Adult ; Aged ; Ascitic Fluid ; chemistry ; Blood Gas Analysis ; methods ; Carbon Dioxide ; analysis ; blood ; Female ; Humans ; Hydrogen-Ion Concentration ; Liver Cirrhosis ; blood ; Male ; Middle Aged ; Oxygen ; analysis ; blood

Felty syndrome is a rare disorder that involves rheumatoid arthritis,a swollen spleen,de-creased white blood cell count,and repeated infections.This article analyze the clinical characters of this disease.

Objective　To study the roles of P-selectin and nitric oxide (NO) on the etiology of pregnancy induced hypertension (PIH). Methods　The levels of plasma P-selectin and nitrite and nitrate (NO2-/NO3-) were determined in 36 patients with PIH. The data were compared with those of normal pregnant group (n=18) and healthy non-pregnant group (n=19). The levels of plasma P-selectin were measured by means of enzyme-linked immunosorbent assay (ELISA) and levels of plasma NO2-/NO3- were measured by Griess reaction after the nitrate was reduced by a Cadmium-reduction method. Results　 The results showed: （1）The level of P-selectin in the normal pregnant group (48.92±15.16) μg/L was higher than that in non-pregnant group ［(30.16±8.42) μg/L, P<0.001］. There was no significantly statistical difference in the levels of P-selectin between the normal pregnant group and the mild PIH group (P>0.05). The levels of P-selectin in the moderate and severe PIH group (70.11±17.65) μg/L were higher than those in the mild PIH group ［(47.33±17.95) μg/L, P<0.01］ and the normal pregnant group (P<0.001). （2）The concentration of NO2-/NO3- in normal pregnant group was higher than that in non-pregnant group (P<0.01). The concentration of NO2-/NO3- in PIH group were lower than was in normal pregnant group (P<0.001). The NO2-/NO3- in mild group was lower than that in normal pregnant group (P<0.001). The Plasma concentration of NO2-/NO3- in moderate and severe PIH group was lower than that of mild group (P<0.05). （3） There was a negative correlation between the plasma concentration of P-selectin and NO2-/NO3- in the PIH group. Conclusion　The changes of plasma levels of P-selectin and NO are related to the occurrence and development of PIH.

Objective To study the present situation of misdiagnosed acute pancreatitis(AP)in China and to im prove the identification of AP.Methods One hundred and forty.four documents of Chinese-language cases studies involving the misdiagnosis of AP published from 1988 to 2007 were identified by searching in the China National Knowledge Infrastructure(CNKI).Retrospective study of misdiagnosed diseases,clinical manifestations,risk fac tors and accessory examinations etc,Was made in 1098 patients with AP.Results(1)The patients related to the departments of internal medicine,surgery,obstetrics and gynecology,and pediatrics and so on.The misdiagnosed diseases were over 63 kinds.The first five places successively were:cholelithiasis combined with biliary infection (182 times),acute gastroenteritis(158 times),coronary heart disease(108 times),acute appendicitis(102 times),and intestinal obstruction(90 times).(2)Abdominal pain(878 cases)is the main manifestation in AP, and the first five regions of abdominal pain successively were:upper-middle abdomen(434 cases),whole abdomen (220 cases),right lower quadrant(79 cases),right upper quadrant(74 cases),left upper quadrant(71 cases). (3)Cholecystolithiasis(145 cases)was the first risk factor,and followed the order of fat meal(106 cases)＞chronic cholecystitis(72 eases)＞alcohol(67 times).(4)The number of cases diagnosed by operation was the most,up to 378;others successively were serum and urine amylase examinations(35 1 CtLSe8)and abdominal CT scan(135 cases),and abdominal ultrasound imaging(59 cases).Conclusions(1)The main causes of misdiag nasis were superficial understanding of predisposing condition,lack of correct analysis on clinical manifestations, and mistakes in the analysis Oil the accessory examinations.(2)Although amylase in serum or urine has limitation in diagnosis,it still Was the main method of diagnosis;and it Was necessary to be examined by abdominal CT or sur gical exploration for patients who were highly suspected as having AP but could not be diagnosed.

Objective To investigate the relationship between helicobacter pylor (Hp) and primary carcinoma of the gallbladder (PCG), providing a theoretical basis for the treatment of PCG.Methods Mucosa and bile of gallbladder samples were collected from 18 patients with PCG (PCG group), 40 patients with chronic cholecystitis or cholelithiasis (CC group), and 20 patients with no PCG and CC (control group). 16S rDNA-based polymerase chain reaction (PCR) followed by DNA sequence analysis of the obtained PCR fragments was performed. A developed search for Hp was also carried out by PCR. Five genes specific for Hp were amplified. Results In the PCG group, 81% samples of mucosa and bile were positive for Helicobacter-specific 16S rRNA gene. The positive rate in PCG group was significantly higher than those of the CC group (50%) and the control group (20%).Of the 16S rDNA sequence of Helicobacter pylori positive samples of mucosa and bile, 52% of samples were positive in cagA, 86% were positive in 26 KDa, 48% were positive in ureA separately. The vacA and rps4 genes were never detected in any of the samples of mucosa and bile. At least one gene was positive in 93% of samples of musca and bile. The sequencing showed more than 99% homology of Helicobacter 16S rRNA in PCG and Hp groups. Conclusion A higher infection rate is present in bile and gallbladder mucosa from patients with PCG. Hp in the biliary system may be one of the risk factors for occurrence of PCG.

