A visualized reformation was carried out in the multimedia coursewares through collecting and adding the related pictures and professional video information.Through the teach-ing practice in the last three years,we have got the opinion from the students that by overcom-ing the stiffness and dullness of the old"General",the reformed"General"obviously has sur-passed the old"General"in teaching quality.

Objective:To optimize the extraction parameters for anthraquinones in Semen Cassiae by Box-Behnken experimental design. Methods:Based on single factor screening, a three-factor and three-level Box-Behnken experimental design was employed with the ethanol concentration, material to liquid ratio and extraction time as the independent variables. The dependent variables including the extration rates of chrysophand and aurantio-obtusin were transformed into desirability mathematically by Hassan 's method. The mathematical relationship was established between the dependent variables and the independent variables. The optimum experimental conditions were selected from the stationary point of the response surfaces. Results:The optimum extraction conditions were as follows:12-fold amount of 44％ ethanol as the solvent, extracted three times with 2. 65h for each time. The extraction rate of chrysophanol and aurantio-obtusin was 1. 921％ and 3. 244％, respectively. Conclusion:The measured value is close to the predicted one,which indi-cates the comprehensive extraction parameters optimized by Box-Behnken experimental design can be used for the extraction of chry-sophanol and aurantio-obtusin from Semen Cassiae.

Many pediatric surgeons have little training in laparoscopic application.The major problem in clinical practice of laparoscopic technician is without regularly training,unsuitable indication,and ignoring peroperation management.so that there are much more serious complications.For these reasons,it is a prerequisite that surgon and anesthetist must be trained before clinical practice,and the qualification of admission should be strictly controlled.

Objective This paper is mainly to discuss accuracy and clinical application value of MDCT double-period enhanced scanning with low -tension water enteroclysis for colon cancer preoperative TNM stag-ing.Methods Sixty-two colon cancer patients with complete images and pathological data were selected in our hospital from January 2012 to May 2013 .We retrospectively analyzed CT image changes of the tumor location ,the extent of tumor invasion,the surrounding fat space,lymph node metastasis and distant metastasis.We compared them with postoperative pathology to prove the accuracy of MDCT double -period enhanced scanning with low -tension water enteroclysis.Results The results showed that its accuracy rate reached to 90.32%(56/62)in co-lon cancer preoperative Stage T,80.64%(50/62)in Stage N,and 100%(62/62)in Stage M respectively.Con-clusions MDCT double-period enhanced scanning with low -tension water enteroclysis can accurately display the site of colon cancer and determine the scope of tumor invasion ,lymph node metastasis and distant metastasis , and give more precise diagnosis of colon cancer and preoperative staging assessments .In conclusion , it can be used as the preferable method of preoperative examination in the colon cancer .

OBJECTIVE To characterize clinical feature,frequency of isolation and antimicrobial susceptibility of bacterial pathogens isolated from patients with healthcare-associated bacterial meningitis(HABM).METHODS We review the charts of all patients in whom the diagnosis was based on(national) diagnostic criteria of healthcare-(associated) infections at Huashan Hospital from 1995 through 2004.The pathogens were routinely isolated,(identified) and susceptibilities against antimicrobial agents were determined by Kirby-Bauer methods.RESULTS During the 10-year study period,109 patients were treated for 120 episodes of HABM.Most of patients had a(history) of recent and remote neurosurgery.Fever was present in all patients,while nuchal rigidity and decrease consciousness were present in less than half of all patients.CSF opening(pressure,) white blood cell count and(protein) were elevated with predominance of neutrophils.A total of 120 strains were isolated from CSF specimen,Gram-positive bacteria and Gram-negative bacilli were accounted for 35.8% and(64.2%) of all isolates,respectively.Acinetobacter spp(24.2%),coagulase-negative staphylococci(22.5%),Klebsiella pneumoniae(12.5%),Pseudomonas aeruginosa(10%),Enterobacter cloacae(8.3%) and Staphylococcus aureas(7.5%) were the 6 most frequent isolates and resistance to the first line antibiotics was common among all pathogens isolated.(CONCLUSIONS) The most common risk factor for HABM is neurosurgery.Gram-negative bacilli and staphylococci are important causes of HABM,resistance to the first line antibiotics is common among all pathogens isolated.

