Objective To evaluate the possibility and safety of balloon kyphoplasty for the aged osteoporotic thoracolumbar burst fractures. Methods From October 2007 to December 2012, 78 patients with aged osteoporotic thoracolumbar burst fractures were treated by balloon kyphoplasty. The inflatable balloon was inserted through pedicle of vertebal arch to make fracture reduction, then the centrum was stuffed with bone cement. The whole procedure was pinpointed and detected by C-arm x-ray machine. Results All operations were completed successfully. The lumbar and back pain of the patients relieved obviously. The quality of patients' life was significantly improved. Imaging examinations revealed that the vertebrae altitude was recovered and the kyphosis was corrected obviously. Conclusion Balloon kyphoplasty is effective to treat the aged osteoporotic thoracolumbar burst fractures. But the operation had certain risk, we must do a good job in preoperative preparation, strictly handle surgical indication and accurately operate.

With the change of medical mode and deepening of the medical education reforms,such educational idea as giving prominence to practice is widely used to improve students' comprehensive quality and innovative ability and practice ability. The medical shool of Tibet university has established long-term apprentice mechanism during the before class and playtimes and found four county hospitals, five health clinics in towns and townships and gradually improved the construction of mutual win-win 9clinical teaching bases. In this way it has been cultivating many advanced medical personnels, who are reliable, available, able to stay, and highly praised by the employers.

Objective:To evaluate the effect of Candida albicans ( C. albicans) hyphae on autophagic flux in murine bone marrow-derived macrophages (BMDM) . Methods:BMDM were in vitro stimulated with C. albicans hyphae for 0.5, 4 and 12 hours, and the 0-hour group treated without hyphae served as a control. Western blot analysis was performed to detect the conversion of microtubule-associated protein 1 light chain 3 (LC3) -Ⅰto LC3-Ⅱ, and determine the expression of phosphorylated mechanistic target of rapamycin (p-mTOR) at each time point. Some BMDM were divided into several groups: control group receiving no treatment, hyphae group treated with C. albicans hyphae, lysosomal inhibitor groups treated with different lysosomal inhibitors, including E-64d (a cysteine proteinase inhibitor) + pepstatin (a pepsin inhibitor) , bafilomycin-A1 (BAF-A1) , ammonium chloride and chloroquine, and hyphae combined with lysosomal inhibitor groups treated with lysosomal inhibitors immediately followed by C. albicans hyphae. After 4- or 12-hour treatment, the effect of C. albicans hyphae on basal autophagic flux in murine BMDM was evaluated. Statistical analysis was carried out by using unpaired t test, factorial design analysis of variance and least significant difference- t test. Results:After 0.5-, 4- and 12-hour in vitro treatment with C. albicans hyphae, the conversion of LC3-Ⅰ to LC3-Ⅱ significantly increased in murine BMDM (1.254±0.118, 1.629±0.391, 1.598±0.379, respectively) compared with the 0-hour group (0.983±0.030; t=3.875, 2.856, 2.804, respectively, all P< 0.05) , while there was no significant difference in the protein expression of p-mTOR among the 0-, 0.5-, 4- and 12-hour groups. After 4- and 12-hour in vitro treatment with C. albicans hyphae combined with lysosomal inhibitors E-64d and pepstatin, the accumulation level of LC3-Ⅱ significantly increased in BMDM compared with those treated with E-64d and pepstatin alone ( t=3.691, 6.648, respectively, both P< 0.05) . Compared with the corresponding lysosomal inhibitor groups, the accumulation level of LC3-Ⅱsignificantly increased in BMDM treated with C. albicans hyphae combined with BAF-A1, ammonium chloride or chloroquine for 4 and 12 hours (all P< 0.05) . Conclusion:In vitro treatment with C. albicans hyphae can increase the conversion of LC3-Ⅰto LC3-Ⅱ in the basal autophagic flux in murine BMDM.

Objective:To investigate the clinical effect of endoscopic sinus surgery in the treatment of sinusitis and nasal polyps and its effect on nasal ventilation and olfactory function.Methods:80 patients with sinusitis and nasal polyps were selected in our hospital from January 2014 to June 2016,who were randomly divided into observation group and control group,each group of 40 cases.The control group was treated with traditional enucleation,while the observation group was treated with endoscopic sinus surgery.The clinical efficacy,the symptom scores,nasal airway resistance and olfactory function score before treatment and 3 months after treatment were compared between the two groups.Results:The total effective rate of the observation group was 95.00％,which was significantly higher than that of the control group 77.50％ (P＜0.05).There was no significant difference in nasal congestion,purulent nasal discharge,olfactory dysfunction,pain and total symptom score between the two groups before treatment (P＞0.05),nasal congestion,purulent nasal discharge,olfactory dysfunction,pain and total symptom score between the two groups at 3 months after treatment were lower than before treatment,and nasal pus,smell disorder,pain and total symptom scores of the patients in the observation group were lower than the control group (P＜0.05).There was no significant difference in nasal airway resistance and olfactory function score between the two groups before treatment and 3 months after treatment (P＞0.05),nasal airway resistance,olfactory function score of patients in two groups at 3 months after treatment were lower than before treatment,and the observation group was lower than that ofthe control group (P＜0.05).Conclusion:Endoscopic sinus surgery for sinusitis and nasal polyps is helpful to improve the clinical symptoms,promote the olfactory function and recovery of nasal ventilation,which is an effective method for treatment of sinusitis and nasal polyps.

