Objective To compare the effects of total intravenous anesthesia or Intravenous-in-halation combined anesthesia on intraoperative somatosensory evoked potential (SSEP)and motor evoked potential (MEP)in spinal surgery.Methods Sixty patients scheduled for spinal surgery under general anesthesia were divided randomly and equally into 2 groups.The anesthesia was maintained with TCI propofol (plasma target concentration 3.0-3.5 μg/ml)and 1% sevoflurane+propofol in group T or group I respectively.BIS was monitored and maintained at 40-50.SSEP and MEP was re-corded before induction of anaesthesia (T0 ),5 minutes after tracheal intubation (T1 ),during skin in-cision (T2 )and at the time of decompressing spinal canal (T3 ).Results The latency of P38 and N45 prolonged,and the amplitudes of P38 and N45 was significantly depressed at T1-T3 compared to those at T0 (P <0.05).No statistically significant differences in cortical SSEP amplitudes or latency was observed in each time point.There was no case who could not detect the wave of MEP intraoperative-ly in this study.Conclusion The data from these cases indicates that 1% sevoflurane can be used in conjunction with SSEP and MEP monitoring for some adult patients undergoing spinal surgery.

Objective To investigate the Toxoplasma gondii infection status in pregnant women with history of adverse preg?nancy and risk factors in Bazhou area,Hebei Province. Methods A total of 302 pregnant women with the history of adverse pregnancy were chosen as respondents(an experimental group)in the hospital from March 2012 to December 2015,and 197 pregnant women without the history of adverse pregnancy as a control group. TOX?IgG and TOX?IgM were detected by using ELI?SA in two groups. The risk factors of Toxoplasma infection were surveyed by questionnaires. Results The total positive rate of Toxoplasma antibodies was 28.15%(85/302)in the experimental group,which was significantly higher than that[9.64%(19/197)]in the control group,and the difference was statistically significant(χ2=24.76,P<0.05). The positive rates of TOX?IgM,TOX?IgG and TOX?IgM+TOX?IgG were 6.95%(21/302),18.54%(56/302),and 2.65%(8/302)respectively in the ex?perimental group,which were higher than 2.03%(4/197),7.61%(15/197),and 0%(0/197)respectively in the control group (χ2=6.07,11.67,3.76,all P<0.05). The questionnaire survey showed that the proportions of keeping pets,cutting board re?gardless,liking to eat hot pot or barbecue,eating raw meat,often eating in the restaurant in the pregnant women with Toxoplas?ma infection were higher than those in the pregnant women without Toxoplasma infection,and the differences were statistically significant(χ2=22.57,3.96,5.87,7.40,4.86,all P<0.05),and therefore,the above unhealthy habits may be important risk factors. Conclusions Toxoplasma infection could lead to adverse pregnancy outcomes. Therefore,the above?mentioned unhealthy habits should be avoided,especially during pregnancy period.

Objective To summarize and analysis CT characteristics of traumatic adrenal hematomas.Methods There were 22 cases ofadrenal hematomas.The size, distribution and density of the adrenal hematomas on CT scanning, and the complications of other visceralinjury were analysed.Results 23 adrenal hematomas were found in 22 cases, of them,16 were in right,6 in left and 1 in bilateral. Conclusion CT has high value in diagnosis of the adrenal hematomas.

Fractures of the calcaneus are the most common type of tarsal bone injuries, and about 75% of total calcaneal fractures are intraarticular. Despite increasingly more experiences with this type of fractures, however, there is considerable debate regarding their diagnosis and management. Controversies involve the most appropriate classification system, treatment options, indications for surgery, surgical approaches, and postoperative management. On the basis of current main views on the diagnosis and treatment of intraarticular calcaneal fractures, this article holds that for displaced intraarticular calcaneal fractures, operative treatments are superior to conservative ones.

Dendritic cells (DC) are important antigen-presenting cells in the development of anti-leukemic T-cells responses and it' s reported that DC can differentiate from monocytes or granulocytes in vitro. In the present study, the human leukemic DC were generated from acute promyelocytic leukemic( APL)cells after treatment with cytokines. M3 APL cells were isolated from peripheral blood of patients and incubated with rhGM-CSF( 100ng/ml)or rhGM-CSF( lOOng/ml) plus rhIL-4(500U/ml)for 14 days and the cells were co-cultured wirh TNF-?(100ng/ml)during last 3 days. The results demonstrated that both proliferation and differentiation of APL cells were induced by GM-CSF as the number of cultured cells increased and the cells expressed high level of CD45. Some cells displayed the characteristics of monocytes which expressed CD14 and some were leukemic DC as they expressed GDI a. The co-culturation of APL cells with GM-CSF and TNF-? augmented the differentiation of cells and about 35 percent of leukemic DC generated (was obtained). The maturation of APL cells could also be induced by GM-CSF plus IL-4 but there were few monocytes generated and about 10 percent of the cells were leukemic DC. If cultured for 3 weeks, the number of leukemic DC increased to 60 percent. The addition of TNF-? could augmented GM-CSF and IL-4 induced maturation of cells significantly and 90 percent of leukemic DC generated. Analysis of the cells with electric microscopy indicated that these leukemic DC displayed the similarly morphologic characteristics as monocyte-derived DC and there were still a few granules in their cytoplasm. The leukemic DC expressed high levels of HLA-DR, B7-1, B7-2 and CD54 molecules and could stimulate allo-T cells to proliferate in vitro. Such kind of leukemic DC might be useful tools for the generation of specific anti-tumor CTL and play important roles in immunotherapy of APL.

