The article summarizes the questions of clinical practicing in obstetrics and gynecology through clinical teaching in person,and find out some measures to improve teaching quality of clinical practicing.

Objective To explore the clinical characteristics and drug sensitivity of newborn pneumonia of klebsiella pneumoniae,and investigate the positive rate of extended-spectrum ? lactamases(ESBLs)in klebsiella pneumoniae.Method Sixty-seven cases of sputum samples newborn pneumonia of klebsiella pneumoniae from Jan.2003 to Dec.2005 were collected.Bacteria identification and drug sensitivity test were performed.At the same time,ESBLs were detected.Results The clinical characteristics of newborn pneumonia of klebsiella pneumoniae were non special,and the positive rate of ESBLs in klebsiella pneumoniae was 17.91%.The klebsiella pneumoniae was 100%sensitivie to carbopenems,but resistant to commonly used ?-antibiotics such as penicillin and cephalosporin.ESBLs negative strains had higher drug sensitivity than ESBLs strains.Conclusions Partial klebsiella pneumoniae are ESBLs strains and insensitive to commonly used antibiotics.In order to decrease ESBLs strains,the antibiotics treatment shall be used appropriately and the selection of antibiotics shall be guided by the results of drug sensitivity tests.

Acupuncture Points ; Acupuncture Therapy ; Child ; Dermatomyositis ; therapy ; Humans ; Male

Objective To evaluate the efficacy of remifentanil combined with propofol in children of different age undergoing short-term ophthalmologic operation.Methods Forty-eight children aged 4-12 yr undergoing elective short-term ophthalmologic operation were divided into 4 groups(n=12 each)according to age and anesthetics:group ⅠPK aged 4-7 yr and group ⅡPK aged 8-12 yr received ketamine and propofol combined anesthesia;group ⅠPR aged 4-7 yr and group ⅡPR aged 8-12 yr received remifentanil and propefol combined anesthesia.In group ⅠPK and ⅡPK the anesthesia was induced with intravenous bolus of ketamine 2 ms/kg and ketamine 1-2 ms/kg.In group ⅠPR and ⅡPR the anesthesia was induced with intravenous remifentanil 1 μg/kg and respiratory rate(RR),cerebral state index(CSI)and SpO2 were recorded before anesthesia induction(baseline),2 min after induction,at the initiation of the operation,15 min after the initiation of operation and at emergence from anesthesia.Adverse effects during and after the operation,induction time,analepsia time,conscious recovery time and total sedation time were recorded.The mean infusion rate of remifentanil was calculated.Results Compared with the baesline,SP,DP,HR,RR and CSI were significantly decreased in 4 groups(P＜0.05).RR,CSI and incidence rates of adverse effects were significantly lower,and the emergence time and the recovery time of consciousness were significantly shorter in group ⅠPR and ⅡPR than in group ⅠPK and ⅡPK(P＜0.05).The average infusion rate of remifentanil was lower in group ⅡPR than in group ⅠPR(P＜0.05).Conclusion Remifentanil combined with propofol can produce good anesthetic effect in children undergoing short-term ophthalmologic operation,with less adverse effects,stable hemodynamics and rapid emergence from anesthesia.The dosage of remifentanil is difierent in children at different ages.

Objective To study the adverse effects on periodontal tissues caused by crownless roots in elderly people with osteoporosis. Methods Totally 60 12?week SD rats(30 male and 30 female)were randomly divided into the control group(10 male and 10 female sham?operated rats)and the osteoporosis group(20 male and 20 female castrated rats). After 12 weeks,the bone mineral density of right femora was measured by dual energy X?ray for all rats to confirm osteoporosis. The right molar crown was pinched off with haemostatic forceps and the molar root was retained. The 10 con?trol rats and the 20 experimental rats were sacrificed respectively at postoperative 2 and 4 weeks. The periodontal tissues of right molar were sampled and the morphology of the parodontium and the alveolar bone was observed by haematoxylin and eosin(HE)staining and the expression of tumour necrosis factor?alpha(TNF?α)and inducible nitric oxide synthase?2(NOS2)was detected by immunohistochemical staining and real time fluores?cent quantitative PCR(qRT?PCR). Results The HE slices indicated that the periodontal tissues in the osteoporosis group were significantly im?paired compared to the control group as the structure of parodontium loosened. Bone impairment aggravated over time. TNF?αstaining showed as a few claybank spots on the parodontium in the control group,while the staining colour was darkened in the osteoporosis group. The expression of TNF?αmRNA was significantly higher in the osteoporosis group than in the control group(P<0.05). The result of NOS2 was contrary to that of TNF?α. The differences in TNF?αand NOS2 were not statistically significant at 2 and 4 weeks(P>0.05). Conclusion The crownless roots in rats with os?teoporosis cause adverse effects of periodontal tissues as the roots accelerate absorption of the surrounding alveolar tissues. It is indicated that crown?less roots in elderly people with osteoporosis should be removed as soon as possible.

