Objective:To analyze the clinical value of dynamic electrocardiogram combined with serum brain natriuretic peptide (BNP) and creatine kinase isoenzyme (CK-MB) levels in evaluating the severity of respiratory tract infection complicated with viral myocarditis.Methods:A total of 125 patients with respiratory tract infection who were admitted to the Affiliated Run Run Shaw Hospital of Medical School, Zhejiang University from January 2018 to December 2022 were selected retrospectively. They were divided into the complication group (71 cases) and the non-complication group (54 cases) according to whether they were complicated with viral myocarditis. Dynamic and conventional electrocardiogram characteristics were compared. Serum BNP and CK-MB levels in the complication group and the non-complication group at admission were analyzed. Dynamic electrocardiograms and serum BNP and CK-MB levels of patients with different severity of myocarditis were comparatively analyzed. The value of combined diagnosis was analyzed.Results:The detection rates of atrial premature beats and sinus tachycardia by dynamic electrocardiogram were higher than those by conventional electrocardiogram: 38.03% (27/71) vs. 22.54% (16/71), 28.17% (20/71) vs. 14.08% (10/71) ( P<0.05). Serum BNP and CK-MB levels in the complication group were higher than those in the non-complication group: (104.26 ± 10.75) ng/L vs. (54.11 ± 5.69) ng/L, (17.89 ± 1.86) U/L vs. (13.46 ± 1.42) U/L ( P<0.05). The detection rates of atrial premature beats, sinus tachycardia, burst ventricular tachycardia, first-degree atrioventricular block, ST segment change and low QRS voltage, serum BNP and CK-MB levels in patients with respiratory tract infection complicated with severe viral myocarditis (37 cases) were higher than those in patients with mild viral myocarditis (34 cases): 51.35% (19/37) vs. 23.53% (8/34), 43.24% (16/37) vs. 11.76% (4/34), 32.43% (12/37) vs. 11.76% (4/34), 29.73% (11/37) vs. 8.82% (3/34), 43.24% (16/37) vs. 14.71% (5/34), 24.32% (9/37) vs. 5.88% (2/34), (107.19 ± 10.56) ng/L vs. (101.08 ± 10.18) ng/L, (18.33 ± 1.85) U/L vs. (17.41 ± 1.76) U/L ( P<0.05). Compared with clinical pathological diagnosis, Kappa values of dynamic electrocardiogram, BNP at admission, CK-MB at admission and combination of the three for diagnosing acute upper respiratory tract infection complicated with viral myocarditis were 0.784, 0.765, 0.733 and 0.879. The sensitivity and accuracy of combined diagnosis were higher. Conclusions:Dynamic electrocardiogram combined with serum BNP and CK-MB can better help to evaluate the severity of respiratory tract infection complicated with myocarditis. Therefore, they are worthy of monitoring.

Objective:To evaluate the effect of Jianpi-Huatan Decoction combined with routine western medicine of COPD patients with lung and spleen deficiency. Methods:A total of 102 patients who met the inclusion criteria from February 2017 to February 2018 were divided into two groups according to random number table method, with 51 in each group. The control group was treated with routine western medicine and the study group was treated with Jianpi-Huatan Decoction on the basis of the control group. Two groups were treated continuously for 3 months. Before and after the treatment, TCM symptoms like cough, expectoration, chest distress, wheezing, asthenia, abnormal stool and abnormal food intake were scored. Then measured FEV1 and FVC by pulmonary function instrument, calculated the value of FEV1/FVC, measured TNF-α;, IL-6 and IL-8 levels in sputum by ELISA, and evaluated its clinical effectd. Results:The total effective rate of the study group was 82.4% (42/51) and the control group was 62.8% (32/51). The difference between the two groups was statistically significant ( χ2=4.923, P=0.027). After the treatment, the scores of cough, expectoration, chest distress, wheezing, asthenia, abnormal stool and abnormal food intake in the study group were significantly lower than those in the control group ( t value were 8.705, 6.969, 9.844, 9.140, 15.540, 11.941 and 5.968, respectively, all Ps<0.01). After the treatment, FEV1 (1.97 ± 0.50 L vs. 1.58 ± 0.43 L, t=4.223), FVC (2.57 ± 0.47 L vs. 2.13 ± 0.45 L, t=4.829), value of FEV1/FVC (76.65 ± 4.11 vs. 74.18 ± 4.33, t=2.955) in the study group was significantly higher than those in the control group ( P<0.01). The levels of TNF-α, IL-6 and IL-8 in sputum of the study group were significantly lower than those in the control group ( t value were 3.917, 5.598 and 8.846, respectively, all Ps<0.01). Conclusions:Jianpi-Huatan Decoction combined with routine western medicine has a significant curative effect in treating COPD of stable period with lung and spleen deficiency, which can significantly reduce clinical symptoms, improve lung function, inhibit airway inflammation with safty.

