An analysis of the results of examination of diagnostics teaching in the middle of the semester of 2008 grade is made to discuss the pnoblems existing in teaching and learning so as to improve the teaching quality.

Objective To investigate the effect of ulinastatin on postoperative cardiac troponin I ( cTnI) in patients underwent carotid endarterectomy ( CEA) under general anesthesia. Methods Forty patients with severe symptomatic carotid artery stenosis underwent unilateral CEA under general anesthesia from January 2011 to March 2012 were divided into either a ulinastatin group or a control group according to a random number table ( n=20 in each group) . Patients in the ulinastatin group received 500 000 U of ulinastatin via veins before induction of anesthesia. The patients in the control group were given the same amount of isotonic saline. The serum concentrations of cardiac troponin I ( cTnI ) were detected before surgery and at day 1,2,and 3 after procedure. Myocardial injury was defined as the cTnI peak concentration>0. 04μg/L . Results The levels of serum cTnI before procedure and at day 1,2,and 3 after procedure in the ulinastatin group were median (M) 0. 00 (0. 00-0. 03) μg/L,0. 07 (0. 00-1. 45) μg/L,0. 01 (0. 00-1. 21)μg/L,and 0. 05 (0. 00-0. 89)μg/L,respectively;those in the control group were 0. 00 (0. 00-0. 01)μg/L,0. 00 (0. 00-1. 42)μg/L,0. 00 (0. 00-1. 39)μg/L,and 0. 00 (0. 00-1. 24)μg/L, respectively. At day 1 after procedure,6 patients ( 30%) in the control group and 11 ( 55%) in the ulinastatin group occurred myocardial injury. There was no significant difference between the two groups (P<0. 05). In all the patients with the increased cTnI levels,the peak cTnI occurred at the first day after procedure,however,they did not reach the level ( >1. 5μg/L) of indicating patients occurring myocardial infarction. Conclusion Ulinastatin may not decrease the postoperative serum cTnI levels in CEA patients under general anesthesia. For whether to the CEA patients have myocardial protective effect,more samples are needed to be confirmed.

ve To explore the mutagenicity of selenium and lead, the antagonistic effects of selenium on lead. Methods The ICR mice were orally perfused with sodium selenite (Na2SeO3) at different concentrations of 2.5,5.0 and 10 mg/kg and lead acetate [Pb(Ac)2] at different concentrations of 5,10 and 25 mg/kg jointly and con-tinuously for 3 days, and then the numbers of bone marrow polychromative erythrocytes were counted. Results The frequencies of micronucleus of mice only exposed to 10 mg/kg Na2SeO3, 10, 25 mg/kg Pb(Ac)2 respectively showed higher levels compared with those of control (P

Objective To observe the effect of clapping acupoint on hyperosteogeny of lumbar vertebra. Methods Ninety-eight cases were randomly divided into 65 cases treated by clapping Ashi point in treatment group and 33cases treated by simple acupuncture in control group.Results Among 65 cases in treatment group, 52 cases were cured and 13 cases were not cured; of 33 cases in control group, 19 cases were cured and 14 cases were not cured, and there had significant difference in cure rate between the two groups, x2 =5.51, P ＜0.05. Conclusion Treatment of hyperosteogeny by clapping acupoint was better than simple acupuncture therapy.

Objective To investigate the treatment of combined subclavian artery and brachial plexus injury. Methods Since 1994, we have treated 5 cases of combined subclavian artery and brachial plexus injury. 2 of them were cut wound, 1 gun shot wound, and 2 blunt trauma. 2 cases had combined aneurysm and 1 had combined aneurysm plus A V fistula. According to the sites of subclavian artery injury, vein graft( 1 case) , suture repair( 1 cases) and ligation (1 case) were performed. The 2 cases of blunt trauma underwent only neurolysis because of masses of hematoma and tissue adhesion. Results The 3 cases of open injury who had underwent early repair of artery and nerve had various degrees of recovery of nerve functions and experienced no pain in the injured extremities. As for the 2 cases of blunt trauma, 1 got only pain relief and 1 had no recovery. Conclusion Dysfunction due to hematoma or progressive pseudoaneurysm compression on the brachial plexus can be relieved and patients can get maximal rehabilitation if hematoma or aneurysm is managed in time and the brachial plexus nerve is decompressed early.

