Objective To investigate the clinical factors dominant in the efficacy of lung recruitment maneuver (RM) with high-level positive end-expiratory pressure (PEEP) under pressure control ventilation in patients with 2009 influenza A (H1N1)-associated acute respiratory distress syndrome (ARDS) by analyzing the clinical data of 24 patients treated with mechanical ventilation.Methods A retrospective study was carried out in a 16-bed capacity emergency intensive care unit (EICU) of the First Affiliated Hospital of China Medical University from October 2009 to January 2010.Twenty-four patients with influenza-associated ARDS were included.During pressure control ventilation,when SpO2 persisted lower than 88％ for more than 30 min,RM with high-level PEEP was initiated to normalize lung volume at 30 cmH2O for 60 s.The RM was responded as SpO2 increased more than 3％ within 15 min; otherwise,the increase below 3％ in SpO2 would be considered non-responded.Variations in respiratory mechanics,oxygen metabolism and hemodynamic parameters were measured before and after RM.Results Of 24 patients with influenza-associated ARDS,16 survived and 8 deceased.The median duration of mechanical ventilation (DMV) in EICU was 5.5 days (range from 3.5 to 12.0 days).During the entire study period,a total of 158 RMs with high-level PEEP were done,including 76 (48.1％) responded RMs (the responded group) and 82 (51.9％) non-responded RMs (the non-responded group).In survivor group,the ratio of effective RM was higher than in nonsurvivors group (66.2％ vs.33.3％,P ＜ 0.01).Compared with the data before RM,HR was increased (92.6 ± 11.8) vs.(73.0 ± 12.6),P =0.038 and MAP was decreased (66.1 ±9.3) mmHg vs.(73.9 ± 11.4) mmHg,P=0.049 during RM,and these difference were not statistically significant at 3 min after RM.The decrease in SpO2 after 134 procedures of RMs in 85.9％ patients,and the minimum value of SpO2 occurred at (2.1 ±0.6) min after RM.In the responded group,the maximum SpO2 were higher than that before RM by (6.9 ± 1.6) ％ occurred at (12.7 ±2.6) min after RM.Compared with the data before RM,SpO2 were increased (90.4 ± 4.4) ％ vs.(86.7 ± 7.6) ％,P =0.047) in responded group at 30 min after RM.The initial PEEP level in the responded group was lower than that of the non-responded group (8.6 ± 3.4) cmH2O vs.(11.3 ±4.2) cmH2O,P=0.028.The initial mean DMV in the responded group was also shorter than that in the non-responded group (4.1 ± 3.1) d vs.(5.8 ± 2.5) d,P =0.011.Furthermore,the initial dynamic lung-thorax compliance (Cdyn) was obviously higher in the responded group than that in the non-responded group (30.8 ±6.2) mL/cmH2O vs.(26.1 ±5.1) mL/cmH2O,P=0.038.Conclusion The lung RM with high-level PEEP may cause temporary hemodynamic changes and the initial PEEP level,DMV,and Cdyn may be potential factors influencing the efficacy of lung RM.

Objective To study the prognostic value of initial arterial lactate level and to explore the relationship between early arterial lactate and the outcome of patients with acute paraquat poisoning by analyzing the clinical data of 235 cases.Methods A total of 235 patients with acute paraquat poisoning were admitted to the Emergency Intensive Care Unit (EICU) from January 2009 to June 2012.Demographics,clinical and laboratory findings were compared between the survivors and non-survivors.Receiver operating characteristic (ROC) curves were used to identify the optimal cut-off points for initial arterial lactate level.Results Totally 235 patients with average age of (33.6 ± 11.5) years old (ranging from 18 to 74),89 male and 146 female.The median estimated amount of 20％ paraquat ingested was 55 mL,(ranging from 10 to 280,IQR:27 mL,77 mL),the median length of time between paraquat ingestion and the arrival at the emergency department was 4.5 h (ranging from 0.5 to 10.5,IQR:2.3 h,6.8 h).The overall mortality rate was 74.0％ (174/235) during a 28 days follow-up period,only 61 of 235 patients survived.The initial arterial lactate level was higher in non-survivors than that in survivors (2.79 ± 0.76) mmol/L vs.(1.62 ± 0.48) mmol/L,P =0.028).Correlation analyses showed that the initial arterial lactate level was associated with increased risk of 28-day mortality (r =0.26,P =0.004),and as the initial lactate increased,the survival time of non-survivors shortened (F =3.246,P =0.037).Using the ROC curve analysis,the initial arterial lactate level had an area of 0.799 (95％ CI:0.745-0.866) and the cut-off point of concentration was 2.57 mmol/L for prediction of prognosis in patients with acute paraquat poisoning (sensitivity 85.2％,specificity 79.6％,the best Youden index was 0.648).The initial arterial lactate level was higher in patients died from circulatory failure rather than from respiratory failure (5.22 ± 1.46) mmol/L vs.(1.87 ± 0.62) mmol/L,P =0.042.And the survival time of patients died from circulatory failure was shorter than that from respiratory failure (4.1 ± 1.3) d vs.(11.6 ± 3.2)d,P =0.023.With the ROC curve analysis,the initial arterial lactate level had an area of 0.882 (95％ CI:0.805-0.941) and the cut-off point of concentration was 3.65 mmol/L for prediction of prognosis of patients died from circulatory failure (sensitivity 87.6％,specificity 82.5％,the best Youden index was 0.701).Conclusions The initial arterial lactate level may be one of early indicators of prognosis in patients with acute paraquat poisoning and it had high potential in predicting the outcome of patients died from circulatory failure.

