Objective To investigate the biology reference intervals for five parameters of thyroid gland function(TSH,T3, T4,FT3 and FT4)in Baoji area,in order to provide evidence for effective filtration and diagnosis.Methods Refer to the files recommended by (NCCLS)C28-A2 about the description of definition,establishment and confirmation,five parameters of thyroid gland function were measured in 4 820 healthy persons by using Roche E601 electrochemical immunoassay analyzer and its assemble reagent,calibration materials and quality control,the statistical method was applied to the data processing by different gender,to establish the biology reference intervals of each parameters.And compared with National Guide to Clinical Laboratory Procedures(Third Edition).Results The range of 95% normal reference intervals of TSH,T3,T4,FT3 and FT4 in male were 0.20~4.28 mIU/L,1.22~2.46 nmol/L,64.64~149.00 nmol/L,3.00~6.04 pmol/L,11.93~22.21 pmol/L respectively,and in female were 0.20~4.52 mIU/L,1.24~2.44 nmol/L,67.60~142.40 nmol/L,2.96~5.76 pmol/L and 11.86~21.54 pmol/L,respectively.Compared the level of TSH,FT3,FT4 between male and female, differences were statistical significance(t=3.962,7.570,5.132;P=0.042,0.026,0.033).Compared the level of T3,T4 be-tween male and female,there was no statistical significance (t=0.000,1.151;P=1.000,0.120).The study compared with National Guide to Clinical Laboratory Procedures (Third Edition),the results of T3,T4,FT3 and FT4 in male were statisti-cal significance (t=9.755,4.349,114.7,79.82;P=0.000,0.003,0.000,0.000),the results of TSH,T3,FT3 and FT4 in female were statistical significance (t=5.304,9.548,128.9,72.99;P=0.002,0.000,0.000,0.000).Conclusion The in-vestigation of biology reference intervals for five parameters of thyroid gland function in Baoji area can provide more precise-ly reference data for clinical diagnosis and treatment.

Objective To investigate the clinical application of serum retinal binding protein and cystain C determination in hem-orrhagic fever with renal syndrome(HFRS).Methods The serum concentrations of RBP,CysC,Urea and Cr were detected for 124 patients with HFRS(patients group)and 100 healthy people who underwent physical examination during the same period(control group),the date were analysed by SPSS19.0 software.Results The concentrations of RBP,CysC,Urea and Cr increased signifi-cantly in febrile stage of HFRS,arrived at peak in oliguria stage,and then declined gradually,there were statistically significant differences between each stage and negative control stage(P <0.05).RBP and CysC had a good positive correlation with Urea and Cr,the correlation coefficient between RBP and Urea or Cr were 0.826 and 0.892,respectively(P <0.05)while with CysC were 0. 841 and 0.924,respectively(P <0.05).The positive rates of RBP,CysC,Urea,Cr in febrile stage were 85.48%,95.16%,69.35%, 83.06% respectively,while in convalescent stage were 67.74%,74.19%,46.77% and 58.06% respectively.Conclusion RBP and CysC are good indicators for diagnosing HFRS,which also have good correlation with Urea and Cr,which are recommended in clini-cal application.

Objective To study teaching cases of health economics in the context of health reform and development in China.Method Preparing for lessons in groups,information collection,experiences summary,and field research.Result Three productions:a teaching plan,a case collection,and a guideline of case teaching.Discuss It is useful to improving students’ ability to contact theory with practices and enhance teacher’s teaching and researching ability,but it also needs further improvement.

Objective To analyze the effect of urinary ostomy bag on reduction of urinary tract infection in ICU patients with diarrhea.Methods A total of 445 diarrhea patients with indwelling catheter were admitted from June 2013 to May 2014,patients were divided into two groups according to the occurrence of diarrhea after admission,219 cases were in the observation group,226 cases were in the control group.The observation group used urinary tract ostomy bag connected with Kangwei anti-inverse drainage device,the control group used traditional methods of perianal care.Then,the incidence of urinary tract infection between two groups and the results of urine culture between patients of two groups with urinary tract infection were compared.Results The incidence of urinary tract infection in the observation group was 5.5％ (12/219),significantly lower than that of the control group,10.6％ (24/226),x2=3.952,P＜0.05.The urine culture results showed that 4 cases were intestinal strains in the observation group,and 17 cases in the control group,the difference was significant,x2=4.629,P＜0.05.Conclusions Urinary tract ostomy bag connected with Kangwei anti-inverse drainage device can effectively reduce the incidence of urinary tract infection in patients with diarrhea,it is simple to operate,and can reduce the workload of nurses and increase the comfort degree of patients,which is worthy of clinical application.

