Objective To explore whether hospitalized elderly patients with severe communityacquired pneumonia ( SCAP) have better outcomes if they are treated with dual-therapy consisting of a β-lactam/macrolide or fluoroquinolone.Methods A prospective study was conducted in patients with SCAP aged 65 years or older between January 2007 and January 2012. These patients were assigned to a combination therapy group or a β-lactam monotherapy group by the attending physicians. Time to clinical stability( TCS) and total mortality were calculated. Prognostic factors for death were analyzed. Results Among the 232 patients, 153 patients were given β-lactam/macrolide or β-lactam/ fluoroquinolone ( macrolide in 67 patients and fluoroquinolone in 86) , while 79 were treated with β-lactam monotherapy. Compared with the monotherapy group, the combination therapy group was associated with significant decreased TCS ( median TCS, 10 days vs. 13 days) , and lower overall in-hospital mortality( 24.2% vs. 43.0%, P lt;0. 01) . Compared with fluoroquinolone, macrolide use was associated with lower ICU mortality ( 14.9% vs. 31.4% , P lt;0. 01) . Simplified acute physiology score Ⅱ, pneumonia severity index, mutilobar infiltration, and β-lactam monotherapy were confirmed as independent predictors of death. Conclusion β-lactam/macrolide or β-lactam/ fluoroquinolone combination therapy, especially with macrolide, has superiority over β-lactam monotherapy in elderly patients with SCAP, and should be recommended.
Ten cases of oblique skin defects of fin-gertips repaired by combined skin flaps werereported. The maximal length of flap ad-vancement was 2. 5cm. which could coveran area of 2.0x2. 7cm. The patients neednot to be hospitalized, Fair skin sensationand good blood supply could be obtained,and the finger could preserve maximallength. Follow- up in 8 cases showed thatthe pulps of fingers were plump with nearlynormal joint movement and two- point dis-criminatiom of 3-6mm.
OBJECTIVE To investigate the clinical result in repair of soft tissue defect with combined skin flap vascularized by pedicle on the one end and vascular anastomosis on the other end. METHODS From October 1990 to August 1995, 5 cases with soft tissue defect at the extremities and 1 cases with sacral bed sore were repaired by the combined skin flaps transfer, ranged from 15 cm x 30 cm to 16 cm x 70 cm in defect, among them, 5 cases with myocutaneous flap and 1 case with skin flap, and the size of the combined skin flaps was 15 cm x 40 cm to 12 cm x 80 cm. RESULTS All the flaps were survived with satisfactory effect. Followed up 3 to 6 years, there was no obvious complication. CONCLUSION Transfer of combined skin flaps vascularized by pedicle and vascular anastomosis is suitable to repair the soft tissue defect, especially in large area defect.
近40年来，胰腺移植在基础和临床研究方面都获得了令人振奋的长足进步。据国际胰腺移植登记中心（IPTR）记录，全球已实施了18 900余例胰腺移植（截至2002年10月），其中绝大多数在美国（近14 000例），约90%为胰肾联合移植（SPK）。迄今为止，SPK被公认是治疗糖尿病合并肾功能衰竭的最有效的方法。据报道，胰腺移植受体1年生存率超过95%，3年生存率接近90%； 移植胰腺有功能（患者不依赖胰岛素）者的1年和3年生存率分别为83%和77%。
摘要:目的: 观察腰硬联合麻醉在前列腺电切术患者中的临床应用效果。 方法 : 76例经尿道前列腺电切术患者(78±7岁)随机均分为腰硬联合麻醉组(C组)及硬膜外组(E组)。C组以腰硬联合穿刺针于L34穿刺至蛛网膜下腔后,注入05%布比卡因2 mL,通过硬膜外穿刺针置入硬膜外导管;E组行L34间隙硬膜外穿刺置管。记录麻醉起效时间、麻醉效果、麻醉前及麻醉后5、15、30分钟时血压、心率。 结果 : 所有患者均穿刺顺利,麻醉起效时间C组为36±13 min, E组68±15 min;C组麻醉效果完善率为100%,E组为95%;麻醉后两组血压均下降(〖WTBX〗P lt;005),但降幅均未超过基础值的20%;两组麻醉前及麻醉后血压、心率均无显著性差异。 结论 :腰硬联合麻醉用于前列腺电切术具有起效快、麻醉效果佳的优点。Abstract: Objective: To investigate and compare the clinical efficacy and safety of combined spinalepidural(CSEA) and epidural(EA) anesthesia on elderly patients undergoing transurethral resection of the prostate(TURP). Methods : 76 patients(78±7 years) suffering TURP were divided into two group: group CSEA(38cases) and groupEA(38 cases). The dose of bupivacaine in spinal anesthesia is 10 mg. Blood pressure(BP), heart rate(HR) and anesthesia efficacy were observed before anesthesia, 5, 15 and 30min after anesthesia. Results : BP decreased after anesthesia in two groups than before anesthesia(〖WTBX〗P lt;005). The decreases of BP were less than 20% of basises. There were no significant differents of BP and HR between two groups before and after anesthesia. Conclusion :CSEA with bupivacaine 10 mg is safe and efficient in elderly undergoing TURP.
