Objective To investigate the use of antibacterial drugs in tension -free inguinal hernia repair before and after the 2012 National clinical use of antibiotics special management ,providing the basis for the rational use of antimicrobial drugs and standardized management .Methods Retrospectively investigate the antimicrobial ap-plication in patients undergoing tension-free inguinal hernia repair and discharged from July to September in 2011-2013,and analyzed the timing of administration ,usage,type and treatment time of antimicrobial drugs .Results There were respectively 93.24%,47.76%and 27.59%of patients in the three groups administrated prophylaxis antibacte-rial drugs,and respectively 9.19%,65.67%and 85.08%of patients with indications .The first wound healing rates were respectively 94.59%,98.51% and 96.55%.The rates of reasonable choice of medicines 70.60%,96.88%and 91.67%,respectively;the rates of reasonable timing for medication were 71.01%,81.25%and 70.83%,respec-tively;the rates of reasonable courses of prophylaxis therapy were 33.33%,56.25% and 58.33% respectively. Conclusion The principle of no preventive antibiotics use in tension-free inguinal hernia repair is operable .After en-actment of special management of antibacterial drugs ,the level of preventive medication for tension-free inguinal herni-a repair is improved greatly .However ,it still needs to strengthen the management of antimicrobial prophylaxis timing and overall prophylaxis treatment course .

An animal model of encephalitis B was successfully established with Jin Wei Yan I strain virus in mice,which made it possible to study the ultrastructural pathology as well as the morphogenesis and release of encephalitis B exerimentally.The ultrapathological changes occurring to the brain tissues especially in the neuron cells were described systematically.A preliminary hypothesis about the morphogenesis and release of encephalitis B virus (Jin Wei Yah I strain) was proposed on the basis of these changes.Replication of the virus was also found to occur in the oligodendroglia but not in the microglia,which maintained its phagocytic function.This fact evidently shows that the micrioglia is not controlled by the mRNA of the virus.According to the literature available to the authors,it seems that the ultrastructural pathological changes of encephalitis B with typical histological lesions in animals had not been reported previously.

Objective To screen the HBV SPⅡ promoter DNA-binding protein, and to investigate its potential role in the regulation of replication and expression of HBV DNA. Methods By using HBV SPⅡ biotinylated promoter DNA as a selective molecule, the T7 select human liver cDNA library was biopanned and the positive clones were selected. After screening, amplification of positive plaques was performed for inserted DNA fragment and then they were cloned into the pGEM-Teasy vector. Results Four positive plaques were chosen for DNA sequencing. The binding protein of HBV SPⅡ promoter was demonstrated as nicotinamide adenine dinucleotide (NADH) dehydrogenase 4 by BLAST. Conclusion The result suggests that this approach may provide a new tool for the study of replication and expression mechanism of HBV DNA.

Clinical data of granulomatosa cheilitis of 33 cases were analysed.Odontogenic infectious foci were found in each patient.Elimination of odontogenic infectious foci was followed by regression or disappearance of the swellings in all the 33 cases,suggesting a close relationship between granulomatous cheilitis and odontogenic infectious foci.Elimination of odontogenic infectious foci can be an important measure for the treatment of granulomatous cheilitis.

Objective To explore the pediatric emergency medical mode in critical ill children by pediatrics specialty and nurses,using equipments of ICU for adults in second class general hospital. Methods We retrospectively analyzed the effect of establishing the pediatric observation unit in the adult observationdistrict and the prognosis and disease spectrum of pediatric critical patients in our emergency ICU in the past five years. Results 5 076 pediatric patients had been admitted to the emergency observation unit accounting for 3.40% of outpatient yearly. There were 464 critically ill children,accounting for 9. 14% of children into the observation unit,251 cases (54. 09%) were transported to other hospitals,35 cases (7.54%) were admitted to emergency ICU due to transport high-risk, 14 cases required ventilator support. The disease spectrum based mainly on childhood accident,including trauma,poisoning and drowning,etc. The other major diseases were severe infection and fulminant myocarditis. After the treatment such as stopping bleeding, respiratory supporting ,correcting shock, and maintaining the function of important organs,77. 14 % were improved or recovered. The survival rate of children with mechanical ventilation was > 85%. Conclusion In our country,the pediatric emergency medical service system is inadequate. The critical illness treatment model of using the advantages of equipments and nurse' s team of adult ICU in second class general hospital ,combining with pediatrician trained in PICU is feasible and consistents with our national conditions.

Objective:To systematically review the teaching effects of flipped classroom (FC) in undergraduate medical education in China.Methods:Such databases as CNKI, VIP Data, and WanFang, were electronically searched for literature of randomized controlled trials (RCTs) on FC versus lecture-based learning (LBL) applied in medical education in China up to March, 2018. The included literature were evaluated for the quality, and RevMan5.3 software was used for Meta-analysis.Results:A total of 26 RCTs were included in the study, including 4 249 students, of whom the FC group had 2 135 cases, while LBL group had 2 114 cases. The students in FC group got significantly higher scores than those of the students in LBL group in the theoretical scores (WMD = 7.81, 95%CI = 5.18 -10.43, P < 0.05), skills tests (WMD = 4.69, 95%CI = 0.65 -8.73, P < 0.05). Conclusion:The FC can significantly improve the teaching results in undergraduate medical education.

