The experience in the orthopedic teaching of the interns of medical science of law was explored.The features of the students of the medical science of law were analyzed.And related teaching project was established during the progress of orthopedic practice.Our experience emphasized on the knowledge teaching of medical ethics and medical disputes.

Objective To observe neutrophil activation and protease imbalance in airway of children after foreign-body aspiration(FBA).Methods Bronchoalveolar lavage fluid(BALF) was obtained through fiberoptic bronchoscopy.The supernatant was assayed for the concentration of neutrophil elastase(NE) using enzyme-linked immunosorbent assay(ELISA) and elastase inhibition capacity(EIC)/free elastase activity using a colorimetric assay.The cell pellet were smeared for the expression of ?1-antitrypsin(?1-AT) using cellular immunohisto-chemistry and cytologic analysis by Wright-Giemsa stain.Results Percentage of neutrophil,concentration of NE and the expression of ?1-AT in BLAF group,pair group and pneumonia group significantly increased compared with that of control group(Pa0.05).The ratio of Lib NE in FBA,par and peumcria group was 30.3%,27.3% and 22.7%.Conclusions FBA induces similar airway neutrophil activation and protease imbalance to bacterial pneumonia.The contralateral airway showes the same change as the foreign body side.

OBJECTIVE: To develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS) screening method for 45 poisonous alkaloids in blood. METHODS: Identification was based on the compound's retention time and two precursor-to-production transitions. The method involved a liquid-liquid extraction (LLE) followed by LC-MS/MS with multiple-reaction monitoring (MRM). When 1 mL of blood was extracted with diethyl ether at pH = 9.2 with SKF525A as the internal standard, the target compounds were analyzed with LC-MS/MS in the positive ionization mode. RESULTS: The target alkaloids had good linearity (r>0.995 1), both the intra-day precision and inter-day precision being less than 14.77%. The limits of detection ranged from 0.05 to 25 ng/mL in blood. CONCLUSION The method is selective and sensitive in detecting poisonous alkaloids with a total running time of 12 minutes; therefore it was successfully applied to some actual cases of suspected alkaloids poisoning.
Alkaloids/chemistry* ; Chromatography, Liquid/methods* ; Forensic Medicine ; Humans ; Liquid-Liquid Extraction ; Mass Spectrometry ; Sensitivity and Specificity ; Tandem Mass Spectrometry/methods*

Objective To explore the executive function in clinical subtypes of attention deficit hyperac?tivity disorder( ADHD) . Methods 19 children with ADHD/ inattentive type( ADHD?I) ,13children with ADHD/hyperactive?impulsive( ADHD?HI) 33 children with ADHD/combined type ( ADHD?C ) and 30 normal children were tested by Stroop test ( included Stroop C and Stroop CW) ,modified Wisconsin card sorting test( M?WCST) , tower of Hanoi,digital span and verbal fluency. Results The scores of Stroop C and Stroop CW,digit inverse reci?ting,tower of Hanoi and WCST in the children with ADHD were worse than those in normal control((104.8±4.0), (105.9±4.2),(104.8±3.7),(104.8±4.0), P<0.05;(84.0±9.2),(84.8±7.9),(78.2±7.8),(92.2±7.1), P<0.01;(4.0±1.8),(3.7±1.2),(3.8±1.5),(5.1±1.6), P<0.01;(3.0±1.0),(3.3±1.0),(2.7±1.3),(3.8±1.3), P<0.01;(4.1±1.6),(4.2±1.9),(4.3±2.1),(5.4±1.7), P<0.05;(6.6±3.2),(6.7±2.4),(8.0±2.9),(5.3± 2.4), P<0.01;(10.2±2.8),(11.1±3.8),(12.3±4.0),(9.4±3.2), P<0.05). The scores of Stroop CW in the chil?dren with ADHD?C were worse than those in other two subtypes(P<0.01). Conclusion The executive functions of the chil?dren with ADHD are impaired,including poor response inhibition,working memory,planning and cognitive flexibility. The dysfunction of response inhibition is possible an index to discriminate the subtypes of ADHD.

