The histological and biomechanical aspects of the osteogenesis in metaphysioto-my lengthening of the tibia were observed in 45 immature rabbits,which were divided into 3 groups as follows:(1)Group A:After metaphysiotomy,the periosteum and endosteum of the transected boneends were well-preserved.(2)Group B:After metaphysiotomy,the periosteum about 0.7 cm in width on the 2 bone ends was circumcised.Then the 2 bone ends were aligned without disturbing the endosteum.(3)Group C:After metaphysiotomy,a part of the bone marrow and endosteum in the 2 bone ends wwere removed.Then the 2 bone edns were well aligned and the periosteum was sutured up.In all the experimental animals,the tibia was lengthened by 1mm/day.It was found that in Group A,the formation and remodelling of the new bone in the lengthened area occurred quite early after metaphysiotomy and the new bone was good in its biomechanical quality;in Group B,the formation of new bone was retarded and the biomechanical quality of the new bone was not satisfactory;and in Group C,new bone formation was sluggish in the early stage after metaphysiotomy but it wwas active in the late stage,and the neww bone formed was similar to that of Group A in its histological morphology and biomechanical quality.The periosteum could grow synchronously with the slow traction without any tearing.In addition,osteotomy and mechanical traction could stimulate and accelerate periosteal osteogenesis.It is believed that an intact periosteal cuff is of significance in the osteogenesis of the lengthened area since it serves as a restriction framework for the adherent growing of the connection between the new bones of the 2 bone ends and periosteal osteogenesis plays a more important role than endosteal osteogenesis in the bony healing of the lengthened area.

Objective To develop a set of indicators for measuring the performance of China's Healthcare Improvement Initiative.Methods Such methods as literature review,expert consultation and onsite preliminary experiment were used,to study and demonstrate the indicators,the evaluation framework,the weight,evaluation indicators,and evaluation standards.Results The final evaluation indicators for medical institutions included nine class-1 indicators,29 class-2 indicators,and 56 class-3 indicators;those for healthcare administrations included six class-1 indicators,nine class-2 indicators,and 13 class-3 indicators.Conclusions The system takes into full account the special nature of healthcare,and mission of the Initiative,as the well as the quality,safety,efficiency and equity of healthcare,to make the system scientific and operational.

OBJECTIVE:To evaluate therapeutic efficacy of tolvaptan combined with levosimendan in the treatment of severe congestive heart failure(CHF). METHODS:100 severe CHF patients were randomly divided into basic treatment group,tolvaptan group,levosimendan group and drug combination group,with 25 cases in each group. All groups were given Digitalis,ACEI,spi-rolactone,furosemidum and other comprehensive treatment;tolvaptan group was additionally given tolvaptan(15 mg/time,qd);le-vosimendan group given levosimendan [0.1 μg/(kg·min)] for consecutive 24 h;drug combination given tolvaptan (15 mg/time, qd)and levosimendan [0.1 μg/(kg·min)] for consecutive 24 h. Blood pressure,heart rate,dyspnea,the improvement of systemic clinical symptoms and 24 h urine volume were observed in 4 groups before and 7 d after treatment. The venous blood samples were collected to determine the change of Na+,K+,renal function,BNP and other related indicators;the changes of LVEDd,LVESd, LVEF,CI and other indicators were determined by UCG. RESULTS:7 days after administration,compared with basic treatment group,the blood pressure,heart rate,BNP,LVEDd and LVESd of tolvaptan group,levosimendan group and drug combination group decreased significantly,while dyspnea,systemic clinical symptoms and LVEF were improved significantly,and 24 h urine volume and CI increased significantly,with statistical significance(P<0.05). The change of drug combination group was more sig-nificant,there was statistical significance,compared with tolvaptan group and levosimendan group(P<0.05). There was no signifi-cant difference in serum electrolytes and renal function. CONCLUSIONS:Tolvaptan combined with levosimendan is effective and better than drug alone in the treatment of severe CHF.

Objective To explore the effect of psychological rehabilitation on patients with limb motor dysfunction. Methods 136 cases of hospitalized patients who needed rehabilitation therapy and training were divided into observation group and control group. The control group received conventional rehabilitation, and the observation group received psychological rehabilitation (psychotherapy and medicine) in addition. Symptom Checklist-90 (SCL-90), Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI) were assessed before and 8 weeks after treatment. Results Most of the 136 patients were involved in psychological problems, including anxiety, depression, somatization,fear, hostility. There was no difference in the scores of SCL-90, FMA and MBI between 2 groups before treatment (P>0.05). After 8 weeks treatment, the scores of SCL-90 were lower, except psychotism (P>0.05), in the observation group than in the control group (P<0.05),the scores of FMA and MBI were higher in the observation group than in the control group (P<0.01). Conclusion The psychological rehabilitation plays an important role in rehabilitation of limb motor dysfunction.

