Objective To investigate the effect of early low-glucocorticoid on hemodynamics and prognosis in the patients with septic shock.Methods Sixty patients with septic shock failing in active fluid resuscitation and vasoactive drugs in our hospital from June 2013 to August 2015 were selected and divided into the control group,early-hormone group and late-hormone group.MAP,HR,PO2/FIO2 and serum lactic acid levels were monitored in all selected patients before treatment and at 12,24,48 h after treatment.Apache Ⅱ,SOFA scores were assessed before treatment and on 1,3,7 d after treatment.The ventilation time,ICU stay time,hospital stay time and intravenous use time of vasoactive agents(VDNT) were recorded.Results The Apache Ⅱ scores and SOFA scores on 3,7 d after treatment in the early-hormone group were significantly decreased compared with the late-hormone group and control group (P＜0.05).MAP and HR at 24,48 h after treatment in the early-hormone group were significantly improved compared with the late-hormone group and control group (P＜0.05).The level of serum lactic acid at 12,24 h after treatment in the early-hormone group and late-hormone group were obviously lower than that in the control group,the levels of serum lactic acid at 12,24 h after treatment in the early-hormone group were obviously lower than those in the late-hormone group (P＜ 0.05).PO2/FIO2 at 12 h after treatment in the early-hormone group and late-hormone group were obviously better than that in the control group,and PO2/FIO2 at 12 h after treatment in the early-hormone group was obviously better than that in the late-hormone group(P＜0.05).The ventilation time,ICU stay time,hospital stay time and VDUT in the early-hormone group were significantly shortened compared with the late-hormone group and control group.The ventilation times,ICU stay time and VDUT in the latehormone group were significantly shortened compared with the control group (P＜0.05).Conclusion Early using low-dose glucocorticoid may restore hemodynamics more quickly,protects the organ function and improves the prognosis in the patients with septic shock.

Eight patients with suspected cases of C .jejuni were etiologically diagnosed and analyzed in this study to pro-vide scientific basis for the confirmation of the cases of human campylobacteriosis in Guizhou Province ,China .Blood or feces of 8 suspected patients were employed to isolate bacteria strains .Conventional and multi-PCR techniques were applied to identify suspicious bacteria strains .The C .jejuni strains were analyzed by using Pulsed Field Gel Electrophoresis (PFGE) .Suspicious strains of C .jejuni were isolated from all the 8 suspected patients of campylobacteriosis and anticipated genes fragment were detected with multi-PCR .With the digestion of restriction enzyme SmaI ,the 8 C .jejuni strains were divided into 7 PFGE pat-terns with 7-10 DNA bands .Cluster analysis showed that the gross similarity of 8 strains of C . jejuni was more than 50% . The similarity of PFGE patterns between strain GZ201004 and GZ201005 from diarrhea patients was as high as 100% ,while the similarity of strain GZ201201 and GZ201007 was 66 .7% .Moreover ,C . jejuni were detected from all the suspected pa-tients of campylobacteriosis .PFGE results indicated that strains GZ201004 and GZ201005 were from the same source ,while all the 8 isolates showed PFGE polymorphism .

OBJECTIVETo observe the effect of nourishing Yin, strengthening Qi and activating blood decoction on Fas/FasL in salivary glands of NOD mice with Sjogren's syndrome and their mRNA expression.

METHODThirty-two NOD mice were randomly divided into the model group, the traditional Chinese medicine group (TCM group, orally given 0.4 mL nourishing Yin, strengthening Qi and activating blood decoction as per 100 g x kg(-1) everyday), the hydroxychloroquine group (given 0.4 mL hydroxychloroquine as per 60 mg x kg(-1) everyday), the traditional Chinese medicine and western medicine group (TCM WM group, given nourishing Yin, Strengthening Qi and activating blood decoction 50 g x kg(-1) and hydroxychloroquine 60 mg x kg(-1), 0.4 mL everyday), with eight mice in each group. Eight Balb/C mice were selected as the normal control group (normal group). All of mice were killed after eight weeks, and their submaxillary glands were dissected. The expression levels of Fas/FasL were examined by immunohistochemical method, and the FasL mRNA was detected by RT-PCR.

RESULTThe expression levels of Fas/FasL in salivary glands of the model group were higher than that of other groups (P < 0.05). The expression level of FasL of the normal group was much lower than that in the hydroxychloroquine group (P < 0.05). The relative expression level of Fas mRNA in salivary glands of the model group was higher than that in other groups, but the control group was notably lower than other groups (P < 0.05). The expression level of FasL mRNA in salivary glands of the model group was higher than that in TCM and TCM WM groups (P < 0.05). But the expression level in TCM WM group was notably lower than the hydroxychloroquine group (P < 0.05).