Objective To explore the effects of rosiglitazone on the expression of TNF-? in visceral adipose tissue of insulin-resistant rats induced by high-glucose diet. Methods Sprague-Dawley (SD) rats were fed with high-glucose diet for 6 months to reproduce the non-obesity insulin-resistant rat model (abbreviated as IR rats). The model rats were then randomized into insulin resistan (IR) group and rosiglitazone (ROS) group (10 each). Ten rats fed with normal diet were enrolled as controls (CN group). Rats in ROS group were administered with 10?mol/(kg?d) of rosiglitazone for 6 weeks from the 7th week of experiment,and those in CN and IR groups were administered with same amount of distilled water. At the 6th and 12th week,the systolic pressure,body weight,and biochemical parameters (fasting and 2-hour post-glucose load plasma glucose,insulin,free fatty acid,triglyceride,high density lipoprotein cholesterol) were measured,and insulin resistance index (HOMA-IR) was calculated. At the end of the 12th week,the visceral adipose tissue was collected to calculate the ratio of visceral fat to body weight (VF/BW),and to determine the protein and mRNA expressions of tumor necrosis factor-? (TNF-?) with inmmunohistochemical assay and RT-PCR. Results As compared with CN group,the systolic pressure,HOMA-IR,plasma insulin,triglyceride and free fatty acid increased,whereas high density lipoprotein cholesterol decreased (P0.05). Inmmunohistochemical examination showed positive expression of TNF-? in intercellular substance,but not in visceral adipocytes. The expressions of TNF-? protein and mRNA in visceral adipose tissue were dramatically higher in IR group than in CN and ROS groups (P0.05). Conclusion Rosiglitazone may significantly abate insulin resistance,reduce the abnormality of plasma lipid and blood pressure,and inhibit the over expression of TNF-? in visceral adipose tissue in the non-obesity insulin-resistant rats induced by high-glucose diet.

Objective: To investigate the potential role of me latonin in the adrenal cortex of human embryo. Methods:Specifi c melatonin receptors was localized and characterized in the adrenal cortex of h u man embryo by means of immunohistochemistry. Results: mt1 （Me l1a）and MT2 （Mel1b）subtype of melatonin receptors was principally localize d to cytoplasm in zona glomerulosa， fasciculata and reticularis. Conclu sion: It is possible that mt1 and MT2 subtype of melatonin receptors co-exist in the adrenal cortex of human embryo.

Objective To investigate the efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin versus cisplatin for patients with middle-advanced stage uterine cervical carcinoma.Methods 180 patients with middle-advanced stage uterine cervical carcinoma were randomized into concurrent chemoradiotherapy with nedaplatin group (nedaplatin group) and concurrent chemoradiotherapy with cisplatin group (cisplatin group).The short-term efficacy and the toxicity were observed.Results In the nedaplatin group,the short-term response rate、the one-year relapse-free surviva l、one-yea metastasis-free survival、the two-year relapse-free survival、the two-year metastasis-free survival were 98.85％、89.66、86.21％ 、85.06％ 和 80.46％,But in the cisplatin group,the short-term response rate 、the one-year relapse-free surviva l、one-yea metastasis-free survival、the twoyear relapse-free survival、the two-year metastasis-free survival were 97.60％ (x2 =3.07,P ＞ 0.05) 、81.93％(x2 =3.07,P ＞0.05) 、83.13％ (x2 =0.31,P ＞0.05) 、78.31％ (x2 =1.30,P ＞0.05) 和 80.72％ (x2 =0.00,P ＞ 0.05),so there was no significant difference.The incidences of nausea and vomiting in the cisplatin group were 52.27％ (grade Ⅰ ～ Ⅳ toxicities),12.50％ (grade Ⅲ ～ Ⅳ toxicities),which were higher than those in the nedaplatin group 27.27％ (grade Ⅱ ～ Ⅳ toxicities),6.82％ (grade Ⅲ ～ Ⅳ toxicities) (P ＜ 0.05),while there were no significant difference in the other toxicities such as anemia,granulocytopenia,thrombocytopenia,diarrhoea between the two groups (x2 =12.18,P ＞ 0.05).Conclusion The efficacy of concurrent chemoradiotherapy with nedaplatin is the same as that of concurrent chemoradiotherapy with cisplatin,and its toxicity is well-tolerated.

