Child ; Community-Acquired Infections ; epidemiology ; Humans ; Pneumonia ; epidemiology

AlM:To investigate the effect of teaching mode of problem- based learning ( PBL ) in the teaching of medical students' clinical ophthalmology.
METHODS: Five classes ( total 148 students ) were randomly selected as experimental group, using PBL method, at the same time another 5 classes ( total 151 students) were also randomly selected as control group, using lecture-based learning ( LBL) mode in 2010 grade. The scores of the experimental group were compared with control at the end of term. ln addition, students and teachers were respectively interviewed using self -administered questionnaire to obtain their evaluation for PBL practice.
RESULTS:The mean scores of PBL group (78. 35±7. 63) were significantly higher than control group (71. 68±6. 37) (P<0. 001). Most of students thought that their ability of referring, synthesizing and analyzing information was enhanced by PBL, and their skills both in written and oral were also improved. PBL made it easier to understand the contexts of course. lt was the best way to improve the effect of teaching in ophthalmology based on the increase of quality in novitiate that gives more chance to students of contacting with practice, developing the ability of clinical thinking and verifying the theory in clinical novitiate. Lots of teachers considered that the classroom atmosphere was more active, students were becoming more and more proactive on their classes and the relationship between students and teachers were more harmonious when PBL was used.
CONCLUSlON:Using PBL teaching mode can highly improve the teaching effectiveness of clinical epidemiology, which is worth popularizing.

ObjectiveTo observe the effect of mild hypothermia on vital signs of the elderly patients with anterior circulation brain infarction (massive hemispheric infarction) and hyperpyrexia.Methods46 elderly patients with massive hemispheric infarction and hyperpyrexia within the first 24 hours after onset were randomly divided into the control group and the hypothermia group with 23 cases in each group. The patients of the hypothermia group were treated with mild hypothermia therapy (33℃～35℃). Those of the control group were treated with routine hypothermal treatment. The temperature and heart rate of all patients were measured after 10 days; the prognosis was evaluated according to mortality and scores of Neurological Deficit Scale (NDS).ResultsFor patients of the hypothermia group, the temperature and heart rate significantly reduced, death rate was significantly lower, the neurological function distinctly improved and prognosis was better than the control group after 10 days treatment ( P<0.05).Conclusion Mild hypothermia is safe and effective to elderly patients with massive hemispheric infarction and hyperpyrexia.

OBJECTIVETo study the in vitro antibacterial activity of cefdinir against clinical isolates of respiratory tract pathogens in Children.

METHODSMIC values of cefdinir against 380 strains were determined with E-test method and compared with those of cefaclor.

RESULTSAll penicillin-susceptible Streptococcus pneumoniae (PSSP) strains were also susceptible to cefdinir and cefaclor. Both cefdinir and cefaclor were not active against penicillin-resistant SP (PRSP). Against penicillin-intermediate SP (PISP) the susceptibility rates of cefdinir and cefaclor were 70.1% and 57.4%, respectively. The activity of cefdinir and cefaclor against beta-lactamases negative Hemophilus influenzae (HI) was excellent, but the susceptibility rates of cefdinir and cefaclor against beta-lactamases positive HI were 85.0% and 70.0%, respectively with MIC(90) of 1.5 mg/L vs. 256.0 mg/L. Cefdinir presented higher activities and lower MIC values than cefaclor against Moraxella catarrhalis (MC), Group A streptococcus (GAS), methicillin susceptible staphylococcus aureus (MSSA), and extended spectrum beta-lactamases (ESBLs) negative Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pn). Both cefdinir and cefaclor were not susceptible to ESBLs positive E. coli and K. pn.

CONCLUSIONSCefdinir exhibits excellent activity against PSSP, PISP, HI, as well as MC, GAS, MSSA and ESBLs negative E. coli or K. pn.

Anti-Bacterial Agents ; pharmacology ; Bacteria ; drug effects ; Cephalosporins ; pharmacology ; Child ; Humans ; Microbial Sensitivity Tests ; Respiratory System ; microbiology

Child, Preschool ; Chromosomes, Human, Pair 22 ; Chromosomes, Human, Pair 8 ; Chromosomes, Human, Pair 9 ; Humans ; In Situ Hybridization, Fluorescence ; Karyotyping ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; Translocation, Genetic

OBJECTIVETo research the clinical application of lower cervical pedicle screw fixation procedure.

