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Application of PiCCO in COPD patients with sepsis shock

Jiangquan YU ; Ruiqiang ZHENG ; Hua LIN ; Nianfang LU ; Jun SHAO ; Haixia WANG ; Xiaoyan WU

Chinese Journal of Primary Medicine and Pharmacy.2013;20(21):3208-3209. doi:10.3760/cma.j.issn.1008-6706.2013.21.004

Objective To evaluate the clinical effects of PiCCO in the treatment of COPD patients with sepsis shock.Methods 43 COPD patients with sepsis shock were randomly divided into two groups.The control group (n =23) were guided fluid resuscitation according to CVP.The study group (n =20) were placed PiCCO,and according to the PiCCO for fluid resuscitation.The average amount of fluid resuscitation,the amount of norepinephrine and the blood lactate level in 24 hours were observed.The average duration of mechanical ventilation and ICU mortality were also observed.Results After 24 hours,the average amount of fluid resuscitation was (3 986.2 ± 542.1) ml of control group and (4 927.9 ± 761.8)ml of study group,the difference between the two groups was statistically significant (t =-4.71,P ＜ 0.05).The average norepinephrine dosage was (0.38 ± 0.21) μg · min-1 · kg-1 of control group and (0.14 ±0.08)μg · min-1 · kg-1 of study group,the difference between the two groups was statistically significant (t =2.45,P ＜ 0.05).The blood lactate level was (4.79 ± 1.95) mmol/L of control group and (3.44 ±1.45) mmol/L of study group,the difference between the two groups was statistically significant(t =2.59,P ＜ 0.05).Five patients died in control group(mortality 21.7％),and three patients died in study group(mortality 15.0％).Mortality between the two groups was not statistically different (x2 =0,03,P ＞ 0.05).The duration of mechanical ventilation in the control group was (101.22 ± 44.77) h,that in the study group was (74.71 ± 20.25) h,the difference between the two groups was statistically significant (t =2.234,P ＜ 0.05).Conclusion Long-term COPD patients maybe have right ventricular dysfunction,and CVP is difficult to truly reflect the volume status of patients,PiCCO can make up for deficiencies in CVP.PiCCO used to guide these patients with fluid resuscitation,which could guide fluid management of patients,reduce the amount of vasoactive drugs,improve tissue hypoxia,and could reduce the duration of mechanical ventilation.

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The screening and treatment of abnormal glucose metabolism during pregnancy

Senge DAI ; Wenmiao ZHANG

Chinese Journal of Primary Medicine and Pharmacy.2013;20(21):3210-3211. doi:10.3760/cma.j.issn.1008-6706.2013.21.005

Objective To screen the abnormal glucose metabolism in pregnant women without diabetes and to give early intervention to reduce perinatal maternal and fetal adverse complications.Methods 2 579 pregnant women who received obstetric examination and revealed no diabetes,underwent GCT screening and OGTr reexamination.The results confirmed the 263 GIGT patients,22 GDM patients.They were givien intervention therapy until delivery and their pregnancy outcome was compared with the normal pregnant women.Results The pregnancy outcome of GIGT pregnant women received intervention and the normal pregnant women had no significant difference.The incidence rates of macrosomia and cesarean section in GDM group were higher than those of normal pregnant women (P ＜0.05,P ＜ 0.01).Conclusion Development of gestational abnormal glucose tolerance screening is important to the early diagnosis and intervention of potential IGT,GDM patients,which can significantly reduce the incidence rate of maternal and fetal adverse complications.

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Research on 10-23 DNAzymes inhibit the expression of Bcl-2 and induce apoptosis of human hepatoma cells

Yongguang YANG ; Mingyi LI ; Manzhou LIN ; Guyu ZHANG

Chinese Journal of Primary Medicine and Pharmacy.2013;20(21):3226-3228. doi:10.3760/cma.j.issn.1008-6706.2013.21.012

