Objective: To compare the efficacy of bupivacaine alone or combined with fentanyl, midazolam or tramadolduring PCEA. Methods:Sixty patients scheduled for abdominal hysterectomy under combined epidural and spinal anesthesiawere randomly divided into four groups. Group A received 0. 125 % bupivcaine, group B 0. 125 % bupivacaine + fentanyl(2.5tg/ml), group C 0.125 % bupivacaine + midazolam(0.5mg/ml), group D 0. 125 % bupivacaine + tramdol(3mg/ml).PCEA parameters were a loading dose of 6mi, a bolus dose of 3mi, a lockout interval of 30 min and continuous infusion of2ml/h. The total drug dosage was recorded for up to 24h after operation. The number of PCEA demand, visual analogue painscales(VAS), sedation scales, the incidence of nausea and vomiting, respiratory rate (RR) and mean arterial pressure (MAP)were measured at 4h, 8h, 12h and 24h postoperatively. Results: The total drug dosage, number of button pressed and VAS ingroup A were significantly higher than those in the other groups( P < 0.01 ), which was the least in group D. The sedationscales were the highest in group C. There was a higher incidence of nausea and vomiting in group B. Conclusions: Bupivacainecombined with fentanyl, midazolam or tramadol used for PCEA produces higherquality of pain relief than bupuvacaine alone.

Objective To analyse a novel splice mutation in EXT1 gene of hereditary multiple osteochondroma, and study its pathogenic mechanism.Methods In April of 2013, the proband was hospitalized from the outpatient department with multiple joint deformity for more than 20 years, peripheral blood of the proband and his parents were collected and genomic DNA was extracted .Coding regions and adjacent intron sequences of EXT1/EXT2 genes in genomic DNA of the family members were amplified and sequenced.Bioinformatics was used to analyze the mutation from sequencing .cDNA from peripheral blood of the proband ,the mother and normal control was made respectively as a template for amplifying coding regions of EXT1 gene, and the product was T-A cloned and sequenced.The abnormal transcripts of each group were counted and analyzed using chi square test to study the pathogenic mechanism of the mutation .Results Sequencing results of family members revealed that there was a heterozygous deletion mutation ( c.1284 +2del) in the 5′splice site of intron 4 in EXT1 gene of the proband and his mother .Bioinformatics predicted that exon 4 of EXT1 gene was skipping or spliced aberrantly due to the mutation .T-A clone and sequencing results as well as the statistical analysis suggested that there was a significantly higher proportion of transcripts with skipping exon 4 in the proband and his mother compared with the normal control (P=0.000, P<0.01).Conclusions c.1284+2del in EXT1 gene is reported for the first time internationally , which results in a considerable number of abnormal transcripts with skipping exon 4 in EXT1 gene, thereby influences the normal transcription and translation of EXT1 gene.

Objective To evaluate the diagnostic value of serum M-type phospholipase A2 receptor(PLA2R) antibody detection for the diagnosis of idiopathic membranous nephropathy(IMN) by meta analysis.Methods By searching the databases of PubMed,Emabse,Wanfang and CNKI from inception to May,2017,all the literatures referred to serum PLA2R antibody for the diagnosis of IMN in both English and Chinese were reviewed and selected according to the inclusion and exclusion criteria.QUADAS was used to assess the quality of eligible studies.Meta-disc 1.4 was used to analyze heterogeneity and pooled effectsize and Stata 12.0 was used to analyze publication bias.Results A total of 20 studies with high quality were included.Heterogeneity test indicated there was no threshold effect.The pooled sensitivity was 0.69 (95 ％ CI:0.67 to 0.72),the pooled specificity was 0.97 (95 ％ CI:0.96 to 0.98) and the summary area under curve was 0.880.Sensitivity analysis indicated that the result was stable.Deek's funnel plot indicated there was no publication bias.Conclusion The sensitivity of detection of serum PLA2R antibody was acceptable for the diagnosis of IMN with high specificity,so more attention on PLA2R antibody should be paid in the clinical practice.