ObjectiveTo explore the influence of clinical symptoms and applicability of discontiguous naikan cognitive therapy(DNCT) among convalescent schizophrenic patients.MethodsApplying DNCT,100 convalescent paranoid schizophrenic patients with convalescent clinical state were consecutively recruited.All the patients were randomly divided into DNCT group and control group and were pretreated with antipsychotic agent therapy,40 patients in DNCT group and 49 patients in control group entered the statistic analysis,11 lost.In DNCT group,the patients received DNCT for successive 28 days.In control group,the patients only received antipsychotic agent therapy.Positive and Negative Syndrome Scale (PANSS),Nurses'Observation Scale for Inpatient Evaluation (NOSIE) were administered to all subjects pre- and post-treatment.ResultsAfter treatment,in the study group,total PANSS scales ( (54.00 ± 10.19 ) vs (45.05 ± 5.28 ),t =5.430,P ＜ 0.01 ),the positive symptom item ((11.00±3.33) vs (9.53 ±1.85),t=3.670,P=0.01),negative symptoms item((12.15 ±4.38) vs (9.40± 2.15 ),t =4.371,P ＜ 0.01 ),general psychopathology item ( (26.90 ± 5.66) vs (22.65 ± 3.07 ) 分,t =4.494,P＜0.01 ) scored lower than before,The difference was statistically significant.PANSS study group after treatment,total scores( (45.05 ±5.28 ) vs (52.04 ± 10.36),t=-3.876 P＜0.01 ),negative symptom item score( t =- 3.789,P ＜ 0.01 ),composite item ( t =2.251,P =0.027 ),the general psychopathology item ( t =- 3.336,P =0.01 ),score significantly lower than the control group.After twelve weeks follow-up study,in the study group,PANSS total scores ( t =4.764,P ＜ 0.01 ),item score of positive symptoms ( t =2.335,P =0.025 ),negative symptoms item score( t =3.083,P =0.004) ),genial psychopathology item score ( t =4.325,P ＜ 0.01 ) was still significantly lower than before treatment,the difference was statistically significant.In study group,after treatment,NOSIE Scale total negative factors scores( t =3.083,P =0.004) were significantly lower than before,total positive factors( t =-2.446,P=0.019),the total estimated factor in the disease scores ( t =-4.730,P ＜ 0.001 )were significantly higher than before treatment.After treatment,in the study group,negative factors ( t =-3.953,P=0.000) were significantly lower than the control group,twelve weeks follow-up,study group total negative factors of NOSIE scale score( t =2.126,P =0.040) was still lower than before treatment,the difference was statistically significant,total positive factor( t =- 2.054,P =0.047 ) still higher than before treatment,the difference was statistically significant.ConclusionDNCT can possibly improve part clinical symptoms of patients with convalescent schizophrenia to a certain extent,especially negative symptom,and the impact remained to the twelve weeks,but need to further prove the effect of naikan cognitive therapy.

ObjectiveTo compare the clinical effects of laparoscopically assisted vaginal hysterectomy (LAVH) and transabdominal hysterectomy (TAH).MethodsOne hundred and twenty-six cases operated with hysterectomy were classified into LAVH group and TAH group by random digits table with 63 cases each.The operation time,intraoperative bleeding amount,exhaust time,hospitalization time and postoperative complications were observed and compared.ResultsThe operation time,intraoperative bleeding amount,exhaust time and hospitalization time was ( 115.6 ± 13.8 ) min,(92.5 ± 11.3 ) ml,(21.8 ±4.8) d and (6.1 ± 1.7) d in LAVH group,( 82.5 ± 8.7) min,( 112.3 ± 17.8) ml,(28.9 ± 6.2) d and (9.6 ±2.2) d in TAH group,there were significant differences between two groups (P＜0.05).The incidence of incision pain,delayed wound healing,vaginal stump infection,thrombophlebitis,and gastrointestinal disorders was 9.5％(6/63),0,1.6％(1/63),0 and 7.9％(5/63) in LAVH group,which was significantly lower than that in TAH group [52.4％(33/63),7.9％(5/63),11.1％(7/63),7.9％(5/63) and 22.2％ ( 14/63 ) ] (P ＜ 0.05).ConclusionCompared with TAH,LAVH can shorten exhaust time,hospitalization time,reduce intraoperative bleeding amount,decrease complication rate,which can be further applied in clinic.

Objective To investigate the relationship between the expression ofα1-antichymot-rypsin (α1-ACT)in plasma and postoperative cognitive dysfunction(POCD).Methods The cognitive function of 64 patients undergoing operation under general anesthesia was evaluated by a battery of cognitive assessment instruments(BCAI)and the levels ofα1-ACT were measured at the time 1 d pre-operatively and 7 d and 3 months postoperatively.The patients were randomly divided into two groups:30 patients in ulinastatin group (group U)were injected with 10 000 U/kg ulinastatin,which was dissolved in 100 ml saline,within 20 min at the time of 30 minutes before induction;while control group (group C)were injected with the same volume saline.Results There was no significant differ-ence between the expression of α1-antichymotrypsin in patients with POCD and in control patients at the time before operation.Compared with control patients,the levels of α1-ACT in patients with POCD at the time of 7 d and 3 months postoperation were significantly higher (P <0.05).The levels of α1-ACT at 7 d postoperation were significantly higher than that preoperatively in both groups (P <0.05).The incidence of POCD in group U were significantly lower than that in group C,at the time of 7 d and 3 months after surgery (P <0.05).Conclusion POCD is associated with high expression of plasma α1-ACT.