Objective To observe the influence of hospital -community -family -individual 4 -level intervention model on schizophrenia patients in compliance,recurrence rate,psychotic symptom,social function,quali-ty of life and provide guidance for disease management.Methods 198 schizophrenia patients were divided into 4 -level intervention model group and conventional intervention group.After 6 moths follow -up,the effect was evaluated by compliance rate,recurrence rate,BPRS,WHO -DASII,SQLS.Results After the intervention for 6 months,the compliance,recurrence rate,the difference of severity of psychotic symptom,the difference of social function of the 4 -level intervention model group were 96.74%,13.04%,(7.57 ±2.83)points,[understanding and communication (6.32 ±3.64)points,physical exercise (5.16 ±3.28)points,self care (2.87 ±1.38)points,get on well with others (9.05 ±3.51)points,life activity (5.42 ±2.49)points,social participation (7.85 ±3.28)points],which of conven-tional intervention group were 74.74%,28.42%,(4.86 ±1.24)points,[understanding and communication (3.89 ± 1.86)points,physical exercise (2.80 ±1.238)points,self care (2.19 ±1.16)points,get on well with others (5.83 ± 3.04)points,life activity (3.41 ±1.96)points,social participation (4.27 ±2.17)points],the differences between the two groups were significant (χ2 =9.020,P =0.003;χ2 =6.932,P =0.009;t =8.527,P =0.000;t =5.775,P =0.000;t =6.554,P =0.000;t =3.652,P =0.000;t =6.712,P =0.000;t =6.144,P =0.000;t =8.829,P =0.000).The differences of before intervention and after intervention in the 4 -level intervention model group were psychological society (16.03 ±6.75)points,power and energy (15.79 ±6.41 )points,symptoms and side effects (19.37 ±7.28 )points,which in the conventional intervention group were psychological society (12.65 ± 5.46)points,power and energy (11.81 ±4.71 )points,symptoms and side effects (15.18 ±6.29 )points,the differences were statistically significant between the two groups (t =3.770,P =0.000;t =4.849,P =0.000;t =4.216,P =0.000).Conclusion Hospital -community -family -individual 4 -level intervention model has a positive effect on schizophrenia patients,which is worthy of clinical promotion.

Objective To explore the technique of implantation of double-J stent via the guide-wire track, which was established through percutaneous renal puncturing, for the treatment of ureteral stricture and obstruction, and to evaluate its therapeutic effect. Methods A total of 75 patients with ureteral stricture or obstruction, who failed to respond to cystoscopic catheterization, were enrolled in this study. The lesions included benign stricture(n=60) and malignant stricture(n=15). Ureteral guide-wire track was established through percutaneous renal puncturing, which was followed by the dilatation of the stricture with balloon catheter and subsequent implantation of double-J stent via the guide-wire track. After the double-J stent was removed, the patients were followed up for 3 months to five years. Results The success rate of the procedure was 98.7%(74/75). Technical failure occurred in one patient with benign ureteral stricture. The cure rate was 70.7%(53/75), the improvement rate was 26.7%(20/75), and no improvement was seen in one case (1.35%). The total effective rate was 97.3%(73/75). Conclusion For the treatment of ureteral stricture and obstruction, the implantation of double-J stent via the guide-wire track, which is established through percutaneous renal puncturing, is a safe and effective method.

The computerized imitating system constructed by the Second Affiliated Hospital of Guangzhou Medical University contains four blocks:administration of student infomation,administration of question bank,on-line tests and administration of score inquiry.It's designed to imitate typical pediatric cases,so that the medical students may put themselves into the practical clinical scenario and solve the challenges step by step in one-direction procedure.Teaching with computerized clinical scenario imitating patients can improve students' test resuhs and activate students' learning enthusiasm significantly.It not only helps to solve the contradiction between increasing number of medical students and clinical typical teaching case shortage but also improves the clinical thinking ability of the medical students.This system can also be used as a test bank for pediatric technical skills examination.

