Objective To clarify the features and early diagnosis of the traumatic diaphragmatocele associated with pelvic fracture. Methods The clinical materials of 486 multiple injuried patients with pelvic fractures as main trauma were retrospectively analysed. The pathogenesis, clinical manifestation and reasons for misdiagnosis in 9 cases of traumatic diaphragmatocele were analysed. Results In this series, the incidence of the traumatic diaphragmatocele was 1.9%(9 of 486). Because of under recognition of this associated injury, 7 in 9 cases of traumatic diaphagmatocele were misdiagnosed or undiagnosed. The incidence of misdiagnosis was 77.8% in this series. Conclusion The main reason for the occurrence of diaphragmatocele was the rapid increase of the intra abdominal pressure which resulted in rupture of the weak area of the diaphragm. Type B1 pelvic fracture can cause traumatic diaphragmatocele easily. The symptoms of the diaphragm hernia are easily overlooked when the trauma is serious or the patient is in shock. Because the early symptoms are not often evident and typical, the doctor can not notice it thoroughly. The main reason for misdiagnosis of the diaphragm hernia is the poor clinical presentation and sign of the diaphragmtocele which initially is very similar to that of the thoraco abdominal injury. In the case with chest and abdominal symptoms concomitant with pelvic fracture should be observed carefully and the chest and abdominal radiographs should be taken as soon as possible. Closed attention should be paid to diaphragmatocele when treating a pelvic fracture in consideration of 7 out of 9 patients being misdiagnosed in this series.

Aim: To study new chemical constituents of the leaves of Ginkgo biloba L. Methods: Isolation and purification were carried out by several chromatographic methods. The structures of the compounds were elucidated by detailed analysis of their UV, IR, MS, ~1H NMR and ~(13)C NMR spectra Results: A new ginkgolide, ginkgolide N( 1, 7, 10-trihydroxy-3,14- dehydroginkgolide, Ⅱ), along with a known compound, was isolated from the leaves of G. biloba. The structure of the known one was elucidated as ginkgolide L(Ⅰ). Conclusion: Compound Ⅱ was a new compound. The complete spectroscopic data of compound Ⅰ were reported for the first time.

AimTo investigate the protective effect of nerve growth factor (NGF) from the Chinese cobra venom on spinal neurons after sciatic nerve lesion. Methods Fourty Wistar rats were divided into 2 groups each containing 20 animals. After surgical crush lesion on the bilateral sciatic nerve, the rats were injected NGF into the target muscle every day. On the d 5 and d 10 after operation, enzyme histochemistry technique was used to show acetycholinesterase(AchE) activity of the motoneurons in L5～S2 spinal cord anterior hornandfluorideresistantacidphophatase (FRAP) activity of substantia gelatinosa in L5～ S2 spinal cord posterior horn. The activity of enzyme was analysed with computer image analysis system. Results Compared with the control group, the activity of FRAP in NGF group was higher on the d 5 and d 10 after operation and the activity of AchE in NGF group was higher on the d 10 after operation. ConclusionIt is demonstrated that NGF could protect the mononeurons in spinal cord anterior horn and the sensory neurons in dorsal root ganglia after axotomy.

Objective To assess the value of CTA and DSA in neurovascular diseases.Methods 20 cases with suspected neurovascular disorders who received CTA and DSA examination between March 1999 and August 2000 were retrospectively collected.The sensitivity,specifility and accurate rate of CTA were analysed compared with DSA as gold standard.Results In 20 cases,neurovascular disorders were found in 17 on CTA.18 lesions were detected,including 6 aneurysms,9 arteriovenous malformations(AVM),2 carotid cavernous fistulae(CCFs)and 1 arterial stenosis.By contrast,19 lesions in 17 cases were detected by DSA,including 7 aneurysms,8 AVMs,2 arterial stenoses and 2 CCFs.The sensitivity,specificity and accuracy of CTA in the detection of neurovascular disorders were 90.6%,95.2% and 90.6% respectively.Conclusion 3D-CTA is a new modality with high sensitivity and specificity in the detection of neurovascular disorders.As it can be obtained simply,conveniently and safely with mild injury to the patient,CTA can be used in the diagnosis of neurovascular diseases,especially in the AVMs.

