Objective To investigate the fluid resuscitation strategies to craniocerebral injury patients combined with multiple trauma.Methods This retrospective review was made on 124 patients with combined craniocerebal injury (GCS 3-12 points) plus multiple trauma.Based on the fluid resuscitation strategies,63 patients were treated with aggressive fluid resuscitation (AFR),and 61 with limited fluid resuscitation (LFR).A restrictive rehydration principle was performed with intensive hemodynamic monitoring:mean arterial pressure was kept between 70-80 mmHg for 48 hours and central venous pressure between 6-8 cmH2O for 48 hours in LFR group; mean arterial pressure was kept in basic level and central venous pressure between 8-12 cmH2O in AFR group.No significant differences were shown in the rest of treatments.Parameters were compared between groups such as blood pressure,shock index,coagulation function,imaging data,GCS,and GOS at 6 months postinjury.Results Between-group differences were insignificant with regard to mean arterial pressure (MAP),shock indices,ISS,trauma severity indices (TSI),and GCS (P ＞0.05).Blood pressure fluctuation in LFR group was (18.5 ±9.9) mmHg vs (29.4 ± 11.1) mmHg in AFR group (P ＜ 0.01).Eight patients developed intracranial hemorrhage progression in LFR group,with 3 being treated with craniotomy.In comparison,19 patients developed intracranial hemmorrhage progression in AFR group,with 10 being treated with craniotomy (P ＜ 0.01).Improvement in coagulation disorders was better in LFR group than in AFR group.On days 7 after admission,GCS in LFR groups was (9.1 ± 3.6) points vs (7.2 ± 2.3) points in AFR group (P ＜0.05).At 6-month follow-up,results were 34 good and 27 poor in LFR group,better than 23 good and 40 poor in AFR group.Conclusion For moderate to severe craniocerebral injury combined with multiple trauma,LFR is effective to treat coagulation disorders and hemorrhagic shock,reduce the probability of delayed intracranial hemorrhage,and further improve the outcome.

58 mm Hg and 24hDBP descend significantly.Diurnal blood pressure rhythm abnormality(blood pressure descending 10% at night)is a high risk factor for renal impairment in essential hypertension.

We surveyed the graduate students at Peking University Health Science Center for the difficulties during their study. The result showed that the major difficulties were job pressure, completing studies and economic burden. Some students were also bothered by love affairs, health conditions and interpersonal relationship. Suggestions were made for future work to help these students to cope with such difficulties to complete their study smoothly.

Humans ; Infant ; Male ; Mycoses ; pathology ; Penicillium ; isolation & purification

A novel strain,which could use 2-hydroxypyridine (2HP) as the sole source of carbon,nitrogen,and energy,was isolated from petroleum-contaminated soil at the Liaohe estuarine wetland.Strain 2PR was identified as Arthrobacter based on the morphology and 16S rRNA gene sequence.The optimum growth and degradation condition upon 2PR is 30℃ and pH 7.0,respectively.Under this condition,2HP degradation rate were 97.34％,94.95％,94.48％ and 89.21％ with 2,4,6 and 8 mg/ml initial concentration of 2HP at 42,96,120 and 156 h,respectively.Strain growth and 2HP degradation kinetics studies indicated that the strain followed Logisitic model,which could provide a theoretical and technical reference for the biodegradation of 2HP.The color of strain 2PR culture upon 2HP-MSN changed from colorless to blue,and then turned to brown.The blue pigment,which was observed at the culture of strain 2PR,was identified as 4,5,4',5'-tetrahydroxy-3,3'-diazadiphenoquinone-(2,2') by high performance liquid chromatography (HPLC) and high-performance liquid chromatography-mass spectrometry (LC-MS) analysis.The LC-MS signal with m/z =249.1 was observed in resting cells reaction sample with 2HP as the substrate.The degradation of 2HP might be achieved by a dioxygenase to produce 2,3,6-trihydroxypyridine,which could transformed to the blue pigment spontaneously,and then 2,3,6-trihydroxypyridine was converted with an pyridine-ring cleavage reaction.Among all the reported strains,strain 2PR has the strongest tolerance and the highest 2HP degradation efficiency at present.The strain has a promising application potential for 2HP waste treatment.

Resident standardization training system is established in the framework of modern western medicine. With less consideration to the specificity of TCM on the curriculum, teaching mode and other aspects, it is not suitable for the actual requirement of TCM hospital. TCM apprentice education has a long history, is an important form of the traditional education of Chinese medicine. Leading the TCM apprentice education mode into the standardized training of resident physicians, exploring the construction of the teaching model suited to help the masses of TCM college graduates training will play an increasingly important role in training work.

