Objective To analyze the causes and possible mechanisms of vertigo for emergency,and to discuss the diagnosis and therapy methods.Furthermore, the possible effective preventions were suggested.Methods 86 elderly patients with vertigo for emergency were enrolled to analyze the causes through symptoms,signs and accessory examinations.Results The majority of the patients fell within the age range between 60～69 ,it occurred more frequently in female patients than in male.The main causes were cervical vertebra disease,hypertension atherosclerosis,acute cerebrovascular disease,hyperlipidemia,diabetes mellitus and autonomous nerve function disorder.Conclusion The mechanisms which induce vertigo in elderly patients are concerned with disturbance of vertebra-basal and blood supply system.It is not only resulted from single disease,but also from several factors.Moreover,it often co-exist with multi-diseases, which shows that symptomatic treatment is still the essential method for curing vertigo in elderly patients for emergency.

OBJECTIVE:To gain a clear idea of difference of drug requirement and DDD between senile women and men patients,so as to provide a scientific basis for safely,effectively,economically and rationally preventing and treating diseases of senile patients and improving their quality of life METHODS:A 2-year(1998～1999)prescription database,which was set up by PRESCRIPTION ANALYSIS research group of 22 hospitals in Beijing,was used for this study Information of senile out-p_atients(≥60 years old)was collected and analysed Foxpro software was used for statistics and analysis RESULTS:The prescription rate for senile male patients was 11 6%,whereas that for senile female patients was 8 3% Proportion of injection for per hundred male out-patients was 17 0% and that for female patients was 20 4% The main kinds of drugs used for both male and female patients were cardiovascular drugs and vitamins,the DDDs of which were lower than those defined by WHO and drug directions,however,the DDDs for male patients were higher than those for female The rate of consultation for cardiovascular disease was high in both sexes Prostate diseases in senile male patients and diabetes in female should be given more concern The drugs used for both sexes accorded with National Essential Drugs List(men 85%;women 87 5%) CONCLUSIO_N:The rate of prescription and DDDs for senile male patients were higher than those for female,however,the proportion of injections for per hundred male patients was lower than that for female

ObjectiveTo investigate the efficacy of low-molecular-weight heparin (LMWH)combined with warfarin in advanced lung cancer patients with acute non-massive pulmonary embolism (PE) and the effect on dyspnea symptom.MethodsFifteen (stage Ⅲ B-Ⅳ ) lung cancer patients with PE from July 2008 to June 2010 were enrolled.All the patients were diagnosed as acute non-massive PE according to spiral computed tomography pulmonary angiography (SCTPA).Enoxaparin (1 mg/kg) was injected with subcutaneous injection twice a day for 7-14 days.Oral warfarin was added once a day 48 h after enoxaparin injection and the dosage was adjusted according to international normalized ratio (INR) level(maintain 2.0-3.0).The medical research council (MRC) grade,results of arterial blood gas analysis and adverse reactions were observed.ResultsSix patients were accompanied with deep venous thrombosis (DVT)according to vascular Doppler ultrasound,2 patients were died at the 6th day and 11th day due to multiple organ dysfunction syndrome.Six patients were cured.5 patients were good,2 patients were improved.The median survial time was 9.2 months.Thirteen patients' MRC grade was decreased trom (3.1 ± 0.5 ) grades to ( 1.9 ± 0.8 ),( 1.5 ± 0.5 ),(0.6 ± 0.6) grades,arterial oxygen pressure (PaO2) was raised from (60.5 ± 7.2)mm Hg (1 mm Hg=0.133 kPa) to (76.1 ±9.7),(81.6±9.2),(86.2±7.5) mm Hg,plasma D-dimer was decreased from (9.44 ± 5.29 ) mg/L to (4.33 ± 3.34 ),(0.88 ± 0.32 ),( 0.41 ± 0.1 7 ) mg/L and alveolar-arterial oxygen tension gradient [ P( A-a)O2 ] was increased from ( 38.5 ± 6.7 )mm Hg to ( 35.5 ± 5.1 ),(29.3 ± 3.2),(24.1 ± 4.1 ) mm Hg after 4,7,14 days of the treatment.There were significant differences in PaO2,MRC grade,plasma D-dimer before and after 4,7,14 days of the treatment(P ＜ 0.05),there was significant difference in P ( A-a)O2 before and after 7,14 days of the treatment (P＜ 0.05).There was no patient with big hemorrhage and thromboembolism during anticoagulant therapy.ConclusionsFor advanced lung cancer patients,the combination therapy with LMWH and warfarin for acute non-massive PE appears to be safe and effective on improving dyspnea symptom and hypoxemia.Adverse reaction is seldom.