CONCLUSIONThe nourishing Yin, strengthening Qi and activating blood decoction could down-regulate the expression level of Fas/FasL in salivary glands of NOD mice with Sjogren's syndrome and their mRNA expression, and had a better efficacy after being combined with hydroxychloroquine. The nourishing Yin, strengthening Qi and activating blood decoction might treat the Sjogren's Syndrome by reducing apoptosis which is regulated by Fas/FasL

Animals ; Fas Ligand Protein ; genetics ; Female ; Gene Expression Regulation ; Medicine, Chinese Traditional ; methods ; Mice ; Mice, Inbred NOD ; Qi ; RNA, Messenger ; genetics ; metabolism ; Salivary Glands ; metabolism ; Sjogren's Syndrome ; blood ; genetics ; therapy ; Yin-Yang ; fas Receptor ; genetics

The study compared the traditional medical microbiology experimental teaching with a new experimental teaching pattern,with the students majoring in anaesthesia as the research object. The new pattern mainly deals with the cultivation of the students' creativity by reforming and exploring the plan,the content,the method of experimental teaching and the ways of checking the students' work, adding general and designing experiment,and working out the PPT of the experiments.The result shows the new experimental teaching pattern contributes to the cultivation of the students'abilities of performing experiment, the ways of thinking, creativity and comprehensive analysis. It's better than the traditional experimental teaching pattern.A new medical microbiology experimental teaching systerm which is suit to the students majoring in anaesthesia has been established.

Objective:To analyze morphological character of lateral tibial plateau fracture fragment, and its correlation to the presence of a meniscus injury in tibial plateau fractures.Methods:A total of 79 consecutive patients of the simple lateral tibial plateau fractures from July 201 1 to July 2015 were inclu-ded in this study,with 65 males and 14 females with an average age of (34.3 ±7.2)years and 22-61 years.According to Schatzker classification,21 cases were of Type Ⅰ,41 cases Type Ⅱ,and 17 cases Type Ⅲ.The characteristics of lateral tibial plateau fractures were evaluated by plain X-ray and magnetic resonance imaging (MRI ).The type and severity of meniscus injury were diagnosed by MRI scan. Three-dimensional measurements of the lateral fragment width (LFW),the lateral plateau depression (LPD),the coronal angulation of lateral fragment (CALF),and tibial plateau widening (TPW)were measured with Picture Archiving and Communication Systems(PACS)software.The patients with and without meniscus injuries were divided into different groups and analyzed respectively.Comparison of the above measurements between the two groups was analyzed by independent t test.Results:In all the 79 lateral tibial plateau fracture patients,26 cases (32.9%)of meniscus injuries were detected by MRI. Among all the meniscus injury cases,3 were of SchatzkerⅠ,16 SchatzkerⅡ,and 7 SchatzkerⅢ.In meniscus intact group,the average LFW was (22.0 ±2.8)mm while in meniscus injury group it was (21.3 ±3.3)mm (t =-1.008,P =0.317).The average LPD of non meniscus injury group was (5.4 ±2.8)mm,while in meniscus injury group was (8.7 ±2.8)mm (t=4.98,P=0.001).The average CALF of the two groups were 9.1°±6.1°and 10.6°±7.1°,and there was no significant dif-ference between the two groups (t=0.38,P=0.831).The average TPW was (3.0 ±1.1)mm,and (4.8 ±1 .7 )mm of the two groups.There were significant differences between the two groups (t =5.216,P=0.001).Conclusion:There was no obvious correlation between the LFD and meniscus inju-ry.The CALF of lateral tibial plateau fracture had no significant correlation with meniscus injury either. The degree of LPD and TPW may indicate injury of the meniscus in tibial plateau fractures.

OBJECTIVEThe best approach for blood pressure (BP) measurement in children remains controversial, especially on the choice of Korotkoff phase 4 (K4) vs. Korotkoff phase 5 (K5) for diastolic BP (DBP) and to compare the differences between K4 and K5 in school-aged children and their predictions to hypertension in adult.

METHODSThe "Beijing children and adolescents BP study" cohort population consisted 2505 school-aged children aged 6 to 17 at baseline survey in 1987, when datum of systolic BP (SBP), DBP measured using K4 and K5, were collected respectively. Among them, 412 individuals with 220 males and 192 females at age of 23-37 years old, were successfully followed up and invited to take part in a clinical examination including anthropometric measurements, SBP and DBP recordings, and a questionnaires in 2005. Method for the BP measurements at both baseline and followed-up was by auscultation with a standard sphygmomanometer. Child hypertension at baseline was diagnosed according to the age-specific cutoffs recommended by the World Health Organization in 1996 (WHO 1996). Adult hypertension was diagnosed according to the China Guideline for Hypertension Prevention and Control issued in 2005. Partial correlation coefficients were calculated to describe the association of K4 and K5 in childhood with SBP and DBP level in adulthood. Multivariate logistic regression analysis was conducted to examine the impact of choice of K5 and K4 as DBP in childhood on prediction to the hypertension in adulthood. Potential confounders such as gender and adult-height were controlled for.

