OBJECTIVE:To explore the effects of the early use of heparin on the prognosis related indicators of patients with acute respiratory distress syndrome(ARDS). METHODS:Data of 86 ARDS patients were retrospectively analyzed and divided in-to observation group(45 cases)and control group(41 cases)by whether the early use of heparin. Control group received invasive mechanical ventilation,using end-expiratory pressure(PEEP)ventilation method,enteral nutrition support,nasogastric enteral nu-trition suspension 35-40 kcal/(kg·d);patients with combined infection were given Sodium ceftizoxime for injection 2 g,adding in-to 0.9% Sodium chloride injection 100 mL by intravenously infused,twice a day. Observation group was additionally given Hepa-rin sodium injection 6250 units by continuous intravenously pumped. They were treated for 14 d. The cumulative incidence of dis-seminated intravascular coagulation(DIC),and D-dimer,platelet count(PLT)before treatment and after 3,7,14 d of treatment, IL-6,IL-8,IL-10,TNF-α levels before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RE-SULTS:The cumulative incidence of DIC in observation group was significantly lower than control group,with statistical signifi-cance(P<0.05). Before treatment,there were no significant differences in the D-dimer,PLT,IL-6,IL-8,IL-10,TNF-α levels, with no statistical significance (P>0.05). After treatment,D-dimer,IL-6,IL-8 and TNF-α levels in 2 groups were significantly higher than before,while observation group was significantly lower than control group;PLT in 2 groups was significantly lower than before,while observaton group was higher than control group,with statistical significance (P<0.05). There was no signifi-cant difference in the IL-10 level in 2 groups before and after treatment (P>0.05). And there were no obvious adverse reactions during treatment. CONCLUSIONS:Based on conventional treatment,early use of heparin can significantly decrease the DIC rick for ARDS patients,which can improve coagulation disorders,reduce inflammatory response,and dose not increase the incidence of adverse reactions.

OBJECTIVE:To observe the efficacy and safety of amikacin different administrations in the treatment of ventila-tor-associated pneumonia. METHODS:Data of 109 patients with ventilator-associated pneumonia were divided into observation group (58 cases) and control group (51 cases) based on different administrations. All patients received 3.0 g Ceftriaxone sodium for injection,adding into 100 ml 0.9% Sodium chloride injection,intravenously,once every 12 h. Based on it,control group re-ceived 7.5 mg/kg Amikacin sulfate injection,once a day. Observation group received 7.5 mg/kg Amikacin sulfate injection,adding into 20 ml 0.45% Sodium chloride injection,aerosol inhalation,twice a day. The treatment course for both groups was 7 d. Clini-cal pulmonary infection score (CPIS),alanine aminotransferase (ALT),serum creatinine (Cr),oxygenation index (PaO2/FiO2), IL-10,IL-6,C-reactive protein(CRP),tumor necrosis factor(TNF)-α,cumulative mortality after 3 months of treatment and the incidence of adverse reactions before and after treatment in 2 groups were observed. RESULTS:Before treatment,there were no significant differences in the CPIS score,ALT,Cr,PaO2/FiO2,IL-10,IL-6,CRP and TNF-α levels in 2 groups(P>0.05). After treatment,CPIS score,TNF-α,IL-6 and CRP levels in 2 groups were significantly lower than before,observation group was low-er than control group,the difference was statistically significant(P<0.05),and there was no significant difference in IL-10 before and after treatment in 2 groups(P>0.05). PaO2/FiO2 in observation group and ALT,Cr and PaO2/FiO2 in control group were signif-icantly higher than before,PaO2/FiO2 in observation group was higher than control group,ALT and Cr were significantly lower than control group,the differences were statistically significant(P<0.05). The cumulative mortality after 3 months of treatment in observation group was significantly lower than control group,the difference was statistically significant(P<0.05). And there were no severe adverse reactions during treatment. CONCLUSIONS:The efficacy of amikacin by aerosol inhalation is superior to by in-travenous infusion in the treatment of ventilator-associated pneumonia,it can effectively reduce inflammatory cytokine levels and mortality rate,do not increase the incidence of adverse reactions.

Through focusing on widely concerned maternal death incident in Peking University Third Hospital,something can be discovered:for the upper hand in doctor-patient conflicts,they start to have a scramble for discourse power based on information dissemination of social media.On one hand,the evolution of social media builds a bridge for interactions and connections between doctors and patients.It contributes to rebuilding professional authority for doctors and increasing objectivity of information dissemination,On the other hand,information dissemination leads the new scramble for discourse power.It causes some problems:self-reflection decline of doctora,truth diiution about incident and even some moral and ethical risks both patients and doctors.Media tactics of doctors are Proposed to regulate and improve the scramble for discourse power in the social media context from two big aspects,namely establishing matrix platform and reducing propagation loss about social media.

