Objective To observe the clinical curative effect of combination of traditional Chinese and western medicine for treatment of patients with hepatitis B virus (HBV) related acute-on-chronic (subacute) liver failure (ACLF). Methods A prospective randomized controlled trial was conducted; 66 cases of HBV-ACLF patients were randomly divided into two groups: a test group (44 cases) and a control group (22 cases). Conventional western medicine treatment was given to both groups; the patients in test group additionally received the traditional Chinese medicine (TCM) in accord to the principles of differentiation of syndromes in TCM, in cases with damp-heat and blood stasis syndrome with yellow appearance, Liangxue Jiedu Huayu decoction (Paeoniae Radix Rubra 60 - 150 g, Artemisiae Scopariae Herba 30 - 90 g, Gardeniae Fructus 9 - 12 g, Hedyotis diffusa Willd 20 - 30 g, Salviae Miltiorrhizae Radix et Rhizoma 30 g, Atractylodis Macrocephalae Rhizoma 30 g, Rubiae Radix et Rhizoma 30 - 45 g, Siegesbeckiae Herba 30 - 45 g, Bletillae Rhizoma 15 g ) was given, in cases with Qi deficiency and blood stasis with yellow appearance, Yiqi Jiedu Huayu decoction (Astragali Radix Preparata Cum Melle 30 g, Pseudostellariae Radix 15 g, Artemisiae Scopariae Herba 30 - 60 g, Polygoni Cuspidati Rhizoma et Radix 15 - 30 g, Salviae Miltiorrhizae Radix et Rhizoma 30 g, Aconiti Lateralis Radix Preparata 10 - 15 g, Atractylodis Macrocephalae Rhizoma 30 g, Rubiae Radix et Rhizoma 30 - 45 g, Siegesbeckiae Herba 30 - 45 g, Gigeriae Galli Endothelium Corneum 20 g) was given, the dosage in both groups being 1 dose daily, one dose was prepared to a water decoction 250 - 300 mL which was divided into two parts, one part taken twice a day; the control group received only western medicine treatment. After 2 weeks of treatment, the clinical comprehensive curative effect, the syndrome score efficacy, and the changes of main indexes of liver function,cholinesterase (ChE), albumin (Alb), prothrombin activity (PTA) were observed in the two groups.Results The clinical total efficacy in the test group was significantly higher than that in the control group [75.0% (33/44) vs. 45.5% (10/22),P < 0.05]. The syndrome score total efficacy in the test group was also higher than that in the control group [75.0% (33/44) vs. 63.6% (14/22)], but the difference was not statistically significant (P > 0.05). After treatment, the alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and direct bilirubin (DBil) were all lower than those before treatment in both groups, while the ChE, Alb and PTA were higher than those before treatment, and the degree of changes was more significant in the test group [test group: ALT (U/L): 63.28±99.28 vs. 574.58±571.08, AST (U/L): 86.84±92.88 vs. 438.20±482.74, TBil (μmol/L): 161.90±178.34 vs. 269.46±95.10, DBil (μmol/L): 115.32±126.51 vs. 209.12±79.78, ChE (U/L): 4 239.14±1 505.00 vs. 3 341.49±1 609.40, Alb (g/L): 32.65±4.77 vs. 29.73±3.31, PTA: (69.69±44.92)% vs. (32.84±7.47)%; control group: ALT (U/L): 93.28±93.86 vs. 365.24±376.98, AST (U/L): 126.26±121.35 vs. 287.17±301.04, TBil (μmol/L): 226.80±187.38 vs. 281.02±103.73, DBil (μmol/L): 172.50±147.32 vs. 227.96±87.20, ChE (U/L): 4 484.66±1 886.53 vs. 3 918.77±1 417.77, Alb (g/L): 33.17±4.76 vs. 30.47±3.03, PTA: (63.80±36.80)% vs. (33.96±6.32)%,P < 0.05 orP < 0.01].Conclusion The combination of TCM and western medicine for treatment of HBV-ACLF can improve liver function, and the prognosis is superior to using western medicine treatment alone.

