Objective To assess the effect of resident training in clinical skills on SARS prevention and treatment. Methods A survey was conducted by means of questionnaires on 101 residents of the authors' hospital who were at the forefront of the fight against SARS. Results Training in clinical skills assisted the residents to various degrees in SARS prevention and treatment. 100% of the residents surveyed held that the training was helpful, beneficial and assisted them in solving problems. Conclusion Training in clinical skills, which rendered the residents proficient in basic skills and more capable of clinical application of the skills, also enhanced their ability to handle emergent events in SARS prevention and treatment.

Objective To observe characteristic imaging of traumatic arteriovenous fistulas(TAVF) and to evaluate the methods of differential diagnosis of TAVF by Doppler ultrasonography. Methods Eleven patients suffering from TAVF were selected to have the examination of Doppler ultrasonography. The blood flow of arteriovenous fistulas, diameter, morphology and blood flow character of affected vessels were observed. Spectral of fistula and affected vessels were analyzed and compared with the healthy side. Results Localization of arteriovenous fistulas was observed directly in eight patients, which presented as intercepted wall of the affected vessels and irregular mosaic flashes flowing towards enlarged vein from artery. Pulsed wave Doppler showed unilateral continuant spectral with maximum velocity 300-390 cm/s when sampled in the fistula. Spectral analysis of proximal arteries of the fistula revealed high velocity and low resistance. Arterialized flow pattern was observed in affected veins. Proximal veins of the fistula revealed arterialized spectral with high velocity and low resistance. Reversed centrifugal blood flow was observed in the distal veins of the fistulas in 4 cases. Conclusions Unilateral shunt in both diastole and systole in the fistula and arterialized flow with high velocity in veins are characteristic presentation of TAVF. Color Doppler ultrasonography has great value in confirming diagnosis and differential diagnosis of TAVF.

0.05). Conclusions Ultrasound contrast agent Levovist improves signal of blood flow obviously. It increases the diagnostic accuracy for intracranial aneurysms and the level of confidence.

Objective To study the association of multi-drug resistance with mutations in mar gene in clinical isolates of Shigella.Methods Fifty-four clinical isolates of Shigella were collected.Susceptibility tests of tetracycline(TE),chloramphenieol(C),ampicillin(AM),cipr ofloxacin(CIP),and norfloxacin(NOR)were performed in a11 isolates.Hexane and cyclohexane were used to study the organic solvent tolerance of all clinical isolates.marOR genes of these strains were analyzed by potymerase chain reaction-single strand conformation polymorphism(PCR-SSCP)and were sequenced. Results Thirty-five multi-drug resistant strains were identified,and the rate of multi-drug resistance was 64.8%.Thirty-eight of 54 strains were tolerant to organic solvent,including 33 multi-drug resistance strains,3 drug resistant strains and 2 sensitive strains. marOR gene was found in all strains by PCR, and 5 multi-drug resistant strains,(14.29%)carrying marOR gene mutations in multi-drug resistant strains were found by SSCP analysis.DNA sequence analysis of marOR gene revealed that there was a 4 base deletion from base 1376 to 1379 in marO gene that resulted in frame-shift mutation.However,this deletion mutation didn;t exist in the standard strain S51250 and sensitive strains.There were 10 point mutations of marR gene in multi-drug resistant strains,2 of them resulting in amino acid changes:1752(G→A)Gly→ser,1854(T→c)Tyr→His.The rest mutations were all nonsense,and some of them occurred in sensitive strains or in many other strains.Conclusion The marO gene mutation may play an important role in the regulation of multi-drug resistance in Shigella spp.

