Objective To analyze the clinical features of infective endocarditis with positive antineutrophil cytoplasmic antibodies ,and compare with ANCA associated small vessel vasculitis(AASV). Methods Three IE patients with positive ANCA were analyzed, and 13 cases from literatures were reviewed. Results Sixteen patients had positive anti-PR3 ANCA, in which 2 cases had both positive (anti-PR3 and anti-MPO ANCA) ANCA. All patients had some clinical manifestations mimic AASV, including fever ( 13/16, 81% ), rash (8/16, 50% ), rapidly progressive glomerulonephritis (7/16, 44% ), splenomegaly (6/16, 38% ). Streptococcal species were identified in 12 patients, and cardiac valvular abnormalities were demonstrated in all patients. All patients except 2, who died of cerebral hemorrhage followed by cerebral infarction, recovered with antibiotic therapy. Conclusion Infective endocarditis sometimes can have the same clinical features as AASV, so physicians should carefully differentiate between them when dealing with patients with positive ANCA antibodies.

BACKGROUND: The effect of cognitive therapy on psychological stress is not remarkable and optimal. Some psychocatharsis through physical activities cannot be accepted by many clients.OBJECTIVE: To explore an effective method to treat and relieve psychological stress.DESIGN: A controlled (the blank control and the self-control) observation study and single blind trial.SETTING: Department of Preventive Medicine, Medical College of Jinagsu University.PARTICIPANTS: Clients who suffered from emotional suppression or nervous stress would be tested with "psychological stress test". Forty clients, with scores over 5, were selected as the subjects. They were randomly divided into two groups matching of ages and scores: control group (n=20) and experimental group (n=20).METHODS: Clients in the control group were treated with common cognitive therapy by means of talking, and those in the experimental group accepted a sing a song loudly therapy. The song named as Qinghai-Tibet Plateau was selected for the treatment. The clients were requested to sing the song loudly in order to release their stress and vent their repression.The psychologist used the language introduction by background music to make a client under a special kind of psychological situation and emotional state when the music was played for one to two times. Then the psychologist would turn up gradually the volume of sound to the maximum when the music was played for the third time. The volume from the VCD would overwhelm that from the client's voice in order to cover up the singer's shyness. The client sung the song of Qinghai-Tibet Plateau loudly for four to five times. The therapeutic room was required to have a blanch curtain.The sound insulation also was required. The soundscape of the loudspeakers should be wide. The power magnifier should be strong. The loudspeaker should be high fidelity. The questionnaire of psychological stress test was adopted in both groups before and after therapy respectively. It had 30 items for the self-diagnosis of symptoms. The client was diagnosed as a low stress if his or her score reached 5, 11-20 as sever stress, and above 21 as adaptability disorder.MAIN OUTCOME MEASURES: Scores of stress level were observed before and after therapy in both groups.RESULTS: The scores in the control group before and after therapy were approximately the same (15.6±5.3 vs 14.7±4.8, t=1.739, P ＞ 0.05). The scores in the experimental group after therapy was significantly lower than those before therapy (11.6±5.8 vs 15.5±6.1, t=9.863, P ＜ 0.05). After therapy, the scores in the experimental group were significantly lower than those in the control group (11.6±5.8 vs 14.7±4.8, t=4.811, P ＜ 0.05).CONCLUSION: Sing a song loudly is an effective method that is easy to operate in treating psychological stress.

OBJECTIVE:To investigate the cognition of clinical pharmacists on the clinical pharmacy practice and their profes-sion,and provide reference for further developing clinical pharmacy practice. METHODS:A questionnaire was designed,and ran-dom sample was conducted for the clinical pharmacists from 30 secondary and tertiary hospitals in Shanghai,and the investigation results were analyzed statistically. RESULTS:Totally 130 questionnaires were sent out,and 102 were effectively received with valid response rate of 78.46%. 94.11% of the investigated subjects were willing to be a clinical pharmacist,but 17.65% of them consid-ered that they were incompetent for their work;29.41% of them thought the current situation of clinical pharmacy practice was not ideal;all the respondents considered that the clinical pharmacist system should be implemented in medical and health institu-tions;the cognition and evaluation of investigated subjects in tertiary hospitals on clinical pharmacy practice and their profession was generally higher than those in secondary hospitals(P<0.05). CONCLUSIONS:The clinical pharmacists in medical and health institutions in Shanghai showed high cognition on their profession,and the clinical pharmacy practice has already made some achievements,but many work still need to be improved. Therefore,clinical pharmacists should continuously study their profession-al knowledge and improve their professional skills and quality;hospitals and universities should strengthen the subject construction and personnel training of clinical pharmacy and deeply carry out the clinical pharmacist system;health administration departments should strengthen the related laws and regulations of clinical pharmacy;colleges and universities should strengthen the discipline construction and personnel training.

