Objective To investigate the clinical significance of lateral position ventilation in the treatment of invasive ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods From October 2014 to December 2016, 60 eligible patients with AECOPD who meeting the inclusion criteria were randomly assigned to an intervention group (n=30) or a control group (n=30). Expectorant, antiasthmatic, anti-infective, invasive ventilation, bronchoscopy, analgesic sedation, invasive-noninvasive sequential ventilation, nutritional support, intensive care and other treatment were conducted in two groups, but lateral position ventilation was subsequently performed in the intervention group and the control group used half lateral position. Outcome measurements included pH, PaO2/FiO2, arterial partial pressure of carbon dioxide (PaCO2), heart rate (HR), respiratory rate (R) and air way resistance (Raw) before and one day after invasive ventilation, and duration of control of pulmonary infection (PIC), invasive mechanic ventilation (IMV), mechanic ventilation (MV) and intensive care unit (ICU) stay. Results Compared with before ventilation, the levels of PaO2/FiO2, PaCO2, HR, R and Raw were significantly changed in two groups after ventilation (P<0.05). One day later after ventilation, pH [interventionvs. control: (7.43±0.07) vs. (7.37±0.11)], PaO2/FiO2[(253.52±65.33) mm Hg (1 mm Hg=0.133 kPa) vs. (215.46±58.72) mm Hg] and PaCO2 [(52.45±7.15) mm Hg vs. (59.39±8.44) mm Hg] were statistically significant (P<0.05), but no significant difference was found in HR, R or Raw between two groups (P>0.05). Compared with the control group, PIC [(3.7±1.4) daysvs. (5.3±2.2) days], IMV [(4.0±1.5) days vs. (6.1±3.0) days], MV [(4.7±2.0) days vs. (7.3±3.7) days] and ICU stay [(6.2±2.1) days vs. (8.5±4.2) days] were significantly decreased (P<0.05) in the intervention group. Conclusions In AECOPD patients, invasive ventilation using lateral position ventilation can significantly improve arterial blood gas index, decrease Raw, shorten the time of PIC, IMV, MV and ICU stay.
Objective To evaluate the effects of prophylactic ondansetron for preventing intrathecal opioid induced pruritus. Methods According to the Cochrane Handbook, such databases as The Cochrane Library, OVID, EMbase, PubMed, CNKI and CBM were searched to collect the randomized controlled trials (RCTs) about ondansetron for preventing intrathecal opioid induced pruritus. According to the predefined inclusion and exclusion criteria, the literatures were screened, and meta-analysis was conducted by using RevMan 5.0 software. Results Eight RCTs involving 577 patients were included. The quality evaluation showed the bias of all studies was unclear. Meta-analysis showed that because the heterogeneity of the included studies was so large (P=0.0001, I2=80%), subgroup analyses were performed. The subgroup analyses on surgery methods showed no statistical heterogeneity among all subgroups. a) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in arthroscopic knee or urologic surgery (RR=0.49, 95%CI 0.35 to 0.67); b) There was no significant difference in incidence rate of pruritus between the ondansetron group and the control group in obstetric surgery (RR=0.98, 95%CI 0.86 to 1.12); c) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in gynecologic surgery (RR=0.51, 95%CI 0.34 to 0.76); and d) There was no significant difference in the incidence rate of pruritus between the ondansetron group and the control group in outpatient surgery (RR=0.49, 95%CI 0.35 to 0.67). Conclusion The subgroup analyses performed because of the large heterogeneity of the included studies indicate that ondansetron can prevent the intrathecal opioid induced pruritus in arthroscopic knee, urologic and gynecological surgeries rather than obstetric and outpatient surgeries. Due to the small scale, large heterogeneity and unclear quality evaluation of the included studies, more high quality RCTs are required to provide reliable evidence.
With the flourishing career of scientific research, the number of medical literature is in the explosion of growth. According to the statistics revealed by the Royal Society in March 2011, it showed that the proportion of published literature in China increased from 4.4% at the beginning of this century to 12.2%, and leaped into the second rank of the world. But the citations lagged behind the growth in number. In addition, the quality of medical literature relates to the reliability of results. Therefore, how to evaluate and improve the quality of medical literature is important. This paper will present some evaluation methods of credible medical literatures.