METHODSFrom September 2011 to July 2013,32 patients underwent posterior pedicle screw-rod system fixation were retrospective analyzed includinig 20 males and 12 females with an average age of 56.4 years old ranging from 21 to 78 years. Among them, 10 patients were traumatic cervical spinal injury, 9 patients were cervical spinal canal tumors, 7 cases were posterior longitudinal ligament ossification of cervical vertebrae, 6 cases were multiple segmental cervical spondylopathy. Preoperatively, X-ray, computed tomography, magnetic resonance imaging and magnetic resonance angiography of the vertebral artery were performed in all patients. After the operation and during the follow-up,X-ray and computed tomography were performed to confirm the pedicle screw position. The accuracy of the pedicle screw placement was evaluated by 4 grades classification from Lee. The spinal cord function was assessed by ASIA impairment scale for traumatic patients and JOA score for non traumatic patients.

RESULTSTotally 144 pedicle screws performed on 32 patients from C3 to C7 involving 132 screws of grade 0,5 screws of grade 1,5 of screws grade 2 and 2 screws of grade 3 according to postoperative CT. There were 12 screws penetrating the pedicle cortex including 8 screws at lateral,2 screws at caudal, 1 screw at medial and 1 screw at cranial. The follow-up time was 12 to 33 months with an average of (21.0±1.5) months. The spinal cord function was not improved in 6 complete cervical spinal cord injury patients,but their paraplegic level descended 1 to 3 segments. Four incomplete cervical spinal cord injury patients' ASIA impairment scale was increased by 1 to 2 grades in average. The JOA score of 22 atraumatic patients increased from preoperative 11.5±0.8 to 15.9±0.6 of postoperative at 6 months (P<0.01). There were no screw loosening,screw pullout and screw-rod breakage.

CONCLUSIONThe lower cervical pedicle screw fixation can provide excellent 3D stability of the vertebral column. The operation risk and Complication could be minimized by adequate preoperative evaluation for appropriate cases and individual pedicle screw placement. It deserved the clinical expansion.

Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Cord Injuries ; physiopathology ; surgery

OBJECTIVETo investigate the rule of the aquaporin-4 (AQP4) expression in acute ischemic brain edema, and to study the correlation between AQP4 expression and diffusion-weighted imaging (DWI).

METHODSThirty-six Wistar rats were divided into 2 groups randomly, control group (n = 12) and operation group (n = 24) in which right middle cerebral artery of each animal had been occluded unilaterally (MCAO) at interval times of: 15 minutes, 30 minutes, 1 hours, 3 hours, 6 hours and 24 hours, respectively. The operation process of the control group was the same as the operation group except for the MCAO. All groups were examined using DWI. The apparent diffusion coefficient (ADC), relative density (rd) and relative area (rs) of the biggest hyperintensity signal layer on DWI were measured. After that the animals were sacrificed and perfused with the mixture solution consisting of TTC. The biggest layers of the ischemic cerebral tissues in each rat corresponding to the DWI were stained with TTC and examined with immunochemistry (DeltaS), in situ hybridization (alpha) and histology.

RESULTSThere was no significant change in the control group. In the operation group, a hyperintensity signal was found in the DWI of the right MAC territory at 15 minutes after MCAO. The ADC value decreased quickly within one hour after MCAO, while the AQP4 expression, rd-DWI and rs-DWI increased rapidly during this stage. As time progressed, the ADC value decreased further to (2.1 +/- 0.6) x 10(-4) mm(2)/s at 3 hours, and then began to increase slowly till 24 hours. But the AQP4 expression (DeltaS and alpha) and rd as well as the rs continuously increased slowly between 1 hour and 6 hours after MCAO, followed a peak after 6 hours. The AQP4 expression (alpha) showed a positive relationship with the rs-DWI, they all presented two peaks and a plateau. The corresponding sequential pathologic changes were a gradual increase of intracellular edema (within one hour), then an emergence of vasogenic edema (1-6 hours), and final necrosis and liquefaction (6 - 24 hours).

CONCLUSIONSUpregulated expression of AQP4 may play a significant role in acute ischemic brain edema, especially during the stages of intracellular edema and necrosis, but it has no correlation to vasogenic edema. Certainly, the high expression of AQP4 is perhaps one of the most important reasons of the decrease of ADC and hyperintensity on the DWI in the intracellular edema.

Acute Disease ; Animals ; Aquaporin 4 ; Aquaporins ; analysis ; Brain Edema ; etiology ; pathology ; Brain Ischemia ; complications ; pathology ; Diffusion Magnetic Resonance Imaging ; Random Allocation ; Rats ; Rats, Wistar