Objective To evaluate the changes in the levels of motilin in the duodenum in a rat model of incisional pain.Methods Eighty-four healthy male Sprague-Dawley rats,aged 6-8 months,weighing 180-220 g,were randomized into 2 groups (n =42 each) using a random number table:control group (group C) and incisional pain group (group P).The animals were anesthetized with sevoflurane.In group P,a 1 cm long incision was made in the plantar surface of right hindpaw.Six rats were chosen from each group and mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 24 h before operation (T0) and 1,6,24,48 and 72 h after operation (T1-5).Six rats were chosen from each group at T0-5 and sacrificed and the duodenal mucosal tissue was prepared for measurement of motilin levels by ELISA.Pearson linear correlate analysis was performed between the motilin level and pain threshold at each time point in group P.Results Compared with group C,MWT was significantly decreased,TWL was shortened,and motilin levels were significantly increased at T1-4,and no significant change was found at T0 and T5 in group P.The motilin levels were negatively correlated with MWT (r =-0.8 910) and TWL (r =-0.8 463) in group P.Conclusion Incisional pain can promote the secretion of motilin in the duodenum.

Objective To investigate the changes in the levels of motilin in the gastric body in a rat model of incisional pain.Methods Eighty-four healthy male Sprague-Dawley rats,weighing 180-220 g,were randomized into 2 groups (n =42 each):normal saline group (NS group) and incisional pain group (P group).In group P an 1 cm long incision was made in the plantar surface of right hindpaw under sevotlurane anesthesia.Six rats were chosen from each group and paw withdrawal threshold to mechanical stimulation (MWT) and paw withdrawal latency to nociceptive thermal stimulation (TWL) were measured at 24 h before operation (To) and 1,6,24,48 and 72 h after operation (T1-5).Six rats were chosen from each group at T0-5 and sacrificed and the gastric mucosal tissues were prepared for measurement of motilin levels by ELISA.Results Compared with group NS,MWT,TWL and motilin levels were significantly decreased at T1-4 (P ＜ 0.05) and no significant change was found at T0 and T5 in P group (P ＞ 0.05).Compared with the baseline value at To,MWT,TWL and motilin levels were significantly decreased at T1-4,and no significant change was found at T5 in group P (P ＞ 0.05).MWT,TWL and motilin levels were significantly higher at T3-T5 than at T1 in group P (P ＜ 0.05).MWT,TWL and motilin levels were increased gradually at T3-T5 in P group (P ＜ 0.05).The motilin levels were positively correlated with MWT and TWL (r =0.9597 and 0.9231,respectively,P ＜ 0.01) in group P.Conclusion The levels of motilin in the gastric body is significantly decreased in a rat model of incisional pain and the decreasing range is positively corre lated with the degree of incisional pain.

Objective:To observe the impact of rehabilitation training,acupuncture-moxibustion combined with Danshen Chuanxiongqin acupoint injection on the patients with shoulder-hand syndrome (SHS) after cerebral infarction (CI).Methods:82 patients with SHS after CI from March 2014 to March 2016 in our hospital were randomly divided into the group A and the group B (n=41).Patients in the group A received comprehensive drug therapy,acupuncture and rehabilitation training,the group B was given Danshen Chuanxiongqin acupoint injection therapy based on the group A.Before and after treatment,the upper limb movement function score (FMA),digital pain score (NRS),the degree of swelling in the shoulder joint,shoulder joint of motion (ROM),and neural function defect scale (CNFDS),daily life activities ability (MBI) and quality of life scores (WHOQOL) of patients in two groups were compared and analyzed.Results:After treatment,the scores of NRS,shoulder swelling,upper extremity CNFDS were significantly higher than those before treatment,the ROM,while the upper extremity FMA,MBI and WHOQOL of both groups were significantly decreased (P＜0.05),these index improved more significantly in group A than those of group B (P＜0.05).Conclusion:Rehabilitation training,acupuncture-moxibustion combined with Danshen Chuanxiongqin acupoint injection was more effective in the treatment of SHS after cerebral infarction than rehabilitation training and acupuncture-moxibustion.