Objective To explore the methods of intervention for street-based female sex workers (FSWs) by assessing the intervention process, and evaluate the effectiveness. Methods By cluster sampling procedure, many streetbased female sex workers in Yuzhong district were intervened systematically after informed consent. Before and after the intervention, questionnaire survey was conducted to understand their KAP towards AIDS and analyzed the results of the questionnaire and the effectiveness of intervention. Results The recognition rate abut AIDS knowledge was improved markedly, from the previous 28% to the later 70.5%; condom use in last act increased the previous 59% to the later 75%, consistent use in recent month changed from 4% to 26%; Peer education was trained. Conclusion systematical intervention among street-based female sex workers is critical for spread of AIDS.
目的 探讨子宫动脉化疗栓塞在剖宫产术后子宫切口妊娠治疗中的可行性和安全性。 方法 回顾分析2006年7月－2011年3月收治的152例剖宫产切口瘢痕妊娠行介入治疗的病例资料。 结果 152例子宫动脉化疗栓塞操作均成功。阴道大出血或不规则出血均得到有效控制。人绒毛膜促性腺激素β亚型较术前下降，差异有统计学意义（Z=−9.295，P=0.000），术后2～22 d行清宫术，术中失血3～100 mL，平均27 mL。3例行子宫切除术，子宫切除率2%。1例发生栓子脱落导致左下肢胫前动脉栓塞并发症。 结论 子宫动脉化疗栓塞治疗剖宫产术后切口妊娠可有效控制大出血、降低清宫风险、降低子宫切除风险，是治疗切口妊娠的有效可行方法之一。
The pharmacy management of medical institutions is the basic condition for the pharmacy management of medical alliances. There are many common factors in the pharmacy management of each medical institution, and these common factors are the basic conditions for the pharmacy management of medical alliances. The pharmacy management of a medical alliance is composed of both shared aspects and aspects that meet the individual needs of different medical institutions. There are many problems in the primary medical institutions of the medical alliances, such as obsolete concepts of pharmacy management and weak pharmaceutical service capabilities. Pharmaceutical information collection is an important part in the pharmacy management of medical institutions, which can connect all aspects and better reflect the advantages of the special organization of the medical alliances. This paper explores pharmacy management in medical consortia for the specific organisational form of medical alliances, examines the basic situation of pharmacy management in different medical institutions in medical consortia, analyzes the basic conditions and basic characteristics of pharmacy management in medical consortia, so as to find a breakthrough in pharmacy management in medical consortia.
Objective To investigate the clinical features of lower respiratory tract infection caused by hypermastigote. Methods The clinical manifestations, chest imaging characteristics, fiber bronchoscopic and etiological test results were analyzed in 16 patients with hypermastigote infection in lower respiratory tract. Results In 16 patients with hypermastigote infection in lower respiratory tract, fever were present in all the cases, cough in 15 cases, night sweat in 12 cases, wheezing in 3 cases, and eosinophilia in 3 cases.Alive hypermastigotes were found in respiratory tract secretion in all the 16 cases. Bacterial culture of respiratory tract secretion yielded positive results in 8 of 16 cases. Chest imaging showed infiltrations in several lobes and segments or a large opacity with fuzzy patches. Bronchoscopy showed an acute inflammation in the respiratory tract lumen. Prognosis was good with the therapy of Metronidazole. Conclusions Detection of hypermastigote infection in lower respiratory tract have a definite clinical significance in Shenzhen area. Mixed infection is common in hypermastigote infection of lower respiratory tract.
Objective To design an open shape memory alloy artificial vertebral body that can be used to reconstruct the vertebral body in spine diseases, such as thoracic-lumbar spine tumors, burst fracture of the vertebrae, kyphosis and scol iosis, and to evaluate the biomechanical stabil ity of lumbar functional segment unit after insertion with the shape memoryalloy artificial vertebral body. Methods The open shape memory alloy artificial vertebral body with nickel-titanium (NiTi)alloy was made. Eight fresh spine specimens (T14-L5) from normal adult porcine were used to detect the range of motion (ROM) in 4 models and were divided into 4 groups: intact vertebrae served as group A; pedicle screw fixation of T15, L1, L3, and L4 was given in group B; after total resection of L2, it was reconstructed by open shape memory alloy artificial vertebral body combined with pedicle screw fixation of T15, L1, L3, and L4 in group C; and after total resection of L2, it was reconstructed by titanium cage vertebral body combined with pedicle screw fixation of T15, L1, L3, and L4 in group D. The three-dimensional ROM of flexion, extension, left/right lateral bending, and left/right rotation in T15-L1, L1-3, and L3,4 segments were detected in turn by the spinal three-dimensional test machine MTS-858 (load 0-8 N•m). Results Compared with group A, groups B, C, and D had good stabil ity in flexion, extension, left/right lateral bending, and left/right rotation, showing significant differences (P lt; 0.05). There was no significant difference in the degree of each motion between group B and group C (P gt; 0.05). Group C had less degree of motion in T15-L1 and L3,4 segments than group D, showing significant differences (P lt; 0.05), but there was no significant difference in L1-3 segment (P gt; 0.05). Conclusion The open shape memory alloy artificial vertebral body has a reasonable structure and good biomechanical stabil ity, it can be used to stabil ize the spinal segment with pedicle screw fixation.