Because of the specificity and complexity,of obstetrics and gynecology,interns often meet doctor-patient communication problems during the internship.This study explores these problems to enhance interns' doctor-patient communication and to cultivate interns' technical proficiency.We have also made them grasp the methods and skills of doctor-patient communication,and enable them to successfully communicate with patients on internship.

Great difficulties and challenges are existed in the training of clinical type postgraduate of neurosurgery because of the acute onset,server illness and difficult diagnosis of neurosurgical diseases.This paper proposed countermeasures of combing theory with clinical practice and strengthening comprehensive ability after analyzing problems of inadequate professional knowledge,lack of doctor-patient communication and insufficient clinical thinking and innovating ability.The aim was to cultivate the overall quality of postgraduates,making them more qualified for the difficult task of being neurosurgery clinicians.

Objective To explore the difference in pulmonary function between chronic obstructive pulmonary disease (COPD) and overlap syndrome patients.Methods 50 hospitalized COPD patients who were randomly recruited were divided into two groups, which contained 33 COPD patients and 17 overlap syndrome patients respectively. All the 50 patients’pulmonary function was evaluated and the results were analyzed statistically.Results The pulmonary function test showed that only PEF and V75 significantly decreased in overlap syndrome patients compared with COPD patients(P=0 032 and 0 048 respectively),But pulmonary volume, small airway function and pulmonary diffusion function in 5 COPD patients with severe sleep apnea syndrom (SAS) were significantly reduced compared with COPD patients.Conclusions Upper airway obstruction in SAS patients aggravates the pulmonary ventilation function in overlap syndrome. And obesity deteriorates both of the pulmonary function and hypoxemia in patients suffered from COPD.

Clinical medicine professional degree education focuses on cultivating students' ability to engage in clinical practice, but the aim of medical postgraduate education program is to cultivate high-leveled clinical and research personnel. In the light of the problems that professional degree postgraduates majoring in obstetrics and gynecology are faced with such as unreasonable energy distribution in scientific research, the weak foundation of scientific research, the emergence of new trend of obstetrical and gynecological dis-eases, we have explored how to improve obstetrics and gynecology professional students' scientific research ability from several aspects such as the guidance of mentors, transferring learning and thinking and strength-ening the communication between various disciplines, to adapt to the requirements of the scientific develop-ment of modern obstetrics and gynecology.

Aged ; Fasciitis, Necrotizing ; complications ; Female ; Humans ; Mediastinitis ; complications ; Neck ; pathology

Purpose Two kinds of forward conditional reasoning including modus ponens (MP) and denial of the antecedent (DA) are the most common deductive reasoning in daily life. The present study aimed to explore the difference between the two neural machanisms. Materials and Methods Three kinds of tasks including MP, DA, and baseline were administrated to 14 undergraduates [7 males and 7 females, mean age (23.4±1.3) years] by using functional magnetic resonance imaging (fMRI) technique. fMRI data was analyzed. Results The reaction times were significantly slower for MP and DA than that of BS (P<0.001), while the effect was not significant for accuracy. In contrast to baseline, both MP and DA tasks activated the left inferior frontal cortex (BA 9), inferior parietal lobule (BA 40), and postcentral gyrus. Bilateral caudate significant activation was found in MP task when compared with DA, whereas the frontal, parietal, occipital lobe and anterior cingulate cortex were acivated more in the DA than in MP task. Conclusion Both forward conditional reasoning of MP and DA commonly activate the left frontoparietal cortex, while significant dissociations can be seen in the regions of caudate and bilateral frontal, parietal and occipital. These results firstly demonstrates the different neural mechanism underlying the two forward conditional reasoning, which might help to further uncover the brain mechanism of conditional reasoning.

