Objective: To investigate the effect of three different goals of blood glucose control by insulin therapy on protein metabolism in the patients with critically cerebral disease.Methods: We performed a prospective,randomized,controlled study.A total of 122 patients with critically cerebral disease were randomly divided into three groups according to the target glucose-control levels:Group A: 4.4-6.1 mmol/L(n=41),Group B: 6.1-8.3 mmol/L(n=42),and Group C: 10-11.1 mmol/L(n=39).The state of protein metabolism and ratio of hypoglycemia of three groups were compared.Results: The indicators of nitrogen balance,prealbumin and transferrin in group A and group B were significantly better than that in group C(P<0.05),but the ratio of hypoglycemia in group A was significantly higher than those in group B and group C(P<0.05).Conclusion: Maintaining the blood glucose level ≤8.3 mmol/L might improve the nutrition status in the patients with critically cerebral disease by decreasing catabolism and promoting synthesis of protein.

A questionnaire survey on learning motivation of standardized training and influence factors was carried out and 94 residents of general practice responded. The results indicated that over 80% respondents showed a positive attitude to study and hoped to obtain opportunity for continuing education;76% thought the training program was basically rational but still need to be improved; 94% felt that the training model should be adapted to the real conditions and work requirements of Chinese community health centers. The authors suggest some measures to improve the training including suitable textbooks, more rational training programs and further improvement of education system.

Cytokines is a kind of important factor on Pathogenic of hysteromyoma.Some study provides evidence that sex homone and its product of metabolism react up regulation/down regulation for hysteromyoma by growth factor. Apoptosis and oncogene and retinoid X have influence to the growth of hysteromyoma.

A total of 20 patients with massive hemorrhage for pelvic fracture, underwent angiographic embolization with gelfoam sponge embolization agents in 3-8 hours after admitted at the Department of Orthopedics, Changhai Affiliated Hospital of Second Military Medical University of Chinese PLA between January 2001 and August 2003 were selected. The patients aged ranged from 18-70 years (mean 43.4-year-old), including 12 male and 8 female. Conduits were inserted into the internal iliac artery embranchment of 8 cases with method of ultraselection, and gelfoam sponge grain and contrast medium were injected together. Conduits combined with gelfoam sponge grain and contrast medium were inserted into 12 cases’ pathic internal iliac artery bole. The whole 20 cases were performed endovascular embolization, and blood pressures turned to normal level after operation gradually without serious complications of embolization. One case died of deterioration after blood pressure stabilization. The result reveals that anglo-graphic embolization with gelfoam sponge embolization agents is a safe, quick and effective method of controlling the severe hemorrhage caused by pelvic fracture.

OBJECTIVE To discuss the mycology characteristic of two strains of Rhodotorula glutinis causing infection in ICU,and conduct molecular biological identification and antifungal agent sensitivity experiment.METHODS The methods used included conventional mycology identification and sequencing the ITS region of strains,and the in vitro antifungal agent sensitivity experiment were done by glutinis liquid-based dilution method(M27-A).RESULTS The two strains of R.glutinis were confirmed after mycology identification and sequenced the ITS region of strains.They were both sensitive to amphotericin B and 5-flucytosine,and insensitive to fluconazole,itraconazole and voriconazole.CONCLUSIONS The reasons causing Rh.glutinis infection include catheter related infections,(total parenteral nutrition TPN) and immunosuppressives.Using amphotericin B and removing intravenous catheter can be the first choices in the treatment of Rh.glutinis infection.Azole shows insensitive to Rh.glutinis in the in vitro antifungal agent sensitivity experiment,therefore it should be used very carefully.

Objective To analyze quality of life (QOL) and its related factors in community middle-aged and aged people with osteoporosis (OP). Methods A total of 152 OP patients in one community in Shanghai were surveyed and their QOL was evaluated with a questionnaire integrated with the QUALEFFO-41 questionnaire. Factors were analyzed using a Kruskal-Wallis test and stepwise multiple regression. Results The QOL scores of these middle-aged and aged people with OP were generally low (62.58 + 14.06). Age, education level, milk intake, a history of fractures or illness, OP grade and menopause time were significant factors predicting QOL scores. Stepwise multiple regression indicated that fractures, illness, education level and menostasis time had a linear relationship with QOL. Conclusion The key points in improving the QOL of middle-aged and aged people with OP in the community are health education, early diagnosis and comprehensive treatment.