Objective To investigate the biomechanical properties of the posterior tibial anatomic plate. Methods A total of 25 fresh frozen adult tibial top and matching femur specimens were randomly divided into four groups. One specimen was used as normal control ( N group), and the remaining 24specimens were with Schatzker Ⅵ tibial plateau fracture and accompanied by rear split and backward fracture displacement. The lateral margin of the tibia was fixed with a L-type plate, and the medial margin was fixed with the same plate after remodeling. The 24 specimens were divided into three groups, eight specimens per group. The posterior margin of the tibia was fixed by posterior tibial anatomic plate ( Group A), T-type plate ( Group B) or straight reconstruction plate ( Group C). The strength, stiffness, torsional biomechanics and failure load performance of the plates in each group were evaluated. Results The strength and stiffness of test groups was superior to that of Group N ( P ＞ 0.05 ), and the torsional biomechanics of test groups was close to that of Group N ( P ＞ 0.05 ). The posterior tibial anatomic plate was superior to T-type plate and straight reconstruction plate in aspects of strength, stiffness, torsional biomechanics and failure load performance ( P ＜ 0.05 ). Conclusions Posterior tibial anatomic plate has excellent biomechanical properties, and it is superior to other materials in treating posterior tibial plateau fracture and restoring the stability of the knee.

Objective To explore the influence of type 2 diabetes mellitus combined with subclinical hypothyroidism on diabetic vascular complications.Methods One hundred and two patients with type 2 diabetes mellitus were selected.The serum free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH),anti-thyroid peroxidase antibody (TPO-Ab),thyroglobulin antibody (TG-Ab) levels were measured by chemiluminescence method.The patients were divided into type 2 diabctes mellitus combined with subclinical hypothyroidism group (47 cases) and type 2 diabetes mellitus with normal thyroid function group (55 cases) according to the thyroid function.The glycated hemoglobin (HbA1c),total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),triacylglycerol (TG),high-density lipoprotein cholesterol (HDL-C),urea nitrogen,creatinine and albumin levels were measured.The estimated glomerular filtration rate (eGFR) was calculated according to the formula of modification of diet in renal disease (MDRD).The presence of diabetic retinopathy was examined by fundus examination,and the presence of lower limb artery lesions was measured by vascular ultrasound.All indicators were compared between 2 groups.Results There were no statistical differences in age,disease course,HbA1c,body mass index (BMI),TC,TG,HDL-C,LDL-C,incidence of lower limb artery lesions and incidence of diabetic retinopathy between 2 groups (P＞ 0.05).TheeGRF in type 2 diabetes mellitus combined with subclinical hypothyroidism group was significantly lower than that in type 2 diabetes mellitus with normal thyroid function group:(83.74 ± 21.55) ml/(min· 1.73 m2) vs.(115.02 ± 12.29) ml/(min· 1.73 m2),and there was statistical difference (t =4.274,P ＜ 0.01).The incidence of diabetic nephropathy in type 2 diabetes mellitus combined with subclinical hypothyroidism group was significanlty higher than that in type 2 diabetes mellitus with normal thyroid function group:48.9％ (23/47) vs.23.6％(13/55),and there was statistical difference (x2 =7.103,P＜ 0.01).Logistic regression analysis showed that subclinical hypothyroidism was a risk factor for diabetic nephropathy (OR =0.524,95％ CI 0.12-0.93,P ＜ 0.05),but it was not the risk factor for diabetic retinopathy (OR =0.618,95％ CI0.19-2.16,P =0.475) and lower limb artery lesions (OR =0.485,95％ CI 0.32-2.13,P =0.689).Conclusion Subclinical hypothyroidism in patients with type 2 diabetes mellitus has no obvious effect on lower limb arterial complications and diabetic retinopathy,but may increase the risk of diabetic nephropathy.

