Objective To explore the pathogen distribution, changes of cardiorespiratory function and changes of serum inflammatory factors in old patients with cardiac failure complicated with pulmonary infection. Methods A total of 153 cardiac failure patients hospitalized in our hospital from March 2014 to September 2017 were retrospectively analyzed. The patients were divided into pulmonary infected group (n=76) and non-infected group (n=77). Another 82 healthy subjects were served as control group. The respiratory secretions were collected to detect pathogen distribution in infected group. The changes of cardiac and pulmonary functions and peripheral blood inflammatory factors were compared between the three groups. Results A total of 110 pathogens were isolated from infected group, which contained 81 (73.63%) gram negative strains, 27 (24.55%) gram positive strains and 2 (1.82%) fungus. Compared with the control group and non-infected group, the lung function index and pulmonary function decreased significantly in the infected group, containing forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, carbon monoxide diffusing capacity (DLCO), maximum mid expiratory flow (MMEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD). Meanwhile, the serum levels of tumor necrosis factor (TNF) –α, interleukin (IL)-6 and procalcitonin (PCT) were significantly higher in the infected group than those in the non-infected group and the control group (P＜0.05). Conclusion Gram negative strains dominate in pulmonary infection of old patients with cardiac failure, and the cardiopulmonary function is significantly decreased due to the infection, whereas the serum levels of inflammatory factors are dramatically increased, which has an auxiliary value in the evaluation of pulmonary infection.

Objective To investigate the value of real-time fluorescence detection technique of RNA (SAT) constantamplification in monitoring the effect of chemotherapy on patients with sputum positive pulmonary tuberculosis. Methods Sixty-two patients were selected, who were clinically diagnosed as the first-time retreatment for sputum smear-positive pulmonary tuberculosis and were hospitalized in our department from June 2015 to December 2016. After two-month standard anti-tuberculosis treatment, sputum samples were detected by Peng’s vessel acid-fast staining, BACTEC MGIT- 960 culture and strain identification, SAT detection. The BACTEC MGIT-960 culture and strain identification were used as gold standards, the value of SAT during the monitoring the therapeutic effect of the anti-tuberculosis drugs was assessed. Results After the treatment, 49 cases out of 62 showed positive results in mycobacterium tuberculosis culture test, among them 42 patients were diagnosed as human type mycobacterium tuberculosis, 7 patients were diagnosed as nontuberculous mycobacteria infection, and 13 cases showed negative results in mycobacterium tuberculosis culture. Thirty-two cases showed positive results in sputum Peng’s vessel acid-fast staining test, and 30 cases showed negative results. Forty-one cases showed positive results in SAT test and 21 cases showed negative results in SAT. SAT results were well concordant with sputum culture results (Kappa value=0.964), and the sensitivity, the specificity, the positive predictive value and the negative predictive value of SAT were 97.62%, 100%, 100% and 95.24% respectively. Peng’s vessel acid-fast staining results were badly concordant with MGIT-960 culture results (Kappa value=0.086), and the sensitivity, the specificity, the positive predictive value and the negative predictive value of Peng’s vessel acid-fast staining were 54.76%, 55.00%, 71.88% and 36.67% respectively. Conclusion SAT results can be used as good indices during the monitoring therapeutic effects of drugs used for the first-time retreatment in patients with sputum smear-positive pulmonary tuberculosis, which is worth promoting.

