Objective To assess the health risk of soil-mouth exposure of soil heavy metal pollution by in vitro method. Methods Collected the soil sampling from the heavy metals contaminated field and roadside. Digested the soil sample by in vitro device and determined the content of Cd, Pb, Zn in the solution in the simulated stomach phase and intestine phase respectively with ICP-MS after centrifuging. Calculated the exposure and assess health risk. Results Bioaccessibility of Cd, Pb and Zn at the stomach phase was 21%-33%, 2%-28%, 33%-43% respectively in the polluted areas, and 27%, 23%, 95% in the control area; At the intestine phase was 16%-19%, 3.4%-4.9%, 8%-14% in polluted areas and 11%,2.6%,18% in control area respectively. The amount of available Cd, Pb and Zn in the stomach phase was 0.04-1.46 ?g/d, 3.09-5.53 ?g/d, 3.86-9.39 ?g/d in polluted areas and 0.01 ?g/d, 0.74 ?g/d ,5.64 ?g/d in control area for children, and 0.01-0.36 ?g/d, 0.77-3.88 ?g/d, 0.97-9.85 ?g/d in polluted areas and 0.00 ?g/d. 0.19 ?g/d, 1.41 ?g/d in the control area for adult ; at intestine phase the amount of available Cd, Pb and Zn was 0.03-0.71 ?g/d, 0.50-9.92 ?g/d, 1.26-9.55 ?g/d in polluted areas and 0.00 ?g/d, 0.08 ?g/d, 1.07 ?g/d in the control area respectively for children, 0.01-0.18 ?g/d, 0.11-2.48 ?g/d, 0.31-2.39 ?g/d in the polluted areas and 0.00 ?g/d,0.02?g/d,0.27 ?g/d in the control area respectively for adult. Conclusion Heavy metals exposure through soil-mouth pathway will increase the total health risk of heavy metal to exposed population.

Objective To evaluate the efficacy of early rehabilitation for severely burned patients in intensive care unit (ICU).Methods One hundred and eighty two severely burned patients were enrolled in the study,including 97 patients receiving early rehabilitation in ICU (rehabilitation group) and 85 patients without early rehabilitation (control group).There were no significant differences in burned surface area,depth and locations between two groups.After one year's treatment,patients were evaluated by the Vancouver Scar Scale (VSS).Results The mean VSS score of rehabilitation group was significantly lower than that of control group (3.1 ± 1.2 vs.5.2 ± 1.3,P ＜ 0.05).Conclusion Early rehabilitation therapy is beneficial for severely burned patients in ICU.

Objective To study clinical efficacy of ulinastatin combined with naloxone in patients with cardiogenic shock(CS) after acute myocardial infarction (AMI).Methods Eighty patients with CS after AMI were randomly divided into routine treatment group (n =19),ulinastatin group (n =20),naloxone group (n =21) and ulinastatin combined with naloxone group (n =20).The levels of serum cardiac troponin I (cTnI),brain natriuretic peptide(BNP),tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6)were measured before and a week after treatment.In the meantime,recovery time of shock,the average hospitalization days and 28-day mortality rate were recorded.Results After the treatment,the levels of serum cTnI,BNP,TNF-α and IL-6decreased in all groups(P ＜ 0.01),and there was significant difference on the decreasing degree of cTnI,BNP,TNF-α and IL-6 in ulinastatin combined with naloxone group when compared with those in routine treatment group,ulinastatin group and naloxone group(cTnI:(1.04 ± 0.17) ng/L vs.(2.06 ± 0.15) ng/L,(1.59 ± 0.16)ng/L,(1.97 ± 0.14) ng/L; BNP:(143.21-56.94) ng/L vs.(261.07 ± 71.43) ng/L,(203.46 ± 65.73) ng/L,(252.96 ± 68.85) ng/L; TNF-α:(13.42 ± 8.93) ng/L vs.(31.21 ± 12.32) ng/L,(20.39 ± 11.08) ng/L,(28.98 ± 11.76) ng/L ; IL-6:(37.58 ± 11.14) ng/L vs.(80.46 ± 27.15) ng/L,(59.84 ± 20.72) ng/L,(76.15 ±26.45) ng/L; P ＜ 0.01).The recovery time of shock,the average hospitalization days and 28-day mortality rate in ulinastatin combined with naloxone group were significantly lower than those in routine treatment group,ulinastatin group and naloxone group(recovery time of shock:(7.16 ± 1.52) d vs.(11.43 ± 2.40) d,(8.05 ±1.81)d,(8.74 ± 1.98)d;the average hospitalization days:(15.03 ±3.23)d vs.(22.64 ±4.18)d,(18.93 ±3.97)d,(19.21 ±3.94)d ;28-day mortality rate:(41.62％ vs.61.20％,50.74％,52.31％ ; P ＜0.01)).Conclusion The application of ulinastatin combined with naloxone can effectively inhibit the cardiac injury and inflammatory response,promote the recovery of circulation function and improve prognosis in patients with CS after AMI.

