0.01).Conclusion The change of thresholds mainly happened in the first working year.As working time increased,the incidence of ears without any response to the maximum output and the thresholds from 18 to 20 kHz were changed more significantly after 4 years working time.The examination of hearing at 10～20 kHz was required for new noise exposure workers and during the first working year,which helped to find the possible susceptibility of subject to noise damage.

Objective To analyze the possible effects of mitochondrial DNA mutation on noise-induced hearing loss.Methods 265 young workers with noise exposure were examined.The average pure tone thresholds at 500,1 000,and 2 000 Hz for 25 voluntary persons were noise-induced hearing loss by nature and selected as the study group.27 voluntary persons with no speech frequency hearing loss were chosen as the control group.DNA was extracted from peripheral blood leukocytes.Polymerase chain reaction(PCR) was used to detect the mtDNA4977 deletion in both groups.Results The detection rate of mtDNA4977 deletion in the study group was 20%(5/25) and it was 0(0/27) for the control group.Conclusion MtDNA4977 deletion in the study group was significantly higher than that of the control group,indicating that mtDNA4977 deletion may play an important role in the development of noise-induced hearing loss.

Purpose To explore the pathological feature of urinary exfoliated cell examination and influence factors by retrospectively comparing the coincidence of diagnosis between urinary exfoliated cell examination and histopathologic results of cystoscopic biopsy. Methods 735 patients underwent both urinary exfoliated cell examination and histopathologic biopsy of cystoscope evaluation from No-vember 2010 to July 2014 in Peking University Shougang Hospital were enrolled in this study. The urinary exfoliated cells were treated with Pap staining, while the histopathologic biopsy were dealt with HE staining. All cases were divided into three groups according to the diagnosis of urinary exfoliated cell examination:negative group ( no cancer or atypical cell detected) , suspicious group ( atypical cell detected) and positive group ( cancer cell detected) . These above diagnoses were confirmed with the histopathologic biopsy. ROC curve analysis, Cochran-Armitage trend test and logistic regression analysis were performed to evaluate the sensitivity and the specificity of urinary exfoliated cell examination as well as the relationship between diagnoses with age and sex. Results The age range of 735 patients (551 male and 184 female) was 28 ~91 years and the median age was 69 years. There were 187 patients in the positive group, including 184 malignant and 3 false-positive cases. The suspicious group, including 186 cases, consisted of 67 malignant, 119 benign reactive changes. Of all 362 cases in the negative group, malignant tumor was detected in 90 cases. For histologic diagnosis, the AUC of ROC(95%CI)was 0. 800 (0. 767~0. 834), displaying significant difference as compared to the histological pathological diagnostic results(P<0. 001). As the cyto-histologic diagnostic level elevated from negative, suspicious to positive, the results of Co-chran-Armitage trend test showed significant differences(Z=15. 83, P<0. 001). If standardized with the histopathologic biopsy re-sults, the AUC (area under curve) of urinary exfoliated cell examination was 0. 800 (0. 767~0. 834) in ROC curve analysis was sig-nificantly larger (P<0. 001). Furthermore, we also found in Logistic regression that the incidence of cancer was 1. 04 (1. 03~1. 05) times higher if aged one year older ( P<0. 001 ) , while there was no significant relationship between the incidence and the sex ( P=0. 655). Conclusions The coincidence rate of urinary exfoliated cell examination increases with the malignant degree. A positive cor-relation is detected between age and the incidence of malignant tumor. Detailed clinical material can markedly improve the sensitivity and accuracy of cyto-histologic diagnosis.

OBJECTIVE:To improve the electronic prescription prior-review mode and increase the rate of qualified prescrip-tions. METHODS:The electronic prescription prior-review mode of our hospital was established by setting up outpatient and emer-gency electronic prescription review team,review evidence and enforcement measures. Aimed at these problems as low review effi-ciency at initial stage,non-unified standards and untimely feedback,quality control circle and internet tools WeChat were used to improve the mode and evaluate its effects. RESULTS:The electronic prescription prior-review mode of our hospital was improved by optimizing system settings,unifying review standard,one-to-one feedback and communication with WeChat public platform, etc. Average time of prescription prior-review had reduced from 50 s to 30.58 s;the rate of qualified prescriptions had increased from 86.77% to 95.30%;prescription review efficiency and the rate of qualified prescriptions had been improved significantly. CONCLUSIONS:The implementation and continuous improvement of electronic prescription prior-review mode can reduce the rate of unqualified prescriptions and promote rational drug use in outpatient and emergency department.

Adenoma ; pathology ; Colonic Neoplasms ; pathology ; Humans ; Intestinal Mucosa ; pathology

To assess the relationship between pronuclear scoring and day-3 embryo quality and pregnancy outcome and to determine the clinical value of pronuclear stage scoring system in human in vitro fertilization-embryo transfer (IVF-ET) program, a pronuclear scoring system was used to score zygotes 16-20 h after insemination during conventional IVF or intracytoplasmic sperm injection (ICSI). The embryos were classified into groups Z1, Z2, Z3 and Z4. Comparisons were made of the rates of arrested embryos and excellent embryos on day 3. Comparisons of pregnancy outcome were made only in those patients in whom cohorts of similarly Z-scored embryos were transferred. The results showed that there were less arrested embryos and more excellent embryos on day 3 in groups Z1 and Z2 than those in group Z3 and Z4. More embryos arrested and less excellent embryos developed in group Z4 than group Z3. The clinical pregnancy rates resulting from the transfer of single pronuclear score homologous embryo types were similar among groups Z1, Z2 and Z3. Implantation rates of group Z1 were higher (P<0.05) than that of group Z3. These findings suggests that pronuclear scoring can predict developmental ability on day 3 and implantation potential. A evaluation that combines the Z-score and day 3 embryo morphology is useful in the determination of the most viable embryos and the number of embryos for transfer.
Cell Nucleus/*metabolism ; Embryo Implantation ; Embryo Transfer/*methods ; Fertilization in Vitro ; Infertility/therapy ; Models, Biological ; Oocytes/metabolism ; Ovary/*metabolism ; Pregnancy Outcome ; Spermatozoa/metabolism

