ObjectiveTo report the treatment of the first imported Middle East respiratory syndrome (MERS) in China, and to investigate the clinical features and treatment of the patient.Methods On May 28th, 2015, the first patient of imported MERS to China was admitted to Department of Critical Care Medicine of Huizhou Municipal Central Hospital. The clinical features and treatments of this patient were analyzed.Results①A 43 years old male of South Korean nationality was admitted with the complaint of back ache for 7 days and fever 2 days with the following characteristics: back ache 7 days ago, without fever or cough or expectoration. He had been suspected to suffer from infection of Middle East respiratory syndrome coronavirus (MERS-CoV) by the Disease Control Department of South Korea, but no specific treatment was given. He had fever for 2 days with maximum body temperature of 39.7℃. He had no chills, cough, expectoration, short of breath, abdominal pain, diarrhea, frequent micturition, or urgency or pain of urination, and no sore throat. The patient had a history of exposure to MERS-CoV patient. He was considered to be a patient of the second batch of South Korean epidemic.② Auxiliary examination: 3 copies of throat swab specimens for virus nucleic acid detection were performed by the Disease Prevention Control Center of China (China CDC), and they were positive on May 29th, 2015, and also for serum, sputum and stool. Based on the results of whole genome sequence analysis, the virus strains were implicated to be derived from Riyahh and Jeddah regions of Saudi Arabia. On admission, the patient's blood test showed that the white blood cell count was low (3.22×109/L), the proportion of the neutrophils was high (0.73), and that of the platelet was low (81×109/L). On admission, the patient's chest X-ray showed that a small amount of infiltration in the lung.③ Treatment: a high-flow nasal cannula (HFNC) with oxygen concentration of 0.50-0.80 was given, with a flow rate was set at 60 L/min if tolerated. It was changed to a low flow oxygen inhalation nasal cannula on the 20th day, and oxygen treatment was stopped on the 24th day. Ribavirin 2.0 g was given as the first dose, and was switched to 600 mg every 8 h (q8h), and it was reduced to 600 mg q12h after 10 days, and extenuated since the 13th day. Ceftriaxone was added on the 4th day with 2.0 g a day , and it was changed to meropenem 2.0 g, q8h on the 7th day for 2 weeks. Gamma globulin was given for 7 days (20 g, qd). Thymosin-α1 was given on the 8th day for 2 weeks. Interferon was given once a week, but only one dose was used. At the same time symptomatic treatment such as methimazole and liver protection therapy were given.④ Patient began to cough at admission, and it disappeared on the 18th day. There was no sputum at first, then a small amount of sputum with a little blood appeared after the admission. Then there was cough without sputum. Mild shortness of breath and diarrhea after exertion were noticed. He had no chest pain, difficulty in breathing or other symptoms. There was dullness on percussion in both sides of chest, and it disappeared gradually. Fine moist rales were detectable in scapular area and interscapular area on the 5th day, and they disappeared after 3 days. Breath sounds on both sides was weak, and it became more obvious in the right lung after 5 days, and returned to normal after 18 days. He had a sustaining fever for 1 week with the maximum temperature of 39.5℃, then the body temperature returned to normal. The viral nucleic acid test as performed by the Center for Disease Control of Guangdong (CDC, Guangdong) showed that the pharyngeal swab cultured turned negative on the 3rd day, that of serum specimens turned negative on the 8th day, that of stool specimen after 2 weeks, and it was persistently positive for sputum culture until 5 days before discharge. The oxygenation index gradually increased, and it was over 300 mmHg (1 mmHg = 0.133 kPa) after 15 days. Pleural effusion was rapidly increased during the first week as shown by chest X-ray films, and it began to be absorbed gradually in the second week, but it was not completely absorbed until discharge.Conclusions The disease course of the reported patient was short, with an acute onset, with fever as the chief complaint, but there were no respiratory symptoms, though there were high fever, cough, shortness of breath, diarrhea and other clinical symptoms after admission. Virus in sputum disappeared after treatment, but pleural effusion was not completely absorbed. Negative test for virus in sputum was late, indicating that clearance of virus was slow from the lungs. It is the first case of MERS in China, therefore, the clinical manifestations and the treatment strategy need to be further explored.

The present study summarized the results of QTc. in 54 subjects, 8 of which were patients with coronary heart disease and 46 normal.The exercise tests were carried out on an ergometric bicycle with a submaximal exercise andQT interval was corrected for heart rate according to Bazett's formula (QTc=QT/R-R-). All patients were subjects to resting ECG before the test, during excerxise, and immediately fol owing the end of the exercise. Electrode jelly contact disk electrodes were used for the CMS. Results showed that coronary heart disease patients all had a prolongation of the QTc following exercise with variations of 0.06+0.02s The QTc of all normal subjects, except one, Showed a shortening or no ohange.Our study thus reveaded that the finding of QTc variations with exercise all of value for the diagnosis of coronary heart disease.