Objective To study the effects of cleavage of Bcl-2 by two DNAzymes on apoptosis of human hepatoma cell line (HepZ1).Methods Two “10-23” DNAzymes(DzT and DzTi) targeting Bcl-2 mRNA and their analogues(DzT' and DzTi') were synthesized and used to cleave Bcl-2 mRNA in vitro and in BEL-7402 cells.The RT-PCR was performed to assess the cleaving efficiency.Expression of Bcl-2 protein was determined by immunofluorescent method.Cell apoptosis was detected by flow cytometry.Results The unmodified Enzymes DzT,and its modified form DzTi,which had an added 3'-inverted thymidine,could effectively cleave Bcl-2 mRNA in vitro.After transfected into BEL-7402 cells,DzTi exhibited more powerful cleaving ability than DzT,significantly down-regulated the level of Bcl-2 protein(P ＜0.01) and inhibited the cell growth(P ＜0.05).The results of flow cytometry suggested that the apoptosis rate of DzT and DzTi significantly increased,appeared apoptotic peak.Cell cycle was delayed in DzT and DzTi group,proportion of cells in G0/G1 increased,S phase cells decreased.Conclusion The synthesized DNAzymes could effectively cleave Bcl-2 mRNA,decrease the level of Bcl-2 protein and induce hepatoma cells apoptosis.

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Comparative study of intravenous medication and pelvic perfusion on patients with gynecological pelvic inflammatory disease

Xiaoli ZHANG ; Hui LIU ; Xiuqin WANG

Chinese Journal of Primary Medicine and Pharmacy.2013;20(21):3234-3235. doi:10.3760/cma.j.issn.1008-6706.2013.21.015

Objective To investigate the effects of intravenous medication and pelvic perfusion in the treatment of gynecological acute and chronic pelvic inflammatory disease.Methods 120 cases with pelvic inflammatory disease were randomly divided into two groups.The control group(60 cases) received intravenous drugs.The observation group(60 cases) were given pelvic infusion therapy.The treatment efficacy of the two groups was compared after treatment for 14 days.Results The obvious effective rate of the observation group was 80.00％,which was significantly higher than 50.00％ in the control group(x2 =11.58,P ＜ 0.05).The total effective rate in the observation group was 90.00％,which was significantly higher than 68.33％ in the the control group(x2 =13.72,P ＜ 0.05).The incidence rate of adverse reactions in the control group was 38.33％,that in the observation group was 20.00％,the difference between the two groups was significant(x2 =4.18,P ＜ 0.05).Conclusion Pelvic perfusion therapy can improve the clinical efficacy of pelvic inflammatory disease,improve the symptoms of patients,reduce side effects,which is worthy of clinical application.

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Clinical observation of noninvasive ventilation in the treatment of patients with acute exacerbations of chronic obstructive pulmonary disease

Jianneng LIAO ; Jian CHEN ; Zhiping LIN ; Manlian LI

Chinese Journal of Primary Medicine and Pharmacy.2013;20(21):3236-3238. doi:10.3760/cma.j.issn.1008-6706.2013.21.016

Objective To investigate the therapeutic effect of non-invasive positi e pressure ventilation (NIPPV) in the treatment of patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Methods 68 AECOPD patients with type Ⅱ repiratory failure were randomly divided into control group and treatment group.The control group was treated by conventional therapy alone and the treatment group was given conventional therapy combined with NIPPV.The levels of power of hydrogen (pH),partial pressure of carbon dioxide in artery(PaCO2),arterial oxygen tension(PaO2),heart rate and repiratory rate were compared between the two groups.The mean length of patient stay,the frequency of tracheal intubation and the hospital mortality were analyzed after discharge from the hospital.Results Before treatment,the arterial blood gas analysis showed that the pH,PaCO2 and PaO2 had no significant differences between the two groups(all P ＞ 0.05).After treatment,compared with the control group,the levels of pH,PaCO2 and PaO2 were obviously improved(all P ＜0.05).The mean length of patients stay in the treatment group was significantly shorter than the control group(P ＜ 0.05).The frequency of tracheal intubation of the treatment group was significantly lower than the control group(P ＜ 0.05).The hospital mortality was lower in the treatment group,but the difference between the two groups was not significant (P ＞ 0.05).Conclusion NIPPV for treating the AECOPD can improve the arterial blood gas analysis,decrease the need of tracheal intubation and shorten hospitalization time.