20 antimicrobial agents were determined by Kirby-Bauer methods by the participating institutions.RESULTS A total of 428 strains were isolated,Gram-positive cocci and Gram-negative bacilli accounted for 49.8% and 50.2%,respectively.The Gram-positive bacteria increased from 44.6% to 51.2% from 1995-1996 through 2003-2004 and Gram negative bacteria decreased from 55.4% to 48.2% in the meantime.The most frequent Gram-positive isolates were coagulase negative staphylococci,Staphylococcus aureus,Enterococcus spp and Streptococcus pneumoniae;the most frequent Gram-negative isolates were Acinetobacter spp,Klebsiella spp,Escherichia coli,Pseudomonas aeruginosa and Enterobacter spp;Neisseria meningitidis,Haemophilus influenzae,Flavobacterium spp and Citrobacter spp were relative less common.No strains resistant to vancomycin were found in staphylococci and enterococci.Gram-negative bacilli were highly susceptible to carbapenem.CONCLUSIONS Gram-positive cocci play an increasing role in central nervous sysytem infections,especilly coagulase negative staphylococci,and Gram-positive cocci have been increasing from 1995-1996 through 2003-2004,resistance to the first line antibiotics is common among all cerebrospinal fluids isolates.

Objective To characterize clinical feature, frequency of isolation and antimicrobial susceptibility of pathogens isolated from patients with nosocomial bloodstream infections in Huashan Hospital, Fudan University from 1995 to 2004. Methods The clinical data of all patients who were diagnosed with nosocomial bloodstream infections based on national diagnostic criteria of nosocomial bloodstream infections were retrospectively analyzed. The pathogens were routinely isolated and identified. Susceptibilities against antimicrobial agents were determined by Kirby-Bauer methods and analyzed by WHONET 5.0 software. Results During the 10-year study period, a total of 395 patients were diagnosed with nosocomid bloodstream infection with 435 strains isolated from blood specimen.Gram positive bacteria, Gram negative bacilli and fungi, accounted for 47.4%, 45.1 % and 7.6%,respectively. Coagulase-negative Staphylococci (21.4%), S. aures (17.9%), E.coli (13.6%), K. pneumoniae (10.8%), Candidaspp (7.4%), Enterococci (6.0%), Pseudomonasspp (6.0%) and Acinetobacter spp (3.7%) were frequently identified isolates. S. aures and coagulase-negative Staphylococci resistant to methicillin were 62.8% and 87.1%, respectively. The susceptibilities of cefotaxime and ceftazidime against E. coli and K. preumonine were 46%-78% and 27.7%-40.4%, respectively. Conclusions The Gram positive cocci are slightly more prevalent than Gram negative bacilli in nosocomial bloodstream infections and resistance to the first line antibiotics is common among all pathogens isolated. Candida spp is the fifth leading cause of nosocomial bloodstream infections.

ObjectiveTo assess the diagnosis and treatment of staphylococcal scalded skin syndrome (SSSS)in children.MethodsA total of 177 children whh SSSS were eligible for this study.Clinical data were retrospectively reviewed to assess the patients' age and geographical areas,predisposing factors,prodrome,clinical features,results of laboratory examination(including bacterial isolation and drug susceptibility test),treatment and prognosis.ResultsThe median age at onset was 23 days past 15 months.Infants aged 1 to 3 years were the most commonly affected population.The male to female ratio was 8:9.SSSS occurred in summer or autumn in 71.2％ of the patients.Most patients came from countryside.Of these patients,148 (83.6％) had no definite inducement,13 (7.3％) had fever or cold history before the occurrence of SSSS.Skin lesions often began in the face(71.6％).Almost all cases presented with erythema and blisters.Abnormal myocardial enzymes were observed in 104(80.6％) of 129 patients,and Staphylococcus aureus was isolated from 38.7％ of 142 patients.Susceptibility testing of 21 Staphylococcus aureus isolates from patients in the past 3 years showed that 95.2％ and 95.0％ were sensitive to cephalosporins and amoxicillin/clavulanic acid respectively.Double-antibiotic therapy was effective in 72.9％ of the patients.Intravenous gamma globulin was given to 36.2％ of the patients in the early stage.Myocardial-protecting drugs were also administrated early in patients with abnormal myocardial enzymes.All the patients healed without scarring.ConclusionsFor infants with acute facial erythema and exfoliative skin lesions,SSSS should be suspected and timely antibiotic treatment should be given.Cephalosporins and semi-synthetic penicillins are effective and the first choice for the treatment of SSSS.Meanwhile,early addition of gamma globulin and myocardial-protecting drugs may be beneficial to disease recovery.

