Objective To summarize the clinical treatment experience of blood culture-negative infective endocarditis,and to explore the surgery chance and therapeutic strategy of blood culture-negative endocarditis. Methods One hundred and sixty-six patients who were diagnosed blood culture-negative endocarditis in the Aisa Heart Hospital of Wuhan from Jul. 2008 to Dec. 2012 were recruited in the study. Broad-spectrum antibiotics including cefuroxime axetil and levofloxacin were used before the result of blood culture,and sensitive antibiotics were selected to control patient's condition when getting the result of blood culture. But broad-spectrum antibiotics were continuously used to the blood culture-negative endocarditis until stable condition. When the conditions were stable,active preparation before surgery should be carried out. Thoroughly clear the vegetation and protect the cardiorespiratory function during operating. Kata-step antibiotics were used to control patient's condition until normal temperature,as well as the number of leukocytes decreased,blood sedimentation normalized and C-reaction protein decreased. Then,the narrow-spectrum antibiotics were selected including cephalosporin until discharged from hospital,and continued treatment of antibiotics for 4 - 6 weeks. Results Five patients died after the operation,including 1 case died of low cardiac output syndrome,2 cases died of multiple organ failure,1 case died of septicemia and the 1 case died of cerebral embolism. All the other patients discharged from hospital successfully. Conclusion The patients with blood culture-negative IE should be controlled rapidly. The duration and dose of antibiotics should be enough. Active operative preparation should be taken and then surgery timely. Thus,the hospital mortality could decrease and prompt the long-term outcome.

Objective The hypoxic-ischemic(HI) cardio-cerebral damage caused by cardiac arrest in perioperative period is the main cause of acute and chronic disability in children patients.To investigate role of mitochondrial dysfunction in hypoxic-ischemic brain damage of mice.Methods The hypoxic-ischemic mice model was established by the bilateral carotid artery occlusion and hypoxia treatment.The neurobehavior of mice in HI model group,sham-operated group,and comparative group were evaluated within 48 hours after operation.After 48 hours,the mice were killed to evaluate the brain water content,mitochondria content,swelling,antioxidant capacity,and respiratory function.Results Within 0,24 hours after operation,the abnormal rate of the neurobehavior of HI model mice was 83.33％,which was significantly higher than comparative and sham-operated groups.The water content of right brain was significantly increased evidently compared to the other two groups (P ＜ 0.05).The content and swelling of mitochondria in brain were increased.The activity of superoxide dismutase (SOD),the glutathione (GSH) content,respiratory state 3 (ST3),and respiration control of rate (RCR) were significantly decreased; while the content of malondialdehyde (MDA) and ST4 were significantly increased (P ＜ 0.05).Conclusions The brain tissue showed different swelling,the mitochondrial function occurred disorder,which might play an important role in hypoxic-ischemic brain damage of mice.

OBJECTIVE：To explore th e applicatio n of team situatio nal simulation education and teaching mode in clinical pharmacy teaching. METHODS ：A total of 60 clinical pharmacy interns were selected as the research objects ，and course disease was type 2 diabetes mellitus. Thirty interns were randomly selected as control group ，using traditional teaching mode ；other 30 interns were selected as trial group ，which carried out team situational simulation education and teaching mode. The teaching effects were evaluated by using the satisfaction of interns to the two modes ，the comprehensive score of graduation examination and the self-evaluation of learning effect. RESULTS ：Compared with traditional teaching mode ，team situational simulation education and teaching mode was conducive to stimulate the learning interest of interns ，improve their interpersonal communication ability ， cultivate teamwork spirit ，improve the awareness of humanistic care ，and cultivate the professional attitude of clinical pharmacists （P＜0.05）. Compared with control group ，the comprehensive score of trial group was dominantly increased （P＜0.001），and the scores of professional quality ，humanistic care and communication skills in the trial group were significantly higher than control group（P＜0.01）. In terms of self-evaluation of learning effect ，except for the pathogenesis of type 2 diabetes and the commonly used treatment regimens ，the self-evaluation scores of the other items in trial group were significantly higher than control group （P＜0.05 or P＜0.01）. CONCLUSIONS ：Team situational simulation education and teaching mode is superior to traditional teaching mode for clinical pharmacy teaching.

OBJECTIVETo study the clinical effects of Achillon for the treatment of acute Achilles tendon rupture (AATR).

METHODSFrom April 2009 to April 2010, 19 patients with AATR who were treated with Achillon were retrospectively analyzed. There were 17 males and 2 females, with an average age of 40.2 years (30 to 58 years). There were 9 cases of sports injury, and 2 case of fall injury. The time from injury to surgery ranged from 0 to 8 days (2.2 days on average). The results of Thompson test and single heel rise test were positive in 19 cases. Clinical data were assessed with the patient satisfaction and the AOFAS hindfoot score during follow-up.

