 24.7％,P =0.08).Different empiric antibiotics strategy was not independent predictor of peritonitis outcome [OR =1.07,95％ CI(0.45,2.56),P=0.87].Conclusion Both cefazolin and vancomycin can be selected as first-line empiric antibiotic covering gram-positive organisms in the treatment of PD related peritonitis.

Objective To study the mechanism and difference of fractured vertebral body’ s prevertebral height recovery following different methods of reduction. Methods A L 1 compressed fracture model was produced by modified Gepstein method with wet human spinal specimens(T11-L 3); the model was reduced by hyperextension, longitudinal extension and device reduction respectively. The measured parameters including the changes of prevertebral height, the changes of anterior longitudinal ligament strain and the changes of vertebral disc’ s height; segments including upward and downward of the fractured vertebral bodies were observed. Results The prevertebral height recovery platform stage happened in all the three methods of reduction. There is no significant difference between the prevertebral heights in the maximum experimental load; the prevertebral height increased first and stayed stationary later in the hyperextension reduction procedure; in the device reduction process, the prevertebral height stayed stationary at first and dereased later. Conclusion The prevertebral heights increase is not unlimited between different reduction process of L 1 fracture, and it is limited by spinal anatomy on the late phase of reduction. Knowing these features is useful for us to treat the patients and improve the devices.

Health Education ; Humans ; Occupational Health Services ; Rural Population

Objective To investigate the risk factors and clinical manifestations of placental abruption, and to analyze the causes of missed diagnosis and misdiagnosis. Methods A retrospective analysis was conducted in 135584 women who delivered in Women′s Hospital, School of Medicine, Zhejiang University from January 2005 to December 2015. The diagnosis of placental abruption was made in 1212 cases. According to the consistency of prenatal and postnatal diagnosis, they were divided into 3 groups.(1) The diagnosis was consistent prenatally and postnatally in 715 cases(58.99%,715/1212) as the diagnosis group.(2)In 312 cases (25.74%,312/1212), the diagnosis was made after birth as the missed diagnosis group.(3)In 185 cases (15.26%,185/1212), the diagnosis was made prenatally but excluded after birth as the misdiagnosis group. The disease classification was made, and the risk factors, clinical manifestations, lab results, the time of termination and perinatal outcomes were recorded in the 3 groups. The reasons of missed diagnosis and misdiagnosis were analyzed. Results (1) In the 1212 cases, the diagnosis of placental abruption was confirmed in 1027 cases, with the incidence of 0.76%(1027/135584). The rate of missed diagnosis was 30.38%(312/1027), and the rate of misdiagnosis was 0.14%(185/134557). (2) There were significant differences in the degree of placental abruption among the 3 groups (P＜0.05). (3)Significant differences were found among the 3 groups regarding the ratio of hypertensive disorders, trauma, induced labor and advanced maternal age (all P＜0.05). (4) There were statistically significant differences among the 3 groups regarding the incidence of vaginal bleeding, persistent abdominal pain and uterine tenderness, bloody amniotic fluid, increased uterine tension and stillbirth (all P＜0.05). (5) There was no significant difference in the rate of abnormal fetal heart rate mornitoring among the 3 groups (P=0.22). The differences were statistically significant among the 3 groups when regarding the incidence of abnormal ultrasound finding and abnormal blood coagulation (P＜0.01), with the highest incidence of abnormal ultrasound in the diagnosis group (68.1%) and the highest incidence of abnormal coagulation in the misdiagnosis group (24.9%). (6)There was statistically significant difference among the 3 groups when comparing the ratio of termination of pregnancy within 24 hours (P=0.01). (7) There were statistically significant differences among the 3 groups when the ratios of postpartum hemorrhage, DIC, neonatal asphyxia and perinatal death were compared (all P＜0.05). The highest incidence of postpartum hemorrhage was in the diagnosis group (17.9%) and the lowest was in the misdiagnosis group (5.4%). The highest incidence of DIC was in the diagnosis group (3.9%) and the lowest was in the misdiagnosis group (0). The highest incidence of neonatal asphyxia was in the diagnosis group (30.6%) and the lowest was in the misdiagnosis group (7.6%). And for perinatal death, the highest incidence was in the diagnosis group (12.6%), the lowest was in the misdiagnosis group (2.2%). Conclusions Placental abruption could be misdiagnosed when depending on risk factors, such as trauma. And it could be missed diagnosis during the induction of labor. Uterine contraction, abnormal fetal heart rate mornitoring, abnormal ultrasound and abnormal coagulation function are important in the diagnosis of placental abruption.

