The clinical data of 19 cases of giant cell arteritis (GCA) including 8 males and 11 females aged 21-92 y (average 62.2 y) from July 2002 to September 2008 were retrospectively reviewed.Among 19 patients,15 first visited the neurology department and 4 the rheumatism department;8 had fever and 16 had headache as primary symptom;the ESR ranged from 20 to 130 mm/1 h (average 71.1 mm/1 h).Fourteen patients were diagnosed as GCA at admission and 18 were treated with steroids hormone and all got remission except 1 death and 2 recurrences.If temporal artery biopsy is not acceptable,integrated analysis of signs,symptoms,laboratory tests,treatment effectiveness and follow-up is important for the correct diagnosis of GCA.

Objective To investigate psychological health status and its change in short term among persons bit by dogs.Methods Psychological health status was evaluated with patient health questionnaire (PHQ-15) Chinese version for the 613 wounded persons bit by dogs,including 368 males and 245 females with average age of 36 years plus or minus 14 years (standard deviation),meanwhile their wounds were handled routinely at clinics,as well as health education and cognitive psychological intervention were provided for them.Results All of the 613 persons with dog bites had mild or moderate somatic syndrome in their initial visits and 478 of them (78.0%) still presented mild somatic syndrome and only 23 (3.7%)with moderate symptoms four week after dog bites by PHQ-15 scores.One hundred and fifty-two of 613 (24.8%) followed-up at their initial visits had depressive symptoms,which could remain in 61 of them (10.0%) four weeks after bites.Two hundred and eighty-four of them (46.3%) had anxiety symptoms at initial visits,and 258 (42.1%) still had mild and nine (1.5%) had moderate symptoms four weeks after bites.Conclusions Psychological symptoms were popular in wounded persons by dog bites,which can persist for a certain time.PHQ-15 can be used for evaluating their psychological status.

Clinical data of 62 children with dilated cardiomyopathy (DCM)admitted to hospital from January 1998 to December 2008 were retrospectively analyzed. The age of patients was from 14 months to 14 year with the average of 8. 2 years. Respiratory infection was the main triggering factor. Cardiac dilatation was the basic conditions for diagnosis of DCM. Arrhythmia was characteristic for DCM, and color cardio uhrasonography was an important procedure of diagnosis and evaluation for cardiomyopathy. With the integrated treatment 38 cases were discharged with improvement ( 61% ), 11 cases died ( 18% ). Early diagnosis and integrated treatment are critical for management of cardiomyopathy in children.

Objective To explore influence of thoracic duct ligation on lipid metabolism after esophagectomy. Methods Seventy-four patients with esophageal cancer received esophagectomy were divided into two groups by their thoracic duct ligation, 39 in ligation group and 35 in non-ligation group. All the patients were fed with nutrients through nasal-duodenal tube placed during operation from the 1 st day to the 8th day after surgery, and started taking liquid diet on the 6th day. Blood specimens were collected from the patients on the 1st day after admission, the 9th day, one month and three months after surgery,respectively for biochemical analysis,including determinations of total cholesterol(TC),triglyeeride(TG),high-density lipoprotein-cholesterol ( HDL-C) and low-density lipoprotein-cholesterol ( LDL-C) . Databetween the two groups were compared with statistical analysis. Results No significant difference in plasma levels of TC, TG and HDI.-C was found between the two groups at varied time points. Plasma level of LDL-C in the ligation group significantly decreased on the 9th day after surgery, as compared with that in the nonligation group ( P ＜ 0. 05), and went down to the lowest level one month after surgery. Conclusions Chylomicron was blocked to enter blood stream and production of LDL-C decreased by thoracic duct ligation,which affect lipid absorption and metabolism leading to poor early nutrition in patients with esophagealsurgery due to slower establishment of collateral circulation.

