The characteristic of atypical atrial flutter episodes on electrocardiogram is different from the typical atrial flutter.Due to the poor diagnosis awareness about atypical atrial flutter,which is easily misdiagnosed as other arrhythmia,for example sinus arrhythmia,atrial fibrillation,and Ⅲ °atrioventricular block.Here we reported a case of atypical atrial flutter in child.In addition to the characteristics of typical atrial flutter,such as regular and more fixed atrial rhythm,fluctuated ventricular rate,faster atrial rate than the ventricular rate,the patient was found equipotential line,slow atrial rate,and uprighted F wave on the inferior wall leads and V 1 lead of electrocardiogram,which were different from typical atrial flutter.

目的观察大剂量纳洛酮对急性脑卒中患者的疗效。方法144例急性脑卒中患者随机分为常规治疗组(对照组)和纳洛酮治疗组,前者给予脱水、降颅压、保护脑细胞等常规治疗,后者在常规治疗的基础上加用纳洛酮(2.0mg/d,静滴),比较两组患者的清醒时间及疗效。结果纳洛酮组患者清醒时间早于对照组(P<0.01),疗效明显优于对照组(P<0.01)。结论纳洛酮对急性脑卒中疗效确切,可使患者清醒时间提前。

Objective To understand the knowledge, attitude, practice (KAP) status and relative demand to combined oral contraceptives (COCs) in medical staffs of obstetric and gynecological department in Tianjin, providing reference basis for the effective intervention measures. Methods By using random, stratified and clustered sampling approach, we selected 382 medical staffs of obstetric and gynecological department in Tianjin. A self-administered Questionnaire on COCs KAP was employed to survey the general characteristics, awareness of COCs knowledge, attitudes to COCs, service capabilities of contraceptive counseling, prescribing behavior and request of continuing education. Results The respondents showed de?fects in COCs indications, non-contraceptive benefits, relationship with cancer and birth defects. The average knowledge score was higher in doctors than that of nurses. The higher the titles and qualifications, the higher the knowledge score. A to?tal of 90.11%of respondents believed that strengthening the contraceptive guidance can help to reduce pregnancy. Strength?ening the interpretation of misunderstanding (81.04%) and enhancing the treatment and follow-up of adverse reactions (62.09%) can help to reduce stop taking. Only 25.82%of respondents could provide detailed COCs relative consulting servic?es;42.96%of obstetricians and gynecologists refused prescribing COCs for women over the age of 40 for the purpose of con?traception. A total of 93.13%medical personnel showed demand on relative training. Conclusion It’s necessary to perform continuing education to medical staffs via different intervention, so as to improve their cognitive level to COCs, ameliorate COCs relative attitudes and behavior, and help them providing better service to women of childbearing age.

Objective: To explore the effects of ramipril, trimetazidine and the combination of ramipril and trimetazidine on renal cell apoptosis index (AI) and cytochrome C (Cyt-C) expression in experimental rats with chronic heart failure (CHF).
Methods: CHF model was established by partially banding of abdominal aorta superior to renal artery in experimental rats. A total of 50 male Wistar rats were randomly divided into 5 groups: Sham operation group, Model group, Ramipril group, Trimetazidine group and Combination (ramipril and trimetazidine) group.n=10 in each group. Renal tubular cell AI was examined by TUNEL method, mRNA and protein expressions of Cyt-C were detected by RT-PCR and Western Blot analysis in each group respectively.
Results: Compared with Sham operation group, Model group had increased AI of renal tubular cells, increased mRNA and protein expressions of Cyt-C,P<0.01. Compared with Model group, Ramipril group, Trimetazidine group and Combination group showed decreased AI of renal tubular cells (20.02 ± 1.14) %, (20.10 ± 1.2) % and (14.27 ± 1.40) % vs ( 40.82 ± 1.31) %; reduced Cyt-C mRNA expression (0.54 ± 0.06), ( 0.56 ± 0.05) and (0.44 ± 0.04) vs (0.89 ± 0.03); reduced Cyt-C protein expression (1.50 ± 0.11), (1.58 ± 0.12) and (0.75 ± 0.06) vs (2.53 ± 0.10); the most reduction was obtain by Combination group, allP<0.01.
Conclusion: Ramipril and trimetazidine can inhibit renal cell apoptosis and effectively improve the renal function in CHF rats. Combined medication is better than either of them alone.

