Objective Analysis of applies the Cleveland needle , Miniature steel plate , Outside the steady rest in treatment palm phalanx bone fracture .Methods Three hundred and twenty -six example 394 palms, phalanx bone fractures .A group of 126 example 157 use in the Cleveland needle fixed;B group of 81 example 99 use in the AO steel plate fixed;Outside C group of 93 example 108 use the steady rest to be fixed;D group of 26 example 30use may absorb in the nail fixed . Surgery time,technique the joint func-tion restores the situation , the bone fracture cicatrization time and the complication occurrence were ana-lyzed.Results TAFS grades:A group was 77.8%;B group was 96.3%;C group was 96.7%.D group was 96.2%( P<0.05 ) .Conclusion Because of different to loss degree palm , we should select and use the different inner or outside fixture respectively .

Objective To evaluate the prognostic factors of elderly patients with noscomial Candidemia in intensive care unit. Methods A retrospective study was carried out in 75 elderly patients with noscomial Candidemia from 2001 to 2008. Multivariate logistic regression analysis was performed to find the correlations of prognosis with clinical and biochemical parameters. Results A total of 75 Candida strains were isolated from blood. The proportion of non-albicans species reached to 70.7%. Fluconazole-resistant candidiasis was increased. Overall mortality rate was 48.0%.Multivariate logistic regression analysis showed that septic shock, comorbid bacteremia, higher serum creatinine and sequential organ failure assessment (SOFA) score more than 10 were independent predictors for in-hospital mortality (Ward=6.34, 5.15, 8.04, 6.82, all P＞0.05). Conclusions Noscomical Candidemia in elderly critical illness patients leads a high mortality, the proportion of nonalbicans species and fluconazole-resistant candidiasis increase. The blood culture and drug sensitive test should be performed routinely to provide proper evidence for antifungal therapy. Monitoring the high risk factors, effective and reasonable therapeutics are the guarantee for reducing the mortality induced by Candidemia.

BACKGROUND:Human-mammal chimeric liver chimera has been a vital significance for the proliferation and differentiation of bone marrow mesenchymal stem cells.
OBJECTIVE:To establish an animal model of human-rhesus chimeric liver using adult bone marrow mesenchymal stem cells.
METHODS:Adult bone marrow mesenchymal stem cells were isolated, purified and cultured for the sixth generation. The number of bone marrow mesenchymal stem cells was no less than 5×108. Bone marrow mesenchymal stem cells labeled with green fluorescent protein were transplanted into the liver of the embryo rhesus with pregnancy of 10 weeks under guided by type-B ultrasound. At the 1st and 3rd months of birth, the liver tissue of the infant rhesus was taken for biopsy. After routine pathological section, histological specimens were observed under fluorescence microscope to confirm if there were adult bone marrow mesenchymal stem cells positive for green fluorescent protein and their distribution, and detected by immunohistochemical staining to identify if human albumin expressed in the liver of infant rhesus.
RESULTS AND CONCLUSION:Fluorescence microscope observation indicated that at the 1st and 3rd months after birth, there were surviving bone marrow mesenchymal stem cells derived from human with green fluorescence in the liver of infant rhesus, and these cells migrated to form more concentrated distribution. The immunohistochemical results demonstrated that functional liver cells expressing human albumin were observed in the liver of infant rhesus at the 1st and 3rd months after birth, and their distribution was in accordance with bone marrow mesenchymal stem cells with green fluorescence. Human-rhesus chimeric liver can be established using adult bone marrow mesenchymal stem cells, which can generate functional liver cells in the liver of infant rhesus.

Objective To evaluate the efficacy and safety of Caspofunjin on invasive fungal infections in patients refractory to Fluconazole in ICU.Methods The open clinical trial was conducted in 44 invasive fungal infections patients who was refractory to Fluconazole,including 7 cases of confirmed,28 cases of suspected and 9 cases for empire treatment.They were treated with Caspofunjin in a dose of 70 mg in the first day,and then in a dose of 50 mg/d for 10～40 d.Results The cure rate of patients was 42.86%,the effective rate was 76.19%,and the eradication rate was 65.22%.All patients were well tolerated.Conclusion Caspofunjin is effective and safe in the treatment of severe invasive fungal infections.