Objective To explore the regularity of incidence of agonal respiration (AR) and agonal respiration frequency rate (ARFR) during untreated cardiac arrest (CA) after ventricular fibrillation (VF) in a swine model.Methods Ten healthy male domestic pigs weighing (25.0± 3.0) kg were employed in this experiment.VF was induced by intraventricular shock with alternating current without treatment for 8 minutes.The incidence of AR and ARFR per minute were recorded for 8 minutes.Statistical analysis was performed using SPSS 19.0 system software.Results AR occurred in all animals after VF induced CA within 8 minutes.There was 1 animal showed AR at the first minute with ARFR (0.2±0.1) times/min,4 animals showed AR at the second minute with ARFR (1.2 ± 1.0) times/min,7 animals showed AR at the third minute with ARFR (2.7 ± 1.4) times/min,all animals showed AR at the fourth to fifth minute with ARFR (3.7 ± 1.6) times/min and (3.2 ± 1.9) times/min,7 animals showed AR at the sixth minute with ARFR (1.3 ± 1.0) times/min,no animal showed AR at the seventh minute,and 1 animal showed AR at the eighth minute with ARFR (0.2±0.1) times/min.The first and the last AR were observed at (2.02±0.84) minutes and (5.21 ± 1.12) minutes respectively.Occurrence of AR reached its peak at the fourth to fifth minute,and it was absent at the seventh minute.ARFR after CA showed a crescendo-decrescendo pattern,which increased from (0.2±0.1) times/min to (3.7±1.6) times/min followed by a fall to (0.2±0.1) times/min.Conclusions AR is one of the symbolic signs after CA.AR occurred in all animals during untreated VF,and it reaches its peak at the fomrth to fifth minute,with a crescendo-decrescendo pattern of ARFR.Effective identification and treatment in victim with AR timely can help to improve the success rate of cardiopulmonary resuscitation and survival rate.

Objective To evaluate inhibitory effects of the Chlamydiaphage phiCPG1 capsid protein Vp1 on Chlamydia psittaci strain guinea pig inclusion conjunctivitis (GPIC) and Chlamydia trachomatis (Ct) serovar E,and to provide new ideas for the treatment of Ct infection.Methods The Chlamydiaphage phiCPG1 capsid protein Vp1 was expressed in Escherichia coli BL21 transfected with the recombinant plasmid Vp1-pET30a (+),identified by Western blot analysis and purified by using dialysis bags.Bicinchonininc acid (BCA) assay was performed to determine the concentration of Vp1 protein.GPIC and Ct serovar E strains were both classified into 4 groups to be firstly incubated with Vp1 protein (Vp1 group),Tris-glycine solution (Tris group),S protein (S group) or Dulbecco's Modified Eagle Medium (DMEM,DMEM group) at room temperature for 3 hours,then were used to infect Hela cells followed by 72-hour (GPIC) or 48-hour (Ct serovar E) culture with the presence of Vp 1 protein (Vp 1 group),Tris-glycine solution (Tris group),S protein (S group) or DMEM (DMEM group).Subsequently,immunofluorescence staining was conducted to observe and count chlamydial inclusions.Results The number of GPIC inclusions was significantly different between the 4 groups after 72-hour culture (F=476.632,P＜ 0.05),and lower in the Vp1 group (5.0 ± 1.5) than in the Tris group (24 ± 1.2,P＜ 0.05),S group (25 ± 1.7,P＜ 0.05) and DMEM group (25 ± 1.5,P＜ 0.05),but insignificantly different between the latter 3 groups (P ＞ 0.05).Compared with the DMEM group,the Vp1 group showed a significant decrease of 80.2％ ± 3.99％ and 77.2％ ± 1.79％ in the number of GPIC and Ct serovar E inclusions respectively,with no significant difference in the inhibitory effect of Vp1 on GPIC versus Ct serovar E (t =2.057,P ＞ 0.05).Conclusion The phiCPG1 capsid protein Vp1 can obviously inhibit GPIC and Ct serovar E infections to a similar degree.

Objective To explore the influence of intubation-surfactant-extubation (InSurE)therapy combined with bilevel positive airway pressure (BiPAP)in the use time of mechanical ventilation,and to clarify the value of BiPAP in the treatment of respiratory distress syndrome in the preterm infants.Methods Toral 95 preterm infants with respiratory distress syndrome were treated with InSurE therapy during January 2011 to October 2014. Among them,the preterm infants before January 2013 were selected as control group who were treated with InSurE and nasal continuous positive airway pressure (nCPAP).After January 2013, 60 preterm infants were treated with BiPAP,as BiPAP group.The rates of InSurE failure,the need for mechanical ventilation (MV)on the 7th day after InSurE failure, total non-invasive ventilation time, total mechanical ventilation time, atmospheric oxygen therapy time and incidence of clinical complications were compared between two groups.Results ① There were no significant differences in the clinical data of the preterm infants between two groups, such as gender and age.② Although there was no significant difference in the failure rate of InSurE,but the rate of repeated mechanical ventilation during 1 week in BiPAP group was lower than that in control group (P <0.01).③ The Rank sum test result showed that the total time of non invasive ventilation in BiPAP group was longer than that in control group (P <0.01).The total time of invasive mechanical ventilation and oxygen therapy in BiPAP group was lower than that in control group (P < 0.05).④ The incidence of retinopathy of prematurity (ROP)and bronchopulmonary dysplasia (BPD)in BiPAP group was lower than that in control group.Conclusion BiPAP can significantly reduce the use of invasive mechanical ventilation after the failure of InSurE,thereby decreases the oxygen toxicity and barotrauma hazards.