RESULTSAll the patients were followed up, and the duration ranged from 12 to 28 months (19.9 months on average). The average operation time was 41 minutes. There were no wound infections, recurrent rupture, or sural nerve complications. At the latest follow-up, 18 patients were totally satisfied with the surgical result, 1 patient feel generally due to mild pain when running. None of the patients were dissatisfied with the final results the latest follow-up. At the latest follow-up, the AOFAS score was 98.42 +/- 3.29 (89 to 100). All the patients regained normal range of motion and were able to resume their previous activities at six months after operation, with a high rate of satisfaction. Average decreased of mid-calf circumference was (0.82 +/- 0.85) cm (ranged from 0 to 3 cm).

CONCLUSIONTreatment with Achillon is safe, effective for AATR with low incidence of complications and early active rehabilitation can be carried out. It is a good method to treat AATR.

Achilles Tendon ; injuries ; surgery ; Acute Disease ; Adult ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; instrumentation ; Retrospective Studies ; Rupture ; Suture Techniques ; instrumentation ; Tendon Injuries ; surgery

Objective To explore the effects of application calcitonin gene related peptide(CGRP) in cisterna magna on cerebral vasospasm after experimental subarachnoid hemorrhage (subarachnoid hemorrhage,SAH) in rat models.Methods 64 male Wistar rats were randomly divided into 4 groups.Group A was normal control group.After the subarachnoid hemorrhage models were established,group B,C,D were given normal saline,CGRP and adenovirus CGRP through cisterna magna respectively.White blood cells in cerebrospinal fluid were detected by automatic blood analyzer,CGRP activity was detected by enzyme linked immunosorbent assay,circulating endothelial cells were observed through laser scanning confocal microscope and parietal cortex regional cerebral blood flow were observed by laser doppler flowmeter.Basilar artery vasospasm and arterial blood gas analysis were detected by digital subtraction angiography and blood gas analyzer respectively.Results Before and after administration,there were no statistical differences in white blood cells and artery blood gas among the 4 groups (both P＞ 0.05).After administration 48 h,compared with group A,concentrations of CGRP in cerebrospinal fluid group B (0.006±0.002) did not increase (P＞0.05),but increased 200 times in Group C ((1.160±0.170) nmol/L,P＜0.05)and nearly 400 times in group D ((2.071±0.412) nmol/L,P＜0.05).Peripheral blood circulating endothelial cells count:after administration 48 h,group C((5.56±0.61) ind/0.9 μL) was less than in group B((9.94± 0.73) ind/0.9 μL).Group D((5.16±0.61) ind/0.9 μL) was less than group C(P＜0.01).Regional cerebral blood flow:after administration,compared with group B,cerebral blood flow of group C and group D increased,and the differences were both statistically significant (P＜0.01).Basilar artery diameter was detected after administration 12 h,group D ((1.000±0.025) mm) was 13％ bigger than group B ((0.670±0.028)mm,P＜0.05),3％ bigger than group C ((0.900±0.023) mm) (P＞0.05).Conclusion Cerebral vasospasm after SAH can be effectively improved by administration CGRP in cisterna magna.Adenovirus CGRP effect is better than CGRP.

OBJECTIVETo compare therapeutic effects of acupuncture at local points of eye and western medicine on paralytic strabismus.

METHODSOne hundred cases were randomly divided into an acupuncture group and a medication group. The acupuncture group (58 cases) was treated with acupuncture at local points of eye, Jingming (BL 1), Tongziliao (GB 1), Shangming (Extra) etc. were selected; and the medication group (42 cases) was treated with oral administration of Methycobal and Vitamin B1. After treatment of 5 courses, the therapeutic effects in the two groups were observed.

RESULTSThe total effective rate of 94.8% in the acupuncture group was superior to that of 85.7% in the medication group (P<0.01); the therapeutic effects of the acupuncture group for treatment of oculomotor nerve and abducent nerve were significantly better than that of the medication group (P<0.05); the acupuncture group was better than the medication group in synoptophore examination results and improvement of rima oculi and pupil (P<0.01, P<0.05), the acupuncture group was superior to the medication group in improvement of the function of paralysis eye muscle, including medial rectus and lateral rectus except superior oblique (P<0.01, P<0.05).

CONCLUSIONAcupuncture on local points of eye is an effective therapy for paralytic strabismus.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Child ; Eye Movements ; drug effects ; Female ; Humans ; Male ; Middle Aged ; Paralysis ; drug therapy ; physiopathology ; therapy ; Strabismus ; drug therapy ; physiopathology ; therapy ; Thiamine ; administration & dosage ; Young Adult

In order to compete the antiviral effects of the host cell in the process of infection, ORFV(known as Orf virus) relies on a series of functional genes developed through long-term population evolution, such as interferon resistance genes, Bcl-2 protein genes and cell cycle inhibitor gene and so on, with these weapons this virus is able to effectively counteract immune clearance and immune regulation from a host cell. Concurrently, ORFV also focuses on exploiting signal transduction pathways of the ubiquitin-proteasome system(UPS), circumvents the intracellular signal transduction and CD8+ T activation, for shielding virus particles towards maturation and releasing outside. This review introduced inner link between the UPS of host cell and intervention mechanism by virus, and analyzed the key roles of certains components in UPS, these all together showed the evolution tendency of ORFV that was involved in the designing of inhibition to immune response and for intracellular immune escape upon the selection pressure in host cell infected.
Animals ; Ecthyma, Contagious ; enzymology ; virology ; Host-Pathogen Interactions ; Humans ; Orf virus ; genetics ; physiology ; Proteasome Endopeptidase Complex ; metabolism ; Ubiquitin ; metabolism

OBJECTIVETo improve the diagnosis and treatment of testicular torsion (or spermatic cord torsion), and reduce its misdiagnosis and mistreatment.

