High resolution melting ( HRM) analysis is a real-time PCR based technique which can detect DNA sequence polymorphism .Immediately after routine PCR with saturated fluorescent dye , melting transition of the amplicon was monitored and fluorescence was collected .According to the different melting curve, single base differences can be distinguished .HRM is a low -cost, single -step, closed -tube, accurate and rapid method , which has aroused general concern .Rapid and sensitive detection of the clinical pathogens is critical to diagnosis of infectious diseases .However , clinical research on application of HRM in infectious disease pathogen identification and drug resistance , especially melting curve analysis based bedside technology integration will provide strong support for the diagnosis and treatment of infectious diseases.

Objective To visualize blood flow changes in verruca vulgaris noninvasively with laser speckle contrast analysis (LSCA), and to evaluate the relationship of size and location of warts with efficacy of laser treatment. Methods Pulsed dye laser(PDL)was used to treat 30 verruca vulgaris lesions in 17 patients. In order to evaluate therapeutic effect of PDL, LSCA was performed to observe blood flow in warts and their surrounding normal skin, and to calculate speckle flow index (SFI)values before laser treatment, and at 10 minutes as well as on 3 weeks after laser treatment. Results Before PDL treatment, SFI values were significantly higher in warts than in their surrounding normal skin (11.600 ± 1.190 vs. 5.280 ± 0.481, t = 8.169, P < 0.01). Compared with those before the treatment, SFI values in warts significantly decreased at 10 minutes(3.112 ± 0.484, t = 4.407, P < 0.01)and on week 3(7.315 ± 1.083, t = 3.294, P < 0.01)after the treatment, and were significantly higher on week 3 than at 10 minutes (t = 4.646, P < 0.01). SFI values in surrounding normal skin significantly increased at 10 minutes after the treatment compared with those before the treatment (20.260 ± 2.063 vs. 5.296 ± 0.708, t = 6.770, P < 0.01), but were significantly lower on week 3 than at 10 minutes (4.941 ± 0.616, t = 6.964, P < 0.01). No significant difference was observed between SFI values in surrounding normal skin on week 3 after the treatment and those before the treatment (t = 0.378, P = 0.707). The efficacy of laser treatment was associated wart size and location. Changes of blood flow(|ΔSFI|)were significantly higher in warts measuring less than 0.5 cm2 in size than in those equal to or more than 0.5 cm2 (t = 2.287, P < 0.05), and significantly differed among warts at different sites (F =15.71, P < 0.01). The greatest changes of blood flow in warts were observed on fingers, followed by the dorsum of feet, toes, palms and soles and periungual areas. Conclusions Blood flow in verruca vulgaris is markedly increased compared with that in normal skin. PDL can clear verruca vulgaris by solidifying and gasifying capillaries. LSCA may be used to evaluate the efficacy of laser on verruca vulgaris more quantitively by monitoring regional blood flow.

ObjectiveTo find out about changes in expenses and the orientation of the insured to medical services and analyze the causes of expense growth and the result of containment so as to offer suggestions for policy formulation. MethodsA statistical analysis was made of the actual data on the medical insurance of retired and working personnel in Nantong City from 2000 through 2002 using SPSS and Excel. Results①The mode of payment via "plate" management and total quantity and mean value control resulted in fairly good expense containment, especially outpatient expense containment while the growth of hospitalization expenses was on the rise. ②Third-tier hospitals were most popular to people seeking hospitalized services while for outpatient services people were increasingly turning to clinics and designated drugstores where the average expenses per visit were low. Conclusion①The managing party of medical insurance should step up research on expense containment strategies, steer the patients towards rational splitflow, try to contain expenses in a scientific way, and improve the efficiency of fund utilization. ②Medical institutions confronted with opportunities and crises should enhance quality construction and deliver standard and reliable services. ③It is imperative to strengthen regional health planning and raise the efficiency of health resources utilization.

Objective To explore the pathogenesis, reason, diagnosis and treatment of cerebral salt wasting syndrome (CSWS) in the patients with serious cerebral injury. Methods The clinical data of 26 cases of CSWS after serious cerebral injury were analyzed retrospectively. Results The diagnosis of CSWS was confirmed by clinical symptoms of the patients and the results of laboratory examinations. After the effective treatment, the low plasma sodium level of 21 patients was corrected, and 5 patients died. Conclusion Hyponatremia,hypernatruria, hypovolemia, the increase of urinary amount and the elevation of plasma ANP and BNP level were main characteristics of CSWS.The supplement of water and salt was safe and effective in the treatment of CSWS.