OBJECTIVE: To observe the effect of perioperative administration of rhubarb on the acute inflammatory response in patients with gastric cancer. METHODS: In this prospective, single-blinded, controlled clinical trial, thirty-one patients with gastric cancer operatively treated were randomly divided into two groups, with 14 patients in control group and 17 in study group. Patients in both groups were given an isocaloric and isonitrogenous enteral diet. The enteral diet was started 36 hours after operation, and continued for 6 days. Patients in the study group were fed with rhubarb before operation, and at 1 day and 2 days after operation. Indexes of acute inflammatory response such as serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha), and indexes of nutritional status such as serum albumin (ALB), prealbumin (PA) and transferrin (TRF) were measured before operation, and at 1 day, 3 and 7 days after operation. RESULTS: Patients in both groups had acute inflammatory response, and the indexes of nutritional status decreased after operation.IL-6, CRP and TNF-alpha tested at 3 and 7 days after operation were lower in the study group as compared with those in the control group, and the recovery time of gastrointestinal motility such as borborygmus, gas elimination and defecation was shorter in the study group as compared with that in the control group. The indexes of nutritional status showed no significant differences between two groups after operation. CONCLUSION: Rhubarb can positively modulate the acute inflammatory response, promote the recovery of postoperative gastrointestinal motility, and benefit enteral nutrition support in patients who have undergone major operations for gastric cancer.

Objective To investigate the application of prenatal ultrasonograpy in diagnosis of fetal heart disease during the medium-term and terminal pregnancy,and to avoid misdiagnosis.Methods The prenatal ultrasonographic screening was conducted in 7020 pregnant women with medium-term and terminal pregnancy.All confirmed and suspicious cases of fetal heart disease were observed by echocardiography once 4 weeks until postnatal sixth month to 1 year while normal cases was traced at the intervals of 8 weeks.All the cases were confirmed by autopsy or surgery while part of them were confirmed by postnatal angiocardiography before surgery.The reasons of misdiagnosis were analyzed.Results In fifty-three cases of fetal cardiovascular abnormality,43 cases were found,2 cases were misdiagnosis while 8 cases were missed diagnosis.2 cases of misdiagnosis included 1 case of pulmonary valve stenosis and 1 case of tetralogy of Fallot.8 cases of miss diagnosis included 2 cases of inferior vena cava in ectopic drainage and 6 cases of ventricular septal defect (defect diameter ＜ 5 mm).The accuracy rate of diagnosis of fetal heart disease was 81.1 ％ by echocardiography.Conclusions Using high frequency probe,image zoom,enhancing the detection of vein-atrium connection and the structure of right ventricular outflow with pulmonary artery are important factors to avoid missed diagnosis and incomplete diagnosis.

To modify uricase with PEG reagent in order to decrease uricase immunogenieity and increase its stability.Methods:The branched PEG of 40 kD was chosen to modify native uricase.The properties of the mod-ified uricase including the stabilities to protease,pH and temperature,in vivo half-life time,as well as the immu-nogenicity were evaluated.The pharmacokinetic profiles of the midofied uricase were studied in mice.Results:It is demonstrated that the conjugation of PEG to lysine residues of Candida utilis uricase resulted in higher tryp-sin resistance.reduced immune response.and prolonged in vivo half-life.PEG modified uricase retained 80% of the enzymatic activity of native uricase.In addition,it was found that half-life in serum of the intravenously injec-ted PEGylated uriease of up to 696 min was longer that that of native uficase of 45 min.Higher plasma drug con-centrations were also reached with dosing of the PEGylated uricase to mice.Furthermore,the binding affinity Was shown to be reduced for the PEG-uricase using ELISA assay.and it was one-eishth that of native uricase.Final-ly,it Was indicated that the PEG uficase induced a delayed immunoresponse in mice following repeated adminis-trations.Conclusion:These findings demonstrate that this chemically modified form of uricase may serve as a potentially effective drug to treat gout patients.