The problems in making PowerPoint slides include too many characters in a single slide,too many presentations in a class hour,lacking or impertinently employing of multimedia materials,deficiency in aesthetic feeling,etc.The problems in clinical theoretical teaching aided with PowerPoint include the teacher becoming a commentator for slides,teaching too many contents in a single hour,neglecting traditional teaching aid,etc.The combination of rich medical knowledge,super teaching skills and ability of good taste for slides is the key to make perfectly and use rightly PowerPoint.

Recently,alveolar recruitment maneuver is one of effective management of mechanically ventilated patients with acute respiratory distress syndrome.Recruitment maneuvers are widely used in clinical practice to open the lung and prevent lung injury by derecruitment,improving the compliance,increasing PaO2,increasing the PaO2/FiO2 ratio,and reducing the pulmonary shunt fraction,although the evidence is still discussed.This review discussed recruitment maneuvers in pediatric patients with acute respiratory distress syndrome.

Objective:To discuss the clinical value of CT-guided interstitial implantation of125I radioactive particle through the percutaneous puncture in the treatment of central-type lung cancer.Methods: 63 patients with the central-type lung cancer treated in Renmin Hospital of Wuhan University from November 2013 to July 2016 were randomly grouped (31 cases in the control group and 32 cases in the observation group). Patients in the control group were given the treatment of bronchial arterial perfusion with the chemotherapeutic drugs; while patients in the observation group were given the CT-guided interstitial implantation of125I radioactive particle through the percutaneous puncture. The clinical therapeutic effect and complications were observed of the two groups and the quality of life scores before and after the treatment were summarized between two groups as well.Results: The overall effective rate of observation group was 84.38% (27/32) that was higher than 61.29%(19/31) of control group, with statistical difference (x2=4.259,P<0.05); the complication rate of observation group was 9.38% (3/32) that was lower than 12.90% (4/31) of control group, with no statistical difference (x2=0.002,P>0.05); the quality of life score of observation group after the treatment was 84.57±3.27 that was higher than 70.38±3.20 of control group, with statistical difference (t=17.402,P<0.05).Conclusion: CT-guided interstitial implantation of125I radioactive particle through the percutaneous puncture in the treatment of patients with central-type lung cancer has the significant effect, and it can effectively improve the quality of life for patients and have the high degree of safety.

Objective To explore the value of detecting serum cytokeratin 19 fragmen 21-1 (CYFRA21-1) and squamous cell carcinoma antigen (SCCAg) in the diagnosis of patients with nasopharyngeal carcinoma.Methods 79 patients with nasopharyngeal carcinoma from October 2013 to October 2015 as case group and 145 patients with nasopharyngeal chronic inflammation as control group were collected.The CYFRA21-1 level was detected by the electrochemical luminescence immunoassay and the SCCAg level was detected by the enzymoimmunoassay.Comparisons of diagnostic value of CYFRA21-1 and SCCAg to nasopharyngeal carcinoma were conducted according to pathological diagnosis.Results The serum CYFRA21-1 and SCCAg levels in case group were (12.37±1.65) g/L and (1.65±0.37) ng/ml,and the control group were (4.26±1.99) g/L and (1.22±0.45) ng/ml,with statistically significant differences (t =8.093,P =0.002;t =4.287,P =0.043).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CYFRA21-1 combined with SCCAg in the diagnosis of nasopharyngeal carcinoma were higher than those of CYFRA21-1 and SCCAg respectively,and the difference all were statistically significant (all P ＜ 0.05).Conclusion Detecting serum CYFRA21-1 combined with SCCAg in the diagnosis of nasopharyngeal carcinoma has high sensitivity and good specificity,which can significantly improve the diagnostic accuracy.

Ubiquitin specific peptidases play important roles in controlling proteasome activity,organogenesis,tumorigenesis and transcriptional regulation.Ubiquitin specific peptidase 9X is able to remove ubiquitin from substrate proteins,so it may effectively regulate the proliferation,adhesion and signal transduction of tumor cells.It is a one of the most important factors in tumor progression.

OBJECTIVETo investigate the therapeutic effects of manipulative reduction for calcaneal fractures.