Objective To discuss the clinical application of ultrasound-guided preoperative guide-wire localization in diagnosing tiny breast lesions. Methods A total of 56 patients with impalpable tiny breast lesions were enrolled in this study. Preoperative guide-wire localization of the lesion was performed under high-frequency ultrasound guidance, which was followed by tracking resection of the lesion. The clinical data were retrospectively analyzed. Results Successful localization and complete resection of the lesion was accomplished in all 56 patients. The lesions included invasive ductal carcinoma (n=11), intraductal carcinoma (n=5), ductal carcinoma in situ (n=2), mucinous carcinoma (n=2), fibroadenoma (n=24), atypical hyperplasia (n=6), intraductal papilloma (n=4) and plasma-cell mastitis (n=2). Conclusion Ultrasound-guided preoperative guide-wire localization is a safe and reliable technique for the diagnosis of impalpable tiny breast lesions. It can precisely localize the lesion, which is very helpful for making a complete resection of the lesion and avoiding unnecessary breast injury. Therefore, this technique should be recommended in clinical practice.

Objective To study the relationship between velocities of ductus venosus(DV),inferior vena cava(IVC) and right hepatic vein(RHV) of fetus,and abnormal perinatal outcome in high-risk pregnancy so as to find out which venous velocity can predict abnormal perinatal outcome and which velocity is the best for predicting abnormal perinatal outcome. Methods Velocities of DV,IVC and RHV in 67 cases of high-risk pregnancy were examined through color Doppler and their relationship with perinatal outcome was analyzed respectively. Results RHV-pulsatility index(PI) ,DV-pre-load index(PLl) ,DV-S/A and IVC-peak velocity index(PVI) could all predict abnormal perinatal outcome in high-risk pregnancy. But RHV-PI had the best prediction, and when its positive cutoff value was taken as 2. 89,the sensitivity for abnormal outcome was 75. 0% ,the specificity was 76. 7% ,and the correct index (Youden index) was 0. 52. Conclusions RHV-PI can best predict abnormal perinatal outcome in high-risk pregnancy,which can help a lot for prompt clinical treatment.

0.05). The ROM of flexion-extension, lateral bending and axial rotation of these two groups was smaller than that of the other three fixators(P0.05). Conclusion Experimentally, the effect of TARP was equal to that of Magerl+Brooks, but it was proved to be more stable than the other three clinically widely used atlantoaxial fixators: Magerl, Brooks and anterior transarticular screw fixation through C 2 vertebral body. TARP's C 1 and C 2 screws were strong enough for atlanto-axial arthrodesis. TARP's biomechanical performance was excellent.

Objective To investigate the feasibility,safety and clinical efficacy of transvaginal myomectomy.Methods A total of 92 patients with uterine leiomyoma were given either vaginal myomectomy(Study Group,n=46) or abdominal myomectomy(Control Group,n=46).Clinical outcomes between the two groups were compared.Results Both vaginal and abdominal myomectomy were performed successfully.The operation time between the two groups was not statistically significant(t=-0.734,P=0.465).There were significant differences between the Study Group and the Control Group in the intraoperative blood loss(60.4(?5.6 ml) vs 82.5?50.2 ml;t=-2.210,P=0.000),the time to first passing flatus(15.3?3.2 h vs 27.5?4.8 h;(t=-14.343,)P=0.030),the incidence of postoperative pain (?~2=29.447,P=0.000),the rate of postoperative pyrexia(?~2=3.903,P=0.048),and the hospital stay(3.1?0.4 d vs 5.2?1.1 d;t=-12.169,P=0.000).Conclusions Transvaginal myomectomy has advantages of little invasion,quick recovery of bowel movement,slight postoperative pain,low rate of postoperative pyrexia,and short hospital stay,being a safe and feasible minimally invasive option for uterine leiomyoma.

Objective To explore the diagnosis value of ultrasound real-time elastography in thyroid diffuse diseases.Methods Eleven elastic quantitative parameters of 123 patients with thyroid diffuse diseases and 42 healthy volunteers obtained from the ultrasound real-time elastography were analyzed with principal components analysis to attain a comprehensive evaluation value which was named stiffness index(SI),reflecting the organization elastic information of different thyroid diffuse diseases.SI among each group was compared by ANOVA.Results Chronic lymphocytic thyroiditis SI was 86.37±20.45,subacute thyroiditis SI was 86.14±19.95,primary hyperthyroidism SI was 54.68±21.69,normal control group SI was 41.34±15.59,respectively.The SI between chronic lymphocytic thyroiditis,subacute thyroiditis,primary hyperthyroidism and normal controls had significant statistical differences (P<0.05),the SI between primary hyperthyroidism and chronic lymphocytic thyroiditis,subacute thyroiditis had significant statistical differences (P<0.05),the SI between chronic lymphocytic thyroiditis and subacute thyroiditis had no significant statistical difference (P>0.05).Conclusions Ultrasound real-time elastography could indirectly reflect the stiffness information of thyroid lension tissue and have a certain degree of diagnosis value in thyroid diffuse disease.