简介：Inprimarymitralregurgitationthereareanatomicabnormalitiesofthemitralvalvecausingbackwardflow,placingahemodynamicburdenontheleftventricle.Ifthisburdenissevereandprolonged,itleadstoleftventriculardamage,heartfailure,anddeath.Thepreferredtherapyisrestorationofmitralcompetencethroughmitralvalverepair,whichissaferthanmitralvalvereplacement.Whenrepairisperformedinatimelyfashion,lifespancanbereturnedtothatofanormalindividual.Triggersfortimelyrepairincludetheonsetofsymptomsandevidenceofleftventriculardysfunctionasdeterminedbyejectionfractionfallingtoward60%and/orend-systolicdimensionincreasingtoward40mm.

简介：Objective:Toassessthetherapeuticeffectofulinastatinonseverecraniocerebralinjuriesandtoexploreitsmechanism.Methods:Therewere87casesofseverebraininjuryinthisseriesandtheywereeithertreatedbyulinastatin(treatmentgroup,41cases)ornot(controlgroup,46cases)besidesroutinemanagements.WeestimatedC-reactiveprotein,interleukin-6,superoxidedismutase,andendothelinfromplasmasofallthecasesonthe1st,3rd,5th,and7thdayafterinjury.Results:C-reactiveproteinlevelroseonthe1stand3rddayafterinjuryinthetwogroups,butdescendedintreatmentgrouponthe5thand7thdayandwassignificantlylowerthanthatincontrolgroup(P<0.01).Nosignificantdifferencewasfoundforinterleukin-6intwogroupsduring1-5daysafterinjury,butonthe7thday,itdecreasedsignificantlyintreatmentgroupthancontrolone(P<0.01).Superoxidedismutasewashigherintreatmentgroupthancontrolonein5-7daysafterinjury(P<0.01).Endothelinelevatedonthe1stdayafterinjurybutdroppedafterwardsinthetwogroups,inwhichthelevelintreatmentgroupwaslowerthanthatincontrolone.Theincidenceofgastrointestinalhemorrhagewaslowerintreatmentgroupthancontrolone(P<0.01).Conclusions:Ulinastatinhasthefunctionofprotectingcerebraltissue,reducingtheincidenceofgastrointestinalhemorrhage,improvinghepaticandrenalfunctionandprognosis.

简介：Objective:Toprobeintoeffectivesurgicalproceduresandimprovetheoutcomeoftreatmentforpatientswithseverehepaticinjury.Methods:Aretrospectivestudyinvolving113patientswithseverehepatictrauma(AASTgradeIVandV)duringthepast12yearswascarriedout.Ninety-eightpatientsunderwentsurgicaltreatment.SurgicalinterventionsincludinghepatectomyordirectcontrolofbleedingvesselsbyfingerfracturetechniquewithPringlemaneuver,selectiveligationofhepaticartery,retrohepaticcavalrepairwithtotalhepaticvascularocclusion,andperihepaticpackingweremainlyused.Results:Inthe98patientstreatedoperatively,thesurvivalratewas69.4%(68/98).Among40patientswithjuxtahepaticvenousinjury(JHVI),15werecuredwiththemaximumbloodtransfusionof12000ml.EightcasesofGradeIVinjurytreatednonoperativelywerecured.Thepercentageoffailureofnonoperativemanagementwas42.9%(6/14).Theoverallmortalityratewas32.7%(37/113),and57%ofthedeathswereduetoexsanguination.Conclusions:Reasonablesurgicalproceduresbasedonclassificationofhepaticinjuriescanincreasethesurvivalrateofseverelivertrauma.AccurateperihepaticpackingiseffectiveindealingwithJHVI.

