Objective To evaluate the clinical significance of myocardial enzymes and high sensitive C-reactive protein( hs-CRP) in children with herpangina. Methods A total of 80 children with herpangina( obser-vation group,n=80),at the same time,50 healthy children as control group(n=50)were assigned for the detec-tion of myocardial enzymes(AST,LDH,CK,CK-MB)and hs-CRP. Results The elevated CRP levels were found in 45(56. 25%)patients of observation group and 2(4%)patients of the control group,showing statistical significance(χ2 =31. 55,P<0. 01). Abnormal myocardial enzyme levels were observed in 59(73. 75%)cases, which included AST 51. 6%, CK 40. 1%, CK-MB 21. 4%, LDH 72. 2%. Abnormal myocardial enzyme levels were observed in 6(12%) cases of control group,which included AST l6%,CK 10%,CK-MB 4% and LDH 12%. The significant differences were observed between the two groups ( P<0. 01 ) . Conclusion Herpangina children may have different degrees of myocardial damage. Myocardial enzymes and hs-CRP are useful indicators for myocardial injury which may effectively provide reference for clinical diagnosis and treatment.

Objective: To prepare a simple, practical fiberoptic bronchoscope (FB) training simulator, and to evaluate its training efficacy. Methods: A box apparatus was designed for basic and advanced FB training; the box consisted of five boards with holes in it. The holes were aligned according to the entries of bronchus to pass the FB. Assistant materials could be placed in the box to simulate foreign bodies due to diseases, which was aimed to help the training of sophisticated skills including tracheal tube intubation, biopsy, brushing and bronchoalveolar lavage. To testify the training efficacy, forty volunteer residents who had never manipulated a FB were randomly assigned into two groups: one group was trained using the prepared training box (Group TB, n = 20) and the other group was trained using video-based technique (Group C, n = 20). The trainees of the two groups received an intubation examination using an advanced patient simulator, and the periods of intubation was compared between the two groups. Results: Flexible fiberoptic bronchoscope could smoothly pass through the holes in the box; the photos of the holes under bronchoscopy well simulated the normal images. All residents completed the training and examination. The mean duration of intubation was (55. 7 ± 10. 2) s in Group TB and (69. 3 ± 8. 9) s in Group C (P<0. 001). Conclusion: The present training box is simple and practical, and it can be used for advanced training of FB, with obvious training efficacy.

Objective: To screen for an optimized siRNA sequence targeting rat Toll-like receptor 4 (TLR4) in vitro. Methods: The full length gene of rat TLR4 was cloned and inserted into pEGFP-C1 plasmid to construct pEGFP-rTLR4. Three pairs of siRNAs targeting rTLR4 were chemically synthesized and were co-transfected with pEGFP-rTLR4 into HEK-293 cells via Lipofectamine2000. Cells were also co-transfected with siRNA targeting EGFP and negative control siRNA. The expression of EGFP was observed under inverted fluorescene microscope and flow cytometry. Results: Compared with the negative control group, 3 pairs of siRNAs targeting TLR4 and one pair of siRNA targeting EGFP significantly suppressed the EGFP expression (P<0.05); the inhibitory effect of siRNA2 (gene sequence: 5′-GTC TCA GAT ATC TAG ATC T-3′, 19 bp, 1 352-1 370) was the strongest one, with an interference efficiency over 75%. Conclusion: We have successfully obtained the siRNA sequence targeting TLR4 mRNA, which can efficiently suppress the expression of rat TLR4 mRNA in vitro.

