Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Musculoskeletal Manipulations ; Snoring ; therapy ; Young Adult

Some human leucocyte antigens(HLA),espeually class Ⅱ genotypes such as HLA DQ/DR are closely linked to type 1A diabetes mellitus(T1ADM).But the genetic susceptibility of HLA DR/DQ are different between Caucasian and Asian populations.The aspartic acid at position 57 of DQ? can not confer resistance to T1ADM in Asians.DQ2 and DQ8 are the well-known susceptible genotypes in Caucasians while DQ4 and DQ9 are in Asians.An unexpected high risk of T1ADM is observed for the linkage disequilibrium between DRB1*0301/ DRB1*0401 and DQ2/DQ8 in both the populations.The DQB1*0302,DQA1*0501,DRB1*0401,*0402,*0407 are associated with T1ADM in Caucasians,but it is not the case in Asians.In contrast,DQB1*0401 shows a positive association to T1ADM in Asians,has a protective effect against T1ADM in Caucasians.Additionally DRB1*09 could be another susceptible gene in Asians.

QIU Fa-zu points out that medical creation is very urgent and importance should be attached to fundmental knowledge,frontier knowledge,connecting the theoretical konwledge with the phical kowledge,analyzing experiences and intertional interactions.Through analyzing these important thoughts of QIU Fa-zu,the passage draws the conclusion that these thoughts are valuble to China' s medical management and scientific policy.

Objective To investigate the etiology of the nosocomial infection and immune function changes anus and anal after operation.Methods 130 patients who needed anus and anal canal surgery were recruited in the study.The clinical data were recor-ded and postoperative nosocomial infection data were observed,including infection type,distribution,pathogenic analysis and im-mune function.Results A total of 67 cases of nosocomial infection occured,the infection rate was 51.5% (67/130),the main types of infection were perineal wound infection,abdominal infections and pelvic infections,urinary tract and vaginal infections were rare. 93 isolates were collected,of which gram-negative bacilli accounted for 67.7% (63/93 ),including bacteroides fragilis (21.5%), Escherichia coli (18.3%),Pseudomonas aeruginosa (10.8%);Gram-positive bacteria accounted for 23.7% (30/93 ),including Staphylococcus aureus(17.2%),Staphylococcus epidermidis(6.5%);5 fungi were isolated accounting for 5.4%,other strains ac-counted for 3.2%.All the immune parameters detected in patients with postoperative nosocomial infection were statistically differ-ent from those before infection(P <0.05)except for IgM(P >0.05).Conclusion The incidence of nosocomial infection was rela-tively high in patients who had anus and anal canal surgery,which could serious affect the patients'outcomes,preventive and control measures should be taken in clinical practice.

Objective To investigate the clinical,neuroimaging, pathological features and prognosis of brainstem encephalitis. Methods The clinical and neuroimaging features and prognosis of 15 cases with brainstem encephalitis were analyzed retrospectively.Among them,1 case of brain autopsy was studied by HE,K-B and immunohistochemical staining. Results In 7 cases,the history of viral infections before the onset of disease was obtained.The initial neurological manifestation was dizzy in 6 cases,diplopia,headache and vomiting in 2 cases respectively,and unconciousness,ptosis and facial numbness in 1 case respectively.The main clinical features were shown that 15 cases demonstrated the involvement of cranial nerves,9 cases pyramidal tract and 5 cases spinothalamic tract,8 cases ataxia,4 cases Horner sign and 2 cases unconsciousness.MRI found single or multiple lesions in the corresponding parts of brainstem in 10 cases.In case of brain autopsy,neuropathological examination revealed local hemorrhagic necrotizing softening lesions in the pontine tegmentum and lateral medulla.A marked infiltration of lymphocytic inflammatory cells and macrophages were observed in the necrotic area.Myelin loss,axonal swelling and mild increase of reactive astrocytes were also observed in the cranial nerve nuclei.There was no positive finding of immunohistochemical staining by using the primary antibodies against HSV-I,Ⅱ,EB,CMV and toxoplasma.The prognosis for other surviving 14 cases were benign,and no relapsing case was found after 39.9 months of follow-up. Conclusions The course of brainstem encephalitis seems to be monophasic and benign,which indicates that it might be not the first episode of multiple sclerosis.The underlying causes of the disease are usually difficult to be identified.

Objective To evaluate the effect of pretreatment with butorphanol to prevent injection pain of rocuronium bromide.Methods One hundred and fifty ASA Ⅰ-Ⅱ grade patients,undergoing elective surgery were divided into 3 groups by random digits table with 50 cases each.Butorphanol group received butorphanol 2 mg,fentanyl group received fentanyl 100 μg,and control group received 0.9％sodium chloride when general anesthesia induced.Anesthesia was induced with propofol 2 mg/kg and the test drug was injected over 30 s,120 s after the test drug injection,1％ rocuronium bromide 0.6 mg/kg was injected.Nausea,vomiting,apnea and bucking were recorded after drugs injection.Results The rates of rocuronium bromide injection pain in fentanyl group[10％(5/50)]and butorphanol group[8％(4/50)]were significant lower than that in control group[82％(41/50)](P ＜ 0.01).None of the patients discovered nausea,vomiting,apnea and bucking in 3 groups.Conclusion Pretreatment with 2 mg butorphanol reduced the incidence of rocuronium bromide injection pain,furthermore,there is no untoward reaction such as nausea,vomiting,apnea and bucking.

