ObjectiveTo investigate the high risk factors,etiology,diagnosis,treatment and precaution of venous thromboembolism (VTE) in pregnancy and puerperium. MethodsData of 16 cases of VTE admitted in Department of Obstetrics and Gynecology,Peking Union Medical College Hospital from January 1992 to April 2011 were analyzed retrospectively.The differences of blood routine test and coagulation function between VTE patients (study group) and normal pregnant women (control group) were compared by paired t test in this case-control study.Results All patients were diagnosed by color Doppler ultrasound or CT pulmonary artery angiography.Five cases (31.2 ％) occurred before delivery and 11 (68.8 ％) occurred during postpartum.Two cases (12.5 ％)complicated by pulmonary thromboembolism,and one of them died.Six cases (37.5％) were older than or equal to 35 years old,and 12 cases (75.0％) had gestational complications.The hematocrit in study group were lower than that in control group (0.29±0.06 vs 0.39±0.02,t=4.56,P=0.01).There was no statistical difference between the coagulation function of the two groups.After anticoagulant therapy or surgery,15 cases recovered.One pulmonary thromboembolism patients complicated with rheumatic cardiac disease remained shock after anti-coagulants was administered,then died of hemorrhage of respiratory tract after inferior vena cava filter placement. Conclusions VTE is likcly to happen in puerperium than in pregnancy.There are no good screening indicators for thromboembolism during pregnancy and puerperium.Anticoagulation is recommended to be the first line therapy.For women with high risk of thromboembolism,it is suggested to prevent actively and treat early to decrease the complications and long-term sequelea.

Objective To determine the role of double stapling technique(DST) in anus-saving operations for lower rectal cancer. Methods The clinical data of 96 patients with lower rectal carcinoma treated by DST were analyzed retrospectively. Results There were 63 males and 33 females,aged from 22 to 84 (an average of 57.7 yesars). The distance from the lower end to dens line was 4～7cm.Dukes classfication: 24 patients belonged to A class, 30 B class, 30 C class,and 12 D class. Histological type: 47patients had high differentiation adenocarcinoma, 27 median differentiation adenocarcinoma, 17 low differentiation adenocarcinoma,and 5 mucous adenocarcinoma. No one died after the operation but 12 had anastomotic leakage(12.5%)postoperatively and all healed after treatment; 5 patients had anastomotic constriction(5.2%)postoperatively and all healed with expanding anus. Conclusions DST is a safe alternation for anus-saving operation for patients with rectal cancer.Conservative therapy is effective in the treatment of anastomotic constriction and anastomotic leakage.

Reviewing the literatures about adverse reactions induced by traditional Chinese medicine injections (TCMI) reported on CNKI from 1983 to 2013. Analyzing the causes of adverse reactions induced by TCMI from its quality standards. Provide ideas for improving security of TCMI and completing its quality standards. This review indicates that TCMI-induced adverse reactions have little relationship with the number of compositions, but have tight connection with chemical ingredients and solvents. Adverse reactions can be decreased by perfecting the quality standards of TCMI.
Adverse Drug Reaction Reporting Systems ; Drug Therapy ; standards ; Drug-Related Side Effects and Adverse Reactions ; epidemiology ; etiology ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; standards ; Humans ; Injections ; Quality Control

Objective To explore the diagnostic value of Holter monitoring for coronary heart disease (CHD) in diabetic and non-diabetic patients. Methods 188 patients with coronary heart disease were divided into diabetic group(n=65)and non-diabetic group(n=123). The diagnostic sensitivity, specificity, accuracy and other indices of Holter monitoring for CHD were compared between the two groups according to the results of angiography and Holter monitoring. Logistic regression analysis was applied to analyze the factors affecting holter ST-segment change. Results The sensitivity of Holter monitoring for diagnosing CHD in diabetic group was higher than that in non-diabetic group(P=0.046). There was an association between the positive ST-segment change and number of stenosal arteries, diffuse arterial lesion and complete vessel occlusion respectively (OR=2.36, 4.91, 3.90). Conclusion Although the sensitivity and specificity of Holter monitoring for diagnosing coronary heart disease were low, it remains some diagnostic value for coronary heart disease in diabetic patients.