This paper was to explore the relationship between plasma omentin and obesity and insulin resistance in patients of polycystic ovary syndrome(PCOS).The results showed that there were statistically significant differences in serum omentin levels among control group,PCOS-normal weight group,and PCOS-overweight group [(115.29 ± 33.92),(111.12 ± 34.50),and (42.85 ± 19.39) pg/ml,P＜ 0.05].Omentin were negatively correlated with homeostasis model assessment for insulin resistance(HOMA-IR) and body mass index(BMI).In the multiple stepwise regression analysis,only omentin was negatively correlated with BMI.Omentin may be involved in the development of PCOS by affecting obesity.

Objective To better understand the knowledge, attitudes, practice (KAP) status and relative demand to post abortion family planning service (PAFPS) in medical staffs of obstetrics and gynecology department in Tianjin. Meth?ods By using random, stratified and clustered sampling approach, 290 obstetrics and gynecology personnels in Tianjin were selected. A Self-Administered Questionnaire on PAFPS KAP was employed to survey the general characteristics, aware?ness of PAFPS knowledge, attitudes to PAFPS and the occurrence of unintended pregnancy themselves, and service capabili?ties of PAFPS and request of continuing education. Results The respondents showed defects in PAFPS forms, follow-up ar?rangements and contraceptive method after abortion. The average knowledge score was higher in tertiary medical institution than that of secondary medical institutions. The score was higher in clinical doctors than that of nurses, and the higher the ti?tle, the higher the score. The 95.34%of respondents believed that it was necessary to develop PAFPS widely. But 93.55%of respondents thought that it can be difficult to carry out PAFPS as being required because of unclear service process, shortage of funds, human resource constraints, inadequate facilities and weak sense of services. The 53.36%of respondents, who had sexual life history, occurred unintended pregnancy themselves. The current defects of PAFPS were no standardized service processes, missing of medium-term and long-term follow-up, missing of collective consulting, providing contraceptives not timely and hadn′t pay attention to contraceptive advice. There were 90.68%medical personnels showed demand on relative training. Conclusion It′s necessary to perform continuing education about PAFPS to obstetrics and gynecology personnels via different intervention. At the same time, we should increase investment and make the service processes perfectly, so as to improve the level of PAFPS in obstetrics and gynecology medical staffs.

Objective:To explore the correlation between serum level of matrix metalloproteinase 2 (MMP-2)and se-verity of coronary artery disease in aged patients with acute coronary syndrome (ACS)complicated hyperhomocys-teinemia (HHCY).Methods:According to serum level of homocysteine (Hcy),a total of 105 aged ACS patients were selected and divided into ACS+HHCY group (n=56)and pure ACS patients (n=49),another 65 healthy in-dividuals were enrolled as healthy control group.The severity of coronary artery disease was showed by Gensini score ;enzyme linked immunosorbent assay was used to measure serum MMP-2 level in each group.Results:Com-pared with healthy control group,there were significant rise in MMP-2 level [(140.8±50.1)ng/ml vs.(442.5± 98.2)ng/ml,(297.9±86.3)ng/ml]in ACS+HHCY group and pure ACS group,P <0.01. Gensini score in ACS+HHCY group was significantly higher than that of pure ACS group [(1.9±0.2)scores vs.(1.1±0.3)scores,P<0.01].Pearson correlation analysis indicated that Gensini score was positively correlated with MMP-2 level in ACS+HHCY group (r =0.424,P <0.05).Conclusion:The serum MMP-2 level is significantly positively correla-ted with severity of coronary artery disease in aged patients with ACS complicated HHCY.