Objective To explore the expression and clinical significance of Twist. E-cadherin and N-cadherin in gallbladder carcinoma. Methods From 2000 to 2008, in Zhejiang Provincial People's Hospital, the expression of Twist, E-cadherin and N-cadherin protein were detected in 79 surgically removed gallbladder carcinoma tissue specimens in paraffin blocks and 20 normal gallbladder tissue specimens by tissue microarray technique and immunohistochemistry. Results Compared with normal gallbladder tissues, the expression of Twist and N-cadherin was up-regulated in gallbladder carcinoma tissues and the positive percentage was 68.3％ and 49.4％ respectively, while which both were 1/20 in normal gallbladder tissues. The percentage of high E-cadherin expression in gallbladder carcinoma tissues was only 27.8 ％, which was significantly lower than that in normal gallbladder tissues (20/20;X2 ＝29.31, P＜0. 05). The expression of Twist was correlated with T classification, lymph node metastasis, distant organ metastasis, hepatoduodenal ligament invasion, lymphatic invasion and UICC stage of gallbladder carcinoma (P＜0.05). The expression of E-cadherin was correlated with T classification, distant organ metastasis, hepatoduodenal ligament invasion, differentiation degree and UICC stage of gallbladder carcinoma (P＜0.05). The expression of N-cadherin was only correlated with lymphatic invasion of gallbladder carcinoma (P ＜0.05 ). There was significant negative correlation between Twist and E-cadherin expression (P＜0. 01). All the 79 gallbladder carcinoma patients were followed up after the surgery, the mean follow-up time was 30.6±14.3months. The 3-year survival rates of patients with low or high Twist expressions were 66％ and 7％ respectively,there was significant difference between the two groups(P＜0. 01). The 3-year survival rates of patients with low or high E-cadherin expressions were 25 ％ and 86 ％ respectively, the difference of two groups was significant(P＜0.01). The 3-year survival rates of patients with low or high Ncadherin expressions were 39％ and 41％ respectively, there was no significant difference between the two groups(P＞0.05). The multivariate analysis indicated that the Twist expression was one of independent prognostic factors of gallbladder carcinoma. Conclusion The abnormal expression of Twist and E-cadherin was correlated with the development and progression of gallbladder carcinoma,and Twist expression was one of the independent prognostic factors of gallbladder carcinoma.

Vibrio parahaemolyticus has been considered as one of the most important foodborne bacterial pathogens.The loop-mediated isothermal amplification(LAMP) that amplifies DNA with high specificity and rapidity under an isothermal condition was applied for rapid detection of this pathogen for the first time.A set of four primers,two outer and two inner primers,was designed specifically to recognize the thermolabile hemolysin gene(tlh) of V.parahaemolyticus.The LAMP reaction mix was optimized.The most optimal reaction temperature and time of the LAMP assay for the tlh gene were 60℃ and 60min,respectively.Genomic DNAs from 28 bacterial strains including 14 V.parahaemolyticus strains were amplified using LAMP,and no amplicon was observed in other bacterial strains.The detection limit of this LAMP assay was around 90 fg of V.parahaemolyticus genomic DNA and 24 colonies forming units for pure cultures.In addition,this method was applied to detect artificially contaminated food samples,and the detection limit was 89 cfu/g for non-cultured artificially contaminated food samples.These results suggested that detection of V.parahaemolyticus by LAMP is an effective and low-cost procedure with high specificity and sensitivity that requires no specialized equipment.This assay is expected to become a valuable tool for rapid detection and identification of V.parahaemolyticus.

A 56-year-old female patient of Han nationality presented with generalized erythema and vesicles for 6 days,as well as high fever for 2 days.Twenty days prior to hospitalization,the patient received surgical treatment combined with oral methazolamide and glucocorticoids for glaucoma.The patient had a history of allergy to sulfanilamides.On admission,the patient presented with generalized erythema,vesicles and occasional erosions with bilateral eyelid and oral involvement.Nikolsky's sign was positive.Wheezing sound was heard over the right lung.Genetic testing showed that HLA-B5901 allele was positive.The patient was diagnosed with methazolamide-induced toxic epidermal necrolysis (TEN) complicated by pneumonia,and managed with immunoglobulin (25 g/day,5 days),glucocorticoids (the largest dose equivalent to methylprednisolone 160 mg/day),fresh plasma,antibiotics,as well as other supporting and symptomatic treatments.The condition was controlled after 2 weeks,and the patient was cured and discharged from hospital after 25 days.The fact that the patient carried HLA-B5901 allele suggests that HLA-B5901 is strongly correlated with methazolamide-induced TEN or Stevens-Johnson syndrome in Chinese descendants or Han population,besides in Japanese and Korean descendants.

Objective To explore the influence factors of hidden blood loss during the treatment of femoral intertrochanteric fractures with percutaneous compression plate( PCCP) in elder patient. Methods The data of 136 patients with intertrochanteric fracture in our hos-pital from March 2009 to March 2012 treated with percutaneous compression plate were retrospectively analyzed,the effect of age,fracture type,preoperative aspirin,internal diseases on perioperative hidden blood loss, and different haemoglobin ( HGB) levels in patients with dif-ferent distribution were analyzed. Results The mean hidden blood loss volume was 499 mL,which accounted for 92. 54% of the total blood loss. The mean HGB decline was 11 g/L. The rate of on admisson haemoglobin level lower than 80 g/L was 6. 62% in AO type A2. 3 and A3 groups,and the rate of postoperative haemoglobin level lower than 80 g/L was 14. 70%. The average hidden blood loss for AO type A2. 3 (862 mL) and A3 (698 mL) were higher than those for AO types A1 (430 mL),A2. 1 (450 mL) and A2. 2 (415 mL) (P<0. 05). Multi-variate linear regression analysis showed that comminuted fracture and preoperative aspirin treatment were independently associated with in-creased perioperative hidden blood loss. Conclusion It indicated that the overt blood loss was fewer for PCCP operation. Intertrochanteric fracture was the main reason for substantial perioperative hidden blood loss. Types A2. 3 and A3 intertrochanteric fracture were early predic-tive factors of postoperative haemoglobin level lower than 80 g/L in elderly patients.