Objective:To compare the diagnosis value of color echocardiography and high resolution CT for early left ventricular dysfunction.Methods:72 cases of left ventricular dysfunction patients in our hospital were chosen, and all of patients were detected with color echocardiography and high resolution CT inspection. Each patient was followed-up for 18 months and then to compare the diagnosis values of the two kind methods.Results: After 18 months follow-up review, the diagnostic accuracy of color echocardiography and high resolution CT were 95.8% (69/72) and 97.2% (70/72), respectively. Both of two methods were higher, and the difference was not statistically significant (x2=0.207,P=0.649). All sorts of cardiac function detection result, such as LVSV, LVEF, LVEDV and LVESV, were similar between color echocardiography and high-resolution CT, and the difference was not statistically significant (t=-0.775,t=1.387,t=-0.624,t=-1.209;P>0.05). Conclusion: Both of the diagnostic accuracy of color echocardiography and high-resolution CT for early left ventricular dysfunction were higher. All of them are worthy generalization and applying in clinical diagnosis for early heart failure.

The new medical model which is more emphasis on patient-centered concept and the patient's state of mind and mental health has brought a lot of new challenges to medical students who are about to become the medical workers while also put forward new tasks to the medical educational workers.Medical professionalism and doctor-patient communication are very important for the students to handle.Medical professionalism is the professional guidelines of the doctors,which is an important guarantee for the interests of the patients and the embodiment of noble character of doctors.Doctor-patient communication is basal to create a harmonious doctor-patient relationship and is a key means to ensure the medical quality.In addition to lay a solid theoretical foundation,medical students should also learn to establish correct medical professionalism and grasp effective communication skills to become qualified doctor.

Objective To investigate the effects of two weaning modes of mandatory rate ventilation (MRV) and SIMV+PSV on respiratory mechanics in patients with type Ⅱ respiratory failure. Methods A total of 30 patients with type Ⅱ respiratory failure were sem randomly divided into two groups. Patients with type Ⅱ respiratory failure received ventilation in CMV mode or CMV/ACMV modes and then SIMV+PSV. When patients could be weaned, MRV mode was adopted in MRV group, but SIMV+PSV modes were adopted in the control group. After continuous operation in each mode for 60 min and when the tidal volume (VT) and minute ventilation (MV) in MRV mode were the same as those in SIMV+PSV mode, PIP, PP, Pm, PEEPi, blood gas changes, and weaning success in the two groups were observed during ventilation. Results PIP, PP, and Pm in patients in MRV mode were significantly lower than those in SIMV+PSV modes ( P 0.05), but the synchronism in patients in MRV group was better. Conclusion MRV is a more adaptable weaning mode for patients with type Ⅱ respiratory failure.

For example of children virus pneumonia, we put forward that clinical research should be carried out by review article analysis, experts’opinions integrated and the requests of evidence-based medicine. On the base of systemic evaluation of the sensitivity, reliability, validity and relation among them of all indicators for effect evaluation on virus pneumonia, we will establish the effect evaluation system of TCM in the treatment of virus pneumonia including disease and syndrome effect evaluation, complication and combining drug,using rate evaluation, safety evaluation and health economics evaluation.

Objective To explore the operational methods and clinical effect of laparoscopic repair of ab -dominal incision hernia .Methods The clinical data of 10 cases with abdominal giant incisional hernia undergone laparoscopic repair were retrospectively analyzed .Results All the cases were successful .Operative time ranged from 85 to 180 minutes,with an average of 150 minutes.The bleeding was 40-120mL during the operation .Postoperative hospital stay was 6-14(average 8) days.3 cases developed pain in operation area after operation and were better after 1-2 months.The seroma was observed in 1 case witch cured by puncture treatment .No incisional infection ,bleeding, intestinal fistula,intestinal obstruction ,or death was observed during the follow-up.In the follow-up after 4 months to 4 years,no recurrence was occurred .Conclusion The laparoscopic repair of abdominal giant incision hernia using composite patch is a safe and effective method ,which is worthy of clinical application .

