The causes of dizziness and vertigo were complex.The traditional diagnostic paradigm was based on symptom quality- what do you mean dizzy? According to this system,a patient with vertigo has a different list of possible causes than those who endorselightheadedness.The new diagnostic paradigm was based on their description of the timing,triggers of symptom strengthened the context of the vertigo medicine.More emergency physicians (EPs) lacked a significant knowledge regarding bedside examination and extensively convinced neuroimaging,resulting in misdiagnosis of serious causes such as stroke,unnecessary use of neuroimaging,and failure to institute specific treatment for many patients with inner ear causes of dizziness.This article focuses on how to use bedside physical examination to more accurately diagnose patients who present with acue dizziness,vertigo,or other similar vestiblar symptoms.This,in turn,could lead to lower rates of misdiagnosis,decrease utilization of expensive imaging studies,and increase in prompt,and correct treatments,thereby to improve patient outcomes.

Objective To investigate the relationship between interleukin-17 (IL-17) and vitiligo.Methods Totally,32 vitiligo patients and 30 healthy human controls were enrolled in this study.Blood samples were collected from all the subjects,and enzyme-linked immunosorbent assay (ELISA) was performed to determine the plasma levels of IL-17.The relationship of plasma IL-17 levels with disease stage,clinical course and lesion area was assessed.Results The plasma levels of IL-17 were significantly higher in the patients with progressive and stable vitiligo than in the healthy controls (both P ＜ 0.05),and higher in the patients with progressive vitiligo than in those with stable vitiligo (P ＜ 0.05).Moreover,the plasma levels of IL-17 were positively correlated with the area of vitiligo lesions (r =0.456,P ＜ 0.05),but unrelated to the clinical course of vitiligo (r =0.239,P ＞ 0.05).Conclusion IL-17 may play a certain role in the occurrence and development of vitiligo.

Objective To analyze the difference and correlation of the evaluation of the medical students' communication ability between the examiners,standardized patients (SP) and medical students themselves in objective structured clinical examination (OSCE),and to provide scientific basis for the appropriate evaluation method of medical students' communication ability.Methods OSCE was used to evaluate the communication ability of 90 medical students in Daping Hospital,Chongqing,and the three parties were evaluated by the examiners,SP and medical students themselves.Excel and SPSS 17.0 statistical analysis software were used,through Friendman M.test,t test and correlation analysis to analyze the differences and correlation of the three parties evaluations.Results The different evaluation between the three parties on the communication ability of medical students was as follows.Examiner's evaluation was the lowest (8.39 ± 1.18),SP's evaluation was the highest (9.62 ± 0.73),Medical students themselves' evaluation was higher (9.28± 1.09);The examiner's evaluation of Medical students' empathy,verbal communication ability,nonverbal communication ability and etiquette was lower (P=0.00).The correlation analysis of the three parties' evaluation showed that there was a significant correlation between the three parties on the connnunication ability,empathy and nonverbal communication ability (P＜0.05).The evaluation of SP and medical students themselves on medical students' language communication ability and etiquette was significantly correlated (P＜0.05).Conclusions Using examiner or SP or medical students themselves only to evaluate the communication ability of medical students is not accurate,The Examiner and SP as the main trial test personnel should collaborate to evaluate medical students' communication ability.The examiner can evaluate three projects such as what is medical ethics and law,empathy,nonverbal communication ability,while the SP can evaluate the two projects:what is language communication ability and etiquette.The collaborative evaluation of the two sides can be more accurate to reflect the doctor-patient communication ability of medical students.

[ABSTRACT]OBJECTIVETo evaluate the accuracy of the watch peripheral arterial tone (Watch-PAT) in the diagnosis of obstructive sleep apnea hypopnea syndrome (OSAHS).METHODSA total of 51 outpatients who had chief complaint of sleep snoring were carried out Watch-PAT test and polysomnography (PSG) simultaneously, and the results were statistically compared.RESULTSFifty one patients, consisted of 44 males and 7 females, had the mean age of (45.7±12.0) years (±s) and the mean body mass index of (28.8±3.6) kg/m2.The mean PSG apnea hypopnea index (AHI) was (45.69±12.02) events per hour, and mean Watch-PAT AHI was (35.49±24.49) events per hour. Significant correlation has been detected between Watch-PAT AHI and PSG AHI (r=0.878,P<0.001). The sensitivity and specificity of Watch-PAT were 97.73% and 85.71%, when PSG-AHI≥5/h events per hour was setting as the threshold value to diagnose OSAHS. The diagnostic efficiency of Watch-PAT has been tested by ROC curve, and the area under the curve approached to 0.997.CONCLUSIONThe Watch-PAT was proved as a portable and reliable device of screening patients who were suspected OSAHS.

