Objective To analyze the correlation between impact positions on the head and hyperextension severities of cervical spinal cord,as well as their treatment.Methods A retrospective analysis was done for 41 cases of hyperextension of cervical spinal cord without fracture-dislocation who had received management in our department from January 1999 to January 2004.All the patients had no cervical disorders before injuries.They were injured by impact mostly on the forehead,cheek or lower mandible.Their neurological findings at admission and 6-month follow-ups were assessed according to ASIA (American Spinal Injury Association) rating system.Results Of the 20 patients who were injured by impact on the forehead,four were rated in neural function as grade B,11 as grade C,and five as grade D at admission,while one as grade C,11 as grade D,and eight as grade E at 6-month follow-up.Of the 12 patients who were injured by impact on the cheek,one was rated in neural function as grade B, four as grade C,and seven as grade D at admission,while one as grade C,two as grade D,and nine as grade E at 6-mouth follow-up.Of the nine patients who were injured by impact on the lower mandible,five were rated in neural function as grade B,three as grade C,and one as grade D at admission,while two as grade B,five as grade C,and two as grade E at 6-month follow-up.The 6-month follow-ups after treatment showed that the neural function was rated below grade C in nine patients,seven of whom had been injured by impact on mandible.Two patients of grade B who showed little improvement after treatment had been injured also by impact on mandible.Conclusion Impact on the lower mandible causes mote severe hyperextension than impact on tbe cheek or forehead.Both rea- sonable non-operative and operative treatments can lead to satisfactory outcome for patients with hyperextension of cervical spinal cord but without fracture-dislocation.

Objective To discuss the influence on peripheral circulation and oxygenation of different colloid osmotic pressure (COP) in pediatric cardiac surgery under cardiopulmonary bypass (CPB).Methods Sixty cases of non-cyanotic congenital heart disease patients under 10 kg were randomly selected and divided into 3 groups(n =20) according to the different COP level.COP values was adjusted by the ultrafiltration technique and colloid addition.The perioperative(T1-T6) arterial lactate level,different value between skin and rectal temperature,peripheral oxygen saturation (SpO2) and oxygenation index (OI) were observed in order to determine the different effect on peripheral circulation and oxygenation.Meanwhile,mechanical ventilation time and ICU time were recorded.Results The variation tendency of arterial lactate level was similar in each group,the value in the COP ＞ 18 mmHg (1 mmHg =0.133 kPa) group(group C) was significantly higher than COP 10-15 mmHg group (group A) and COP 16-18 mmHg group (group B) in T3 and T4,after CPB weaned,the values of Group A (1.25 ± 0.42) and Group C (1.33 ± 0.51) were higher than Group B (0.71 ± 0.29) at T6 point (P ＜ 0.05);the variation tendency of SpO2 was similar in each group too,the value of group C was significantly lower than group A and B at T5 point,the values of group A and C were significantly lower than group B at T6 point,P ＜ 0.05;the different value between skin and rectal temperature in group A was significantly higher than group B and C from T1 to T2 point(P ＜0.05),but not in T3 to T6 point;The minimal OI values of all the groups were appeared in T4 point,group B value was significantly higher than A and C in all time point,group C value was the lowest(P ＜0.05);the mechanical ventilation time in group B(2.13 ± 1.36) days and group C (2.93 ± 1.69) days were significantly lower than group A (3.83 ± 1.47) days,P ＜ 0.05.ICU time of group B (3.9 ± 1.1) days was significantly lower than group A (5.7 ± 2.5) days and C (6.0 ± 1.5) days.Conclusion During the pediatric CPB,the improper COP level will lead to bad oxygenation and poor peripheral circulation,got different prognosis ultimately.A reasonable COP level(16-18 mmHg) will do benefits to all the pediatric patients.

[Objective] To explore the mechanism of fever in damp- heat syndrome. [Methods] Hyperlipemia rabbit models were established by feeding fatty - sweet diet. After the injection of endotoxin, the secretion of tumor necrosis factor and interleukin 1 was observed in rabbit model (Group A) and compared with normal rabbits (Group B) . [ Results] The peak of tumor necrosis factor and interleukin 1 secretion was decreased and the decline was slow in Group A. [ Conclusion ] The damp - heat syndrome in seasonal febrile disease is not merely a simple addition of damp and heat, but a result of retention and interaction of the two factors.