Objective To observe the expression of immune substances secreted by peripheral bloodγδT cells after stimulated by early secreted antigenic target-6(ESAT-6),and explore its mechanism of signaling pathway.Methods Peripheral blood mononucle-ar cells(PBMC)were collected from health human blood with the ficoll density gradient centrifugation method,and theγδT cells were separated from the PBMC with flow cytometry;the inhibitor of TLR-4 signaling pathway(E5564)was used to cocultured withγδT cells to inhibit the function of TLR-4,and the change of TLR-4 was analyzed by the methods of PCR and Western blot.ESAT-6 were used to stimulate theγδT cells,and the control group without any stimulating factor was established,then the expression levels of IL-17,TNF-α,IFN-γwere determined by ELISA method after 0、1、3、6、9 and 12 days.Results The results of PCR and Western blot showed that ESAT-6 could increase the expression of TLR-4(P<0.01);The results of ELISA showed that ESAT-6 could enhance the expression of IL-17,TNF-αand IFN-γ(P<0.01),and the inhibitor of TLR-4(E5564)could decrease the expres-sion of IL-17,INF-α,IFN-γ(P<0.01).Conclusion ESAT-6 can induceγδT cells to produce more IL-17,TNF-α,IFN-γ,and the mechanism of which maybe concerned with TLR-4 signaling pathway.

OBJECTIVETo study the expression and significance of platelet derived growth factor (PDGF) and its receptor (PDGFR) in liver tissues of patients with chronic hepatitis fibrosis and liver cirrhosis.

METHODSThe expression, distribution, quantitation, and correlation of PDGF-A, PDGF-B, PDGFR-alpha, PDGFR-beta, and alpha-SMA in the liver tissues were analyzed by immunohistochemical techniques in 21 patients with chronic hepatitis and 42 patients with liver cirrhosis.

RESULTSIn the liver tissues of chronic hepatitis and liver cirrhosis, PDGF and its receptor and alpha-SMA mainly distributed in the fibrotic septa and the infiltration area of inflammation, particularly in branch spindle-shaped cells (activated HSC). The expression of PDGF-B and PDGFR-beta was stronger than that of PDGF-A and PDGFR-alpha with a significant difference between them (P<0.05 approximately 0.01). The expression and distribution of alpha-SMA was basically identical with the expression and distribution of PDGF-A, PDGF-B and PDGFR-alpha, PDGFR-beta and quantitative analysis showed a positive correlation (r=0.606, P<0.001).

CONCLUSIONSPDGF and PDGFR play a key role in liver fibrogenesis and development. The biologic effects of PDGF are elicited through activising HSC. Inhibiting PDGF and its receptor is a new approach to the treatment of liver fibrosis.

Actins ; biosynthesis ; physiology ; Adolescent ; Adult ; Aged ; Female ; Hepatocytes ; metabolism ; Humans ; Liver Cirrhosis ; metabolism ; Male ; Middle Aged ; Muscle, Smooth ; chemistry ; Platelet-Derived Growth Factor ; biosynthesis ; physiology ; Proto-Oncogene Proteins c-sis ; biosynthesis ; physiology ; Receptor, Platelet-Derived Growth Factor alpha ; biosynthesis ; physiology ; Receptor, Platelet-Derived Growth Factor beta ; biosynthesis ; physiology