Objective: To determine the antibody titer in the serum of allergic rabbits after the injection of 1, 3-di-caffeoylquinic acid contained in Shuanghuanglian injection.Methods: The complete antigen was prepared by incubating the suspected small molecular hapten 1, 3-di-caffeoylquinic acid contained in Shuanghuanglian injection with the serum from the normal rabbits.The specific antibody was obtained in the immunized rabbits.The antibody titers of antiserum were measured by ELISA kits.Indirect competitive ELISA was used to determine serological specificity, and the obtained data was used to plot the inhibition curves.The content of IgE antibody in the antiserum of rabbits was detected by rabbit immunoglobulin E (IgE) ELISA kits.Results: The antibody titer (A) of 1,3-di-caffeoylquinic acid was 2 times higher than that of the negative control, which indicated its potential allergenicity.The regression equation was I=0.170 6 lg C + 0.317 5 , which was with the correlation coefficient of r=0.985 4 , the detection limit of IC 10 =57.40 μg·ml-1 and the half inhibitory concentration of IC 50 =8.732 0 mg·ml-1.Furthermore, the exogenous IgE antibody was produced in the rabbits.Conclusion: The results indicated that the hapten substance 1,3-di-caffeoylquinic acid in Shuanghuanglian injection was allergenic under the present experimental conditions.

Objective Cervical reserve cells are the maternal cells of cervical neoplasia. It's proliferation and origin were studied. Methods The pathological morphology of cervical reserve cell proliferating was observed by light microscopy in 238 cases of cervical benign diseases; Immunohistochemical technology of CD44v5 was used to inspect the expression of cervical reserve cells in 54 cases. Results and Conclusion 1.Reserve cell proliferation was common in most cases of cervical benign diseases and it was originated from stroma; 2 The proliferating reserve cells were composed of four types:large cells, small cells, clear cells and spindle cells; 3The expression of CD44v5 in reserve cells showed 100% strongly positive. The cells proliferation was common in begin diseases of cervix; Reserve cells possibly were originated from stroma.

Objective:To investigate the anticoagulant causes, hemorrhagic susceptibility factors and clinical characteristics of patients with warfarin-related major bleeding in the emergency department of a general hospital.Methods:In a registry study from January 2017 to February 2020, 114 cases of warfarin-related major bleeding patients admitted to Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University were enrolled. The descriptive methods were used to analyze anticoagulant causes, hemorrhagic susceptibility factors and clinical characteristics. Patients were divided into the international normalized ratio (INR) overrange group and the INR non-overrange group according to INR value during bleeding. The Chi-square test, Student’s t test, and Wilcoxon rank sum test were used to compare the differences between the INR overrange group and the INR non-overrange group. The Wilcoxon rank sum test and Student’s t test were used to analyze the characteristics of gastrointestinal tract bleeding and cerebral hemorrhage. Results:Warfarin-related major bleeding accounted for 0.36% (114/32 040) of first aid cases and 9.84% (114/1 158) of warfarin-taking cases, respectively. Seventy-seven cases (67.5%) of anticoagulant causes were related to atrial fibrillation (AF) and 32 cases (28.1%) were related to post-operative cardiac valve replacement. Of the bleeding susceptibility factors, HAS-BLED scored at 4.0 (3.0, 5.0), 84 cases (73.7%) had a history of drug use, 77 cases (67.5%) aged older than 65 years old, 65 cases (57.0%) had irregular INR monitoring, and 29 cases (25.4%) had recent increase in dose. Forty cases (35.1%) were gastrointestinal tract bleeding with the lowest hemoglobin (Hb) value and the highest score of HAS-BLED. Twenty-one cases (18.4%) were cerebral hemorrhage with the shortest prothrombin time (PT), the lowest INR value, the highest Hb, and the lowest score of HAS-BLED. Twelve cases (10.5%) died or gave up treatment in critical condition, including 6 cases of cerebral hemorrhage, 5 cases of gastrointestinal tract bleeding, and 1 case of hemoptysis. There were statistically significant differences in previous history of antiplatelet therapy, recent increase in dose, HAS-BLED score and bleeding site between the INR overrange group and the INR non-overrange group (all P<0.05). Conclusions:Among patients with warfarin-related major bleeding, AF and post-operative cardiac valve replacement are the main causes of warfarin anticoagulation. INR overrange is related to the previous history of antiplatelet therapy, recent increase in dose, and the high score of HAS-BLED. The gastrointestinal tract bleeding is the most common, with the lowest Hb value and the highest score of HAS-BLED. Cerebral hemorrhage is the second common, with the shortest PT, the lowest INR value, and the highest Hb. The incidence and mortality rates of warfarin-related major bleeding are relatively high.