Objective To investigate the predictive value of mnodified early warning score (MEWS) in predicting emergency potential in critically ill patients and its feasibility.Methods A total of 298 patients in the emergency department and emergency room were evaluated using the MEWS.The distribution of transfer to cadiopulmanary resuscitation (CPR),intensive care unit (ICU) and high dependency unit (HDU),length of hospital stay ( more than 1 month or not) and transferred to advanced hospital,death were recorded,and all patients were followed up.Results Patients with different MEWS were treated significantly differently ( x2=258.697,P ＜ 0.001 ),and their prognosis were also significantly different ( x2=115.938,P ＜ 0.001 ).the condition of patiens were significantly correlated with MEWS ( r=0.848,P ＜ 0.001 ).Conclusion The MEWS in the prediction of potential in critically ill patients in emergency department is feasible as a special emergency assessment system and is recommended for promotion.

ObjectiveTo explore the operation effect and clinicopathologic characteristics of elderly patients with gastric carcinoma(GC) and the relationship between prognosis and age.MethodsThe clinical data and treatment outcomes of 112 elderly patients suffered from GC( elderly group≥70 years of age) and 135 younger patients (control group ＜50 years of age) were analyzed retrospectively.ResultsThe elderly GC patients had more preoperative comorbidities,and a well or moderately differentiated histology(P ＜0.05).And more young patients had a poorly differentiated histology and signet ring cell carcinoma,using the Borrmann classification,type Ⅳ was more frequent in the young patients(P ＜0.05 ) ; Whereas there were no significant differences beween the two groups in other factors ( including liver function,tumor invasion,nodal involvement,hepatic metastasis,peritoneal dissemination,tumor stage,type of surgery,post operation complication and 5-year survival rates of elderly patients and young patients) ( all P ＜0.05).ConclusionOutcomes in elderly patients with gastric carcinoma were comparable to young patients.The important prognostic factor was whether the patients undergo a curative resection.For the elderly patients without preoperative comorbidities or with controlled comorbidities,gastrectomy was a safe and effective treatment.

Objective To investigate clinical presentation, diagnosis,gestational outcome and treatment of Eisenmenger’s syndrome during pregnancy. Methods Two patients with Eisenmenger’s syndrome during pregnancy were reported retrospectively. Results The first case was admitted in labor at 34 weeks and 4 days in pregnancy,She had dysphoria,tachypnea and dyspnea right after vaginal delivery and died immediately The diagnosis of pulmonary embolism was highly suspected clinically. The second case was admitted because of fetal growth restriction Cesarean section was performed after cyanosis worsened at 35 weeks and 4 days She was discharged from the hospital two weeks after delivery. Conclusion Eisenmenger’s syndrome during pregnancy was associated with extremely poor maternal and fetal outcome Pregnancy is contraindicated in such patients Contraception is necessary after marriage Pregnancy should be terminated as early as possible in such women. In cases who intends to continue the pregnancy,closely observation must be provided to ensure the safety for both mother and the fetus.

The discovery of microRNA (miRNA) has opened up a new train of thought for the diagnosis and treatment of esophagus cancer.let-7 is one of the most widely research of miRNA.In a variety of tumors,the expression of let-7 is down-regulated.let-7 can play the role of tumor suppressor gene by targeting to high mobility group A2 (HMGA2) and inhibit the cell proliferation.Recent studies have shown that the lower the degree of differentiation of cells,let-7 expression level is lower.It is expected as a symbol of poorly differentiated tumors.In addition,let-7 and esophagus cancer's radiation and chemotherapy sensitivity are closely related.

BACKGROUND:Leukocytic infiltration induced by release of inflammatory cytotkines and up-regulation of adhesion molecules is closely associated with the formation of cerebral infarcted focus. The related factors have been widely studied.OBJECTIVE: To explore influence of estrogen on inflammatory reaction in rats after focal ischemia/reperfusion injury.DESIGN: Randomized controlled experiment.SETTING: Nanjing General Hospital, Nanjing Military Area Command of Chinese PLA.MATERIALS:The experiment was performed at the Department of Neurology, Department of Pathology, Nanjing General Hospital, Nanjing Military Area Command of Chinese PLA. Adult male SD rats were selected to establish cerebral ischemic models, with the body mass of 280-350 g.METHODS:The rats were assigned into 3 groups: control group,ovariectomized group and estrogen treatment group (estradiol, 200 μg/kg,subcutaneous injection, once a week for 4 weeks). Four weeks later, models with right middle cerebral artery occlusion (MCAO) for 1 hour and 2 hours as well as reperfusion for 0, 1, 3, 6, 22 and 70 hours were established with thread embolism method. Mean number of infiltrative neutrophils in brain tissue was calculated under microscope with 10 high power fields in ischemic hemisphere with hematoxylin and eosin staining. Expression of nuclear factor-κB was determined with immunohistochemical method.MAIN OUTCOME MEASURES:Infiltration of neutrophils and expression of nuclear factor-κB in brain parenchyma.RESULTS: ①Expression of nuclear factor-κB: There was expression of nuclear factor-κB in the ovariectomized group at hour 1 after ischemia.Positive cells appeared at hour 2 after ischemia in the control group and estrogen treatment group. The expression was in the peak at ischemia for 2hours and reperfusion for 3 hours in the three groups, and decreased gradually. There was slight expression at reperfusion for 70 hours in the ovariectomized group, while there was no clear factor-κB positive cell at reperfusion for 22 hours in the control group and estrogen treatment group.②Infiltrative neutrophils in cerebral ischemic region in the ovariectomized group significantly increased at ischemia for 2 hours and reperfusion for 22 hours. Compared with the estrogen treatment group, there was significant difference (P=0.045). At ischemia for 2 hours and reperfusion for 70 hours,infiltrative neutrophils in the ovariectomized group were more than those in the control group and estrogen treatment group, but there were significant differences only between ovariectomized group and control group.CONCLUSION: Estrogen can inhibit inflammatory reaction after cerebral ischemia/reperfusion injury.