Objective To assess clinical competencies of trainees with standardized patients(SPs)and explore reform in methods of assessment for trainees at their completion in standardized training for general practice.Methods Totally,52 trainees in clinical training bases for general practice in Shanghai attended the examinations.Their skills in commanication skills,information and data gathering,comprehensive consultation,clinical thinking and decision-making in diagnosis and treatment were examined by rotation of three serial assessment stations in a specified time to perform standardized tasks,including medical history-taking,physical examinations(PE),medial record writing and oral tests.Results Scoresof history-taking,PE and skills of communication with SPs were higher than those agsessed by examiners themselves.but they both correlated each other with a P-value less than 0.01,with the highest coefficient of correlation of 0.774 between score of PE and that assessed by examiners.There was significant difference in average score among all clinical skills(F=9.867,P＜0.01),with the lowest one of comprehensive consultation skills of 64±22(P＜0.01).Skills of communication with patients had the highest correlation with data gathering ability(r=0.582,P＜0.01).Results of analysis for influential factors showed no significant difference in average score for all skills between men and women trainees(P＜0.05).Average score of comprehensive consultation ability in those with work experience was lower than that in thoge without it(P＜0.05)and no significant difference in scores of all the other skills wag found between those with varied length of working(P＞0.05).There was significant difiefence in average scores of communication skills,medical record writing,and case analysis between various trainees(P＜0.01).In addition,average scores of information collecting and medical record writing also differed among trainees from varied bases for general practice training(P＜0.05).Conclusions Clinical skills,ability to direct teaching work,and improvement of teaching model can be assessed in a comprehensive and objectively way using standardized patients in general practice training.

Objective To explore rules of changes in velocity of ultrasound wave transmission at the tibia and radius by a quantitative bone mineral density ultrasound scanner in examination of early incipient rickets in infants and its significance in clinical diagnosis.Methods One hundred and fifty-seven infants who visited child health-care clinic of the Capital Institute of Pediatrics,Beijing during May 2004 to December 2007 and clinically diagnosed as rickets according to the Criteria of Diagnosis for Rickets in Infants and Young Children formulated in 1986 by the Ministry of Health,as well as 124 normal healthy infants as controls,were enrolled in the study and followed-up for three months.Velocity of ultrasound wave transmission at the tibia and radius in all the infants were measured by a bone mineral density ultrasound scanner (Sunlight Omnisense 7000R made in Israel).Results One hundred and fifty-seven infants were clinically diagnosed as rickets,127 of them undergone with carpal plane roentgenography and 90 of the 127 with positive change in bone x-ray imaging and 37 without it.Velocity of ultrasound wave transmission at the tibia and radius measured by z-score was significantly lower in infants with clinically diagnosed rickets than that in healthy controls (Z-values of-10.411 and-10.399 at the tibia and-5.646 and-5.517 at the radius,respectively,P = 0.000 with Mann-Whitney test).Velocity of ultrasound wave transmission at the tibia and radius measured by z-score was lower in those with positive change in x-my imaging than that in those without it,but not reaching a level of statistically significant difference.Velocity of ultrasound wave transmission and z-score correlated positively with change in bone x-ray imaging,respectively with Spearman coefficients of correlation of 0.581 and 0.677 for tibia,0.316 and 0.467 for radius (P = 0.000).Receiver operating characteristic (ROC) curve was drawn from those with rickets and positive left carpal plane roetgenograph.Area under curve of ROC for z-score of velocity of ultrasound wave transmission at the tibia was 0.812 and 0.799 (95% CI 0.758-0.856 and 0.742-0.855,P =0.000),respectively.Area under ROC curve of z-score of velocity of ultrasound wave transmission at the radius was 0.715 and 0.697 (95% CI 0.650-0.780,0.631-0.764,P =0.000),respectively.Cut-off value of z-score was-205--1.95 at the tibia,according to the largest sensitivity and the least false-positivity,with sensibility of 0.8 to 0.9 and specificity of 0.733 to 0.702.As its sensitivity at the radius was more than 0.7,its specificity was lower than 0.524.Conclusions Quantitative ultrasound scanning can be used to detect insufficient bone mineral density in infants and their early skeletal change by rickets but without change in bone x-ray imaging.Velocity of ultrasound wave transmission at the tibia can be used as an indicator to predict early rickets in infants rather than its severity.