Objective To evaluate the effects of proportional assist ventilation (PAV) and pressure support ventilation (PSV) on ventilate parameters of patients with chronic obstructive pulmonary disease (COPD) combined with respiratory failure.Methods Fifteen intubated stable patients recovering from acute exacerbation of COPD combined with respiratory failure were randomized to receive PAV or PSV support 60 min and then crossed over to alternative mode.Respiratory mechanics including respiratory systemelastic resistance and airway resistance were monitored by least square fitting (LSF) methed.During PAV support.the ratio of volume assist (VA) and flow assist (FA) level wag 80%.The ventilate parameters and arterialblood gas at different ventilate condition was observed.Results Compared with low level PSV (PS 10 cm H2O,1 cm H2O=0.098 kPa,PS10),tidal volume in high level PSV (PS 15 cm H2O,PS15) and PAV was significantly increased [(443±12)ml vs(532±34)ml,(464±23)ml,P<0.05].There was no difference in respiratory rate and peak inspiratory pressure between PAV and PS10.Airway occlusion pressure and time product of triggering was d()reased from (5.70±0.25)cm H2O to (4.53±0.25)cm H2O and (0.42±0.04) cm H2O to (0.32±0.03)cm H2O(P<0.05),PaO2/FiO2 ratio and PaCO2 was also significantly improved after PAV supported compared with PS10,and similar with PS15.The rapid shallow breath index at PAV was similar with PS10.Condusion As a positive feedback system,PAV seems more efficacious than low level of PSV in decreasing the work of breathing during the inspiratory phase,resulting in fewer patient-ventilator asynchronism,and it may be beneficial for weaning.

Objective To investigate the severity of airflow obstruction in stable COPD patients and to assess the effects of salbutamol by analysis of tidal breathing flow-volume curves(TBFV).Methods 61 moderate-to-severve COPD patients and 68 normal controls were performed pulmonary function test and TBFV loops in seated position.Measurements of TBFV loops and spirometry were performed at rest after salbutamol 400 ?g inhalation in 26 COPD patients.Results COPD patients exhibited a significant decrease in FEV_1%、FEV_1/FVC、FEF50% and FEF75%.The fraction of exhaled volume to achieve PTEF to V_(TE)(V_(PTEF)/V_(TE))and the fraction of exhaled time to achieve PTEF to T_(E)(T_(PTEF)/T_(E))were lower than 18%[(12.8?2.7)% and(11.6?2.4)%],and much lower than normals(25.0?3.1)% and(29.5?3.7)%.But peak tidal expiratory flow(PTEF)and peak tidal inspiratory flow(PTIF)were decreased slightly.After salbutamol administration,26 COPD patients exhibited a significant increase in TEF50%(21.5?6.8)% versus(15.6?4.2)%,P

Objective To review the early postoperative complications and its treatment in infants with tetralogy of Fallot(TOF).Methods From January 2004 to March 2007,35 infant patients with TOF,aged 4 to 12 months,underwent corrective procedure with hypothermic cardiopulmonary bypass(CPB) and general anaesthesia in Anhui provincial children's hospital.Of all the patients,30 cases received radical surgery and the other 5 cases with initial palliation.Results The early postoperative complications occurred in 10 cases,of which 6 cases comlplicated with low cardiac output,2 cases had severe arrhythmia,2 cases manifested as perfusion lung,2 cases were symptomized by residual right ventricular outflow tract(RVOT) obstruction and 1 case suffered from residual ventricular septal defect(VSD).There were 3 cases of early postoperative death with 8.6% of hospital mortality.Conclusion The operative mortality can be effectively reduced by careful preparations for surgery,reliable surgical procedure,effective myocardial protection and timely treatment for postoperative complications.This study demonstrated that repair of TOF in infancy can be done with excellent results.

Objective To survey the multi-drug resistance among the isolates of methicillinresistant Staphyloeocus from lower respiratory tract in post-cardiothoracic surgery patients and the risk factors contributing to infection aggravation.Methods The clinical data of lower respiratory tract infections were reviewed retrospectively from June 2011 to December 2012.The antimicrobial susceptibility testing was analyzed according to CLSI breakpoints 2010.Results A total of 323 clinical isolates was identified in 264 patients,including gram-positive coccus (126 strains) and gram-negative bacillus (197 strains).The prevalence of methiciIlin-resistant srtains was 88.5 ％ (54/61)in Staphylococus.Aureus (MRSA),and 77.3％ (17/22) in Staphylococcus epidermidis (MRSE).No VISA or VRSA strain was identified.One enterococcal strain was resistant to Vancomycin and teicoplanin.MRSA/MRSE were also isolated from hands and nasal vestibule of nurses,article surfae,pipeline/interface of breathing machine and ward atmosphere.Conclusions Patients after cardiothoracic operation are susceptible to lower respiratory tract infection with gram positive cocci,which should be paid more attention to airway management.Rational administration,sterile operation and antimicrobial therapy are effective ways for control of multi-durg resistance.

