Clinical practice is a special learning phase. Interns, as both students and doctors are confronted with multiple pressures from studies, employment and examination. Their ideology tends to fluctuate due to the influence of the society. Therefore, it's very important to strengthen the ideo-logical and political education. It is relatively difficult in managing interns due to their dispersed loca-tion and unfixed daily schedule. Internet not only expands the space and time of the ideological edu-cation, but also it has the features of vivid, interesting, timely, open and resource conservation. On the basis of analyzing the characteristics and difficulties of the clinical ideological education and the pros and cons of the network, we proposed the methods to utilize the advantages of network informa-tion technology to enhance the ideological and political education of clinical interns.

ion:Objective To study the effect of enteral nutrition on cardio-pulmonary function in elderly patients with chronic obstructive pulmonary disease (COPD) .Methods Fifty-eight elderly COPD patients were randomly divided into treatment group (enteral nutrition group ,n=29) and control group (free diet group ,n=29) .Their nutrition parameters (BMI ,serum total protein ,al-bumin and prealbumin) ,LVEF and pulmonary function (FEV1 ,FVC ,FEV1/FVC) were assayed before and after treatment .Results The BMI ,serum levels of total protein ,albumin and prealbu-min were significantly higher in treatment group after treatment than before treatment ( P<0.05) .However ,no significant difference was observed in these parameters in control group after treatment .The LVEF ,FVC ,FEV1 and FEV1/FVC were significantly higher in treatment group than in control group after treatment (P< 0 .05) .Conclusion Enteral nutrition in combination with conventional treatment can improve the nutrition and cardio-pulmonary function in elderly COPD patients ,thus shortening their hospital stay time .

OBJECTIVE To study the lower respiratory tract Acinetobacter baumannii infection in cardiac ICU and its risk factors,in order to take effective control measures. METHODS The risk factors of 5 cases respiratory A. baumannii infection in cardiac ICU of our hospital were investigated. RESULTS Patients with A. baumannii infections were concentrated,accounting for 21.7% at the same period in external cardiac ICU. According to the exposure time among children,the regional distribution and the same kinds of pathogens,the nospital acquired infection was determined as a local outbreak epidemia. The pathogenic microorganism monitoring carried out on ventilator-pipes,hands of health care workers and cardiopulmonary bypass machines etc. A. baumannii was found in tube of warming devices. CONCLUSIONS The in-door distribution and pracedures in cardiac ICU do not meet hygiene requirements,the poor sterile concept among medical staff and bad compliance of hand-washing,and the longterm use of mechanical ventilation,broad-spectrum antibiotics and immunosuppressive agents. All these factors contribute the outbreak of hospital acquired infection.

Objective To set up a method to detect the mutation of CYP2C9 1075A ＞ C and VKORC1-1639 G ＞ A in clinical practice,investigate the distribution of CYP2C9 1075A ＞ C and VKORC1-1639 G ＞ A in Beijing Han native,and evaluate the correlations between CYP2C9 1075A ＞ C,VKORC1-1639 G ＞ A and Warfarin maintenance dose,so that the results will contribute to Warfarin therapy.Methods A total of 145 Han Beijing patients received long-term Warfarin anticoagulant therapy orally in the people's hospital between May to September in 2011 were enrolled in this study.The patients suffer from atrial fibrilation,thromboembolism and heart operation respectively.The ARMS-TaqMan real time PCR technique was used to detect the mutation of CYP2C9 1075A ＞ C and VKORC1-1639 G ＞ A.The data were collected on gender,age and BSA.The correlations between stable warfarin dosage and each factor were analysised.Results The detection limit of ARMS-TaqMan real time PCR technique was 105 copies/ml in this assay.The intra-and inter-coefficients of variations (CV) were less than 5.5％ and less than 9.0％ respectively.The coincidence rate of ARMS-TaqMan real time PCR and direct sequencing was 100％ for testing 50 paralled samples.Among the 145 patients,the frequencies of CYP2C9 1075 AA,AC and CC was 93.8％ (136/145),6.2％ (9/145),0(0/145) respectively.The frequencies of VKORC1-1639 GG,GA and AA was 0.7 ％ (1/145),21.4％ (31/145),77.9％ (113/145) respectively.Allele frequencies of genotypes were in Hardy-Weinberg equilibrium.Every patients' INR was within range 2.0-3.0.Among the 145 patients,dosage requirements were higher in CYP2C9 1075 AA phenotype than that in AC type (F =0.199,P ＜0.05) and were higher in VKORC1-1639 GA phenotype than that in AA type (F=1.745,P ＜0.001).Irrespective of other factors,age,BSA,CYP2C9 1075 and VKORC1-1639 was accounted for 11.9％,12.9％,4.4％ and 16.7％ of interindividual variation of Warfarin dosage respectively.Linear stepwise regression analysis was used to identify factors contributing to Warfarin stable does.The final equation accounted for 40.4％ of interindividual variation of Warfarin dose.Conclusions The ARMS-TaqMan real time PCR technique was established to analyse CYP2C9 1075 and VKORCl-1639 genotype.The technique can achieve the needs of clinical practice.Warfarin dosing by multivariable regression equation in patients could increase efficiency for Warfarin dose adjustment,and could give suggestion for the individualization and rationalization for Warfarin dose.