Objective To investigate the molecular signal mechanism of transform growth factor (TGF)-β induced arterial endothelial-mesenchymal transition. Methods Rat arterial endothelial cells were primarily cultured by ex-transplant method. The endothelial cells were incubated by combinant TGF-β (10 ng/mL) for 48 hours and then were detected by immunofluorescence staining and western blotting to observe the cell surface marker expression profile and Akt/mTOR signal activation. On the other hand, the endothelial cells were preincubated by Ly294002 (20 μmol/L) and rapamycin (10 nmol/L) to inhibit the Akt/mTOR signal, and then the cells were further treated with TGF-β (10 ng/mL) for 48 hours to observe the cell surface marker expression profile without Akt/mTOR signal activation. Results Rat artery endothelial cells by TGF-β after incubation, the expressions of smooth muscle cell markers α-smooth muscle actin (α-SMA) and smooth muscle-22α (SM-22α) were up-regulated, and the endothelial cell markers CD31 and vW factor were significantly down-regulated, at the same time, the expressions of phosphorylated Akt and mTOR were also up-regulated. However, after preincubation of Ly294002 (20 μmol/L) and rapamycin (10 nmol/L) to inhibit the phosphorylation of Akt and mTOR signal, above TGF-β-induced expressions of α-SMA and SM-22α in arterial endothelial cells were significantly suppressed and the expressions of CD31 and vWF were preserved. Conclusion TGF-β-induced arterial endothelial-mesenchymal transition is dependent on activation of Akt/mTOR signal, suggesting that Akt/mTOR-dependent arterial endothelial-mesenchymal transition would be one of the mechanisms for intima hyperplasia in transplant arteriosclerosis.
Objective To evaluate the safety and efficacy of laparoscopic-assisted gastrectomy (LAG) comparing with conventional open gastrectomy (COG) in elderly patients with gastric cancer. Methods Databases included PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP were searched to collect the case-control studies about LAG versus COG for elderly patients with gastric cancer, and the searched time was from inception to May 2017. Then meta-analysis was performed by using RevMan 5.2 software. Results Finally, ten case-control studies included 1 522 patients were enrolled. There were 757 patients in observation group (underwent LAG) and 765 patients in control group (underwent COG). Results of meta-analysis showed that: the observation group was associated with less intraoperative blood loss ［MD=–121.12, 95% CI was (–179.93, –62.31), P<0.000 1］, more harvested lymph nodes ［MD=1.62, 95% CI was (0.60, 2.65), P=0.002］, shorter time to the first ambulation ［SMD=–2.58, 95% CI was(–4.58, –0.58), P=0.01］, shorter the postoperative intestinal function recovery time ［SMD=–0.85, 95% CI was (–1.20, –0.51), P<0.000 01］, shorter the time of oral intake ［MD=–0.90, 95% CIwas (–1.27, –0.52), P<0.000 01］, shorter hospital stay ［MD=–4.03,95% CI was (–5.62, –2.44), P<0.000 01］, lower incidences of overall postoperative complications ［OR=0.49, 95% CI was (0.38,0.64), P<0.000 01］, surgical-related complications ［OR=0.54, 95% CI was (0.39, 0.74), P=0.000 1］, incision relatedcomplications ［OR=0.42, 95% CI was (0.22, 0.81), P=0.010］, and respiratory complications ［OR=0.60, 95% CI was (0.38, 0.95), P=0.03］, but there was no significant difference on the operative time ［MD=8.36, 95% CI was (–10.97, 27.69), P=0.40］ and incidence of anastomotic fistula ［OR=0.60, 95% CI was (0.27, 1.31), P=0.20］. Conclusions The available evidences suggest that LAG is equally safe and feasible compared with COG, it has a significant advantages in reducing intraoperative blood loss and ensuring the number of lymph node dissected during surgery, with less trauma, shorter postoperative hospital stay, lower overall postoperative complications rate, and other short-term efficacy advantages.