Objective To construct a new intubation method with an otoscope and establish a murine model of Acinetobacter baumannii pneumonia with this method.Methods Part I:The Hallowell Intubation Pack for mice (Braintree Scientific Inc., USA)was used to construct a new intubation method with an otoscope.Part II:Twenty-four female ICR mice were randomized into 3 groups including control (group 1),immunosuppression (group 2)and infection after immunosuppression groups (group 3),with 8 mice in each group.The mice were treated with cyclophosphamide (CTX)by peritoneal injection to posterior orbital venous plexus.The total number of white blood cells,the number of neutrophils and the percentage of neutrophils were determined.Four mice were sacrificed at 0 h and 48 h after inoculation in each group.Then the lungs from each mouse were aseptically collected for quantitative culture and histopathology.Results Part I:Ten mice were successfully intubated using the new method and none of the mice was dead.Pulmonary bacterial culture at baseline (0 h)was (2.91×107-5.32×107 )CFU/g tissue,while the mean± standard deviation was (4.05 × 107 ± 0.82 × 107 )CFU/g tissue.The results showed that this new method had a perfect repeatability.Part II:Over 48 h,2 mice were dead in group 3,while no mouse was dead in other 2 groups.For group 3,the average pulmonary bacterial culture was 4.13×107 CFU/g tissue at 0 h and reached 3.62×1010 CFU/g tissue at 48 h (increased appropriate 1 000 times,P <0.01).The histopathologic changes in lung showed local granulomas and abscess in the alveolar space.Conclusions Intubation under the guidance of otoscope had the advantages of high repeatability and easy to operate.Additionally,the method provided stable and consistent bacterial inocula into lungs.The murine model of Acinetobacter baumannii pneumonia was successfully established with a new intubation method under the guidance of otoscope.

The pediatric risk of mortality Ⅲ(PRISM Ⅲ) score and pediatric critical illness score(PCIS) are physiology-based scores for assessing the severity of illness and mortality risk in pediatric patients.The PRISM Ⅲscore was revised version of the PRISM and was first developed in 1996.It includes 17 physiologic variables subdivided into 26 ranges.It had been validated by numerous studies worldwide and is the most widely known and used at pediatrics intensive care unit(PICU).The PCIS was first developed in 1995 in China,which included 10 physiologic variables.It had been validated by numerous studies nationwide and was simple,effective and suitable to Chinese situations.The scoring systems also can be used for quality assessments,grading the severity of illness in clinical study,and(stu)-dies of ICU resource utilization and management.There were no such study for validating the PRISM Ⅲ at present,comparing the performance of the PRISM Ⅲ score and the PCIS in China.

Objective To design T-shaped shoes with a chuck regulator to facilitate the orthopedics patient in lower limb immobilization,nursing and rehabilitation training.Methods Each of the shoes was composed of the body of low temperature thermoplasticized plate,a regulator,two cross bars controlled by the regulator and a circular silica gel liner at the heel.The stability of triangles kept the limb involved at the middle position,and prevented the lower limb from inward turning,outward turning or dropping.The shape of the triangles was modified by adjusting the regulator to form an individualized fixation posture for each patient.Results The shoes facilitated clinical nursing,enhanced the patient comfort and decreased the complications.Conclusion The shoes gains advantages in wearing,low cost and repeated use,and thus is worthy promoting practically.

Objective To investigate the relationship between carotid stiffness and coronary angiography in elderly patients with coronary heart disease(CHD). Methods Thirty-five elderly patients with CHD who underwent coronary angiography were enrolled in the study. The carotid stiffness was measured by ultrasound, the results were compared with those in hypertension group,hyperlipemia group and healthy elderly group. Results There were significant differences in carotid tensity (8.15 ± 1.54), arteriectasis ( 0.34 ± 0.07 ) and carotid stiffness ( 640.51 ± 150.98 ) of elderly patients with CHD compared to other groups (all P＜0.05 or P ＜ 0. 01 ). There was significant correlation between coronary angiography score and carotid stiffness in elderly patients of CHD(P＜0.05 or P＜0.01). Conclusions There is close relationship between carotid atherosclerosis and coronary atherosclerosis in elderly patients with CHD.

