Objective To observe the efficacy,feasibility and safety of continous intravenous infusion of furosemide,dopamine combined with Shenmai on treatment of refractory heart failure. Methods Fifty-six patients with diuretic resistance and refractory heart failure were divided into control group(28 patients)and treatment group(28 patients)by random digits table. Conventional diuretics and other anti-heart failure treatment were used in two groups, meanwhile, continuous intravenous infusion of furosemide,dopamine and Shenmai were used in treatment group for 5-7 days. The clinical symptoms and signs, pulmonary edema in chest X-ray and the improvements of pulmonary congestion were observed before and after treatment. Results In treatment group, 10 patients were markedly effective, 14 patients were effective, and 4 patients were unfruitful. The total effective rate was 85.7%(24/28). In control group, 3 patients were markedly effective, 10 patients were effective, and 15 patients were unfruitful. The total effective rate was 46.4%(13/28). There was significant difference in total effective rate between two groups (P ＜ 0.05). The indexes of left ventricular end-diastolic dimension, fractional shortening, left ventricular ejection fraction and cardiac index were significantly improved in treatment group(P ＜ 0.05), but was not significantly improved in control group(P ＞ 0.05). After treatment,2 patients emerged hypokalemia and hyponatremia, after symptomatic treatment,they all recovered. Conclusion Conventional treatment combined with continuous intravenous infusion of furosemide,dopamine and Shenmai in patients with refractory heart failure is markedly effective, feasible and safe.

Objective To investigate the microecological status of vaginal microflora in the women with different vaginal symptoms. Methods From March 2006 to October 2007, 6982 cases with varying degree vaginal symptoms including pruritus, increaseed leucorrhea, the leucorrhea having unusual smell, in the gynecology outpatient department were studied. The vagina secretions were examined in terms of the pH value, the hydrogen peroxide test, and Gram dyeing inspection of vaginal bacteria and microecology appraisal for colony's density, the multiplicity, the superiority fungus, and the inflammatory response. Results Among 6982 patients, normal vaginal microecology was identified in 750 (10. 74%, 750/6982 );abnormal mieroeeology was found in 6232 ( 89. 26%, 6232/6982 ) ; bacterial vaginosis (BV) was detected in 729 (10. 44%, 729/6982);vulvovaginal candidiasis (VVC) was in 1527 ( 21.87%, 1527/6982 ). Ninety five patients (1.36% ,95/6982) were with both BV and VVC. Abnormal bacteria colonies were found in 1229(17. 60% ,1229/6982),and others were found in 2652(37. 98% ,2652/6982). Conclusions The vaginal microecology in the women with different vaginal symptoms can be either normal or abnormal. Microecology clinical evaluation system can assess the vaginal microecosystem.

Objective:To investigate the pathogen flora of recurrent vulvovaginal candidiasis(RWC),and to discuss its treatment. Methods: Fungal culture and susceptibility tests of vaginal discharge from 108 RWC patients were performed. Sensitive drugs were selected for effective consolidating treatment for half year. Fungal smears were examined at the 3rd and 6th months after the treatment respectively. Results:①Among RWC patients,there were 81 cas es of Candida albicans(75.0%), 19 cases of C. Glabrata(17.6%), 4 cases of C. Parapsilosis(3.7%) ,2 cases of C.tropicalis (1.9%) and 2 cases of M. Krusei (1.9%). The drug susceptibility test showed that 80.6% of these 108 patients were sensitive to nystatin; 66.7% were sensitive to clotrimazole; 65.7% were sensitive to miconazole; 57.4% were sensitive to fluconazole;8.3% were sensitive to ketoconazole;6.5% were sensitive to itraconazole; 7.4% were resistant to all of the above drugs.②The score of symptom and sign was significantly improved compared with the first visit at the 3rd and 6th month after the treatment( P<0.0001). The negative rate was 76.2%(80/105) at the 3rd month after the treatment and 64.8%(68/105)at the 6th month after the treatment. Conclusions:①The rate of non Candida albicans is increased to 25% in RWC patients, and 17.60% is Candida glabrata.②During the treatment of RWC, the drugs should be selected according to fungal culture, results of susceptibility test, medication experience of patients,and attack character. The research of immune abnormality of the local vagina will be helpful to improve the cure rate of RWC.