OBJECTIVE:To determine the plasma concentration of mycophenolic acid (MPA) in renal transplantation patients by HPLC-Fluoremetry. METHODS: The sample was subjected to precipitation of proteins using 5% Zinc Sulfate methanol saturated solution,and the supernatant (20 ?L) was taken for sample injection and determination on Zorbax Eclipse XDB C18 with mobile phase consisted of acetonitrile-methanol-0.2 mol?L-1 glycine buffer(18∶2∶80,pH=9.0) at a flow rate of 1.0 mL?min-1. The column temperature was of 25℃;the excitation wavelength(EX) was 342 nm and the emission wavelength(EM) was 425 nm. RESULTS: The linear range of MPA was 0.5～40 mg?L-1,with its lowest limit of quantitation at 0.5 mg?L-1. The methodology recovery was 98.23%～101.00%;the extraction recovery of MPA was 91.56%～94.46%;the intra-day RSD was 0.64%～3.22% and the inter-day RSD was 5.12%～6.10%. CONCLUSION: The method is sensitive,rapid,accurate,convenient,and applicable for the quantitative determination of plasma concentration of MPA in renal transplantation patients.

Objective To assess the efficacy of the mixtures of different concentrations of ropivacaine(R) and chloroprocaine(C)for epidural anesthesia in patients undergoing hysterectomy.Methods Sixty ASAⅠorⅡpatients aged 27-56 weighing 45-75 kg undergoing elective hysterectomy were randomly divided into 4 groups(n= 15 each);groupⅠ0.75% R alone;groupⅡ0.5% R-1% C;groupⅢ0.5% R-1.5% C and groupⅣ0.75% R+1% C.The epidural catheter was placed at L_(2,3)interspace and advanced 3.5 cm into the epidural space in cephalad direction.A total of 22 ml of epidural solution was injected in each group.The onset time,block height and duration of sensory block and the onset time,degree and duration of motor block(using Bromage scale)were assessed.The use of supplementary drugs(ketamine and ephedrine)and side effects were recorded.Results The onset time of sensory and motor block was significantly shorter in groupⅡ,ⅢandⅣthan in groupⅠ(0.75% R alone).The duration of sensory and motor block was significantly shorter in groupⅡandⅢthan in groupⅠandⅣ.The incidence of hypotension was significantly increased but the incidence of discomfort produced by traction on the viscera during operation was reduced in groupⅣas compared with groupⅠ.Conclusion The anesthetic efficacy of epidural 0.5% ropivacaine is significantly enhanced when mixed with 1.0% or 1.5% chloroprocaine.

Objective To investigate the relationship between the different ambulatory arterial stiffness index and the markers of renal impairment in order to provide a scientific method for detecting the renal impairment of essential hypertension. Methods Three hundred essential hypertensive patients without overt proteinuria were enrolled. The ABPM was performed and the blood pressure parameters were analyzed in order to estimate the symmetrical ambulatory arterial stiffness index (S-AASI) and ambulatory arterial stiffness index (AASI) . Microproteinuria was measured by urine microalbumin to creatinine (mAlb/Cr)as well as n-acetyl-β-D-glucosaminidase (NAG)to creatinine rate (NAG/Cr). Creatinine clearance (Ccr) and Glomerular filtration rate (eGFR) were estimated from serum creatinine (sCr) . Linear correlations were performed to confirm the independent predictive power of S-AASI and AASI for renal lesion. Results Correlation test showed a significant positively relationship of S-AASI with urine mAlb/Cr (0.708, <0.001), urine NAG/Cr (0.700, <0.001) and sCr (0.229, <0.05) . Ccr (0.601, <0.001) and eGFR (0.309, <0.05) were negatively correlated with S-AASI. On the other hand, AASI was also correlated with urine mAlb/Cr (0.489, <0.001),urine NAG/Cr (0.470, <0.001) and Ccr (0.311, <0.05),but not with the sCr (0.064, >0.05) and eGFR (-0.135, >0.05) . S-AASI seems to get an independent relationship with all of the parameters of renal impairment which could not be detected with AASI. Conclusion This results suggested that S-AASI may be a better approach than AASI to estimate hypertensive renal impairment.

Objective To study the influence of carboxymethyl-chitosan(CM-chitosan)on chondro- cyte apoptosis induced by recombinant human interleukin-1?(rhIL-1?)and explore its mechanism.Methods Rabbit chondrocytes were isolated and cultured.Chondrocytes were pretreated with different concentrations of CM-chitosan for 1 h,then 10 ng/ml IL-1?were added into the culture medium.After 24 h,the apoptotic rates of chondrocytes were measured by flow cytometry with AnnexinⅤ-FITC and PI staining.The morphology of nuclei was observed by fluorescent microscopy with Hoechst 33342 staining.The mitochondrial membrane po- tentials were tested by confocal laser scanning microsocopy with Rhodamine-123 and ATP contents were mea- sured by luciferase reaction.Results CM-chitosan could inhibit chondrocyte apoptosis and restore the func- tion of mitochondria induced by IL-113 in a dose-dependent manner.Conclusion CM-ehitosan can inhibit chondrocyte apoptosis by protecting mitochondrial function.