OBJECTIVE:To explore the effects of xingnaojing combined with naloxone on related indexes of patients with he-patic encephalopathy. METHODS:In retrospective analysis,76 patients with hepatic encephalopathy were divided into control group(40 cases)and observation group(36 cases)according to drug use. Based on routine treatment,control group was additional-ly given Naloxone injection 1 mg added into 10% Glucose solution 100 mL intravenously twice a day. Observation group was addi-tionally given Xingnaojing injection 20 mL added into 0.9% Sodium chloride injection 250 mL intravenously once a day on the ba-sis of control group. Treatment courses of 2 groups lasted for 2 weeks. HDS score,MMSE score,the levels of blood ammonia,β-endorphin,CRP,IL-6 and TNF-α,the occurrence of ADR were observed in 2 groups before and after treatment. RESULTS:Af-ter treatment,HDS score and MMSE score of 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group;the levels of blood ammonia,β-endorphin,IL-6,CRP and TNF-α in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,with statis-tical significance(P<0.05). There was no statistical significance in the level of IL-10 between 2 groups before and after treatment (P>0.05). There was no statistical significantly in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on routine treatment,Xingnaojing combined with naloxone can significantly improve cognitive function for patients with hepatic en-cephalopathy and reduce peripheral blood neurotoxin and inflammatory factor,moreover,do not increase the incidence of ADR.

Objective To analyze the difference of the peripherally inserted central venous catheter (PICC) and central venous catheter (CVC) in cancer chemotherapy.Methods All eligible studies on PICC and CVC were searched in China National Knowledge Infrastructure,Wanfang database and VIP database.The Jadad scale was used for quality assessment of all the included studies.All analysis were conducted in Stata 12.0.Results Thirty-six studies with a total of 4920 cases of patients were included in this meta-analysis,with 2349 cases in PICC group and 2571 cases in CVC group.PICC group had advantages in puncture success rate for the first time,the average puncture time,the average catheter time than the CVC group.PICC group had fewer complication,such as the hemopneumothorax incidence,the strayed artery incidence and catheter infection incidence; however,the phlebitis incidence was higher than the CVC group.Conclusions PICC has some advantages specific in simple operation,a long retention time,fewer complications and safety.Therefore,PICC can be widely used in cancer chemotherapy.

OBJECTIVE:To establish the preparation technic and method of qualit y control of fleroxacin-tinidazole(FLX-TNZ)hollow effervescent suppository METH ODS:36-type semi-synthetic aliphatic ester was used as base material and doub le-wavelength UV-spectrophotometry was adopted for determination of the conten ts of fleroxacin and tinidazole RESULTS:The average recovery rates(n=5)of fler oxacin and tinidazole were 99 72% and 99 08%,while RSDs were 0 95% and 1 02% respectively CONCLUSION:This method has a sound design and feasible tec hnnology

After the systems, methods and criteria for assessment of scientific research capability in USA, Germany, Britain and Japan were described, the advances in studies on assessment of scientific research capability in China were summarized, their characteristics were compared, and the enlightenments to perform assessment of medical research institution capability were elaborated.

Cadmium ; adverse effects ; Dose-Response Relationship, Drug ; Environmental Exposure ; adverse effects ; Humans ; Occupational Exposure ; adverse effects ; Risk Assessment

Objective To study the expression of P27,c-fos protein in neuron cell after ischemia and reperfusion accompany with the DWI imagings in rat brain.Methods 12 healthy SD rats with MACO were divided into three groups.Group A,ischemia 30 minutes with 60 minutes reperfusion;Group B,ischemia 60 minutes with 60 minutes reperfusion.Group C,ischemia 60 minutes.The DWI imaging was scanned after surgery immediately.The expressions of P27 and c-fos were determined by immunochemistry procedure.Results The P27 protein positive reaction was not detected in all ischemia and reperfusion groups.The c-fos protein positive reaction was observed in the cortex and basal ganglion in all groups.The hyperintense signal was presented the in DWI after fifteen minutes following the ischemia.Conclusions P27 protein is endogenous cyclin dependent kinase inhibitor.There may be the relationship between low expression of P27 protein in rat brain and the programmed cell death in neuron after the ischemia.C-fos protein participates in the neuron cell injury after the ischemia.DWI has good sensitivity to acute cerebral ischemia.

Objective To describe the clinical features of convulsive status epileptieus (CSE) in our hospital and to provide a basis for future CSE prevention and treatment. Methods Patients with CSE hospitalized from January 1996 to October 2007 were prospectively observed. Logistic regression was used to identify predictors of prognosis. Results All 220 eases of CSE were prospeetively analyzed, a hundred and two patients(46.4%) originated from rural areas. The primary cause of CSE was central nervous system(CNS)infectian (72cases, 32.7%), followed by discontinuation or reduction of antiepileptie drugs (AEDs, 35 cases,15.5%). The median duration of CSE was 5 hours and median duration of seizures before treatment was 2 hours; both were longer in rural patients (7.0 and3.5 hours respectively) than in urban patients (3.0 and 2.0 hours, Z=-3.433,-1.558,both P<0.05). The fatality rate by the time of discharge was 15.9%. Logistic regression analysis showed that the duration of CSE (χ2=20.941), a history of epilepsy (χ2=4.910), and respiratory depression (χ2=16.086) were independent predictors of CSE prognosis (allP<0.05) . Comparisons between these data of USA and Europe were made. Conclusions CSE occurs mostly in rural population and epilepsy patients. CNS infection and withdrawal or reduction of AEDs in patients with epilepsy were important triggers of CSE. Antiepileptic therapy for status epilepticus in China falls behind that in the European countries.