Objective To investigate the relationship between subclinical hypothyroidism (SCH) and visceral adipose tissue. Methods A total of 68 SCH subjects from medical examination center and inpatient department of our hospital and 100 healthy controls matched for age and sex were enrolled in this study. The patient gender, blood pressure (SBP/DBP), anthropometric measurements, lipid profile, lipid accumulation product (LAP) and visceral adipose area (VA) were compared between two groups. The Sperman’s correlation was used to analyze the correlation between thyroid stimulating hormone (TSH) and variables, and the Binary logistic regression analysis was used to analyze the impact of variables on SCH. Results The waist circumference (WC), waist to hip ratio (WHR), non high density lipoprotein cholesterol (nonHDL-C), three acylglycerol (TG), TSH, LAP and VA were higher in SCH subjects than that in the healthy controls (P＜0.05), while HDL-C was lower in SCH subjects (P＜0.05). There were no significant differences in sex, age, body mass index (BMI), SBP, DBP, total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) between two groups (P<0.05). Correlation analysis showed that TSH was positively correlated with WC, TG, nonHDL-C, LAP and VA, and negatively correlated with HDL-C (P＜0.05). There was no significant correlation between TSH and age, BMI, WHR, TC and LDL-C (P> 0.05). Binary logistic regression analysis showed that female and low level of HDL-C were risk factors of SCH, while the effects of VA and LAP on SCH were not statistically significant. Conclusion Our findings show that the dyslipidemia and VA increase are more serious in subjects with SCH than those with normal thyroid function and healthy controls, which suggest that SCH is closely related to abdominal obesity.

Objective To investigate the association between neutrophil to lymphocyte ratio (NLR) and the severity of coronary artery disease in patients with acute coronary syndrome (ACS), and analyze the value of NLR in the diagnosis of acute myocardial infarction. Methods The clinical data of 259 ACS patients with coronary angiography at our hospital from November 2016 to March 2017 were retrospectively analyzed. Among them, there were 148 cases of unstable angina (UA group), 46 cases of acute non-ST elevation myocardial infarction (NSTEMI group), and 65 cases of acute ST-elevation myocardial infarction (STEMI group). The differences of white blood cell count (WBC), neutrophil counts (N), lymphocyte count (L), NLR, hypersensitive c-reactive protein (hs-CRP), myocardial enzyme spectrum, blood lipids, blood glucose, and liver function were compared between the three groups. According to the results of coronary angiography, patients were divided into single-vessel disease group (n=70), double-vessel disease group (n=70) and three-vessel disease group (n=119) in the basis of the number of coronary lesions, and the differences in inflammatory cells were compared between the different-number vessel lesion groups. At the same time, the receiver operating characteristic (ROC) curves of NLR were drawn to evaluate the predictive values of NLR for acute myocardial infarction. Results The levels of WBC, N, NLR, hs- CRP, cTnT, CK and CK-MB were significantly higher in turn in UA group, NSTEMI group and STEMI group (P＜0.05). NLR increased gradually with the increased numbers of stenosed coronary artery. The ROC curve showed that the area under the curve of NLR was 0.865 (95%CI: 0.814-0.916)． In addition, the optimal cutoff value of NLR in predicting acute myocardial infarction was 4.22 with sensitivity of 72.1% and specificity of 95.3%. Conclusion NLR levels are positively correlated with the severity of ACS, and which have high value for the diagnosis of acute myocardial infarction, and can be used as a predictor of the condition of ACS patients.

