Objective To study the efficacy and adverse reactions of different kinds of antibiotics in the treatment of patients with acute leukemia after chemotherapy.Methods 112 cases with acute leukemia after chemo-therapy and infected were selected as the research subjects,and were randomly divided into the study group and the control group,56 cases in each group,Two groups of patients were intravenously injected amikacin sulfate,control group was intravenously injected ceftazidime and study group was given cefepime,two groups of patients were treated for 7 days.The clinical efficacy,the defervescence time,C -reactive protein (CRP)level,peripheral blood neutro-philic granulocyte (ANA)distribution levels and adverse reactions were observed.Results In the control group,the total effective rate was 83.9%,which of the study group was 94.6%,the difference between the two groups was statis-tically significant (χ2 =4.92,P =0.02).The normal rate of ANC in the study group was significantly higher than the control group (χ2 =6.62,P =0.01).The average defervescence time of the control group was (3.9 ±0.8)d,which of the study group was (2.6 ±0.8)d,there was significant difference between the two groups (t =8.44,P =0.00);CRP level of the study group after treatment was (21.18 ±4.07)mg/L,which was significantly lower than (37.27 ± 5.32)mg/L of the control group,with significant difference between the two groups (t =7.71,P =0.00).The incidence rate of adverse reaction of study group was 5.3%,which was significantly lower than 19.6% in the controlgroup,with significant difference between the two groups (χ2 =5.22,P =0.02).Conclusion Cefepime in the treat-ment of acute leukemia chemotherapy after infection has significant curative effect,can improve patients'neutral granu-locyte number and adverse reactions are mild,it is worthy of popularization in clinical.

Objective To observe and analyze the change state of serum inflammatory mediators of patients with secondary septic shock after chemotherapy for acute leukemia .Methods 56 patients with secondary septic shock after chemotherapy for acute leukemiawere were selected as the group A,56 patients without secondary septic shock after chemotherapy for acute leukemia were selected as the group B ,56 healthy persons of the same age were selected as the group C,then the serum inflammatory mediators levels of three groups were detected and compared,and the serum indexes of group A with different severity degree of shock were compared, then the detection results of group A and group B with different types ( lymphocytic leukemia and nonlymphocytic leukemia)were compared.Results The serum inflammatory mediators levels, including TNF-α, IL-4, IL-6, IL-10 and other inflammatory factors, including PGE2 , sICAM-1, sVCAM-1 and sCD44, there were group A >group B >group C, severe shock >moderate shock>mild shock ( all P<0.05 ) .The above serum inflammatory mediators and other inflammatory factors levels of different types in group A were higher than those in group B, and the above mediators in lymphocytic leukemia of group A and group B were higher than those in nonlymphocytic leukemia (all P<0.05).Conclusion The serum inflammatory mediators of patients with secondary septic shock after chemotherapy for acute leukemia show higher expression state,and the influence of shock degree and leukemia types for the expression are great.

Objective To explore the thyroid function changes of episodes period and remissions period in children with primary nephrotic syndrome (NS).Methods The urinary protein quantitation and serum albumin,total cholesterol,thyroid hormone level [total triiodothyronine (TT3),total thyroxine (TT4),free triiodothyronine (FT3),free thyroxine (FT4) and thyroid stimulating hormone (TSH)] of episodes period and remissions period in 15 children with primary NS were retrospectively analyzed.Results There were statistical differences in urinary protein quantitation and serum albumin,total cholesterol in children with NS between episodes period and remissions period (P ＜ 0.05).The TT3,TT4,FT3,FT4 in episodes period were significantly lower than those in remissions period [(0.6 ± 0.3) μ g/L vs.(1.3 ± 0.3) μ g/L,(40.0 ± 23.0)μ g/L vs.(68.0 ± 15.0) μ g/L,(1.6 ± 0.3) pmol/L vs.(3.3 ± 0.3) pmol/L,(8.6 ± 2.5) pmol/L vs.(12.2 ± 2.0) pmol/L],TSH was significantly higher than that in remissions period [(5.6 ± 2.1) mU/L vs.(2.5 ± 1.1) mU/L],there were statistical differences (P ＜ 0.05).Conclusions Thyroid function of episodes period in children with primary NS is decreased temporarily,associated with heavy proteinuria leads to thyroid hormone missing from urine.Detecting thyroid function plays an important role in estimating the state and guiding the treatment of primary NS.