Objective To study the relationship between Miao drum and hypertension in the Miao women of the countryside . Methods A survey of blood pressure measurement and questionnaire investigation were conducted among 1 069 Miao females ,by using cluster multistage sampling in countryside of Hunan ,Hubei ,Chongqing ,and Guizhou .A case-control analysis for 226 cases with new diagnosed hypertension and 226 controls with normal blood pressure .Results Among 1 069 sample ,the standardized prevalence rate of hypertemion was 24 .5% .There were significant differences in the prevalence rates of hypertension between the different age groups(χ2 =174 .46 ,P<0 .01) .The single factor logistic regression analysis(OR=0 .383 ,95% CI:0 .262-0 .558)and multi-conditional logistic regression analysis(OR=0 .379 ,95% CI:0 .255-0 .565)showed that Miao drum was probably protective factor for hypertension in the Miao women of the countryside .Conclusion Miao drum was probably protective factor for hyperten-sion in the Miao women of the countryside in Hunan ,Hubei ,Chongqing ,and Guizhou .Long-term adherence to participate in miao drum exercise may prevent high blood pressure .

ObjectiveTo investigate the value of high flow nasal cannula (HFNC) in treating a patient with Middle East respiratory syndrome (MERS).Methods The effect of HFNC applied in the first imported MERS patient with complication of acute respiratory distress syndrome (ARDS) to China was observed. The patient was admitted to Department of Critical Care Medicine of Huizhou Municipal Central Hospital on May 28th, 2015, and the changes in various clinical parameters and their significance were analyzed.Results A 43-year old male was admitted to negative pressure isolation intensive care unit with the complaint of back ache for 7 days and fever for 2 days. Vital signs and saturation of pulse oximetry (SpO2) were monitored continuously. After admission, ribavirin was given orally for 12 days andα-interferon was administered once on the first day. However, after 2-week anti-virus therapy, the virus test was positive. Ceftriaxone was given on the 4th day, and it was changed to meropenem on the 3rd day for 2 weeks. Immune globulin was given on the 4th day and continued for 1 week. Thymosin-α1 was given on the 8th day and continued for 2 weeks. According to his past history, methimazole had been given continuously for hyperthyroidism and other symptomatic treatment. Oxygen inhalation (6 L/min) was given immediately after admission, but the condition of patient worsened with the following symptoms: frequent cough and obvious shortness of breath. Moreover pleural effusion gradually increased as shown by X-ray. SpO2 was maintained only at about 0.91. Oxygenation index (PaO2/FiO2) decreased to 144 mmHg (1 mmHg = 0.133 kPa). So oxygen inhalation via nasal cannula was changed to HFNC after 2 days. The parameters were set as follows: temperature 34℃, flow rate 20 L/min, fraction of inspired oxygen (FiO2) 0.50. The flow was raised 5 L/min every 10 minutes, and was continued till the target value reached 60 L/min. FiO2 was modified according to SpO2 and PaO2/FiO2. FiO2 was set to 0.80 on the 5th day of admission. Shortness of breath of the patient was improved on the 7th day of admission after the application of HFNC. FiO2 was then decreased to 0.58 as PaO2/FiO2 rose. Then the flow was gradually decreased to 30 L/min. HFNC was reduced with continuous improvement in PaO2/FiO2. HFNC was changed to low flow oxygen inhalation nasal cannula (2-3 L/min) on the 20th day. Oxygen treatment was stopped on the 23rd day, and SpO2 was maintained at 0.98-1.00. Activities on bed were gradually increased. The patient was cured and discharged from hospital on June 26th. The patient showed good tolerance and high compliance during the treatment with HFNC. No nosocomial spread occurred during the treatment.ConclusionsHFNC could improve respiratory function of the patient with MERS obviously, and complication ARDS was prevented. HFNC might reduce nosocomial spread.