Objective To design and develop a kind of venipuncture auxiliary device to use in the absence of light condition or patients with poor vein condition, and validate its clinical effect. Methods A total of 70 patients with shock were divided into experimental group (venipuncture auxiliary device group with 37 cases) and control group (non-device group with 42 cases) by random digits table method. The one-time puncture success rate and operating time were compared between two groups. Results The one-time puncture success rate was 94.59%(35/37) in experimental group and 78.57%(33/42) in control group, and there was significant difference, χ2=4.214, P<0.05. The time of establishing a single vein passage was (73.63±29.35) s in experimental group and (107.61±45.94) s in control group, and there was significant difference, t=3.656, P<0.05. Conclusions The device is small in size, low cost, easy to carry, the screen is clear, is a rapid infusion with explore vascular equipment. It can guide nurses accurately on vascular puncture, fast, smooth and effective transfusion puncture process.

Objective To observe the clinical effects and safety of Angongniuhuang Pill (a traditional Chinese medical preparation)adjuvant to haloperidol for the treatment of Intensive Care Unit (ICU)patients in postoperative delirium.Methods A prospective study of 243 postoperative patients with delirium adimitted in Intensive Care Unit of Xinjiang Medical University First Affiliated Hospital (January 2013-December 2014),by using confusion assessment method of Intensive Care Unit (CAMICU).All of 243 patients with delirium were randomly divided into two groups by computer randomization software (SAS 9.1):group A in which patients were treated with Angongniuhuang Pill adjuvant to haloperidol and group Fin which patiets were treated with haloperidol alone.The end of two intervention methods was determined by two consecutive CAMICU showing negative or the treatment were ended up at seven days treatment.The data of general information,and the results of treatment were recorded and analized by statistical software SPSS 19.0.The measurement data was expressed as mean ±standard deviation;the comparision between two groups was tested by t test;and repeated measurement was analised by variance.Count data was described as number and constitution ratio;and intergroup comparision was tested by Chi-square test. Results There was no significant difference in general information between two groups.The delirium duration and ICU treatment time in group A were shorter than those in group F [(3.0 ±0.9)d vs.(3.8 ±1.0) d,P =0.010; (6.2 ± 1.4) d vs.(6.7 ± 1.5) d,P = 0.008].When delirium was diagnosed (T0),all patients had EEG abnormalities.As treatment went on,EEG abnormal rate gradually declined.At day one (T1),there was no statistically significant difference in EEG findings between group A and group F (95.7% vs.97.5%,P = 0.045 ).At day two (T2 )and day three (T3 ),there was statistically significant difference in EEG findings between group A and group F (65.5% vs.77.7%,P =0.038;42.2% vs.56.2%,P = 0.032).The levels of S100βprotein,interleukin-6 (IL-6),tumor necrosis factor α(TNF-α)in two groups at T0 were all elevated without noticeable difference.These markers were all deceased at T1,T2,T3,but the speed of descend in group A was relatively faster than that in group F.The differences were statistically significant (S100β:time effect P <0.01,inter-group effectp =0.002,interaction effectp =0.686;IL-6:time effect P <0.01,inter-group effectp =0.034,interaction effectp =0.01;TNF-α:time effect P <0.01,inter-group effectp =0.003,interaction effectp =0.516). The discharge rate in group A after improvement of general condition was higher than that in group F (89.7% vs.79.3%,P =0.029).The incidence of postoperative complications and mortality 28 days after operation in group A were lower than those in group F (45.7% vs.58.7%P =0.045;12.9% vs. 24.0%,P =0.028).Conclusion During the treatment of delirium,Angongniuhuang pill adjuvant to haloperidol was a better method compared with using haloperidol alone in respect of effectiveness and safety perspectives.It may be a novel approach to the treatment for delirium by the combination of Chinese and Western medicine.

The microbial transformation of buflomedil by Cunninghamella blakesleana AS 3.153 was studied, as well as a microbial model which can be used to mimic metabolism of buflomedil in mammal was established. Experiments were conducted to screen the capabilities of four strains of Cunninghamella species to transform buflomedil, in which C. blakesleana AS 3.153 was selected for a preparative biotransformation. Furthermore, the microbial model was established based on the transformation condition optimization. The parent drug and its metabolites produced by C. blakesleana AS 3.153 were detected by liquid chromatography-mass spectrometry method and three metabolites were identified while two of them were new found metabolites. Two major metabolites, para-O-desmethyl buflomedil and 12-C-oxidated buflomedil, were isolated by semi-preparative HPLC. Based on the comparison between different species, the microbial transformation of buflomedil by C. blakesleana AS 3.153 is more similar to the metabolism of buflomedil in human and Beagle dog than that in rat.

