Objective To study the efficacy and safety of warfarin and aspirin in the treatment of adverse catheter function in long -term catheterization for hemodialysis.Methods 62 patients with renal failure treated with long -term central venous catheterization were selected,and all the patients were divided into the warfarin group (31 cases)and aspirin group(31 cases).Heparin in sealing was used in both two groups,and warfarin pill was given additionally in warfarin group,while aspirin pill was given additionally in aspirin group.The situation of adverse catheter function,coagulation,bleeding events,and catheter -related infections of the patients in the two groups were recorded during the time when they had 40 times of hemodialysis treatment.Results There were 3 cases of adverse catheter function in the warfarin group,the incidence rate was 9.68%,and there were 8 cases in the aspirin group,the incidence rate was 25.91%.The incidence rate in the warfarin group was lower than aspirin group(χ2 =9.081,P <0.05).The addition of urea remove index in the warfarin group was (0.13 ±0.07),which in the aspirin group was (0.04 ±0.03).The addition of urea remove index in the warfarin group was higher than aspirin group(t =0.941, P <0.05).There were no significant differences of PT,APTT and INR between the two groups(t =0.001,0.003, 0.001,all P >0.05).After treatment,there was 1 case of limb ecchymosis and 1 case of conjunctival hemorrhage in the warfarin group,and there was 1 case of conjunctival hemorrhage and 1 case of bleeding gums in the aspirin group. No catheter -related infections were found in the two groups.Conclusion Warfarin was better than aspirin in treating adverse catheter function in long -term catheterization for hemodialysis.

OBJECTIVE:To provide reference for clinical rational use of antidiabetic essential medicines. METHODS:Retro-spective analysis was used to sort and analyze the consumption sum,DDDs and DDC of antidiabetic drugs in the outpatient of our hospital from May 1st,2012 to Apr. 30th,2014. RESULTS:The consumption sum and DDDs of insulin and oral antidiabetic drugs had upward trend. The top 3 consumption sum and DDDs of oral antidiabetic drugs were acarbose,metformin and glimepiri-de,and the highest DDDs of insulin was short-acting and premixed recombinant human insulin,all of them were in the National Essential Medicine List (2012 edition);DDDs of Glibenclamide tablets,Glipizide tablets and Chinese patent medicine were rela-tively small;DDC in long-acting insulin analogues was obviously higher than other kinds of insulin. The sales ratio of essential medicines was increased from 10.48% to 67.78% after National Essential Medicine List (2012 edition)carried out. CONCLU-SIONS:The use of antidiabetic drugs in the outpatient of our hospital is basically rational. Acarbose and metformin have the high-est DDDs,and DDDs of insulin analogues grow rapidly.

Objective To construct a prokaryotic expression system of human ferritin L which could be overexpressed in E.coli, and then prepare quality control materials of rFL and evaluate the homogeneity, stability, precision and application value of the rFL.Methods RT-PCR was used to clone ferritin L gene with total RNA from peripheral blood.Ferritin L gene was inserted into plasmid pGM-T to construct subclone plasmid pGM-T/ferritin L, which was identified by sequencing.The recombinant plasmid pET-30a/ferritin L was transformed into E.coli BL21 (DE3) and efficiently expressed under IPTG induction.rFL was identified by SDS-PAGE, and its antigenicity was examined by WB.The concentration of rFL was measured by ACCESS immunoassay system.Fifteen control samples were randomly selected using random number table.The homogeneity and stability of rFL were evaluated by one-way analysis of variance (ANOVA) and a linear regression model, respectively.The uncertainties of homogeneity, stability and the precision were evaluated.Results A prokaryotic expression system of ferritin L was successfully constructed.Sequence analysis showed that the ferritin L gene inserted was identical with the one from GenBank(NM_000146.3).The PCR products were 527 bp long, in complete agreement with length of ferritin L gene.The molecular weight of rFL highly expressed in E.coli induced by IPTG was 19 000 Da.The WB analysis indicated that this rFL protein had good antigenicity.The concentration of rFL(1 000 times dilution) measured by ACCESS immunoassay system was (1115.84±38.38) ng/ml.Homogeneity evaluation of low-concentration QC sample and high-concentration QC sample of rFL showed that there were no statistical significances in the within-groups and between-groups (for high-concentration F=2.336, P>0.05 and for low-concentration F=0.730, P>0.05).A linear regression based on the stability test indicated that there was no statistically significant trend of instability in five and a half months (F=1.755, P>0.05). Precision analysis showed the within-run CV, the between-run CV, the between-day CV and the total CV of high-concentration QC sample were 2.06%, 2.12%, 0% and 2.96% respectively; the within-run CV, the between-run CV, the between-day CV and the total CV of low-concentration QC sample 2.03%, 2.08%, 0% and 2.90%, respectively.Conclusion This rFL for quality control materials with independent intellectual property rights could meet the clinical requirement of homogeneity, stability and precision, and could provide raw materials for preparation of mixed ferritin for quality control.

