Objective To explore the influence of adenoid hypertrophy on the state of the middle ear in children.Methods Two hundred and seventy two adenoid hypertrophy patients,aged from 2 to 12 years old,were examined with otoscopy,tympanometry and temporal bone computered tomography before adenoidectomy.The average age of the patients was 6.3 years old.These patients were divided into two groups:Group A contained 94 normal hearing patients(188 ears),Group B 178 patients(356 ears) containing of hearing loss.Results Out of the temporal bone computed tomography (CT) revealed that 209 patients(396 ears) had middle ear effusions in(72.79%,396/544ears),and 37 patients(65/188 ears,34.57%) hydrotympanum in Group A and 172 patients(331/356 ears,92.98%) in Group B.All the 396 ears effusion were confirmed by operation.Three hundred seventy three ears effusion were confirmed by the CT and operation in the two groups,377 ears with B type tympanogram(373/377,98.94%),93.85%(61/65 ears) in Group A,100%(312/312 ears) in Group B,respectively.The positive predictive value for middle ear effusion of the B-type tympanogram was higher in Group B than in Group A(P＜0.01).Fourteen ears with peak pressure ＜-200 daPa revealed hydrotyrnpanum and 23 ears with normal acoustic stapedius reflex revealed no fluid by CT and operation in 73 ears with C-type tympanogram.CT also revealed two patients suffered from large vestibular aqueduct syndrome and one with cochlear malformation in Group B.Conclusion Type B tracing tympanogram has a high positive predictive value for middle ear effusion in adenoid hypertrophy children.Type C tympanogram could not exclude effusion when the peak pressure is＜-200 daPa.CT is the best tool for identifying hydrotympanum.

During the period of establishing and perfecting socialist market economy in current situation,the professional morality of medical trade emerges much more new matters and problems and faces severe challenges.This article analyses the causes of these problems and difficulties on improving the professional morality of medical trade nowudays,and raises some strategies to solve these problems,such as reforming the medical system in-depth,strengthening supervision and so on.

Objective To evaluate the value of standard large trauma craniotomy in frontotemporal and parietal contrecoup craniocerebral injury.Methods Forty-six patients with frontotemporal and parietal contrecoup craniocerebral injury were treated by standard large trauma craniotomy. Based on GOS, the clinical curative effect and complications of these patients during 3 to 6 months after operation were evaluated.Results 22 cases (47.83%) recovered well, 6 cases (13.04%) suffered from moderate disability, 4 cases (8.7%) remained severe disability, and 14 cases (30.43%) died. The common complications after operation were delayed intracranial hematoma, cerebral penetrating malformation, hydrocephalus, defect of skull syndrome and so on.Conclusion Standard large trauma craniotomy is a good therapeutic method for frontotemporal and parietal contrecoup craniocerebral injury.

Objective Methicillin-resistant Staphylococcus aureus (MRSA) is a growing public health concern that has been associated with pediatric fatalities. This study investigated the genotypes of staphylococcal cassette chromosomal mec (SCCmec) and Panton-Valentine Leukocidin (PVL) in MRSA strains isolated from Shanghai Children's Hospital by PCR. Methods A total of 30 strains of MRSA were isolated from various clinical specimens from October 2005 to June 2006. The antimicrobial susceptibility was measured by agar diffusion method. SCCmec typing was conducted using a novel multiplex PCR assay allowing for concomitant detection of methicillin resistance (mecA gene) to facilitate detection and classification of all currently described SCCmec typesⅠ, Ⅱ, Ⅲ, Ⅳa, b, c, d andⅤ. PVL gene was also determined by PCR. Results mecA gene was positive in all the strains. SCCmecⅡ was identified in 6(20.0%) isolates, SCCmecⅢ in 15(50.0%) isolates, SCCmecⅤ in 2 and SCCmecⅣa in 1 isolate. Six MRSA strains were non-typeable. The isolates with SCCmecⅡ or SCCmecⅢ were resistant to multiple antibiotics. The strains harboring SCCmecⅣa or SCCmecⅤwere susceptible to all antibiotics except β-lactams. Eleven (36.7%) isolates were PVL positive. The genotypes and subgenotypes of staphylococcal chromosomal cassette mec of eleven PVL-positive MRSA were SCCmecⅡ(1 isolates), SCCmecⅢ (5 isolates), SCCmecⅣa (1 isolate), SCCmecⅤ (2 iso-Lates) non-typeable (2 isolates). Conclusions SCCmecⅡ and SCCmecⅢ are the major genotypes of MRSA in our hospital. These isolates are multi-resistant to antibiotics. The prevalence of PVL gene is higher in SCCmecⅡ- or SCCmeⅢ-positive MRSA. The isolates with SCCmecⅡ or SCCmecⅢ were resistant to multiple antibiotics.