Objective To study the feasibility of the acute gastrointestinal injury (AGI) classification standard for evaluation of gastrointestinal function in intensive care unit (ICU) patients,and to discuss its value in administration of early enteral nutrition (EN).Methods A perspective study was conducted.85 patients with AGI admitted to ICU of Tianjin First Center Hospital from January 2013 to June 2013 were enrolled.EN was conducted after ICU admission or within 12-24 hours after high catabolic state.The patients were divided into four groups according to the AGI classification,i.e.grade Ⅰ,Ⅱ,Ⅲ,and Ⅳ,and they were treated according to the treatment procedure for AGI.The primary end points were 7-day rate of intake of standard EN,the degree of disease and nutrition,and their correlation with AGI classification.Secondary endpoint was rate of giving EN within 48 hours.Results Gastrointestinal dysfunction patients accounted for 49.42％ (85/172) of the ICU patients,and number of patients in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ were 29,28,19,9 respectively.On the first day of ICU stay,there were no statistical differences in age,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,serum albumin (ALB) and prealbumin (PA) among four groups,and it was demonstrated that the baseline data were comparable.APACHE Ⅱ score on the seventh day of ICU stay was significantly lower than that on the first day in grade Ⅰ,Ⅱ and Ⅲ patients (grade Ⅰ:20.48 ± 2.45 vs.22.59 ± 2.06,t=-3.120,P=0.031 ; grade Ⅱ:19.34 ± 1.80 vs.21.65 ± 2.22,t=-4.316,P=0.012; grade Ⅲ:20.63 ± 1.34 vs.23.31 ± 1.70,t=-5.640,P=0.000),and serum PA (g/L) was significantly increased (grade Ⅰ:24.37 ± 6.54 vs.10.62 ± 7.24,t=-4.866,P=0.000; grade Ⅱ:19.79± 12.48 vs.11.57±8.94,t=-2.116,P=0.031; grade Ⅲ:19.15±8.43 vs.13.78 ± 6.59,t=-3.601,P=0.000).On the seventh day ofICU stay,the APACHE Ⅱ score was higher in grade Ⅳ than that in grade Ⅰ,Ⅱ and Ⅲ patients (22.87 ± 3.31 vs.20.48 ± 2.45,19.34 ± 1.80,20.63 ± 1.34,P＜0.05 or P＜0.01),and PA was obviously lower in grade Ⅳ than that in grade Ⅰ,Ⅱ and Ⅲ patients (g/L:14.02 ± 8.70 vs.24.37 ± 6.54,19.79 ±12.48,19.15 ± 8.43,P＜0.05 or P＜0.01).There was no statistically significant difference among four groups in respect of serum ALB (F=0.454,P=0.722).The rate of giving EN in 24 hours in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ patients was 95.4％,72.1％,52.0％ and 0,respectively (x2=8.310,P=0.016),and in 48 hours it was 100.0％,83.0％,76.0％,and 0 (x2=5.470,P=0.025).7-day standard EN intake rate was 100.0％,88.7％,84.0％ and 34.0％ respectively in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ patients (x2 =0.720,P=0.017).Correlation analysis showed that there was a negative correlation between AGI classification and rate of giving EN in 1 day (r=-0.62,P=0.04) and 7-day standard EN intake rate (r=-0.76,P=0.02).Conclusions AGI classification can be used to estimate the gastrointestinal function of patients with critical illness,and it has a significant correlation with early EN support.An early goal achieving intervention based on the AGI classification can improve the nutritional status and the general state of the patients.