In order to study the status of cell apoptosis in psoriatic epidermis, we have investigated the changes of the lesions in various stages in patients with psoriasis vulgaris by using terminal deoxynueleotidyl transferase-mediation dUTP-biotin nick end labelling (TUNEL). The results showed that the highest frequency of apoptotic keratinocytes was observed in the early scaling papular lesions, and the frequency was reduced in the progressive maculo-papular lesions and the coalescent plaques successively. The frequency of hyperproliferation of epidermis was in the reverse order in comparison with the above results. These results suggest that increased apoptosis of keratinocytes is the initial change of psoriatic epidermis, then hyperproliferation of keratinoeytes follows.

Objective:To study the indications, surgical technique and complications of the coronal approach in the treatment of zygomatic complex fractures.Methods:Eighty-four patients with zygomatic complex fracture underwent coronal incisions for surgery. Micro or mini titanium bone plates were used to stabilize the fractured bones.In patients with endophthalmos orbital wall fractures were treated with hydroxyapatite.Follow-up was conducted for 3 months to 2 years.Results:All patients had no wound infection after operation. There was no permanent facial nerve motor function deficit. All of the patients with malocclusion regained their functional occlusion after treatment. The patients with restriction of mouth opening recovered after training. Eight patients had observable asymmetry characterized by widening of the face on the side of the injury. One patient sustained the postoperative endophthalmos beyond 3 mm.Conclusion:Coronal approach is feasible in the surgical treatment of zogomatic complex fracture.

Objective To understand the species,clinical distribution features and drug susceptibility situation of bloodstream infection pathogenic bacteria in this hospital to provide reference for clinical empirical treatment.Methods The retrospective analysis was performed on 1 938 strains of pathogenic bacteria isolated from blood culture in our hospital from January 2012 to August 2016,their species distribution,department distribution and drug sensitivity were analyzed.Results A total of 1 938 strain of bacteria were comprised of 56 kinds of bacteria and 8 kinds of fungi.Gram-negative bacteria had 1 216 strains,accounting for 64.2%,Gram-positive bacteria had 677 strains,accounting for 34.9%,Fungi had 45 strains,accounting for 2.4%.The top 5 of isolation rates were Escherichia coli(628 strains,32.4%),Klebsiella pneumoniae(230 strains,11.9%),Salmonella(143 strains,7.4%),Staphylococcus epidermidis(142 strains,7.3%) and Staphylococcus hominis (130 strains,6.7%).Enterobacteriaceae bacteria had 1 098 strains(58.0%),which was dominated by Escherichia coli and Klebsiella pneumoniae,in which 363 strains(57.8%) were Escherichia coli and 85 strains(37.0%) were extended spectrum β lactamases (ESBLs) producing Klebsiella pneumoniae.Nonfermenters had 118 strains(6.1%),Acinetobacter baumannii and Pseudomonas aeruginosa were predominant.Staphylococcus aureus had 75 strains (3.9%),the MRSA occurrence rate was 25.3%,coagulase-negative staphylococci (CoNS) had 401 strains (20.7%),the methicillin-resistant CoNS occurrence rate was 72.8%.Enterococcus had 85 strains(4.5%).The top 5 departments in positive rates were respiratory department,ICU,hepatobiliary department,gastroenterology department and hematology department.The other departments were consistent to the overall distribution except for ICU and pediatrics.The majority of Acinetobacter baumannii showed multi-drug resistant.Vancomycin-resistant Staphylococcus and Enterococcus did not be detected,Candida maintained good sensitivity to commonly used antifungal agents.Conclusion Bloodstream infection pathogenic bacteria in this hospital are widely distributed.Commonly used drug have different sensitivities,the overall drug resistance rate is higher,clinic may conduct early medication according to the pathogenic bacterial department distribution and drug sensitivity.