METHODSOne hundred and thirteen misdiagnosed clinical cases of testicular torsion from 1994 to 2004 were reviewed and analysed.

RESULTSThe error rate of initial diagnosis was 84.3%, among which 81 cases (71.7%) were misdiagnosed as acute epididymitis or testis, 10 (8.8%) as hydrocele of the tunica vaginalis, and 7 (6.2%) as acute enteritis. The lengths of time between the income and diagnosis of the disease varied from 2 hours to 2 months, averaging 6.3 days. Hand replacement succeeded in 3 cases, surgical examination was carried out in 92, resection of the testis or epididymis was performed in 64, testis atrophy occurred in 26, and the total testis impairment rate was 79.6%.

CONCLUSIONThe key to the reduction of misdiagnosis is to improve the diagnostic methods, which can be achieved by the combined use of case history, physical signs and color ultrasonography. Surgical examination of the scrotum is the best option for both the diagnosis and the treatment of testicular torsion.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Diagnostic Errors ; Epididymitis ; diagnosis ; Humans ; Infant ; Male ; Middle Aged ; Orchitis ; diagnosis ; Retrospective Studies ; Spermatic Cord Torsion ; diagnosis

OBJECTIVE: To learn the anatomical structure of the parapharyngeal space and to analyze the pathological type, preoperative evaluation and choice of surgical approach of parapharyngeal space tumors. METHOD: To conduct a retrospective analysis of the clinical data of 43 patients who receive surgery in our department from March 2002 to January 2011. All patients undergo enhanced CT and MRI before surgery and enhanced CT reconstruction was also adopted in the cases after the year 2009. All 43 cases of surgeries were performed under general anesthesia. Of all the cases, the lateral neck path were chosen for 38 cases, lateral neck parotid path for 3 and lateral neck path combined with mandibular split operation for 2, 1 of which tracheotomy was conducted. Suction drainage was placed in the surgical cavity of all cases. And patients without contraindications were treated with glucocorticoids. RESULT: In 42 of all 43 cases, the tumor was removed completely during the first operation while tumor reoccurred after 3 years and was cured by reoperation in the other one case. CONCLUSION Parapharyngeal space is deep and the anatomy structure is complicated. Cancer incidence rate is low and mostly benign in this regional. Surgical resection is the preferred treatment and lateral neck approach is most commonly used. CT and MRI is an effective preoperative examination and enhanced CT reconstruction can provide a more intuitive spatial conformation.
Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pharyngeal Neoplasms ; surgery ; Retrospective Studies ; Young Adult

Objective To explore the protective effect of erythropoietin(EPO) administrated by intranasal on cerebral ischemia reperfusion in rats with acute cerebral infarction reperfusion.Methods Total of 100 SD rats were divided into model control group,sham operation group,intraperitoneal administration group ([PEPO group),nasal saline group (INNS group) group,and nasal drug delivery group (INEPO group) with 20 in each group.The middle cerebral artery occlusion model of rat was established by thread embolism method and the NSS method was used to evaluate the neural behavior of rats.The expression of EPO in peripheral blood,cerebrospinal fluid and brain regions of rats were detected by Elisa.The vascular endothelial growth factor(VEGF) in brain was detected by immunofluorescence and then the density of newborn blood vessels in the brain was measured.Results Fifteen days after the operation,the NSS score of INEPO group(3.80± 1.61) was significantly lower than that of IPEPO group (11.53±2.11),and the difference was statistically significant(P＜0.01).And the levels of EPO in blood,cerebrospinal fluid and different brain regions of rats in INEPO group were higher than that of INNS group(all P＜0.01).Compared with IPE-PO group,the level of EPO cerebrospinal fluid and different brain regions of rats in INEPO group increased obviously,the difference was statistically significant (all P＜0.01),and the EPO concentration of the olfactory bulb was the most obvious (INEPO group:(1 456.90 ± 128.22) pg/ml,IPEPO group:(426.11 ± 36.68)pg/ml,P＜0.01).Seventy-two hours after operation,the expression of CD31 in ischemic penumbra of rats of model control group (18.21 ± 3.45),INNS group (18.54 ± 2.58),IPEPO group (27.01 ± 2.13) and INEPO group(35.52±2.79)was increased compared with sham operation group (5.14± 1.28),and the difference was statistically significant (all P＜0.05).The expression of CD31 in IPEPO group and INEPO group was significantly higher than that in INNS group (P＜0.05).In INEPO group,the expression of CD31 increased significantly compared with that of IPEPO group (P＜0.05).Conclusion Nasal administration of EPO can effectively improve the neurological function of rats with ischemia-reperfusion,and increase the expression of CD31 in the brain tissue of rats.The effect of nasal administration is better than that of intraperitoneal administration.