METHODSFrom January 2009 to June 2012, 53 cases (60 affected feet) of Sanders type I-IV calcaneal fractures were treated by manipulative reduction and external fixation with cardboard splint,including 45 males and 8 females with an average age of (33.5 +/- 1.54) years old ranging from 18 to 65. The course of disease ranged 0.5 h to 7 d. Before treatment the feet were swelling, ache and activity limitation in evidence, some feet were wide flat deformity, the cortical bone was broken in the imaging examination. All selected cases were evaluated using Creighton-Nebraska health foundation assessment scale for fractures of calcaneus.

RESULTSAll cases were followed up at 12 months after treatment, 13 feet got excellent curative effect, 34 good, 11 moderate and 2 poor.

CONCLUSIONManipulative reduction for Sanders type I-IV calcaneal fractures could get excellent curative effect. Manipulative reduction for calcaneal fractures could avoid surgical trauma while assure high curative effects. Manipulative reduction is not only economical and easy therapy, but also can restore maximum function of the calcaneus with few complications and facilitate early rehabilitation of ankle and joint function.

Adolescent ; Adult ; Aged ; Calcaneus ; injuries ; surgery ; External Fixators ; Female ; Fractures, Bone ; rehabilitation ; surgery ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Splints

OBJECTIVETo observe the clinical effects of essential hypertension treated with acupuncture at Siguan [Hegu (LI 4) and Taichong (LR 3)], Quchi (LI 11) and Xingjian (LR 2).

METHODSSixty cases of essential hypertension were randomly divided into an acupuncture group and a medication group, 30 cases in each group. Two groups of acupoint, which were (1) Siguan [Hegu (LI 4) and Taichong (LR 3)] and (2) Quchi (LI 11), Xingjian (LR 2), were selected alternatively in the acupuncture group, once everyday. In the medication group, captopril was prescribed for oral administration 25 mg per time, three times per day. Seven days made one session in both groups and totally three sessions were required.

RESULTS(1) After treatment, the blood pressure were decreased significantly in the two groups (all P < 0.01). Compared with the medication group, the diastolic pressure after 14 days, 21 days of treatment in the acupuncture group was decreased significantly (both P < 0.01). (2) In the terms of TCM syndrome score, the improvement of dizziness, soreness and weakness of waist and knees, palpitations was significant in the acupuncture group compared with that in the medication group(all P < 0.05). (3) The acupuncture group had less adverse reactions compared with the control group (P < 0.05).

CONCLUSIONAcupuncture at Hegu (LI4) and Taichong (LR 3), Quchi (LI 11) and Xingjian (LR 2) can effectively decrease blood pressure; the effect of controlling diastolic pressure is better than captopril. It can also improve the symptoms of dizziness, soreness and weakness of waist and knees, and palpitations.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Blood Pressure ; Essential Hypertension ; Female ; Humans ; Hypertension ; physiopathology ; therapy ; Male ; Middle Aged ; Treatment Outcome ; Yin Deficiency ; therapy ; Yin-Yang

