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。

BACKGROUND:The glass ionomer cement has good biological stability and can sustain the release of fluoride, which has been used as dental repair materials. But because of its low mechanical strength, the glass ionomer cement is confined to the front teeth and other parts with smal er force.
OBJECTIVE:To analyze the compressive strength, microleakage and other physical performances of Fuji IX glass ionomer cement after the addition of 8%modified nano-hydroxyapatite.
METHODS:(1) Universal testing machine was applied to detect the compressive strength of Fuji IX glass ionomer cement, Fuji IX glass ionomer cement added with 8%modified nano-hydroxyapatite, and super glass ionomer to fil the stainless steel cylinder. (2) Fuji IX glass ionomer cement, Fuji IX glass ionomer cement with 8%modified nano-hydroxyapatite and super glass ionomer were used to fil the tooth cavity;then, the microleakage was detected. (3) Fuji IX glass ionomer cement, Fuji IX glass ionomer cement added with 8%modified nano-hydroxyapatite, and super glass ionomer were used to fil stainless steel rectangular specimens. Then, universal material testing machine was applied to detect the bending strength value.
RESULTS AND CONCLUSION:The compressive strength, microleakage, and bending strength of specimens fil ed with Fuji IX glass ionomer cement the addition of 8%modified nano-hydroxyapatite were better than the other two groups, and Fuji IX glass ionomer cement was superior to the super glass ionomer in the compressive strength, microleakage and bending strength of fil ed specimens. It is shown that Fuji IX glass ionomer cement after addition of 8%improved nano-hydroxyapatite can improve the compressive strength and microleakage.

Objective To observe the pain behavioral performance of rats that different sensory nerve fibers were transected,and examine the expression of brain-derived neurotrophic factor(BDNF) in these models.Methods Twenty-four rats were divided into three groups according to random number table method:SUR group,GS group and SHAM group, which received sural nerve transection, gastrocnemius-soleus nerve transection or sham operation respectively.There were 8 rats in every group.The expression of BDNF in the lumbar 5 DRG and spinal dorsal horn were detected,and the types of damaged cells were also observed.Results In GS group, 50% paw-withdrawal thresholds were significantly decreased on the ipsilateral hind paw compared with baseline and with those in SHAM group,and the paw-withdrawal durations in response to the thermal stimulus increased significantly (P＜0.01 ＝.In contrast, no change was found in SUR group(P＞0.05 ).The expression of BDNF in the lumbar 5 DRG ( (37.87 ± 4.23 ) % ) and spinal dorsal horn ( (21.9 ± 3.1 ) % ) was significantly higher in GS group than in SHAM group( ( 17.31 ± 2.12 ) %, ( 12.6 ± 1.3 ) % ), and no significant difference was found between SUR and SHAM groups(P＞0.05 ).FG opposite cells which also expressed BDNF in GS group were more than those in SUR group ( (47.7 ± 1.8) % and (26.7 ± 2.3 ) % ) (P ＜ 0.01 ＝.The percentage in N200 and FG double positive cells to N200 positive cells in GS group was significantly increased in GS group than those in SUR group ( (47.7 ±1.8 ) %, (26.7 ± 2.3 ) % ) (P ＜ 0.01 ＝.Conclusion The data suggest that injury of the sensory nerve innervating skin does not produce hyperalgesia, but injury of the sensory nerve innervating muscle does.Different kinds of neuron were damaged and the differences of BDNF expression is essential for this difference.

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 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 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.

Objective? To?investigate?the?antimicrobial?resistance?and?beta-lactamase?production?profile?in?the?gram-negative?bacilli?isolated from urinary tract infections in the Second People's Hospital of Gansu Province during the period from 2014 to 2015. The results will provided to clinicians for better antimicrobial treatment. Methods? The?bacterial?isolates?were?identified?via?conventional?laboratory?tests?or?automatic?identification?systems?and?subjected?to?antimicrobial?susceptibility?testing?by?using?Kirby-Bauer?method.?Three-dimensional test was used to detect the enzymes conferring antimicrobial resistance. The susceptibility testing results were interpreted according to the CLSI breakpoints issued in 2012. Results A total of 987 gram-negative strains were isolated from urinary tract infections, including E. coli (51.6%, 509/987), Enterobacter (11.0%, 109/987), P. aeruginosa (10.5%, 104/987), K. pneumoniae (9.9%, 98/987), P. mirabilis (9.3%, 92/987), C. freundii (4.7%, 46/987), and other gram-negative bacilli (2.9%, 29/987). ESBLs were produced?in?494?(50.1?%)?of?the?987?strains?of?gram?negative?bacilli.?Preliminary?screening?test?identified?243?AmpC?beta-lactamases?producing?strains,?and?135?(13.7?%)?strains?were?confirmed?by?three-dimensional?test.?Both?ESBLs?and?Amps?beta-lactamases?were?produced in 16 (1.6%) strains. The prevalence of ESBLs-producing strains was 79.6% in E. coli, 34.6% in P. aeruginosa and 37.8% in K. pneumoniae?isolates.?Metallo-β-lactamase?or?KPC?beta-lactamase?was?not?identified.?The?antimicrobial?resistance?was?serious?in?gram-negative bacilli, which showed relatively low resistance rate to imipenem (0.02%), amikacin (10.6%), cefoperazone-sulbactam (23.8 %), and nitrofurantoin (25.2 %). E. coli prevalence of levofloxacin,?ciprofloxacin?resistance?respectively?were?89.8%,?91.8%. The gram-negative bacilli from urinary tract also showed various levels of resistance to cephalosporins. Conclusions The gram-negative bacilli isolated from urinary tract infections are mainly E. coli. The gram-negative isolates show high level antimicrobial resistance and high prevalence of beta-lactamases. Imipenem, amikacin, cefoperazone-sulbactam, and nitrofurantoin still have very high antibacterial activity against these isolates in vitro.

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.