Purpose: The purpose of this study was to explore the experiences of caregivers in long-term care facilities as they implement palliative care. Although palliative care has been available in Taiwan for more than 30 years, it is often provided in hospitals, few models in the long-term care facilities. Methods: Semi-structured interviews using grounded theory methodology and purposive sampling. Two small long-term care facilities that had performed well in palliative care were selected from eastern Taiwan. A total of 12 caregivers participated in in-depth semi-structured face-to-face interviews. Results: Four major stages in the implementation of palliative care were identified: (1) feeling insecure, (2) clarifying challenges, (3) adapting to and overcoming the challenges, and (4) comprehending the meaning of palliative care. The core category of these caregivers as “the guardians at the end of life” reflects the spirit of palliative care. Conclusion This study demonstrates that successful palliative care implementation would benefit from three conditions. First, the institution requires a manager who is enthusiastic about nursing care and who sincerely promotes a palliative care model. Second, the institution should own caregivers who possess personality traits reflective of enthusiasm for excellence, unusual ambition, and a true sense of mission. Third, early in the implementation phase of the hospice program, the institution must have the consistent support of a high-quality hospice team.

Purpose: The purpose of this study was to explore the experiences of caregivers in long-term care facilities as they implement palliative care. Although palliative care has been available in Taiwan for more than 30 years, it is often provided in hospitals, few models in the long-term care facilities. Methods: Semi-structured interviews using grounded theory methodology and purposive sampling. Two small long-term care facilities that had performed well in palliative care were selected from eastern Taiwan. A total of 12 caregivers participated in in-depth semi-structured face-to-face interviews. Results: Four major stages in the implementation of palliative care were identified: (1) feeling insecure, (2) clarifying challenges, (3) adapting to and overcoming the challenges, and (4) comprehending the meaning of palliative care. The core category of these caregivers as “the guardians at the end of life” reflects the spirit of palliative care. Conclusion This study demonstrates that successful palliative care implementation would benefit from three conditions. First, the institution requires a manager who is enthusiastic about nursing care and who sincerely promotes a palliative care model. Second, the institution should own caregivers who possess personality traits reflective of enthusiasm for excellence, unusual ambition, and a true sense of mission. Third, early in the implementation phase of the hospice program, the institution must have the consistent support of a high-quality hospice team.

AIM: To study the prognositic value of PTEN and Her-2 expression in primary breast cancer.METHODS: 81 breast cancer specimens with 15 years follow-up were obtained from 1989 to 2004.Immunohistochemical methods were used to detect the expression of PTEN and Her-2 in 81 paraffin-embedded specimens.The correlation between expression of PTEN and clinipathological factors was discussed with the Chi-square test.The survival rate analysis results were calculated with Kaplan-meier method.Long-rank test and Cox model by SPSS 10.0 software.RESULTS:(1) PTEN expression significantly affects 5-year and 10-year survival rate of breast cancer(P

BackgroundGlaucoma is an optic neuropathy caused by structural damage of the optic nerve,and its early diagnosis is critical for arresting the irreversible damage of visual function. Optical coherence tomography (OCT) allows an early diagnosis of glaucoma by the measurements of the optic disc and retinal nerve fiber parameters. Objective This study was carried out to evaluate the effects of optic disc tomography and the measurement of the retinal nerve fiber layer (RNFL)thickness by spectral-domain OCT on the diagnosis of glaucomatous eye. MethodsIt was a noninterventional, cross-sectionalstudy. The optic disctopographic parameters and total and regional RNFL thickness were measured by RTVue OCT in 62 normal eyes and 67 glaucomatous eyes. The area under the receiver operating characteristic curve( ROC ) was used to assess the ability to differentiate glaucoma eyes from normal eyes of each testing parameter. This trial complied with the Helsinki Declaration and was approved by the Clinical Trial Ethic Committee of Beijing TongrenHospital. All of the participants signed the written informed consent before any medical examination. Results In the comparison of demography ,the ages of patients, the mean deficiency( MD ) and pattern standard difference( PSD ) of perimetry were obviously larger in the glaucoma group, primary open angle glaucoma ( POAG ) group and primary closure-angle glaucoma(PACG) group than those of normal controls( P＜0. 01 ). No significant differences were found in the disc area between a total glaucoma group, POAG group or PACG group and normal group ( P =0. 101,0. 741 and 0. 652, respectively) ;however, the average RNFL thickness between normal eyes and glaucomatous eyes were significantly different( 109. 758 μm versus 79. 539 μm, P＜0. 01 ). Among the eight regions around the optic disc, the thickest RNFL located at the inferotemporal( 150. 109 μm) and superotemporal( 146. 105 μm) regions in normal eyes,and at the superotemporal( 104. 354 μm) and inferotemporal( 102. 436 μm) regions in glaucomatous eyes. Both in normal and glaucomatous eyes,the thinnest RNFL located at the nasal(NU+NL) and temporal(TU + TL) regions. For optic disc topographic parameters,the highest ROC were observed in rim volume( ROC--0. 850,0. 841 and 0. 862 in total glaucoma,POAG and PACG, respectively) and vertical cup/disc ratio( ROC =0. 840,0. 849 and 0. 830 in total glaucoma,POAG and PACG,respectively), and the sensitivities for specificity cutoff set at 80％ were 73.1％ and 76. 1％ in total glaucoma,73.0％ and 81.1％ in POAG and 73.3％ and 70.0％ in PACG, respectively. For RNFL thickness ,the highest ROC was observed in average RNFL( ROC =0. 925,0. 910 and 0. 942 in total glaucoma, POAG and PACG,respectively) ,and the sensitivities for specificity cutoff set at 80％ were 89. 6％ ,89.2％ and 90. 0％ in total glaucoma,POAG and PACG, respectively. Among the eight regions around the optic disc, RNFL thickness of region IT achieved the highest ROC, RNFL thickness of region TU and TL had the lowest ROC. Conclusions RTVue OCT appears to be of fair discriminating ability in distinguishing normal from glaucomatous eyes. RTVue OCT shows promise for the diagnosis of glaucoma.