Electric and electronic products are required to pass through the certification on electrical safety performance before entering into the market in order to reduce electrical shock and electrical fire so as to protect the safety of people and property. The leakage current is the most important factor in testing the electrical safety performance and the test theory is based on the perception current effect and threshold. The traditional method testing the current threshold for perception only depends on the sensing of the human body and is affected by psychological factors. Some authors filter the effect of subjective sensation by using physiological and psychological statistical algorithm in recent years and the reliability and consistency of the experiment data are improved. We established an experiment system of testing the human body's current threshold for perception based on EEG feature analysis, and obtained 967 groups of data. We used wavelet packet analysis to detect α wave from EEG, and used FFT to do spectral analysis on α wave before and after the current flew through the human body. The study has shown that about 97.72% α wave energy changes significantly when electrical stimulation occurs. It is well proved that when the EEG feature identification is applied to test the human body current threshold for perception, and meanwhile α wave energy change and human body sensing are used together to confirm if the current flowing through the human body reaches the perception threshold, the measurement of the human body current threshold for perception could be carried out objectively and accurately.
ObjectiveTo explore the innovative application and effect of lead-type close medical consortium under the epidemic situation of coronavirus disease 2019 (COVID-19).MethodsDuring the epidemic of COVID-19, Jintang First People’s Hospital implemented a series of innovative countermeasures under the guidance of West China Hospital of Sichuan University, the leading hospital of a lead-type close medical consortium. To verify the implementation effect of the countermeasures, the patient satisfaction questionnaire and medical personnel satisfaction questionnaire were administered in confirmed or suspected COVID-19 patients and anti-epidemic healthcare workers. The relevant health economic indicators were extracted through the hospital information system for descriptive analysis.ResultsA total of 16 patients were included, including 10 confirmed patients and 6 suspected patients. The median score of patient satisfaction was 66. All patients were cured and discharged. A total of 56 healthcare workers were included, including 18 doctors and 38 nurses, with a median satisfaction score of 81. The average length of hospital stay of patients was 11.00 d, the average hospitalization cost was 5 117.35 yuan; the average drug cost was 1 099.95 yuan, accounted for 21.49%; the average material cost was 38.63 yuan, accounted for 0.75%.ConclusionsThe innovative application of the lead-type close medical consortium in the treatment of patients with COVID-19 plays an important role in the prevention and control of epidemic, and has achieved remarkable results in patients treatment, patients satisfaction, and hospital management. It is worthy of being widely popularized.
目的 交流断流术加脾肾分流术联合治疗门静脉高压症的体会。方法 对我院1994～2000年采用断流术加脾肾分流术联合治疗的12例门静脉高压症患者资料进行回顾性总结与分析。结果 全组病例均获随访，除1例在术后15个月因肝癌死亡外，其余11例均健在，其中10例生活质量良好，并恢复原来工作，生存时间最短15个月，最长8年，中位生存时间4年。术后均无出血和肝性脑病发生。结论 应用联合术治疗门静脉高压症避免了单一断流术、分流术及脾切除术的缺点，具有术后再出血率低，患者生存质量高及远期生存率高等优点，是一种理想的术式。