Objective To explore the risk and prognosis factor of cranial nerve injury in non acquired immune deficiency syndrome(AIDS)-related cryptococcal meningitis.Methods The clinical data of 115 patients with non-AIDS-related cryptococcal meningitis were reviewed retrospectively.Clinical characteristics,initial antifungal therapies and outcome of these patients were analyzed.The risk and prognosis factor was performed by multivariate Logistic regression.Results The incidence of cranial nerve injury was 35.7％(41/115).Among of them,the involved ratio was 48.8％ (20/41),39.0％ (16/41),24.4％ (10/41),12.2％ (5/41),7.3％ (3/41),4.9％ (2/41) in optic nerve,oculomotor nerve,acoustic nerve,abducent nerve,olfactory nerve,facial nerve.Predictive risk factor for cranial nerve injury was duration of diagnosis (OR =1.057,95％ CI 1.003-1.112),low cerebrospinal fluid cell count and intracranial hypertension were also the independent predictive factors (both P ＜ 0.05).In the follow-up peried,72.2％ (26/36) patients who had cranial nerve injury were fully recovered,with a median time of 0.5-24.0 (3.8 ±1.7) months.The independent predictors of recovery were numbers of nerve involved (OR =0.241,95 ％ CI 0.067-0.801,P =0.023) and combination therapy (OR =10.328,95 ％ CI 2.087-51.026,P =0.006).Condusions Cranial nerve injury is common in non-AIDS-related cryptococcal meningitis.Delay in diagnosis,intracranial hypertension and low cerebrospinal fluid cell count are independent predictive factors.Less cranial nerve involvement and combination therapy predicts recovery.

Objective To study the therapeutic effect and mechanism of enteral nutrition support for treatment of chronic cardiac failure of rats.Methods Ligature of abdominal aorta was used to prepare SD rat model of chronic cardiac failure.The rat models of cardiac failure were randomly (random number) divided into three groups:conventional therapy group,conventional therapy plus enteral nutrition support group and non-therapy group.The rats in conventional therapy group were administrated with routinely used drugs for chronic cardiac failure.The rats in conventional therapy plus enteral nutrition support group were treated with conventionally used medicine plus enteral nutrition liquid.The rats in non-therapy group were given the same amounts of dummy medicine and normal saline.Ultrasonic cardiography,ELISA for detection of atrial natriuretic peptide (BNP) and examination of pathological change in myocardium tissues after HE staining were carried out for comparison of cardiac function of rats with chronic heart failure between pre-and post-treatment.Results The commonly used drug enabled the heart of rats with chronic heart failure to elevate the LVFS (left ventricular fraction shortening) and LVEF (left ventricular ejection fraction) levels (q=3.59,P＜0.05; q=4.01,P＜0.05),to decrease the BNP in blood plasma (u=2.285,P＜0.05) and to lessen the injury of myocardial tissue (u =2.332,P ＜ 0.05).However,compare to the chronic cardiac failure rats administrated with commonly used drug,the chronic cardiac failure rats treated by combination of the commonly used drug and enteral nutrition liquid presented significantly higher LVFS and LVEF levels (q =4.34,P ＜ 0.05 ; q =3.98,P ＜ 0.05),lower plasma BNP level (u =2.548,P ＜0.02) and milder injury of myocardial tissue (u=2.631,P＜0.02).Conclusions The commonly used drug plus enteral nutrition support promotes in higher efficiency the heart function of chronic cardiac failure rats,suggesting that this nutrition support can be used as an adjuvant therapy for patients with chronic cardiac failure in clinic.

Objective To investigate the causes and measurement of the colonic fistulas after severe acute pancreatitis(SAP),so as to increase its cure rate.Method A retrospective study was made on 19 SAP cases complicated with colonic fistulas after drainage operation in order to find out the risk factors,the location and the time of complicated colonic fistulas,and to sum up the experiences of earlier diagnosis and comprehensive treatment.Results Most patients occurred colonic fistulas within 4~6 weeks postoperation.Seventeen patients recovered,the cure rate being 89.5%(17/19),and two case died of serious systemtic infection and multiple organ systemtic failure.Conclusions Colonic fistulas complicated by SAP is related to anatomic factors,the degree of local inflammation,the way of draingic tube putted away,and improper surgical therapy.Comprehensive therapy including taking double cannula to drainage in active,earlier jejunostomy nutrition support or colostomy,supplementing with recombinant human growth hormone can lead to better results.