RESULTSAt baseline, the prevalence rates of hypertension were 5.0% with DBP measured using K4, and 2.4% with DBP measured using K5, respectively. The geometric mean difference value of K4 minus K5 (K4 - K5) was (10.1 +/- 1.7 mm Hg) (1 mm Hg = 0.133 kPa) for the 2505 school-aged children, and decreased as age increased. There was no significant difference regarding the values of K4 - K5 between males and females in all age groups except for children who at pubertal stage. The distribution of K4 - K5 value across age groups was statistically significant (P < 0.001), 59.6%, 60.5%, 56.3% and 45.1% of children who aged 6-9 years, 10-12 years, 13-15 years, and 16-17 years with their K4 - K5 value over 10 mm Hg. K4 in childhood was better correlated to both SBP and DBP in adulthood than K5. In general, K4 seemed to be superior to K5 in predicting hypertension in adulthood. The odds ratios of hypertension in adulthood were 1.69 (95% CI: 1.11-2.00), 1.45 (1.05-2.02), 2.18 (1.37-3.47), and 1.66 (1.07-2.59) with each 5 mmHg increasing of K4 measured in children aged 6-9 years, 10-12 years, 13-15 years, and 16-17 years, respectively. The agreement diagnosis between child hypertension and adult hypertension was higher for childhood DBP measured using K4 (20.2%) than that using K5 (12.8%).

CONCLUSIONThere was significant difference between K4 and K5 in Chinese children and adolescents. Choice of diastolic Korotkoff blood pressure could affect DBP tracking from childhood into adulthood. K4 seemed superior to K5 when using auscultator technique to measure DBP.

Adolescent ; Adult ; Blood Pressure ; physiology ; Child ; Female ; Humans ; Hypertension ; epidemiology ; Male

Bilingual teaching is adapted to the development of higher education in china.Based on actual fact of college,teaching mode,evaluation and effect of bilingual teaching on medical microbiology were studied,which started with necessity of bilingual teaching to use original edition teaching material in English. The result would provide some gist to choice the suitable pattern of bilingual teaching for other subject of our college.

Objective To detect the levels of five trace elements in whole blood of patients with Keshan disease(KSD) and dilated cardiomyopathy(DCM) and explore their role in the pathogenesis of KSD.Methods One hundred and four patients with chronic KSD were selected from Keshan diseased areas in Shandong,Sichuan and Inner Mongolia.Thirty patients with DCM were selected from Qilu Hospital of Shandong University,Jinan Central Hospital,The First People's Hospital.Ninety-one healthy people from KSD endemic areas and 39 healthy people from Jinan were selected as endemic healthy controls and non-endemic healthy controls,respectively.Blood samples were collected to determinate the level of selenium (Se),copper (Cu),zinc (Zn),chromium (Cr) and manganese (Mn) with fluorescence method and atomic absorption spectrometry,according to the principle of informed consent.Results The level of Se,Zn and Cr of KSD group[(36.0 + 4.9)μg/L,(22.73 + 4.62)mg/L,(0.56 + 0.17)mg/L] was significantly lower than that of non-endemic healthy controls [(56.4 ± 6.8)lμg/L,(25.35 ± 4.44)mg/L,(0.71 ± 0.17)mg/L,all P ＜ 0.05],but the level of Cu of KSD group[(0.95 ± 0.24)mg/L] was significantly higher than that of non-endemic healthy controls[(0.73 ± 0.13) mg/L,all P ＜ 0.05].The level of Se and Cr of KSD was significantly lower than that of endemic healthy controls[(54.5 ± 5.4)μg/L,(0.87 ± 0.02)mg/L,P ＜ 0.05],and Cu was significantly higher than that of endemic healthy controls[(0.66 ± 0.02)mg/L,P ＜ 0.05].The level of Cu and Zn of KSD was significantly lower than that of DCM [(1.21 ± 0.23)mg/L,(27.09 ± 7.10)mg/L,all P ＜ 0.01].The level of Se and Cr of DCM group[(39.6 ± 3.5)μg/L,(0.58 ± 0.14)mg/L] was significantly lower than that of non-endemic healthy controls(all P ＜ 0.01),but Cu[(1.21 + 0.23)mg/L] was significantly increased (P ＜ 0.01).Compared with non-endemic healthy controls,the level of Se of endemic healthy control group was significantly decreased (P ＜ 0.01),while Cu was significantly increased (P ＜ 0.01).Se,Zn and Cr level of KSD decreased gradually following elevated heart function level,but the level of Cu gradually increased.Conclusions The metabolism of Se,Cr,Cu and Zn is unbalanced in KSD patients,whose Se level is still lower than that of people in non-endemic areas.The change of Se,Cr,Cu and Mn level between KSD and DCM is consistent.

