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That thranscatheter therapy of congenital heart disease (CHD) can cause myocardial injury is one of the focal points of attention in disciplines. Cardiac troponin (cTn) with its high specificity and sensitivity becomes special myocardial injury measure indicators. The types of CHD, the sizes of defect and occluder, the degree of stenosis, and the patients age and body weight, with their influence due to the concentrations of cTn,can be tested as associated risk factors of the myocardial injury.

Objective To study the value of plasma D-dimer ＜ 500 μg/L level in diagnosis of pulmonary thromboembolism occurred in patients.Methods The clinical data of the patients with pulmonary embolism confirmed by imaging examination with plasma D-dimer levels ＜ 500 μg/L admitted from January 1st 2008 to June 30th 2011 were analyzed retrospectively.Results Totally,there were ten pulmonary embolism patients with plasma D-dimer levels ＜ 500 μg/L.The 10 eligible patients were assessed for the possibility of pulmonary embolism by using the Wells score (i.e.Wells clinical pretest probability prediction model).Of them,0 cases was evaluated as low clinical pretest probability (grade ＜2),7 cases as moderate clinical pretest probability (grade 2 ～6) and 3 cases as high clinical pretest probability (grade ＞ 6).Conclusions Pulmonary thromboembolism was easily misdiagnosed for lacking specific clinical manifestations and the missed diagnosis in patients caused high mortality,so it was difficult to exclude acute pulmonary embolism simply depending on the D-dimer levels ＜ 500 μg/L.Therefore,in case of plasma D-dimer levels less than 500 μ g/L,the possibility of pulmonary embolism cannot be ruled out in patients with moderate or high Wells clinical pretest probability.

Objective To analyze the clinical effectiveness,safety and significance of treatment with external circular fixator,through the relationship of inducible nitric oxide synthase (iNOS) and bone regeneration to further explore the mechanism of the molecular biology of bone lengthening at the same time.Methods Collected bone defect after tibial shaft fractures secondary infection who were treated with external circular fixator as study group (28 cases),all the cases fixed by external circular fixator,20 healthy volunteers as control group.Study group in different time point measured the levels of serum iNOS content,were compared with the control group.Results All patients were scheduled to reach the extremity lengthening and the bone defect were repaired and healed in study group.The bacterial culture results showed that 18 cases (64.29％,18/28) of resistant Staphylococcus aureus,5 cases (17.86％,5/28) of Hemolytic streptocaccus,2 cases (7.14％,2/28) ofP.aeruginosa,one case (3.57％,1/28) of drug-resistant Enterobacter cloacae,one case(3.57％,1/28) of Staphylococcus epidermidis,one case(3.57％,1/28) of Onion-like aeromonas,the proportion of the former two was significantly higher than other bacteria (P ＜ 0.05).The levels of serum iNOS content 1 d after surgery in study group were increased,compared with control group,difference was no significant (P ＞ 0.05).The levels of serum iNOS content 14 d after surgery,stoped extend,1 d stoped extend,3 d stoped extend in study group were significantly higher than those in control group [(118.8 ± 6.6) U/L vs.(86.4 ± 5.4) U/L,(136.2 ± 8.4) U/L vs.(88.2 ± 3.6) U/L,(132.6 ± 9.0) U/L vs.(87.6 ± 4.8) U/L,(103.8 ± 5.4) U/L vs.(86.4 ± 4.2) U/L] (P ＜ 0.05),there was no significant difference between two groups in other times (P ＞ 0.05).Conclusions External circular fixator for the repair and reconstruction effects in patients with bone defect can achieve the desired therapeutic goal,the higher expression of iNOS may be one of the molecular biological mechanisms of bone lengthening.

Objective:To explore the clinical significance detecting adrenomedullin (ADM)and high sensitive C reac-tive protein (hsCRP)in patients with acute coronary syndrome (ACS).Methods:A total of 51 inpatients,which were eliminated for coronary heart disease (CHD)by coronary angiography (CAG),were enrolled as non CHD group,and 124 ACS patients diagnosed by CAG were regarded as ACS group.ADM and hsCRP concentrations were measured before and after CAG in non CHD group and before and after percutaneous coronary intervention (PCI) in ACS group,and they were compared between two groups.Results:Before CAG/PCI,compared with non CHD group,ADM [(28.7±1.6)pg/ml vs.(36.7±2.5)pg/ml]and hsCRP [(4.74±3.21)mg/L vs.(27.65±11.76) mg/L]levels significantly rose in ACS group,P<0.05 or <0.01.Compared with before PCI,there were signifi-cant increase in levels of ADM [(36.7±2.5)pg/ml vs.(47.1±5.3)pg/ml]and hsCRP [(27.65±11.76)mg/L vs.(39.53±4.83)mg/L]in ACS group after PCI,P<0.01 both,and significantly higher than those of non CHD group (P<0.05~<0.01).There were no significant difference in ADM and hsCRP levels in non CHD group be-tween before and after CAG (P>0.05 all).Conclusion:Detecting arenomedullin combined high sensitive C-reac-tive protein is gelpful to early diagnosis and evaluating lesion severity for acute coronary syndrome.

One of the biggest differences between ordinary undergraduate education and higher vocational education is more emphasis on the cultivation of students' vocational skills so as to adapt to so-cial demand and employment. In order to overcome the deficiencies in current teaching outline of voca-tional education and to change from subject knowledge teaching to applied skill cultivating , medical and health curriculum standard including 'curriculum philosophy, curriculum goal, curriculum content, curriculum implementation' four elements was formulated based on concepts of 'education as base , practice orientation and lifelong learning' and cultivation mode combining industry standard with cur-riculum teaching goal and combing work with study. All measures taken above were aimed at promoting coordinated development of students' knowledge, ability and emotion and satisfying the social demand for talent.

BACKGROUND:Each clinical treatment option for avascular necrosis of the femoral head has its own advantages and disadvantages, but early diagnosis and early treatment are firmly rooted in most of orthopedic doctors, and the purpose of treatment is focused on how to preserve the femoral head and how to maintain the hip function.
OBJECTIVE:To summarize the current opinions and studies concerning the treatment of avascular necrosis of the femoral head, including core decompression and porous tantalum rod implantation, and to elucidate the clinical results and cost-effectiveness of the use of porous tantalum rod.
METHODS:The PubMed database was searched by the first author for the articles on the aspect of pathogenesis, risk factors, disease staging and treatment options of avascular necrosis of the femoral head from January 1985 to August 2013 with the key words of“avascular necrosis”,“osteonecrosis of the femoral head”and “tantalum rod”in titles or abstracts. Literatures exhibiting poor correlation with the research purpose and duplicate literature were excluded, and final y, 42 articles were included in result analysis.
RESULTS AND CONCLUSION:The key point of treating avascular necrosis of the femoral head depends on early diagnosis and early intervention. Core decompression plus porous tantalum rod implantation is a minimal y invasive technique in treating early-stage avascular necrosis of the femoral head, in which the subchondral fracture and the femoral head col apse do not occur. If core decompression and porous tantalum rod implantation is used properly, this option does delay or prevent the progress of avascular necrosis of the femoral head. But, if avascular necrosis of the femoral head is in late stage, which means that subchondral fracture and the femoral head col apse occur, the clinical results of this option are poor. Although porous tantalum rod implantation in the treatment of early-stage avascular necrosis of the femoral head demonstrates good exciting short-term results, the clinical value of its long-term results and cost-effectiveness should be elucidated in multicentre, double-blinded, randomized, control ed trials in the future.