BACKGROUND: Blood-letting puncture on 12-well points of hand is a kind of effective emergent approaches on cerebral apoplexy. It is testified in animal experiment that bleeding on 12-well points of hand can dilate cerebral vessels, enhance blood flow in brain, improve acute anoxic state in ischemic brain tissue and relieve acid toxin due to accumulation of lactate.OBJECTIVE: To explore the effects and mechanism of blood-letting puncture of 12-well points of hand nitric oxide (NO) contents and nitricoxide synthase (NOS) activity after cerebral ischemia in rats.DESIGN: Randomized controlled animal experiment was designed.SETTING: Department of Physiology of Medical Institute of Xianning College.MATERIALS: The experiment was performed in Department of Physiology of Medical Institute of Xianning College from March 2003 to February 2004. Totally 84 Wistar rats were employed in the experiment, aged of 2 or 3 months, of either sex, body weighted (230±20) g and provided from Experimental Animal Center of Medical Institute of Xianning College.METHODS: Totally 84 rats were randomized into sham operation group,ischemia group and ischemia + bleeding group, 28 rats in each one. Modified Longa method [3] was applied to prepare the model of embolism of cerebral middle artery in rat. In ischemia + bleeding group, after cerebral ischemia, blood-letting puncture was applied with three-edged needle on Shaoshang (LU11), Shangyang (LI1), Zhongchong (PC9), Guanchong (TE1),Shoochong (HT9) and Shaoze (SI1) in sequence firstly on the left foreleg,and then on the right one, corresponding to the analogy of 12-well points of hand of human. One blood drop was just required. NO content and NOS activity were assayed in 30 minutes, 1 hour, 2 hours and 4 hours of ischemia in brain tissue successively in each group.MAIN OUTCOME MEASURES: NO content and NOS activity in brain tissue in each group.RESULTS: ① NO content in 30 minutes, 1 hour, 2 hours and 4 hours of ischemia in ischemia group was (116.16±26.63), (118.94±24.47),(115.65±25.29) and (108.87±26.52) μmol/L successively and NOS ac tivity was (507.22±92.52), (502.08±92.52), (510.71±96.63) and (495.29-±88.41) μkat/L, which was higher significantly than the sham operation group (t=2.474-4.731, P ＜ 0.05 or 0.001). ② In ischemia + bleeding group,, NO content was (91.8±11.51), (93.55±13.88), (92.52±11.62) and (84.3±11.51) μmol/L successively and NOS activity was (337.6±88.41),(340.99±96.63), (344.48±84.3) and (337.6±90.46) μkat/L, indicating significant difference in comparison with ischemia group (t=2.199-3.507,P ＜ 0.05-0.01).CONCLUSION: Blood-letting puncture on 12-well points of hand inhibits the increased NO content and NOS activity in ischemic brain tissue and alleviates the injury of free radical to brain tissue so that the focal brain ischemia of rats is protected.

Objective:To analyze the rationality of off-label drug use in nephritic syndrome prescriptions to provide scientific basis for clinical rational drug use and further regulate the off-label drug use in our hospital. Methods:Totally 1 908 outpatient prescriptions of nephritic syndrome selected from our hospital during November 2014 to April 2015 were analyzed, and all the off-label drugs were listed . The rationality of the off-label drug use was analyzed and evaluated by searching the related kidney disease guidelines and litera-tures. Results:The off-label drug use of tacrolimus capsules, mycophenolate mofetil capsules, cyclophosphamide for injection, ciclos-porin soft capsules, dipyridamole tablets, hydroxychloroquine sulfate tablets and warfarin sodium tablets were recommended by domes-tic and overseas guidelines with better evidence of evidence-based medicines. Tripterygium glycosides tablets and leflunomide tablets were supported by the literatures on clinical studies at home and abroad. The above 9 kinds of off-label drugs were rational drug use. Lumbrokinase enteric-coated capsules, salvia miltiorrhiza and ligustrazine injection and pidotimod dispersible tablets were reported only by a handful of journals. Bacteria lysate capsules and boric acid powder had no related information support, which belonged to the em-pirical prescriptions of physicians. The above 5 kinds of off-label drugs were not rational drug use. Conclusion:It is a widely existing phenomenon that the medication in nephrotic syndrome is beyond the instruction, the most of off-label drug use are reasonable, and cli-nicians should prescribe medicines carefully. Our hospital needs to further standardize the management of off-label drug use supported by higher evidence in order to improve the level of clinical rational drug use and the reasonable rate of prescriptions.

