Objective To discuss the feasibility and superiority of EST combined with LC in treating cholecystolithiasiswith common bile duct stones.Methods Patients underwent LC(laparoscopic cholecystectomy) preceded by EST(endoscopic sphincterotomy) and removal of common bile duct stones.ENBD(Endoscopic nasal biliary drainage tube)was placed if EST failure and then the patient underwent LC+laparoscopic biliary duct exploration(LCBDE),or open operative bile duct exploration.Results In 91 of the 99 cases,LC preceded by EST and stone removal was successful,while EST following LC was successful in 3 cases,and stone removal by EST was unsuccessful in 3 cases.Two cases less than 15 years of age underwentLC+LCBDE through the cystic duct and did not undergo EST.Three cases,who had EST failure,underwent LC+LCBDE with primary suture of the common bile duct or LCBDE with T-tube drainage of commonbile duct,or open bile duct exploration with primary suture of the common bile duct(ENBD was in place).All patients were discharged from hospital without serious complications.Conclusions EST combinedwith LC in treating cholecystolithiasis with common bile duct stones is a safe and effective method.Combination of endoscopic and laparoscopic procedures fully reflects the advantage of minimally invasive therapy.

Objective To realize the isolation of multidrug-resistant organisms (MDROs)from ward environment, and provide evidence for clinical prevention and control of MDRO transmission.Methods Patients with MDRO in-fection in a stomatology hospital from September 2012 to July 2014 were as trial group,12 randomly selected pa-tients without MDRO infection were as control group,environmental object surface in patients’ward were taken specimens and performed culture,isolated organisms were identified and performed antimicrobial susceptibility tes-ting.Results Of 44 patients with MDRO infection,13 patients’surrounding environment were detected MDROs,the total detection rate was 29.55%(13/44).The detection rate of methicillin-resistant Staphylococcus aureus (MRSA),multidrug-resistant Acinetobacter baumannii (MDRAB),and methicillin-resistant Staphylococcus epidermidis (MRSE)were 45.45%(5/11),66.67% (2/3)and 66.67%(6/9)respectively.Detection rates of MRSA from nasal cavity and hands of MRSA-infected patients were 72.73% and 54.54% respectively,from nasal cavity and hands of patients’caregivers were 36.36%and 18.18% respectively.The difference in bacterial count between trial group and control group was not significantly dif-ferent (all P >0.05).Conclusion Isolation rate of MDROs from ward environment of MDRO-infected patients is higher than that of non-MDRO-infected patients,monitoring,cleaning and disinfection for MDRO-infected patients’surrounding environment should be strengthened,so as to prevent the spread of MDROs in hospital.

0.05], whereas it is significantly decreased in ACEI group[(69.3?14.6)ml?min-1? (1.73 m2)-1 vs (63.5?16.4)ml?min-1?(1.73m2 )-1,P

According to the training of all levels and all kinds of personnel during our hospital's digital construction and implementation process,this article discussed the training char-acteristic of computer skill and the teaching principle for doctors and nurses

Now medical undergraduates are faced with a series of problems in the clinical practice.Instructors should work well on students' education work to improve the effect and quality of clinical practice.

Objective To observe the clinical efficacy and safety of Azithromycin Sequential Therapy in the treatment of mycoplasma pneumonia for children.Methods 112 children with mycoplasma pneumonia were randomly divided into observation group and control group,each 56 cases.The observation group was treated with Azithromycin Sequential Therapy in the treatment,while the control group was treated with erythromycin lactobionate anti infection treatment.The clinical efficacy was compared between two groups after treatment,the clinical symptoms disappeared time and drug adverse reaction occurred the situation.Results The total effective rate of the observation group was 96.43%,which was significantly higher than 80.36% of the control group,the difference was statistically significant (χ2 =7.04,P <0.05).The fever,cough,pulmonary rales disappearance time of the observation group were (3.74 ± 1.58)d,(3.24 ±0.47)d,(5.58 ±2.23)d,which were significantly shorter than (4.68 ±1.71 )d,(4.64 ± 0.97)d,(7.82 ±2.70)d of the control group(t =4.27,4.68,4.59,all P <0.05).The gastrointestinal reactions, local pain,rash,the elevation of ALT of the observation group were significantly lower than the control group,the difference was statistically significant (χ2 =4.26,7.04,7.03,5.23,all P <0.05 ).Conclusion Azithromycin Sequential Therapy for the treatment of mycoplasma pneumonia in children has the advantages of good clinical effica-cy,fast effect,high safety.

Objective To investigate the refraction change and nursing character in myopic amblyopia during the perceptual learning treatment. Methods Refraction of 54 children (98 eyes) with myopic amblyopes were selected,which were selected from the amblyopia clinic between 2007 and 2009, the spherical diopter, astigmatism and spherical equivalent were collected before and after perceptual learning,the refractive dynamic was compared according to the degree of amblyopia. Results The spherical average annual growth of myopic amblyopia during treatment was 0.52D, the growth of astigmatism was 0.03D;the spherical equivalent average annual growth was less than 0.50D accounted for 57.14%. The dynamic changes of spherical or SE of mild, moderate and severe amblyopia had significant difference, but the cylinder had not significant difference in change. Conclusions The treatment of perceptual learning in patients has little effect on the growth of refraction in myopic amblyopia, however, it is still necessary to pay close attention to refraction changes of in myopic amblyopia in the course of treatment.