ObjectiveTo evaluate the accuracy of cerebral state index (CSI) as an indicator of anesthesia depth in the induction of anesthesia with target-controlled infusion (TCI) with propofol and remifentanil patients.Methods Forty-four ASA Ⅰ or Ⅱ patients undergoing elective surgery were anesthetized with TCI with propofol and remifentanil.Anesthesia was induced with TCI with remifentanil and propofol.The target effect-site concentration of remifentanil was 4 ng/ml.The initial effect-site concentration of propofol was 1.5 μ g/ml and was increased by0.5 μ g/ml every 4 min,till 1 min after the level of observer’s assessment of alertness sedation (OAA/S) score was 0 score.Electric tetanic stimulation was given when the level of OAA/S score was 1 score.The CSI,mean arterial pressure (MAP),heart rate (HR),OAA/S score and the effect-site concentration of propofol were recorded.ResultsCSI values declined with the decrease of OAA/S score,CSI was 91 ±5,77 ±7,70 ±7,62 ±6,49 ± 12,36 ± 10 at OAA/S score with 5,4,3,2,1score.CSI values were statistically different between 0 score and 1 score,1 score and 2 scores,3 scores and 4 scores,4 scores and 5 scores of OAA/S score(P ＜0.05).The differences of MAP,HR had no statistical significance between two scores of OAA/S score (P ＞0.05).The Spearman rank correlation coefficients between CSI,MAP,HR and OAA/S score were 0.899,0.342,0.125,respectively.The prediction probabilities to differentiate different OAA/S score for CSI,MAP,and HR were 0.89 ± 0.05,0.62 ± 0.08,0.53 ±:0.11,respectively.There was linear regression relationship between CSI and the effect-site concentration of propofol (the coefficient of determination was 0.812,P ＜ 0.01 ).ConclusionDuring the induction of patients with TCI with propofol and remifentanil,the CSI is accurate as an indicator of awakening and different levels of consciousness after anesthesia,and can reliably predict the anesthesia depth.

Objective To understand the status quo of work satisfaction of the graduates of GP vocational training program by Zhongshan hospital Fudan university,to provide bases for making best GP career development strategy by health authorities.Methods Using short form of the career orientation inventory to conduct career investigation of the 152 graduates of GP vocational training program by Zhongshan hospital,Fudan university.152 questionnaires were issued and the effective response rate was 100％.Results The top of GPs' career anchor is job security orientation (106,69.7％),followed by technical competence (28,18.4％),service (8,5.3 ％),managerial (5,3.3 ％),autonomy (3,1.9％),lifestyle (1,0.7 ％),entrepreneurship (1,0.7 ％),pure challenge (0,0) and geographic security orientation (0,0).We found that for male GPs,they displayed higher score for entrepreneurship orientation than female GPs (t =2.775,P =0.006).Those older than 35 displayed higher score for geographic security orientation than those younger than 35 (t =-2.154,P =0.033).GPs with at least 10 years' work experience displayed higher score for geographic security orientation than those with less than 10 years' work experience (t =-2.414,P =0.017).The distribution of all types of career orientations of GPs was the same no matter how different their degrees and professional titles were.Conclusions Job security orientation and technical competence are the major job orientations of GP vocational training program by Zhongshan hospital,some career anchor orientations are related to age,gender and duration of work experience.Effective career management should be conducted based on these characters of the graduates' career orientation.

Most pelvic fractures were commonly seen in polytrauma caused by violent forces,and often complicated with hemorrhagic shock,with mortality being 25%～39%.Anti-shock and control of bleeding are th e philosophy of treatment of this critical condition.Since 1985,hundred s of pelvic fracture victims have bee n sal-vaged in my hospital by VIP procedure which means ventilation(V),infusion(I),and pulsation(P).First,V was to establish an airway,then I was to manage hypovolumic shock,and fin ally,P was to improve the impaired heart function to maintain normal hemodynamics and tissue perfusion.It was necessary for antishock therapy to infuse rapidly and sufficiently in o rder to gain diluted blood.Pneumatic antishock garment,angiography an d em-bolism,and retroperitoneal tampon aded bleeding could control most hem orrhage associated with pelvic fractures.[

Images of 812 patients undergoing dual-source CT coronary angiography were analyzed retrospectively. Effectively nursing can be improved to guarantee the quality of coronary angiography and diagnosis of diseases.