Objective To survey the training needs for key general practice (GP) trainers.Methods The survey was conducted among participants of the first training course for national key GP trainers hold on March 2014 in Shanghai.The contents of questionnaire used for the survey included training needs of GP relevant knowledge,teaching ability and modes of assessment.The differences in training needs between GP trainers from community teaching bases and hospital teaching bases were analyzed.Results Total 151 key trainers completed the questionnaire (male/female:48/103) with average age of (38 ± 6)years.Among them 67.5％ (102/151) were from community teaching bases and 29.8％ (45/151) from hospital teaching bases;60.9％ (92/151) participated in the General Practitioner Structured Vocational Training Program (GPSVTP).According to the survey,general practice clinical kills (72.2％,106/151) and general practice clinical thinking (70.2 ％,106/151) were most required relevant knowledge;while general practice basic concept was least required (25.8％,39/151).The rate with need of policy system related GP training in hospital trainers was higher than that in community teaching base trainers(66.7％ vs.44.1％,P ＜ 0.05).For teaching ability needs,85.4％ (129/151) selected teaching methods,75.5％ (114/151) chose teaching assessment and evaluation methods.The participants showed more interesting in new-type teaching and evaluation methods,such as PBL,OSCE,mini-CEX and DOPS,and would use them in future teaching work (P ＜ 0.01).Workshop (58.3％,88/151),demonstration(57.0％,86/151) and experience exchange (50.3％,76/151) were three most interested modes in current training;meanwhile theoretic teaching was lease interested (38.4％,58/151).Study tour was most interested training models for the future (71.5％,108/151),followed by short-term courses (49.0％,74/151),overseas study (39.1％,59/151) and distance learning (27.8％,42/151).Conclusion There are different needs for GP trainers from hospital and community teaching bases.To meet the different requirements,the focused training course and training method should be adapted.

Objective To evaluate the value of non invasive examinations in the diagnosis of vascular disease of lower extremity. Methods Segmental systemic pressure (SEG), pulse volume recorder (PVR) and continuous wave (CW) were adopted to examination of 36 patients with arterosclerosis obliterans of lower limbs, and the foundings were compared with that of MRA and operation . Results In all 36 cases, non invasive examinations detected abdominal aorta and common iliac artery with femoral artery occlusion in 12 cases ,femoropoplitea artery occlusion in 28 cases, popliteal artery and the distal artery occlusion in 16 case; MRA together with operation confirmed abdominal aorta and common iliac artery with femoral artery occlusion in 11 cases, femoropopliteal artery occlusion in 32 cases and popliteal artery and the distal artery occlusion in 13 cases. The accurent diagnosis rate of non invasive examination was 85.7%. Conclusions Although PVR has not yet been used to replace the arteriography to directly observe the local situation of arterial lesions , it can preliminarily determine the obstruction sites and severe degree of the occluded arteries. PVR has convenient and reliability in the diagnosis,evaluation of the therapeutic effect and the postoperative follow up of blood vessel diseases,it is worthy to be widely applied in the clinical practice.

Objective To evaluate the efficacy and safety of prophylactic cefiazidime on early bacterial infection in APBSCT recipients during neutropenia.Methods APBSCT recipients were prospectively randomly assigned to intravenous ceftazidime treatment group and control group (no prophylaxis of antibiotics).The treatment started from the first day until resolution of neutropenia or the appearance of early bacterial infection.Results From March 2010 to January 2013,70 APBSCT recipients were enrolled in the study with 36 in treatment and 34 in control group.Overall,29 (41.4％) patients developed early bacterial infection,among which,9(25.0％) in the treatment group and 20(58.8％) in the control group (P =0.004).The median infection free survival (IFS) was not reached in the treatment group and was 8 days in the control group (P =0.005).Despite whether patients received single high dose melphalan or other conditioning regimes,the early bacterial infection rate was lower in the treatment group than in the control group,and the median IFS was longer in the treatment group than that in the control group.The mean courses of antibiotic administration were (8.08 ± 2.03) days and (3.68 ± 3.56) days respectively in the treatment and control groups (P ＜ 0.001).However,the duration of empirical carbapenems were (1.67 ±3.03) days and (3.68 ±3.56) days respectively (P =0.013).There was no significant difference of antibiotics cost per patient between the two groups.Four patients in the treatment group had a transient elevated serum creatinine.Overall,no infection related mortality was observed in either group.Conclusions Prophylaxis of intravenous ceftazidime for APBSCT recipients is effective in preventing early bacterial infection with an acceptable toxicity and cost profile.However,it doesn't have effect on infection related mortality.Therefore,our results do not support the use of antibiotic prophylaxis for patients undergoing APBSCT.

Discussed in this paper is how to provide the personal , differential and intelligent information service for the users of library by putting the people-oriented purpose into its different information services .

Although internal fixation is still a standard treatment for geriatric Garden Ⅰ/Ⅱ femoral neck fractures, it is reported to lead to a high rate of reoperation. Therefore, identification of risk factors for internal fixation failure can help a sensible decision-making in initial treatment. In recent years, many studies have suggested that posterior tilt of the femoral head before surgery may affect the rates of internal fixation failure and reoperation. Some studies have even recommended hip arthroplasty for geriatric Garden Ⅰ/Ⅱ femoral neck fractures. However, different studies adopted different measurement methods and thus obtained inconsistent results. By literature review, this article expounds on various measurement methods for femoral head tilt and correlation between posterior tilt of femoral head and prognosis after internal fixation, and compares therapeutic efficacy between internal fixation and hip arthroplasty, hoping to provide useful information and data for clinical treatment of geriatric Garden Ⅰ/Ⅱ femoral neck fractures.