Objective To analyze the antimicrobial resistance profile of clinical isolates in Shanghai Xinhua Hospital Chongming Branch affiliated to Shanghai Jiaotong University School of Medicine , a member of China Antimicrobial Resistance Surveillance System, during 2015, for the purpose to facilitate rational antimicrobial therapy. Methods Strain identification?and?susceptibility?testing?were?carried?out?for?the?clinical?isolates?using?MicroScan?WalkAway?96?Automated?Systems and Kirby-Bauer method. Results In 2015, a total of 1815 isolates were collected, including gram-negative bacteria (73.2 %) and gram-positive bacteria (26.8 %). The top three frequently isolated species were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. ESBL-producing strains were found in 36.3 % of the Escherichia coli isolates, 12.6 % of the Klebsiella (K. pneumoniae and K. oxytoca) isolates, and 28.0 % of the Proteus mirabilis isolates. The prevalence of carbapenem-resistant strains was 0.69 % in Enterobacteriaceae isolates. The prevalence of methicillin-resistant strain was 29.1 % in S. aureus, and 61.4 % in coagulase-negative Staphylococcus isolates. No more than 15 % of the Enterobacteriaceae isolates and no more than 20 % of the P. aeruginosa and Acinetobacter isolates were resistant to carbapenems. No vancomycin-or linezolid-resistant strains were found in Enterococcus or Staphylococcus. Conclusions Antibiotic-resistant clinical isolates are a serious threat for clinical antimicrobial treatment. We should pay more attention to such urgent situation and rational use of antibiotics.

Objective To evaluate clinical efficacy and safety of fluvoxamine in the treatment of trichotillomania.Methods 24 outpatients who met the DSM-Ⅳ diagnosis criteria for trichotillomania received fluvoxamine for 12 weeks and 17 tricholillomania outpatients weren't treated with fluvoxamine.Clinical efficacies and adverse reactions were assessed with the spence children's anxiety scale(SCAS),Kovacs children's depression inventory (CDI),clinical global impression(CGI) and treatnent emergent symptom scale(TESS) before treatment and the end of the 4th and 12th week.Results After 4 weeks treatment,the scores of the SCAS (59.75 ± 12.35),CDI (24.95±7.68) and CGI(SI) (3.79±0.93) were lower than those before treatment(71.50±20.65,31.60± 10.40,5.88±0.68 respectively) (P＜0.05).After 12 weeks treatment the scores of the SCAS,CDI and CGI (SI) were lower than those after 4 weeks treatment (P＜0.05).After 12 weeks treatment the scores of the CGI(GI) (1.54±0.59) were lower than that at the end of 4 weeks treatment (2.96± 0.69) (P＜ 0.05).Conclusion Fluvoxamine has a good efficacy and higher safety in the treatment of trichotillomania.

OBJECTIVETo propose the seed quality standard of Belamcanda chinensis.

METHODThe seed purity, 1000-grain weight, water content, vitality, germination rate of seed of B. chinensis from different producing areas were measured, and seed characteristics were observed. Cluster analysis was used to analyze to data.

RESULTThe first level seed was lustrously dark and thoroughly rounded, seed purity was above 98%, 1000-grain weight was above 28.00 g, water content was lower than 12.8%, vitality was over 90%, germination rate was over 85%. The second level seed was dark and relatively rounded, seed purity was above 92%, 1000-grainweight was above 20.00 g, water content was below 12.8%, vitality was between 70%-90%, germination rate was between 65%-85%, the third level seed was puce, seed purity was above 86%, 1000-grain weight was above 20.00 g, water content was below 12.80%, vitality was over 50%, germination rate was above 40%.

CONCLUSIONThe seed purity of B. chinensis was almost above 90%, and 1000-grain weight was between 15.27 and 30.76 g. The vitality and the germination rate of B. chinensis seeds from different sources varied obviously.