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Evaluation of resectability of hilar cholangiocarcinoma with 64-slice CT angiography combined with negative-contrast CT cholangiography

Zhiqiang SHEN ; Zanhui JIN

Chinese Journal of Primary Medicine and Pharmacy.2013;20(21):3238-3240. doi:10.3760/cma.j.issn.1008-6706.2013.21.017

Objective To investigate the 64-slice spiral CT angiography combined with negative contrast CT cholangiography in the evaluation of resectability of hilar cholangiocarcinoma.Methods The clinical data of 46 patients with hilar cholangiocarcinoma were analyzed.The resectability was observed by the 64-slice spiral CT angiography combined with negative contrast CT cholangiography,and compared with the postoperative results.Results Preoperative CT Bismuth-Corlette classification and postoperative results showed no significant difference (x2 =0.00,0.53,1.96,0.59,2.63,all P ＞ 0.05).Preoperative CT assessed the resectability of 26 cases with hilar cholangiocarcinoma,The intraoperation evaluated resectable 22 cases,the difference was not significant (x2 =1.51,P ＞ 0.05).Conclusion 64-slice spiral CT angiography combined with negative contrast CT cholangiography can make a good evaluation of hilar cholangiocarcinoma involving the degree of blood vessels and bile ducts,provide an important basis for the selection of clinical protocols.

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Analysis of atypical imaging of tuberculosis

Zhikui MI

Chinese Journal of Primary Medicine and Pharmacy.2013;20(21):3241-3242. doi:10.3760/cma.j.issn.1008-6706.2013.21.018

Objective To explore the atypical imaging features of patients with pulmonary tuberculosis,in order to improve the diagnosis and differential diagnosis of pulmonary tuberculosis with atypical imaging.Methods The imaging findings of 30 cases with atypical pulmonary tuberculosis,confirmed by sputum tubercle bacillus check and antituberculous therapy tracking in our hospital from January 2010 to August 2012,were retrospectively analyzed.Results After comparative analysis of antituberculous treatment results and symptoms,the correct rate of right posterior basal segment of lower lobe and the right anterior basal segment of lower lobe lesion site was 80％.The total correct rate of imaging findings was 80％,the imaging findings and diagnosis results had positive correlation,0 ＜ r ＜ 1.Conclusion Radiographic examination of pulmonary tuberculosis with atypical lesion,the differential diagnosis of lesions in dynamic changes play an important role,master of pulmonary tuberculosis in patients with atypical imaging features,and in combination with the clinical manifestations,can effectively reduce the misdiagnosis,significantly improve the accuracy rate of imaging for atypical pulmonary tuberculosis diagnosis.

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Application value of cancer gene c-erbB-2 and its protein product expression in evaluation of the diagnosis and prognosis of breast cancer with lymph node metastasis

Hong YE

Chinese Journal of Primary Medicine and Pharmacy.2013;20(21):3251-3253. doi:10.3760/cma.j.issn.1008-6706.2013.21.023

Objective To discuss the application value of cancer gene c-erbB-2 and its protein products P185 in evaluation of the diagnosis and prognosis of breast cancer with lymph node metastasis,and to explore the relationship between c-erbB-2 expression and tumor pathology classification,relapse.Methods 112 cases with mammary disease were selected as the research subjects.According to different clinical diagnosis,they were divided into breast cancer lymph node metastasis group,breast cancer without metastasis group and mammary gland benign pathological change group.The c-erbB-2 gene and carcinoembryonic antigen(CEA) were detected by immunohistochemical method,enzyme-linked immunosorbent(ELISA) and electrochemical luminescence method.The c-erbB-2 protein(P185)and CEA of the three groups were compared,the sensitivity and specificity of c-erbB-2 expression and CEA in the diagnosis of breast cancer with lymph node metastasis were analyzed.At the same time,the relationship between cerbB-2 expression and tumor pathology classification,relapse was analyzed.Results P185 and CEA index of breast cancer lymph node metastasis group and breast cancer without metastasis group were significantly higher than those of mammary gland benign pathological change group(t =7.093,6.443,9.232,8.508,all P ＜ 0.0 1),and P185 index of breast cancer lymph node metastasis group was significantly higher than without metastasis group (t =2.281,P ＜0.05),and there was no significant difference of CEA between the two breast cancer groups (t =0.406,P ＞ 0.05).The sensitivity of c-erbB-2 expression in dignosis of breast cancer lymph node metastasis had no difference with CEA (x2 =0.632,P ＞ 0.05),but the specificity was significantly higher than CEA(x2 =11.900,P ＜ 0.01).The positive expression rate of c-erbB-2 and tumor pathology classification had no obvious relation:Postoperative recurrence rate of c-erbB-2 positive expression patients was significantly higher than the negative expression patients(x2 =5.141,P ＜0.05).Conclusion c-erbB-2 gene and its protein product has good sensitivity and specificity in the diagnosis of breast cancer lymph node metastasis,and has obvious correlation with postoperative breast cancer recurrence,has important reference value in evaluation of the diagnosis and prognosis of breast cancer.