Objective To analyze the clinical data of 112 patients with adult-measles in the Af- filiated Shanghai Sixth People's Hospital and Third People's Hospital of Shanghai Jiaotong University from January to June in 2005,and to evaluate the epidemiologieal and clinical characteristics of adult- measles.Methods To retrospectively analyze the clinical data of 112 patients with adult-measles. Results Totally,112 measles patients were involved in this study,with male 63 and female 49 re- spectively.The gender rate was 1.3:1,average age about 32 years and the proportion of non-resi- dents was 40.18%.The peak of the incidence of disease emerged in April and May,and the positive rate of measle virus IgM antibody in serum was 96.43%.There were 97 patients(86.61%)who had the fever that beyond 39℃and 36 patients(32.14%)who had measle caused viral hepatitis.Conclu- sions There is a trend that the ages of patients that suffered from measle were postponed and the in cidences of disease are increased year by year,which maybe related to the nonstandard inoculation of measle vaccine,or the decrease of IgM antibody levels and so on.Meanwhile,serious toxemie symp- toms and liver damage can be observed.

Objective To explore the correlation between time-intensity curve (TIC) parameters of CEUS and microvessel density (MVD) of inverted papilloma of bladder (IPB) and bladder urothelial carcinoma (BUC).Methods Clinical and CEUS characteristics of 30 patients with IPB and 50 patients with BUC confirmed by pathology were retrospectively analyzed.CEUS TIC parameters included rise time (RT),mean transit time (MTT),peak intensiy (PI),time from peak to one half (TPH),wash in slope (WIS),time to peak (TP),semi-descending slope (DS) were acquired by QLab software and statistical analysis was carried out.The MVD of the resectioned tissue specimens were quantified via immunohistochemistry for CD34 and the correlation with CEUS TIC parameters was investigated.Results In CEUS quantitative parameters,PI,TPH,TP and DS had statistical significance in IPB and BUC (all P＜＜0.05).MVD of BUC was obviously higher than that of IPB (P＜0.05);TPH and DS both correlated with MVD (rs =0.74,-0.81,both P＜0.05).Conclu sion CEUS characteristics has certain clinical value in identification of IPB and BUC.TIC parameters of CEUS can reflect the MVD of IPB and BUC.

Simultaneous concurrence of subacute thyroiditis and Graves' disease is rare.We present one case of subacute thyroiditis with Graves' disease and combine with other reports to explore the clinical characteristics and therapeutic considerations.If subacute thyroiditis is considered coexisting simultaneously with Graves' disease,radioactive iodine uptake,thyroid autoantibody,fine-needle aspiration of thyroid gland,thyroid nuclide imaging examination,etc,should be done to make correct diagnosis and to adjust the therapeutic plan.

Objective To compare the clinical outcomes of long and short InterTan intramedullary nailing of senior intertrochanteric hip fracture in conjunction with early total care (ETC).Methods In this prospective study, records of 30 elder patients with intertrochanteric fracture hospitalized between January 2011 and September 2013 were included.Using the concept of ETC, the patients were treated with long (long-nail group, n =15) and short InterTan intramedullary nails (shortnail group, n =15) within 72 hours postinjury.The two groups were compared for operation time, intraoperative blood loss, fracture healing time, Harris hip score, time to pre-injury mobilization and hardware failure rate.Results Operation time was (77.25 ± 7.38) minutes in long-nail group versus (72.10 ± 6.90) minutes in short-nail group (P ＜ 0.01).Time to pre-injury mobilization was (7.45 ± 1.61) months in long-nail group versus (8.57 ± 2.18) months in short-nail group (P ＜ 0.05).There were no significant differences between long-and short-nail groups regarding the blood loss [(180.75 ± 38.26)ml vs (178.62 ± 34.79)ml], fracture healing time [(4.82 ± 1.12)months vs (4.76 ± 1.04) months], and Harris hip score [(83.75 ± 1.71) points vs (82.57 ± 2.18) points] (P ＞ 0.05).Conclusions Either long or short InterTan intramedullary nailing combined with ETC is effective in treatment of intertrochanteric hip fracture in the elderly.However patients treated with long nails return to pre-injury mobilization relatively earlier.Long InterTan intramedullary nail system is better for the patients combined with serious osteoporosis.