Objective We evaluated the molecular epidemiology ofStenotrophomonas maltophilia strains in adult patients in Renji Hospital to Shanghai Jiao Tong University School of Medicine for better control ofS.maltophilia infections.Methods Nonduplicate clinical isolates of S.maltophilia were collected from Renji Hospital from January 2014 to September 2014.We examined the clonality among the S.maltophilia isolates by multilocus sequence typing (MLST) and pulsed field gel electrophoresis (PFGE).Antimicrobial resistance pattern was investigated by Kirby-Bauer method and prevalence of toxin genes (Stmpr1,Stmpr2,stmr-1,Smlt3773locus) by PCR.We also studied the biofilm formation of S.maltophilia by semiquantitative biofilm formation test.Results A total of 78 nonduplicate S.maltophilia isolates were analyzed,of which 26 were isolated from surgical intensive care unit,and 53 strains were from male patients.All patients infected by S.maltophilia had received antibiotic therapy before the strains were isolated.At least three kinds of antibiotics were used in 62.8％ of the patients.MLST analysis indicated that 49 isolates were assigned novel STs(STnewl-STnew38),with new combinations of allelic profiles.The largest cluster of isolates was ST23 (6 strains).PFGE showed that there was weak genetic linkage between S.maltophilia strains.The 78 isolates were divided into 58 groups.About 2.6％ (2/78) and 10.3％ (8/78) of these strains were resistant to levofloxacin and trimethoprim-sulfamethoxazole,respectively.All the strains were susceptible to minocycline.The prevalence of virulence genes Stmprl,Stmpr2,snf-1 and Smlt3773 locus was 79.5％ (62/78),93.6％ (73/78),94.9％ (74/78) and 48.7％ (38/78),respectively.Biofilm formation test indicated that the mean ability of biofilm formation was 0.51±0.44 in terms of D492.There was no significant difference between males and females.Conclusions All patients with Stenotrophomonas maltophilia infection had a history of antibiotic use and male patients were susceptible population.Stenotrophomonas maltophilia isolates showed high prevalence of virulence genes.No clonal dissemination was found in the same department of hospital.

With more and more non-affiliated hospitals of universities joining the clinical teaching of infectious diseases,there have been some dilemmas on clinical teaching,such as the shortage of staff,teaching experience,poor lecture art and teaching enthusiasm,textbook lag,the shortage of case teaching abd students'fear of infectious disease etc. Countermeasures such as perfecting the organizational structure,formulating preferential policy,clearing historical mission,increasing students' interest in learning,adding new academic progress,enriching teaching methods,setting up experts'supervision will ensure the effective teaching quality.

ObjectiveTo observe the influence of rehabilitation training on heart rate of stroke patients in the early stage.MethodsThe heart rate (HR) of 30 patients within one week after the onset of stroke was evaluated by FUKUDA DS 880A teleelectrocardiograph and the rating of perceived exertion (RPE) was collected during practicing bridging, rolling and moving the arms.ResultsThe HR of 30 patients was only increased 7.57, 6.23 and 6.57 beats per minute during practicing bridging, rolling and moving the arms. RPE of all patients was less than 11.ConclusionAppropriate rehabilitation training is safety and unable to increase the loading of heart in the early stage after the onset of stroke.

Objective To investigate the accuracy of careful clinical evaluation in hemodynamic status and guidance of PiCCO monitor in clinical treatment.Methods A total of 96 hemodynamic unstable cases were evaluated prior to the insertion of the PiCCO catheter.The attending physician in charge of the patient was required to complete a questionnaire to predict the range of key hemodynamic variables for CI,GEDI,SVRI and EVLWI.Additionally,the attending was also asked to indicate a plan for therapy based on the predicted hemodynamic profile and decide if the predicted therapy plan was altered after the the first measurement of hemodynamic variables.Results The accurate prediction of hemodynamic variables was CI (55.2％),GEDI(60.4％),SVRI(63.5％) 和 EVLWI (78.1％),among which EVLWI had a higher accuracy(P ＜ 0.05).49％ doctors altered their planned therapy according to the result of the PiCCO information.Doctors had more difficulty in accurately predicting hemodynamic values in critical patients which APACHE Ⅱ scored 15 ～25 (42.3％ vs 67.9％ and 42.3 ％ vs 75.0％,x2 =4.755,5.231,P ＜ 0.05).The prediction of patients with acute myocardial infarction was more accurate than those of without acute myocardial infarction,and less to alter the planned therapy(21.1％ vs 55.8％,x2 =7.382,P =0.007).The patients of impaired oxygenation had less accurate predictions and less therapy alterations(32.3％ vs 56.9％,x2 =5.110,P =0.024).Attending was able to predict the hemodynamic status more accurately(63.9％ vs 40％,x2 =5.152,P =0.023) and alter the predicted therapy less(39.3％ vs 65.7％,x2 =6.189,P =0.013) in patients who were enrolled later.Conclusions Clinical evaluation in hemodynamic status of critically ill patients had a lower accuracy,the information obtained by PiCCO often instruct clinical doctors to choose the optimal treatment.

