Objective To select the intravenous anesthetic with less effects on the erythrocyte immunity,and observe regulation of ?-endorphin on erythrocyte immunity in vivo Methods Seventy-two mice were randomly allocated to receiving intraperitoneally normal saline 0 04ml/g (group I,n=13), thiopental sodium 60mg/kg (groupⅡ,n=10),etomidate 20mg/kg (groupⅢ,n=10),etomidate -lipuro12mg/kg (groupⅣ n=9), midazolam 20mg/kg (groupⅤ,n=12),fentanyl 100?g/kg (groupⅥ,n=10) or pethidine 20mg/kg (groupⅦ,n=10) at 9 o'clock in the morning ,respectively and were administered at half dosage at 3 o'clock in the afternoon At 9 o'clock of the next day.Results Compared with those in group Ⅰ, the rosette rate of RBC-C3b receptor(RC3bRR) decreased significantly in group Ⅱ, Ⅳ,Ⅴ and Ⅶ(P

The authors compared the purpose,and the main content of three international standards in medical education developed by the Institute for International Medical Education (IIME), World Health Organization Western Pacific Regional Office (WHO/WPRO), and World Federation for Medical Education (WFME) respectively. The IIME's standard is deferent from the others. The IIME's standard contains seven broad educational outcome domains and 60 items in the domains. The purpose of IIME's standard is to improve the common core competency of individual medical graduates of each medical school in the world, and the standard focuses the outcome of medical education and belongs to summative individual evaluation. The WHO/WPRO's and WFME's standards are quite similar. They define the standards across nine broad areas of medical schooling divided into 38 sub-areas. The ultimate goal of the WHO/WPRO's standard is to encourage national governments to adopt a quality assurance process in medical education. The aim of the two standards is to promote the quality assurance of medical schools. Both of the two standards focus the whole process of medical schooling and medical schools, and belong to formative evaluation.

OBJECTIVE: To understand the value of Child-Pugh (CP) classification and model of end-stage liver disease (MELD) score for patients with cirrhosis and their prognosis by retrospectively analyzing the two methods in hemorrhage death and non-hemorrhage death in patients with liver cirrhosis. METHODS: A total of 72 patients who died of cirrhosis (the death group) were analyzed retrospectively, and the initial data in the hospital before death were collected. The initial information of the control group (88 patients) at the same time was also obtained. The death group was divided into two subgroups: esophagus varicosity burst massive hemorrhage death group and non-hemorrhage death group. RESULTS: MELD score and CP score of the death group (22.230±13.451, 10.264±2.028) were significantly higher than those of the control group (15.370±6.201, 9.318±1.644; P<0.05). The MELD score and CP score for the massive bleeding death group were close to those of the control group. There was significant difference between the non-hemorrhage death group and the control group. The ratio of patients with CP grade A and MELD scores<20 died for massive bleeding in the death group was more than 70%, and that of CP grade C and MELD scores ≥ 30 in the death group was higher. ROC surve analysis found the accuracy of short-term predication of survival by MELD score and CP classification was improved after eliminating the risk factors of hemorrage. CONCLUSION MELD and CP play a role in evaluating the state and prognosis of patients with cirrhosis. MELD score and CP classification predict the short-term survival efficiently on the premise of excluding the risk factors of esophagus and/or stomach bottom varicosity burst massive bleeding. CP and MELD scores are deficiencies, especially for low MELD score (<20) and CP level A patients. The prognostic accuracy may be improved when combining esophageal gastric fundal varices.
End Stage Liver Disease ; diagnosis ; mortality ; Esophageal and Gastric Varices ; Humans ; Liver Cirrhosis ; diagnosis ; mortality ; Prognosis ; ROC Curve ; Retrospective Studies ; Risk Factors ; Severity of Illness Index

Objective:To evaluate the clinical outcome of transplantation of metatarsophalangeal and proximal interphalangeal joint of the second toe with toe preservation for repair of traumatic digital arthritis.Methods:From February, 2016 to June, 2018, nine cases with traumatic digital arthritis were treated, including 7 males and 2 females aged from 19 to 46 (average 26.7) years. Three cases had index finger and 6 middle fingers injuried. Four cases had arthritis in metacarpophalangeal joint (MP) and 5 in proximal interphalangeal joint (PIP). All cases with digital arthritis were secondary to trauma. The involved digital joints were reconstructed by transplanting the MP or PIP of the second toes. At the same time, the affected joints (7 cases) or autologous iliac bone grafts (2 cases) were used to repair the bone defects to retain the length of toes. The donor site were closed directly. The appearance and healing of fractures of the fingers and toes, range of motion (ROM) of the transplanted digital joint, healing of the donor site, foot function and complications were observed.Results:All 9 grafted joints survived. In 1 case, the bone defect in the donor site was fixed with iliac bone graft and mini-plate. The wound did not heal at 1 week after operation, which was considered as a rejection of internal fixator. The wound healed smoothly after having the plate removed and replaced it with a cross-fixation by Kirschner pins. Duration of postoperative followed-up was 6-30 (mean 16.3) months. Primary postoperative healing was achieved in all cases. The bone healing time in the hand was 7 to 10 (mean 8.3) weeks. The appearance and function was satisfactory. The postoperative range of motion (ROM) in the transferred MP was 50°-75°(mean 65.3°), and ROM of PIP was 10°-80°(mean 61.5°). According to the evaluation standard of upper limb function set up by the Society of Hand Surgery of Chinese Medical Association, excellent in 5 cases, good in 3 cases and fair in 1 case, with an overall satisfaction of 88.9%. The bone healing time in the foot was 9 to 12 (mean 10.2) weeks. All cases presented with good appearance of the toe without obvious affect to walking and running. For the ilium, there was only an inconspicuous linear scar without any discomfort in the donor iliac area of 2 cases.Conclusion:Transfering of MP and PIP of the second toe with toe preservation can restore the anatomy structure and function of the digital joint. Meantime, the use of autogenous iliac bone graft to replace the donor site defect may retain the length of the toe and minimizes the injury to the donor site.