Objective To investigate the influencing factors of the results of liver function tests.Methods The clinical data of 357 cases of outpatient examination for liver function were retrospectively analyzed.According to the results of the examination,they were divided into two groups,178 cases in the control group (normal liver func-tion);179 cases in observation group (abnormal liver function).The influencing factors of liver function test results were analyzed.Results In the observation group,the gender,marital status,age,culture degree,BMI,sleep time com-pared with the control group,the differences in marital status were statistically significant(all P <0.05),the liver function abnormal rate of male was 58.66%,which was higher than 41.34% of female(χ2 =14.139,P <0.05).The detection rate of abnormal liver function of the people with age over 40 years old was 55.87%,which was higher than 44.13% of the people with age under 40 years old (χ2 =8.495,P <0.05).The detection rate of abnormal liver func-tion of the crowd in high school level and above was 45.25%,which was lower than 54.75% of the crowd under the high school(χ2 =5.685,P <0.05).The detection rate of abnormal liver function of the crowd with BMI≥24kg/m2 was 62.57%,which was higher than 37.43% of the crowd with BMI <24kg/m2 (χ2 =5.731,P <0.05).The detec-tion rate of abnormal liver function of the crowd with sleep time≥8h was 53.07%,which was lower than 46.93% of the crowd with sleep time <8h (χ2 =18.011,P <0.05).There was no significant difference in the detection rate of abnormal liver function of marriage between the two group(P >0.05).Conclusion The gender,age,culture degree, BMI,sleep time have impact on the liver function test,and the bad eating and living habits should be reasonable corrected,the physical exercise should be strengthened,and the quality of life should be constantly improved.

Objective To observe the protein expression of grow thassociated protein-43 (GAP-43) in mid-brain ventral tegmental area in morphine withdrawal rats at different time, and to evaluate the effect of GAP-43 on morphine withdrawal memory. Methods Rat models of morphine dependent 1 week, 2 weeks and 4 weeks were established by morphine hydrochloride intraperitoneal injection with increasing doses to establish natural withdrawal. The protein expression of GAP-43 in midbrain ventral tegmental area was observed by im munohistochemical staining and the results were analyzed by Im age-Pro Plus 5.1 im-age analysis system . Results With prolongation of dependent time, the expression of GAP-43 was de-creased then increased in midbrain ventral tegmental area . Conclusion GAP-43 could play arole in morphine withdrawal memory in midbrain ventral tegmental area.

Objective To train medical students' competence of independent thinking and problem solving and to improve the quality of teaching.MethodsThe case-based PBL teaching model was introduced to teaching practice for 25 undergraduates majoring in medical laboratory.The teaching process included pre-class mobilization,question,self-study,discussion and summary.Effectiveness of teaching was evaluated with questionnaire.Results For these medical students,the enthusiasm of learning ( 83.3％ ),ability of self-learning and information seeking ( 79.2％ ),ability of discussing and problem solving ( 79.2％ ),ability of scientific thinking and clinical reasoning ( 79.2％ ) were significantly improved.Teaching satisfaction rate of case-based PBL teaching model was up to 95.8％.ConclusionBetter results of teaching were achieved and the case-based PBL teaching model is worth spreading.

Objective To investigate the influence of murine cytomegalovirus ( MCMV) infection on the expression of downstream differentiation related target genes of Wnt signaling pathway in neural stem cells (NSCs) in vitro and explore the molecular mechanism of fetal encephalodysplasia caused by CMV infection. Methods NSCs were separated from fetal BALB/c mouse and cultured in vitro. The NSCs infected by MCMV at a MOI (multiplicity of infection) of 5, 1 and 0.1, respectively, were cultured in differentiation medium. The dynamic expression of the downstream differentiation related target genes ( c-myc, cyclinD1, ngn-1 and ngn-2) of Wnt signal pathway in NSCs were measured by Western blot. Real-time RT-PCR was employed to measure the expression levels of the key differentiation genes ngn-1 in Wnt signal pathway of NSCs post infection. Results The protein levels of c-myc in the infected groups were significantly lower than that in the normal control at 0.5-5 d (P＜0.05) ; At 0. 5 d and 1 d post-infection (p. i. ) , the protein levels of cyclinDl in the infected groups were lower than that in the normal control (P＜0.05). At 2 d and 3 d p. i. , the cyclinD1 expression in the infected groups was higher than that in the control group (P ＜ 0. 05). However, at 4 d and 5 d p. i. , the cyclinD1 levels in the group of the MOI of 5 were lower than in other three groups (F＜0.05). The expression of ngn-1 protein in the infected groups was reduced importantly compared with normal control at 1 -5 d p. i. ( P ＜ 0.05 ). The expression of ngn-1 mRNA in the infected groups was lower than that in the control group at all time points (P ＜ 0. 05 ). The expression of ngn-2 protein decreased at first and then increased, which was opposite to the normal control. The peak of ngn-2 expression in groups of the MOT of 0.1 and 1 occurred later and were significantly lower than that in the normal control (P ＜0. 05). No distinct peak was seen in the group of the MOI of 5. At 1 d p. i. , the expression of ngn-2 of all infected groups was significantly lower than that in the normal control ( P ＜ 0. 05 ). At 2 d p. i. , the expression of in the group of the MOI of 5 was still lower (P ＜ 0.05). While at 3 d, 4 d and 5 d p. i. , the protein levels in all infected groups were higher than that in the normal control (P ＜ 0. 05). The protein expression of these genes increased following the increase of MOI. Conclusion MCMV inhibited the protein expression of c-myc and ngn-1 in differentiated NSCs, repressed the mRNA expression of ngn-1 and caused the perturbed expression of cyclinDl and ngn-2 in a MOI-dependent manner. These data suggest that inhibition of or interference with the protein expression of downstream differentiation related target genes of Wnt signaling pathway in NSCs by MCMV may be one of the important mechanisms, by which proliferation and differentiation of NSCs are inhibited and thus fetal brain is impaired after MCMV infection.