Objective To analyze the incidence,clinical feature and the risk factors of invasive fungal infection in pediatric intensive care unit (PICU). Methods We retrospectively summaried the invasive fungal infection in our PICU from Jan 2007 to Dec 2009 in order to analyze the incidence, clinical feature and the risk factors of invasive fungal infection in PICU. Multiple clinical data were collected such as pediatric critical illness score, mechanical ventilation, urinary drainage tube, indwelling gastric canal and continuous blood purification. Results ( 1 ) The incidence rate of invasive fungal infection was 1.65 % ( 35/2 116 ). The morbidity was 20. 00% ( 7/35 ). ( 2 ) Mean infected day was ( 10. 4 ±- 8. 3 ) d after admission. The clinical manifestations included fungal pneumonia( 60. 0% ), peritonitis ( 14. 3% ), urinary tract infection ( 11.4% ),intestinal tract infection(8. 6% ) ,sepsis(2. 9% ) and meningitis(2. 9% ). All of the patients had used broad spectrum antibiotic. (3) The risk factors of invasive fungal infection included lower pediatric critical illness score, mechanical ventilation, indwelling gastric tube, urinary drainage tube and continuous blood purification.(4) Candia albicans was the predominant pathogen in invasive fungal infection. Conclusion Invasive fungal infection has become one of the main nosocomial infection in PICU. Lung is most commonly involved and candida albicans is the major pathogen. Using antibiotics appropriately, decreasing unnecessary invasive performance,and rationally using antifungal agent mi.ght be effective strategy for invasive fungal infection in PICU.

BACKGROUND: The rehabilitative intervention accelerates the recombination and reconstruction of cerebral structure and function and then promotes the amelioration of function.OBJECTIVE: To evaluate the influence of early and late rehabilitative interventions on the motor function and activities of daily living (ADL) with neurologic deficit score (NDS), Fugl-Meyer assessment (FMA) and modified Barthel index in patients with cerebral infarction.DESIGN: A randomized controlled trial.SETTING: Department of Neurology, Qilu Hospital of Shandong University; Department of Rehabilitation, Jinan Great Wall Hospital; Department of Neurology, the Third People' s Hospital of Heze.PARTICIPANTS: Totally 216 inpatients with cerebral infarction (125 males and 91 females, aged 60-75 years), who were selected from Qilu Hospital of Shandong University, Jinan Great Wall Hospital and the Third People's Hospital of Heze from December 2000 to December 2003, were randomly divided into early rehabilitation group (n=108) and late rehabilitation group (n=108) after admission.INTERVENTIONS: In the early rehabilitation group, the patients began to receive rehabilitation at 48 hours to 14 days after the stability of vital signs and absence of the progress of neurological signs. In the late rehabilitation group, the patients began to receive rehabilitation at 15-30 days after attack. They were trained with Bobath method and motor relearning program, once a day, 45 minutes for each time, and 6 times every week.Before and 30 days after the rehabilitative treatment, the rehabilitation was evaluated with modified Barthel index (100 points as normal, 0-20 as extremely severe functional defect, 25-45 as severe functional defect, 50 -70 as moderate functional defect, 75-95 as mild functional defect), FMA (total score was 100 points, including the highest scores of upper and lower limb movement were 66 and 34 points respectively) and NDS (the highest and lowest scores were 45 and 0 point, 0-15 as mild, 16-30 as moderate, 31-45as severe).ter treatment.RESULTS: All the 216 patients with cerebral infarction were involved in obviously lower than that before treatment in both groups (P ＜ 0.01), lower in the early rehabilitation group than in the late rehabilitation group score at 30 days after treatment was obviously higher than that before treat ment in both groups (P ＜ 0.01), higher in the early rehabilitation group than in the late rehabilitation group [upper limb: (32.43±21.52), (26.69±19.79)dex: The modified Barthel index at 30 days after treatment was obviously higher than that before treatment in both groups (P ＜ 0.01), higher in the early rehabilitation group than in the late rehabilitation group [(54.23±30.33),(46.57±29.85) points, P ＜ 0.05].CONCLUSION: Both early and late rehabilitative interventions can obviously accelerate the recovery of neurological function, motor function and ADL, but the effect of early rehabilitative intervention is superior to that of the late one.