Objective To compare the effect between problem-based learning and lecture-based learning for clinical teaching in the department of cardiovascular medicine. Methods Totally 110 five-year-program cardiovascular interns from June 2011 and June 2012 were selected. They were randomly divided into the PBL group(n=55) and LBL group(n=55). PBL and LBL teach-ing methods were applied in the two groups respectively. Teaching effects were evaluated by exam and questionnaire investigation. SPSS 15.0 was used to do data processing; t test was used to compare the average score of two groups;chi-square test was used to process the results of the questionnaire. P<0.05 signifies sta-tistically significant differences. Results There were statistical differences in examinational average score between PBL group and LBL group ((87.89 ±5.39) vs. (82.63 ±5.26), P<0.05). PBL group had significantly higher satisfaction rate in motivating study interests , deepening understanding of theoretical knowledge, cultivating self-learning ability, training verbal expression and developing clin-ical thinking, etc(P<0.05). Conclusions PBL teaching method demonstrates advantages in teaching of cardiovascular medicine and enhances the teaching effect. But the PBL teaching method should be improved in basic knowledge teaching, cultivation of teachers' ability and case selection.

Objective It is purposed to evaluate clinical efficacy of adefovir dipivoxil combined with anti-tuberculosis (TB) drugs in treatment for chronic hepatitis B (HB) complicated with pulmonary TB. Methods Ninety-four eases of pulmonary TB complicated with chronic HB receiving anti-TB drug treatment at Liaocheng Hospital for Infectious Disease during September 2006 to September 2008 were divided into treatment and control groups matched on their pulmonary TB lesion, damage in liver function and HB virus (HBV) DNA load. Forty-seven cases in the treatment group were administered with anti-TB drugs, i.e., isoniazid (INH) 0. 3 g daily, rifapentine (RFT) 0.45 g twice a week, pyrazinamide (PZA) 1.5 g daily, streptomycin (SM) 0. 75 g daily or ethambutol (EMB) 0. 75 g daily, and regular liver-protection drags, as well as oral adefovir dipivoxil 10 mg daily for eight months, and another 47 cases in the control group were administered with the same anti-TB drugs and regular liver-protection drugs as the treatment group. Two to eight weeks after treatment, clinical symptoms, liver function, HBV DNA load, negative conversion of acid-fast staining bacteria in sputum smear, and absorption of pulmonary TB lesion were evaluated for all the patients in both groups. Data were analyzed with U-test and χ2-test, respectively. Results After treatment, damage in liver function worsened in three cases (6.4%), as compared to that in 47.3 percent of the control group (P<0.05). Clinical symptoms, including tiredness, loss of appetite, abdominal distension, uncomfortable in upper abdomen, and so on, appeared in three cases of the treatment group (6.4%) during anti-TB treatment, as compared to those in 18 cases of the control group (47.3%) (P<0.05). HBV DNA conversed to negative (less than 1.0×103 lg copies/ml) in 24 cases of the treatment group (51.1%), HBV load went down to 1.0×103-1.0×104 lg copies/ml in 23 cases (48. 9%), sputum smear bacteria conversed to negative in 41 cases (87. 2%) and pulmonary lesion absorbed in 45 cases (95.7%), all with statistically significance as compared to those in the control group (47. 3% , 0. 0% , 2. 6% , 39. 5% and 50. 0% , respectively, P <0. 05). Renal function was all in normal in both groups and no patient with drug resistant variant HBV was found during and after treatment, and no obviously adverse reaction was found in patients with adefovir dipivoxil. Conclusion Adefovir dipivoxil has a good safety and can reduce laver damage in anfi-TB drug treatment for patients of chronic hepatitis B complicated with pulmonary TB.