Objective To explore the competency of community health administrators in a survey of such administrators at large in Shanghai. Methods McClelland's Competency Dictionary was used to set two benchmark positions, while the behavioral event interviewing and questionnaires were made to survey 19 community health service centers in Shanghai. Results The competency model benchmarking on the head of a medical branch consists of 6 character clusters, 11 characteristic items, 27 evaluation dimensions and 27 typical behavior descriptions. The model benchmarking on the community team leader consists of 5 character clusters, 8 characteristic items, 21 evaluation dimensions and 21 typical behavior descriptions. Conclusion Findings of the survey provide objective criteria for competence appraisal of community health administrators, and serve as reference for formulating their development plans as well.

Objective To evaluate the early diagnostic values of soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) in patients with ventilator associated pneumonia (VAP).Methods A total of 112 clinical suspicion VAP ventilator-associated pneumonia (VAP) patients accepted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay separately made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups:VAP group (n =74) and non-VAP group (n =38).The levels of sTREM-1 in broncho-alveolar lavage fluid (BALF) collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay (ELISA) on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic (ROC) curve.Results A total of 112 clinical suspicion VAP patients admitted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups:VAP group (n =74) and non-VAP group (n =38).The levels of sTREM-1 in broncho-alveolar lavage fluid (BALF) collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay (ELISA) on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic (ROC) curve.Conlclusions In suspected VAP patients,measurement of sTREM-1 levels in BALF and in serum could help identify VAP in early stage.

Objective:To evaluate the clinical application value of gastrointestinal contrast-enhanced ultrasound combined gas injection method in verifying the location of nasointestinal tube in critically ill patients.Methods:Data of 60 critically ill patients who had the indications of indwelling nasointestinal tube were collected from September 1,2015 to September 1,2016 in the Intensive Care Unit of Zhejiang Provincial People(s) Hospital.The position of nasointestinal tube in patients who underwent bedside blind insertion would be confirmed routinely through gas injection auscultation method.After tube was inserted,its route was scanned by ultrasound with gas perfusion assistance.Afterwards,rapid gas perfusion was used until suspicious tube end position was determined.Furthermore,oral ultrasound contrast agent was injected into the tube if instantaneous strong echo of gas was observed in localized lumen,and contrast agent filling meant the placement being successful.Two methods of position confirmation of nasointestinal tube in critically ill patients included gastrointestinal contrast enhanced ultrasound combined gas injection and gas injection auscultation only,and the effect of the two methods was compared and confirmed by chest and abdominal X ray examinations to verify the location of nasointestinal tube below pylorus.Results:A total of 60 patients were included in this study,58 patients(96.7％)in gastrointestinal contrast enhanced ultrasound combined gas injection group were successfully positioned.Among them,the placements of tube in 56 cases were below pylorus,while 2 cases were above pylorus.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of location of gastrointestinal contrast enhanced ultrasound combined gas injection method were 96.6％,100％,100％,50％,96.7％ and of gas injection auscultation method were 74.1％,50％,97.7％,6.3％ and 73.3％.The differences of the sensitivity,specificity,negative predictive value and accuracy between the two methods were statistically significant (P ＜ 0.05).Conclusion:Gastrointestinal contrastenhanced ultrasound combined gas injection method is a safe,simple and convenient method with high sen-sitivity,specificity,negative predictive value and accuracy in confirming the location of the nasointestinal tube.