Background Continuous interscalene nerve block (CISB) is considered to be the most effective method for postoperative analgesia after shoulder surgery with prolonged severe pain.This study was performed to evaluate the minimum effective background infusion rate and the effective background infusion rate of ropivacaine 0.2％ for CISB after arthroscopic rotator cuff repair surgery in 95％ of patients.Methods Patients scheduled for arthroscopic rotator cuff repair surgery under general anesthesia at Peking University Third Hospital were prospectively enrolled from December 2011 to May 2012.Preoperatively,an interscalene catheter (ISC) was placed under the guidance of ultrasound and nerve stimulation in each patient.Consecutively,30 patients with successful nerve block were included.A continuous infusion of ropivacaine 0.2％ with a 5 ml patient-controlled bolus available hourly was started at postoperative anesthesia care unit (PACU) after completion of surgery.The initial background infusion rate was 6 ml/h,which was subsequently varied for each consecutive patient according to the analgesic effects of the previous one.The minimum effective background rate was determined using the Dixon and Massey up-and-down method.The effective background rate in 95％ of patients was calculated using isotonic analysis.Results The minimum effective background rate based on the Dixon and Massey up-and-down method was 2.8 ml/h (95％ CI,2.3-3.3 ml/h).The effective background rate in 95％ of patients calculated with the isotonic regression analysis was 4.4 ml/h (95％ CI,3.8-6.5 ml/h).Conclusion The effective background rate for patient-controlled interscalene brachial plexus analgesia after shoulder surgery in 50％ and 95％ of the patients was 2.8 and 4.4 ml/h,respectively.

To report a case of imported furuncular cutaneous myiasis,and to analyze the sequence of the mitochondrial cytochrome C oxidase subunit Ⅰ (CO Ⅰ) gene of the pathogenic Cordylobia anthropophaga.A 33-year-old female patient had a travel history to Ghana and Cameroon in Africa 1 month prior to the presentation.No anti-mosquito measures were taken during her stay,and she hung up the laundries outside to dry for several times.Skin examination showed furuncular protuberances with diameters of 1-2 cm on the inner side of the left upper arm as well as on the outer side of the left chest,which were bright red and hard on palpation with irregular borders and a small hole on their central surface.Morphological identification revealed that the larva squeezed from the lesion was suspected as myiasis.After PCR amplification of the CO Ⅰ gene of the larva,an about 650-bp PCR product was acquired.Sequencing and BLAST analysis showed that this product was most closely related to the CO Ⅰ gene (GenBank accession number:FR719158.1) of Cordylobia anthropophaga isolated in Cameroon in 2010 with the sequence similarity being 99.84％,and they were grouped together on the phylogenetic tree.According to the clinical features and travel history of the patient and the sequencing results of the pathogenic Cordylobia anthropophaga,this case was confirmed as imported furuncular cutaneous myiasis caused by Cordylobia anthropophaga.

Objective To provide a suggestion for physicians participating clinical research of how to write a clinical trial protocol correctly and standardly in the course of clinical trial design.Methods By exploring clinical trial protocols,we analyzed their common problems in the methodological details and the reporting standards with respect to typical cases.Results The common problems in the clinical trial protocols are:lack of clear outline when selecting the research subject;incorrect selection of research type;lack of comprehensiveness and accuracy of PICO elements;inappropriate application of methodologies in randomization and blinding;absence of statistical analysis plan;incorrect calculation of sample size;non-standard format of the protocol etc.Conclusions Many clinicans do not have enough understanding of the key points in designing the clinical trial and writing the protocol.However,the quality of the clinical trial protocol determines success or failure of the whole study.Therefore,carefully handling the technical details of PICO elements,methodology and statistics application,and writing the protocol in accordance with the CONSORT (Consolidated Standards of Reporring Trials) 2010 and SPIRIT (Standard Protocol Items:Recommendations for Interventional Trials)2013 Statements,are the key points that each clinical researcher should pay attention to.

This study evaluated the standardized ultrasound operation skill video courseware recording and online teaching of undergraduate clinical internship course in the direction of medical imaging ultrasound technology in West China Clinical Medical College of Sichuan University. Through the systematic teaching plan preparation of ultrasound skill operation teaching video, script writing, post production, recording and implementation of teaching, the results showed that 116 students (81.69%) thought knowledge points of skill operation video course were reasonably divided, 128 ones (90.14%) thought the explanation was clear, 118 ones (83.10%) thought the video duration was appropriate, 121 ones (85.21%) thought the degree of difficulty was moderate, 119 ones (83.09%) thought the ultrasonic image was consistent with the anatomical image, and 124 ones (87.32%) thought it was helpful to improve the level of clinical operation skills. Standardized ultrasound skill operation video online teaching has the advantages of no time and place restrictions and good repeatability, which can exercise students' self-study ability, improve their learning enthusiasm, help students master operation skills more comprehensively, and is of great significance to the implementation and promotion of ultrasound clinical skill training video online teaching.