To explore the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of upper gastrointestinal bleeding in patients with hepatocirrhosis. Methods Totally 75 hepatocirrhosis patients with upper gastrointestinal bleeding accepted TIPS treatment in our institution from March 2012-March 2017 were collected retrospectively in this study. Patients were divided into two groups, the control group (n=35) underwent conservative treatment, and the TIPS group (n=75) received TIPS treatment on the basis of conservative therapy. Indexes of portal venous pressure, portal vein diameter, portal velocity, platelet count (PLT), erythrocyte count (RBC), albumin (ALB), total bilirubin (TBIL), glutamic-pyruvic transaminase (ALT), and glutamic-oxalacetic transaminase (AST) before and after operation were compared between two groups. Data of survival rate, rehaemorrhage rate and living quality after the operation were followed up, and which were compared between the two groups. Results Totally 75 patients received TIPS and were all successful, with the technical success rate 100%. There were no patients died during the perioperative period. No serious complications such as cardiac tamponade, hematocelia and biliary fistula were found. Compared with pre-operation, portal venous pressure and portal vein diameter were significantly decreased, and portal velocity was increased after operation (P＜0.05). Totally 11 patients were dead during the follow-up period, with fatality rate 14.7%. Original unobstructed rate of TIPS runner at 3, 6, 12, 24 and 36 months were 95.6%, 90.1%, 85.7%, 79.0%, and 74.2% respectively. Compared with pre-operation, indexes of PLT, RBC and ALB at 6 months after surgery were improved (P＜0.05). Whereas there were no significant differences in TBIL, ALT and AST before and after operation (P＞0.05). There were no significant differences in accumulate survival rates at 3, 6, 12, 24 and 36 months between control group (94.3%, 91.3%, 75.8%, 71.0%, and 59.2% respectively) and TIPS group (98.7%, 97.3%, 95.7%, 83.4%, and 70.6% respectively, Log-rank χ2=2.743, P=0.098). Accumulate rehaemorrhage rates at 3, 6, 12, 24, and 36 months were 5.7%, 17.1%, 23.5%, 31.9%, and 43.2% respectively in the control group, and they were 2.7%, 4.0%, 8.3%, 14.4%, and 24.0% respectively in the TIPS group. There were significant differences in accumulate rehaemorrhage rates between the two groups (Log-rank χ2=4.608, P=0.032). Compared with control group, indicators of living quality were improved at 6 months after surgery in the TIPS group (P＜0.05). Conclusion TIPS is safe and effective for cirrhosis patients with upper gastrointestinal bleeding. Compared with conservative treatment, TIPS can decrease rehaemorrhage rate and improve living quality of patients.

Objective To discuss the etiology, clinical features, imaging manifestations, treatment principles and prognosis of the orbital infectious diseases. Methods Thirty-four patients with orbital infectious diseases hospitalized in Tianjin Medical University Eye Hospital from August 2011 to October 2017 were collected and retrospectively analyzed. We analyzed clinical data of patients including the etiologies, types of the infection, imaging manifestations, treatments and prognoses. Relsults There were 21 patients with orbital abscesses, 13 patients with orbital cellulitis only, no abscess formation. The main cause of the orbital infectious patients disease was related to paranasal sinusitis, others included furuncles of eyelid skin, dacryocystitis, trauma, entophthalmia, odontogenic infection, nosocomial infection and systemic diseases. Twenty-two cases were operated, and 12 cases were treated conservatively. Thirty (30/34) cases acquired well prognoses without serious complications, except 1 occurred central retinal artery and vein occlusion, and 3 were treated by ophthalmectomy and lost their visual function permanently. The CT imaging of orbital infectious diseases showed the swelling, increased density, diffuse inflammation and unclear boundaries of the involved tissues. The imaging of orbital abscesses showed that in addition to inflammation, the abscesses and the masses were obvious in the orbit. MR generally showed long T1 and long T2 signals. Conclusion There are many causes of orbital infectious diseases, and the course progresses rapidly. With the help of imaging examination, it can accurately locates the infection, and shows the type and range, and comprehensively evaluates the disease in combination with clinical features. Anti-infection and etiological therapy are crucial factors, if necessary, surgery and multiple department treatment should be combined to avoid serious complications.

Objective To compare the therapeutic effect of epithelial flap removed laser subepithelial keratomileusis (LASEK) and femtosecond laser assisted LASIK (FS-LASIK) in the treatment of moderate and low myopia. Methods A total of 103 patients (103 eyes) of low and moderate myopia were selected, 51 patients (51 eyes) were treated with LASEK and 52 patients (52 eyes) were treated with FS-LASIK. Data of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), residual equivalent spherical degree (SE), total high-order aberrations (HOAs), spherical aberration, coma and trefoil were examined before operation and 1month and 3 months after operation, and compared between two groups of patients. Results There were no significant differences in UCVA and BCVA 1 month and 3 months postoperatively between the two groups. SE shifted to myopia direction in LASEK group compared with that of FS-LASIK group 1 month postoperatively (P＜0.05), but reached a similar level 3 months after surgery. The HOAs and spherical aberration were significantly increased 1 month and 3 months postoperatively compared with those before operation in LASEK and FSLASIK groups (P＜0.05). Coma was significantly increased 1 month postoperatively in FS- LASIK group and returned to the preoperative level 3 months postoperatively, while it remained at baseline 1 month and 3 months postoperatively in the LASEK group. The HOAs and coma were significantly higher 1 month postoperatively in FS-LASIK group compared to those of LASEK group (P＜0.05), while they reached a similar level 3 months postoperatively. Conclusion The therapeutic effect of epithelial flap removed LASEK can reach a level equal to FS-LASIK at the early stage after surgery. It is a good selectable choice for patients with low to moderate myopia.