Objective To evaluate the feasibility of trans-umbilicus two-port laparoscopic procedures in pediatric surgery.Methods Sixty children (age, 3 months～14 years; mean, 3.5 years) with indirect inguinal hernia and 40 children (age, 2.5～14 years; mean, 6.3 years) with appendicitis underwent supra-high ligation and appendectomy, respectively, by using mini laparoscope from January 2003 to December 2003. During the supra-high ligation, the camera and forceps were respectively introduced via the left and right side of umbilical ring, and a hernial-ring needle with suture was brought in at the site of body surface projection of internal ring to apply external knotting. During the appendectomy, laparoscopic instruments were put through the site of right McBurney’s point, and explorations for contralateral hernia or other digestive tract malformations were applied simultaneously. Results All the operations were completed smoothly. The mean operating time was 8.5 min and 55.7 min in hernia repair (per side) and appendectomy, respectively. The mean postoperative hospital stay was 1～2 days in children with indirect inguinal hernia and 5～7 days in children with appendicitis. Follow-up for 3～12 months showed no recurrence of hernia except for 1 case of intraoperatively misdiagnosed latent hernia, which relapsed 2 months after the surgery. Postoperative abdominal cavity infection took place in 2 cases of perforated appendicitis. Conclusions Trans-umbilicus two-port laparoscopic technique is simple to perform, safe and minimally invasive. The technique has fewer complications and gives satisfactory cosmetic results, being highly recommended.

Objective To investigate the alkaloidal constituents of Nauclea officinalis, an anti-inflammatory and antibacterial traditional Chinese herb. Methods The alkaloids were isolated and purified by silica gel, Sephadex LH20, and C-18 ODS column chromatography repeatedly, and their structures were identified by spectral analysis. Results Eleven alkaloids were isolated from the stems of N. officinalis and their structures were identified as angustoline (Ⅰ), 19-O-ethylangustoline (Ⅱ), 3-S-3, 4-dihydroangustoline (Ⅲ), 3-R-3, 4-dihydroangustoline (Ⅳ), naucleamide A (Ⅴ), strictosamide (Ⅵ), vincosamide (Ⅶ), 6′-acetyl-strictosamide (Ⅷ), 2′-acetyl-strictosamide (Ⅸ), pumiloside (Ⅹ), 3-epi-pumiloside (Ⅺ). Conclusion Compounds Ⅰ-Ⅺ are isolated from this plant for the first time.

Objective To evaluate the current methods for psychiatry clinical internship and needs for innovation from the perspectives of medical undergradutes.Methods Independent interview on patients and their relatives as well as social psychological interview were conducted for five-year psychiatry majors in clinical internship (n =72).Self-made questionnaire was used to investigate the teaching feedback concerning the practice effect and teaching method tendency.Data were analyzed by t test and P ＜ 0.05 signifies statistically significant differences.Results Medical students considered the clinical internship as the main source of psychiatry knowledge (rising from 29.4 ％ (20/69) to 36.2％ (25/69),t =4.67,P ＜0.01).Respective interviewing with patients and their families and then doing focus-group discussion was the most acceptable method for medical undergraduates:82.6％(57/69) of medical undergraduates thought this method helped expose defects of clinical skills and prejudice against psychiatry; 54.3％ (37/69) of medical undergraduates thought this method was more beneficial to acquire psychiatry knowledge.The second acceptable method was the demonstration of a typical case by teacher:27.3％ (19/69) thought this method helped expose defects of clinical skills and prejudice against psychiatry; 27.2％ (19/69) thought this method was more beneficial to acquire psychiatry knowledge.62.0％ (43/69) of medical undergraduates ranked the characteristics of the symptomatology and core symptoms differentiation as the first place.49.0％ (34/69) considered the training of interviewing skills with patients as the second important in the clinical training.91.3％ (63/69) expected to see more kinds of mental disorders.65.2 ％ (45/69) expected to learn more about the interviewing skills.Conclusions It is necessary to pay more attention to the method of doing respective interviewing with patients and their families and then making focus-group discussion.Meanwhile training of interviewing skills in the clinical internship of psychiatry should be enhanced.

Objective To explore the relationship between the expression of pS2 protein and the clinicopathological parameters in breast cancer and to evaluate the value of pS2 as a prognostic factor for breast carcinoma and a predictive factor for response to endocrine therapy. Methods Expression levels of pS2 protein, estrogen receptor (ER) and progestogen receptor (PR) in tissues from 75 cases of breast cancer were detected by immunohistochemical assay. The relationship of pS2 protein expression with patient age, menopausal status, tumor size, metastasis to the axillary lymph nodes, pathological types, ER and PR was analyzed. Results pS2 protein, expressed in 33.3% of breast carcinomas, was correlated with patient age and pathological types, but was not correlated with tumor size. The positive rate of pS2 protein before menopause was higher than that after menopause, but no significant difference was found. Similarly, higher positive rate of pS2 protein was found in patients with metastasis to axillary lymph nodes than those without, but no significant difference was found. pS2 expression was correlated with ER and PR, but they were not perfectly consistent. Conclusion In breast cancer, pS2 protein expression, associated with some clinical factors and pathological features, is a good prognostic factor. pS2 expression may be a reasonable index for endocrinotherapy of breast carcinoma, but the detection of pS2 protein can not be employed in place of the detection of ER and PR.