The evaluation on clinical efficacy of traditional Tibetan medicine (TTM) is an important scientific subject during the development of TTM. Firstly, the authors introduced the current situations and problems in evaluation on clinical efficacy of traditional Tibetan medicine both at home and abroad in this study. Secondly, they compared the similarities and differences between TTM and traditional Chinese medicine (TCM) in evaluation on clinical efficacy, define their differences in details but not in nature, and proposed that TTM could selectively learn TCM's experiences in clinical research and build a specific methodology system for evaluation on clinical efficacy according to its own characteristics. Thirdly, they discussed the methodological challenges in evaluation on clinical efficacy of TTM, including the pending clinical research guidelines and disease diagnosis standards according to its own characteristics. Finally, they propound some suggestions for promoting the evaluation on clinical efficacy of TTM, including the comprehensive application of multiple research methods, overall research-based evaluation on efficacy of TTM complex intervention and selection of accepted and objective outcome indexes for efficacy evaluation.
Biomedical Research ; Clinical Trials as Topic ; Drug Evaluation ; methods ; standards ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, Tibetan Traditional ; Treatment Outcome

【Objective】 To investigate the synergistic action of therapy of strengthening Qi,warming yang,activating blood to promote diuresis on routine western medicine for congestive heart failure(CHF) and to observe its effect on neuroendocrine factors.【Methods】Seventy CHF patients with cardiac function of grade Ⅱ～Ⅳ which were classified into Qi deficiency and blood stasis complicated with fluid retention,were randomized into groups A(n=42) and B(n=28).Group B received routine treatment with digoxin,diuretics,angiotensin converting enzyme inhibitors and ? receptor antagonists.Group A additionally received oral use of decoction of herbal medicines of Radix Astragali,Herba Epimedii,Herba Leonuri,Rhizoma Alismatis,etc.,which has the actions of strengthening Qi,warming yang,activating blood to promote diuresis.Four weeks constituted one treatment course.The therapeutic effect as well as the changes of cardiac function and neuroendocrine factors before and after treatment was observed.【Results】In group A,24 were markedly effective,16 effective,2 ineffective and the total effective rate was 95.24%;in group B,19 were markedly effective,4 effective,5 ineffective and the total effective rate was 82.14%.The therapeutic effect in group A was superior to group B(P

Objective To investigate the application value of single or combined detection of HE4 and CA125 in the differentia‐tion diagnosis of endometriosis .Methods The detection results of serum HE4 and CA125 levels in 105 cases of patients with ovari‐an endometriosis (endometriosis group) ,53 cases of patients with (ovarian malignant group) tumor and 64 healthy women undergo‐ing the healthy physical examination(control group) were performed the retrospective and statistical analysis .Results The positive rates of serum HE4 in the endometriosis group ,ovarian malignant tumor group and control group were 57 .1% ,90 .6% and 12 .5%respectively with statistically significant difference among them (P< 0 .05) .The positive rates of serum CA125 in the above 3 groups were 44 .8% ,92 .5% and 14 .0% respectively ,and the differences were statistically significant(P<0 .05) .(3)The sensitivity and specificity of 70 pmol/L≤ HE4<150 pmol/L for diagnosing endometriosis were 57 .14% and 53 .86% respectively ,which of 35 U/mL≤CA125<150 U/mL for diagnosing endometriosis were 44 .76% and 61 .24% .But the sensitivity and specificity of their combined detection were 70 .32% and 60 .38% .There were statistically significant differences of sensitivity and specificity among single and combined detecion of HE4 and CA125(P<0 .05) .Conclusion Serum HE4 and CA125 levels are significantly elevated in the patients with endometriosis ,their combined detection could further raise the sensitivity for diagnosing endometriosis .