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The dynamic observation of platelet parameters in children with mycoplasma pneumoniae pneumonia

Qiwu WU ; Ping ZHAO

Chinese Journal of Primary Medicine and Pharmacy.2013;20(21):3254-3255. doi:10.3760/cma.j.issn.1008-6706.2013.21.024

Objective To investigate the changes and significance of platelet parameters and leucocyte in the children suffered from mycoplasma pneumoniae pneumonia (MPP).Methods The platelet parameters (PLT),the platelet volume(MPV),the platelet distribution width (PDW),and the white blood cell count(WBC) were detected by automatic blood cell analyzer respectively in 300 children with MPP before and after the treatment by macrolides antibiotics for a week as well as in 40 normal children.The comparison was made among them.Results There were 156 cases that suffered from thrombocytosis (PLT ＞ 300 × 109/L) in MPP group,the incidence rate was 52.0％(156/300).While there was 1 case with thrombocytopenia,the incidence rate was 0.3％ (1/300).The WBC,MPV and PDW in MPP group before and after one-week treatment were higher than the control group.And the PLT was higher than the initial stage of hospitalization and the control group.The differences had statistical significance.Conclusion The incidence rate of thrombocytosis was high in the children suffered from MPP.The dynamic observation of platelet parameters and WBC in children with MPP could be used as the elementary basis of judging MP infection.

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Clinical analysis of 26 neonatal pneumonia patients complicated with pneumothorax

Suqin LIU ; Yanping ZHANG ; Yu JIN

Chinese Journal of Primary Medicine and Pharmacy.2013;20(21):3263-3265. doi:10.3760/cma.j.issn.1008-6706.2013.21.028

Objective To explore the clinical features and prevention measures of neonatal pneumonia complicated with pneumothorax.Methods Clinical data of 26 neonatal pneumonia patients complicated with pneumothorax were retrospectively analyzed.Results In 26 cases of neonatal pneumonia complicated with pneumothorax,16 cases(61.4％) were aspiration pneumonia,10 cases(38.5％) were infectious pneumonia.2 cases of not obvious mild cyanosis and dyspnea were given conservative treatment,24 cases were shortness of breath cyanosis,groan,face pale,difficulty in breathing,restlessness,irritability.Breath sounds were reduced or disappear,sound shift,cyanosis to oxygen can not be sustained remission.Blood oxygen saturation were lower grade.One side or both sides of the chest profile were apparent uplift with thoracic puncture exhaust or thoracic closed drainage.24 cases(92.5％) suffered from pneumothorax were cured.2 cases (7.7％) gave up the treatment,including 1 case died and 1 case loss prevention.Conclusion Pneumonia of newborn pneumothorax is secondary to inhalation of most inappropriate,infection,airway pressure,suction.Once found,timely treatment is important.Mild cyanosis can spontaneous remission,cyanosis having oxygen can not be sustained remission.The prognosis of it by thoracic puncture exhaust or closed thoracic drainage is good.Actively control influence during pregnancy,birth and postpartum.Preventing meconium inhalation can reduce the occurrence of neonatal pneumonia complicated with pneumothorax.

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