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 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.

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 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:This study aimed to explore the effects ofnesfatin-1 on gastric distension (GD)-sensitive neurons in the basomedial amygdala (BMA) and the potential mechanism for nesfatin-1 to regulate gastric motility through the arcuate nucleus (Arc).Methods:The projection of nerve fiber and expression of nesfatin-1 were observed by retrograde tracing and fluo-immunohistochemistry staining;The nuclei microinjection and nuclei electrical stimulation,extracellular discharges of single unit neuron were used to observe the effects ofnesfatin-1 on the GD neurons;Gastric motility recording in vivo were used to monitor the effects ofnesfatin-1 on the amplitude of constriction and frequency of gastric motility in conscious rats.Results:NUCB2/Nesfatin-1/fluorogold-double labeled neurons were from ARC to BMA;Nesfatin-1 could excited the firing rate of most of the GD-E neurons (4.25± 1.02 Hz vs.5.32± 1.17 Hz,P＜0.01) and decreased the firing rate of most of the GD-I neurons (3.73± 0.92 Hz vs.2.64± 0.86 Hz,P＜0.01),inhibited the gastric motility,amplitude and frequency,SHU9119 could weaken the responses induced by nesfaton-1;Electrical stimulation of the Arc,the firing rate of nesfatin-1-induced GD-response neurons (GD-E:5.14± 1.32 Hz vs.6.75± 1.84 Hz,P＜0.05;GD-I:2.84± 0.86 Hz vs.4.05± 1.12 Hz,P ＜0.05) and the gastric amplitude and frequency were increase.Conclusion:It was suggested that nesfatin-1 in the BMA plays an important role in decreasing gastric motility and the Arc may be involved in this regulation process.

Objective:The current study investigated the effects of nesfatin-1 in the hypothalamic paraventricular nucleus (PVN) on gastric motility and the regulation of the lateral hypothalamic area (LHA).Methods:The projection of nerve ?ber and expression of nesfatin-1 were observed by retrograde tracing and fluo-immunohistochemistry staining;The nuclei microinjection and nuclei electrical stimulation,extracellular discharges of single unit neuron were used to observe the effects of nesfatin-1 on the GD neurons;Gastric motility recording in vivo were used to monitor the effects of nesfatin-1 on the amplitude of constriction and frequency of gastric motility in conscious rats.Results:Nesfatin-1 inhibited the majority of the GD-E neurons(1.97± 0.12 Hz vs.1.15± 0.07 Hz) and excited GD-I neurons (1.74± 0.10 Hz vs.3.04± 0.18 Hz) in the PVN,which were weakened by oxytocin receptor antagonist H4928 (GD-E:1.38± 0.08 Hz,P＜0.05 vs.nesfatin-1;GD-I:2.49± 0.15 Hz,P＜0.05 vs.nesfatin-1).Gastric motility experiments showed that administration ofnesfatin-1 in the PVN decreased gastric motility.Retrograde tracing and immunofluorescent staining showed that nucleobindin-2/nesfatin-1 and fluorogold double-labeled neurons were observed in the LHA.Electrical LHA stimulation excited the firing rate of GD-responsive neurons (GD-E:2.06± 0.12 Hz vs.4.23± 0.21 Hz,GD-I:1.61± 0.09 Hz vs.4.83± 0.25 Hz) in the PVN.Pre-administration of an antinucleobindin-2/nesfatin-1 antibody in the PVN strengthened gastric motility,decreased GD-E neurons (1.74± 0.10 Hz vs.3.04± 0.18 Hz) and excited the discharging of the GD-I neurons(4.15± 0.18 Hz vs.4.83± 0.25) induced by electrical stimulation of the LHA.Conclusion:Nesfatin-1 in the PVN could serve as an inhibitory factor to inhibit gastric motility,which might be regulated by the LHA.

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.

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.

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.

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.