Objective To improve the diagnosis and treatment of eosinophilic lung disease.Methods Patients who were diagnosed with eosinophilic lung disease and hospitalized in the First Affiliated Hospital of Guangxi Medical University Hospital were retrospectively analyzed from January 2004 to August 2012.Data of etiology,clinical manifestation,imaging and pathological features,diagnosis and treatment were recorded.Results A total of 25 patients were diagnosed with eosinophilic lung disease including 9 chronic eosinophilic pneumonia,6 churg-strauss syndrome,and 10 cases of parasitic infection of which two patients were the simple pulmonary eosinophilia (L(o)ffler syndrome).Eosinophil counts in peripheral blood and bronchoalveolar lavage fluid (BALF) were increased.Arterial gas analysis showed varying degree of hypoxemia,which pulmonary function tests showed restrictive,obstructive,mixed ventilatory dysfunction.Chest CT showed bilateral flaky,streak or flake diffuse ground-glass infiltrates and reticular opacities.Results of pulmonary biopsy or skin biopsy identified diffuse eosinophil infiltration.Corticoidsteroid therapy alone or combined with immunosuppressive agents were both effective.Conclusion (1) Liver fluke and other food-borne parasites are the most common causes in eosinophilic lung disease; followed by unexplained chronic acidophilic granulocyte pneumonia; (2) In addition to histopathological evidence,the diagnosis of eosinophilic lung disease was made comprehensively based on clinical features,laboratory test,the BALF analysis,and imaging data.

Objective: To observe the influence of acupoint application therapy on serum eosinophilic granulocyte cationic protein (ECP), 6 keto prostaglandin F 1 (6-keto-PGF 1) and thromboxane B2 (TXB2). Methods: 300 cases of asthma out-patients in a remission period were divided into a treatment group (150 cases) and a control group (150 cases). The control group was given the basic treatment, and the treatment group was given external application on the acupoints in July and December every year, as well as the basic treatment of the control group, with continuous treatment for 2 years as one course. ECP, 6-keto-PGF 1, and TXB2 were checked every year in the patients of the two groups, and an Asthma Control Test Table was filled in for comparative analysis. Results: After the external application on the acupoints, the frequency of seizures, dyspnea and frequency of medication administration of the patients had been more reduced than those in the control group, indicating that the levels of ECP in inflammation of air passage and of 6-eto-GF 1 and TXB2 were obviously improved (P＜0.05). Conclusion: The herbal application on the acupoints is effective and positively influential to the improvement of the symptoms in the asthma patients and to ECP, 6-keto-PGF 1, and TXB2 remarkably.

Background Transscleral diode laser cyclophotocoagulation (TDCP) was used to later stage of glaucoma in the past.However,the indications of TDCP are expanding gradually over time and there are more and more reports about its application in different stages and different types of glaucoma.Objective This study was to compare the clinical efficacy of TDCP and trabeculectomy for primary acute angle-closure glaucoma (PAACG) with persistent ocular hypertension.Methods Ninety-five PAACG patients with persistent ocular hypertension were retrospectively analyzed.The patients were divided into TDGP group (62 eyes of 56 cases) and trabeculectomy group (44 eyes of 39 cases) based on the difference of treating fashions.The clinical outcomes were compared between the two groups with the evaluating indexes of visual acuity,intraocular pressure (IOP) before and 1 week,3 months and the end of following-up as well as the number of drug used and the re-treatment.Results The demography was matched between the two groups (all at P＞0.05).The number of eyes with visual improvement was significantly different among the groups (x2 =30.927,P =0.002) in the TDCP group.Compared with before treatment,the number of visual improvement in 1 week after treatment was significantly raised (x2 =16.778,P =0.002).No significant differences were seen in the eye number of visual improvement in various timepoints after treatment (all at P＞0.008).Also,the eye number of visual improvement was significantly different among the different timepoints (x2 =44.345,P＜0.001),and statistically significant change was found between the preoperation and postoperative 1 week (x2 =23.725,P＜0.001).However,there were no significant differences in the eye number of visual improvement in various timepoints after operation each other (all at P＞0.008).The IOP was insignificantly altered among the groups at various timepoints (Fgroup =3.836,P =0.053),but the change was significantly different over time (Ftime =757.078,P＜0.001).The postoperative IOP was significantly higher than that of preoperation in both groups (all at P＜0.001).The proportion of eyes using lowering-IOP drugs was 48.4％ in the TDCP group,and that in the trabeculectomy group was 27.3％,showing a significant difference between them (x2 =4.796,P =0.029).The retherapy was performed in 20 eyes (32.3％) and 2 eyes (4.5％) in the TDCP group and the trabeculectomy group,respectively.Conclusions The short-term lowing-IOP effecacy of TDCP is similar to trabeculectomy,but the longterm lowing-IOP efficacy of TDCP is not good.Compared with the trabeculectomy,TDCP shows more simple operation,less time-consuming during the surgery and milder tissue damage,but the eyes continuing to use anti-glaucomatous drugs or re-therapy are increased.