Objective:To investigate the iodine nutrition level of pregnant women in Shanxi Province, and to provide basis for guiding pregnant women to supplement iodine scientifically.Methods:From 2016 to 2018, 40, 80 and 118 counties were selected in Shanxi Province. In each county, 5 townships were selected according to the east, west, south, north and middle orientation, 20 pregnant women were selected from each township. Urine and salt samples of pregnant women were collected, and urinary iodine and salt iodine contents were determined, respectively.Results:From 2016 to 2018, 3 590, 7 907, and 11 750 salt samples were collected from pregnant women's homes. The medians salt iodine were 23.80, 23.70, 23.25 mg/kg, and the qualified iodized salt consumption rates were 91.06% (3 269/3 590), 90.06% (7 121/7 907), 92.21% (10 835/11 750), and the coverage rate of iodized salts were 97.72% (3 508/3 590), 97.00% (7 670/7 907), 98.53% (11 577/11 750), and the qualified rate of iodized salts was 93.19% (3 269/3 508), 92.84% (7 121/7 670), 93.59% (10 835/11 577), respectively. There were statistically significant differences in the median salt iodine and qualified iodized salt consumption rate among pregnant women in different years ( H = 99.915, χ 2 = 27.988, P < 0.05). Totally 3 902, 7 892 and 11 745 urine samples of pregnant women were tested, and the medians (quartiles) urinary iodine were 174.20 (114.00, 251.08), 180.70 (117.13, 258.58) and 179.40 (115.90, 249.00) μg/L, respectively. There was statistically significant difference in the median urinary iodine among pregnant women in different years ( H = 12.368, P < 0.05). From 2016 to 2018, counties with appropriate levels of iodine accounted for 70.00% (28/40), 73.75% (59/80) and 70.34% (83/118), respectively. The medians (quartiles) urinary iodine levels of pregnant women in the early, middle and late stages of pregnancy ( n = 2 225, 5 727, 3 793) in 2018 were 177.62 (117.28, 257.23), 178.21 (117.40, 248.40) and 172.70 (112.98, 245.70) μg/L, respectively, and there was statistical by significant difference in urinary iodine levels among pregnant women in different pregnancy periods ( H = 11.077, P < 0.05). Conclusions:From 2016 to 2018, the iodine nutrition level of pregnant women in Shanxi Province is generally in an appropriate state, iodine deficiency or more than appropriate still exists in some areas. We should continue to carry out monitoring work, and focus on strengthening health education for pregnant women, and guide them to supplement iodine scientifically and accurately.

To investigate molecular epidemiology of DuCV in Cherry Valley ducks in China,the complete genomes of six DuCV strains,which were detected from Cherry Valley ducks in China between 2007 and 2008,were sequenced.Sequence and phylogenetic analysis were carried out to compare these six strains with another 27DuCV strains from Mulard duck,Muscovy duck,Pekin ducks and Mule duck.The analysis showed that the six DuCV strains exhibited typical genetic features of the family of DuCV,such as a stem-loop structure,three major open reading frames (Rep,Cap and ORF3),four intergenic repeats and the conserved motifs for rolling circle replication and for the dNTP binding domain located in the Rep protein.Phylogenetic analysis of the nucleotide sequences of the complete genome and Cap gene of these strains together with those that have been previously published demonstrated two distinct DuCV genotypes.The DuCV strains with complete genomes containing 1988and 1989 nucleotides clustered in genotype A,whereas the strains with complete genomes containing 1991,1992,1995 and 1996 nucleotides lay in genotype B.The six DuCV strains from Cherry Valley ducks were divided into the two groups.The results of the study provides some insight into the variation of DuCVs in Cherry Valley ducks.