ObjectiveTo explore the effect of CQI on the teaching of physical diagnostics.MethodsThe theory and practice of CQI are discussed in accordance with specific conditions of the teaching of physical diagnostics.ResultsThe level of the teaching of physical diagnostics can be raised by applying CQI.ConclusionThere will be broad prospects in the application of CQI to quality teaching of physical diagnostics.

Objective To investigate the clinical efficacy of laparoscopic versus open omental patch repair for perforated peptic ulcer. Methods One hundred and twenty-seven patients who underwent omental patch repair for perforated peptic ulcer were analyzed retrospectively. There were 74 cases in the laparoscopic repair group (LR group) and 53 cases in the open repair group (OR group) respectively. Operative time, intraoperative blood loss,postoperative pain at 1 d and 3 d.time to first flatus and resumption of diet, time to drainage removal,surgical site infections (wound infection and intra-abdominal abscess),systemic complications and length of postoperative hospital stay were compared. Results LR group experienced less intraoperative blood loss[(32.7 ±25.6) ml], lower postoperative pain at 3 d[(2.8 ±1.5) scores], earlier time to first flatus [ (25.8 ± 20.1) h] and resumption of diet [ (2.7 ±2.1) d ], shorter time to drainage removal [(2.0±1.5) d], less wound infection (0) and shorter hospital stay[(4.8 ±2.3) d] than those in OR group [(53.2±30.0) ml, (36.9±27.9) h, (3.7±2.0) scores, (3.6±2.3) d,(2.9±2.2) d,9.4%(5/53), (6.6±4.0) d](P< 0.01 or <0.05). There were no significant differences in operative time,postoperative pain at 1 d, incidence of intra-abdominal abscess and systemic complications between the two groups. There were no suture-site leakage, reoperation and death in two groups. Conclusions Laparoscopic omental patch repair for perforated peptic ulcer is safe and efficacious. It has significant advantages over open approach with respects of less postoperative pain,earlier return of bowel function,less wound infection and shorter hospital stay.

OBJECTIVE To establish a simple and stable animal model with abdominal infection due to drug-resistant bacteria.METHODS Forty healthy rabbit were infected by Klebsiella pneumoniae ATCC700603,and divided into three test groups:A1(bacterial dose 8?109CFU/kg),A2(bacterial dose 16?109 CFU/kg) and A3(bacterial dose 24?109 CFU/kg).Normal control group B was established at the same time.Vital signs,white blood cell count(WBC),blood and abdominal irrigating solution cultures and strain identification were observed at 12,24,48,72 and 96h after infection.Patho-samples were obtained after being executed.RESULTS The body temperature,WBC,heart rate(HR) and respiratory rate(R) in group A3 were significantly higher than groups A1 and B,after rabbits having being infected 12-24 hours.And it continued for 96 hours(P

There were some limitations existed in current teaching mode of diagnostics,including simple evaluation methods,mechanical internship for body sign,tedious internship for laboratory diagnosis and unsustainable interest-stimulating.Interest teaching was proposed in the teaching reform and some concert measures were implemented including interesting inquiry,interesting skill examination,interesting teaching of laboratory diagnostics,simulated case discussion,interesting training of centesis as well as interesting clinical involvement and interesting medical community activities.The interesting teaching contributed to the improvement of students'comprehensive analysis ability,practical ability,adaptability,humanistic quality,English communication ability and doctor-patient communication,which is of grate importance.

In order to solve the problem of poor communication, low efficiency of consultation, and even affecting self-confidence caused by unskilled skills and insufficient cooperation with patients in the real clinic, and to solve the problem during the clinical thinking training that beginners do not know how to organize effective information and complete the process of diagnosis and differential diagnosis more efficiently. By applying the artificial intelligence (AI) virtual patient (VP) system to the process of teaching diagnostic knowledge and clinical thinking training. It provides the students with the experience of simulating the diagnosis and treatment of the clinical real scene. Let the students talk with the VP system for inquiry training and then go to the clinic to give the real patients inquiry and by simulating the process of treating the real patients, let the students take the initiative to complete the collection of medical records and clinical decision-making under the simulated scene to train the clinical thinking. This can not only solve the shortcomings of the previous simulation teaching and clinical teaching, but also stimulate students' interest in learning. According to the results of the questionnaire, students have a high acceptance of VP system simulation teaching. Through the results of homework and assessment and evaluation, the teaching results are better than before, and this teaching method should be further popularized.