Objective To investigate clinical features of alopecia areata such as sex, age, and subjective symptoms, and relationships between these factors and disease severity. Methods Clinical materials of patients who were diagnosed as alopecia areata were collected. The role of sex was analyzed in the disease and the correlation between disease severity and sex, age or psychological factors was analyzed. Results 118 patients including 101 cases of localized alopecia areata (AA), 5 alpecia totalis (AT) and 12 alopecia universalis (AU) were collected. The ratio of male to female was 1.2:1 and there was no correlation between sex and disease severity. The patients were from 1 to 76 years old while average age was 31.3?1.3 years, and that of the female patients was 28.9?1.9 and the male was 33.2?1.8; The median course was 2.5 months, while AA was 2 months, and AT/AU was 18 months; 14.4% patients (17/118), including 11 cases of AA and 6 AT/AU had subjective symptoms; 20.3% patients (24/118) had psychological factors before onset, 60.2% patients (71/118) had difficulties in sleeping, nail changes were found in 15.2% patients (18/118), and ocular symptoms were found in 5.9% patients (7/118), 5.9% patients (7/118) had family history, 3.4% patients (4/118) were accompanied by disease of thyroid gland, 1.7% patients (2/118) were accompanied by vitiligo, TGA and TMA levels elevated abnormally in 4.8% patients (3/62). Conclusion Alopecia areata often affects young to middle-aged people, and there is no correlation between sex and disease severity; Female patients are younger than male; A few patients are induced by psychological factors, and some accompanied by other autoimmune diseases. AT/AU is easier to have subjective symptoms than AA.

Objective To observe the impact of the diverse caloric energy intake on the outcomes and occurrence rate of complications in septic patients.Methods A prospective single-blind randomized controlled trial was conducted.158 cases of septic patients in intensive care unit (ICU) were enrolled and randomly assigned to three groups according to their different target value of nutrition:group A [measurements of resting energy expenditure (MREE)＜90％],B (MREE 90％-110％) and C (MREE ＞ 110％).The caloric intake,mechanical ventilation duration (MVD),nosocomial infection rate,28-day and 60-day mortality were analyzed.Results Daily energy intake in 7 days after ICU admission was as follows:the difference in target value of nutrition(kJ/d:7 075.0 ± 1 046.5,5 667.8 ± 1 908.8,4 428.8 ± 1 377.8),calory intake (kJ/d:4 671.6 ± 1 205.6,5 655.3 ± 1 373.0,6 053.0 ± 1 557.2),enteral nutrition value (kJ/d:2 051.1 ± 1 046.5,3 980.9 ± 1 586.5,5 337.1 ±2 921.8) and average intake rate [(66.0 ± 15.8)％,(100.0 ± 5.7)％,(134.0 ± 19.7)％],and they were statistically significant difference among A,B,C groups (all P＜0.05).The parenteral nutrition in group C were much higher than that in group A and group B (kJ/d:2 055.3 ± 273.4vs.427.0 ± 273.4,473.0 ± 332.0,both P＜0.05).The calories provided by glucose and diprivan were similar among three groups.The MVD and ICU stay were shorter in group B than that in groups A and C [MVD (days):8.4 ± 6.3 vs.11.0 ± 8.2,17.8 ± 13.0,P＞ 0.05 and P＜ 0.05 ; ICU stay (days):11.0 ± 6.4 vs.14.9 ± 9.6,17.8 ± 13.0,respectively,P＞0.05 and P＜0.05].The total hospital stay (days:32.0 ± 22.5,26.8 ± 7.0,30.4 ± 21.4) and nosocomial infection rate [91.1％ (51/56),84.0％ (42/50),90.4％ (47/52)] were similar among A,B,C groups (all P＞0.05).There was no difference in survival rate at 28 days among three groups as shown by the Kaplan-Meier survival curve (F=3.145,P=0.076).The survival rate at 60 days showed a tendency of lowering in groups A and C,especially in group C (F=9.284,P=0.010).Conclusion Both higher and lower caloric energy intake may be associated with an adverse impact,but appropriate caloric intake would improve the outcome and reduce the complication rate in septic patients.

