OBJECTIVE:To discuss the relationship between the changes in pla sma endotoxin levels and use of antibiotics in patients with serious traumatic injury before and after operation.METHODS:The plasma bacterial endotoxin levels were dynamically detected by kinetic turbidimetric assay in20patients with severe traumatic injury used with different antibiotics before and after operation,at the same time the normal control group was established.RESULTS:Plasma endotoxin levels in patients with severe traumatic injury increased remarkably before and after operation,as compared with the normal control group(P0.05).CONCLUSION:Intestine-borne endotoxin induced in a stress condition can strengthen the pathological reaction of the body ,therefore dy?namic detection of plasma endotoxin can provide guidance for clinical therapy.

Objective Carry out the reform of the online learning mode of prehospital training for refresher doctors , and evaluate the effect of reform in Peking Union Medical College Hospital .Methods An exploration was carried out on the refresher doctors prehospital training mode from traditional classroom teaching to online learning , Estab-lished the online learning system .Evaluated the effect of online learning by the way of questionnaire investigation andreexaminationamong289refresherdoctors.Results 289refresherdoctorshavecompletedthestructuredon-line courses of prehospital training , and the average pass rate of the first test was 42.2%.The questionnaire and retest was conducted , A total of 262 doctors completed the work , The recovery rate was 90.7%, and the average pass rate of retest was 74.9%, showing improvement by 32.7%.Conclusions Online learning mode is an effec-tive tool for knowledge dissemination , and has a better learning effect .

Prostatic disorders are common and frequently occur in male,which have caught wide attention in society.At present,the medication,surgery treatment and physical therapy are the main treatments for prostatic disorders.In this article,a new-type apparatus for prostate therapy is introduced.With radio frequency current on affected part,the abnormal tissues' temperature is raised so that the accelerated blood circulation can kill the pathogenic bacteria for cure.At the same time,there is a shaking device and a magnetostatic field in its probe,which can hasten the excretion of putrescence and desquamative tissues in the pathological parts with other normal tissues unaffected.It is worth popularizing for its safety and effectiveness.

Objective To investigate whether paclitaxel can efficiently induce the apoptosis of ovarian cell HO-8910,and to study the relationship between the apoptosis of cells and the cell cycle.Methods With the treatment of paclitaxel with different concentrations and different time,the morphologic change of HO-8910 ovarian cells was observed using fluorescence microscopy and transmission electron microscopy(TEM),and the apoptosis of cells and the changes of cell cycle were determined by flow cytometry(FCM). Results The typical changes of HO-8910 cell apoptosis were observed by TEM and Fluorescence microscopy.With the treatment of paclitaxel,the HO-8910 ovarian cells were firstly arrested in G_2/M phase,and the typical ultrastructural changes of apoptosis were appeared only after the cells were apparently arrested in G_2/M phase.Conclusion Paclitaxel can induce the apoptosis of HO-8910 cells and the apoptosis is associated with the blockage of G_2/M phase in cell cycle.

Objective To explore the expression and regulatory mechanism of hypoxia inducible factor-1?(HIF-1?)during fracture healing. Methods Mouse models of tibia fracture healing were established,and callus samples were collected 1,3,7,14,21 and 28 days after fracture.The development of callus and new bone formation were evaluated with roentgenology,Micro-CT and tetracycline double labeling method,and the expression of HIF-1?,vascular endothelial growth factor(VEGF),Runx2 and ALP in callus were detected with RT-PCR,Western blotting and immunohistochemistry.The relationship between HIF-1? and fracture healing was analysed. Results The expression of HIF-1? was detected in cells in the fracture sites as well as in evolved osteoblasts,chondrocytes and osteocytes in early callus under hypoxia.The highest expression rate of HIF-1? achieved on the 7th day after fracture,lasted for about 7 days,then decreased gradually,and returned to intact level on the 28th day after fracture.The expression tendency of VEGF resembled that of HIF-1?.Bone formation activity was more active in early callus,and the callus volume peaked on the 14th day after fracture and decreased gradually.The mineralization of callus mainly took place in the late healing period(14th to 28th day after fracture).Conclusion Cells involved in fracture healing are hypoxia-responsive cells,which express HIF-1?.HIF-1? can regulate cell state and function,and can promote angiogenesis so as to play a crucial role in fracture healing.

In the process of building a high level resident standardized training base, the competency training of the management staff is an important mission.The connotation of management staff`s competency is divided into three levels: knowledge competence, work competence and problem-solving competency.The training of management staff`s competency needs to be decomposed and analyzed on three levels of competency, and to be implemented according to the specific training process.