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简介：AbstractSevere asthma is "asthma which requires treatment with high dose inhaled corticosteroids (ICS) plus a second controller (and/or systemic corticosteroids) to prevent it from becoming 'uncontrolled’ or which remains 'uncontrolled’ despite this therapy." The state of control was defined by symptoms, exacerbations and the degree of airflow obstruction. Therefore, for the diagnosis of severe asthma, it is important to have evidence for a diagnosis of asthma with an assessment of its severity, followed by a review of comorbidities, risk factors, triggers and an assessment of whether treatment is commensurate with severity, whether the prescribed treatments have been adhered to and whether inhaled therapy has been properly administered. Phenotyping of severe asthma has been introduced with the definition of a severe eosinophilic asthma phenotype characterized by recurrent exacerbations despite being on high dose ICS and sometimes oral corticosteroids, with a high blood eosinophil count and a raised level of nitric oxide in exhaled breath. This phenotype has been associated with a Type-2 (T2) inflammatory profile with expression of interleukin (IL)-4, IL-5, and IL-13. Molecular phenotyping has also revealed non-T2 inflammatory phenotypes such as Type-1 or Type-17 driven phenotypes. Antibody treatments targeted at the T2 targets such as anti-IL5, anti-IL5Rα, and anti-IL4Rα antibodies are now available for treating severe eosinophilic asthma, in addition to anti-immunoglobulin E antibody for severe allergic asthma. No targeted treatments are currently available for non-T2 inflammatory phenotypes. Long-term azithromycin and bronchial thermoplasty may be considered. The future lies with molecular phenotyping of the airway inflammatory process to refine asthma endotypes for precision medicine.

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简介：AsknownfromtheSouthernPowerGrid,theGridisinamoreseveresituationofpowersupplythisyearthanlastyear.Itsbiggestpowergapisestimatedat7800MW,anincreaseof2800MWascomparedtothatof2004;andelectricenergygapat3.5TWh,anincreaseof15TWh.GuangdongProvince'spowergapwillreachabout4500MW.

简介：Objective:Toimprovethediagnosisandtreatmentofseverecerebralfatembolism(SCFE).Methods:ThedataofninepatientswithSCFEwereretrospectivelyanalyzed.Themanifestationsofthecentralnervesystem,respiratorysystemandhemorrhagewererecorded,atthesametime,accessoryexaminationincludingarterialoxygen,fatmacroglobulesinvenousbloodandimageexaminationwasadapted.Thepatientsweretreatedwithexopexy,pharmocotherapyandoxygentherapy.Results:Twooftheninepatientsdiedofseverecomplications,theothersevenrecoveredwithoutseveresequela.Conclusions:GurdstandardshouldbeimprovedforearlydiagnosisofSCFE.Ifsverecomplicationscanbeprevented,patientswhoreceiveearlytreatmentwillhavefavourableprognosis.

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简介：Objective:Toinvestigatetheeffectof360-degreeretinectomyforsevereocularruptureandevaluatetherelatedfactorsassociatedwithprognosis.Methods:Aretrospectiveanalysiswasperformedon28consecutivepatients,18menand10women,withsevereocularruptureadmittedtotheChinesePLAGeneralHospitalbetweenJanuary1999andJanuary2002.Thepatients'agesrangedfrom16to58years,mean29.5years.Alloperationswereperformedbythefirstauthor.Allpatientsunderwentstandard3-portparsplanavitrectomywithscleralencirclingbuckle,endophotocoagulation,andtamponadedwithsiliconeoil.Lensectomywereperformedon15eyes.360-degreeretinotomyandretinectomywereperformedatanteriorequatoron16eyes,andposteriorequatoron12eyes.Results:Duringoperation,allpatientswereconfirmedtohavevitreoushemorrhageandretinaldetachment,inwhichhemorrhagicciliarybodydetachmentwasfoundin9eyes,suprachoroidalhemorrhagein12eyes,retinaltwistinglikeflowerstalkin11eyes,andretinalincarcerationin17eyes.Postoperativefollow-upwasconductedin26cases,rangedfrom6monthsto46months.Retinalreattachmentachievedin20eyes(76.9%),inwhichthreepatients'retinawasreattachedafterrevitrectomy.Thesiliconeoilwasremovedatthefourthmonthin8eyespostoperatively.Correctedvisualacuityof0.02ormorewasin14eyes(70.0%)amongthe20patientswithreattachedretina.Visualacuityof0.05ormorewasin7eyes(35.0%),and0.1ormorewasin3eyes.Thebestvisualacuitywas0.3in1eye.Conclusions:Retinectomymayimprovetheprognosisofsevereocularruptureandsavethevisualfunctionofsomepatients.