Objective To investigate the dosage and safety of insulin aspart in continuous subcutaneous insulin infusion plus oral antidiabetic drugs for the treatment of hyperglycemia in elderly hip fracture.Methods Patients with hip fracture and hyperglycemia who required insulin pump therapy were divided into 2 groups according to age:elderly group (patients aged over 65 years,n=42) and non-elderly group (patients aged under 65 years,n=43).All patients were treated with insulin aspart in continuous subcutaneous insulin infusion plus oral antidiabetic drugs combined with diet therapy.Dosages of aspart insulin and adverse effects were compared between the two groups.Results There were no significant differences in basic aspart dosage and additional premeal dosage between elderly and non-elderly groups [(0.29±0.09) IU/kg vs.(0.30±0.07) IU /kg,(0.27±0.09) IU/kg vs.(0.27±0.07) IU/kg,both P＞0.05].The incidences of hypoglycemia with and without symptoms in elderly versus non-elderly groups were 4.8％ vs.4.7％ and 14.3％ vs.18.6％,which had no significant differences between the two groups (P＞0.05).Hypoglycemia accompanied by consciousness disorders,allergy,nonhealing and slow healing wounds were not found in the two groups.The ratio of oral antidiabetic drugs including metformin,glimepiride,and glycosidase inhibitor had no differences between the two groups.Conclusions Aspart insulin in continuous subcutaneous insulin infusion is effective and safe in the treatment of acute severe hyperglycemia in elderly patients with hip fractures when combined with diet therapy and oral antidiabetic drugs.

ObjectiveTo investigate the clinical features and pregnant outcomes of the pregnant women with congenital adrenal hyperplasia (CAH) 21-hydroxylase deficiency (21-OHD).MethodsThe clinical features,therapies,pregnant outcomes of the pregnant women with 21-OHD were retrospectively reviewed in Peking Union Medical College Hospital,from January 2005 to April 2011.ResultsThere were 8 pregnant womenwith 21-OHD including 5siinplevirilizing patientsand 3nonclassical 21-OHD women.Eightpatientswereacceptedprogestationalandprenatalcontinuallowerglucocorticoid treatment.During the gestational period,the dosage of glucocorticoid was adjusted in one pregnancy.The serum level of 17-alpha hydroxyprogesterone (17-OHP) were elevated after pregnancy [ (70 ± 38 ) versus (24 ±23) nmol/L,P ＜ 0.05].The fertility and offspring rate of 8 patients was 8/12,the fertility and offspring rate of patients who started treatment at preadolescence was significantly increased (4/5 versus 4/7).Four patients were accepted genital reconstructive surgery ( clitorectomy,clitoroplasty,vulvoplasty) before pregnancy.The incidence of GDM was 1/8.All patients selected caesarean at from 37 +6 gestation weeks to 39+6 gestation weeks.The average newborn birth weight was (3210 ± 447 ) g,and height was (48 ±2) cm of 8 neonates,none of them was CAH.Conclusions Medical and surgical therapy provides satisfactory fertility and pregnancy outcomes for women with 21-OHD.It is safe to pregnant women with 21-OHD and their fetus in continual lower glucocorticoid treatment.The dosage of glucocorticoid should be carefully adjusted during the pregnancy individually according to serum level of 17-OHP.

Objective: To establish a mice model of congenital heart disease transposition of great arteries in order to provide a research reference for the occurrence and development of transposition of great arteries. Methods: A total of 20 pregnant ICR mice at 8-10 weeks of age were divided into 2 groups: Control group, the mice received a single dose of DMSO 70 mg/kg at 8.5 days of gestation,n=5 and Experiment group, the mice received a single dose of all-trans retinoic acid 70 mg/kg at 8.5 days of gestation,n=15. All animals were treated for 18 days and then the embryos were taken to observe cardiac morphology under stereomicroscope. Results: Compared with Control group, Experiment group had obviously increased occurrence rates of premature delivery, abortion and embryo absorption, and 61.2% phenotype for transposition of great arteries; meanwhile, combining with non-heart defect phenotypeas exophthalmos and spinal malformation. Conclusion: All-trans retinoic acid may induce transposition of great arteries in mice embryos, which is a feasible animal model in experimental research.