Objective To evaluate the application effect of the problem based learning in clinical teaching of orthopedics. Methods We chose sixty five-year program students of Peking univ-ersity health science center as research object. All students were randomly divided into experimental and control groups, with thirty students in each group. Experimental group was given PBL teaching combined with lecture based learning (section-based learning, LBL), while the control group only received the LBL teaching. Two groups were given 8 hours of teaching experiments. After the end of the study, the teaching effect of the two groups was evaluated by the theory course and clinical skills. The questionnaire was distributed to the 2 groups. The scores of both experimental group students and control group students in theory courses and clinical skills were analyzed using SPSS 19.0 software using t-test and x2 test. Result The score of the experimental group was (53.7 ±3.2) in the knowl-edge-based grades exam, while the control group was (52.3±2.2), showing no obvious difference when compared to the control group's grades (P>0.05). The score of the experimental group was (24.0±1.5) in the hands-on technique grades exam, while the control group was (22.3±1.6). The difference in grades showed statistical significance (P<0.05). Feedback survey results showed that the experimental group's teaching satisfaction degree was also significantly higher than the control group, and the dif-ference was statistically significant (P<0.05). Conclusions The application of PBL in clinical teach-ing in orthopedic clinical teaching can improve students' learning interest and self-study ability, and helps to develop students' clinical thinking ability. But the role of PBL teaching in improving students' medical knowledge level is not obvious.

Objective To explore the infections of human cytomegalovirus (HCMV) in chronic hepatitis C patients and the hepatic impairment in chronic hepatitis C patients co-infected with HCMV.Methods HCMV-DNA was determined by fluorescence quantitative-PCR (FQ-PCR) in 95 patients with chronic hepatitis C (observation group) and 95 healthy controls(control group) and HCMV active infections were analyzed.HCV-RNA was determined by FQ-PCR in observation group,and the difference of HCMV-DNA positive rate between high HCV-RNA(＞ 104 copies/ml) and low HCV-RNA(≤ 104 copies/ml) was analyzed.Alanine aminotransferase (ALT),aspartate aminotransferase (AST) were determined by rate method in two groups and the hepatic impairment was analyzed.Results Twenty-five cases with positive HCMV-DNA in observation group,the positive rate was 26.3％(25/95).Five cases with positive HCMV-DNA in control group,the positive rate was 5.3％(5/95).There was significant difference between two groups for HCMV-DNA (x2 =14.29,P ＜0.01).Twenty-one cases with positive HCMV-DNA in 43 cases of high HCV-RNA patients,the positive rate was 48.8％(21/43).Four cases with positive HCMV-DNA in 52 cases of low HCV-RNA patients,the positive rate was 7.7％(4/52).There was significant difference between the two (x2 =19.90,P ＜ 0.01).ALT,AST in observation group was higher than that in control group (P ＜ 0.01).ALT,AST in chronic hepatitis C patients positive for HCMV-DNA was higher than that in chronic hepatitis C patients negative for HCMV-DNA significantly (P ＜ 0.01).Conclusions HCMV in chronic hepatitis C patients becomes active again and co-infects easily.When chronic hepatitis C patients co-infect HCMV actively,hepatic is further injured.

The enzyme activity of α－Acetolactate Decaroboxylases (ALDC)from different microbes was studied, the results demonstrated that it was quite different among them. There were diversities of their enzyme reaction velocities. It was clear that the enzyme activity was affected by the pH of the enzyme reaction system, for example, the optimum pH of ALDC from Lactococcus lactis was 6.6, while for Aerobacter Aerogenes it was 5.8. Addition leucine,valine and isoleucine into enzyme reaction system obviously affected the enzyme activity of ALDC from different microbes.