Objective Controversies remain as to the recovery time, recovery quality, and incidence of peri-recovery adverse reactions of the patient receiving general anesthesia with remifentanil and sufentanil.This study aimed to systematically assess the qual-ity of recovery from general anesthesia with remifentanil and sufentanil. Methods Randomized controlled trials ( RCTs) were re-trieved from The Cochrane Library, PubMed, MEDLINE, EMbase, Ovid, Springer, Web of Science, CNKI, CBM, VIP, and Wan-Fang Data.According to the modified Jadad quality scale, the literature retrieved was screened and subjected to quality evaluation and meta-analysis was performed on the included studies using the RevMan 5.1 software. Results Thirty-three RCTs involving 2175 pa-tients were finally included.The results of meta-analysis showed no significant differences between the remifentanil and sufentanil groups undergoing thyroid surgery either in the recovery time to spontaneous breathing ( T1) and eye-opening ( T2) and endortracheal extubation time ( T3 ) ( P >0.05 ) or in the incidence rate of postoperative nausea and vomiting (PONV) (P>0.05).T1, T2 and T3 were significantly shorter in the sufentanil than in the remifentanil group in other types of surgery (P<0.05).The patients with level-1 Ramsay score were remarkably more in the remifentanil than in the sufentanil group ( MD =13.67, 95% CI 2.67 -69.91 ) ( P <0.05), and the VAS scores were markedly higher in the former than in the latter group at 30 minutes (MD=3.37, 95% CI 3.28-3.46) and 1 hour after extubation (MD=2.53, 95% CI 2.43 -2.63) (P<0.05). Conclusion Compared with sufentanil, remifentanil provides a quicker recovery but a weaker analgesia effect and a higher rate of post-operative agitation.However, sufentanil produces a better pain relief and a higher quality of recovery after operation.

Objective To investigate the interventional treatment timing of patients with non-ST segment elevation myocar-dial infarction with ST segment elevation in lead aVR.Methods Totally 57 cases with non-ST segment elevation myocardial infarc-tion with ST segment elevation in lead aVR in our hospital from July 2010 to July 2013 were selected.They were divided into two groups,30 cases in group A and they were given emergency PCI treatment with in 12 hours of onset,27 cases in group B and they were given emergency PCI treatment within 12-24 hours of onset.Compare the therapeutic efficacy and adverse cardiovascular e-vents after discharge.Results Therapeutic efficacy of group A was better than group B after 1,6,12 month follow up and rate of adverse cardiovascular events of group A was shorter than group B.Conclusion Emergency PCI treatment within 12 hours can im-prove the prognosis of patients with non-ST segment elevation myocardial infarction with ST segment elevation in lead aVR.

Objective To investigate the protective effects of insulin like growth factor 1(IGF-1) on cortical neurons under condition of hypoxia and the possible mechanism. Methods Cerebral cortical neurons from newborn rats were cultured under the condition of oxygen and glucose deprivation (OGD) . On day 7, neurons were treated with IGF-1 or IGF-1 plus LY294002 or PD98059 under condition of OGD or normal condition. MTT assay was used to analyze the viability of neurons in each group. The expression of total Akt and p-Akt were analyzed by Western blot. Results Compared with the control, the neuron viability was significantly higher in IGF-1 treated group under normal or OGD condition (P＜0.05). The protective effects of IGF-1 were attenuated in the presence of LY294002 but not PD98059. The result of Western blot showed IGF-1 upregulated the expression of p-Akt, which was inhibited by LY294002. Conclusion PI3K pathway may play an important role in neuroprotection afforded by IGF-1.

Objective To study the changes of the bone density and metabolic makers in patients with lupus nephritis (LN) after long time prednisone treatment.Methods All patients were women.The healthy controls (group A, n =20),the patients with normal renal function (group B, n =25) were studied before and after 2 and 4 month prednisone treatment.Dual energy X ray absorptiometry was used to measure bone mineral density (BMD) in the lumbar spine at L2～L4,femoral neck,Ward′s triangle,great trochanter (GT) and ultradis (ULT).Simultaneously,the serum calcium,phosphate,alkaline phosphate enzyme,PTH M,BGP,24 hour urine calcium,creatinine and other biochemical indices were examined in all of them.Results ① There were no significant differences in BMD between both groups ( P