Objective To observe the effect of anti-pyretic and anti-inflammatory of Shufeng Jiebiao decoction.Methods Intraperitoneal injection of Lipopolysaccharides (LPS) was made to cause fever in rats and then to observe the anti-pyretic effect of Shufeng Jiebiao decoction.Intraperitoneal injection of glacial acetic acid was made to led inflammatory exudate in rats and then to observe the anti-inflammatory effect of Shufeng Jiebiao decoction.Smearing cylene in auricles was done to cause inflammatory swelling in rats and then to observe the effect of the alleviation of the inflammatory swelling of Shufeng Jiebiao decoction.Results ①The temperature of rats in the group of the aspirin and the Shufeng Jiebiao decoction were become lower at each time.The basic temperature of the model control group was (37.14±0.39) ℃,the temperature in the first hour was (40.31±0.34) ℃,the second hour was (40.44±0.44) ℃,the fourth hour was (40.24±0.34) ℃,the sixth hour was (40.05 ±0.44)℃,and the eighth hour was (39.85 ±0.37)℃.The basic temperature of the aspirin group was (37.13±0.33)℃,the temperature in the first hour was (38.74±0.42)℃,the second hour was (38.86±0.33) ℃,the fourth hour was (39.05±0.36)℃,the sixth hour was (38.74±0.37)℃,and the eighth hour was 38.64±0.24) ℃.The basic temperature of the Shufeng Jiebiao decoction group was (37.03±0.46) ℃,the temperature in the first hour was (39.02±0.49) ℃,the second hour was (38.82±0.49) ℃,the fourth hour was (38.63±0.46)℃,the sixth hour was (38.62±0.52)℃,and the eighth hour was (38.42±0.44)℃.The differences were statistical significance compared with the model control group (P＜0.01),the onset of anti-pyretic of the Shufeng Jiebiao decoction group was slower than the aspirin group,but it had a longer lasting effect.Moreover,the rats' temperature decrease of the Shufeng Jiebiao decoction group in the fourth hour had a statistical significance compared with the aspirin group.(P＜0.05).② After the intevention of aspirin and the Shufeng Jiebiao decoction,the optical density of evans blue:the model control group was (0.221 ±0.045),the aspirin group was (0.162±0.053),the Shufeng Jiebiao decoction group was (0.176±0.049),the permeability of the abdominal capillary of the rats reduced significantly (P＜0.01).The intervention of the aspirin and the Shufeng Jiebiao decoction had almost no difference.③ After the intervention of the dexamethasone and the Shufeng Jiebiao decoction,the weight of the auricals:the model control group was (1.94±0.55)mg,dexamethasone group was (1.18±0.40)mg,Shufeng Jiebiao decoction group was (1.04±0.41)mg,showing the degree of the swelling of auricals decreased obviously (P＜0.01).The intervention of the dexamethasone and the Shufeng Jiebiao decoction had almost no difference.Conclusion Shufeng Jiebiao Decoction had anti-pyretic and anti-inflammatory effects.

Objective To analyze the clinical features of patients with open injuries combined with infections in Chinese Wenchuan earthquake and summarize the therapeutic experience. Methods An analysis was done on 54 patients with open injuries combined with infection transferred to our depart-ment from May 13, 2008 to June 10, 2008. Thorough debridement was performed based on general sup-porting management and anti-bacterial thempies done on the basis of results of bacteria culture and sus-ceptibility test. In the meantime, other managements including high-pressure oxygen therapy and external fixation were done for open fractures. Results Infection could be found in all open injuries, primarily combined infections with G+ coccus and G- bacillus or anaerobic. Moreover, most of the patients were infected by anaerobia. Of all, 1 patient with amputation received multiple debridement and repair because of severe infection of the amputation site and no death occurred. All patients recovered uneventfully, with sound wound healing, except for 2 patients. External fixation was stable and in good position. Conclu-sions The repeated and thorough debridement and the timely closure of wounds on the basis of energeti-cally anti-infection measures are key to diminishing the mortality rate and mutilation rate. Appropriate ad-junctive therapy can dramatically improve the curative effect.

AlM: To introduce a new color pediatric visual acuity chart and its clinical application.
METHODS:The color pediatric visual acuity chart was designed based on principle of visual angle. The optotype on the color chart had graphics. The progression rate of optotype size between 2 lines was 10 10 and 1. 2589. A regular geometric progression of optotype sizes and distribution was employed to arrange 8 lines with 11 optotype on the color chart. The testing distance was 3m. The visual acuity score could be recorded as logarithm of the minimum angle of resolution notation or decimal notation. The reliability of naked distant measurements with this new chart was tested in one eye of 100 children (4 ~ 6 years old) taking the Chinese national standard logarithm visual acuity chart standard.
RESULTS: The color pediatric visual acuity chart and logarithmic chart controls, visual acuity test results that in the two groups had no significant difference (t=1. 2671, P> 0. 05 ). Two sets of vision data existed positive correlation (r= 0. 924, P<0. 01). Cooperation rate was 100%, the recognition rate was more than 90%.
CONCLUSlON:Children are easier to accept used new color pediatric visual acuity chart to inspect vision. New chart is reliability and apply to children's vision screening.