Objective To explore the influence of middle cerebral artery blood flow on mechanical ventilation in very low birth weight premature after using Budesonide(BUD) mixed with pulmonary surfactant(PS),and to explore the protection mechanism of cerebral injury.Methods Forty premature infants (gestational age ＜ 34 weeks,birth weight ＜ 1 500 g) with respiratory distress syndrome(RDS) were randomly assigned into study group and control group in Nanjing Maternal and Child Health Hospital from Aug.2010 to Mar.2012.PS and BUD mixture was used in study group (Per 70 mg PS adding BUD 0.25 mg),PS dose of 70 mg/kg,BUD dose of 0.25 mg/kg.Control group was only administered with PS,dose 70 mg/kg.It was administered intratracheally after 30 to 60 minutes of birth in both groups.The index of blood flow rate and blood vessel elasticity of arteria cerebri media [including systolic velocity (Vs),diastolic velocity (Vd),mean velocity (Vm),resistant index (RI) and elasticity index (PI)] were monitored by using transcranial Doppler.Results The Vs increased steadily in study group,but instability in control group,and there were of statistical differences on the 4 d,5 d,6 d and 7 d (t =3.21,2.95,3.12,3.43,all P ＜ 0.05).The Vd increased steadily in study group,but unsteadily in control group,and there were statistical differences on the 4 d,5 d,6 d and 7 d (t =4.21,3.10,3.98,4.56,all P ＜0.05).The Vm of study group was higher than that in the PS group,and there were statistical differences on the 4 d,5 d,6 d and 7 d (t =2.68,2.98,3.98,3.57,all P ＜ 0.05).The RI of study group was higher than that in the control group,and there were statistical differences in the 5 d,6 d and 7 d(t =3.10,3.98,4.06,all P ＜ 0.05).PI steadily in study group,but instability in control group,and there were statistical differences in the 5 d,6 d and 7 d (t =4.18,3.23,3.02,all P ＜ 0.05).The overall incidence of periventricular/intraventricular hemorrhage showed no significant difference,but severe periventricular/intraventricular hemorrhage (grade Ⅲ,Ⅳ) of study group was less than that in the control group (x2 =4.80,P ＜ 0.05).The incidence of periventricular leukomalacia was reduced in the study group compared with that in the control group (x2 =3.31,P ＜ 0.05).Conclusion The very low birth weight infants treated with mechanical ventilation show steady cerebral blood flow and lower incidence of brain injury after using BUD mixed with pulmonary surfactant.

Ph.D candidate education is the highest level of higher education. Training model of Ph.D candidate in Medical College of Georgia and University of Manitoba)has vivid characters compared with that in China,which is reflected by the training objective,qualification of students and tutors,culti-vating procedures and admission requirements for graduation. This kind of cultivating model performs stringent selection and can gradually pick out persons who are really fit for the scientific research. Ph.D candidate quality in the two universities is guaranteed by systemic and deep courses learning,immediate update of knowledge and strict evaluation system. The goal of this article is to provide experience and ref-erence for improving the education quality of medical Ph.D candidates in China.

Objective To investigate the efficacy and safety of combination of transcatheter arterial chemoembolization (TACE)and percutaneous radiofrequency ablation (RFA)in treatment of hepatocellular carcinoma (PHC).Methods 70 cases of PHC were divided into combined group (TACE +RFA,n =37) and control group (only TACE,n =33).Patients were followed up for1 to 2 years,and the therapeutic effects and side effects were compared between the two groups.Results The patients with tumor completely necrosis and AFP level lower than >50% in combined group were significantly more than those in control group (P <0.05);the half of year,one year and two years survival rate in combined group were greatly higher than those of control group;no severe side effect was observed in two groups.Conclusions TACE+RFA is effective and safe in treatment of PHC of more than 5 cm in diameter.

To investigate the scientificity of patient-reported outcome (PRO) scale for myasthenia gravis (MG), which was used to evaluate the clinical effects of traditional Chinese and Western medicine treatment on MG patients. Psychometric performance of the MG-PRO scale was also expected to be evaluated in this study.

