Objective To study the influence of clinical nutritional support on the effects of mechanical ventilation (MV), and to find the factors affecting the outcome of patients undergoing MV. Methods A case-control study was conducted. The clinical data of 235 patients undergoing MV admitted to intensive care unit (ICU) of Tongde Hospital of Zhejiang Province from January 2015 to June 2017 were retrospectively analyzed. The patients were divided into two groups according to whether weaning successfully within 7 days. The clinical data of patients in the two groups were collected including gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, underlying disease, nutritional indicators, nutritional support, and complications. The outcome of withdrawal within 7 days was served as a dependent variable, all observed indicators were served as independent variables, and Logistic regression analysis was carried out to screen the influencing factors of the weaning results within 7 days. Results 235 patients undergoing MV were enrolled, 128 patients were successfully withdrawn within 7 days, and 107 were unsuccessfully withdrawn. Compared with the successful weaning group, the patients of weaning failure group were older, and had higher APACHEⅡ score and lower albumin (Alb) and hemoglobin (Hb), more patients with internal medical underlying diseases and receiving parenteral nutrition (PN) and mixed nutrition, and the incidences of secondary infection, vomiting, abdominal distension, abnormal bowel sound, gastric retention, and diarrhea were higher. However, there was no statistical significance in gender between the two groups. The variables of statistical significance in univariate analysis were enrolled in the multifactor analysis model showing that age [odds ratio (OR) = 1.269, 95% confidence interval (95%CI) = 1.119-1.439, P < 0.001], APACHEⅡ score (OR = 1.643, 95%CI = 1.423-1.897, P < 0.001), internal medical underlying diseases (OR = 6.298, 95%CI = 4.012-9.887, P < 0.001), secondary infection (OR = 8.323, 95%CI = 2.568-26.975, P < 0.001), abdominal distension (OR = 3.368, 95%CI = 1.586-7.152, P = 0.002), abnormal bowel sounds (OR = 2.856, 95%CI = 1.215-6.713, P = 0.017), gastric retention (OR = 1.996, 95%CI = 1.183-3.368, P = 0.010), diarrhea (OR = 3.035, 95%CI = 1.337-6.890, P = 0.008) were risk factors for unsuccessful weaning,and compared with PN, enteral nutrition (EN; OR = 0.191, 95%CI = 0.098-0.372, P < 0.001) and mixed nutrition (OR = 0.375, 95%CI = 0.150-0.938, P = 0.037) were protective factors of successful weaning. The gender, Alb and Hb before and after MV, vomiting, gastrointestinal hemorrhage were not associated with weaning outcome within 7 days. Conclusions Elder, high APACHEⅡ score, internal medical underlying diseases, or secondary infection, abdominal distension, abnormal bowel sounds, gastric retention, diarrhea were risk factors of weaning failure within 7 days in patients undergoing MV. Compared with PN, EN and mixed nutrition were protective factors for successful weaning. For patients undergoing MV, EN should be performed early in the case of full recovery, hemodynamic stability, and serious metabolic disorders.

Objective To analyze the clinical manifestation caused by local injections of botulinum toxin type A for cosmetic reason and the effect of antitoxin for adverse reaction.Methods Diagnosis and treatment process of 40 patients were retrospectively analyzed for adverse reactions due to botulinum toxin injections for beauty.Severe adverse reaction was assessed according to the patients clinical manifestation and the nervous system of physical assessment.The patients were given symptomatic treatment,observation or antitoxin therapy.Results Adverse reactions developed in 40 patients were mainly the nervous system abnormalities.Dyspnea developed in four cases.34 cases (85 ％) were given symptomatic treatment.4 cases (10 ％) were given botox treatment,and the patients were followed up for 1-3 months.The patients fully recovered to normal and did not leave any neurological sequelae.Conclusions The management of type A botulinum toxin injections should be strengthened.In case of poisoning,antitoxin therapy should be given as early as possible.

Objective To observe effect of hyperbaric oxygen (HBO) intervention on osteoporosis in rats with experimental premature ovary failureMethods Forty female Wister rats (with an age of 6 weeks) were randomly divided into 5 groups:the sham group,the deovary group,the estrin group,the HBO group and the hyperbaric air group,each consisting of 8 animals.With the exception of the sham group,all the other groups had ovariotomy bilaterally following anesthesia.One week later,the animals in the sham group and the deovary group were left there without any treatment,while the animals in the HBO group were exposed to HBO at a pressure of 0.1 MPa,one session a day for a succession of 10 days,then had one week interval every 10 sessions,with a total exposure time of 12 weeks.The animals in the hyperbaric air group were exposed to hyperbaric air at the same pressure and with the same treatment time and conditions.The animals in the estrin group received abdominal injection of estradiol benzoate once a week,for a succession of 12 weeks.After termination of the experiment,the animals of all the groups received lumbar vertebra and femora mineral density,bonc biomechanics and bone morphometry detection.Results After ovariotomy,lumbar vertebra mineral density was (0.087 8 ± 0.007 4) g/cm2 and femora mineral density was (0.114 1 ± 0.006 7) g/cm2.Lumbar vertebra biomechanics (216.32 ± 45.26) N and femora biomechanics (87.50 ± 4.01) N were significantly decreased,and statistical significance could be seen,as compared with those of the sham group [(381.58 ±28.75) N and(120 ± 16.26) N] (P ＜ 0.05).However,the levels of the above indicators did not reduce considerably and there was no significant difference,as compared with those of the sham group (P ＞ 0.05),but there was obviously significant difference in them,when it was compared with that of the hyperbaric air group (P ＞ 0.05).Conclusions HBO could delay the loss of bone mineral density and the reduced property of bone biomechanics in ovarectomized rats,and it had certain protective effect on the occurrence of osteoporosis after menopause.