简介：Infantileaphasia,frequentlyseenofterin-fantileencephalopathysuchasbraintraumaandmeningitis,belongstothecategoriesof"suddenlossofvoice"and"difficultyinspeechduetore-tractionofthetongue"inTCM.Asthereisnoeffectivespecifictherapyintreatingthisdis-easeinmodernmedicine,acupunctureissuperi-ortoothertherapiesinthetreatmentofinfantileaphasia.Inourclinicfordifficultdisease,wehavetreatedtheillnessbyacupuncturewithfili-formandmagneto-plum-blossomneedlecom-binedwithChineseherbsandtutorialmethods.Ourtherapyiseffectiveandquickinproducingtherapeuticeffectswithshorttreatmentcourse,whichisreportedindetailinthefollowing:

简介：Thecurrentulcerativecolitis(UC)treatmentalgorithminvolvesastep-uptherapeuticstrategy,mainlyaimingatinducingandmaintainingitsclinicalremission.Althoughthistherapeuticstrategymayseemtobecost-efficientandreducetheriskofsideeffects,recenttrialsandcasereportshaveshownthattop-downtherapyusingin·iximabinducesarapidclinicalresponse,enhancespatientqualityoflife,promotesmucosalhealing,reducessurgeriesandindirectcostoftreatmentforpatientswithsevereUC.Moreover,sincelong-termtreatmentwithin·iximabissafeandwelltolerated,earlyaggressivetop-downtherapeuticstrategymaybeamoreeffectiveapproach,atleastinasubgroupofsevereextensiveUCpatients.

简介：严重流行性感冒为人在它的毒力仍然保持不平常。复杂并发症或最终，从这些感染产生的死亡经常与proinflammatorycytokine生产的hyperinduction被联系，它也作为‘被知道；cytokinestorm’；。为这疾病，immunomodulatory治疗可以改进结果，这被建议了，与或没有抗病毒的代理人的联合。这里，我们考察免疫系统的各种各样的受动器怎么开始cytokine暴风雨并且在主人加重病理学的损坏的当前的文学。我们也在严重流行性感冒为cytokine暴风雨的治疗考察一些当前的immunomodulatory策略，包括corticosteroids，peroxisome激活proliferator的受体收缩筋，sphingosine-1-phosphate受体1收缩筋，cyclooxygenase-2禁止者，抗氧化剂，anti-tumour-necrosis因素治疗，静脉内的免疫球蛋白治疗，statins，arbidol，植物，并且另外的潜在的治疗学的策略。

简介：Objective:Tostudytheemergencymanagementprinciplesofseveretraumainhospital(injuryseverityscore≥16).Methods:Weused'ATPprinciple'tomanageseveretraumaticpatients.TheATPprincipleiscomposedof:1)attendingsurgeonsofferinginitialmanagement(A);2)teamworkcommencementimmediatelyafterpatientsadmittedtohospital(T);3)parallelprinciple,ie,emergencyresuscitation,evaluationandlaboratorytestperformedsimultaneously(P).ClinicaleffectsbeforeandafterapplyingATPprinciplewereretrospectivelyanalyzedandcompared.Results:DuringJanuary1,2002toDecember31,2003,338patientsweretreatedwithoutapplyingATPprinciple,inwhichISSwas25.9±6.4,152casesdiedwiththemortalitybeing39.2%,andthetimestayedinemergencydepartmentandthetimetooperationroomafteradmissionwere(102.8±16.7)min,(140.3±20.6)min,respectively.DuringJanuary1,2004toDecember31,2005,438patientsweretreatedbasedonATPprinciple,inwhichISSwas28.6±7.8,87casesdiedwiththemortalitybeing19.9%,andthetimeinemergencydepartmentandthetimetooperationroomafteradmissionwere(69.5±11.5)min,(89.6±9.3)min,respectively.ISSshowednosignificantdifferencebetweenthetwogroups(P>0.05),butthemortality,thetimestayedinemergencydepartmentandthetimetooperationroomafteradmissionweregreatlyreducedandshowedsignificantdifferencebetweenthetwogroups(P<0.05).Conclusions:ApplyingATPprincipletotreatseveretraumaticpatientscanshortenemergencytreatmenttimeinhospitalanddecreasemortality.

简介：Objective:Toexploretheriskfactorsofnosocomialinfectioninseverecraniocerebraltraumaandthewayofprevention.Methods:Theclinicaldataof387patientswithseverecraniocerebraltraumawerereviewed.Results:Thetotalnosocomialinfectionrateofthisstudywas22.99%.Pulmonarynosocomialinfectionpresentedmostfrequently.TheG-bacilliwerethemostcommoninfectiousbacteria.Themortalityrateoftheinfectiongroupwas38.20%.Conclusions:Complicationsofnosocomialinfectionaffecttheprognosisofcraniocerebraltraumapatients.Nosocomialinfectionisrelatedtotheageofthepatients,craniocerebraltraumaseverity,unreasonableutilizationofantibioticsandinvasiveoperations,suchastrachealcannula,mechanicalventilation,urethralcatheterizationanddeepvenouscatheterization.Patientswithseverecraniocerebraltraumashouldbecarefullytreatedandnursedtoavoidnosocomialinfection.Inordertoreducetherateofnosocomialinfection,intensivemeasurementshouldbeadopted.