Objective To investigate the association between bone mineral density (BMD) and left ventricular mass index (LVMI) in elderly men in Beijing.Methods Totally 370 elderly men with an average age of (76.6±9.3) years from the departments of gerontology were included.BMD,echocardiography measurements as well as blood chemistry were analyzed.LVMI was obtained by echocardiography.All the subjects were divided into two groups:non-LVH group (n=231) and LVH group (n =139).Differences in quantitative variables were tested by independent-sample t test.Multiple stepwise linear regression analysis were performed to identify determinants of LVMI.Results The serum creatinine concentration was significantly higher in LVH group than in non-LVH group [(97.1±43.0) μmol/L,(88.2±21.1) μmol/L (P＜0.05)].Compared with non-LVH group,LVH group showed that the lumbar spine BMD (L1-L4) were significantly lower[L1:(0.90±0.16) g/cm2 vs.(0.95±0.21) g/cm2,P=0.05; L2:(0.95±0.17) g/cm2 vs.(1.01±0.20) g/cm2,P＜0.01 ; L3:(0.99±0.19) g/cm2 vs.(1.06±0.28) g/cm2,P＜0.01] as well as the lumbar spine totalBMD [(0.97±0.18) g/cm2 vs.(1.03-1-0.26) g/cm2,P＜0.05].The femur BMD was lower in theLVH group than in non-LVH group [trochiter:(0.64±0.11) g/cm2 vs.(0.67±0.17) g/cm2,P＜0.05; inter area:(1.00±0.17) g/cm2 vs.(1.05±0.22) g/cm2,P＜0.05].Multiple stepwise linear regression analysis demonstrated that BMI (r=0.27,P＜0.01),the lumbar spine BMD (r=-0.20,P＜0.01),age (r=0.16,P＜0.05),serum creatinine (r=0.15,P＜0.05) were independently correlated with LVMI.Conclusions In elderly men in Beijing,the lumbar spine BMD is an independent correlative factor for LVMI.

Objective To detect beta-human papilloma virus (HPV) and determine its genotype in actinic keratosis (AK) lesions.Methods Tissue specimens were collected from the lesions of 39 patients with AK and normal skin of 40 healthy controls.A nested PCR was performed to detect alpha-HPV and beta-HPV DNA in these specimens.The genotype of beta-HPV was determined in beta-HPV DNA-positive specimens by a common PCR using specific primers targeting 12 HPV genotypes,including HPV 5,8,15,17,19,20,21,23,36,38,49 and 80.Results The detection rate of beta-HPV DNA was 84.6％ (30/39) in the patients with AK,and 30.0％ (12/40) in the healthy controls (x2 =6.76,P ＜ 0.05),while no significant difference was observed in the detection rate of alpha-HPV DNA between the two groups (12.8％ vs.7.5％,x2 =0.91,P ＞ 0.05).HPV 38 was the predominant genotype of beta-HPV in these patients with a detection rate of 36％ (12/33),followed by HPV36.The prevalence of all the 12 genotypes of HPV was consistently low in the healthy controls.Mixed HPV infections were observed in 10 AK lesions,but in none of the healthy controls.No statistical difference was noted in the positivity rate of beta-HPV among patients at different ages,of different genders,with different occupations or clinical courses (x2 =0.53,0.94,0.81,0.73,respectively,all P ＞ 0.05).Conclusions Compared with healthy controls,the patients with AK showed a higher beta-HPV infection rate,with HPV38 as the predominant genotype.

Objective To investigate the detection of IMP andVIM metallo-β-lactamases (MβLs)genes in clinically iso-lated gram-negative bacteria as well as bacterial resistance toβ-lactam antimicrobial agents.Methods 113 clinically isolated bacteria were performed antimicrobial susceptibility testing by Kirby-Bauer method ,drug-resistant genes IMP and VIM were detected by polymerase chain reaction (PCR),PCR products were sequenced and aligned with BLAST software. Results VIM gene was detected in 1 Pseudomonas fluorescens strain ,IMP gene was detected in 15 strains ,they were Klebsiella pneumoniae (n=6),Acinetobacter baumannii (n=3),Escherichia coli (n=2),Ralstonia picket-tii (n=1),Pseudomonas aeruginosa (n=1 ),Citrobacter amalonaticua (n=1 ),and Enterobacter cloacae (n=1 ). BLAST results showed that VIM gene was VIM-2 subtype,similarity with gene bank was 99%;all IMP genes were IMP-1 subtype,which were highly homologous ,similarity was 98%-99%.Resistant rates of IMP positive strains to ceftriaxone,cefotaxime,cefoxitin,aztreonam and imipenem were all significantly higher than negative strains (all P <0.05).Conclusion IMP genes of different strains are highly homologous,all are IMP-1 type,indi-cating that IMP genes are highly transmissible and can spread among different species of bacteria.IMP genes are related with resistance ofβ-lactam antimicrobial agents.