Objective To observe effect of hyperbaric oxygen (HBO) intervention on osteoporosis in rats with experimental premature ovary failureMethods Forty female Wister rats (with an age of 6 weeks) were randomly divided into 5 groups:the sham group,the deovary group,the estrin group,the HBO group and the hyperbaric air group,each consisting of 8 animals.With the exception of the sham group,all the other groups had ovariotomy bilaterally following anesthesia.One week later,the animals in the sham group and the deovary group were left there without any treatment,while the animals in the HBO group were exposed to HBO at a pressure of 0.1 MPa,one session a day for a succession of 10 days,then had one week interval every 10 sessions,with a total exposure time of 12 weeks.The animals in the hyperbaric air group were exposed to hyperbaric air at the same pressure and with the same treatment time and conditions.The animals in the estrin group received abdominal injection of estradiol benzoate once a week,for a succession of 12 weeks.After termination of the experiment,the animals of all the groups received lumbar vertebra and femora mineral density,bonc biomechanics and bone morphometry detection.Results After ovariotomy,lumbar vertebra mineral density was (0.087 8 ± 0.007 4) g/cm2 and femora mineral density was (0.114 1 ± 0.006 7) g/cm2.Lumbar vertebra biomechanics (216.32 ± 45.26) N and femora biomechanics (87.50 ± 4.01) N were significantly decreased,and statistical significance could be seen,as compared with those of the sham group [(381.58 ±28.75) N and(120 ± 16.26) N] (P ＜ 0.05).However,the levels of the above indicators did not reduce considerably and there was no significant difference,as compared with those of the sham group (P ＞ 0.05),but there was obviously significant difference in them,when it was compared with that of the hyperbaric air group (P ＞ 0.05).Conclusions HBO could delay the loss of bone mineral density and the reduced property of bone biomechanics in ovarectomized rats,and it had certain protective effect on the occurrence of osteoporosis after menopause.

Objective To investigate the effect of continuous veno-venous hemofiltration (CVVH) on pulmonary vascular permeability in the early stage of septic shock.Methods Fifty-one patients of septic shock admitted in intensive care unit of the First Affiliated Hopsital of Medical College,Zhejiang University between June 2010 and December 2011 were randomized into two groups by simple random method.Routine treatment was carried out to patients in group A,and routine treatment plus CVVH to patients in group B in the first 72 hours.Repeated respiratory mechanic hemodynamic measurements were done at baseline (Tb) before treatment,at 48 hours (T48) and 72 hours (T72) after the treatment.Pulmonary compliance (Cst),platform pressure (Pplat),oxygenation index (PaO2/FiO2),extravascular lung water index (EVLWI) and E-selectin determined at each time point were recorded in two groups.Results (1) Pplat were decreased significantly after treatment in two groups,and the Pplat in group B were all lower than those in group A at T48 and T72 (t =2.215,P ＜ 0.05 ; t =4.266,P ＜ 0.01).Cst were elevated after treatment in two groups,and Cst in group B were all higher than those in group A at T48 and T72 (t =2.516,P ＜0.05 ; t =3.052,P ＜ 0.01).(2) Compared to before treatment,PaO2/FiO2 increased significantly after treatment in two groups,and PaO2/FiO2 in group B were all higher than those in group A at T48 and T72 (t =2.732,P ＜0.01 ; t =3.511,P ＜0.01).(3) EVLWI were decreased significantly after treatment in two groups,and the EVLWI in group B were all lower than those in group A at T48 and T72 (t =2.597,P ＜0.05; t =2.125,P ＜ 0.05).ITBVI,CI,SVRI and MAP did not change over time in two groups compared with those at Tb (all P ＞ 0.05).(4) E-selectin were decreased significantly after treatment in two groups,and the E-selectin in group B were all lower than those in group A at T48 and T72 (t =2.154,P ＜0.05 ; t =3.581,P ＜ 0.01).Conclusion CVVH in early stage of septic shock can improve pulmonary vascular permeability and oxygenation,increase Cst,and decline EVLWI,with neither increased hemodynamics.

Objective: To observe the curative and side effects on malignant pleural effusion treated with Ya Dan Zhi's grease (YDZ) and DDP by injecting chest. Methods:Patients were divided into 3 groups randomly: treatment group (24 patients of MPE, injected to chest with DDP60mg and YDZ80mL once every week)、YDZ group (25 patients)、DDP group (23 patients), observing the effects、strength improvement and the side effects.Results: The toltal effective rates in the treatment group was 88.33% and YDZ group 56%、DDP group 56.52% respectively ( P