Objective: To observe the effect of low-dose aspirin on allogeneic chronic allograft nephropathy in renal recipient rats and the possible mechanisms. Methods: Chronic allograft nephropathy model of rats were established and the recipient rats were randomly divided into 2 groups with 10 in each group. Cyclosporine A (5 mg/kg) was administered as a basic treatment one day before surgery to prevent and treat acute rejection. Aspirin therapy group was given oral aspirin (5 mg/kg) daily, and control group were given oral saline 2 ml/d. Animals were sacrificed 8 weeks after operation and the serum creatinine, urea nitrogen levels were determined. Renal histomorphology and immunohistochemistry approaches were used to examine TGF-β1 expression. Results: The severity of pathological lesion, increase of serum creatinine and blood urea nitrogen levels, and expression of fibrosis associated factor TGF-β1 in aspirin therapy group were significantly slighter than those of the saline control group (P<0.05). Conclusion: Low-dose aspirin in addition to routine anti-rejection treatment can be used for treatment of chronic allograft nephropathy in rats, which might be associated with the decreased expression of anticoagulation factor TGF-β1.

Objective To evaluate the efficacy and safety of intermittent use of low-dose urokinase in the treatment of pulmonary embolism. Methods Forty-two patients with acute pulmonary embolism were divided into UK group with UK 10 000 U/(kg·d),7 days and rt-PA group with rt-PA 50 mg/2 h randomly. The efficacy was determined by the improvement of right heart dysfunction and perfusion defect 8 d and 14 d after the treatment. The bleeding incidence, death rate and PE recurrence were also evaluated. Results Differences of right heart dysfunction and perfusion defect between UK group and rt-PA group indicated no statistical significance (P >0.05).The rate of bleeding in UK group was lower than that of rt-PA group. Conclution The intermittent use of low-dose urokinase in the treatment of pulmonary embolism exhibits similar efficacy as rt-PA.

Mesenchymal chondrosarcoma originated in the primitive mesenchymal tissue .It usually devel-ops in the short bones such as hand ,foot and body bone ,while extremeIy rare in the orbit .We report a case of mesenchymal chondrosarcoma of the orbit which is confirmed by pathology .

Objective To investigate the effect of penehyclidine hydrochloride (PHC) on iNOS expression in lung in septic mice.Methods Female KM mice were subjected to cecal ligation and puncture (CLP,a model of polymicrobial sepsis) or shame operation.Thirty-six KM mice weighing 20～25 g were randomly assigned into three groups:shame CLP group,CLP group and PHC group.Mice in PHC group were given PHC 0.45 mg/kg intraperitoneally at 1 h before CLP. Six hours after CLP,the lungs of each group were sampled for light and electronic microscopy.The expression of iNOS mRNA in lung tissue were detected by in situ hybridization.The survival rates were observed at 24 h after the operation. Results The CLP group was observed thickened alveolar septa,as well as mitochondrial cristae swelling and mitochondrial vacuolation under electronic microscope.Emptied lamellar bodies could be also found.Histology of lung in PHC group had little changed.Expression of iNOS in lung in PHC group was significantly lower than that of the CLP group.At 24 h after CLP challenge,70.0% of the PHC mice lived,remarkably increased compared with that of the CLP group (26.7%),P＜0.05.Conclusion PHC had effective effect for increasing the survival rates of septic mice,inhibiting the expression of iNOS and reducing the severity of lung injury.

Acupressure ; Acupuncture Points ; Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Middle Aged ; Motion Sickness ; therapy ; Young Adult

Objective To investigate whether taking diastolic potential(DP)and earliest Purkinje potential(PP)as ablation targets together is superior to taking earliest PP alone in patients with left posterior fascicular ventricular tachycardia(VT).MethodsTotally 18 patients who were admitted in our department from May 2006 to May 2009 were enrolled,and the results of their electrophysiological examination were analyzed.According to radiofrequency(RF)ablation targets,patients were classified into 2 groups:DP+PP group(DP and PP as ablation targets together)and PP group(PP as the target alone).Successful RF ablation was established when the ventricular tachycardia was no longer inducible.The acute success rate,recurrent rate,number of ablation application,procedure time,X-ray exposure and complications were compared between DP+PP and PP groups.ResultsThere was 1 case receiving no ablation because of not being induced to clinical VT.Seventeen cases were induced to clinical VT and displayed right bundle branch block(RBBB)and left axis morphology(DP+PP group 7 cases,and PP group 10 cases).All cases were successfully ablated,their DP-Q interval and PP-Q interval were 60.17?8.16 and 30.64?7.19 ms,respectively.There was no significant difference between the 2 groups in the age,ventricular tachycardial cycle,procedure time and recurrent rate.Compared to the PP group,the number of RF application in DP+PP group was fewer(4.55?2.07 vs 7.50?1.64,P=0.04),and X-ray exposure time was a little longer(18.33?1.51 min vs 15.37?2.77 min,P=0.03).There was neither left posterior fascicular block nor other complications seen in the 2 groups.The follow-up period was 14.29?10.05 months,and during this there was 1 case recurrence in DP group(2 months after procedure)and 1 case in PP group(1 month after procedure)respectively.ConclusionThe 2 methods are effective and safe for successful ablation of left posterior fascicular VT.Compared to ablation of earliest PP site alone,ablation of DP+PP might need fewer times of RF application but longer X-ray exposure time.