Objective To summarize the experience of combined application of low and high frequency ultrasound in the diagnosis of acute primary epiploic appendagitis. Methods The clinical data of 130 patients with acute primary epiploic appendagitis confirmed by operation or other clinical examinations were retrospectively analyzed. Results All the 130 patients were found homogenous or heterogeneous solid block in the area of the abdominal pressure point. Four patients were treated by operation and 126 patients were cured by symptomatic supportive treatment. There were no serious complications in all patients. Conclusion Ultrasonography plays an important role in the diagnosis and differential diagnosis of acute primary epiploic appendagitis.

Objective To improve diagnostic and therapeutic levels of pneumocystis pneumonia (PCP) in non-HIVinfected patients. Methods The clinical data (including clinical manifestation，laboratory examination, imaging features, diagnosis, treatment and prognosis) of sixteen non-HIV-infected patients with acute respiratory failure caused by PCP who were diagnosed in our intensive care units (ICU) during January 2015 to December 2017, were summarized and discussed. Results Almost all patients were immunocompromised by hormone or immunosuppresant before PCP (15/16). Fever, dry cough, and dyspnea were the first symptoms in all patients. The development of PCP was rapid. All patients showed acute respiratory failure [oxygen index: (85.8±16.8) mmHg]. Invasive ventilator support was required in 11 patients (68.8%), high flow oxygen therapy was used in 5 patients (31.2%). The chest CT characteristics indicated diffuse ground glass opacity. Two patients were found methenamine silver-stained positive in bronchoalveolar lavage fluid. Sixteen cases were positive for pneumocystis detected by PCR. Sixteen patients were treated with compound sulfonamide (SMZco)，caspofungin and corticosteroid. Eight patients were cured, 7 died and 1 case was given up and then died. The ICU length of stay was 3-29 days, average days (13.0±7.1). Conclusion PCP is a kind of opportunistic infection among patients who are treated with immunosuppressive agents. SMZco combined with caspofungin and corticosteroid is effective in the treatment of severe PCP patients.

Objective To observe the effect of dezocine combined with dexmedetomidine on reducing adverse reaction of hyperthermic intraperitoneal chemotherapy (HIPEC) after intestinal operation, and provide reference for clinical application. Methods A total of 80 patients with HIPEC were divided into intervention group and routine group according to different methods of sedation and analgesia. On the basis of routine sedation and analgesia，the 5 mg muscle injection of dizocine was given for patients in intervention group, and normal saline 48 mL+ dexmedetomidine 200 μg were continuously pumped at 0.3 μg/(kg·h) until the end of the HIPEC. The occurrence of adverse reactions in HIPEC was compared between the two groups of patients. Results Results showed that the heart rates [(83.34±8.25) times/min vs. (90.11±10.69) times/ min] and body temperature [(37.33±0.42)℃ vs. (37.95±0.51)℃] were significantly lower in the intervention group than those of routine group (P＜0.01). The incidence rates of nausea, vomiting, pain and irritability were significantly lower in the intervention group than those of routine group (P＜0.05). Conclusion Dezocine combined with dexmedetomidine can significantly reduce the incidence of adverse reactions in patients undergoing HIPEC after intestinal surgery.