Objective To investigate the clinical features of stroke in young adults with infective endocarditis (IE).Methods This is a retrospective analysis of clinical data of young patients (aged between 18 and 44 years) diagnosed with IE in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2003 to March 2013.Results Three hundred IE patients (209 male and 91 female) were enrolled with mean age of (31.8 ± 7.8) years old.Fourteen of them were prosthetic valve endocarditis.All of the cases were found vegetations.The vegetations were mainly distributed in the mitral valve and/or aortic valve (262/300 patients).Congenital heart disease and rheumatic valvular disease were most frequently background diseases.Thirty-five cases (11.7％) were complicated with stroke.Among them,21 cases were with cerebral infarction (including 7 subjects with hemorrhagic transformation),9 cases with cerebral hemorrhage,3 cases with subarachnoid hemorrhage,and 2 with reasons unknown.Within the 21 cerebral infarction cases,the infarction sites were mainly distributed in internal carotid artery system with 5 cases involving bilateral internal carotid artery systems and 2 vertebro-basilar artery systems.As to the cerebral hemorrhage,lobar were the bleeding sites in all cases,and mainly distributed in internal carotid artery system.The proportions of left-sided endocarditis and rheumatic valvular disease were significantly higher in patients with stroke than those without [100.0％ (35/35) vs 86.4％ (229/265),P =0.02;22.8％ (8/35) vs 6.4％ (17/265),P =0.001,respectively].Regression analysis showed that the OR of the rheumatic valvular disease for stroke in young IE patients was 4.950 (95％ CI 1.626-15.072),and the OR of stroke for death was 8.387 (95％ CI 1.997-35.225),respectively.Conclusions Stroke is common in young patients with IE.Cerebral infarction often involves multiple vascular systems,and is prone to hemorrhagic transformation.Intracerebral hemorrhage often occurs in lobar.Rheumatic valvular disease might be a risk factor for stroke in young patients with IE,which is an independent risk factor for death of these patients.

Equity of the essential medicine system involves social justice,being important in health services availability equity.The essential medicine system,in practice in China,has to a certain extent improved the equity of health service availability,yet found with poor equity in the process due to differences in insurance,regional diversity,pricing of essential medicine,and poor implementation of the system at primary medical institutions.Such equity needs to be further improved in the future in such aspects,consistence of different insurance reimbursement percentages,further support to underdeveloped areas,encouragement of market competition,and better compliance of primary medical institutions in implementing the system.

Objective To summarize the characteristics of neurological symptoms in patients with aortic dissection.Methods The clinical data including symptoms,signs,and imaging of 865 consecutive patients with aortic dissection were analyzed retrospectively.Results Neurological symptoms occurred in 225 cases (26.0％) with aortic dissection.The most common symptom was dizziness (56 cases,6.5％),followed by syncope (49,5.7％),single lower limb sensory disturbances(47,5.4％),single lower extremity weakness(27,3.1％),coma (22,2.5％),paraplegia (19,2.2％),headache (13,1.5％)and hemiplegia (9,1.0％).The first manifestation of five cases was the neurological symptoms,including syncope (2),dizziness(1)and headache (2).Patients with type A aortic dissection were more vulnerable to the neurological symptoms than those with type B aortic dissection (34.6％ vs 14.7％),and the symptoms with significantly higher occurrence were syncope,coma,hemiplegia,paraplegia and lower limb sensory disturbances.Conclusion Neurological symptoms are common in patients with aortic dissection,especially in those with type A aortic dissection.

Objective To analyze causes for complications after proximal femoral intramedullary nail treating unstable femoral intertrochanteric fractures in the elderly.Methods A total of 172 cases of unstable intertrochanteric fractures treated with proximal femoral intramedullary nail from December 2001 to May 2007 were reviewed upon postoperative complications to find out the causes for complications and discuss countermeasures.Results Of all, 149 cases were followed up for 6-42 months(mean 18. 5 months), which showed excellence rate of 89. 0% in aspect of functional recovery of the hip. Postoper-ative systemic complications occurred in 26 cases and local complications in 21.Condusions Proxi-real femoral intramedullary nail can be used in most elderly patients with unstable intertrochanteric frac-tures. A thorough evaluation of physiological function, treatment of preoperative comorbidities and aug-mentation of surgical technique are prerequisites for operation safety and decrease of complications.