Objective To investigate the application of fundamental cause in the preparation of surgical instruments.Methods The fundamental cause analysis method was used to analyze the situations of improper preparation of surgical instruments in the operation room to analyze the fundamental causes and work out countermeasures.The preparation of surgical instruments before and after the implementation was compared.Result The qualification rate of surgical instruments increased from 96.0％ before the implementation to 98.6％ after the implementation,with statistically significant difference (P＜0.001).Conclusion The fundamental cause analysis can help the operation room to find out the problems in the surgical equipment preparation process so as to improve the working procedures and the qualification rate of prepared surgical instruments.

Objective To investigate whether ultrasound-mediated microbubble destruction can effectively deliver pEGFP-N1 plasmid into human gingival fibroblasts (HGFs).Methods The primary cultured HGFs were divided into 4 groups,that is,plasmid,microbubble+plasmid,ultrasound+plasmid,and ultrasound+microbubble+plasmid groups.pEGFP-N1 plasmid was used to transfect to HGFs as a gene marker with ultrasound-mediated microbubble destruction.The last group was further divided into subgroups to optimize the transfection conditions.After 48 h,phase-contrast fluorescent microscopy was employed to evaluate the expression of green fluorescent protein (GFP).The cell vitality was measured by the MTT assay.Results The transfection efficiency of the ultrasound+microbubble+plasmid group was higher than other experiment groups.Optimal gene expression was found when ultrasound was radiated at 1.5 W/cm2 for 60 s,microbubble was at a concentration of 10% and plasmid was at a concentration of 6.67 ?g/ml,and the transfection efficiency was highest under this condition.Conclusion Under specific conditions,ultrasound mediated microbubble destruction enhances the reporter gene transfection and expression in HGFs.

Objective To investigate the curative effect of different time of irrigating after endolacrimal recanalisation surgery by Nd:YAG laser combining eye ointment stuffing. Methods Seventy-five cases (75 eyes) of lacrimal duct obstruction, which received endo-lacrimal recanalisation surgery by Nd:YAG laser combining eye ointment stuffing were divided into three groups by random digits table with 25 cases in each group. Group A received irrigating: the first day postoperative, consecutive 3 days,followed by once a week till a month. Group B received irrigating:the third day postoperative, consecutive 3 days,followed by once a week till a month. Group C received irrigating:the sixth day postoperative, consecutive 3 days, followed by once a week till a month. Followed-up survey for 12 months at the ophthalmologic outpatient clinic,the curative effect in each group was compared. Results In 6 months after surgery, the comparison of the curative effect was no statistical difference between group B and group C (P＞ 0.05), while the curative effects in group B and group C was superior to that in group A (P ＜ 0.05). In 12 months after surgery, the curative effect in group C was better than that in group A and B, the difference were statistically significant (P＜0.05). But there was no statistical significance compared with group A and group B (P＞0.05). Conclusions Properly delayed irrigating may improve the curative effect after endo-lacrimal recanalisation surgery by Nd:YAG laser combining eye ointment stuffing, while easier irrigating can increase the incidence of re-blockage of lacrimal duct and reduce the efficacy.

Objective To investigate the accuracy of contrast enhanced ultrasound (CEUS) in diagnosing acute severe panereatitis.Methods Thirty three patients with acute severe pancreatitis were enrolled in the study and all of them underwent CEUS and spiral computed tomography(CT) scan.CT was taken as gold standard in acute severe pancreatitis diagnosis.CEUS were done within 72 hours after CT scan.Results Compared with CT, the sensitivity, specificity,accuracy, positive predictive value,and negative predictive value of CEUS for detecting the necrosis of pancreas were 90%, 95%, 94%, 90% and 95%respectively.The sensitivity, specificity, accuracy, positive predictive value,and negative predictive value of CEUS in diagnosing severe acute pancreatitis were 85%, 92%, 88%, 94% and 80% respectively, while 37% ,86% ,58%, 78%, 50% for conventional ultrasound respectively.Conclusions CEUS is accurate in detection of pancreatic necrosis and diagnosis of acute severe pancreatitis.