Objective To evaluate the effect of heart rate control with esmolol on hemodynamics, inflammatory cytokines and clinical outcomes in patients with septic shock.Methods A prospective randomized controlled trial was conducted. The patients with septic shock admitted to Department of Critical Care Medicine of China-Japan Friendship Hospital from August 2014 to October 2016 were enrolled. After 24 hours of resuscitation and other therapy, they were randomly divided into two groups by sealed envelope. The patients in experimental group was treated with continuous intravenous esmolol infusion for 24 hours, initial dose was 0.05 mg·kg-1·h-1, and was titrated to decrease the heart rate by 20% as compared with the value at the time of enrollment or below 95 bpm, while isotonicsaline was given to control group through intravenous line at 3 mL/h for 24 hours. The differences in hemodynamic parameters at 0, 1, 4, 8, 12, 24 and 48 hours, as well as serum inflammatory cytokines and blood lactate (Lac) at 0, 12, and 24 hours, 28-day mortality were compared between the two groups.Results Seventy-six septic shock patients were admitted during the study, 12 were excluded forsuspicious acute myocardial infraction (AMI) or acute left heart failure or for the history of chronic obstructive pulmonary disease (COPD), 4 were quitted the study for being unable to tolerate the lowest dose of esmolol, giving up treatment, or death within 24 hours. Finally, 60 patients completed the study, 30 patients in experimental group, and 30 in control group. There were no differences in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and infection source between two groups, indicating the general data between the two groups were balanced and comparable. The decrease in heart rate was more markedly in experimental group than that of control group at 1, 4, 48 hours after esmolol administration (bpm: 97.4±16.5 vs. 110.9±19.6, 95.2±15.3 vs. 105.1±17.9, 86.4±12.1 vs. 97.2±22.6, allP < 0.05), cardiac index (CI) at 8, 24, 48 hours was significantly increased(mL·s-1·m-2: 57.2±13.5 vs. 46.5±11.0, 57.7±15.7 vs. 48.7±14.7, 61.2±16.5 vs. 51.5±14.7, allP < 0.05), and stroke volume index (SVI) at 4, 8, 24 hours was significantly increased (mL/m2: 34.1±6.9 vs. 29.0±8.7, 35.0±6.1 vs. 28.8±9.6, 38.3±10.1 vs. 31.9±13.2, allP < 0.05). Interleukin-1β (IL-1β) at 24 hours in experimental group was significantly higher than that of control group (ng/L: 0.15±0.06 vs. 0.13±0.05,P < 0.01). There were no differences in mean arterial pressure (MAP), Lac, white blood cell (WBC), IL-6, IL-10, and tumor necrosis factor-α (TNF-α) between the two groups, and no difference in 28-day mortality between experimental group and control group was found (30.0% vs. 36.7%,χ2 = 0.300,P = 0.583).Conclusions It is efficient and safe to use esmolol for heart rate control in patients with septic shock after resuscitation. Esmolol can improve cardiac performance without affecting blood pressure and Lac, but has no effect on inflammatory cytokines and prognosis.

Objective To discuss the clinical feature ,diagnosis and treatment of the occult cerebrospinal fluid rhinorrhea after tracheotomy in patients with severe traumatic brain injury .Methods The clinical data of 18 cases of the occult cerebrospinal fluid rhinorrhea after tracheotomy in patients with severe traumatic brain injury were retro -spectively analyzed .Results 15 cases showed involuntary swallowing movements ,frequent stimulus-likecough, abnormal increased secretions in the oral and nasal;3 cases performance of aspiration ,hypoxemia ,respiratory distress . After a three -dimensional thin skull CT , cisternography , nasal endoscopic examination can confirm the diagnosis . After the treatment with replacing the tracheostomy tube with a balloon ,continuous lumbar drainage ,endoscopic repair leak,the cerebrospinal fluid rhinorrhea were cured .Conclusion Patients with occult cerebrospinal fluid rhinorrhea performance the diversity and easily missed ,early detection and timely treatment can prevent cerebrospinal fluid rhi-norrhea delayed healing and intracranial infection and promote patient recovery .