Objective To explore the applicability and feasibility of the hierarchical linear model in dealing with the repeated measurement data by applying it into multi-center clinical trials’ evaluation of new Chinese medicine. Methods The theoretical research described the basic concepts and principles of hierarchical linear model and compared the applying conditions of traditional statistical methods with hierarchical linear model. In the empirical study, the hierarchical linear model was used into a real multicenter clinical trial research of traditional Chinese medicine, with the TCM syndrome score as the analysis indicator. Results The hierarchical linear model added time, group and time×group as random variables into the model to get the final result. All of the three variables were significant in the result. The interaction (time×group) statistical result was t=2.65, P=0.008 1. During the whole treatment, the TCM syndrome mean score of trial group reduced 8.5 and the control group reduced 7.47. At the end of treatment, the TCM syndrome mean score of trial group was 2.46, and the control group was 3.31, which was higher than trail group. For this result, combining with the TCM syndrome score’s developing trend, we can see that the efficacy of trial group is not worse than the control group. Conclusion By comparing the data requirements, applying conditions and analysis results, the hierarchical linear model could be an effective method which can be used in multi-center trial to evaluate traditional Chinese drug.

Objective To understand the species,clinical distribution features and drug susceptibility situation of bloodstream infection pathogenic bacteria in this hospital to provide reference for clinical empirical treatment.Methods The retrospective analysis was performed on 1 938 strains of pathogenic bacteria isolated from blood culture in our hospital from January 2012 to August 2016,their species distribution,department distribution and drug sensitivity were analyzed.Results A total of 1 938 strain of bacteria were comprised of 56 kinds of bacteria and 8 kinds of fungi.Gram-negative bacteria had 1 216 strains,accounting for 64.2%,Gram-positive bacteria had 677 strains,accounting for 34.9%,Fungi had 45 strains,accounting for 2.4%.The top 5 of isolation rates were Escherichia coli(628 strains,32.4%),Klebsiella pneumoniae(230 strains,11.9%),Salmonella(143 strains,7.4%),Staphylococcus epidermidis(142 strains,7.3%) and Staphylococcus hominis (130 strains,6.7%).Enterobacteriaceae bacteria had 1 098 strains(58.0%),which was dominated by Escherichia coli and Klebsiella pneumoniae,in which 363 strains(57.8%) were Escherichia coli and 85 strains(37.0%) were extended spectrum β lactamases (ESBLs) producing Klebsiella pneumoniae.Nonfermenters had 118 strains(6.1%),Acinetobacter baumannii and Pseudomonas aeruginosa were predominant.Staphylococcus aureus had 75 strains (3.9%),the MRSA occurrence rate was 25.3%,coagulase-negative staphylococci (CoNS) had 401 strains (20.7%),the methicillin-resistant CoNS occurrence rate was 72.8%.Enterococcus had 85 strains(4.5%).The top 5 departments in positive rates were respiratory department,ICU,hepatobiliary department,gastroenterology department and hematology department.The other departments were consistent to the overall distribution except for ICU and pediatrics.The majority of Acinetobacter baumannii showed multi-drug resistant.Vancomycin-resistant Staphylococcus and Enterococcus did not be detected,Candida maintained good sensitivity to commonly used antifungal agents.Conclusion Bloodstream infection pathogenic bacteria in this hospital are widely distributed.Commonly used drug have different sensitivities,the overall drug resistance rate is higher,clinic may conduct early medication according to the pathogenic bacterial department distribution and drug sensitivity.

Supernumerary tooth is a rare case. This report described a case of nasal cavity supernumerary tooth association with maxillary sinusitis. A 28-year-old male patient reported with the chief complaint of nasal obstruction, headache and purulent secretion for the past three months. Clinic examination and CT examination showed that there was a supernumerary tooth in the right nasal bottom, and maxillary sinus was infected in the same side. This patient was performed supernumerary tooth removing and given antibiotics for 3 days. Ten days after the operation, there was no clinical symptoms, and nasal bottom mucosa was normal. After 3 months of follow-up, reexamination of coronal CT scan appeared normal.
Adult ; Anti-Bacterial Agents ; therapeutic use ; Humans ; Male ; Maxillary Sinus ; pathology ; Maxillary Sinusitis ; etiology ; Nasal Cavity ; pathology ; Nasal Obstruction ; Tomography, X-Ray Computed ; Tooth, Supernumerary ; complications ; diagnosis