Objective To examine the application effect of intelligent simulator(SimMan) in comprehensive skill training among doctors and nurses.Methods Totally 168 doctors and nurses were chosen as the training object,6 people (4 doctors and 2 nurses) formed a work team.Comprehensive training course was in accordance with 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science.Real clinical situation was designed by using the third generation SimMan of Norway laerdal company.Trainees were administered two tests before and after training,in which there were two parts containing specialized operation ability and non-technical ability.Overall qualification rate,average mark and treatment time of qualified teams were compared before and after the training.SPSS 16.0 software was used to analyze the data and P ＜0.05 signifies statistically significance.Results Overall qualification rate,average mark and treatment time of qualified teams were 71.43％,(84.70 ± 3.15),and (449.25 ± 77.0) s respectively before training while 100％,(93.55 ± 3.86) and (323.71 ± 42.26) s after training.There were significant differences in results of two groups before and after training (P =0.002,0.000,0.000).Conclusions Application of the third generation intelligent simulator (SimMan) in comprehensive training will obviously improve training effectiveness and cultivate the non-technical ability.

Objective To investigate the changes of excitatory amino acids (EAAs) of cerebrospinalfluid (CSF) in patients with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Method The EAAs levels of CSF including glutamate (Glu) and aspartate (Asp) in 24 patients with DEACMP and 20 controls with migraine were measured by high performance liquid chromatography( HPLC ).Results Glu and Asp levels in patients with DEACMP were significantly higher than those of the controls [(3.76 ± 1.52) μmol/L vs ( 1.55 ± 1.03 ) μmol/L, (0.73 ± 0.44) μmol/L vs (0.38 ± 0.33 ) μmol/L, P all <0.01]. Glu and Asp levels in moderate and severe DEACMP patients were higher than those in mild DEACMP patients. Conclusion It suggests that EAAs participated in the pathogenesis of DEACMP. The Glu and Asp levels in CSF may be regarded as indicator of DEACMP.

Objective To evaluate the diagnostic value of magnetic resonance tomographic angiography(MRTA) with 3.0T scanner for neurovascular compression in patients with trigeminal neuralgia and hemifacial spasm.Methods MRTA using three-dimensional time-of-flight(TOF) sequence was performed in 52 cases with trigeminal neuralgia and 9 cases with hemifacial spasm.MR oblique sagittal and coronal images were created to display the relationship between trigeminal and facial nerves and surrounding vessels,and compared with that of operation MRA showed that.Results In 52 cases with trigeminal neuralgia,the trigeminal nerves were compressed by vessels or contacted with vessels in 46 cases at MRTA,and in 9 cases with hemifacial spasm,all trigeminal nerves showed having vascular compression or in contact with vessels.The accuracy,sensitivity and specificity of MRA in diagnosing trigeminal neuralgia and hemifacial spasm caused by vascular compression were 90.2%,96.4% and 80%,respectively,which compared with that of operation.Conclusion MRTA is sensitive to neurovascular compression,which plays an important role in diagnosing trigeminal neuralgia and hemifacial spasm.

Objective To study the clinical feature of ciguatera fish poisoning.Methods Thirty-nine patients with ciguatera fish poisoning were observed.Results The clinical symlptoms of ciguatera poisoning usually began to appear 2～10 hours after eating a poisonous fish and could be classified into three broad groups:neurological,gastrointestinal cardiovascular symptoms.Gastrointes tinal symptoms were the most common complaint.Neurological symptoms generally stayed for 1～2 weeks.The clinical picture was characterized by temperature reversal.Conclusion Ciguatera poisoning can be differentiated by unique features affecting the neurological system.

An ordered mesoporous silica ( OMS ) was synthesized through hydrothermal process. The synthesized material was characterized by different techniques such as X-ray diffraction, nitrogen adsorption-desorption and transmission electron microscope. The electrochemical characteristics of the OMS modified carbon paste electrode ( OMS/CPE ) were investigated by using cyclic voltammetry and electrochemical impedance spectroscopy. Compared with bare carbon paste electrode ( CPE ) , the OMS/CPE exhibited a larger electrode surface and a faster electron-transfer rate. Electrochemical behaviors and kinetic properties of L-tryptophan ( L-Trp) at the OMS/CPE in the presence of sodium dodecylsulphate ( SDS) were studied. The results showed that the voltammetric response of L-Trp at OMS/CPE was improved due to the synergistic effect of OMS and SDS. The electrochemical oxidation of L-Trp at OMS/CPE in the presence of SDS was an irreversible process involved two electrons and two protons, and the electrode process was controlled by the adsorption step. Some parameters such as SDS concentration, accumulation time, accumulation potential and pH were optimized. Under optimal conditions, the oxidation peak current was linearly proportional to L-Trp concentration in the range of 8. 0×10-8 to 4. 0×10-6 mol/L, with a detection limit of 7. 0×10-8 mol/L (S/N=3 ) . The proposed method was applied for the determination of L-Trp in oral liquid with the recoveries of 99 . 6%-102 . 6%.