The physical and chemical factors affecting the allergenic potency of the house bdust mite Dermatophagoides farinae extract were determined by skin test and ELISA technique in the asthmatic patients sensitive to the mite. The results showed that the allergenic potency of the extract could be reduced by heat sterilization, trypsin trea-tment and lyophization,but not lost completely,and that the potency could be increasedby supersonic treatment and repeated freeze-thaw(but less than 10 times).It was alsoshowed that the allergenic potency of the extract preserved at -20℃ was more stablethan those preserved at 4℃ or at room temperature,and that the mite extract preservedat 4℃ more than 9 years still had allergenic potency.

Objective To observe neutrophil activation and protease imbalance in airway of children after foreign-body aspiration(FBA).Methods Bronchoalveolar lavage fluid(BALF) was obtained through fiberoptic bronchoscopy.The supernatant was assayed for the concentration of neutrophil elastase(NE) using enzyme-linked immunosorbent assay(ELISA) and elastase inhibition capacity(EIC)/free elastase activity using a colorimetric assay.The cell pellet were smeared for the expression of ?1-antitrypsin(?1-AT) using cellular immunohisto-chemistry and cytologic analysis by Wright-Giemsa stain.Results Percentage of neutrophil,concentration of NE and the expression of ?1-AT in BLAF group,pair group and pneumonia group significantly increased compared with that of control group(Pa0.05).The ratio of Lib NE in FBA,par and peumcria group was 30.3%,27.3% and 22.7%.Conclusions FBA induces similar airway neutrophil activation and protease imbalance to bacterial pneumonia.The contralateral airway showes the same change as the foreign body side.

Objective To explore if the day surgery for cataract is safe and should be popularized. Methods From September to October in 2015, among the patients who received the ultrasonic phacoemulsification and intraocular lens implantation in the cataract department of Tianjin Medical University Eye Hospital, according to the admission time, one hundred and three patients were chosen respectively from the day ward(the experimental group)and the traditional ward(the control group)based on the purposive sampling. The average time of waiting for admission, the falls events before admission, the awareness about postoperative considerations, the postoperative complications and the infection rate between the two groups were compared. Results The average time of waiting for admission in the experimental group was much shorter than that in the control group, (6.36 ± 4.02) days vs. (21.35 ± 18.58) days. The difference was significant (Z=-8.386, P<0.01). The rate of falls before admission in the experimental group was lower than that in the control group and the difference was significant, 9.71%(10/103) vs. 20.39%(21/103),χ2=4.595, P<0.05. No infection happened in both groups. Conclusions The day surgery model doesn′t increase the risk and is as safe as the traditional surgery model. It should be extended as it also has the advantages of shorter hospital stay, less medical resource consumption and less hospitalization expenses, besides, it saves time and labor. What′s more, the mean waiting time for hospitalization for day surgery is shorter. It means the patients can receive the operation as soon as possible, which ensures the patients′safety, and reduce the unsafe factor in their life, bring the benefit to the society.

OBJECTIVETo study the results of arthroscopic partial meniscectomy for medial meniscal tear in late middle-aged adults.

METHODSFrom October 2010 to October 2012,49 patients meeting inclusion criteria were treated with arthroscopic partial meniscectomy for medial meniscal tear. There were 31 males and 18 females,with an average age of (55.3±2.8) years old. There were 22 left knees and 27 right knees. The average flexion angle was (116.01±12.03)°. The pre-operative HSS Knee Score was 48.73±8.43, and the Lysholm score was 63.95±5.45. The patients were followed up and evaluated. All the patients received a standard surgery, in which the torn tissue was removed, and the anterior part of the meniscus was left in situ.