Objective To investigate the effect of geraniin on expression of Wnt3a protein and mRNA in bone marrow stromal cell (BMSC) from osteoporotic rats. Methods The model of osteoporosis (OP) was duplicated by ovariectomy in rats. BMSCs were isolated and cultured. BMSCs from shamed rats were routinly cultured and taken as normal control, and BMSCs from OP rats were divided into model group, 1μmol/L simvastatin positive group, and geraniin group (0.01, 0.1, 1, 10, 100 μmol/L), respectively. The methods of realtime-PCR and western blot were used to assay the protein and mRNA expression of wnt3a, respectively.Results As compared with normal control group, the protein and mRNA expression of wnt3a in model group were significantly suppressed;Compared with model group, 1 μmol/L simvastatin, and 0.1, 1, 10 and 100 μmol/L geraniin significantly increased the expression of wnt3a protein and mRNA. Conclusion It is suggested that geraniin activates wnt/β-catenin pathway though increasing the expression of signaling protein wnt 3a in BMSCs from OP rats. It would be beneficial to osteogenic differentiation of BMSCs and osteogenesis.

Objective To investigate the metabolite changes in systemic lupus erythematosus (SLE) patients with and without neuropsychiatric symptoms using magnetic resonance spectroscopy (MRS) and explore the associations between image findings and clinical variables. Methods Twenty-two SLE patients with neuropsychiatric symptoms (NPSLE), twenty-one SLE patients without neuropsychiatric symptoms (non-NPSLE) and twenty healthy controls (HCs) underwent routine MRI scan and multivoxel magnetic reson-ance spectroscopy (MVS). The absolute metabolite concentrations were measured bilaterally in the posterior cingulate gyrus (PCG), dorsal thalamus (DT), lentiform nucleus (LN) and posterior paratrigonal white matter (PWM) using LCModel and SAGE software. The relationships between metabolite con-centrations and cognitive function scores were analyzed by Spearman rank correlation. Single-factor Chi-square analysis and t-test were used for analysis. Results ① Compared to control subjects, NPSLE patients had significantly lower N-acetylaspartate (NAA) values in bilateral PCG and DT, with the mean differences of -1.504 [95% confidence interval ( CI) (-2.335, -0.672), P=0.001], -1.460 [95%CI (-2.349, -0.570), P=0.002], -1.259 [95%CI (-1.894, -0.625), P=0.000] and -1.022[95%CI (-1.688, -0.356), P=0.003] for RPCG, LPCG, RDT and LDT, respectively. The concentration of total creatinine were observed to decline in RPCG and RDT, with the mean differences of-1.094 [95%CI (-1.845, -0.342), P=0.003], -0.955 [95%CI (-1.630, -0.280), P=0.006], -1.259 [95%CI (-1.894,-0.625), P=0.006] respectively. Glutamine and glutamate-values decreased significantly in RDT [mean difference=-2.586, 95%CI (-4.139, -1.033), P=0.002]. ② Compared to non-NPSLE patients, NPSLE patients had a lower NAA level in LPCG [mean difference=-1.256, 95%CI (-2.146, -0.367), P=0.006]. Positive correlations between mini-mental state examination scores [RPCG: rs=0.312, P<0.05; LPCG: rs=0.355, P<0.01], Montreal cognitive assessment scores (RPCG: rs=0.362, P<0.01; LPCG: rs=0.285, P<0.05) and NAA values in bilateral PCG were detected. Conclusion Both NPSLE and non-NPSLE patients may have metabolite dysfun-ctions in different brain regions. The cognitive disorder in SLE patients may be interpreted by neuronic damage of PCG.

Objective To observe the effects of neuromuscular activation (Neurac) training on balance and walking in children with hemiplegic cerebral palsy. Methods 30 children with hemiplegic cerebral palsy from March to October, 2015 were divided into observation group (n=15) and control group (n=15). Both groups received routine rehabilitation, while the observation group received 30-minute Neurac training in addition, 5 times a week, for 3 months. They were assessed with D and E domains of Gross Motor Function Measure 88 (GM-FM-88), balance of Fugl-Meyer Assessment and footprints analysis before and after treatment. Results The scores of D and E domains of GMFM-88 and balance of Fugl-Meyer Assessment, and the step length, step width and velocity improved in both groups after training (t>7.31, P<0.001), especially in the observation group (t>2.08, P<0.05). Conclusion Neuroac training can further promote the recovery of gross motor function, balance and walking in children with hemiplegic cerebral palsy.