Objective:To explore the ultrasonic classification in cesarean scared pregnancy (CSP)and its effect on guiding the clinical treatment.Methods:The clinical data of 41 patients with CSP in the Third people's hospital of Chengdu from January 2013 to January 2016 were analyzed retrospectively.Diagnosis was confirmed according to the diagnostic criteria for ultrasound imaging by Godin etal and the history of cesarean section.Patients were divided into type Ⅰ group and type Ⅱ group through measuring the outside uterine muscle layer thickness of pregnant bursa,based on the criteria by Vial et al.Type Ⅰ:MTX intramuscular injection followed by ultrasound guided Dilation and Curettage(D&C)3 days later.Type Ⅱ]:Uterine artery chemo-embolization (UACE)followed by ultrasound guided D&C 2 days later,or lesion resection and repair of the uterus by trans-abdominal or laparoscopic or trans-vaginal operations 2 days later.Results:The outside uterine muscle layer of pregnant bursa in type Ⅱ] was more thinner than that in type Ⅰ (2.1 ± 1.1 mm vs 3.7 ±0.6 mm,P ＜ 0.05).The number of abortion in type Ⅱ was more than that in type Ⅰ (2.8 ± 0.7 vs 1.5 ± 0.6,P ＜ 0.05).There were no statistically significant differences in age,amenorrhea duration and the number of cesarean section (P ＞ 0.05).Patients from two group were treated successfully,and there was no statistical significance about,intraoperative bleeding volume,preoperative serum levels of β-HCG and average recovery time of serum β-HCG(P＞0.05).The average hospital stays and cost in type Ⅰ were less than that in type Ⅱ,with statistical significance (4.7 ± 2.5 vs 8.6 ± 2.7 days,5234.6 ± 1688.8 vs 15668.4 ±4623.4 RMB,P ＜ 0.05).Conclusions:The ultrasonic classification of CSP plays a directive role in making treatment option,with reliabe effect and the good prognosis.UACE as a pretreatment which can control intraoperative bleeding,is an effective method for CSP.For its higher cost,UACE should be selectively used in type Ⅱ[CSP,with cost-effective.MTX intramuscular injection used in type Ⅰ CSP before D&C is reliable and cost-effective.

Objective To explore the control effect of proactive monitoring on senile stroke women with Escherichia coli infection caused by indwelling catheter.Methods From October 2011 to September 2012 elderly female stroke patients with indwelling urinary catheter were chosen in the department of neurology and were given proactive monitoring,which included the following:management of antibiotics has been humanized,urinary catheter care used first-cleaning and then disinfection method,pathogen monitoring professionals directly went to the bacteria room for obtaining information.The monitoring results were compared with those last year.Results The urinary Escherichia coli infection in monitoring popu-lations declined sharply,Escherichia coli infection rate reduced from 20.5％ to 3.6％.The urinary infection rate in hospitalized patients reduced from 10.8％ to 5.7％ respectively.The preventive application of an-tibacterial drugs greatly reduced from 70.0％ to 24.7％.The nursing staff all mastered the nursing method of the catheter.Conclusions To give proactive monitoring to senile stroke women with indwelling urinary catheter can control Escherichia coli and other bacteria induced urinary infection due to indwelling catheter significantly,demonstrate a deterrent effect on unreasonable application of antibiotics,which can be recommended to control other indwelling catheter induced urinary hospital infection.

Objective To observe the effects of diacetyldianhydrogalactito (DADAG) on the proliferation and apopotosis in lung cancer cell NCI-H460.Methods MTT assay was performed to determine the half inhibitory concentration of DADAG(2.88,5.75,11.50,23.00 and 46.00 μg/mL)for the NCI-H460 cells and colony formation assay was used to detect the ability of cell proliferation; through AO/EB staining method, morphological changes of apoptotic cell under fluorescent microscope were observed;cell apoptosis was detected by flow cytometry to test the effects of DADAG on NCI-H460;RT-PCR was used to detect the effect of DADAG on Bcl-2 and Bax mRNA expres-sion levels within the cell. Results Compared with that in blank control group, cell proliferation was inhibited in the group treated with DADAG; the number of colony formation decreased and AO/EB staining results showed that cell apoptosis was characterized by typical morphological changes such as swelling, shrinking and fragmentation. Flow cytometry detection results showed that apoptosis rate was increased in the group treated with DADAG(all P<0.05).RT-PCR results indicated that the expression of pro-apoptosis gene Bax was up-regulated,while expression of anti-apoptosis gene Bcl-2 down-regulated. Conclusions DADAG exhibits the inhibitory activity in lung cancer cell NCI-H460 and can induce the apoptosis.The potential mechanism maybe associated with up-regulating the ex-pression of Bax but down-regulating the expression of Bcl-2.

