Objective To determine the biological reference interval of urinary conductivity in healthy people and to study the relationship between urine conductivity and other parameters as well as its clinical feasibility.Methods Conductivities of midstream urine specimen from healthy people (n=10119,5074 males and 5045 females,aged under 96 years) or patients with different diseases (n=3449) were determined.Among them the following parameters:conductivity,osmolality,specific gravity,creatinine,urea,uric acid,sodium,potassium and chloride of 250 random urine specimens were simultaneously determined.Results The urinary conductivities in healthy people exhibited normal distribution and significant differences were found in the subjects with different age and sex.The reference range of urinary conductivity was between 10.42?4.61 mS/ch and 24.10?6.81 mS/ch in healthy people and between 7.95 mS/ch?2.40 and 18.01?5.90 mS/ch in the patients with different diseases.Conductivity determined was positively correlated with osmolality (r:0.894),specific gravity (r:0.727),sodium (r:0.698),potassium (r:0.563),chloride (r:758),uric acid (r:0.521),urea (r:0.556) and creatinine (r:0.495).Conclusions Urine conductivity,which determination is simple and rapid,may reflect the conductive capacity of electrolytes in urine and positively correlated with osmolality,so it can be used as a new parameter for urinalysis to diagnose renal concentrative function in routine laboratory.

Objective To study the clinical features of target organ damage in children with essential hypertension.Methods From Jan.2007 to Oct.2013,86 children were enrolled who were diagnosed as essential hypertension in the Children's Hospital Affiliated to Capital Institute of Pediatrics.All children received the following examinations:fundus oculi,electrocardiogram,echocardiography,serum triglyceride,glucose,insulin,C peptide,uric acid,renal function,urine microalbumin,serum and urine β2-microglobulin.All data were collected as standard procedure and analyzed by using statistic methods.Results In all recruited children,there were 68 boys (79.1％)and 18 girls (20.9％) with the average age of (12.3 ±2.4) years old.There were 46 children(53.5％) with grade Ⅰ hypertension and 40 (46.5％) with grade Ⅱ hypertension,13.5％ (7/52 cases) of the children with retinal vessel damage,21.0％ (17/81 cases) with abnormal electrocardiogram,and 2.6％ (2/78 cases) with left ventricular hypertrophy and increased left ventricular posterior w all thickness.Thirty-seven percent (30/81 cases) of the children had a higher voltage of R wave in V5 than average values at the same ages.Renal damage mainly included increased serum creatinine and microalbuminuria,with the rates of 40.2％ (33/82 cases) and 39.7％ (23/58 cases),respectively.Metabolic disorders mainly included 87.5％ (56/64 cases) hyperuricemia,32.5％ (25/77 cases) hypertriglyceridemia,22.1％ (19/86 cases) hepatic adipose infiltration,and 36.1％ (30/83 cases) hyperinsulinemia or sugar intolerance damage.There were 58 (67.4％) children wit h obesity.Compared with normal weight children,children with obesity had a higher rate of target organ damage(98.3％ vs 82.1％,x2 =5.291,P =0.021),and hyperinsulinemia or sugar intolerance damage(45.5％ vs 17.9％,x2 =6.123,P =0.013).Children with the course longer than 6 months showed a higher rate of hyperinsulinemia or sugar intolerance damage than the children with the course less than 6 months(50.0％ vs 25.5％,x2 =5.788,P =0.021).Conclusions Target organ damage caused by adolescent essential hypertension is present at diagnosis in most of these children.Electrocardiogram and echocardiography are effective measures for early detection of cardiac damage of hypertension.Serum uric caid and urine microalbumin can be used as early warning and screening indexes.To enhance blood pressure monitoring of children with obesity will be helpful for early diagnosis of essential hypertension,which will decrease the rate of target organ damage with earlier effective interference.

Although the surgical techniques has already improved in heart transplantation, heart preservation is still the biggest obstacle to the surgery.At present, heart preservation effective time is only 4-6 hour.How to extent the time of heart preservation is a major research direction.Comparison of available preservations for heart transplantation based on its mechanism and the prospect of its Clinical application.

Objective To construct a mouse model for real-time,noninvasive and specific monitoring of inflammation activation in hepatic tissues.Methods An inflammation reporter gene was targeted to the liver by hydrodynamic gene delivery technology.Bioluminescence imaging was used to detect the firefly luciferase(Fluc) expression in the mouse liver after inflammatory stimulation.Besides,the relevance between the light intensity and inflammation level was also intensively investigated.Results pIL-6-Fluc was successfully delivered to the liver.The hydrodynamic gene delivery could cause a transient liver injury that could return normal in 5 to 7 days.The expression of pIL-6-Fluc could be induced by lipopolysaccharides(LPS) treatment with an about (46.80±13.35) fold increase at the peak value,which was significantly higher than that detected by ELISA [(4.09±0.96)fold].Conclusion An inflammation reporter mouse model is constructed in this study by hydrodynamic gene transfection,allowing noninvasive monitoring of inflammation activation specifically in hepatic tissues.The reporter model is capable of monitoring inflammation activation with a sensitivity higher than that of ELISA.