Objective To investigate the association between the level of advanced oxidation protein products (AOPP) in serum and the dialysate glucose exposure dose in patients undergoing non-diabetic maintenance peritoneal dialysis (PD). Methods In this cross-sectional study, the levels of serum AOPP were measured in 192 non-diabetic PD patients. Based on the exposure dose of dialysate glucose , PD patients were assigned into the high-dose exposure and low-dose exposure groups. Serum C-reactive protein levels were also measured and the rates of cardio-vascular disease (CVD) were recorded in both groups. Results The levels of serum AOPP were higher in the high-dose exposure group, as compared with the low-dose exposure group [(78.7 ± 15.6) mmol/L vs. (71.7 ± 14.8) mmol/L, P = 0.003]. The serum C-reactive protein levels [4.6 (3.0-11.4) mg/L vs. 3.0 (2.2-5.3) mg/L, P < 0.001] and the rates of CVD (53.6% vs. 35.8%, P = 0.014) were also higher in the high-dose exposure group. After multivariate adjustment ,the level of serum AOPP was independently associated with dialysate glucose exposure dose (β = 0.157, P = 0.031) and duration of PD (β = 0.164, P =0.043). Conclusion The serum AOPP levels are associated with the dialysate glucose exposure doses in non-diabetic PD patients. Minimizing the glucose load might reduce the risk of developing CVD.

BACKGROUND:Currently, there are a lot of studies addressing oral microflora variation in patients wearing fixed orthodontic appliance. OBJECTIVE:To determine the changes in Streptococcus mutans, Lactobacil us and oral health in teenagers wearing metal orthodontic appliances. METHODS:Twenty-three who were subjected to fixed metal orthodontic appliances as testing group and 18 adolescent volunteers with no oral diseases served as controls. We col ected saliva samples from al the participants immediately, 90 days and 180 days after fixed metal orthodontic treatment to detect changes in Streptococcus mutans and Lactobacil us, which can lead to dental caries, and other oral parameters, including gingival index and oral hygiene index. RESULTS AND CONCLUSION:In the control group, there were no difference in Streptococcus mutans, Lactobacil us, gingival index and oral hygiene index at three time points. In the testing group, the hazard levels of Streptococcus mutans and Lactobacil us were significantly increased at 90 and 180 days than immediately after fixed metal orthodontic treatment (P<0.05), as wel as the gingival index at 90 days and oral hygiene index at 180 days became worse (P<0.05). At 180 days after fixed metal orthodontic treatment, the hazard levels of Streptococcus mutans and Lactobacil us, gingival index and oral hygiene index were severer in the testing group than the control group (P<0.05). These findings indicate that the fixed metal orthodontic appliance could lead to increasing of Streptococcus mutans and Lactobacil us, and reduce oral health status badly.

Objective To explore the change of serum high-sensitivity cardiac troponin T(hs-cTnT),myoglobin(MYO),creatine kinase isoenzyme(CK-MB)mass(CK-MB mass)and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in the patients with renal dysfunction.Methods The inpatients with renal dysfunction(excluding cardiac and skeletal muscle diseases)in our hos-pital were collected and divided into the compensation period group(30 cases),decompensation period group(24 cases)and uremia group(22 cases)according to serum urea and creatine concentration,and 36 healthy individuals were selected as the control group. Venous blood was collected on an empty stomach and separated for obtaining serum.Serum levels of hs-cTnT,MYO,CK-MB mass and NT-proBNP were measured by the electrochemiluminescent immunoassay.Results Serum hs-cTnT levels in the compensation period group,decompensation period group,uremia group and the control group were 16.4(10.9-24.2),17.0(13.0-25.5),25.9 (16.5-33.8),13.7(9.4 -19.7 )pg/mL respectively.Serum MYO levels were 52.4 (40.0 -96.5 ),87.9 (57.7 -118.3 ),115.7 (94.2-175.8),34.8(24.3-48.1)ng/mL,respectively.Serum CK-MB mass levels were 1.03(0.82 -1.75),1.31 (1.08 -1.69), 1.66(1.01-2.46),1.88(1.63-2.43)ng/mL,respectively.Serum NT-proBNP levels were 292.5(123.3-576.2),363.3(192.3-893.3),1 357.2(536.5 -4 662.9),110.3 (70.1 -196.3)ng/mL,respectively.The serum hs-cTnT,MYO and NT-proBNP levels were increased with renal function decrease.The nonparametric Kruskal-Wallis H test showed statistically significant difference a-mong groups(H =14.46,49.81 and 35.00,P <0.05 ).The CK-MB mass level had no statistically significant difference among groups(P >0.05).Conclusion The patients with renal dysfunction have the higher risk rate for complicating the cardiovascular e-vents.Early detection of cardiac markers conduces to the diagnosis of myocardial injury,the evaluation of the risk rate of myocardial infarction occurrence in future and the diagnosis of heart failure and evaluation of the risk rate of heart failure occurrence in future.