Objective To investigate awareness about tuberculosis (TB) prevention and treatment and influence of professional training on TB detection among health-care workers (HCWs) in general hospitals.Methods In total,750 HCWs were trained for TB-related knowledge for eight class-hours in a two-day course in three general hospitals,and 20 HCWs from each of the three hospitals classified as grade 3A and grade 2A in urban Beijing and grade B at suburban Beijing,respectively,were interviewed with questionnaire designed to understand their awareness about TB prevention policy,epidemiology,diagnosis and treatment,and to evaluate effectiveness of the training,respectively.All the trainees responded before and after the training,with a hundred percent of response rate.TB diagnosis and reporting one year before training in the three hospitals were compared to those one year after it.Results Scores of knowledge about TB diagnosis and treatment averaged 64-80 for HCWs before training,with statistically significant difference among three hospital (F = 5.984,P ＜ 0.01).Scores increased after training,but without significant difference from those before it (P ＞ 0.05).Awareness of TB prevention policy,regulations and epidemiology was insufficient in most HCWs of those hospitals,with lowest and highest average scores of 38.3 and 71.7 before training,respectively,but scores increased significantly after training (P ＜ 0.01).Proportion of TB diagnosis with chest roentgenograph at grades 3A and 2A hospitals was significantly higher one month,three months and six months after training,as compared to that at suburban hospitals (P ＜0.01).There was significant decrease (P ＜ 0.01) in proportion of chest roentgenograph at respiratory departments in hospitals grade 3A and grade 2A after training.There was no significant difference in reporting of pulmonary TB and positive sputum smear (P ＞ 0.05) before and after training.Conclusions HCWs in general hospitals had experience and capacity in diagnosis and treatment of pulmonary TB,but their knowledge of TB prevention policy and epidemiology was insufficient.Their ability in finding and reporting TB can not been improved with short-term training.

Inner fistula by abdomino-back anastomosis of cephalic vein to radial artery was erformed in 86 patients with hemodialysis (test group) and end-to side arteriovenous anastomosis was performed in 85 cases (control group).There were no significant differences in postoperative anastomotic blood flow and vascular complications between two groups (P ＞ 0.05);however the average time consuming for operation in test group was shorter than that in control group (36 min vs.75 min,P ＜ 0.01).The minimally invasive abdomino-back anastomosis is a desired arteriovenous fistula method for hemodialysis patients.

Clinical data of 27 children with renal calculi (11 cases on the right side and 16 on left)who were treated with extracorporeal shockwave lithotripsy (ESWL) using HB-ESWL-VG lithotripter from April 2006 to October 2008 were retrospectively reviewed.The size of stones ranged from 5 mm to 17 mm in diameter (mean 11 mm).In 22 out of 27 cases (82%) stones were crushed completely after the first course.Eleven of 27 ESWL cases were stone-free in 7 days,8 patients in a month after treatment;the stonefree rate was 96% when patients were followed up for 1 year.The results suggest that ESWL is a safe and effective method for treatment of renal calculi in children.

The data on nosocomial infection of 4060 patients who were stayed in intensive care unit (ICU) more than 48 h from January 1997 to August 2008 were reviewed.From Jan 2004 the target monitoring of hospital-acquired infection was implemented in ICU.The nosocomial infection rates before and after target monitoring were 35.25% (871/2471) and 30.77% (489/1589) respectively (P ＜ 0.01);however there was no significant difference in case infection rate before and after target monitor were practiced (47.67% vs.45.25%,χ~2 = 2.2836,P ＞0.05).The incidence of Acinetobacter infection was increased after target monitoring.Targeted monitoring can decrease the nosocomial infection rate in ICU,and also reduce the cost of medical care.