Objective To analyze the distribution and antimicrobial resistance situation of pathogens isolated from blood culture to provide the scientific basis for the accuratel use of antibacterial drugs and preventing and controlling nosocomial acquired blood‐stream infection .Methods The US BACTEK‐FK automatic blood culture instrument and the French VITEK 2 COMPACT auto‐matic bacteria identification/susceptibility system were used to conduct the culture ,identification of blood culture isolated bacterial strains and drug susceptibility test .The results of drug susceptibility test were judged by adopting the 2011 criteria of the Clinical Laboratory and Standards Institute(CLSI) .Results The main isolated bacteria from blood culture for the recent three years were E coli ,staphylococcus aureus and klebsiella pneumonia bacteria ,coagulase negative staphylococcus(CNS) ,etc .The proportions of hos‐pital‐acquired bloodstream infections during these period were 42 .2% ,46 .9% and 54 .1% respectively .The detection rate of methi‐cillin‐resistant staphylococcus aureus (MRSA) was 18 .8% ,which of multiple drug resistant acinetobacter baumannii (MDRAB) was 42 .9% ,which of producing extended spectrum beta lactamase (ESBLs) in E .coli and klebsiella pneumoniae were 71 .8% and 69 .8% respectively .Conclusion The bloodstream infections pathogens in this hospital are mainly Enterobacteriaceae bacteria ,the proportion of hospital‐acquired bloodstream infections increases year by year ;the detection rate of multi‐drug resistant Acinetobact‐er baumanni (MDRAB) is higher ,clinic should pay more attention to the change of blood culture pathogens and their drug resist‐ance trend ,meanwhile nosocomial bloodstream infection should be prevented and controlled .

Objective To evaluate effects of minimally invasive dynamic hip screw(DHS)in treatment of intertrochanteric femoral fractures.Methods The study involved 98 patients with intertrochanteric femoral fractures treated by closed reduction and C-arm fluoroscopy guided minimally invasive DHS from January 2004 to January 2010.According to AO classification,there were 38 patients with type A1 fractures and 60 with type A2 fractures.According to Evans classification,there were nine patients with typeⅠ?fractures,29 with type Ⅱ,36 with typeⅢ?and 24 with type V.Intraoperative blood loss,operation time and incision length were recorded.Results The intraoperative hemorrhage,operation time and incision length were average 250 ml(range,150-450 ml),54.3 minutes(range,45-70 minutes),and 5.2 cm(range,4-7 cm),respectively.All the patients were followed up for 12-38 months(mean 16.8 months).Fracture healing time was 10-14 weeks(average 11.5 weeks).According to Zuekerman functional scoring for hip joint,the results were excellent in 61 patients,good in 30,fair in four and poor in three,with excellence rate of 92.9％.Varus deformity of hip occurred in four patients.No patient presented surgical site infection,implant failure or displacement of fractures.Conclusion Minimally invasive DHS is an effective means in treating intertrochanteric femoral fractures,but the key point of successful treatment is to strictly grasp the correct operative procedures.

Objective To investigate the early diagnostic value of EBV-DNA load in Plasma and peripheral blood mononuclear cells (PBMCs) for Children′s Primary Infectious Mononucleosis(IM).Methods The plasma and PBMCs samples were collected from children of 67 cases with primary IM (IM groups) and 75 healthy cases (H groups) during April, 2015 to March, 2016 in our hospital. The EBV-DNA load in PBMCs and plasma samples were quantified by Real-time PCR. Statistical differences between two groups were analyzed by using Mann-Whitney Test. Receiver operating characteristic curves (ROC) were analyzed to assess the early diagnostic value of EBV-DNA load for primary IM.Results Levels of EBV-DNA in the samples of plasma were significantly higher in the IM groups (median, 380 IU/ml) compared to the H groups (Z=-9.332,P<0.01), and levels of EBV-DNA in the PBMCs samples were also significantly higher (median, 2.51×105 IU/ml, Z=-9.194,P<0.01). According to ROC curve analysis, the AUC of EBV-DNA load in plasma was 0.908, the most appropriate cut-off value was 12.5 IU/ml (sensitivity: 83.6% and specificity: 94.7%),the AUC of EBV-DNA load in PBMCs was 0.944, the most appropriate cut-off value was 2.19×104 IU/ml (sensitivity: 89.6% and specificity: 82.7%), the AUC of combined testing(plasma and PBMCs) was 0.967(sensitivity: 98.3% and specificity: 99.0%).Conclusions Combined testing of plasma and PBMCs have better clinical value, it may be useful for the diagnosis of early stage of Children′s Primary Infectious Mononucleosis.