Objective To analyze the reasons of the TB outbreak in that school and to explore strategy of warning and preventing TB in schools.Methods epidemical investigation,screening close-contactors,analyzing and dealing with epidemic situation.Results 51 TB cases were detected from Oct 2003 to Mar 2005,among them,there were 42 acquired TB cases (6 sputum smear positive cases),9 tuberculosis pleurisy cases.30 of them didn't experience any health education about TB control and prevention,and know nothing about TB.Rest of them is not much better.Only tow of them is resisted by school infirmary,7 of 16 students who were diagnosed with TB before screening and took treatment were reported to local CDC.Conclusions Students lack of self-protective ability; administration of school infirmary was not well-organized,so that so many TB cases in a short period couldn't be noticed and the weakness of the report system is the major reason causing the outbreak to be long term and involving so many victims.it is emergency to enforce TB control in schools,and it is crucial to establish TB warning system in schools.

Objective To evaluate the clinical features and early management of combined thoracoabdominal injury (CTI).Methods A retrospective study was carried out in 29 cases with CTI treated surgically.There were 21 cases with penetrating injuries and 8 cases with blunt injuries.All cases were associated with penumothorax and/or hernothorax at various degrees and 13 cases complicated with shock.In this study thoracotomy was performed in 17 cases,laparotomy in 6 cases,thoracotomy plus laparotomy in 5 cases and combined thoraco-laparotomy in 1 case.Results The injury severity score in this series was (40.16±15.23) scores.Four cases were died from hemorrhagic shock (2 cases),pericardial tampenade(1 case) and multiple organ failure(1 case).Conclusions CTI has high mortality rate,and the most frequent cause of death is hypovolemic shock.The operative approach is based on individual injury condition.Early diagnosis and timely surgical intervention are key to improving the cure rate and reducing mortality in severe CTI.

Objective To analysis the relationship between gestational age and perinatal outcomes in patients complicated with early onset severe preeclampsia.Methods Retrospective study was conducted on clinical documents of 221 patients with early onset severe preeclampsia( ＜ 34 weeks) who delivered after 28 gestational weeks in Peking University First Hospital from July 1999 to June 2009.Patients were divided into three groups based on gestational weeks at delivery: group Ⅰ (n = 81 ) delivered at 28 -31 weeks+6,group Ⅱ (n = 78) at 32 -33 weeks+6 and group Ⅲ (n = 62) after 34 weeks.The clinical characteristics and perinatal outcomes were compared among those three groups.Results ( 1 ) Outcome of neonates:Among 221 neonates, 13 neonates lost follow-up, including 9 in group Ⅰ , 3 in group Ⅱ, 1 in group Ⅲ.The incidence of neonatal respiratory distress syndrome ( RDS ) of 26% ( 19/72 ) in group Ⅰ were significantly higher than 7% (5/75) in group Ⅱ and 10% (6/61) in group Ⅲ (P ＜ 0.05 ).The neonatal mortality rate of (43% ,31/72) in group Ⅰ were significantly higher than 3% (2/61) in group Ⅲ and 28%(21/75) in group Ⅱ (P ＜0.05 ).The incidence of maternal complications showed no statistical difference among three groups.(2) Neonatal death analysis: all neonatal death were due to parents' give up, including 26%(8/31) in group Ⅰ, 67% (14/21)in group Ⅱ and 1/2 in group Ⅲ, which reached statistical difference(P＜0.05).Conclusions The incidence of neonatal RDS in mother with early onset severe preeclampsia was decreased if delivered after 32 weeks, and the perinatal mortality was remarkably decreased if delivered after 34 weeks.Therefore, the perinatal survival rate in women with early onset severe preeclampsia can be improved by minimizing the impact of social factors.