Objective:To discussed the diagnostic value of magnetic resonance cholangiopancreatography (MRCP), and the use of laparoscopic surgery in management of patients with choledochal cyst with extrahepatic bile duct anomaly.Methods:Of 330 consecutive patients who underwent laparoscopic choledochectomy at Guangzhou Women and Children's Medical Center from January 2010 to September 2018, there were 23 patients with extrahepatic bile duct anomaly. The data of these patients were retrospectively analyzed. There were 4 males and 19 females, with an average age of 3.2 (range 0.3~9.0) years. According to whether the extrahepatic bile duct anomaly was diagnosed by preoperative MRCP, these patients were divided into the preoperative MRCP diagnosis group and the preoperative MRCP undiagnosed group. The impact of MRCP in diagnosing bile duct anomaly to prevent bile duct injury, on operation time, hospital stay and the types of extrahepatic bile duct anomaly on outcomes of laparoscopic treatment were analyzed.Results:All the 23 patients with choledochal cysts complicated by extrahepatic bile duct anomaly were confirmed at surgery. The incidence of extrahepatic bile duct anomaly was 6.97% (23/330). There were 47.8% of type II AHD (11/23); 36.8% of type III AHD (7/23); 4.3% of type IV AHD (1/23); 17.4% (4/23) of the type with communication with accessory bile duct (CABD). The preoperative MRCP diagnosis group consisted of 14 patients, while the preoperative MRCP non-diagnosis group consisted of 9 patients, including 2 patients without MRCP. The diagnostic rate of MRCP in preoperative diagnosis of extrahepatic bile duct anomaly was 66.7%(14/21). The preoperative MRCP undiagnosed group, when compared with the preoperatives MRCP undiagnosed group, had a significantly higher bile duct injury rate [preoperative MRCP diagnosis group 7.1%(1/14), preoperative MRCP non-diagnosis group 55.6%(5/9)], and a significantly longer operation time [preoperative MRCP diagnosis group(232.6±10.0) min, preoperative MRCP undiagnosed group (278.9±22.45)min], (all P<0.05). Laparoscopic surgery was completed in 22 of 23 patients. One patient was converted to open surgery. AHD reconstruction was needed in 11 patients with type II AHD and 1 patient with type IV AHD. Seven patients with type III AHD did not require any surgical intervention for the anomaly. The 4 patients with CABD underwent simple ligation. Postoperative chyloperitoneum developed in 1 patient, who successfully responded to conservative treatment. Postoperative recovery was uneventful in the remaining patients. At a median follow-up of 2 years (range 1 to 5 years), no further complications, including intrahepatic bile duct dilatation and hepatic atrophy were detected. Conclusions:MRCP was effective in preoperative diagnosis of choledochal cysts with extrahepatic bile duct anomaly. It helped to decrease intraoperation injuries to bile duct anomalies. MRCP was also useful in classifying patients with extrahepatic bile duct anomaly to better preoperatively planning of surgical treatment strategies. Laparoscopic surgery could be completed in the majority of these patients with good postoperative results.

Objective To evaluate the validity of original plasma cortisol level and responses to lowdose ACTH stimulation test in assessing the severity of critical illness.Method Original level of cortisol and cortisol concentrations 30 min after administration of a low dose ( 1 μg/1.73m2 ) of cosyntropin were determined within 24 hours after admission to our PICU.Critical illness related cortisol insufficiency was defined by initial level of cortisol ＜ 10 μg/dL or an increment cortisol [ Δmax =Stimulated plasma cortisol level (T1) -initial cortisol level (T0)]≤ 9 μg/dL.Results Ninety-five consecutive patients were admitted to PICU from May 2010 to April 2011.The patients were assigned to severe sepsis group (35/95),major operation group (30/95),and other critical illness group (30/95).Overall mortality was 12.6％ (12/95).The initial and stimulated plasma cortisol levels in three groups were (37.17 ± 47.35 ) μg/dL,(31.52±52.78) μg/dL,(28.61 ±17.45) μg/dL,vs.(50.26±48.21) μg/dL,(58.56±73.21)μg/dL, (42.41 ± 13.56) μg/dL,respectively.There were no significantly differences between above groups ( P ＞ 0.05 ).The incidence of critical illness-related corticosteroid insufficiency (CIRCI) in this study was 55.8％.The incidences of CIRCI were 60％,53.3％,and 53.3％ in severe sepsis,other critical illness and major surgery illness,respectively ( P ＞ 0.05 ).The morbidity of CIRCI and normal response group were 7.5％ and 19％ (P ＞0.05).The levels of T0 and T1 were related to the PCIS (P ＜0.05). Conclusions CIRCI is often seen in children with critical illness. And a low-dose ACTH stimulation test can be used to evaluate the adrenal function in critical illness.However,there is no significant correlation between CIRCI and mortality of critically ill children in this study.