Objective To develop a diabetes risk score (DRS)to predict the risk of development of incident diabetes in male senile people in Beijing. Methods DRS was developed basing on a test group including a cohort of 1 370 individuals aged 48-87 years without diabetes at baseline, followed for 10 years by Logistic regression and validated on a value group including a cohort of 340 individuals aged 43-88 years without diabetes at baseline. Results The model with the highest area under the ROC curve ( AUC ) included age, hypertension,history of hyperglycemia, body mass index, fasting plasma glucose, triglycerides, and high-density lipoproteincholesterol (HDL-C). DRS was developed basing on this model with a range from 0 to 12 and an optimal cut-off of 4. AUC were respectively 0. 726 ( 95% CI0. 692-0. 759 ) and 0. 765 ( 95% CI0. 691-0. 839 ) in test group and validation group. The sum score value ≥4 had sensitivity of 65.3% and 68. 1%, specificity of 70. 0% and 64.8%, positive predictive value of 37.0% and 23.2%, negative predictive value of 88.2% and 94. 1%.Conclusion The DRS, derived from clinical information combined with plasma glucose and lipids, is an effective tool to predict incident diabetes.

Objective To evaluate the rationale of lowering the cutoff value of impaired fasting glucose(IFG)by studying the extent and severity of angiographic coronary artery disease(CAD)and the cardiovascular risk factors in subjects with different fasting plasma glucose(FPG)levels. Methods A total of 911 consecutive patients who had undergone coronary angiography were selected according to inclusion criteria. The subjects were studied in view of the extent and severity of angiographic CAD and the cardiovascular risk factors with different FPG levels. Results (1) Compared with the group of FPG<5.6mmol/L, the numbers of diseased vessels in the group with FPG 5.6-6.0mmol/L were significantly increased(P<0.05)after adjustment of age, sex and other influencing factors; the group with FPG 6.1-6.9mmol/L had both raised number of diseased vessels and the CAD Gensini cumulative index(P<0.01). (2) The prevalences of overweight, hypertension, hypertriglyceridemia, metabolic syndrome were progressively increasing with graded FPG levels. The prevalence of hypertriglyceridemia was significantly increased with FPG level at 5.0-5.6mmol/L(P<0.05),and the prevalences of metabolic syndrome and other components were significantly elevated with FPG level at 5.6-6.0mmol/L(P<0.05). Conclusion (1) The extent and severity of angiographic CAD were increased with increased FPG even in prediabetic period. The risk of angiographic CAD became increased significantly with FPG at 5.6-6.0mmol/L level. (2) The cardiovascular disease(CVD)risk was also increased with increasing FPG even in prediabetic period. The phenomenon of clustering of CVD risk factors was found at FPG 5.6mmol/L.