BACKGROUND: Cephalocervical cancer is closely related with genetic factors, but do the first-degree relatives have a higher risk for cancers? Slenderstyle acanthopanax root-bark has an anti-mutation chromosome stabilizer, can it enhance the anticaner ability of the first-degree relatives? OBJECTIVE: To study the genetic factor of cephalocervical cancer and antimutagenic effect of slenderstyle acanthopanax root-bark.DESIGN:A controlled experiment with human peripheral blood as the sample.SETTING: The Department of Medical Genetics of the Basic Medical Science School, and the Department of Otolaryngology of the First Hospital of Jilin University; The University of Warwick, UK.PARTICIPANTS: The subjects were taken during the period of October 2001 to March 2002. The patients with cephalocervical tumor and their first-degree relatives were all from the Department of Otolaryngology,FirstHospital of Jilin University, and healthy group were well-being blood devoting volunteers from Changchun City Central Blood Bank. There were group( n = 50) included 25 males and 25 females who were healthy blood patients group( n =30) were composed of 22 males and 8 females who did first-degree relative group(n=30) consisted of 19 males and 11 females. They were the first-degree relatives of patients with carcinoma of larynx and carcinoma of nasopharynx. Except for the family history of cancer,they themselves were all healthy. Informed consents were obtained from all of them.METHODS: The peripheral blood was collected as the sample and the lymphocyte culturing was performed. The culture cycle was 72 hours and bleomycin(BLM) (15 mL) was added into it at the 67~ hour, also the slenderstyle acanthopanax root-bark(SARB) (800 mg/L) was added into the antimutagenesis experiment. The cells were collected after culturing for another 72 hours. The conventional method was used for slide preparation. The slides were stained with Giemsa solution without banding. Choosing the proper objective and observing the numbers of chromatid breaks. The numbers of chromatid breaks were converted into the numbers of chromatid breaks per cell (b/c value). Namely, b/c value equals to the quotient, the number of chromatid break divided by the number of the cell observed in the slide.MAIN OUTCOME MEASURES: The number of chromatid breaks per cell (b/c value).RESULTS: All the 110 cases in the 3 groups entered the stage of result It was lower in the control group than that in the patients group and first-degree relatives group(0.16 ± 0.06, 0.48 ± 0. 14, 0.42 ± 0. 12, P ＜0.01). There was no significant difference in b/c value between the paparison between b/c value induced by combined SARB with BLM and only BLM was performed: The b/c value of former is significantly lower than the latter (0.48±0.14,0.15 ±0.08,0.42±0.12, 0.17±0.11,P ＜ 0.01).CONCLUSION: The first-degree relatives of the patients with cephalocervical cancers should be classified as tumor high-risk group. SARB as a chromatid stabilizer has an obvious inhibitory effect on b/c value of the patients induced by BLM and that of the first-degree relatives.

objective To analyze the correlation between the level of serum uric acid and the clinical and pathological features of IgA nephropathy.Methods Totally 148 patients diagnosed as IgA nephropathy by renal biopsy in our hospital from January 2007 to December 2010 were divided into hyperuricaemic group(41 cases)and non-hyperuricaemic group(107 cases)according to the level of serum uric acid.The clinical parameters and renal pathology grade were compared.Results There were significant differences between hyperuricaemic group and non-hyperuricaemic group in the incidences of hypertension(63.4%vs 38.3%),disease duration[(18.90±10.12)months vs(9.46±3.91)months]and body mass index[(22.81±3.60)kg/m2vs(15.32±2.54)kg/m2](all P<0.05),while no differences in age and sex(both P>0.05).The blood urea nitrogen(BUN)[(8.93±4.28)mmol/L vs (5.21±2.18)mmol/L],creatinine(Cr)[(155.96±107.72)μmol/L vs(79.52±40.01)μmol/L],serum triglycerides[(2.11±1.06)mmoVL vs(1.86±1.20)mmol/L]and 24-hour urine protein amount [(4328.16±1434.25)mg/24 h vs(2885.10±1388.15)mg/24 h]were significantly different between the two groups(all P<0.05).The percentage of Lee's grade I+Ⅱin hyperuricaemic group was 12.2%,and IV+V grade was 39.0%,while percentage of Lee's grade I+Ⅱin non-hyperuricaemic group was 25.2%,and IV+V grade was 16.9%(P<0.05).Tubulointerstitial lesions(TIL)gradeⅢ+IV was more in hyperuricaemic group,which was 68.3%,while TIL grade II was more in non-hyperuricaemic group,which was 76.6%.Renal artery damage grade II+Ⅲ was more in hyperuricaemic group.which was 73.2%,while renal artery damage grade 0+1 was more in non-hyperuricaemic group,which was 69.2%.Conclusion The level of serum uric acid was related with 24-hour urine protein amount,blood pressure and kidney function in IgA nephropathy,and Lee's grade,TIL grade and renal artery damage grade were severe in hyperuricaemic group.