Objective:To study the efficacy of drugs combined with rehabilitation training in the treatment of schizophrenia and the influence on social function. Methods:Totally 160 cases of schizophrene were divided into the control group and the observation group according to the admission time sequence with 80 ones in each. The control group was treated with medicines, and the observation group was given labor skills training, life skills training and health education additionally. The treatment course was 8 weeks. Before and after the treatment, brief psychiatric rating scale ( BPRS) and inpatient rehabilitation efficacy rating scale ( IPROS) were used to evaluate the clinical efficacy and social function of the two groups, and the score changes and curative effect in the two groups were compared. Results:After the treatment, BPRS and IPROS in the two groups were significantly decreased from the fourth week ( P<0. 05), and the reduction degree in the observation group was significantly larger than that in the control group (P<0. 05). There was no statistically significant difference in BPRS and IPROS of efficacy between the two groups (P>0. 05), while BPRS and IPROS of ef-fective rate in the observation group were significantly higher than those in the control group(P<0. 05). Conclusion:Drugs combined with rehabilitation training in the treatment of schizophrenia patients can improve mental symptoms, social life ability and cognitive function, which is better than drug treatment alone.

About 15% of the world's population at child-bearing age suffer from infertility. After cancer and cardiovascular and cerebrovascular diseases, the infertility will become the third-largest intractable disease. Among the causes of infertility, male factors account for about half. As a main male factor, genetic factor has become the focus of reproductive research in recent years. Therefore, to formulate a corresponding diagnosis and treatment scheme for male infertility, accurate genetic testing is needed. It is an effective means to meet the demand of high fertility and solve the problem of population decline in current society.

Medical experimental zoology is a very important course in medical colleges. The course construction of medical experimental zoology is of great significance for students in their understanding of the subject and scientific research as a whole. This article reviews the current situation of experimental zoology courses in medical colleges at home and abroad, describes the teaching design, teaching content and assessment methods in our school (North Sichuan Medical College), and then collects feedback and advices from students after they finish the course. This study aims to provide certain reference and thought for medical science curriculum reform innovation.

Objective To evaluate the value of fast track surgery (FTS) in laparoscopic hepatectomy.Methods The clinical data of 142 patients undergoing laparoscopic liver resection from January 2014 to January 2016 were analyzed retrospectively.74 patients received fast track surgery treatment (FTS group) and 68 patients received traditional treatment methods (control group).Results Compared with control group,FTS group had a shorter operative time and less blood lose (t =2.279,t =2.432,P ＜0.05),quicker postoperative intestinal function recovery (t =3.548,P ＜ 0.05),a shorter postoperative hospitalization time (t =2.821,P ＜ 0.05),a lower hospitalization cost (t =2.507,P ＜ 0.05),a lower postoperative VAS scores (t =3.394,t =3.176,t =7.079,P ＜ 0.05) in 3 post-op successive days.There were 3 patients with major post-op complications in FTS group (4.05％,3/74) compared with 4 cases in control group (5.88％,4/68) (x2 =0.253,P ＞ 0.05).Conclusion The application of fast track surgery in laparoscopic liver resection is safe and effective,and helpful in reducing patients' inhospital cost.