BACKGROUND:FGF2,TGFβ/activin/nodal and IGF signal pathways are necessary for keeping functions of human embryonic stem calls,but there was no report concerning whether addition of exogenous basic fibroblast growth factor,transforming growth factor β and insulin can maintain self-renewal of human embryonic stern cells.OBJECTIVE:To establish a feeder layer-and serum-free culture system of human embryonic stem cells.DESIGN,TIME AND SETTING:The cytological in vitro study was performed at the Kunming Animal Institute of Chinese Academy of Sciences from September 2007 to February 2009.MATERIALS:Pregnancy 12.5 or 13.5-day ICR strain mica (clean grade) were provided by the Animal Center of Kunming Medical College.Human embryonic stem cell line BG02 was purchased from Bresagen,USA.METHODS:BG02 cells were digested,centrifuged,resuspended in feeder layer-free medium,and then incubated for 5-7 days.Differentiated human embryonic stem cells were removed.Dispase was added for digestion.Samples were cut into blocks,centrifuged,resuspended,and then incubated at 1:3 in a 4-well plate coated with laminin in feeder layer-free and serum-free medium,supplemented with 80% DMEM/F12,20% KSR,2 mmol/L glutamine,1% non-essential amino acid,0.1 mmol/L β-mercaptoethanol,insulin-transferrin-selenium (ITS) (×1),10~6 U/L penicillin,100 mg/L streptomycin,4 μg/L basic fibroblast growth factor (bFGF) and 0.12 μg/L transforming growth factor-β1 (TGF-β1).ICR fetus mica were sterilely obtained to culture mouse embryonic flbroblasts by tissue pancreatin digestion method.These cells were incubated in a 6-well plate coated with 0.1% gelatin.Human embryonic stem cell line BG02 cultured on mouse embryonic fibroblasts feeder layers was transferred to laminin-coated plates in serum-free medium containing bFGF,TGFβ1 and ITS.MAIN OUTCOME MEASURES:The morphology of BG02 cells in feeder layer-and serum-free condition was observed.The specific molecular markers of human embryonic stem cells were determined by immunohistochemical staining.The karyotype and differentiation ability in vitro of BG02 cells were analyzed.The differences in the proliferation and the differentiated rate of BG02 clumps in feeder layer-and serum-free condition or mouse embryonic fibroblast feeder layer condition were compared.RESULTS:BG02 calls had been continuously cultured for at least 20 passages in feeder layer-and serum-free culture condition.BG02 clones in this culture system had typical human embryonic stem cell morphology.BG02 cells all expressed SSEA-4,SSEA-3,TRA-1-60,TRA-1-81,Oct-4,but did not express SSEA-1.After 20 days of culture,BG02 cells had the capacity to differentiate into derivatives of embryonic endoderm,mesoderm,and ectoderm.Differentiated cells could express alpha-fetoprotein,nestin,α-actin.At passage 20,call karyotype was normal (46XY).The growth of BG02 cells cultured in feeder layer-and serum-free condition was more slowly compared with mouse embryonic fibroblast feeder,and doubling time was significantly prolonged (P ＜ 0.05).Differentiation rate of the colonies was significantly increased (P ＜ 0.05).CONCLUSION:A feeder layer-and serum-free condition for culture of BG02 cells has been established.The addition of bFGF,TGFβ1 and ITS can maintain the self-renewal of BG02 cells.

To analyze complications of hyperbar ic treatment and the management of these complications． Methods: There are 129 cases treated with huperbaria, 125 were severe head injury, 2 were brain infarction, one was carbon monoxide toxication and an other was anesthesia accident． These complications were analyzed． Results: There were 7 of 129 cases suffered with headache and vertigo, one of them was dead． Conclusion: Severe h ead injury patients treated with hyperbaria must be careful, cease the huperbaric treatmen t immediately whenever patients feel discomfort．