RESULTSAll the surgeries were successful with no serious complications. All the patients were followed up,and the duration ranged from 12 to 36 months. All the patients had 5 degrees of muscle strength. The average flexion angle was (136.77±18.56)°. There was significant difference between the two angles before operation and after operation. The pre-operative HSS Knee Score was 90.17±4.10, and the Lysholm score was 87.84±5.16. Statistically, the difference between preoperative score and the postoperative score was significant.

CONCLUSIONArthroscopic partial meniscectomy is a good option for medial meniscal tear in late middle-aged adults. Operative indication is crucial and the excellent surgical technique is also critical for the good clinical outcome. All the patients could get good clinical results, although there are some patients with motion restrictions in the early stage after operation.

Arthroscopy ; methods ; Female ; Humans ; Knee Injuries ; surgery ; Male ; Menisci, Tibial ; physiopathology ; surgery ; Middle Aged ; Tibial Meniscus Injuries

Cholestasis, Intrahepatic ; etiology ; Citrullinemia ; complications ; Humans ; Infant ; Male

Since 2000,most of H5N1 subtype influenza A virus had a unique mutation of NS gene with 15base pair deletion from 263 to 277. In order to investigate the bio-characteristics of this mutation,two different NS recombinants,RWSN-248 and RWSN-m248,were generated via plasmid rescue from A/WSN/33(H1N1) and A/SD/04(H5N1). RWSN-248 had a higher viral titer than RWSN-m248 in MDCK and COS-1 cells that have an IFN response,but they had the similar growth ability in Vero cells that lack an IFN response. Both of two recombinants grew well in embryonated chicken eggs and had the similar viral titer and MDT. The results above revealed that the deletion from 263 to 277 sites of NS gene did not influence viral virulence to but decreased viral anti-IFN ability of H5N1.

Background Orthokeratology has been proved to temporarily alter the equivalent sphere,but its effects on visual quality deserve attention.Objective The present study was to investigate the visual quality after overnight orthokeratology in pre-adolescent myopes.Methods Written informed consent was obtained form each subject prior to entering into this series.A descriptive study design was used.One hundred and fifty eyes of 76 teenagers aged (14.90± 1.24)years with low and moderate myopia (-2.79 ± 0.82)D were included in the study.Fitted with Ortho-K contact lens,the lens was wore every night for over 8 hours.Subjective refraction,uncorrected visual acuity (UCVA),contrast sensitivity function,corneal-topography,and aberrometry were examined before,1 week and 3 months after the initiation of orthokeratology.Visual quality was generally evaluated by comparing before wearing,1 week and 3 months after wearing using the National Eye Institute refractive error quality of life instrument (NEI-RQL-42TM).All the procedures were performed by the same clinician.Results Spherical equivalent refractions were (-0.33± 1.02) D and (-0.26 ± 0.60) D 1 week and 3 months after orthokeratology,showing significant decline in comparison with (-2.79±0.82) D of before orthokeratology (P =0.001,0.001).However,no considerable difference was seen between 1 week and 3 months after orthokeratology (P=0.161).Contrast sensitivity function was significantly different in all spatial frequencies before wearing,1 week and 3 months after wearing,and those of 1 week and 3 months after wearing were significantly lower than those of before wearing (1 week:3 cpd P =0.001,6 cpd P=0.001,12 cpd P＜0.05,18 epd P＜0.05 ;3 months:3 cpd P=0.001,6 cpd P=0.001,12 cpd P＜0.05,18 cpd P＜0.05).There was no significant change in contrast sensitivity function between 1 week and 3 months of orthokeratology (P＞0.05).Flat K,steep K and corneal eccentricity (e) were significantly reduced (P =0.000),and surface asymmetry index (SAI) and surface regularity index (SRI) were significantly improved after orthokeratology in comparison with before orthokeratology (both P =0.001).Root mean square (RMS) of total higher-order,third-order and fourth-order aberrations were significantly increased (P＜0.05),but RMS of whole aberration and second-order aberrations significantly decreased after orthokeratology (P＜ 0.05).There were no significant changes in the fifth-order,sixth-order and seventh-order aberration among pre-wear,1 week and 3 months after orthokeratology.Scales of dark to bright,nocturnal driving,glare,visual fluctuate and halo were lower than those before orthokeratology (P＜0.05).The scales of visual fluctuate between 1 month and 3 months after orthokeratology had significant differences (P＜0.01),while the rest of the scales had no significant differences (P＞0.05).Conclusions Orthokeratology can reduce myopic diopter 1 week after orthokeratology.The overnight wearing of fitted orthokeratology can decrease contrast sensitivity and increase corneal surface irregularity and RMS of third-order and fourth-order.Compared with spectacles,orthokeratology reduces subjective visual quality,especially nocturnal quality.