Objective To compare the effects of propofol versus isoflurane on brainstem auditory evoked potential (BAEP) and explore the difference in the effects of the two anesthetics on the brainstem. Methods Thirty ASA Ⅰ or Ⅱ patients aged 20-50 yr without heating disorder, scheduled for elective surgery performed under general anesthesia were randomly divided into 2 groups (n = 15 each): propofol group (group P) and isoflurane group (group Ⅰ). SpO2, PET CO2, BIS and BAEP were continuously monitored before and during anesthesia. Anesthesia was induced by propofol administered by TCI or isoflurane inhalation. Tracheal intubation was facilitated with vecuronium. The patients were mechanically ventilated. PET CO2 was maintained at 35-40 mm Hg and SpO2 at 98%-100%. After intubation BIS was maintained at 70 and 50 respectively ,the latency of the wave Ⅰ , Ⅱ and Ⅴ and the inter-peak latency (IPL) betwecn wave Ⅰ -Ⅲ , Ⅲ-Ⅴ and Ⅰ -Ⅴ were recorded.Results In group P there was no significant difference in the latency of the wave Ⅰ , Ⅲ and Ⅴ and the IPL between wave Ⅰ - Ⅲ , Ⅲ - Ⅴ and Ⅰ - Ⅴ between the baseline before anesthesia and at BIS 70 and 50. In group Ⅰ the latency of wave Ⅲ and Ⅴ and the IPL between wave Ⅰ - Ⅲ , Ⅲ - Ⅴ and Ⅰ - Ⅴ were significantly longer at BIS 50 than the baseline before anesthesia, while the latency of wave Ⅲ and Ⅴ and the IPL between wave Ⅰ -Ⅲ andⅠ -Ⅴ at BIS 50 were significantly longer than that at BIS 70. At BIS 50 the latency of wave Ⅴ and the IPL between wave Ⅰ -Ⅴ were significantly longer in group Ⅰ than in group P. Conclusion At comparable depth of anesthesia propofol exerts less depressant effects on BAEP indicating less depression of brainstem.

Objective To determine the optimal dose of dexmedetomidine for intravenous analgesia after open radical resection of intestinal neoplasms when mixed with flurbiprofen axetil and butorphanol.Methods A total of 120 patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 20-60 yr,weighing 45-80 kg,undergoing elective open radical resection of intestinal neoplasms,were divided into 4 groups (n =30 each) using a random number table:control group (group C)and different doses of dexmedetomidine groups (group DEX1,group DEX2,group DEX3).Group C received flurbiprofen axetil 2 mg/kg and butorphanol 0.05 mg/kg for intravenous analgesia.In DEX1,DEX2 and DEX3 groups,dexmedetomidine 0.3 μg/kg was intravenously infused starting from 30 min before the end of surgery,and the analgesia solution contained dexmedetomidine 1,2 and 3 μg/kg,respectively,which was mixed with flurbiprofen axetil 2 mg/kg and butorphanol 0.05 mg/kg in 100 ml of 0.9％ normal saline,and the mixture was infused at a rate of 2 ml/h.Butorphanol 0.5 mg was intravenously injected as a rescue analgesic,postoperative pain was assessed using the visual analog scale at coughing,and visual analog scale score was maintained ＜4.The requirement for rescue analgesics was recorded within 48 h after operation.The occurrence of postoperative adverse reactions such as nausea and vomiting,respiratory depression,somnolence,bradycardia,hypotension and over-sedation,patient's satisfaction with analgesia and length of postoperative hospital stay were recorded.Results Compared with group C,the rate of rescue analgesia after operation was significantly decreased,and the degree of satisfaction with analgesia was increased in DEX2 and DEX3 groups,and the incidence of postoperative somnolence was significantly increased in group DEX3 (P＜0.05).No other adverse effects were found in DEX1,DEX2 and DEX3 groups.Conclusion When mixed with flurbiprofen axetil and butorphanol,the optimal dose of dexmedetomidine for intravenous analgesia after open radical resection of intestinal neoplasms is 2 μg/kg.

Cryptosporidium spp.are protozoan parasites that infect the epithelial cells of the gstrointestinal tract of hosts.In humans,cryptosporidiosis is usually a self-limiting infection in immunocompetent individuals,but severe diarrhea and dissemination to extra-intestinal sites can occur in high-risk individuals,such as the very young,the elderly,immunedeficiency individuals,particularly in HIV-positive patients.So far,molecular epidemiological data have confirmed the presence of 30 species and over 40 genotypes with genus Cryptosporidium,with 21 species and genotypes being found in humans.The majority of human cryptosporidiosis cases are responsible for C.hominis and C.parvum.Human cases caused by C.meleagridis,C.ubiquitum,C.felis and C.canis have been increasing.Besides that,with data accumulation of molecular epidemiology of human cryptosporidiosis,some more Cryptosporidium species and genotypes were newly identified in humans.This paper mainly reviews epidemiology status of these new emerging Cryptosporidium species and genotypes in humans.