Objective To investigate the epidemiological feature of respiratory viruses in children with respiratory tract infection and to provide evidences for diagnosis and rational use of drugs .Methods Nasopharyngeal secretion were collected from 399 chil‐dren with acute respiratory tract infection ,and 7 respiratory viruses ,including respiratory syncytial virus (RSV) ,adenovirus(ADV) , influenza virus A (FA ) ,influenza virus B (FB) ,parainfluenza virus Ⅰ(PIVⅠ) ,parainfluenza virus Ⅱ (PIVⅡ )and parainfluenza vi‐rus Ⅲ(PIVⅢ) ,were detected by using direct immunofluorescence assay .The clinical epidemiological characteristics were analyzed by age group ,virus distribution and seasons .Results Among 399 children ,142 cases were positive for 7 viruses ,which included 40 cases of RSV infection(28 .2% ) ,26 cases of ADV infection (18 .3% ) ,43 cases of FA infection (30 .3% ) ,15 cases of FB infection (10 .6% ) ,5 cases of PIVⅠ infection(3 .5% ) ,4 cases of PIVⅡ infection(2 .8% ) and 9 cases of PIVⅢ infection(6 .3% ) .The total positive rate was 35 .6% .The number of infected infants of <1 year group were 40 cases(36 .0% ) ,the number of infected infants of 1 to 3 year group were 48 cases(32 .0% ) and the number of infected infants of >3 year group were 54 cases(39 .1 .0% ) .In 4 seasons ,the positive rates were 32 .1% (spring) ,26 .9% (summer) ,29 .3% (autumn) ,45 .0% (winter)respectively .The positive rate in winter was the highest .Conclusion FA and RSV is the major virus in children with respiratory tract infection .FA infection rate in infants(>3 years old )is the highest ,and FA is most prevalent in winter .RSV infection rate in infants (< 1 years old )is the highest ,and RSV is most prevalent in spring .

Objective To explore the consistency of knee articular cartilage defect area by magnetic resonance imaging (MRI)and arthroscopy.Methods Thirty-six patients (36 knees)with knee cartilage lesions were collected in our study.The defect area meas-urement of knee articular cartilage by MRI and arthroscopy was compared.Results A total of 92 lesions were detected by both MRI and arthroscopy with an average of 2.6 defects per knee.Preoperative MRI resultes demonstrated the mean defect area per knee was (1.9±1.5)cm2 ,while arthroscopic measurement after debridement indicated the mean defect area per knee was (2.9±2.6)cm2 , which had significant difference(P <0.001).The area measured by MRI was less than that by arthroscopy,and the mean difference was (1.7 ± 1.1)cm2 .The mean area measured by MRI was 70.1% of that by arthroscopy.Conclusion Arthroscopy and MR have good consistency in the number of articular cartilage defect lesions .MRI can reflect the knee articular cartilage defect area directly or indirectly,and be capable of accurate positioning and qualitative diagnosis.

Objectives To investigate the activities of daily living and analysis of the influencing factors among elder hospitalization patients.Methods A series of scales including Activity of Daily Living Scale,Mini-Nutritional Assessment,Mini Mental State Examination,Geriatric Depression Scale 15,Falls Risk Assessment Tool and Euro Qol-5D Questionnaire were used to assess the physical and psychological health status among elder patients at first hospitalization,as well as their social-economic status,and to analyze the activities of daily living and influencing factors.Results Interviewees with less than nine years educational level had 5.93 (95 ％ CI:1.14-33.23)times higher risk for impaired activities of daily living than those with higher education levels.Patients with EQ-5D score ≥1 scale or with cognitive disorder showed 2.86 (95％ CI:1.04-8.05) times or 18.14 (95 ％ CI:1.64-540.63) times higher risks for impaired activities of daily living than their normal controls,respectively.The risks for the decreasing activities of daily living were increased along with ageing (P =0.025).There was a marginal correlation between regular exercise and activities of daily living(P=0.104).Conclusions Educational level,health status and cognitive function are important factors for activities of daily living among elder hospitalization cases and enlarged sample size is required for validation.