Objective To investigate effects of intrathecal injection of morphine and fentanyl combined with low-dose naloxone on the pain behavior and the expression of blood motilin (MTL) in the rat model of incisional pain.Meth?ods A total of 72 healthy male Sprague-Dawley rats (weight 180-220 g), successfully intrathecally catheterized, were ran?domly divided into 6 groups (n=12 ):normal saline group (NS group), incisional pain group (P group), morphine (5μg/kg)+fentanyl (0.25μg/kg) group (MFP group), morphine+fentanyl+naloxone (0.2 ng/kg, 1 ng/kg, 5 ng/kg) group (MFPN1, MF?PN2 and MFPN3 groups). All groups except NS group were made the model of incisional pain on the right plantar surface. At 24-hours before intrathecal cathetherization (T0), 24-hours before modelling (T1), 1-hours (T2), 3-hours (T3) , 6-hours (T4), 24-hours (T5) , 48-hours (T6) and 72-hours (T7) after modelling respectively, paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were detected in right hind paw in 6 rats of each group. The other 6 rats in each group were sacrificed 6-hour after operation. The plasma expression of motilin was detected by ELISA. Re?sults Compared with NS group, the PWMT was not significantly different in all time points in MFPN2 group. The values of PWTL were significantly longer at T2 and T5 in MFPN2 group than those of NS group (P<0.05). The PWMT and the PWTL were significantly decreased at T2, T3 and T4 in P and MFPN3 groups than those of NS group (P<0.05).Compared with P group, the PWMT at T6, and PWTL at T3 and T4 were significantly decreased in MFPN3 group (P<0.05). The MTL at T6 was significantly decreased in P, MFP, MFPN1 and MFPN3 groups compared with that of NS group (P<0.05). There was no significant difference in MTL between MFPN2 group and NS group (P>0.05).Conclusion In the rat model of incision?al pain, intrathecal injection of naloxone at 1 ng/kg can inhibit the down-regulation of blood motillin caused by morphine and fentanyl, and which can up-regulate the PWTL, enhancing the analgesic effects of opioids.

Objective To investigate the diagnosis and surgical management of adult choledochal cyst.Methods The clinical data of 58 adult patients with congenital choledochal cyst who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 1997 to December 2010 were retrospectively analyzed.All patients were diangosed by the B ultrasonography,computed tomography (CT),Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Surgical procedures were selected according to the diagnosis and Todani classification.All data were analyzed using the t test or chi-square test.Results The accurate rates of B sonography,CT,MRCP and ERCP were 78％ (45/58),92％ (23/25),9/9 and 5/5,respectively.Forty-one patients underwent complete excision of the cyst + hepaticojejunostomy (2 patients were converted from laparotomy due to abdominal adhesions),2 underwent resection of the cyst and involed hepatic segments + hepaticojejunostomy,8 underwent laparoscopic excision of the cyst + hepaticojejunostomy,1 underwent left hemihepatectomy,3 underwent pancreaticoduodenectomy ( including partial hepatectomy in 1 patient),2 underwent common bile duct exploration + cholecystectomy due to acute obstructive suppurative cholangitis,1 underwent external drainage of choledochal cyst due to advanced malignance.The mean operation time and postoperative duration of hospital stay of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were (235 ± 70) minutes,(320 ± 50) minutes,and ( 10.0 ± 2.3 ) days,( 12.6 ±6.6) days,respectively,with significant differences between the 2 groups (t =3.157,2.162,P ＜ 0.05).The postoperative morbidities of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were 18％ (7/39) and 3/8,respectively,with no significant difference (x2 =1.515,P ＞ 0.05 ).Canceration of the choledochal cyst was observed in 6 patients( 10％ ).No perioperative mortality was observed,and the operative complication rate was 24％ (14/58).The duration of the follow up ranged from 1 to 15 years,no severe long-term complications were observed in patients with benign lesions.Four of the 6 patients with malignancy died in 1 year after operation,the other 2 patients survived for 3 years and 5 years,respectively.Conclusions Abdominal B ultrasonography should be the first choice for diagnosing adult congenital choledochal cyst,while MRCP is the gold standard.Surgical intervention should be timely considered once diagnosed. Complete excision of the cyst combined with Roux-en-Y hepaticojejunostomy is the first choice of treatment.