Objective To investigate whether thalidomide inhibits the over expression of type I collagen in pulmonary fibrosis rats via inhibiting the JNK signaling pathway,thereby reducing bleomycin induced pulmonary interstitial fibrosis in rats.Methods 90 healthy male SD rats were randomly divided into normal control group (group N),model group (group M),thalidomide group (group T),SP600125 group (group SP) and thalidomide+SP600125 group (group T+SP).The pulmonary fibrosis models were prepared via intratracheal injection of 5mg/kg bleomycin,and rats in groups were given corresponding drugs from the first day after preparing model.Rats were randomly sacrificed at 7,14 and 28 days after treatment.The degree of pulmonary alveolitis and fibrosis was evaluated by H&E and trichrome masson stainings.The level of hydroxyproline in the lung tissue was detected by applying alkaline hydrolysis technique,and expression levels of p-JNK and type I collagen were tested by Western bloting for protein expression and real-time polymerase chain reaction (RT-PCR) for mRNA expression.Results In group M,alveolitis was the most serious on day 7; a marked pulmonary fibrosis formed on day 28; the level of hydroxyproline also peaked on day 28,and the contents of p-JNK and type I collagen were higher than in group N(F=277.87,472.51,both P＜ 0.01).Group T,SP and T+SP showed mild alveolitis and fibrosis at all time points,and their levels of hydroxyproline,p-JNK and type I collagen were remarkably decreased as compared with group M (F=14.77,61.59,101.73,all P＜0.01;F=10.33、79.12、57.48,all P＜0.01).No significant difference in p JNK was found between group SP and group T+SP.Conclusions Thalidomide may inhibit the over expression of type I collagen in pulmonary fibrosis rats via inhibiting the JNK signaling pathway,thereby reducing bleomycin induced pulmonary interstitial fibrosis in rats.

Objective To observe the sedation and analgesia in surface anesthesia in conscious glossopha-ryngeal LMA for the clinical effect of laparoscopic hysterectomy.Methods 90 patients undergoing elective laparo-scopic total hysterectomy were randomly divided into three groups,30 cases in each group.The observation group (group A):sedation,analgesia,full surface anesthesia,control group 1 (B group)control group 2 (group C)were treated with endotracheal intubation under general anesthesia.At intubation and pull tube stage,the patients'reaction, hemodynamic changes,pneumoperitoneum 1 h blood gas and perioperative complications were observed.Results The mean arterial pressure(MAP)and heart rate(HR)of A group were (92.7 ±10.6)mmHg and (82.8 ±12.1)/min. Those of B group were (98.4 ±11.6)mmHg,(89.1 ±11.4)/min,C group were (111.2 ±12.5)mmHg,(104.1 ± 13.2)/min,those in A group and B group were better than C group(A group and C group,t =6.18,6.52,P <0.01;B group and C group,t =4.11,4.71,all P <0.01).The pulse oxygen saturation(SpO2 )and peak airway pressure (Paw)of A group were (99.6 ±0.4)and (17.3 ±2.1)mmHg,those in group B were (99.5 ±0.5)% and (17.6 ± 2.0)mmHg,group C were (99.5 ±0.5)% and (22.5 ±2.8)mmHg.The differences between A group and B group were statistically significant(compared with C group,t =14.3,8.14,all P <0.01;B group and C group,t =12.7, 7.78,all P <0.01).The incidence rates of perioperative complications and adverse reactions of A,B,C groups were 27%,33%,67%,that in C group was significantly higher than A group and B group(χ2 =9.64,6.67,all P <0.01). Conclusion The laryngeal mask airway was used for laparoscopic total hysterectomy under the condition of sedation and analgesia,and it can shorten the time of the whole body,prevent the difficulty of intubation,emergency airway and anesthesia related complications.