AIM: We sought to evaluate the expression of apoptosis related genes, p53 and bcl-2, in cultured vascular smooth muscle cells (VSMCs) in which apoptosis was induced by the ligands of PPAR?-ox-LDL,ciglitazone and 15-deoxy-△ 12,14-PGJ 2,and then influenced by PGF 2?,an antagonist of PPAR?. To clarify whether PPAR? is involved in the regulations of p53 and bcl-2.METHODS: Rat aorta smooth muscle cells were isolated and cultured in DMEM containing 10%FBS. ox-LDL,ciglitazone and 15 d-PGJ 2 were added into the medium for 24 h, respectively. Using PGF 2? to inhibit PPAR? activation via activation of MAP kinase. We employed the flow cytometry analysis to quantitatively analyze the apoptosis of VSMCs. Also, we measured and analyzed the discrepancies of the expression of p53 and bcl-2 between every groups. RESULTS: During the process of apoptosis induced by PPAR?,the expression of P53 protein increased (P

Objective To discuss the diagnosis,treatment and following-up of cervical intraepithelial neoplasia (CIN) during pregnancy.Methods Eighteen pregnant women with CIN,presented to the hospital from Jan.2004 to May.2008,were retrospectively reviewed.Pap smear,HPV,copolscopy and cervical biopsy were performed for diagnosis and all were followed up by Pap smear and copolscopy during pregnancy every 12 weeks,while 15 were followed up until 6-8 weeks postpartum.Results The incidence of CIN during pregnancy was 0.16%.All of the 18 women had abnormal Pap smear,followed by colopscopy and biopsy.Conservative management during the pregnancies every 3 months showed no progress in CIN.Among the 18 cases,17 delivered at term and only 1 preterm (36+4 weeks).Two out of the 18 women had normal delivery (11.1%),2 by forceps(11.1 %) and 14 by cesarean sections (77.8%).No neonatal apnea or neonatal respiratory distress syndrome had been observed.Pathological diagnosis was confirmed in all cases prenatally,including 4 CIN1,4 CIN2 and 10 CIN3.Four out of the 10 CIN3 remained after delivery,while 1 changed to CIN2.These 5 cases underwent leep electrical excision procedure and Pap smear results turned to normal at 6 to 11 months after delivery.One HSIL case were lost.The rest 4 CIN3 and all of the 8 CIN1 and CIN2 cases turned to normal or lesser degree.Fourteen of the 18 women received HPV test during pregnancy,and 12 (85.7%) were positive,among which 7 women were followed up at postpartum and 6 of them were HPV positive.Conclusions The three steps method for diagnosis of CIN during pregnancy is safe and effective.Conservative management of CIN during pregnancy is recommended.

Objective To study the clinical and pathologic features of aggressive angiomyxoma (AAM) and its occurrence, treatment and prognosis Methods The 8 cases of AAM were analyzed retrospectively, among which 6 cases in vulva, 2 cases in perineum, vagina and pelvis As well we performad immunohistochemical studies Results The neoplastic cells were at least focally immunoreactive for vimentin (7/7), smooth muscle actin (7/7), factor 8 (7/7), proliferating cell nuclear antigen (4/7), estrogen (3/7) and pregesterone (4/7) receptors All of the examined tumors were negative for S100 protein and cluster designation 68 Conclusions AAM is an uncommon mesenchymal tumor that preferentially involves the pelvic and perineal regions of females In immunohistochemical investigation the neoplastic cells of AAM exhibit fibroblastic and myofibroblastic features They are characterized by slow growth, infiltration of adjacent structures, absence of distant metastases, a tendency to recur locally and a fairly good prognosis Treatment should consist of wide surgical excision, as complete as technically possible

Objective To assess the influence of cumulative energy balance on outcome in septic patients requiring mechanical ventilation. Methods The indirect calorimetry (IC) was used to obtain target energy in 60 septic patients. The cumulative energy balance between survivors and non-survivors were compared. Logistic regressions was used to analyze the risk factors of death. Results Non-survivors had higher negative energy balance than survivors (P<0.05). The logistic regression analysis demonstrated that the start time of feeding and cumulative caloric balance were risk factors of mortality. Conclusions Effective nutrition support might be a good strategy to improve outcomes.

Objective: To discover the connection between migraine and Tianmashouwu Tablet (TMT) in endothelial cell perspective. Methods: Serum containing TMT was added to rat's cerebral capilary endothelial cell's culture to observe the changes of NO and ET, and effect on express of ETmRNA and iNOSmRNA. Results: Levels of iNOSmRNA, rCMECs and ETmRNA were all downregulated, and contents of both NO and ET were decreased. Conclusions: TMT is effective in protection against rCMECs induced apoptosis, and has a therapeutic effect on migraine.