Objective:To establish the lung blast injury model in mice, detect the proteomic changes of lung in mice at different time points, and explore the mechanism of lung blast injury.Methods:A total of 60 healthy male C57BL/6 mice were randomly (random number) divided into the control group, 12-h group after thorax blast, 24-h group, 48-h group, 72-h group and 1-week group ( n=10 each group). Experiments were carried out in the animal laboratory of the General Hospital of the Northern Theater Command. The model of lung blast injury in mice was established by using a self-developed precision blast device, and the lung tissue injury situation was evaluated by gross observation and HE staining. The proteins in mouse lung tissue were quantitatively analyzed based on LC-MS/MS proteomic technology, and the differentially expressed proteins were screened. On this basis, bioinformatics tool was used to analyze proteomic changes. Results:After lung blast injury, scattered bleeding spots could be observed on the surface of lung tissue of mice, and the bleeding points were gradually increased with time, showing a patchy distribution, and the symptoms were the most severe at 24 h. The results of HE staining showed that the normal tissue structure of alveoli disappeared at 12 and 24 h under light microscopy with diffuse bleeding in the alveolar cavity, infiltration of a large number of inflammatory cells, increased interstitial exudate, thickened alveolar wall, and collapsed and merged alveolar cavity. A total of 6 861 proteins were identified by LC-MS/MS in lung tissue samples of mice after thorax blast, and 608 differentially expressed proteins were quantified, of which 227, 140, 202, 258 and 71 differential proteins were at 12 h, 24 h, 48 h, 72 h, and 1 week, respectively. According to GO analysis, 130 biological process subtypes including cell adhesion, extracellular matrix tissue and collagen fibril tissue were obtained. Besides, 66 cellular component involving extracellular exosomes, extracellular matrix and cytoplasm were obtained. And 43 molecular functional subclasses such as extracellular matrix structure composition, actin binding and antioxidant activity were obtained. KEGG analysis yielded 24 pathways including ECM-receptor interactions, focal adhesions and PI3K-Akt signaling pathway across the endothelium.Conclusions:Differentially expressed protein combinations are also different at different time points in the early stage after lung blast in mice, and the injury mechanism is complicated. The lung blast injury is the most serious at 12-24 h after blast and produces significant inflammatory response.

BACKGROUND: Splint fixation was a common treatment for limb fracture, but there were some limitations, such as lack of individual difference, easy to lose and being unable to self-adjusting.OBJECTIVE: To explore the design method of digital splint and related finite element analysis.METHODS: Forearms were scanned with CT; periphery parameters were extracted, followed by reverse modeling and modifying. The digital splint models were constructed. Material attribute and mechanical loading were conducted. Thelimb length, maximum stress and displacement of the bone, soft tissue and splint were calculated by finite elementanalysis. RESULTS AND CONCLUSION: The digital splint has favorable tight attaching and balanced stress to skin, and whichkeeps well stability for the micro-motion fracture ends. Our study indicated that better tight attaching splint could bedesigned by digital modeling technology. Favorable fracture fixation and mechanical property could be also achieved.

OBJECTIVETo analyze the common hemorrhage sites during laparoscopic rectal cancer surgery in order to take reasonable prevention and management.

METHODSClinical data of 355 rectal cancer patients who underwent laparoscopic total mesorectal excision in Shanxi Provincial People's Hospital from January 2012 to December 2014 were retrospectively analyzed. Common bleeding sites, blood loss, and hemostasis time were recorded. According to the date of operation, patients were divided into 2012 group (91 cases), 2013 group (122 cases) and 2014 group(142 cases). Hemorrhage rates were compared among three groups.

RESULTSNo significant differences were observed in the baseline data among the three groups(all P>0.05). The location in the order of the hemorrhage rate from high to low was seminal vesicle tail (63.0%, 131/208), inferior mesenteric vessels (27.3%, 97/355), Toldt's space (24.2%, 86/355), lateral rectal ligaments (12.1%, 43/355) and post-rectal spatial (8.2%, 29/355). According to the blood loss, post-rectal spatial[(14.1±7.1) ml], inferior mesenteric vessels [(12.7±6.1) ml] and seminal vesicle tail [(12.4±6.5) ml] were ranked in top three. The hemostasis time of seminal vesicle tail [(11.5±6.6) minutes] and post rectal spatial [(10.3±7.8) minutes] was longer than the others. Compared with 2012 group, shorter operative time [(205±50) minutes vs. (235±55) minutes, t=4.296, P=0.001], less blood loss [(35±19) ml vs. (81±24) ml, t=16.243, P=0.001] and lower hemorrhage rate [Toldt's space: 7.7%(11/142) vs. 39.6%(36/91), inferior mesenteric vessels: 9.2%(13/142) vs. 44.0%(40/91), post-rectal spatial: 0.7%(1/142) vs. 15.4%(14/91), lateral rectal ligaments: 2.1%(3/142) vs. 29.7%(27/91) and seminal vesicle tail: 50.6%(41/81) vs. 79.6%(43/54)] were found in 2014 group. The decline of hemorrhage rate in seminal vesicle tail was the slowest (χ=11.792, P=0.003).