Objective To update the knowledge on the sensitizing drugs and clinical features of drug eruption. Methods The clinical data on 138 patients hospitalized for drug eruption in the Department of Dermatology, Institute of Dermatology, Chinese Academy of Medical Sciences, from January 2005 to June 2007, were collected and retrospectively analyzed. Results Totally, 178 episodes of drug eruption were observed in these patients during the tested period. The major sensitizing drugs included antibacterial agents (31.46%), non-steroidal anti-inflammatory drugs (28.09%), traditional Chinese medicines (15.73%). Amoxicillin triggered 20 episodes of drug eruption and was the most common causative drug. Oral administration was the predominant sensitizing route of administration (54.17%). Of all the drug eruptions, 33.71% manifested by erythema multiforme, 28.09% by fixed drug eruption, 22.47% by exanthematous drug eruption. Severe types of drug eruption were mainly caused by traditional Chinese medicines and anti-gout drugs. Conclusions Antibacterial agents and non-steroidal anti-inflammatory drugs have become the major sensitizing drugs of drug eruption, especially amoxicillin. The frequency of traditional Chinese medicine-induced eruptions are increasing. Furthermore, caution is warranted for the drug eruption caused by oral administration.

Aim To determine the roles of peripheral ? 1 and ? 2 -adrenoceptors (? 1-AR,? 2-AR) in inhibition of carotid sinus barore ceptor reflex(CSR) induced by intracerebroventricular injection (icv) of histami ne (HA).Methods The left and right carotid sinus regions were i solated from the systemic circulation in 22 male Sprague-Dawley rats anesthetiz ed with pentobarbital sodium.The intracarotid sinus pressure (ISP) was altered in a stepwise ma nner in vivo.ISP-mean arterial pressure (MAP) relationship curve and its ch aracteristic parameters were constructed by fitting to the logistic function wit h five parameters.The changes in CSR performance induced by icv HA and the effec ts of pretreatment with ? 1-AR or ? 2-AR selective antagonist into the per ipheral vein on the responses of CSR to HA were examined.Results icv microinjection of HA (60 ?mol?L -1 in 5 ?l) significantly shifted the ISP-MAP relationship curve upwards (P0.05).Conclusion The intracerebroventricular administration of HA results in a rapid resetting of CSR and a decrease in reflex sensitivity, and the functions of both the peripheral ? 1-AR and ? 2-AR may attenuate CSR resetting induced by icv microinjection of HA. Furthermore,the peripheral ? 1-AR might play an important role in mediating the responses of CSR to central HA.

Objective To measure and determine the position of the tibial attachment of the anterior cruciate ligament (ACL)in relation to its anterior ridge on the magnetic resonance imaging (MRI)of normal knee joints,and to explore the clinical role of the anterior ridge in guiding tunnel positioning during ACL reconstruction as well as in facilitating postoperative radiographic evaluation.Methods The knee MRI of one hundred young adult patients with an intact ACL and normal knee joint (mean age:25.1 years,range:18-40 years)was retrospectively reviewed.All MR images were obtained at full extension of the knee on the same MRI machine.Using digital image software on MRI,the measurements in the sagittal view were taken,including the depth of the tibia,the distance from the anterior edge of the tibial plateau to the most anterior and posterior portions of the ACL insertion on the tibia and the anterior ridge according to Staubli and Rauschning's method.Results The center of the tibial insertion of the ACL is located between 28.43％ and 50.94％ of the total anterior-posterior depth of the tibia,which was less than 43.3％ in 58 patients.The average distance from the anterior edge of the tibial plateau to the anterior ridge was 13.61 ± 2.17 mm (ranging from 8.03 to 18.65 mm),26.80％ ±3.89％ (ranging from 17.74％ to 33.94％)across the tibial plateau.There were significant positive correlations between the distance from the anterior edge of the tibial plateau to the most anterior portion of the ACL insertion and that to the anterior ridge.The distance from the most anterior portion of the ACL insertion to the anterior ridge was averaged 0.56 ± 0.68 mm (ranging from-0.28 to 2.71 mm).During the ACL reconstruction,with the anterior edge of the tibial tunnel determined at posterior 0.5 mm to the anterior ridge,the graft size as 8 mm,and the tibial guider angle set as 55 degree,96of the patients (96％)would have the center of the tibial tunnel located before the center of their native ACL attachment.Conclusions On sagittal MR images,the location of the anterior ridge and the most anterior portion of the ACL insertion correlated well,with the average distance between them of 0.56 mm.The study indicates that during ACL reconstruction,tibial tunnel drilling with the anterior edge of the ACL graft positioned at the anterior ridge can achieve a more anterior position than the traditional methods to orientate according to the center of the bone tunnel.