Objective To detect VP1 and 2A genes of Enterovirus type 71 (EV71) isolated from clinical specimens of patients with light or heavy symptoms and analyze the homogeneity and phylogenetic tree. Methods Fifty clinical specimens of children with hand-foot-and-mouth disease ( HFMD) were dealed with, which were tested by RT-PCR assay with specific primer pairs for EV71. EV71 isolates from patients with light or heavy clinical symptoms were tested by RT-PCR assay with two specific primer pairs for VP1 and 2A genes of EV71 respectively. All of the PCR products were sequenced and compared with that of previously isolated EV71 isolates available from GenBank by homogeneity and phylogenetic tree analyses. Results The RT-PCR results indicated that 30 isolates were EV71, 13 of 30 isolates were from clinical specimens of patients with light symptoms of hand-foot and mouth, the other were from clinical specimens of patients with heavy symptoms of complications. VP1 genes and 2A genes of 10 EV71 isolated strains including 5 light strains and 5 heavy strains were sequenced and compared with that of previously isolated 5 EV71 Chinese isolates available from GenBank (fuyangEU703814.1, xi_anHM003207. 1, shandongEU753418.1, shenzhenFJ607337.1, henanGU366191. 1) by homogeneity and phylogenetic tree analyses. The homogeneity of VP1 and 2A genes of the 10 EV71 isolated strains and 5 previously isolated strains were between 94.7% -99.4% and 93.6% -99.3% respectively, with the representative isolates of A and B genotypes was between 81.0%-84. 6% and 78. 4%-82. 2% respectively. The data suggested that all of the 10 Chinese isolates belong to EV71 genotype C. There were only 87.8% -90.2% homology among these 10 strains and the representative strains of C1, C2, C3 sub-genotypes of EV71 but 96. 8% -99.6% homology among these 10 strains and the representative strains of C4 sub-genotypes of EV71, this suggested that these 10 Chinese isolates composed the C4 sub-genotype, of the C genotype, that formed a single branch in the phylogenetic tree. Conclusion EV71 of sub-genotype C4 distributed in Mainland China, and VP1 genes have close genetic relationship between isolated strains. There is no obvious difference in 2A genes between clinical specimens of patients with light or heavy symptoms by homogeneity and phylogenetic tree analyses.

Objective To clarify the diagnostic value of salivary gland ultrasonography in Sj(o)gren's syndrome (SS),and its correlation with the disease activity index and important organs involvement were analyzed.Methods A total of 116 patients with SS were involved,including 71 cases of primary SS and 45cases of secondary SS.Ultrasonography examination of major salivary glands was conducted for these patients,at the same time the clinical data including inflammatory parameters,the immunological parameter and the involved systems were collected.Ultrasonography examination was conducted in 49 cases as the control group.Use t test,x2test and analysis of variance for statistical analysis.Results The positive rate of salivary gland uhrasonography in SS (56/116,48.3％) was significantly higher than that of the normal control groups (1/49,2.0％),(The chi-square value was 32.57,P＜0.05),the sensitivity of salivary gland ultrasonography in primary SS (62.0％) was obviously higher than secondary SS (27％),(The Chi-square value was 13.75,P＜0.01).The specificity of salivary gland ultrasonography was 98％.The scores of salivary gland ultrasonography had shown positive correlation with the erythrocyte sedimentation rate,the levels of Immunoglobulin (Ig)G,and RF(r=0.234,0.353,0.176;P=0.002,0.000,0.013),and negative correlation with the white blood cell count (r=-0.292,P=0.000).Conclusion Salivary gland ultra-sonography provides additional evidence for the diagnosis of SS,particularly in primary SS groups.The scores of ultrasonography are correlated with inflammatory biomarkers,indicating that salivary gland ultrasonography is related to disease activity.

ObjectiveTo investigate the clinical efficacy of warm needling moxibustion plus tricolor medicinal paste in treating knee osteoarthritis.MethodNinety-one patients meeting the diagnostic criteria were randomly allocated to a treatment group (45 cases) and a control group (46 cases). The treatment group was given warmneedling moxibustion plus tricolor medicinal paste and the control group, warm needling moxibustion alone. The clinical therapeutic effect and the WOMAC score were observed in thetwo groups. An improvement in the symptoms of knee osteoarthritis was assessed in the patients after treatment.ResultIn both groups, there were statistically significant pre-/post-treatment differences in the pain and daily activity scores and the WOMAC total score (P<0.05) but not in the morning stiffness score (P>0.05). There were statistically significant differences in the daily activity score and the WOMAC total score (P<0.05) but not in the pain and morning stiffness scores (P>0.05) between the two groups.Conclusion The study shows that warm needling moxibustion plus external application of tricolor medicinal paste has a marked improving effect on the pain, swelling and physiological functions in patients with knee osteoarthritis. Improving lower limb function further in daily activities can produce a satisfactory and stable therapeutic effect.