Objective To analyze plague epidemic tendency in the Three-River Region of Qinghai.Methods Using retrospective study,the Three-River Region during 1954-2006 year pestis epidemic focus were investigated and analyzed.Result Pestis prevailed mainly in Yushu,Chindu,Qumalai,Nangqian,Zhiduo and the Geermu.Tanghla Township.It was first found that the nature plague focus of miefitus existed in Chengduo County.There are 1 5 kinds of 12 branches in 8 trees infected plague animals were founded,336 Yersinia pestis were separated from the driven objects.Among them there were 291 Himalayas marmot body,account for 86.60%of the total,13 of Tibet sheep,accounts for 3.87%.10 of Qinghai field-mouse,accounts for 2.98%,Also there were 114 Yersinia pestis which were separated from each kind of vector insect in vivo.And,46 pestis strains came from the axe shape of flea in vivo account for 40.35%(46/114),38 pestis strains separated from Xie mountain flea,account for 33.33% (38/114).During 1960-2006 years there were 85 human plague cases were founded,238 occurred,134 died,the case fatality rate wero 56.30%(134/238),the popular seasons were started from May to November,the peak season happened in Aug and Sep.After Oct mainly due to Tibet sheep pestis which will cause as the origin of infection.The majority of sickness was pulmonary plague,account for 49.58%(117/238),whereas the first round case caused by the gland bubonic plague,account for 77.12%(91/118).Conclusions There are two pestis strains natural epidemic focus places in Three-River Source Region of Qinghai including the Himalayas marmot pestis strain and the Qinghai field-mouse pestis strain.The case of human pestis strain causes by the marmot strain,the fiehl-mouse mold mushroom spawn causes human pestis strain has not yet discovered,Three-River Source Region of Qinghai is a pestis strain key popular area in Qinghai Province.

?AlM:To study the relationship between blood lead level and abnormal eye blinking in children.
? METHODS: The patients with chief complaint of frequent eye blinking, whose diagnosis of abnormal eye blinking, were randomized to experimental group. The patients in this group carried out vision and the slit-lamp examination, detected corneal fluorescein staining and tear break-up time, and improved the level of blood lead and trace elements examination. The patients in control group with chief complaint of health physical examination in our hospital, excepted of blood lead level, the other body check results were normal and were divided into boys group and girls group according to the gender. The changes of the experimental group and control group in blood lead level were compared.
?RESULTS: Totally 371 cases ( male:295 cases; female:76 cases) with mean age was 6. 56±2. 41 years and 6. 08±2. 82 years respectively were in experimental groupe. ln control group, there were 300 cases ( male: 186 cases;female:114 cases) with mean age was 6. 99±3. 01 years and 6. 56±2. 80 years respectively. The average of blood lead level of boys in experimental group was 63. 82 ±24. 56μg/L and 53. 98±15. 42μg/L in control group. The average of blood lead level in experimental group was higher than that in control group. The difference between of the two group was statistically significant (χ2=16. 96, P<0. 01 ). The average of blood lead level of girls in experimental group was 56. 96±16. 69μg/L and 48. 18±12. 35μg/L in control group. There was no difference between of the two group (χ2=5. 77, P=0. 56). ln control group, the average of blood lead level with <3 years, 3~6 years and >6 years children were 48. 73±11. 67μg/L, 51. 39 ± 14. 87μg/L, 52. 98 ± 14. 45μg/L respectively. ln expirement group, the results were 56. 57±17. 89μg/L, 59. 92±18. 46μg/L and 67. 00±32. 55μg/L in <3, 3~6 and >6 children, respectively. There was no significant difference with <3 years (χ2=3. 54, P=0. 17). The difference with 3~6 years and >6 years children were statistically significant (χ2 = 9. 62, P = 0. 008 ) and (χ2 = 19. 22, P = 0. 000 ) respectively. The blood lead level were divided into three grades: <50μg/L, 50 ~100μg/L, >100μg/L, and relative risk (RR) were 0. 65, 1. 22, and 10. 11 respectively.
?CONCLUSlON: Blood lead level of experimental group is higher than that of control group. The relationship between blood lead level and abnormal eye blinking in children is positive correlation.

Objective To assess the clinical relevance of polymorphisms at position-251 in the promoter region of IL-8 gene and the incidence of sepsis in patients with severe trauma.Methods A total of 296 patients with severe trauma were included in the prospective cohort study.Incidence of sepsis was decided on the basis of the clinical manifestations and blood culture results.Muhiple organ dysfunction score (MODS) was performed using Marshall' s standard.IL-8/-251 gene polymorphisms were genotyped using restriction fragment length polymorphism polymerase chain reaction (PCR-RFLP).IL-8 plasma level was determined using ELISA method.Results Genotype frequency at IL-8/-251 locus in trauma patients was in accord with Hardy-Weinberg equilibrium (P ＞ 0.05).Sepsis incidence in trauma patients with TT,TA,and AA genotypes at IL-8/-251 locus was 58.1％,49.6％,and 25.0％ respectively.Multiple regression analysis showed inverse correlation between sepsis incidence and quantity of A alleles [OR =0.637,95％ CI (0.421,0.963),P ＜ 0.05].Carriers of AA genotype presented lower MODS score than those of other two genotypes (P ＜ 0.05).IL-8 plasma level presented significant difference among carriers of the three genotypes (P ＜ 0.01) and A alleles were associated with the down-regulation of IL-8 (P ＜ 0.01).Conclusion IL-8/-251T/A polymorphisms are implicated in the development of posttraumatic sepsis and AA genotype is protective against posttraumatic sepsis.

Objective To evaluate the reliability of objective structured clinical examination based on standardized patients in clinical skill test for medical students.Methods To analyze the scores of 8 stations OSCE by applying multivariate generalizability theory.Results The relative G coefficient of the 8 stations OSCE was 0.886, and the absolute G coefficient was 0.883.Conclusions Multivariate generalizability theory is an objective and scientific method to evaluate the OSCE stations, and the analysis results facilitate to improvement the practice interms of quality and efficacy.