Objective: To identify the clinical features and prognostic factors in relation to extremity osteosarcoma with pathological fracture. Methods: The clinical data from 244 patients with extremity osteosarcoma between October 2003 and October 2011 were retrospectively reviewed. These patients were divided into two groups: patients with pathological fracture group and the patients without pathological fracture group. The differences in the clinical features of the two groups were analyzed. The survival analysis was performed using Kaplan-Meier method. For patients with pathological fracture, a univariate analysis (log-rank) was used to determine the prognostic factors related to the survival, and a COX proportional hazards regression model was used to identify the independent prognostic factors. Results: A higher proportion of patients with larger tumor size (P = 0.012), humeral osteosarcoma (P = 0.004) or local recurrence (P = 0.002) was observed in patients with pathological fracture. Additionally, more patients with pathological fracture received an amputation surgery, as compared with patients without pathological fracture (P = 0.032). The median survival time of patients with pathological fracture was significantly shorter than that of patients without pathological fracture (16 vs 21 months, P = 0.006). The univariate analysis showed that the significant prognosis-related factors were the tumor size, Enneking's surgical staging, KPS (Karnofsky performance status) score, cycles of adjuvant chemotherapy, local recurrence and metastasis (P < 0.05). The multivariate analysis revealed that the factors of KPS score, cycles of adjuvant chemotherapy and metastasis were the independent prognostic factors of extremity osteosarcoma with pathological fracture. Conclusion: Compared with the patients without pathological fracture, a higher proportion of patients receiving amputation surgery or having larger tumor size, humeral osteosarcoma or local recurrence was observed in patients with pathological fracture, and the prognosis of these patients was poor. The KPS score, cycles of adjuvant chemotherapy and metastasis were independent prognostic factors of extremity osteosarcoma with pathological fracture. Copyright © 2012 by TUMOR.

Objective To explore the clinical value of serum procalcitonin(PCT)and C-reactive protein(CRP)combination detec-tion in early diagnosis of liver cirrhosis complicating spontaneous bacterial peritonitis(SBP).Methods The peripheral blood sam-ples were collected from 30 cases of liver cirrhosis complicating SBP,30 cases of simple ascites liver cirrhosis (non-SBP)and 45 healthy subjects as control group.The serum PCT level was detected by the dry immunofluorescence quantitation method and the serum CRP level was detected by the immunoturbidimetry.The sensitivity and specificity of PCT,CRP and PCT combined with CRP in diagnosing liver cirrhosis complicating SBP were compared and the relationship between PCT levels and prognosis was ana-lyzed.Results Compare with the healthy control group and the non-SBP group,the serum PCT and CRP levels in the SBP group were markedly increased(P <0.05).The sensitivity of PCT,CRP and PCT combined with CRP in diagnosing liver cirrhosis compli-cating SBP was 93.3%,90.0% and 96.6% respectively,and the specificity was 90.0%,75.0% and 95.0% respectively.Conclusion The combination detection of serum PCT and CRP can increase the sensitivity and specificity of the diagnosis and has more clini-cal value in early diagnosing liver cirrhosis complicating SBP.

Objective To research the most commonly used five method to evaluated the difficulty airway , and compare which methods were more suited for the pregnant woman in general anesthesia. Methods 214 patients with full-term pregnancy who requested emergency or elective caesarean-section were assigned. During the pre-anesthetic visit,we evaluated patients from Mallampati score, thyromental distance, body mass index (BMI), inter-incisor gap, and upper lip bite test. After endotracheal intubation ,patients were divided into 2 groups based on Cormack classification. Results Five ways sensitivity descending order were upper lip bite test (79.5%)、Mallampati score (76.9%)、BMI (56.4%)、inter-incisor gap (51.3%)、thyromental distance (35.9%); specificity descending order were upper lip bite test (93.1%)、Mallampati scores (86.3%)、inter-incisor gap (85.1%)、thyromental distance (76.6%)、BMI (62.3%). Conclusions In pregnant women ,Mallampati score and the upper lip bite test are the better indicators to predict difficult airway.

Objective To analyze the influence of radial neck fracture on the upper limb function in older children,and to evaluate the curative effect of plate fixation in the treatment of Salter-Harris Ⅱ type of radial neck fracture.Methods The clinical data of 16 older children with radial neck fractures who treated by T plate internal fixation were retrospectively analyzed.16 cases were closed fractures,merging radial nerve injury in 1 case,3 cases of distal humerus fractures,1 case with rib fractures,fractures were Salter-Harris Ⅱ type,adopt steel plate internal fixa tion.Results 1 6 patients were followed up for 9-1 8 months.X-ray healing time was 6-9 weekson average 7.6 weeks.No malunion and no healing,no case of epiphyseal injuries.1 patient appeared steel block forearm supination.Postoperative patients with forearm pronation were greater than 90° supination were greater than 60 °.No radial nerve injury.Evaluation results were good.Conclusion Clinical treatment effect of open reduction and plate internal fixation in the treatment of older children with Salter-Harris Ⅱ type of radial neck fracture is satisfactory.Surgical treatment not only can enhance the fracture stability,but also can do the elbow joint function exercise to prevent dysfunction much earlier.