Two hundred and twenty five children aged 4-12 years with phimosis were treated by flexible dilatation combined with topical betamethasone cream from January 2003 to January 2015.Two hundred and eight cases (92.44％) were completely cured and penile edema and urination were returned to normal 7 d after a single operation;while,17 children received 2-3 additional flexible expansion.During follow-up of 2-24 months,221 children achieved the cure standards with an overall cure rate of 98.22％.Flexible dilatation combined with topical betamethasone cream is effective modality for phimosis in children,with less surgical trauma and low complication rate.

AIM: To investigate the effect of Se-containing spirulina phycocyanin (Se-SPC) on liver injury of mice induced by carbon tetrachloride (CCl 4). METHODS: The mouse model was conducted by intragastric feeding with 2% CCl 4 oil for three times, meanwhile Se-SPC, spirulina phycocyanin (SPC) and Na 2SeO 3 were injected (ip) to various groups for 7 days. Then selenium (Se), glutathione peroxidase (GPx), superoxide dismutase (SOD), alanine aminotransferase (ALT), malondiaoldehyde (MDA) and nitric oxide (NO) levels in blood and liver were measured. RESULTS: The level of Se, GPx and SOD activities were obviously higher ( P

Objective To investigate the efficacy,safety of allogeneic hematopoietic stem cell transplantation(Allo-HSCT)in lupus mice.Methods22BXSB was pre-treated with myleran and cyclophosphamide,12BXSB were treated with CTX and prednisone as the control group.Peripheral blood stem cells of doner mouse(C57BL/6)after mobilizing with G-CSF were infused into recipients after pretreatment.Hematopoietic and immune reconstitution after transplantation were measured by blood cell analysis and flowcytometry.Recipients' renal pathological changes were measured with direct immunofluorescence after transplantation,proteinuria and anti-dsDNA antibody were also determined.Complications and mortality were compared between the two groups.Recipients'genetic map was analysed with PCR.Results Recipients'complete chimerism was observed after60days of transplantation.The lowest value of WBC declined to0.2?0.1?10 9 /L in Allo-HSCT group.The duration of WBC increased from the lowest value up to1.0?10 9 /L was47.5?12.8d in Allo-HSCT group.Early immune reconstitution could not be found in Allo-HSCT group.After transplantation reduction of proteinuria occurred in95.5%BXSB,anti-ds-DNA antibody turned to negative in54.5%BXSB,decrease of kindey immunofluorescence in90.9%BXSB,there was a significant difference between the two groups.There was no significant difference in the incidences of complication of bleeding,pneumonia and mortality between the Allo-HSCT group and the control group.Conclusions Allo-HSCT is an effective treatment method for lupus mice.It may be helpful in improving proteinuria and anti-dsDNA antibody and renal pathological changes of lupus mice.But the incidences of complication and mortality related to transplantation in Allo-HSCT group are higher than those in control group,so the value of Allo-HSCT in the treatment lupu mice has to be further studied.

Objective To investigate the correlation between cytomegalovirus infection and heart rate variability (HRV) in elderly patients with atherosclerosis.Methods 160 patients with coronary heart disease who met World Health Organization diagnostic criteria for coronary heart disease in 1979 were collected.According to the IMTHCMV PP65 antigen test results,patients were divided into positive group (observation group,n=103) and negative group (control group,n=57).We detected the levels of of HRV,metalloprotease-9 (MMP 9) and tumor necrosis factor α (TNF-α) in the two groups in order to access the plaque stability.Results The all sinus standard deviation of RR interval (SDNN),standard deviation of the average NN interval (SDANNI),mean value of sinus standard deviation of RR interval (SDNNI) were lower in observation group than in control group (P ＜0.05).There were no significant differences in square root of the mean squared differences of successive NN intervals (RMSSD) level and percentage of differences exceeding 50ms between adjacent normal number of intervals (PNN50) between the two groups (P＞0.05).The levels of total cholesterol and low density lipoprotein were higher and the levels of MMP 9 AND TNF α were lower in observation group than in the control group (all P＜0.05).Compared with control group,the plaque stability was decreased in observation group [20.4％ (21/103) vs.61.4％ (35/57),x2=4.273,P=0.015].Conclusions Patients with atherosclerosis combined with cytomegalovirus infection have a greater heart rate variability and poorer plaque stability.