Based on the research of risk assessment of medical equipment safety and operation to formulate evaluation criteria and methods of how to use the practical management work. Objective to evaluate the practical method is to use and the risk of adverse events of medical equipment in operation risk in order to find the risk, control risk, ensure safety in time, so that Improve the level of risk management of medical equipment.
Equipment Safety ; Humans ; Risk Assessment ; Risk Management

Clustered regulatory interspaced short palindromic repeats (CRISPR) found in bacteria and archaea genome that contains multiple short repeats loci, provides acquired immunity against invading foreign DNA via RNA-guided DNA cleavage. The first inkling of this hot new genetic engineering tool turned up in 1987, when a research team observed an oddly repetitive sequence at one end of a bacterial gene. Now three types of CRISPR/Cas system have been identified: types I, II and III. In the type II CRISPR/Cas9 system, short segments of foreign DNA termed 'spacers' are integrated within the CRISPR genomic loci, transcribed and processed into short CRISPR RNA (crRNA). These crRNAs anneal to trans-activating crRNA (tracrRNA) and direct sequence-specific cleavage in that a double-strand break (DSB) is generated by Cas proteins. Based on these findings, various genetic methods, including gene targeting (Gene disruption), gene insertion, gene correction etc., are being designed to manipulate the genomes of different species at specific loci. Compared with zinc finger nucleases (ZFN) and transcription activator-like effector nucleases (TALEN), CRISPR/Cas9 is simpler with higher specificity and less toxicity. This review summarizes recent progress, discusses the prospects of CRISPR/Cas9 system, with an emphasis on its structure, principle, applications and potential challenges, and provides a useful reference for researchers who are interested in this new technique.
Bacteria ; CRISPR-Cas Systems ; DNA ; Genetic Engineering ; Genomics ; RNA

Objective To evaluate the effect of comprehensive intervention measures on reducing the bacterial colonization of the intensive care unit (ICU)bedside notebook computer keyboards and mice.Methods According to bacterial contamination of ICU bedside notebook computer keyboards and mice,comprehensive intervention meas-ures were taken (including wiping computer keyboards and mice with alcohol twice a day,intensifying hand hy-giene,and monitoring hand-washing compliance),specimens of keyboards and mice were taken,bacterial detection results were analyzed.Results Before intervention,bacterial counts of keyboards and mice of 8 specimens were all>5 CFU/cm2 ,detection rate of Bacillus subtilis was 64.71 %,Micrococcus ,coagulase negative staphylococcus, Acinetobacter baumannii ,and Klebsiella pneumoniae were 17.65%-58.82%,Escherichia coli and Acinetobacter calcoaceticus were both 5.88%.After comprehensive intervention measures were taken,bacterial counts of only two specimens of keyboards and mice were >5 CFU/cm2 ,the qualified rate of monitoring result after intervention was significantly higher than before intervention (88.24% vs 52.94%;χ2 =5.10,P <0.05).Conclusion Compre-hensive intervention measures can significantly reduce bacterial count on ICU bedside notebook computer keyboards and mice,and decrease the occurrence of healthcare-associated infection.

TheInner Canon of Huangdi originated from moral.In the aspect of knowledge, it advocatesthat the doctor should not teach bandits, selecting and teaching, upright character, open but not narrow;In terms of career pursuit, it advocatesthat the doctor should adopt and frequently ask, work hard and to be a good doctor;In the as-pect of ethics, it advocatesthatdoctor should cherish life, be meticulous;In terms of professional belief, it advocat-esthatdoctor should learn from the ancient, firmly believe that science, opposing superstition; TheInner Canon of Huangdi advocate consummate medical skillthe noble medical ethics, with far-reaching influence, become the ori-gin of Chinese medical ethics thought germinal, future generations of today′s high-quality professional talents of Chinese medicine has a very important guiding significance.

Objective To explore the significance of thyroid function determination at the first and second trimesters of pregnan‐cy .Methods Electrochemiluminescence immunoassay was used to detect the levels of TSH ,FT3 and FT4 in first trimester women (T1 group) ,second trimester women (T2 group) and non‐pregnant women (control group) ,respectively .And the results were an‐alyzed .Results There were significant difference in the levels of TSH ,FT3 and FT4 between T1 group and control group (P<0 .05) .The total prevalence rate of thyroid diseases in pregnant women was 28 .85% ,which was significantly higher than that in control group(15 .00% ) ,P<0 .05 .Hypothyroidism and subclinical hypothyroidism were the main forms of thyroid dysfunction in pregnant women .Conclusion The determination of thyroid function at the first and second trimesters of pregnancy will benefit pre‐natal and post‐natal care .

Objective:To study the mesiodistal teeth size and the relationship between upper and lower teeth dimension of normal occlusion from Han Chinese in Xi'an. Methods: 52 males and 55 females with normal occlusion were selected. The mesiodistal width of each tooth was measured using a vernier gauge caliper. Statistical analysis was performed. Results: For the 107 cases with normal occlusion, the mean and standard deviation of the teeth size were calculated. There were significant differences between males and females in maxillary incisors, canines, first molar and mandibular canines, premolars. The normal range was obtained for the anterior and overall tooth size ratio(anterior ratio:78.32?3.01 overall ratio:91.10?2.27); and the regression equation that was used to quantify the tooth size discrepancies was expressed according to the significant correlation between the upper and lower tooth (r anterior=0.754, rtotal=0.851). Conclusion: There is a relationship between upper and lower teeth dimension. Sex difference should be considered when tooth size was used in clinic.