Objective To investigate the value of C- reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-?) in early diagnosis of neonatal sepsis. Methods Sixty- five newborns were divided into experiment group and control group, experiment group was also divided into sure group and doubtful group by blood culture We assessed the level of serum CRP, IL-6 and TNF-? in 24 hours and after 24 hours of clinical diagnosis of sepsis in experiment group, and examined the blood culture before antibiotic treatment Serum CRP, IL-6 and TNF-? were also examined in 3 to 6 days old. Results 1 The levels of serum CRP, IL-6 and TNF-? in experiment group were significantly higher than that in control group 2. The sensitivity of IL-6 and TNF-? were higher than CRP in 24 hours in experiment group. 3. After 24 hours, the sensitivity of CRP was elevated,and there was no statistical difference compared with the IL-6. Conclusion IL-6 and TNF-? are the credible marker in the early diagnosis of neonatal sepsis, and are more sensitive than the CRP, the IL-6 is the first sensitive marker.

Objective: To develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method with cation exchange-based solid phase extraction (SPE) for determination of tetrodotoxin (TTX) in salted pufferfish. Methods: Evenly crushed salted pufferfish samples were subjected to ultrasound-assisted extraction with 0.5% acetic acid/50% methanol/water. The extract was cleaned with cation exchange-based SPE cartridge and eluted with 0.3% hydrochloric acid and 50% acetonitrile/water. The eluent was neutralized with ammonia and separated with a Waters XBridgeTM BEH Amide column (150 mm×3.0 mm, 1.7 μm), and determined using LC-MS/MS in a multiple reaction monitoring mode. Results: The matrix effects of TTX were 85.7%-92.4%, and the matrix suppression effect was under effective control following clean-up procedures using the optimized SPE method. The TTX showed a good linear relationship at the range of 2.0 to 4 000 μg/kg, with a correlation coefficient (r2) of 0.999 2. The limits of detection and quantitation for TTX in sample matrix were 1.0 μg/kg and 2.0 μg/kg, respectively. The mean spiked-recovery rates were 81.2% to 96.5% at spiked amounts of 2.0, 200 μg/kg and 2 200 μg/kg, with relative standard deviations (RSDs) of 4.3% to 7.5%. The intraday accuracy and precision of TTX were 84.4% to 95.6% and 4.9% to 5.8% in quality control samples, and the interday accuracy and precision of TTX were 86.1% to 94.9% and 5.5% to 8.5% in quality control samples. The detection of TTX was 60.5% in 38 market-sold salted pufferfish products using the established LC-MS/MS method. Conclusion The established LC-MS/MS method is effective for accurate quantitative determination of TTX in salted pufferfish.

Smart classroom as the basis support of classroom teaching, should set the function of smart teaching, real-time interaction, environmental control, video monitoring and remote control, teaching reform, evaluation feedback and other functions into an organic whole, and by using new technology integration and development, to achieve the optimization of the teaching effect. In view of the characteristics of practice and complexity of medical teaching, The spatial structure of smart class-room should provide long-distance education, remote operation, live classroom group discussion, group exhibition, HD recording, classroom attendance voting and other functions, and by choosing the appro-priate teaching mode in teaching to promote the innovation and development of medical teaching.

Objective:To detect the distribution of the receptor for advanced glycation end products(RAGE) in gingival tissues of patients with non-insulin dependent diabetes mellitus(NIDDM) accompanying periodontitis.Methods:5 patients with chronic periodontitits(CP) and 4 patients with NIDDM accompanying periodontitis were included. Immunohistochemical staining was performed to detect RAGE and tumor necrosis factor ?(TNF-?) expression in gingival tissues.Interleukin 6(IL-6) and TNF-? levels in gingival crevicular fluid and serum of these patients were examined by ELISA.Results:More RAGE cells were observed in the gingival tissus in the patients of NIDDM with CP than in those of CP(P0.05).Conclusion:RAGE may play a role in the destruction of periodontal tissues in NIDDM patients with CP.

Objective To systematically compare the efficacy of three-dimensional conformal radiotherapy (3D-CRT) versus intensity-modulated radiotherapy (IMRT) in the treatment of prostate cancer (PCa).Methods Clinical comparative studies of IMRT and 3D-CRT in the treatment of PCa were collected from PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), and Wanfang Data after two independent researchers developed the strategy and inclusion and exclusion criteria for the literature search.Articles published up to February 2017 were searched for, and the languages of publications were restricted to English and Chinese.Clinical meta-analysis of the data from the relevant studies was performed using the RevMan5.3 software.Results A total of 15 relevant retrospective cohort studies were collected from the databases in strict accordance to the search strategy and inclusion and excluding criteria.There were 4608 PCa patients, including 2229 in the IMRT group and 2379 in the 3D-CRT group.IMRT and 3D-CRT had similar adverse effects in terms of early-stage (odds ratio[OR]=0.77, 95% confidence interval[CI]:0.43-1.40, P=0.390) and late-stage (OR=0.75, 95%CI:0.55-1.04, P=0.080) urinary tract injury.However, IMRT led to reduced early-stage (OR=0.47, 95%CI:0.27-0.82, P=0.008) and late-stage (OR=0.52, 95%CI:0.35-0.78, P=0.001) intestinal injury compared with 3D-CRT.Meanwhile, the biochemical recurrence-free survival rate was also significantly higher in the IMRT group than in the 3D-CRT group (OR=1.87, 95%CI:1.51-2.32, P=0.000).Conclusions IMRT is more protective against intestinal injury with a higher biochemical recurrence-free survival rate compared with 3D-CRT during the treatment of PCa.