Objective To evaluate the effect of ecoimmunonutrition enteral nutrition on systemic inflammatory response and prognosis in patients with acute severe acute pancreatitis. Methods Fifty-seven patients with severe acute pancreatitis were randomly divided into two groups: parenteral nutrition (PN) group(28 cases), and ecoimmunonutrition(EIN) group (29 cases), each of the two nutrition formulas was given to each group respectively for 7 days. The level of plasma endotoxin and serum concentrations of TNF-α ,IL-1β ,IL-6 and IL-10 and monocyte NF-κB were tested at admission,1 d,3 d,5 d,7 d after nutrition support. Statistics the two groups results of clinical prognosis. Results The levels of endotoxin, TNF-α ,IL-1β ,IL-6 and IL-10 , NF-κB activities in EIN group were no significant difference compared with PN group at admission. After nutrition support 7 d, the levels of endotoxin, TNF-α ,IL-1β ,IL-6 and IL-10 , NF-κB activities in EIN group were (2.70 ± 0.13) ng/L, (30.13 ± 8.12) ng/L, (20.17 ± 8.04) ng/L, (36.43 ± 8.24)ng/L, (86.45 ± 14.54) ng/L, (70.4 ± 3.2)% respectively, which all were significantly lower than those in PN group [(3.25 ±0.32) ng/L, (313.42 ± 144.35) ng/L,( 155.29 ±32.78) ng/L, (324.15 ± 31.47) ng/L, (472.72 ±48.55) ng/L, (88.4±53)% ](P<0.05 or <0.01). Conclusion EIN can attenuate endotoxemia.decrease NF-κB activities and concentrations of cytokines, maintain the balance of pro-and anti-inflammation, improve patients' condition and prognosis.

AIM: To investigate the process of human bone marrow stromal cells (hBMSCs) differentiation into neural-like cells and to determine the role of 26S proteasome in neuronal differentiation. METHODS: Purified hBMSCs were treated with β-mercaptoethanol (β-ME) for 1 day and retinoic acid (RA) for 3 days, followed by growth factor (10 μg/L bFGF or 20 μg/L NGF) for another 3 days. Immunofluorescence was performed to detect the expression of nestin (a neural precursor cells marker), Tuj1 (a premature neuronal marker), and neurofilament (NF, a mature neuronal marker) at all stages of induced differentiation. Immunostaining and RT-PCR were used to analyze the expression of 26S proteasome during neuronal differentiation of hBMSCs. To further confirm the role of 26S proteasome in hBMSCs differentiation, cells were treated with β-ME/RA and then followed by protesome inhibitor MG132 and growth factor. Immunostaining was performed to detect NF-positive cells. RESULTS: Quantification results showed that the untreated cells were almost never positive for nestin, Tuj1 and NF. After treated with β-ME/RA, the numbers of nestin-positive cells (34.41%±1.27%) and Tuj1-positive cells (27.79%±1.27%) were increased. Notably, the numbers of NF-positive cells were significantly increased to 56.72%±2.4% after induction with β-ME/RA/GF. Immunofluorescence analysis showed that undifferentiated hBMSCs cells were weakly stained by antibody against 26S proteasome, but the numbers of cells with high-intensity of 26S proteasome were increased after treated with β-ME/RA. The RT-PCR result of 26S proteasome further confirmed that the mRNA level of the cells differentiated by β-ME/RA (1.33), as well as by β-ME/RA/GF (1.77), was significantly increased compared to the undifferentiated cells. Moreover, hBMSCs incubated with protesome inhibitor MG132 significantly decreased the numbers of NF-positive cells (37.59%±1.52%). CONCLUSION: After induction with β-ME/RA/GF, hBMSCs can be differentiated into neural-like cells, which is concomitant with the increase in 26S proteasome expression. Inhibitor of 26S protesome prevents hBMSCs differentiation, suggesting that 26S proteasome may be involved in the differentiation of hBMSCs into neural-like cells.

AIM: To study the relationship between myocardial HSP70 and PKC during myocardial ischemic preconditioning(IPC). METHODS: PKC inhibitor, polymyxin B(PMB) and PKC activator, phorbol 12-myristate 13-acetate(PMA) were applied to the models of myocardial ischemia/reperfusion in vivo and in vitro in rabbits, respectively, and the ventricular functions, PLA 2 in the serum, and the expression of mycardial HSP70 mRNA were examined.RESULTS: IPC decreased PLA 2 activity, improved the left ventricular function and increased the expression of myocardial HSP70 mRNA. Howerer, all these effects of IPC could be blocked by PMB. Interestingly, PMA mimicked IPC with attenuating the injuries of cardial myocytes and increasing myocardial HSP70 mRNA expression. CONCLUSION: PKC is involved in the myocardial HSP70 expression in case of ischemic preconditioning.