OBJECTIVETo analyze the correlation between myocardial ischemia and carotid atherosclerosis in hypertensive patients.

METHODSThe clinical data were collected from 85 hospitalized hypertensive patients admitted between May 2005 and September 2008 without the complication of coronary artery disease as confirmed by cardiac computed tomographic angiography (CTA). According to the results of treadmill exercise test, the patients were divided myocardial ischemia group and ischemia-free group. Univariate and multivariate analyses were used to screen the risk factors of myocardial ischemia. The correlations were analyzed between myocardial ischemia, common carotid artery intima-media thickness (IMT), Crouse score of the carotid plaque, thickness of the intraventricular septum and left artrium. The receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of IMT and Crouse score in predicting the presence of myocardial ischemia in hypertensive patients.

RESULTSCarotid plaque formation was identified as the major risk factor of myocardial ischemia in hypertensive patients (OR=4.982, P=0.004). The incidence of myocardial ischemia in the hypertensive patients with carotid plaques was significantly higher than that in the patients without the plaque (Chi2=9.317, P=0.002). Myocardial ischemia in hypertensive patients was positively correlated to the thickness of the intraventricular septum (r=0.362, P=0.001) and left artrium (r=0.298, P=0.009), and the IMT of the common carotid artery was positively correlated to the thickness of the intraventricular septum (r=0.231, P=0.045). The area under cure (AUC) of the ROC curve of Crouse score was 0.726-/+0.061 in predicting the presence of myocardial ischemia in the hypertensive patients (P=0.001), and that of IMT was 0.682-/+0.061 (P=0.006).

CONCLUSIONCarotid plaque formation is the major risk factor of myocardial ischemia in hypertensive patients and shows a positive correlation to the onset of myocardial ischemia, but both the common carotid artery IMT and the Crouse score of the carotid plaque are not accurate markers for predicting myocardial ischemia in patients with hypertension.

Adult ; Aged ; Aged, 80 and over ; Atherosclerosis ; complications ; pathology ; Carotid Artery, Common ; diagnostic imaging ; pathology ; Coronary Angiography ; methods ; Female ; Humans ; Hypertension ; complications ; pathology ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Ischemia ; etiology ; pathology ; Risk Factors ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo introduce the method and evaluate the efficacy of endoscopic repair of nasal septal perforation with acellular dermal matrix and pedicled mucoperichondrial flap.

METHODSTwelve patients with perforation of nasal septum were encountered since February 2006 to October 2010. The most common symptoms and sings were nasal obstruction and crusting at the margin of the perforation. Eight of 12 patients were iatrogenic following surgery. The perforation typically located at anterior medial part of the nasal septum, with their sizes ranged approximately 1.0-2.3 cm in diameter. The incision was made at the anterior edge of the perforation from the left nasal cavity and continued to the nasal floor horizontally. It ended at the lateral nasal cavity. Then, another incision was made parallel to the first one, which was 1.5 cm from the posterior of the perforation. The two incisions was connected. The mucoperichondrium was stripped along with the incisions and the pedicle of mucoperichondrial flap kept on the nasal septum. Then, the flap was turned up to cover the perforation and fixed with apposition suture. Put the acellular dermal matrix graft on the perforation from the right nasal cavity and fixed it with apposition suture.

RESULTSThe healing of the acellular dermal matrix and mucoperichondrium was good in the first week postoperatively and there was no rejective reaction and contracture. The epithelization of the nasal septal perforation finished 4 weeks after surgery. Follow-up ranged from 3 months to 4 years. Eleven patients had successful outcomes with complete closure of their perforations. One patient failed the operation. All of them had no complications.

CONCLUSIONSUsing acellular dermal matrix graft and mucoperichondrial flap to repair the septal perforation is a simple method and the success rate is high. Therefore, it is an effective way to repair the perforation of nasal septum.

Adolescent ; Adult ; Aged ; Child ; Dermis ; transplantation ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nasal Mucosa ; transplantation ; Nasal Septal Perforation ; surgery ; Nasal Septum ; pathology ; surgery ; Otorhinolaryngologic Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps ; Treatment Outcome ; Young Adult