Cluster Analysis ; Germination ; Iridaceae ; chemistry ; growth & development ; Medicine, Chinese Traditional ; standards ; Quality Control ; Seeds ; chemistry ; growth & development ; Water ; analysis

Trauma and chronic wear often make diverse injuries of rotator cuff.With the continuous development of medical technology,the treatment of rotator cuff tears is also being improved,including the modified suture techniques based on traditional single-row and double-row suture,the application of micro-fractures and tissue engineering strategies to facilitate the healing of rotator cuff,the adoption of superior capsular reconstruction and tendon transfer technique in the treatment of massive tears.Clinically,different types of rotator cuff tears have various repair techniques and therapies for healing promotion while each of them owns advantages and disadvantages.This article aims to review the current treatment of rotator cuff tears.

OBJECTIVETo investigate thirdhand smoke (THS) pollution in certain places of Nanjing, as well as to analyze its distribution characteristics.

METHODSFrom March to May, 2014, we selected 3 types of places (residencies, public places and transportation vehicles) that were close to people's living in Jianye,Yuhua,Jiangning,Xuanwu,Gulou and Pukou districts of Nanjing city.For each of the above 3 types of places, 2-3 smoking and non-smoking (smoking ban) locations were investigated, totally 51 locations, 9-10 samples were collected each location, totally 477 samples. The surface wipe sampling method in conjunction with liquid chromatography-tandem mass spectrometry (LC-MS/MS) was utilized to quantify the levels of nicotine that served as the tracer of THS pollution.One-way ANOVA and t-tests were employed to compare the levels of nicotine collected at different places and locations.

RESULTSTotally 477 samples were collected in this study, of which 27.0% was from residencies (129/477), 61.0% (291/477) from public places and 11.9% (57/477) from transportations. The levels of indoor surface nicotine in smoking residences, public places and transportations were (214 ± 55),(1 408 ± 177) and (1 511 ± 785) µg/m(2), respectively, which were all higher than those in the corresponding non-smoking places ((23 ± 9),(62 ± 11), and (46 ± 15) µg/m(2); t values were 13.79, 13.15, 3.45, respectively. P values were <0.001, <0.001 and 0.006, respectively).In the smoking places, the levels of surface nicotine on walls, desks, sofas, cabinets, door backsides and air conditioning openings were (171 ± 62),(232 ± 38),(373 ± 151),(903 ± 239), (978 ± 212), (1 721 ± 517) µg/m(2) (F = 7.06, P = 0.009).In the smoking condition, the levels of surface nicotine collected from public places were higher (F = 9.25, P = 0.024), while under non-smoking (smoking ban) conditions, the levels of surface nicotine collected from residences were lower (F = 7.88, P < 0.001).

CONCLUSIONTHS pollution was widespread in public places, residences and transportations in Nanjing city, which was more serious in the smoking environments than non-smoking (smoking ban) environments; the contamination was less serious in non-smoking (smoking ban) private residences; in the smoking condition, the levels of surface nicotine were relatively high at locations close to air conditioning openings, door backsides and cabinets.

Air Conditioning ; China ; Housing ; Humans ; Nicotine ; Public Facilities ; Smoking ; Tandem Mass Spectrometry ; Tobacco Smoke Pollution ; Transportation

Objective To investigate antimicrobial susceptibility profile of clinical isolates in Xinhua Hospital Chongming Branch affiliated to Shanghai Jiaotong University School of Medicine for rational use of antibiotics. Methods WHONET 5.6 software was used to analyze the distribution and susceptibility testing data of clinical isolates. Results A total of 5 278 bacterial isolates were collected from 2015 to 2017. The top three bacterial species were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, accounting for 24.8％, 16.1％ and 8.4％, respectively. The prevalence of major antibiotic-resistant bacteria was increasing. The prevealence of carbapenem-resistant Enterobacteriaceae (CRE) was 0.8％, 3.5％ and 7.0％ in the 3 years. The prevalence of MRSA was 32.4％, 41.9％, and 51.3％, respectively. The prevalence of the Acinetobacter strains resistant to antibiotics, especially to imipenem and meropenem, increased from 20.3％ to 64.6％. No vancomycin-or linezolid-resistant isolates were found in gram-positive bacteria. Conclusions The clinical bacterial isolates show increasing resistance to most antibiotics during the 3-year period in this secondary care general hospital. Especially, carbapenem-resistant Enterobacteriaceae poses a serious threat. Attention should also be paid to surveillance of antimicrobial resistance in secondary care general hospital.