Objective To discuss the application of early intraperitoneal perfusion combined with intravenous chemotherapy in patients with advanced colorectal cancer.Methods 100 patients with advanced colorectal cancer were randomly divided into two groups, 50 cases in each group.The control group was treated with intravenous chemotherapy alone after surgery.The observation group was given low perfusion combined with intravenous chemotherapy after surgery.The clinical effect and adverse reaction of the two groups were compared.Results The total effective rate and 3-year survival rate of the observation group(86.0%,34.0%) were significantly higher than those of the control group(68.0%,20.0%).The recurrence rate and metastasis rate of the observation group(14.0%,10.0%) were significantly lower than those of the control group(34.0%,28.0%), the differences were statistically significant(x2=4.482,4.486,5.482,5.263,all P<0.05).At the same time,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Early intraperitoneal perfusion combined with intravenous chemotherapy in the treatment of advanced colorectal cancer can improve the long term survival rate of patients,and the curative effect is accurate.Therefore,it has the value of popularization and application in clinic.

BACKGROUND:Pedicle screw implantation is a common method to repair many kinds of diseases of the lower cervical spine. Three-dimensional (3D) reconstruction visualization system can be used in order to improve the accuracy of the implant and improve the prognosis.
OBJECTIVE:To investigate the effect of 3D reconstruction visualization system on the accuracy of cervical pedicle screw implantation.
METHODS: The clinical data of 89 patients with cervical spine dislocation, who underwent cervical pedicle screw implantation, were analyzed retrospectively. Patients were divided into control group (46 cases) and observation group (43 cases) according to the navigation method. Patients in the control group underwent C arm X ray two dimensional navigation. Patients in the observation group underwent three-dimensional reconstruction visualization system navigation. Intraoperative placement time was observed, and the accuracy of screw placement was assessed in both groups. The cases were folowed up for 12 months, and the adverse events were recorded and compared.
RESULTS AND CONCLUSION: (1) Intraoperative implantation time was shorter in the observation group than in the control group, but no significant difference was found (P> 0.05). (2) Accuracy rate: There were no three types of nail cases in the observation group, and the accuracy rate was 93% (40/43). In the control group, two cases affected three types of nailing, and the accuracy rate was 81% (37/46). The accuracy rate was significantly higher in the observation group than in the control group (P < 0.05). (3) Postoperative folow-up: None suffered from nerve tissue injury to vertebral artery, blood vessel and spinal cord. The screws of the two groups were in stable condition, without screw breakage or loosening. (4) Results suggested that in lower cervical pedicle nail implantation, 3D reconstruction navigation system can effectively improve the accuracy of screw placement, and does not increase nailing time or lead to adverse events. It is a safe and effective navigation mode.

Objective To explore the value of elastography score and strain rate ratio in the diagnosis of small breast malignant focus. Methods We retrospectively analyzed 22 patients with breast small malignant foci less than 10 mm. Ultrasound characteristics were summed up in breast small cancer. Results On elastogram, 2 patients scored 3, 14 scored 4 and 6 scored 5.The average strain rate ratio of all foci was 4.76, and there was correlation between it and elastography scores. Conclusion Ultrasonic elastography has important value in the diagnosis of breast small cancer.