Objective To compare biomechanical effects of augmentative plating assisted by different types and numbers of intramedullary nails in the treatment of nonunion of femoral shaft fracture after intramedullary nailing.Methods Twenty-five specimens of synthetic femur were randomly divided into an experimental group (20 bones) and a control group (5 bones).All the bones were made into models of nonunion of femoral shaft fracture after intramedullary nailing.The control group was subjected to no augmentative plating.The experimental group was further divided into 4 subgroups (n =5) which were subjected to fixation respectively by:a 7-hole plate with 3 bicortical screws on each side,a 7-hole plate with 3 unicortical screws on each side,a 5-hole plate with 2 bicortical screws on each side,and a 5-hole plate with 2 unicortical screws on each side.The torque values of all the subgroups were measured and compared when the models were subjected to torsional angles of 5°,10°,15°,20° and 25°.Results The anti-torsional strengths at torsional angles of 5°,10°,15°,20° and 25° in the 4 experimental groups were all significantly greater than in the control group(P ＜ 0.05).At a torsion angle of 25°,the mean torque value in the 3-bicortical-screw group (46.51 ±6.66 nm) was significantly greater than in the 2-bicortical-screw group (39.03 ±8.52 nm) (P ＜0.05).At torsion angles of 5°,10°and 25°,the mean torque values in the 3-unicortical-screw group (13.48±1.68 nm,23.29±3.72 nm and 48.19±5.34 nm,respectively) were significantly greater than in the 3-unicortical-screw group (9.56 ± 3.62 nm,16.99 ± 5.49 nm and 38.69 ± 6.56 nm,respectively) (P ＜ 0.05).At torsion angles of 20° and 25°,the mean torque values in the 3-unicortical-screw group (39.15 ± 5.07 nm and 48.19 ± 5.34 nm) were significantly greater than in the 2-bicortical-screwgroup (32.50 ± 5.65 nm and 39.03 ± 8.52 nm) (P ＜0.05).Conclnsions The anti-torsional strength of fixation by 3 screws on each side is significantly greater than by 2 screws on each side.When the number of screws is the same,there is no significant difference between fixation by unicortical locking screws and that by bicortical conventional screws.Augmentative plating with 3 unicortical screws or 3 bicortical conventional screws on each side is recommended for treatment of nonunion of femoral shaft fracture after intramedullary nailing.

Objective To evaluate the safety and efficacy of CT-guided radioactive 125I seed implantation in treating retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy.Methods A total of 10 patients with retroperitoneal lymph node metastasis (12 lesions in total)due to recurrent cervical cancer after radiotherapy,who were treated with CT-guided 125I seed implantation during the periodfrom November 2011 to October 2015,were included in this study.The diameters,that were perpendicular to each other,of the involved lymph nodesranged from 1.7 cm×1 cm to 6.5 cm×5 cm,the diameter of 6 involved lymph nodes (50％) was ＜5.0 cm and the diameter of other 6 involved lymph nodes (50％) was ≥5.0 cm.With the help of treatment planning system for brachytherapy,the source distribution was formulated.Under CT guidance,the 125l seedswith the activity of 0.3-0.7 mCi were implanted.Postoperative validation showed that D90 (90％ minimum prescription dose received by the target volume) was 36-110 Gy (median 59 Gy).After the treatment,the changes in lesion size,pain relief and complications were recorded.Results The 10 patients were followed up for 4.3-16.1 months,the median follow-up time was 9.7 months.The 2-month local control rate and the 2-month effective rate were 100％ and 58.3％,respectively.The 2-month,6-month and 12-month survival rates were 100％,66.7％ and 58.3％,respectively.The median survival time was 12.1 months.One patient (10％) died of gastrointestinal bleeding at five months after treatment,six patients (60％) died of distant metastases,three patients (30％) survived withno evidence of local recurrence.No major complications such as massive hemorrhage,intestinal infection,bone marrow suppression or other 125I seed-related complications occurred.Conclusion For the treatment of retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy,CT-guided radioactive 125I seed implantation has satisfactory short-term curative effect,and this technique is safe and feasible.

目的探索脑瘫患儿早期发现、早期干预的工作模式。方法临床、保健、康复相结合 ,采用产前检查、孕妇学校、产时儿科医生进产房、新生儿行为神经评定测定、高危儿抚触训练室、婴儿期儿童保健监测、各街道防治站常规体检筛查转诊等多种形式结合早期发现并干预脑瘫高危儿。结果此工作模式较模式前显著提高了脑瘫的早期诊断率及康复疗效。结论临床、保健、康复相结合的方式整合了医疗资源,起到了促进脑瘫早发现、早诊断、早治疗的作用 ,值得推广。