CONCLUSIONSThe common hemorrhage sites during the laparoscopic rectal cancer surgery are inferior mesenteric vessels, Toldt's space, lateral rectal ligaments, post rectal spatial and seminal vesicle tail. Appropriate preventive measures can ameliorate the intraoperative bleeding significantly, however, more attention should be paid to the seminal vesicle tail during operation because of its higher hemorrhage rate, more blood loss and difficult hemostasis.

Objective To explore the diagnosis,treatment and prognosis of neuroblastoma in children. Methods The clinical data of 36 children With neuroblastoma admitted to Department of Pediatric Surgery,Henan Pro﹣vincial People＇s Hospital betWeen August 2013 and August 2018,Were retrospectively analyzed. The patients included 22 males and 14 females With the age of 1 month－13 years old[( 20. 0 ± 18. 5)months]. TWenty－one cases of neu﹣roblastoma originated from the adrenal glands,the other 15 cases from the sympathetic ganglion( including 7 cases in retroperitoneum,6 cases in postmediastinum,and 2 cases in neck). Fifteen patients in loW risk and intermediate risk groups underWent primary surgery before multiple chemotherapy,While other 21 cases in high risk groups underWent chemotherapy until the mass could be removed completely,then continuely underWent multiple chemotherapy. Results Of the 36 patients,23 cases(63. 9%)had a radical resection,13 patients underWent palliative resection and 2 pa﹣tients Were treated With vascular repair during surgery(abdominal aorta in 1 patient,inferior vena cava in 1 patient). TWenty－seven patients had effective in formation and 16 patients survived,during folloW－up,12 patients belonged to stage Ⅰ－Ⅲ disease,2 patients stage Ⅳ disease and 2 patients stage Ⅳs disease,respectively. Four cases underWent re－operation due to disease recurrence,then they underWent chemothearopy,and 3 patients Were survival With tumor. Conclusions Neuroblastoma is a highly malignant pediatric cancer accompanied With a high rate of metastasis on ini﹣tial diagnosis. Radical resection is an effective therapeutic strategy for improving the survival rate. If radical resection is impractical,palliative resection combined With chemotherapy can significantly prolong patients＇ survival time. And a better prognosis is achieved if it can be early diagnosed and treated timely.

To explore the application effect of team-based learning (TBL) model in functional experiment teaching. A clinical case related to the animal experiment was selected and distributed to students through Internet before class. Individual tests for students were conducted in class to assess their understanding for the case. Then group tests were carried out, which were completed by in-group discussion. Finally, the clinical case was analyzed within group. The teaching process possesses several characteristics and advantages in helping students retrieve literature, cultivate their spirit of cooperation, their ability of clinical practice and so on, but it also has some shortcomings and deficiencies. Therefore, this paper summarizes the advantages and disadvantages of TBL teaching in functional experiment teaching based on existing experience so as to promote a broader application of TBL in our medical education.

Objective To evaluate the diagnostic value of A-F mnemonic performed by sonographers with limited experience in patients with acute chest pain. Methods This was a prospective observational study. Bedside cardiac ultrasound for patients with chest pain was performed by six sonographers with limited experience using A-F mnemonic, evaluating indexes including aortic dissection(A), both ventricles (B), regional wall motion abnormality (RWMA), left ventricular ejection fraction (LVEF) ≤ 50％ (C ,contractility), dimensions (D), pleural and pericardial effusion (E) and further abnormalities (F). Afterwards, experienced cardiac sonographers performed the same examinations, and the difference in the time of ultrasound examination was calculated. The diagnosis of experienced sonographers were referred as the control group, and kappa test was applied to analyze the sensitivity, specificity, positive predictive value and negative predictive value. Results There were 245 cases eligible for study, and 20 cases were excluded. Finally 225 cases of acute chest pain were included in the analysis, containing 158 fatal chest pain and 67 low-risk chest pain. The experienced sonographers diagnosed 20 cases of ascending aortic dissection, 5 cases of right ventricular dilatation, 72 cases of RWMA, 12 cases of LVEF ≤ 50％, 45 cases of left ventricular dilatation, 6 cases of hydropericardium, and 6 cases of other abnormalities. The consistency between beginners and experienced sonographers were as follows:completely same (hydropericardium, Kappa=1.000), highly consistent (ascending aortic dissection, Kappa=0.853, right ventricular dilatation, Kappa=0.931, and other abnormalities, Kappa=0.829), moderately consistent (RWMA, Kappa=0.768, LVEF ≤ 50％, Kappa=0.713 and left ventricular dilatation, Kappa=0.766). The sensitivity and negative predictive value of RWMA and LVEF ≤ 50％ and the positive predictive value of left ventricular dilatation in the beginner sonographers were lower than those in the experienced sonographers. Conclusions A-F mnemonic was a simple and practical way for the beginner sonographers to perform bedside cardiac ultrasound. It was of significant value in making correct diagnosis of most acute chest pain patients and providing quick and reliable information for clinicians.