objective To explore a new method of repairing skin defects complicated with fracture and tendon rupture at the middle and distal sections of the second to fifth fingers. Methods The reversed dorsal metacarpal island flap was designed to be pedicled on the digital proper artery-common digital artery-fingerweb artery-dorsal metacarpal artery-cutaneous branch of dorsal metacarpal artery.In repairing digital palmar skin defects,after the flap was dissected,the proximal incision was extended along the direction of dorsal metacarpal nerve to harvest an enough length of the nerve so that the dorsal metacrppal nerve can be anastomosed with the digital proper nerve to restore the sensation of finger pulp.From the June 2003 to March 2009,the flap was used to repair 26 fingers in 24 patients with middle and distal digital skin defects complicated with fracture and tendon rupture.They were 17 men and 7 women,aged from 16 to 63 years (average,37 years).There were 15 cases of palmar skin defect and 9 cases of dorsal skin defect.In the 2 cases of combined tendon defects,a section of the extensor tendon of index(or little) finger was dissected together with the flap to repair the tendon rupture. Results The areas of the flap ranged from 3.1 cm ×1.6 cm to 6.0 cm × 4.0 cm.The flaps survived in all 24 cases without any vascular crisis.Twenty-two patients obtained an average follow-up of 14 months (from 4 to 32 months) but 2 were lost to the follow-up.The flaps were fine in texture,colour and appearance.The finger pulps appeared full and recovered sensations of pain and temperature.The average two-point discrimination was 7.5 mm (from 5 to 9 mm).Sensory function evaluation revealed an outcome of S3 + ～ S4.Tendon adhesion occurred in 4 cases which recovered digital function following secondary lysis 3 to 6 months postoperation. Conclusion Application of the reversed dorsal metacarpal island flap pedicled on the digital proper artery is a good way to repair skin defects complicated with fracture and tendon rupture at the middle and distal sections of the second to fifth fingers.

Objective Plasma levels of matrix metalloproteinase-9 ( MMP-9 ) and serum level of high-sensitivity C reactive protein (hs-CRP) were detected to investigate their distributions between patients with stable stroke and those with asymptomatic intracranial artery stenosis and to explore their clinical significance. Methods The mean level of the serum hs-CRP of the group with recurrent stroke (2.34 mg/L)was the highest, followed by that of the group with the stable stroke( 1.45 mg/L),asymptomatic intracranial artery stenosis ( 1.31 mg/L) and control group (0.96 mg/L) ( P = 0.001 ). The level of the MMP-9 was in sequence of recurrent stroke group ( 121.82 ± 72.99 ) μg/L ＞ asymptomaticintracranial artery stenosis group ( 119.18 ± 80.01 ) μg/L ＞ stable stroke group( 112.76 ± 59.66) μg/L,while no statistical significance was found among groups( P = 0.947 ). However, the level of MMP-9 of three patient groups( 118.08 ± 71.06 ) μg/L was significant higher than control group( 57.55 ± 10.44 )μg/L (P ＜0.001 ). The spearman analysis for the relationship showed that the concentration of MMP-9 was positively associated with that of hs-CRP ( r = 0.337, P ＜ 0.001 ). Conclusions The hs-CRP maintained a high level in stable stage of stroke. The MMP-9 level in the patients group was significant higher than control group and the level of MMP-9 was positively associated with that of hs-CRP which suggested MMP-9 might be correlated with atherosclerosis other than stroke occurrence.

Objective To observe the effect of treatment of the diabetide foot with the fresh skin of the bufo bufo gargarizans cantor. Methods 42 diabetic foot patients were randomized into the control group and the treatment group with 21 patients in each. In the control group the patients were treated with disinfection routinely and dressing changing. In the treatment group the patients were treated with the fresh skin of the bufo bufo gargarizans cantor covering the infected feet after routine disinfection treatment. The treatment effect, the healing time and the length of antibiotics treatment course were compared between the two groups. Results The treatment effect of the treatment group was 100.00%, significantly higher than 80.95% of the control group. The healing time of the treatment group was (9.05 ±4.09) days, shorter than (17.41±4.20)days of the control group. The length of the antibiotics treatment course of the treatment group was(9.33±4.73)days, shorter than (17.10±4.83) days of the control group. Conclusions The fresh skin of the bufo bufo gargarizans cantor can improve the recovery rate, shorten the healing time and the length of the antibiotics treatment course by covering the infected feet.