简介：A70-year-oldmanisseenforevaluationofaheartmurmurheardbyhisprimarycareprovider.Thepatientplaysdoublestennistwiceperweekandclaimstobeasymptomatic.–Medication:amlodipineforhypertension.–Physicalexamination(PE):pulse82bpm;bloodpressure140/90mmHg.–Neck:neckveinsflat.Carotidsdelayed.–Chest:clear.–Cardiovascular:grade2/6latepeakingsystolicejectionmurmur.–Extremities:normalpulses.–Echocardiogram:heavilycalcifiedaorticvalve.Peakjetvelocity4.6m/s.Aorticvalvearea0.7cm2.Rightventricularsystolicpressurenotobtainable.

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简介：Objective:Tostudytheeffectofmethylprednisolone(MP)onreperfusioninjuryinsevereuncontrolledhemorrhagicshockandexplorethepossiblemechanisminvolved.Methods:Twelvedogswererandomlydividedintotwogroups,controlgroup(GroupI,n=6)andMPgroup(GroupII,n=6).Theanimalswerebledcontinuouslyfromafemoralarterycathetertoproduceuncontrolledhemorrhagicshockmodels.ResuscitationwithlactatedRinger's(LR)solutionwasinitiatedwhenmeanarterialpressure(MAP)decreasedto20mmHg,andMAPwasmaintainedat30-40mmHg.MP(4mg/kg)wasinjectedintravenouslyinGroupIIwhenresuscitationbegan.WhileinGroupI,normalsaline(NS)wasinjectedinstead.Thelevelsofsuperoxidedismutase(SOD)andmalondialdehyde(MDA)weremeasuredbeforeexsanguination(T1),whenMAPdecreasedto20mmHg(T2),60min(T3)and120min(T4)afterresuscitation.Heartrate,MAPandcardiacoutput(CO)levelswererecordedconcomitantly.Results:InfusionvolumeandhemorrhagevolumeshedfromthesuperiormesentericarteryinGroupIwerehigherthanthoseinGroupII(P<0.01andP<0.05).Afterreperfusion,bloodSODlevelsdecreasedprogressivelyandMDAlevelsincreasedrapidlyinGroupI.InGroupII,bloodSODlevelsatT3andT4decreasedascomparedwiththatatT1butastepwiseincreasewaspresent.AtT4,bloodSODlevelwassignificantlyhigherinGroupIIthaninGroupI(P<0.01).AtT3andT4,MDAlevelsweremarkedlylowerinGroupIIthaninGroupI.Duringreperfusion,MAPwasmoresteadyinGroupIIthaninGroupIandsurvivalrateafter120min(atT4)washigherinGroupIIthaninGroupI(P<0.05).Conclusions:MPhasaprotectiveeffectonsevereuncontrolledhemorrhagicshockandsubsequentreperfusioninjury.Themechanismmainlyinvolvestheanti-lipidperoxidationactivityofMP.

简介：AbstractIntroduction:Pityriasis rubra pilaris (PRP) is a rare chronic papulosquamous disease and is often difficult to treat, especially in children. Here we reported a PRP infant successfully treated by cyclosporine A.Case presentation:An 18-month-old infant with severe PRP presented with reddish follicular papules and inflammatory, infiltrated erythema over the whole body. The condition rapidly and completely responded to oral cyclosporine A. Complete clearance of the lesions was achieved within 16 weeks, and no recurrence developed during 6 months of follow-up. During both treatment and follow-up, routine blood parameters, serum creatinine, serum urea nitrogen, liver function, and blood pressure were regularly monitored once a month and remained within the reference ranges. Moreover, the child grew and developed normally and the body weight increased by 3 kg.Discussion:To date, there are not well established protocols for treatment of PRP in children. Cyclosporine A has been demonstrated to be effective treatment in psoriasis in adults and children which do not respond to some other treatments. The rapid onset of action and good efficacy of cyclosporine A were observed in our case, who achieved complete response after 16 weeks of treatment without any side effects.Conclusion:Cyclosporine A might be a safe and effective option for treating severe PRP in children.

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