Objective To study the curative effect of prostaglandin E1(PGE1)on maintaining Sa(O2) and life span in the neonates with complete transposition of the large arteries(TGA).Methods Eleven of 19 neonates complete TGA received continuous PGE1 with the dosage of 5-20 ng/(kg?min),while the other 8 cases were set as control.The body temperature,Sa(O2),heart rate and blood pressure of both groups were recorded during the trial.Results The average Sa(O2) in trial group was (82.3?3.56)%,which had significant difference compared with the control group(t=8.232 P=0.001).The life span in trial group was much longer than control group.The body temperature,heart rate and blood pressure of trial group had no significant fluctuations.Conclusion PGE1 has an compkete effect on maintaining the ope-ning of patent ductus arteriosus (PDA) in TGA patients,which can improve the Sa(O2) and prolong the life span.

Objective To explore the changes of etiology and mortality of upper gastrointestinal bleeding (UGIB) in the last 20 years in Guangdong region. Methods A total of 3140 UGIB cases diagnosed in Guangdong General Hospital from January 1990 to October 2009 were analyzed with retrospective analysis. Groups were divided according to admission chronological order and age to analyze the causes of UGIB to get the trend of changes and influencing factors. Results UGIB occurred more in men than in women, the gender ratio was 2. 5∶1. There was no significant change in gender composition between the first and later 10 years. Peptic ulcer bleeding (PUB) was the main cause of UGIB in young and middle-age patients (age<60 years), especially duodenal ulcer (DU)bleeding (45. 0%) , and secondary was acute gastric mucosal lesion ( AGML) (16. 6%). While in elder patients group (age≥60 years), the main cause of UGIB was AGML (40. 5%), the frequency was significantly higher compared with the young and middle-age group (40. 5% vs 16. 6%,P<0. 01).Compared the first 10 years with the later 10 years, the occurrence rate of PUB was overall in downward trend (57. 4% vs 42. 8%, P<0.01), of which DU and compound ulcer(CU) bleeding reduced significantly (DU: 43.8% vs 27.7%, P<0. 01 and CU: 7.7% to 5.5%, P<0. 05). While the incidence of gastric ulcer (GU) (7.4% vs 8. 1% ,P>0. 05) and esophagogastric variceal bleeding (EVB) (11. 7% vs 12. 9%, P>0.05) remained stable. The occurrence of AGML bleeding significantly increased than before (32. 4% vs 18. 8%,P<0. 01), and became one of the most important causes of UGIB. Conclusions PUB is still the most important cause of UGIB in Guangdong region. AGML becomes another important cause of UGIB in elder patients, which may relate to the increasing use of non-steroidal anti-inflammatory drugs (NSAIDs), anti-platelet and antineoplastic medicine.

Alkaline Phosphatase ; blood ; Biomarkers ; blood ; Child, Preschool ; Female ; Humans ; Infant ; Isoenzymes ; blood ; Phosphorus Metabolism Disorders ; blood ; diagnosis ; Risk Factors

International medical community has seen the prevail of outpatient teaching for medical students in recent years. A student-centered and faculty-run teaching clinic was set up based on current outpatient resources in 2008 by Division of General Internal Medicine (DGIM) in Peking Union Medical College Hospital (PUMCH). We concluded that teaching clinic was an effective teaching mode for medical students to improve clinical skills, diagnostic proficiency and health-care professionalism in internal medicine.

Objective To evaluate the desflurane-induced sympathetic activation with finger tip perfusion index (FTPl). Methods Forty-eight ASA ⅠorⅡ patients aged 25-60 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups (n=16 each): groupⅠsevoflurane; group Ⅱ desflurane and groupⅢ desthrane + propofol. Anesthesia was induced with midazolam 0.03 mg/kg, propofol 2 mg/kg and fentanyl 2 μg/kg. Tracheal intubatian was facilitated with vecuronium 0.1 mg/kg. The patients were mechanically ventilated (VT 8-10 ml/kg, RR 12 bpm). PETCO2 was maintained at 35-40 mm Hg. In group ⅠandⅡanesthesia was maintained with sevoflurane and desflurane respectively. The end-tidal concentration of sevoflurane and desflurane were rapidly increased to 0.5 MAC, 1.0 MAC and 1.5 MAC and maintained at each level for 5 rain. In group Ⅲanesthesia was maintained with TCI of propofol and destlurane. The target plasma prepofol concentration was set at 1 μg/ml and the end-tidal concentration was rapidly increased to 0.5 MAC and 1.0 MAC and maintained at each level for 5 mitt. MAP, HR, FTPI and BIS were continuously monitored and recorded at 5 rain after midazolam (T0), 3 rain after induction of anesthesia (T1), immediately after tracheal intubation (T2), as soon as the end-tidal concentration of sevoflurane and desflurane reached 0.5 MAC(T3), 1.0 MAC(T5) and 1.5 MAC(T7) and after being maintained at 0.5 MAC (T4), 1.0 MAC (T6) and 1.5 MAC (T8) for5 rain. The plasma renin activity and the levels of angintonin Ⅱwere determined at T0, T1, T2, T5 and T7 by using radioimmuno-ssay. Results FTPI was significantly lower at T5 than at T4 in group Ⅱ HR and MAP were significantly lower at T4-6 and T8 and FTPI were significantly lower at T3～6 and T0 than at T7 in group Ⅱ. HR and MAP were significantlyhigher while FTPI was lower at T7 in groupⅡthan in group Ⅰ The changes in MAP and FTPI between T4 and T5 were significantly less in group Ⅲthan in group Ⅱ. The time when the highest value of FTPI was maintain was significantly shorter than the time when the highest values of HR and MAP were maintained at T5 and T7 in group ⅡΔFTPI was negatively correlated with ΔHR and ΔMAP (r=-0.593, P<0.05;r=-0.591, P<0.05). Conclusion FTPI can reflect the desflurane-induced sympathetic activation promptly and sensitively.