Objective:To investigate the factors affecting the application of systemic glucocorticoids in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with carbon dioxide (CO 2) retention, and to guide the formulation of a strategy to reduce systemic glucocorticoid exposure. Methods:The AECOPD patients with CO 2 retention admitted to the Ningde Municipal Hospital of Fujian Medical University from January 2017 to December 2019 were enrolled. The general information, past history, times of acute exacerbations within 1 year, pneumonia on admission, causes of COPD, heart failure, blood gas analysis, eosinophil count (EOS), albumin (Alb) and apolipoprotein E (ApoE) levels, exhaled nitric oxide (FeNO) level, inhaled glucocorticoid and non-invasive mechanical ventilation treatment at acute exacerbation were collected. The patients were divided into recommended dosage group (exposure levels in the recommended dosage range, cumulative prednisone dosage ≤ 200 mg) and exceeded group (exposure levels exceeded the recommended dose, cumulative prednisone dosage > 200 mg) according to cumulative systemic glucocorticoid exposure dosage of the patients during hospitalization. The clinical data of patients between the two groups were compared, and possible factors with P < 0.1 in univariate analysis were included in multivariate Logistic regression analysis to screen the related factors of systemic glucocorticoid exposure level in AECOPD patients with CO 2 retention. Results:According to the order of hospitalization, 151 AECOPD patients with CO 2 retention were enrolled, 8 patients were excluded, and 143 patients were enrolled in the analysis. Of the 143 patients, 68 received the recommended dose of systemic glucocorticoid, and 75 received excessive systemic glucocorticoid. Age, percentage of forced expiratory volume in 1 second (FEV1%) at stable phase, frequency of acute exacerbation within 1 year, heart failure ratio, oxygen index (PaO 2/FiO 2), arterial partial pressure of carbon dioxide (PaCO 2), serum EOS and ApoE levels at admission, the ratio of aerosolized inhaled glucocorticoids and non-invasive mechanical ventilation showed statistical differences between the two groups. Multivariate Logistic regression analysis showed that related factors affecting systemic glucocorticoid exposure levels of AECOPD patients with CO 2 retention were FEV1% at stable phase [odds ratio ( OR) = 0.957, 95% confidence interval (95% CI) was 0.921-0.994, P = 0.023], acute exacerbation frequency within 1 year ( OR = 1.530, 95% CI was 1.121-2.088, P = 0.007), heart failure ( OR = 3.022, 95% CI was 1.263-7.231, P = 0.013), PaCO 2 ( OR = 1.062, 95% CI was 1.010-1.115, P = 0.018) and EOS at admission ( OR = 0.103, 95% CI was 0.016-0.684, P = 0.019), aerosolized inhaled glucocorticoids ( OR = 0.337, 95% CI was 0.145-0.783, P = 0.011) and non-invasive mechanical ventilation at acute exacerbation ( OR = 0.422, 95% CI was 0.188-0.948, P = 0.037), of which high FEV1% at stable phase, high EOS at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation were protective factors, while high frequency of acute exacerbation within 1 year, heart failure and high PaCO 2 were risk factors. Conclusions:For AECOPD patients with CO 2 retention, high FEV1% at stable phase, high EOS level at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation can reduce systemic glucocorticoid exposure. In addition, high frequency of acute exacerbation within 1 year, heart failure, and high PaCO 2 can increase systemic glucocorticoid exposure.