Objective To study the percentage and the distribution of nosocomial infection, and susceptibility of related pathogens to antibiotics in patients with systemic lupus erythematosus (SLE). Methods The clinical data of in patients with SLE in our hospital from June, 1990 to June, 1998 were analyzed. The susceptibility of the pathogens to antimicrobial agents was tested by K-B paper dilution method. Results The percentage of nosocomial infection in these cases was 16.1％ . The major pathogens were staphylococcas aureus, Escherichia coli and Candida. The most highly resistant microbes were E.coli, S.arueus and Pseudomonas aeruginosa. Conclusions The nosocomial infection is one of the most common complication of SLE in the in patients. It is necessary to examine the pathogens regularly and use antibacterial agents according to the susceptibility.

Objective To improve the effectiveness of internship nursing students in infectious diseases by implementing peer teaching method. Methods The nursing students were divided into two groups according to the order of student number. The control group was given the teaching method of the general outline. On the basis of the outline teaching, the experimental group gave counseling and counseling to the students in their professional and psychological aspects. Results There were significant differences between the two groups in terms of the results of the three tests and the theoretical evaluation, and the results of the test group were better than those of the control group (P<0.05). Conclusion Peer- to- peer learning method can improve the practical effect of surgical nursing students in infectious diseases, and can be popularized in a certain extent.

Objective To observe the clinical effects of hyperbaric oxygen combined large dose ganglioside on delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Methods A totol of 72 patients of DEACMP were randomly divided into the observation group(37)and the control group(35).The patients of control group were given the routine treatment with hyperbaric oxygen.In the treatment group patients were given large doses of gangliosides 100 mg,1 times a day,for a period of 20 to 30 days additionally to the routine treatment of hyperbaric oxygen.All patients were examined before and after treatment in EEG examination (EEG),mini-mental state examination(MMSE).Results The abnormal rate of EEG was 37.83％(14/37) in the control group,which was significantly lower than that of 65.71％(23/35) in the treatment group((x2 =5.60,P ＜ 0.05).In the treatment group,the MMSE was(15.45±2.93) and(23.70±2.13) before and after treatment,respectively; in the control group,the MMSE was(14.88±2.84) and(20.33±2.09) before and after treatment.The MMSE was significantly impoved after treatment in both group(t =3.18 and 2.91,Ps ＜0.05).Furthermore,the MMSE impoved more significantly in the treatment group compared to the control group (t =6.28,P ＜ 0.05).The effective rate of treatment group was 86.48％(32/37),which was significantly higher than that of 51.43％(20/35) in the control group(x2 =7.72,P ＜ 0.01).Conclusion Application of large dose ganglioside treatment had significant clinical effects in delayed encephalopathy after acute car-bon monoxide poisoning,which is better than the effect of routine hyperbaric oxygen treatment.

Objective To analyze the effect of clinical pathways on single disease management.Methods Clinical controlled trials on tumors of uterine,benign biliary tract diseases and benign thyroid neoplasm were collected and related literatures were screened according to the criteria of inclusion.The literature so collected underwent a Meta analysis.Results A total of 21 literatures were included.Meta analysis indicated that statistical difference existed in the total cost of hospitalization(WMD=1046.06,95％CI:- 1281.15 ～ - 810.96,P＜0.00001) and length of hospital stay (WMD=- 2.18,95％CI:-2.59～- 1.76,P＜0.00001)between non-clinical pathways group and clinical pathways group.Conclusion Implementation of clinical pathways can further reduce hospital costs and shorten hospital days of the single disease management.

Objective To study the correlation between the dynamic changes of sex hormones and the severity and prognosis of head injury,and to investigate the role of sex hormones in traumatic brain injury.Methods The dynamic changes of sex hormones were quantitatively dynamic measured in 100 patients with head injuries,while the relationships between glasgow coma score(GCS),glasgow outcome score(GOS) and the concentration of sex hormones were also studied.Results The estradioi,progesterone and testosterone levels in serum increased within 12 hours after trauma in all groups.Estradiol increased markedly continuously within 1,3 days in GCS≤12 group,testosterone levels in serum decreased within 3 days after trauma in GCS=3～8 group,with a significant differnce compared with others groups.The concentration of sex hormones correlated positively with GOS.Conclusions The measurement of sex hormones may be useful to judge the severity and prognosis of head injury in earlystage.The increases of estradiol in the early stage after traumatic brain injury may exert powerful protective effects on brain tissues.Decreases of sex hormones are important factors leading to death of patients of traumatic brain injury.