BackgroundHypoxia and hyperglycemia are the common causes of retinal neovascularization.In these states,H+ accumulates because of the elevated glycolysis and failure of retinal circulation,thus the retinas readily acidified. ObjectiveThe present study was to explore whether retinal acidosis independently regulates the production of vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) and whether the regulation is related to oxidative stress.Methods The retinas from 2-week-old male SD rats were cultured with explant method in DMEM modulated by NaHCO3,and culture retinas were randomly divided into pH 7.2,6.8 and 6.5 groups for 24 hours.In addition,after 24 hours of culture as above described,retinas were washed using PBS two times and then followed by again culture in DMEM with pH 7.2 for another 24 hours.Also,antioxidant was added in different pH values of DMEM for culture as above described.The retinal samples were prepared for histopathological examination.The expressions of VEGF and PEDF proteins and their mRNA in retina tissue were detected by Western blot and fluorescence quantitative polymerase chain reaction (PCR) respectively.Results The retina showed the clear structure and morphology in pH 7.2 group and pH 6.8 group,but retinal vacuoles change was seen in pH 6.5 group after culture for 24 hours.No significant difference was seen in the expressing level of VEGF mRNA in retina between normal group and pH 7.2 group( 112％ ±11％ vs 100％ ±7％ ) (P=0.55),but those in pH 6.8 group and pH 6.5 group were significant increased in comparison with pH 7.2 group( 196％ ±43％ vs 100％ ±7％ ;251％ ±29％vs 100％ ±7％ )( P＜0.05 ).The expressing level of PEDF mRNA in retina in normal group was similar to that of pH7.2 group(86％ ±19％ vs 100％ ±33％) (P=0.64),but that in pH 6.5 group was significantly higher than pH 7.2 group( 230％ ±66％ vs 100％ ±33％ ) ( P＜0.05 ).The resemble results were found in the expressions of VEGF and PEDF protein.After pH reversion,the expressing levels of VEGF mRNA were 100％ ±13％,111％ ±9％,113％ ±9％ in pH 7.2 group,pH 6.8 group and pH 6.5 group respectively without significant difference among them (F=2.51,P=0.16).The expressing levels of PEDF mRNA were 100％ ±13％,110％ ±9％,108％ ±11％in different groups ( F =0.98,P =0.43 ).Under the presence of antioxidant,the expressing level of VEGF mRNA in pH 6.5 group increased in comparison with pH 7.2 group and pH 6.8 group ( P ＜ 0.05 ).The expressing levels of PEDF mRNA were significant different among pH 7.2 group( 100±31 )％,pH 6.8 group( 282±45 )％ and pH 6.5 group(480±117)％ (F=20.73,P=0.00). Conclusions VEGF can be induced by retinal acidification alone,which may be regulated by oxidative stress.Under the retinal acidification,antioxidants promote the expression of PEDF,suggesting that oxidative stress inhibits the production of PEDF.

Objective:To explore the effect of comprehensive intervention program based on the concept of fast track surgery in early enteral nutrition tolerance and rehabilitation in patients with esopha geal cancer.Methods:93 selected patients were divided into the intervention group and the conventional control group according to the admission time.Patients in intervention group were treated with comprehensive intervention,and control group were given routine nursing care.Enteral nutrition intolerance incidence,the first time of bowel sounds,the first time exhaust and defecation and complications were compared between the two groups.Results:36 patients from 47 patients (76.60％) in the intervention group could tolerate the early feeding,while 24 patients from 46 patients (52.17％) in the control group could tolerate.There was significant difference between two groups (P ＜ 0.05).The first time of exhaust,bowel sounds and defecation,and the hospitalization time of patients in the intervention group were better than that in the conventional control group (P ＜ 0.01).Incidence rate of incision infection,pulmonary infection and intestinal obstruction in patients of the comprehensive intervention group was lower than that in the control group (P ＜ 0.05).Conclusion:Compared with the traditional treatment,the comprehensive intervention can effectively reduce the enteral nutrition intolerance incidence,promote the recovery,reduce hospitalization time and the incidence of postoperative complications,and improve the life quality of patients after surgery.