Objective To evaluate the value of real time continuous blood glucose monitoring system (RT-CGMS) versus intermittent blood glucose monitoring (IGM) in the critically ill patients under intensive insulin therapy (IIT).Methods A systematic searching randomized and controlled trials (RCT) in databases was performed for meta-analysis by Review Manager 5.2 software.Outcomes were hypoglycemia episode,alteration of mean blood glucose level,the percentage of time at a blood glucose level within optimal target range,and the early mortalities.Results Six studies,totally 531 patients,were included in this meta-analysis.The pooled SMD of mean blood glucose level was =-0.21 (95％ SMD:-0.43-0.01,P=0.07).The pooled SMD of percentage of time at a blood glucose level within optimal target range was 0.20 (95％ SMD:-0.09-0.49,P =0.18).The pooled OR of hypoglycemia episode frequency was 0.20 (95％ CI:0.09-0.43,P ＜ 0.01).The pooled OR of early mortalities was 0.35 (95％ CI:0.14-0.89,P =O.03).Conclusions In critically ill patients under the intensive insulin therapy,RT-CGMS had obvious beneficial effect on reducing hypoglycemic events.RT-CGMS had no obvious beneficial effect on keeping blood glucose level within optimal target range.

Objective To study the efficacy of disodium pamidronate in the treatment of patients with primary hyperparathyroidism (PHPT) complicated by hypercalcemic crisis.Methods A total of 9 patients (12 cases) admitted into our hospital were diagnosed as PHPT complicated by hypercalcemic crisis.Of them,4 patients had parathyroid carcinoma,3 patients had parathyroid adenoma,2 patients had parathyroid hyperplasia.The intravenous disodium pamidronate was given for 12 times in all 9 patients.Serum calcium were monitored before and after treatment.Results Before the treatment,the serum calcium levels was 3.75 (3.66,3.99) mmol/L.On the second and third day after the treatment with disodium pamidronate,the serum calcium levels were 3.44 (2.95,3.78) mmol/L and 2.79 (2.50,3.14) mmol/L.The lowest level of serum calcium after treatment was 2.25 (2.00,2.55) mmoL/L.There were significant differences in the level of serum calcium of different days (P ＜ 0.05).On the second and third day,the change of serum calcium were 0.46 (0.10,0.88) mmol/L,0.60 (0.25,0.75) mmol/L,there were no differences.After intravenous disodium pamidronate,the serum calcium level decreased below 3.5 mmol/L in (2.27 ± 0.65) days,and were kept below 3.5mmol/L for 18.45 ± 12.30 days.Conclusions Disodium pamidronate can decrease serum calcium levels in hypercalcemic crisis caused by primary hyperparathyroidism effectively with mild adverse events.

Objective To investigate the effects of Panax notoginseng saponins(PNS,三七总皂苷) on extra-vascular lung water(EVLW) and respiratory dynamics in dog with oleic acid induced acute lung injury(ALI).Methods Eighteen Beagle dogs,intubated and mechanically ventilated with intermittent positive pressure ventilation(IPPV) mode(tidal volume(VT) 10 ml/kg, positive end-expiratory pressure(PEEP) 0,inspiratory oxygen concentration(FiO2) 1.00),were randomly assigned into three groups(each n=6): normal control group,ALI model group(induced by intravenous injection of oleic acid) and PNS group(received PNS after the ALI model was constructed).PNS 10 mg/kg being dissolved in 100 ml 5% glucose solution(GS) was pumped into central vein (2.5 ml/min) after ALI model was formed in the PNS group.Similar amount of glucose solution was given to the normal control and model groups.Respiratory dynamics and arterial blood gas(ABG) were monitored every hour.Four hours after the establishment of ALI,the dogs were sacrificed and extra-vascular lung water index(EVLWI) was quantified by a gravimetric measurement.Results In ALI dogs,PNS significantly decreased the index of EVLWI((14.10?1.45) ml/kg vs.(17.97?0.85) ml/kg,P0.05).Conclusion PNS has certain protective effect on dog with oleic acid induced ALI,it may lower EVLW and elevate the Cst total,that is beneficial to the improvement of hypoxemia.