Objective To evaluate the value of transthoracic echocardionraphy(TTE)and angiographic appearance for measurement of the diameter of patent ductus arteriosus(PDA)in transcatheter interventions.Methods In 52 patients,the position,diameter and length of ductus arteriosus between the descending aorta and the pulmonary artery were observed and the narrowest diameter of PDA was measured by TTE.In angiographic appearance,pig catheter was selected to perform left lateral aortography and measure the narrowest diameter of PDA.Comparative studies were performed on the numbers measured by 2 methods.Results Aortography showed that 45 patients had funnel shape PDA and 5 patients had tubular shape PDA,while 1 patient had funnel plus tubular shape PDA and 1 patient had residual shunt after operation.TTE showed that 46 patients had funnel shape PDA,4 patients had tubular shape PDA and 1 patient had window shape PDA,1 patient had residual shunt after operation.The mean diameter of PDA measured by angiographic appearance was(3.72?2.51)mm,which was statistically lower than those by TTE(4.47?2.31)mm(t=5.17 P

Objective To explore the diagnosis and Fogarty catheter embolectomy operation management of acute arterial embolism in the extremities.Methods The clinical data of 87 cases of acute arterial embolism in the extremities treated by Fogarty catheter was ana- lyzed retrospectively,Results All cases were diagnosed through asking patient history and symptom,physical examination and the check of color Doppler while the results were proved by operation.No one case received vasography.After operation,78 cases blood stream of limb had been resumed and cure rate of 87.6% was achieved while 4 cases improved(4.5%),and no occurrence of ischemic necrosis and amputated ex- tremity.5 cases(5.6%)received amputation at the relative level and there were 2 cases(2.3%)of perioperative death.Those cases who re- ceived operations within 48 hours from the time of morbidity achieved cure rate of 100%,while those cases more than 48 hours achieved cure rate of 47.6%,improvement rate of 19.0%,amputation rate of 23.8% and mortality of 9.6%.Conclusion First,Ultrasound Doppler exami- nation should be taken for avoidance of misdiagnosis when acute extremity arterial embolism is suspected.Second,The key Intraarterial embo- lectomy using Fogarty catheter is an effective method for the treatment of acute arterial embolism in the extremities,is significant in application,Third,as soon as the diagnosis is established,embolectomy with Forgarty catheter must be carried out to avoid clot extension and necrosis of the extremity.Satisfactory therapeutic efficacy can be got,if the patient receive operation within 48 hours from onset.

Objective To evaluate the criteria for diagnosis of atypical squamous cells(ASC)and its two subtypes: undetermined significance ASC (ASC US) and atypical squamous cells cannot exclude high grade intraepithelial lesion (HSIL, ASC H) defined in 2001 the Bethesda system(TBS) Method One thousand one hundred and eighty six pap smears and liquid based thin layer preparations with diagnosis of atypical squamous cells of undetermined signification (ASCUS) according to TBS 1991 criteria, were re classified by a cytopathologist using TBS 2001 criteria Results The cytologic diagnosis according to TBS 2001 criteria was: negative in 285 cases(24 0 %), ASC US in 627 cases (52 9 %), ASC H in 254 cases(21 4 %), low grade intraepithelial lesion (LISL) in 16 cases(1 3 %), and HISL in 4 cases (0 3 %), respectively Out of 1186 cases, 168 received histological examination Cervical intra epithelial neoplasia (CIN) II III were diagnosed in 18 9 % of patients with ASC H, 5 2% of patients with ASC US, and 14 3% of patients with ASCUS defined by using TBS 1991 criteria, respectively ( P