Objective To investigate the clinical efficacy of Hiru doid,Sufu and Musk Hemorrhoids Ointment on preventing peripheral chemothera?peutic phlebitis due to continuous infusion of 5?fluorouracil. Methods Totally 90 patients with esophageal squamous cell carcinoma treated with continuous infusion of 5?fluorouracil were recruited and randomly divided into Hirudoid group,Sufu group and Musk Hemorrhoids Ointment group, with 30 cases in each group. Three groups were applied with drugs respectively along the vein punctured while connecting the pump of 5?fluorouracil 3 times a day(each time interval of 6 hours)for 5 consecutive days. The occurrence of chemotherapy phlebitis was observed and recorded. Results Musk Hemorrhoids Ointment and Sufu were more effective than Hirudoid in reducing the incidence of phlebitis and relieving the degree of venous in?jury(P<0.05);however,there were no differences between Musk Hemorrhoids Ointment and Sufu(P>0.05). Musk Hemorrhoids Ointment was the most effective among the three in relieving the pain caused by phlebitis(P<0.05). There were no difference between Sufu and Hirudoid(P>0.05). Conclusion Musk Hemorrhoids Ointment can effectively prevent peripheral chemotherapeutic phlebitis caused by continuous infusion of 5?fluorouracil with affordable expense which is worthy of promotion in clinic use.

Objective To compare the therapeutic effects of hyperbaric oxygen (HBO) therapy at different time points on patients with spinal cord injury. Methods A total of 284 cases of spinal cord injury (SCI) were divided into an HBO group and a control group. The control group was treated with routine interventions (including a dehydrator, medication for neurotrophy, rehabilitation management, acupuncture and supportive treatment). The HBO group was treated with HBO in addition to the routine treatments, initiated at different time points after onset of SCI ( from less than 8 hours to longer than 1 week). All of the patients were evaluated in terms of scores on the American Spinal Cord Injury Association (ASIA) assessment and Barthel's index (BI) before and after treatment.Results Both groups had excellent effects when the treatment was initiated within the first 8 hours after the onset of SCI. There was no significant difference between the two groups. Average ASIA and BI scores in both groups improved significantly within the first 24 hours, and over the 1 st week after the onset of SCI. The recovery of neurological function and ability in the activities of daily living (ADL) was significantly better when HBO treatment was initiated within 8 hours after SCI compared with that initiated after 24 hour and 1 week. The therapeutic effects in the HBO group patients were significantly better than in the control group when HBO was initiated at 8 and 24 hours after onset of SCI. Neither the HBO group nor the control group had significant further improvement in ASIA scores or ADL performance when treatments initiated after 1 week. Conclusions HBO can significantly improve neurological function and ADL performance after SCI if it is administered within 1-8 hours.

Objective To test the validity of the stress-cognition vulnerability-model of depression in Chinese undergraduates.Methods 647 undergraduate students finished the Chinese version of 6 scales in time one.Cognitive Style Questionnaire(CSQ),Response Styles Questionnaire(RSQ-SF),Self-Esteem Questionnaire(SEQ),Dysfunctional Attitudes Scale(DAS),General Social and Academic Hassles Scale for Students(GSASHS),Center for Epidemiologic Studies Depression Scale(CES-DA)follow-up assessment in 1 month later,the General Social and Academic Hassles Scale for Students(GSASHS)scale and Center for Epidemiologic Studies Depression Scale (CES-D)scale were completed.Then,vulnerability factors for depression symptoms were used to predict depression symptoms by Multiple Hierarchical Regression(MHR).Path analysis and structural equation model(SEM)were used to explore integrated vulnerability-stress model of depression in Chinese undergraduates.Results Vulnerability-stress interaction was entered into regression equation.The results showed that the vulnerability-stress interaction provided incremental predictive validity to depressive.Symptoms path analysis showed that negative cognition→rumination→depression was a important pathways to cause depression(β=-0.31,P<0.01).The structural equation model for integrated vulnerability-stress model of depression analysis indicated the fit index:GFI =0.95,CFI=0.94,IFI=0.94,RMSEA=0.085.Conclusion A cognition vulnerability-stress medels of depression in Chinese undergraduates was provided and to be confirmed.The rumination was a important mediated variable.

The rapid deployment flow for medical support unit of health-care train is discussed in the aspect of personnel spot-training with carriage. A handbook is compiled for loading and unloading health-care train's equipment. A series of methods and processes are put forward based on the principle of " fixed type of equipment, fixed person for loading or unloading, fixed position, fixed operation steps", which provides a possibility for rapid deployment flow at medical support unit.