Objective To understand the distribution and antimicrobial resistance of pathogens causing wound in-fection in army officers and soldiers following military training injury,and provide reference for antimicrobial use in clinical anti-infection treatment.Methods Wound secretion from injured army patients who were admitted to a mili-tary hospital between January 2014 and June 2015 was performed bacterial culture and antimicrobial susceptibility testing.Results 647 pathogenic bacteria strains were isolated from 1 029 wound secretion specimens ,isolation rate was 62.88%,the top 6 isolated bacteria were Staphylococcus aureus (S .aureus ,29.99%,n =194),Escherichia coli (E.coli,19.32%,n=125),Pseudomonas aeruginosa (19.17%,n=124),Enterococcus spp .(13.60%,n=88), Klebsiella pneumoniae (K .pneumoniae ,7.73%,n =50),and Acinetobacter baumannii (A.baumannii,5.87%, n=38).S .aureus and Enterococcus spp .had high susceptibility to vancomycin,linezolid ,and daptomycin (resist-ance rates ≤3.41 %),44.33% of S .aureus were methicillin-resistant,2.27% of Enterococcus spp .were vancomy-cin-resistant .E.coli and K .pneumoniae had high susceptibility rates to piperacillin/ tazobactam (resistance rates were 1 .60% and 0 respectively),except A.baumannii,resistance rates of gram-negative bacteria to carbapenems were all low (resistance rates ≤4.00%).Conclusion Military clinicians should select appropriate antimicrobial agents according to antimicrobial susceptibility testing results,reduce the disability rate due to infection in trauma patients,and provide clinical support for the treatment of the wounded.

BACKGROUND:With the development of industry and agriculture, organotin compounds have been widely used in China. Organotin compounds cause a common occupational poisoning. The toxicity of organotin was reported in animal studies; however the reports about human organotin intoxication are very rare. In this study we retrospectively analyzed the clinical manifestations of 15 organotin-poisoned patients who had been treated at our hospital from 2002 through 2007. METHODS:Fifteen patients with organotin poisoning were admitted to Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from 2002 to 2007. They were 9 males and 6 females, aged from 25 to 52 years. Clinical manifestations and Glasgow Coma Scales showed that the poisoning was mild in 4 patients, moderate in 6 and severe in 5. The severe patients were given glucocorticoid after hospitalization by intravenous guttae of 500 mg methylprednisolone for the first day, followed by 160 mg methylprednisolone per day for three days, and then 80 mg methylprednisolone per day for another three days. Potassium glutamate and sodium glutamate were intravenously dripped to reduce blood ammonia; intravenous guttae plus oral administration of potassium 9 g/day was used to correct intractable hypokalemia; sodium bicarbonate was used to correct metabolic acidosis, and sedatives were used to control spasm and twitch; mechanical ventilators were used in 4 patients with dyspnea. RESULTS:Most of the patients showed elevated level of blood ammonia, decreased level of blood potassium and metabolic acidosis, but some had demyelination changes shown by CT and MRI. Treatments included correction of metabolic acids, blood potassium and ammonia, and mechanical ventilation when necessary. For patients with injuries of the nervous system, glucocorticoids were given immediately after hospitalization. These patients showed intractable hypokalemia and metabolic acidosis during the treatment. Forteen patients recovered completely without long-term side-effect. One patient in the aphasiac stage restored the linguistic capacity during a 6-month follow-up. CONCLUSIONS:Elevated level of blood ammonia, decresed level of blood potassium, and metabolic acidosis are common in patients with organotin poisoning. Demyelination can be observed in patients with severe poisoning. The abnormalities of the patients are reversible after suitable treatments.