Objective:To summarize the experience in the postopera ti ve management of free flap transfer for the repair of the defects in head and ne ck region. Methods:Thirty three free flaps were transfere d to repair head and neck defects.The factors that may influence the survive of the flaps,and the way that may be used to handle those problems were analyzed. Result: Thirty two of the thirty three free flaps surviv ed and one was lost. The overall free flap success rate was 97.0% .Thrombosis of vein developed in 2 patients. By flap salvage, one flap survived,the other ex perienced total failure. The total postoperative complication rate was 36.4% inc luding thrombosis,infection,bleeding,wound break and so on.Corresponding treatme nt was given and all the flaps were kept except one mentioned above. Conclution:The most common complications in free flaps transfer are v essel thrombosis and hematoma. Timely salvage can prevent the necrosis of the flaps

本文根据汶川地震伤员救治工作取得的阶段成果,针对部分伤员可能造成的伤残问题,从康复工作的组织管理角度,探讨采取积极的康复措施,使伤员尽早通过早期康复干预、系统康复训练、社区家庭康复,最大限度地恢复和改善功能,达到生活自理,回归家庭和社会的目标。

ObjectiveTo evaluate biomechanical properties of transoralpharyngeal atlantoaxial reduction plate (TARP) prepared from magnesium alloy and titanium alloy for the atlantoaxial dislocation by using three-dimensional finite element analysis and to exam the feasibility of using magnesium alloy for preparation of TARP system so as to provide a theoretical basis for clinical surgery.MethodsA patient with typical atlantoaxial fracture dislocation was involved in the study,and received thin CT scan with clinically used titanium alloy TARP system for obtaining DICOM image data.Three-dimensional finite element analysis software was imported to simulate magnesium alloy and titanium alloy TARP systems for reduction and fixation.Then,stress changes of the atlas,axis,internal fixators and C2/3 zygapophysial joints were determined with three-dimensional finite element analysis and analyzed statistically.Results ( 1 ) The finite element model of atlantoaxial dislocation reduction and fixation had lifelike outline and good geometric similarity.There were 53 586 nodes and 180 784 units.(2) During the simulation of head in neutral position,the stress concentration region was C2/3 zygapophysial joints followed by the anterior arch,posterior arch and lateral mass of atlas respectively,and C2 vertebral arch again.( 3 )Magnesium alloy and titanium alloy TARP systems showed significant difference in stress distribution (P ＜0.05).Conclusions(1)The atlantoaxial model established according to its structure information on CT can be used for biomechanical experiments.(2) For the treatment of atlantoaxial dislocation using the existing titanium TARP system,maintaining the integrity of anterior and posterior arch of atlas and confirming the bone fusion in lateral mass can better keep the stability of the atlantoaxis.After atlantoaxial fusion,the increased stress of the zygapophysial joints of the adjacent segments accelerates structural degeneration,which should be closely followed up.( 3 ) Magnesium alloy TARP system for fixation and reduction shows the fall in peak value of the stress concentration region,and improvement of the uniformity of stress distribution as compared with titanium alloy TARP.

Problem-based social practice is organically combined with health education lessons,to improve tobacco control capacity of preventive medicine students,through study in class and social practice after class.The students' awareness rate of tobacco regulations,support rate of smoke-free school,rejecting smoking rate,and lifetime non-smokers rate have significantly increased ( 40％～90％ ) after intervention.The teaching method is adult learning model,and it has effectively enhanced preventive medical students' tobacco control capacity.