AIM:To determine the effects of glutamine ( Gln) pretreatment on occludin protein in the rats with intestinal ischemia-reperfusion ( I/R ) injury.METHODS: Male Wistar rats ( n =30 ) were randomly divided into 3 groups (n=10):sham group, I/R group and Gln pretreatment group.The rats in Gln pretreatment group were pretreated with Gln at dose of 1 g? kg-1? d-1 by orogastric route for 7 d, and those in the other 2 groups were pretreated with the same volume of normal saline .Intestinal I/R was induced by 30-min occlusion of the superior mesenteric artery followed by 24 h of reperfusion.After the operation, the levels of IL-10, IL-2, TNF-α, SOD and MDA were measured.The occludin protein was determined by the methods of immunohistochemistry and Western blotting .RESULTS: The occludin protein level in I/R group was significantly lower than that in sham group and Gln group (P<0.05).The levels of MDA and TNF-αin I/R group were significantly higher than those in sham group and Gln group ( P<0.05 ) .The levels of SOD , IL-10 and IL-2 in I/R group were significantly lower than those in sham group and Gln group ( P<0.05 ) .CONCLUSION:Glutamine has a protective effect on occludin protein in intestinal ischemia-reperfusion injury .The mechanism may be rela-ted to oxidative stress response and inflammatory inhibition .

Objective To identify the risk factors for early postoperative elevation in body temperature in patients undergoing coronary artery bypass grafting (CABG).Methods Nine hundred and forty-one patients of both sexes,aged 14-70 yr,were assigned into hyperthermia (≥ 38 ℃) group or non-hyperthermia (＜ 38 ℃) group according to the bladder temperature at 8h after operation.Factors including age,sex,height,weight,complications (hypertension,hyperlipemia,diabetes),history of smoking and drinking,preoperative blood pressure,heart rate,ejection fraction,routine blood examination,routine urine examination,and respiratory function examination,intraoperative cardiopulmonary bypass (CPB) and hormone,operation time,extubation time,duration of stay in the intensive care unit,and blood pressure,heart rate,ejection fraction,routine blood examination,and routine urine examination at the end of operation,and postoperative analgesia were recorded.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the risk factors for early postoperative elevation in body temperature after CABG.Results Six hundred and ninety patients developed early postoperative elevation in body temperature (73.3％).Logistic regression analysis showed that preoperative respiratory dysfunction,preoperative ejection fraction ≤ 50％ and CPB were independent risk factors for early postoperative hyperthermia after CABG (P ＜ 0.05).Conclusion Preoperative respiratory dysfunction,preoperative ejection fraction≤ 50％ and CPB are independent risk factors for early postoperative elevation in body temperature in patients undergoing CABG.

Objective: To set up an HPLC method for the simultaneous determination of p-hydroxybenzoic acid plus o-hydroxy-benzoic acid and p-hydroxybenzeneacetic acid in Senecio scandens Buch. Methods:The column was a Shiseido( Fine Chemicals) Cap-cell Pak C18 (250 mm × 4. 6 mm, 5 μm) column at the room temperature. The mobile phase was methanol-water-formic acid (13∶87∶0. 5) at a flow rate of 1. 0 ml·min-1 . The detection wavelength was 240nm. Results: p-Hydroxybenzoic acid plus o-hydroxybenzoic acid had a favorable linear relationship within the range of 0. 025-0. 400 mg·ml-1 , the regression equation was Y=5. 94 × 106 X+2.46×104(r=0.9998),theaveragerecoverywas97.59% andRSDwas1.22%. p-Hydroxybenzeneaceticacidhadafavorableline-ar relationship within the range 0.05-0.80 mg·ml-1, the regression equation was Y=4.09 ×106X+1.12 ×104(r=0.999 8), the average recovery was 98. 07% and RSD was 1. 90%. Conclusion:The method is simple, feasible and reproducible. It can be used in the quality control of p-hydroxybenzoic acid plus o-hydroxybenzoic acid and p-hydroxybenzeneacetic acid in Senecio scandens Buch.