Objective:To explore the relationship between ventilator-associated pneumonia (VAP) and neutrophil/lymphocyte ratio (NLR) before mechanical ventilation in patients with malignant tumors.Methods:A retrospective nested case-control study was conducted. Patients with malignant tumor treated by mechanical ventilation admitted to the Third Affiliated Hospital of Guizhou Medical University from February 2015 to February 2020 were enrolled. The patients with VAP were selected as the case group, and the matched non-VAP cases were selected according to 1∶2 as the control group. The clinical data were collected, and the differences of each index between the two groups were compared. The influencing factors of VAP in patients with malignant tumor were analyzed by multivariate Logistic regression.Results:During the study period, 1 271 patients with malignant tumors were treated with mechanical ventilation, of which 241 cases had VAP, and the incidence of VAP was 18.96%. There were 232 VAP patients in the case group matched 464 non-VAP patients in the control group. The clinical data of age, gender, hospitalization diagnosis, primary tumor, regional lymph node and distant metastasis (TNM) stage, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), complications, duration of mechanical ventilation, hemoglobin (Hb) and serum albumin (Alb) levels were balanced and comparable between the two groups, and the cluster nursing measures were consistent. Compared with the control group, although there was no significant difference in neutrophil count (NEU) and lymphocyte count (LYM) in the case group [NEU (×10 9/L): 3.81±1.07 vs. 3.64±1.05, LYM (×10 9/L): 2.06±0.59 vs. 2.15±0.62, both P > 0.05], NLR was significantly increased (2.07±1.05 vs. 1.89±0.96, P < 0.05), and the hospital stay was significantly longer (days: 24.84±3.81 vs. 13.19±3.98, P < 0.01). NLR, gender, age, APACHEⅡ score, TNM stage, Hb, serum Alb and duration of mechanical ventilation were included in multivariate Logistic regression analysis. The results showed that patients with elevated NLR had higher risk of VAP [odds ratio ( OR) = 1.187, 95% confidence interval (95% CI) was 1.015-1.387, P = 0.032]. In patients with VAP, NLR was negatively correlated with the time of mechanical ventilation before VAP (r = -0.327, P = 0.000), and positively correlated with the time of treatment with antibiotics after VAP (r = 0.559, P = 0.000). Conclusion:Elevated NLR in patients with malignant tumors who were on mechanical ventilation can significantly increase the risk of VAP and increase the difficulty of treatment.

Objective To evaluate the anatomic relationships between the portals and radial nerve of three different operations of antrolateral approach elbow arthroscopy.Methods The dissections were pedormed in 10 formalin soaked adult cadaver elbows.The distances from the three different antrolateral portals to the radial nerve in extension and flexion 90° position were measured.The portal A was located at 3 cm distal and 1 cm anterior to the lateral epicondyle;the portal B was located at 2 cm distal and 2 cm anterior to the lateral epicondyle;the portal C,1 cm distal and 1 cm anterior to the lateral epicondyle.Results The nearest distances from the anterolateral portal A,B,and C to the radial nerve in extension position were (2.30 ± 0.95) mm,(3.00 ± 1.56) mm,and (3.60 ± 1.65) mm,with significant differences (F =11.097,P =0.001).Statistical difference in distances from the anterolateral portal to the radial nerve between portal A and C was found (P =0.006).No statistically significant difference was seen between A and B or B and C (PA-B =0.134,PB-c =0.072).The distances from the anterolateral portal A,B,and C to the radial nerve in flexion 90° position were (4.40 ± 2.01) mm,(6.10 ± 1.79) mm,and (7.90 ± 1.85) mm,with significant differences (F =54.775,P =0.000).There were statistically significant difference among the three approaches (PA-B =0.000,PA-c =0.000,PB-c =0.002).The distances increased when the position changed from extension to flexion 90° for portal A (t =-5.161,P =0.001),portal B (t=-8.188,P=0.000),and portal C (t =-10.167,P =0.000).Conclusion The anterolateral portal 1 cm distal and 1 cm anterior to the lateral epicondyle is the safest apporach.

ObjectiveTo find out the prevalence of brucellosis in Baotou,and to provide a scientific basis for integrated control of brucellosis.MethodIn 2010,high-risk people 7 to 70 years of age engaged in livestock farming,grazing,slaughtering,processing and selling were investigated in 9 districts (banners,counties)of Baotou city.In accordance with the principle of informed consent,blood samples were collected,serum titer was tested using the rose bengal agglutination test and tube agglutination test(SAT),and serum titer of 1:100(+ +) was considered as positive brucellosis,and results were evaluated based on brucellosis monitoring standards(GB 16885-1997).ResultsA total of 5832 copy blood samples were collected,and 250 cases were tested positive,the positive rate was 4.25％.The number of new cases was 164,accounting for 2.81％ (164/5832).Age was mainly concentrated in the 40 to 60 years,accounting for 66.0％(165/250).Brucellosis infection in the livestock industry accounted for 80.87％ (4757/5882).From the regional distribution,DAMAOQI had the most detected cases,and the detection rate was 12.10％ (73/603).ConclusionsContinue to increase the brucellosis prevention knowledge propaganda,carry out brucellosis surveillance of high-risk people,quarantine,and strengthen immunity is the only measure of effective control of brucellosis epidemic.