Objective To estimate the 10-year risk of coronary heart disease in patients with psoriasis,and to determine whether the risk profile is affected by disease duration,family history and clinical types of psoriasis.Methods Data were pooled from 322 inpatients with psoriasis and 297 inpatients with other skin diseases (151 cases of acute urticaria,33 drug eruption,113 herpes zoster) from December 2008 to December 2010 in the Department of Dermatology,West China Hospital of Sichuan University.Risks of coronary heart disease were estimated by using the Framingham risk score algorithm.Wilcoxon rank test,Kruskal-Wallis test and chi-square tests were used to evaluate the differences in risks and risk factors between the patients with psoriasis and controls.Results As far as the Framingham 10-year risk score was concerned,the difference was statistically significant between the patients with psoriasis and the control population (6％ vs.4％,Z =4.342,P =0.000),as well as between patients with different clinical types of psoriasis (6％ for psoriasis vulgaris vs.4％ for pustular psoriasis vs.7％ for psoriasis arthropathica vs.7％ for erythroderma psoriaticum,H =8.484,P ＜ 0.05),but was insignificant between patients with familial and sporadic psoriasis (6％ vs.6％,Z =0.406,P ＞ 0.05 ).No correlation was observed between the Framingham 10-year risk and psoriasis duration (P ＞ 0.05 ).Conclusions Increased risks of coronary heart disease exist in patients with psoriasis compared with those with acute urticaria,drug eruption or hepers zoster,and in patients with psoriasis arthropathica or erythroderma psoriaticum compared with those with pustular psoriasis.The Framingham 10-year risk of coronary heart disease is uncorrelated with disease duration and unaffected by family history of psoriasis.

Objective To investigate the correlation between brain natriuretic peptide(BNP)and left ventricular diastolic function in the elderly patients with diabetes mellitus and hypertension.Methods 128 elderly patients with diabetes mellitus were divided into diabetes without hypertension (n=63)and with hypertension(n=65),and other 62 normal subjects were selected as control group.Plasma BNP levels and indexes of echocardiography,including left ventricular mass index(LVMI),the mitral peak flow velocity during early(E)and late diastole(A),ratio of E/A,average peak velocities at mitral annuluses of six sites in left ventricular wall during early(MEm)and late diastole (MAm),and relative E/MEm were measured in all patients.Results LVMI,E/MEm and the levels of BNP were significantly higher in groups of diabetes without and with hypertension[(91.6 ±17.3)g/m2 and(116.7±20.5)g/m2,(10.3±1.8)and(12.5±1.4),(47.7±29.4)ng/L and(105.7±32.5)ng/L]than in control group[(78.7±19.5)g/m2,(8.9± 1.6)and(20.8±11.63)ng/L,respectively](F=11.54,13.83 and 9.75,all P＜0.05),while MEm in two diabetes groups[(6.8±1.0)and(5.4±0.9)cm/s]were decreased as compared with control group[(8.0± 1.1)cm/s,F=11.26,P＜0.05].The BNP levels were negatively correlated with E/A and MEm(r =-0.42 and -0.51,all P＜0.01),and positively correlated with LVMI and E/MEm(r=0.48 and 0.58,all P＜0.01).Conclusions Left ventricular diastolic function is impaired in diabetes mellitus and more severely impaired in diabetic patients with hypertension.A combination of plasma BNP and echocardiography parameter may be helpful to accurately evaluate left ventricular diastolic function in the elderly patients with diabetes mellitus and hypertension.