Objective To investigate epidemiological and clinical features of patients with acute brucellosis.Methods The epidemiological,clinical,laboratory and treatment data of patients diagnosed as acute brucellosis during 2002 to 2004 in our hospital were retrospectively analyzed. Results Fifty-one patients had a history of close contact with sheep or cows with brucellsis.Twenty- seven patients had drunk milk or eaten instant boiled mutton.The transmission routes were unknown in 8 patients.All the patients had fever and most had low-grade fever.Fifty-five patients had irregu- lar fever and 20 patients had intermittent fever.The most common manifestations were fever(86/86), fatigue(63/86),sweating(43/86),arthralgia(68/86),orchiditis(7/86),hepatomegaly(8/86),sple- nomegaly(7/86)and headache(18/86).Forty-seven patients had liver dysfunction and 17 patients had thrombocytopenia.Eighty patients recovered and 6 patients relapsed after combination therapy with rifampicin,sulfamethoxazole and quinolone.Conclusion The changes in epidemiological and clinical features of patients with acute brucellosis should be noticed.

Objective : To investigate the effects of the exposure of sludge from sewage treatment plants and microplastic extracted from sludge on the oxidative stress levels in zebrafish, so as to put insights into the research into the impact of sludge and microplastics on human health. Methods : Adult wild AB zebrafish were exposed to five groups of sludge (0, 12.5, 25, 50 and 75 g/L) and four groups of microplastics extract from sludge (0, 240, 480, 960/L), with 24 zebrafish in each group. The color, activity and death of zebrafish were observed every day. The contents of superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and malondialdehyde (MDA) were detected 0 h, 24 h, 48 h, 72 h, 96 h and 7 d post-exposure. A two-factor ANOVA was used to analyze the effects of different concentrations and time of exposure on the indicators above. Results : Under 75 g/L sludge exposure, zebrafish began to show mortality at 72 h and all died after 7 d. The zebrafish in the other sludge groups and all microplastic groups had normal color and activity, and no mortality was observed. Sludge concentration interacted with exposure time to affect SOD, CAT, GSH and MDA (P<0.05). With increasing sludge concentration and exposure time, SOD decreased, MDA increased, CAT increased first and then decreased, GSH decreased first and then increased, and GSH continued to decrease since 24 h in the 75 g/L group. The microplastic concentration interacted with exposure time to affect SOD and GSH (P<0.05), but not CAT or MDA (P>0.05). With increasing microplastic concentration and exposure time, SOD and MDA increased, CAT increased first and then decreased, the GSH was slightly increased at 24 h and decreased after 72 h. Conclusion Both sludge and microplastics extracted from sludge can induce oxidative stress damage in zebrafish, and exposure time and concentration can interact to affect oxidative stress levels. The microplastics extracted from sludge have less effect on oxidative stress levels in zebrafish than sludge.

AIM: To explore correlation,consistency and comfort between traditional tear film examination methods and Oculus Keratograph.METHODS: A retrospective study.Totally 101 cases (101 eyes) were diagnosed myopia and then accepted LASEK (laser epithelial keratomileusis).Non-invasive tear film break-up time(NIBUT),lower tear meniscus height(LTMH) were measured with Oculus Keratograph,fluorescein tear film break-up time(fl-BUT) and Schimer Ⅰ test (SⅠt) were performed on all cases.The correlations analysis between NIBUT and fl-BUT,LTMH and SⅠt were performed by Spearman rank correlation,consistency check between NIBUT and fl-BUT by Bland-Altman analysis.Visual analogue scale(VAS) was applied on evaluating the comfort of two kinds of examination methods.RESULTS: LTMH and SⅠt showed positive correlation (rs=0.346,P=0.001).NIBUT and fl-BUT showed positive correlation (rs=0.393,P=0.001),95% consistency limits range-9.62 to 14.18 in Bland-Altman Figure.There was significant difference between VAS of NIBUT and VAS of fl-BUT(z=-2.324,P=0.020).There was significant difference between VAS of LTMH and VAS of SⅠt (z=-8.845,P=0.001).CONCLUSION: Oculus Keratograph can objectively measure NIBUT and LTMH,and was more comfortable than traditional tear film examination methods.It can effectively assess tear film function before corneal refractive surgery.