The study is designed to investigate the progress in cardiac auscultation proficiency of residents after training program.Thirty eight residents were selected to test their ability of cardiac auscultation.There were 13 cardiac events(or murmurs)in 15 patients,and the auscultation proficiency was expressed as the percentage of recognizing cardiac events accurately.The results showed that the highest auscultation proficiency was whole systolic and diastolic murmurs(up to 79 percent and 61 percent respectively)before training.The percentage of recognizing continuous murmurs,click,mitral stenosis and regurgitation,aortic stenosis increased significantly after training program(P＜0.05).

Objective To observe the role of resting metabolic rate (RMR) in evaluation of animal model of glucocorticoid-induced Kidney Yin deficiency and Kidney Yang deficiency syndrome.Methods Male BALB/c mice were divided into control group,model group,Jinkuishenqi pill group,and Zhibaidihuang pill group.The later 3 groups were given drinking water containing corticosterone (first dissolved in 1% ethanol,with a final concentration of corticosterone 100 μg/mL).The control group was given drinking water containing 1% ethanol.RMR was measured by closed fluid pressure respirometer.At the end of the experiment,the mice were sacrificed to detect the weight index of perirenal fat,epididymal fat,quadriceps,and tibialis anterior muscle.ELISA assay was used to detect the level of serum hormones.Histological changes of the liver and kidney were examined by HE staining.Malondialdehyde (MDA) content,succinate dehydrogenase (SDH) activity,cytochrome c oxidase (COX) activity and ATP level were measured.Results Compared with the control group,the RMR of model group was significantly increased at the 2nd day of beginning of the experiment,reached the highest on the 4th day (P<0.01),then decreased gradually,and to the 66th day,the RMR was significantly reduced (P<0.05).Use of corticosterone resulted in decrease of the serum levels of thyroxine (T4),muscle mass index,SDH activity,COX activity and ATP level,while increase of fat mass index and MDA level.The two Kidney nourishing prescriptions reduced animal mortality,and reduced the content of MDA in liver tissue.But only Jinkuishenqi pill increased the RMR at the 4th and 66th days (P<0.05),and significantly improved the liver SDH activity,COX activity and ATP level (P<0.01).The Zhibaidihuang pill showed no such effects.Conclusions RMR can be used for evaluation of animal model of Kidney Yin or Kidney Yang deficiency induced by glucocorticoids.

Objective To evaluate the regional cerebral metabolic changes in different episodes by magnetic resonance spectroscopy (MRS) after explosive brain injury in rabbits. Methods Fortyfive New Zealand white rabbits were randomly divided into eight groups, ie, normal control group( 10 rabbits) and trauma group (35 rabbits). The explosive injury in trauma group was induced by explosion of 600 mg TNT equivalent of paper detonators at 6.5 cm above the rabbit brain. The rabbits in trauma group was divided into 1,6, 12, 24 hours, 3, 7, 14 days subgroups (6 rabbits per group). The survival rate was observed at different time points after explosive injury. The MRS was used to detect the regional cerebral metabolic changes including N-acetylaspartate (NAA)/creatine (Cr) ratio and choline(Cho)/Cr ratio as well as evolution of blast injuries over time. Results The rabbits survived for overseven days in the trauma groups, with typical brain contusion manifested by pathological and conventional MRI. Compared with the normal control group, the NAA/Cr ratio was markedly decreased at one hour after injury, slightly rose again at 24 hours and fell again after seven days. The Cho/Cr ratio was markedly increased at one hour after injury, slightly fell again at 12 hours and rose again at three days after injury.Conclusions MRS can manifest the regional cerebral metabolic changes of rabbits with explosive injury at different time points and hence provide a theoretical basis for understanding the local tissue changes and determining the type of tissue damage after blast injury.

Objective To evaluate the efficacy and safety of different antimicrobial regimens in patients with bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP).Methods The clinical date of patients with CRKP bloodstream infections were retrospectively analyzed at the First Affiliated Hospital of Zhejiang University Medical College between January 2017 and January 2018.All subjects were separated into three groups based on antibiotics regimens over 72 hours,including meropenem 2.0 g every 8 hours,tigecycline 200 mg as initial dose and 100 mg every 12 hours,and polymyxin B 1.25 mg/kg every 12 hours as salvage treatment of tigecycline.Results A total of 86 patients were finally recruited,including 14,52 and 20 patients in groups of meropenem,tigecycline and polymyxin B salvage,respectively.All of the strains were resistant to meropenem and susceptible to tigecycline and polymyxin B initially,while 2 of them became resistant to tigecycline during treatment.The 28-day mortality was significantly higher in meropenem group (13/14) than that in tigecycline group and polymyxin B salvage group (61.5％,32/52) and (12/20),respectively (P＜0.01),while as no significant difference was seen in the last two groups (x2=0.014,P＞0.05).The incidences of hepatic impairment [3.8％(2/52) vs.1/20] and renal dysfunction (0 vs.1/20) between tigecycline group and polymyxin B salvage group were both comparable (P＞0.05).Conclusion The meropenem-based therapy is not recommended for CRKP-related bloodstream infections.Tigecycline-based therapy is still disappointing despite salvage use of polymyxin B after 72 hours.Hepatic and nephretic toxicities caused by additional polymyxin B are acceptable.