OBJECTIVETo explore the rhythm regulatory mechanism of interleukin-6 (IL-6) in the process of moxibustion for rheumatoid arthritis (RA).

METHODSA total of 144 Sprague-Dawley (SD) rats were randomly divided into a blank group, a model group, a moxibustion group, a sham operation group, an operation group, an operation+moxibustion group, 24 rats in each one. Each group was divided into 4 time points (0:00 am, 6:00' am, 12:00 am, 6:00 pm), 6 rats in each time point. The Light-Dark 12 : 12 was given in all rats for light-dark cycle. Except the blank group, rats in the remaining groups were treated with intracutaneous injection of freund's complete adjuvant at right-side foot to establish the model of RA. After the model establishment, bilateral adrenal, glands were removed in the operation group and operation + moxibustion group, while those in the sham operation group were not removed with identical operation procedure. Rats in the moxibustion group and operation + moxibustion group were treated with grain-sized moxibustion from 7:00 am to 9:00 am at "Shenshu" (BL 23) and "Zusanli" (ST 36) once everyday, 6 times were taken as one session and 3 sessions were required tatclly, while rats in the remaining groups received identical fixation without moxibustion. The general health state and foot volume of rats were measured before model establishment, after establishment and after treatment. After treatment, rats were sacrificed at each time point to collect the blood sample and measure the content of IL-6 by using enzymne-immunoassay method.

RESULTSCompared with the blank group, the foot swelling in the model group was obviously increased (P<0. 05); the IL-6 maintained circadian rhythm (P<0. 05), but the peak phase had a backward trend, famplitude had an increased trend and the median was significantly lifted (P<0. 05). Compared with model group, !the foot swelling in the moxibustion group was obviously decreased (P<0. 05); the IL-6 maintained circadian. rhythm (P<0. 05), and the peak phase had a forward trend, amplitude had a decreased trend and the median was significantly reduced (P<0. 05). Compared with the moxibustion group, the foot swelling in the operation--moxibustion group was obviously increased (P < 0.05); the IL-6 maintained circadian rhythm (P < 0.5), but the peak phase moved forwrd, and the median was significantly elevated (P < 0.05).

CONCLUSIONThe IL-6 in plasma maintains significant pathological circadian rhythm in RA rats; with the complete hypothalamic-pituitary-adrenal axis, moxibustion is likely to regulate the circadian rhythm of IL-6 to play an important role of anti-inflammatory effect in RA rats.

Acupuncture Points ; Animals ; Arthritis, Rheumatoid ; metabolism ; physiopathology ; therapy ; Circadian Rhythm ; Disease Models, Animal ; Female ; Humans ; Hypothalamus ; metabolism ; Interleukin-6 ; metabolism ; Male ; Moxibustion ; Pituitary-Adrenal System ; metabolism ; Rats ; Rats, Sprague-Dawley ; Time Factors

Objective To investigate the clinical value of neutrophil-to-lymphocytc ratio(NLR) in identifying blood stream infection caused by different pathogens and for differentiating coagulase negative staphylococcus(CNS)bloodstream infection and contamination.Methods Medical records of 500 patients who underwent blood culture test and routine blood test at the same time were retrospectively analyzed,blood culture negative group 356 patients,blood culture positive group 144 patients,which included Gram-negative group,Gram positive group,fungi group,CNS bloodstream contamination and mingled group.Collected the results and calculated the NLR at the same time.NLR were applied by t test of each group.ROC curve was used to determine the cut off value of NLR.Results ①Mean values of NLR in negative blood culture,blood stream infection group,CNS bloodstream infection and contamination were 6.12,13.15,10.11 and 6.24.NLR had statistical difference between negative blood culture and blood stream infection group,CNS bloodstream infection group and contamination group (P＜0.05).②Mean values of NLR in and fungi group were 15.33,11.63 and 10.58,respectively.NLR had statistical difference between Gram-positive bacteria group and Gram-negative bacteria group (P＜0.05).NLR had no differences among Gram-positive bacteria (15.33) and Gram negative bacteria (11.63) compared with (10.58) fungi respectively (P＞0.05).③The area under the curve of NLR predicting a positive blood culture,distinguishing Gram-positive bacteria and Gram-negative bacteria,differentiating CNS bloodstream infection and contamination were 0.86,0.60 and 0.75,respectively.The optimal cut off values of NLR for predicting a positive blood culture,distinguishing Gram-positive bacteria and Gramnegative bacteria,differentiating CNS bloodstream infection and contamination were 10.45,7.50 and 8.10 respectively.Conclusion NLR is highly effective in distinguishing blood stream infection and differentiating CNS bloodstream infection and contamination.

This study was aimed to investigate short-term modulation mechanism of scalp acupuncture according to the experimentation of cortical excitability and motor-related cortical potentials in ten normal volunteers.Through scalp needle stimulation in specific theoretical areas related to underlying cerebral surfaces,scalp acupuncture can be used as an effective therapy by changes in relative cerebral function,which is the basic principle.According to the available neurophysiological data in our study,the modulation of scalp acupuncture displayed in late part of motor-related cortical potential noticed mainly in the motor and sensory cortexes,contralateral to the needle stimulate site.Also,acupuncture can develop inhibition at longer interstimulus intervals,in paired pulse magnetic stimulation,from the somatosensory input of contralateral sensory cortex via scalp needle stimulation.In our study,it might be difficult to produce more acupuncture inhibition.The maintaining of scalp needles subcutaneously without other management after achieving needling sensations cannot achieve the requested strength of the acupuncture stimulation.