ObjectiveTo evaluate the influence of different hemoperfusion (HP) intensity on 7-day and 28-day mortality for patients with paraquat (PQ) poisoning, and examine the factors that may affect the decision of the clinicians to prescribe a high intensity HP.Methods A retrospective cohort study was conducted. The patients admitted to the department of critical care medicine of Anhui Provincial Hospital Affiliated to Anhui Medical University with the diagnosis of PQ poisoning from August 2012 to August 2014, fulfilling the following criteria were enrolled in the study: older than 18 years, interval from ingestion PQ to hospital admission shorter than 12 hours, and receiving HP treatment within 24 hours, and expecting surviving time exceeding 24 hours after admission, and data of the patients available for at least 28 days after admission. Depending on the intensity of HP, patients were assigned to either lower intensity HP group (LHP, defined as receiving HP for less than 4 hours, 2 columns) or higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients' data were retrieved from hospital's electronic database after hospital admission, and the results at 7th day and 28th day were recorded. Multiple logistic regression model was used to determine factors with which the clinician decided to choose the intensity of HP for the patients, and Cox regression model was used to evaluate 7-day and 28-day mortality.Results Data of 60 patients was finally available for this study. LHP group consisted of 28 patients, with a 7-day mortality of 53.6%(15 patients) and 28-day mortality of 64.3% (28 patients); 32 patients were assigned to HHP group with 7-day mortality of 43.8% (14 patients) and 28-day mortality of 62.5% (20 patients). Twenty-eight patients constituted as the HHP group, with higher PQ concentration in plasma, higher incidence of respiratory alkalosis and acute kidney injury (AKI), and higher level of lactate (Lac) compared with LHP group. However, a lower 7-day mortality was observed in the HHP group. Multiple logistic regression model indicated that at admission, interval from ingestion PQ to hospital admission longer than 4 hours [odds ratio (OR) = 1.461, 95% confidence interval (95%CI) = 1.132-1.435,P< 0.001], younger than 50 years old (40-49 years old:OR = 1.397, 95%CI = 1.251-1.703,P = 0.002;< 40 years old:OR = 1.701, 95%CI = 1.253-1.836,P< 0.001), PQ plasma concentration≥ 2 mg/L (OR = 3.140, 95%CI = 1.511-3.091,P< 0.001), white blood cell (WBC)> 10×109/L (OR = 1.222, 95%CI = 1.032-1.275, P = 0.018), Lac> 2.0 mmol/L (OR = 2.392, 95%CI = 2.090-2.734,P< 0.001), AKI on admission (stage 2:OR = 2.350, 95%CI = 2.160-3.910,P< 0.001; stage 3:OR = 2.821, 95%CI = 1.932-3.651,P< 0.001), accompanying hypoxia (OR = 2.420, 95%CI = 2.131-2.662,P = 0.003) were more likely to receive higher intensity of HP. Furthermore when compared with patients survived for 28 days, patients who were older, with higher levels of PQ concentration at admission or after 4 hours of HP, accompanied by AKI, increased serum creatinine (SCr), WBC, Lac, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, lower arterial partial pressure of carbon dioxide (PaCO2) and lower pH value were more likely to die. After adjusted for con-variables in COX regression model, HHP was associated with lower 7-day mortality after admission [hazard ratio (HR) = 0.843, 95%CI = 0.732-0.971, P = 0.032], but devoid of lowering effect on 28-day mortality rate (HR = 0.930, 95%CI = 0.632-1.411,P = 0.423). In addition, age> 50 years old (HR = 1.282, 95%CI = 1.050-1.530,P = 0.043), PQ concentration increased by 1 mg/L (HR = 2.521, 95%CI = 2.371-3.825,P = 0.012), AKI on admission (HR = 3.850, 95%CI = 2.071-5.391,P< 0.001), WBC>10×109/L (HR = 1.932, 95%CI = 1.782-2.171,P = 0.006), Lac> 2.0 mmol/L (HR = 2.981, 95%CI =2.210-3.792,P = 0.002), and PaCO2< 35 mmHg (HR = 1.772, 95%CI = 1.483-2.516,P = 0.008; 1 mmHg =0.133 kPa) were independent risk factors for 28-day mortality.Conclusions Though HHP was helpful in lowering mortality rate in patients with PQ poisoning within 7 days, it did not influence on 28-day mortality. Clinicians' decisions on HP intensity need further investigation, and more perfect clinical evaluation system is required for reasonable use of expensive medical resources such as HP.