10.3969/j.issn.2095-4344.2013.24.021

Objective:To optimize the determination technology for the total amino acids in Runing pills. Methods:The process was optimized by L9 (34 ) orthogonal design using the hydrolysis temperature, hydrolysis time and hydrochloric acid concentration as the evaluation factors,and the content and yield of total amino acids as the evaluation indices. Results: The optimal determination condi-tions were as follows:the hydrolysis temperature was 110℃, the hydrolysis time was 22 h and the hydrochloric acid concentration was 6 mol·L-1 . Conclusion:The optimal determination technology can be applied in the total amino acids from Runing pills,which pro-vides the basis for the further research of Runing pills.

Objective To decrease radiation induced toxicities especially mucostis in patients with locally advanced nasopharyngeal carcinoma( NPC ) who underwent concurrent radiochemotherapy, the maximum tolerated dose and dose limited toxicities of capecitabine combination with cisplatin were observed. Methods From Aug 2006 to Oct 2007, 24 patients with intensity modulated radiotherapy(IMRT) and concurrent chemotherapy with capecitabine and cisplatin for nasopharyngeal carcinoma(stages Ⅲ-Ⅳ) were enrolled in this study. There were four dose-level groups of Capecitabine[625-1250 mg/(m2 ·d) , d1-14]and fixed cisplatin dose[20 mg/(m ·d) ,d1-5) ]MRI and CT scan were used for evaluation of tumor shrinkage. Treatment related toxicities were evaluated according to the common toxicity criteria( NCI-CTC Version 3.0). Results The acute side-effects include Grade 3 or Grade 4 mucosal toxicity(lasting for at least 5 d) and Grade 3 or Grade 4 non-mucosal toxicity were evaluated. Group 625 mg/m2 and Group 825 mg/m2 had none, Group 1000 mg/m2 had 6 patients and Group 1250 mg/m2 had 3 patients for mucosal toxicity, which were the main dose-limited toxicity and relevant to the dose of capecitabine apparently( P < 0. 05 ). There was also a trend of increase by the dose level of capecitabine for other toxicities. The median follow-up time for all patients was 28. 5 months. The locoregional recurrence occurred in 2 patients and distant metastasis in 2 patients. Two-year overall survival rate and locoregional control rate were 100% and 91.7%, respectively.Complete response and partialresponse were found on MRI or CT scan in patients of 29. 2% at the end of treatment and 83. 3% after three months, respectively. Conclusions The combination regimen of capecitabine and cisplatin is safe and effective according to the preliminary result. Toxicities related to radiochemotherapy for NPC were significantly associated with the dose level of chemotherapy.

Objective To investigate the present situations of anticoagulant treatment of non-valvular atri-al fibrillation in order to get better guidance of the clinical anticoagulant therapy and reduce the incidence of stroke caused by atrial fibrillation. Methods The clinical data of NVAF patients hospitalized in the first affili-ated hospital of Chongqing Medical University from January 1 , 2012 to December 31 , 2014 were retrospectively reviewed and analyzed in terms of basic characteristics , medical treatment plan and INR monitoring. Results A total of 1,390 patients were enrolled, 85.97% of whom needed anticoagulant therapy and 25.18% of whom were treated with anticoagulants. For 15.71% of the NVAF patients treated with warfarin , INR met the standard during hospitalization. In the study, such factors as age, coronary heart disease, history of stroke and history of bleed-ing might affect prescription of anticoagulant drugs. Conclusion Most NVAF patients need anticoagulant thera-py, but the rate of anticoagulant therapy is lower than we expected. Among those patients treated with warfarin during hospitalization , the rate of INR meeting the standard is at a lower level. The novel oral anticoagulants are not in wide use in the clinical practice.