Objective To study the perception of patients and nurses for the artificial airway suction,in order to provide theoretical reference for building the artificial airway suction clinical practice guidelines.Methods CNKI,Wanfang,VIP,Pubmed,Science direct databases were searched for papers of patients and/or nurses' perception over the limited period of 2005 to 2013.The retrieved papers were analyzed.Results Nineteen eligible papers were identified.Extract relevant contents found the majority of patients retained the memory of that airway suction,mainly for pain,choking,suffocation,and eager to get the relevant knowledge and information.There were few researches on nurses' subjective feeling about airway suction.Conclusion We should pay attention to the perception of patients,while strengthening the research on nurses' perception of artificial airway suction and improve communication with patients,in order to relieve their discomfort experience,and could be helpful for the building of airway suction clinical practice guidelines.

AIM:To observe the transplantation of acellular porcine corneal stroma on the treatment of superficial keratitis by drug-resistant fungal.METHODS:We performed a retrospective analysis of 16 cases of fungal keratitis received the transplantation of acellular porcine corneal matrix from June 2015 to March 2016 with a follow-up of 6mo.We analyzed on items as postoperative visual acuity, corneal graft status, postoperative recurrence and postoperative complications.RESULTS:We observed a healing time of corneal epithelium in 7 to 10d postoperatively generally and the absence of corneal edema in 1mo, while the cornea gradually returned transparent in the 16 cases.Two cases required medication for an epithelial recovery and 3 cases received intervention for decreasing intraocular pressure to a certain level.During the follow-up we observed no cases of cornea degeneration, recurrence of infection or rejection.The vision acuity showed 1.27±0.22, 1.11±0.13, 0.79±0.22 in 1, 3 and 6mo after operation respectively.There was no statistical difference between vision in 1mo and the vision before surgery (P=0.06);while we found a statistical difference when comparing the vision of 3 and 6mo with vision before surgery (P=0.01,0.001).The vision in 6mo increased with a statistic difference to the vision at 1 and 3mo (P<0.001) while no statistic difference was observed between 1 and 3mo(P=0.11).CONCLUSION:Transplantation of acellular porcine corneal matrix is a safe and efficient treatment for fungal keratitis.

AIM:To investigate the differences among Lenstar 900, A-scan ultrasound and keratometer in measurement of axial length ( AL ) , anterior chamber depth ( ACD ) and corneal curvature ( K1 , K2 , Km ) , and evaluate the consistency of the instruments, with the purpose providing references for the clinical application of Lenstar 900.
METHODS: In this study we picked up 36 patients ( 50 eyes ) underwent cataract surgery, and lens nucleus hardness were under level IV. Before the operation, AL, ACD and K1 , K2 , Km were measured by Lenstar 900, A-scan ultrasound and keratometer respectively. The differences between the results were compared by the paired t-test. The correlation of the results was analyzed by Pearson correlation analysis, and the consistency was measured by Bland-Ahamn method.
RESULTS: The mean AL and ACD values measured by Lenstar 900 and A-scan ultrasound had no significantly statistic differences (P>0. 05). The K1, K2, Km measured by Lenstar 900 and keratometer were not significantly statistical different (P>0. 05). The results measured by these three instruments had close linearity correlation ( r>0.9, P<0. 01). The consistency of the results was well in Bland-Ahamn analysis.
CONCLUSION:The preoperatively biometric result of Lenstar 900, A - scan ultrasound and keratometer in patients with cataract are all reliable, and they can be substituted by each other. However, Lenstar 900 can not only measure AL, ACD and corneal curvature at the same time, but also cornal thickness, lens thickness, white to white, pupil size, optical axis eccentricity, retinal thickness and so on. It has a number of advantages such as non-touching, convenient and efficient, and can be recommended to use widely.