Objective To evaluate and compare the curative effect between the microinvasive craniopuncture therapy and the clearance of hematoma by craniotomy with small bone flap in treating patients with moderate cerebral hemorrhage (30-60 ml)in the basal ganglion part of the brain. Methods Ninety-five patients with intracerebral hemorrhage were randomly divided into treatment group (microinvasive craniopuncture therapy) and control group (the clearance of hematoma by craniotomy with small bone flap). The main indexes of evaluation were the neurological impairment degree (NID) on the 14th day after treatment, activities of daily living (ADL) by the end of the third month, the incidence rate of complications, and the case fatality during 3 months. Results On the 14th day after treatment, there was no significant difference between the two groups in the NID and the ADL of patients. The incidence rate of respiratory tract infection, gastrointestinal hemorrhage, electrolyte disorder in treatment group [16.33% (8/49), 6.12% (3/49), 6.12% (3/49), respectively] was significantly reduced than those of control group [56.52% (26/46), 21.74%(10/46), 21.74% (10/46),respectively] during hospitalization (P < 0.05). By the end of the third month, there was significant difference in favorable outcomes (Barthel index 95-100) (χ~2 = 18.7524,P =0.0009) and in improving the ADL (MRS)(t =5.2723,P =0.0001) between the two groups [39.13% (18/46), 4.65% (2/43),respectively]. In ease fatality, there was no significant difference between the two groups [6.12% (3/49),6.52% (3/46),respectively]. Conclusion As compared with the clearance of hematoma by craniotomy with small bone flap, the microinvasive craniopuncture therapy can remarkably reduce the incidence of complications, and improve the ADL of patients with moderate cerebral hemorrhage (30-60 ml) in the basal ganglion, and decrease disability without increasing fatality.

Objective To observe the concentration changes of plasma cortisol ( Cor ) and adrenocorticotropic hormone( ACTH) in preterm infants with respiratory failure receiving ventilation treatment. Methods The 30 preterm in-fants with respiratory failure requiring mechanical ventilation were selected as the preterm group with respiratory failure, and 32 full term infants with respiratory failure in need of mechanical ventilation were selected as the term infant group with respiratory failure, and 52 preterm infants( preterm control group) and 17 full term infants( term control group) were selected as controls. All the cases were chosen from Neonatal Intensive Care Unit of Anhui Province Children′s Hospital during January to December 2014. The levels of plasma Cor and ACTH were measured and analyzed. Results (1) Cor level:on the 3rd day, the level of plasma Cor in the preterm group with respiratory failure was lower than that in the term group with respiratory failure[262. 50(162. 00-332. 50) nmol/L vs 531. 00(244. 75-644. 00) nmol/L], and higher than those in the preterm control group[199. 50(49. 05-388. 95) nmol/L] and term control group[120. 00(43. 90-191. 00) nmol/L], the differences were statistically significant(all P<0. 05). On the 7th day, the level of plasma Cor in the preterm group with respiratory failure was lower than that in the term group with respiratory failure[128. 00(65. 85-244. 00) nmol/L vs 222. 00 (131. 50-377. 85) nmol/L], the difference was statistically significant(P<0. 05). (2) ACTH level:on the 3rd day, the level of ACTH in the preterm group with respiratory failure was higher than those in the other groups[38. 20(25. 18-76. 65) pmol/L vs 24. 60(19. 03-38. 20) pmol/L vs 22. 30(14. 40-40. 60) pmol/L vs 24. 20(13. 90-45. 65) pmol/L], the differences were statistically significant(P<0. 05). On the 7th day, the concentration of ACTH in the preterm group with respiratory failure was lower than those in the term group with respiratory failure[16. 55(12. 78-31. 80) pmol/L vs 29. 85(18. 23-54. 65) pmol/L], and there were statistical differences(P<0. 05). Conclusions The newborns with respiratory failure were in criti-cal stress, the level of plasma Cor in the preterm infants with respiratory failure was lower than that of the term infants with respiratory failure, while the level of ACTH in the former was higher than that in the latter. And when the stress disap-peared, both of the plasma Cor and ACTH recovered to the normal level.