Objective To assess whether asymmetric spin echo version of echo planar imaging (ASE EPI) sequence can reflect cerebral oxygen metabolism by means of the changes in oxygen extraction fraction values before and after surgical operations in the canine model of ischimia. Methods A total of 12 healthy crossbreed dogs were enrolled in this study. All canines underwent cerebral MR imaging including coronal T2WI, DWI, MRA, ASE EPI and 3D PCASL. The bilateral carotid arteries (CA) were separated by surgical operations. The bilateral CA were ligated in 6 dogs, and the other 6 dogs had embolization in ligated bilateral CA. The cerebral MR imaging with the above protocol was repeated at 1 hour after surgical operation for each dog. All dogs were executed when they finished the MR examinations. Then the whole brains of the dogs were taken out for cutting coronal sections and 2, 3, 5-triphenyltetrazolium chloride (TTC) staining. The ASE EPI data were processed by the Functool software in the workstation to generate OEF maps. For measuring the OEF values before and 1 hour after surgical operations, one and the same region of interest (ROI) was respectively placed in the left and right hemispheres on the OEF maps for each dog. 3D PCASL data were processed by the Functool software in the workstation to yield CBF maps. The method for measuring the CBF values before and 1 hour after surgical operations on CBF maps was same as that for measuring on OEF maps. The changes of measurements before and after surgical operations were compared between the dogs with ligated bilateral CA and the dogs with embolization in ligated bilateral CA by using an independent samples t test. The measurements before and after surgical operations were respectively compared in the dogs with ligated bilateral CA and the dogs with embolization in ligated bilateral CA by using a paired t-test. The cutting slices with TTC staining were analysed for determining ischimia. Results The CBF values of the dogs with ligated bilateral CA were (59.81±23.59) and (38.56± 12.98) ml/(min · 100 g) before and after surgical operations, respectively. The CBF values of the dogs with embolization in ligated bilateral CA were (58.94±18.35) and (28.01±11.41) ml/(min·100 g) before and after surgical operations, respectively. The CBF values were significantly lower before surgical operations than after surgical operations in the dogs with ligated bilateral CA and the dogs with embolization in ligated bilateral CA, respectively (t=8.92 and 13.42, respectively; P=0.00, respectively). The CBF values were decreased more significantly in the dogs with embolization in ligated bilateral CA than in the dogs with ligated bilateral CA (t=2.92, P=0.00). The OEF values of the dogs with ligated bilateral CA were 0.29±0.02 and 0.32 ± 0.06 before and after surgical operations, respectively. The OEF values of the dogs with embolization in ligated bilateral CA were 0.29 ± 0.02 and 0.35 ± 0.06 before and after surgical operations, respectively. The OEF values were significantly higher before surgical operations than after surgical operations in the dogs with ligated bilateral CA and the dogs with embolization in ligated bilateral CA, respectively (t=-7.21 and-4.43, respectively;P=0.00, respectively). The OEF values were increased more significantly in the dogs with embolization in ligated bilateral CA than in the dogs with ligated bilateral CA (t=2.18, P=0.03). The pathological results showed that the dogs with embolization in ligated bilateral CA had swollen cortex with focal infarction which was matched with the hyperintensity areas on the OEF and DWI images. However, the dogs with ligated bilateral CA only had swollen cortex whereas didn't have focal infarction. Conclusions ASE EPI sequence can reliably reflect cerebral oxygen metabolism in ischemia. This sequence has an important role for assessing hemodynamic state in patients with cerebral vascular diseases.

The elbow is more susceptible to motion loss than other joints after trauma,and elbow stiffness leads to functional impairment in the upper limb and interferes with daily activities.Open arthrolysis is the most common and classical treatment for post-traumatic elbow stiffness.In this paper,we review the treatment protocols like preoperative clinical evaluation,arthrolysis strategies and postoperative rehabilitation program for post-traumatic elbow stiffness,discuss relevant issues and assess their prospects.