This report presented a case of disseminated infection with nocardia in lupus erythematosus (SLE) and reviewed the current literature. Nocardiosis was a rare, sometimes life-threatening opportunistic infection in SLE patients. The isolation and identification of pathogen was fundamental for the diagnosis of nocardiosis. Sulfonamides were traditionally the agent of choice for treatment of nocardiosis; while it must be given for several months even more than one year, particularly in patients with suppressed immune function. Issues regarding the drug resistance and the toxicity of sulfonamides in long-term therapy needed to be considered. Linezolid could be an effective agent for the treatment of nocardiosis, whether it could reduce the treatment course need to be further studied.

Scene teaching is to simulate the clinical scene in class.To cultivate the studnts’abilities of thinking,search and practice in clinical practice,the second clinical college ap-plied the problem-base learning(PBL) in surgery teaching,creating the scene with the standard-ized patients and teachers and drawing out the content from the problems.This article is to summarize the teaching practice.

Objective To observe the effect of scalp nerve block ( SNB ) with ropivacaine hydrochloride at different time points on pain management after craniotomy. Methods Ninety patients undergoing craniotomy were randomly divided into 3 groups:group A, SNB conducted before surgery;group B, SNB conducted after surgery;group C, SNB conducted both before and after surgery, with 0. 5% of ropivacaine hydrochloride in each group. All patients received the same general anesthesia and diclofenac sodium were administered rectally as rescue analgesics. Sites and duration of surgeries, end-tidal sevoflurane concentration during incision, HR and SBP levels during the course of surgery and postoperative period, the VAS scores, GCS and Ramsay scores at 0. 5, 2, 4, 6, 12, 24, 48 h postoperatively, time of the first rescue appication analgesics and total consumption of rescue analgesics, the adverse effects, awareness under anesthesia were analyzed respectively, as well as local anesthesia relevant adverse events and time of wound healing. Results The end-tidal sevoflurane concentration was significantly decreased in group B (3. 19±0. 36)% as compared with group A (1. 81±0. 24)% and C (1. 77±0. 33)% (P<0. 05);The VAS scores of group A (3. 77±2. 27, 4. 20±2. 09) at 2 and 4 h were higher than those in group B (2. 77±1. 98, 3. 20±2. 20) and C (2. 97±1. 77,2. 27±1. 93) (P<0. 05), while at other time points the differences were not significant (P>0. 05);Compared with group A (600 mg), the consumption of rescue analgesics of group B (300 mg) and C (250 mg) were statistically lower (P<0. 05);Vital signs, GCS, Ramsay scores, time of the first rescue analgesics postoperatively used, and time of wound healing among the three groups were not various significantly (P>0. 05);The relevant side effects were not different statistically, and there were no patients suffering from obvious awareness under anesthesia, pruritus, respiratory depression or local anesthesia relevant adverse effects. Conclusion SNB conducted before surgery can decrease the consumption of sevoflurane during incision, but has limited analgesic effects postoperatively. SNB conducted after surgery may provide transitional analgesia for neurosurgical patients undergoing craniotomy, while SNB conducted both before and after surgery does not show significantly longer analgesic time in postoperative pain management.