Objective To develop an ultrasonic frostbite treatment instrument to enhance the efficiency of its treatment.Methods The instrument was designed with thermal effect of ultrasound,which used LPC1788 controller as the core of the hardware circuit.Corresponding software was developed based on KEIL uvision4.0 platform.The instrument was composed of the circuits for square wave generation,boosting,transduction,LCD and power source.Results Five-to-seven-day treatment by the instrument gained high efficacy,and no adverse response occurred.Conclusion The instrument has the characteristics of high reliability,strong controllability,wide adaptation and no side effects,and thus is worthy promoting practically for the clinical treatment of frostbite.

Objective To establish a standardized management system and process for teaching ward rounds of clinical practice,so as to improve the quality of clinical practice. Methods (1) We established the system and process for teaching ward rounds. (2) The students of 2008 grade were divided into two groups. The new system and process for teaching ward rounds was used in 71 students in the experimental group,and the primary teaching ward rounds system was used in 72 students in control group. (3) A survey concerned about students' abilities of grasping theoretical knowledge, clinical thinking, self-study, clinical operation and doctor-patient communication were investigated in both students and their tutors. Result The result showed that the abilities of grasping theoretical knowledge,clinical thinking,self-study,clinical operation and doctor-patient communication in the experimental group were enhanced much more than the control group ( <0.01) . Conclusion The standardized management system and process for teaching ward rounds of clinical practice can improve the students, comprehensive abilities and the quality of clinical practice.

Objective To evaluate the clinical value of determination of composition of kidney stones by shap and density and of prediction of the efficacy of extracorporeal shock-wave lithotripsy (ESWL) by X-rays. Methods The data of 358 patients were analyzed,with 204 male and 154 female and with 276 cases of solitary stones and 82 cases of multiple stones.Determine the composition of kidney stones by shap and density,predict the efficacy of ESWL by X-rays,and choose the appropriate method of treatment.Analyze stone chemical property by Infrared stone composition automatic analyzer to checkout the prediction results before surgeries. Results 339 cases were successful to remove stones after treatment.The prediction results of 308 cases (86.0％) were consistent in stone chemical property,and the preperative prediction results of 339 cases (94.7％) were consistent in ESWL efficacy. Conclusions Determination of composition of kidney stones and prediction of the efficacy of ESWL by X-rays were feasible.

Objective To explore the significance in judging the different clinical stages of relapsing polychondritis (RP) patients through examining the changes of aggrecanase and metabolic fragments of aggrecan.MethodsIn comparison with the control group (20 cases),40 patients were divided into the stable stage group (22 cases) and the active stage group (18 cases).The aggrecanase-generated neoeptitopes in cartilage matrix were analysed by immunohistochemistry and Western blot(WB) respectively.The mRNA and protein levels of aggrecanase-1,2 expressed in cartilage cells were measured by real-time reverse transcriptional polymerase chain reaction(RT-PCR) and WB respectively.The difference of these results among these three groups was analyzed accordingly.ResultsThe expression of aggrecanase-1,2 in mRNA level was measured by real-time RT-PCR.The values of aggrecanase-1,2 mRNA 2 -ΔΔC1 were 1.00 ± 0.26 and 1.00 ± 0.27 in control group,1.47 ± 0.11 and 1.57 ± 0.13 in stable stage group,2.09 ±0.12 and 2.09 ± 0.19 in active stage group respectively.By one-way ANOVA analysis,the difference between every two groups was statistically significant (F was 299.113 and 459.013,P ＜ 0.01 ).In comparison with control group,aggrecanase-1,2 increased significantly in both stable and active stage group (P ＜ 0.01 ) and aggrecanase-1,2 increased more significantly in active stage group than in stable stage group (P ＜ 0.01 ).The results from WB analysis indicated that aggrecanase-1,2 could not be detected in control group,and they were detectable in stable stage group and increased in active stage group at the relative molecular of 68 000 Da or 73 000 Da respectively.The aggrecanase-generated neoeptitopes were analyzed by WB as well.The results indicated that NITEGE and ARGSV could be detected in stable stage group and increased in active stage group at the relative molecular of 70 000 Da or 48 000 Da respectively,but there were no signals in control group.Similar with the previous WB results,no signals of NITEGE or ARGSV eptitopes were detected in normal cartilage matrix ( no red staining) by use of immunohistochemical staining.However,in stable stage group and active stage group,these eptitopes were apparently detected (obviously red staining).ConclusionWith the progression of the RP,the activity of the aggrecanase is enhanced,and the degradation of the aggrecan is increased,associated with the severity of the disease.

Objective: To explore the relationship between platelet counts at admission and in-hospital mortality in patients with type A acute aortic dissection (AAD). Methods: We investigated 183 consecutive patients with CT conifrmed diagnosis of type A AAD treated in our hospital from 2012-02 to 2013-05. There were 126 (68.9%) male and the patients were divided into 3 sets of groups.①In-hospital surviving group,n=157 and In-hospital death group,n=26.②According to platelet counts, the patients were divided into 5 groups: Q1 group, platelet counts ≤ 119×109/L,n=36, Q2 group, platelet (120-149) ×109/L,n=37, Q3 group, platelet (150-173)×109/L, n=36, Q4 group, platelet (174-228)×109/L,n=37, Q5 group, platelet >228×109/L,n=37.③At admission, platelet ≤ 119×109/L,n=36 and platelet >119×109/L,n=147. In addition, the patients were further divided into another 4 groups based on operative condition: platelet ≤ 119×109/L with operation,n=18, without operation,n=18; platelet > 119×109/L with operation,n=96, without operation,n=51. The basic information at admission including platelet counts, WBC and D-dimer were studied in all groups, the primary endpoint was in-hospital mortality. Results: The overall in-hospital mortality was 14.3%. Compared with In-hospital surviving group, the In-hospital mortality group had decreased platelet counts, lower blood pressure and higher level of D-dimer. The mortality in Q1 group (38.9%) was higher than those in Q2, Q3, Q4 and Q5 groups (10.8%, 11.1%, 8.1% and 2.7%), allP<0.001. The risk of death in Q5 group was higher than Q1 group (HR=11.2, 95% CI 2.13-123.3,P=0.007). With adjusted age, gender and other relevant factors, when platelet counts ≤ 119×109/L, the risk of in-hospital mortality with Cox multivariate model I analysis was (HR3.90, 95% CI 1.67-9.09,P=0.002), with Cox model II was (HR=2.67, 95% CI 1.15 -6.19,P=0.023). Conclusion: AAD patients with admission platelet counts ≤ 119×109/L had the high risk of in-hospital death, even with operation, lower platelet counts was still related to in-hospital death.

Objective This study was designed to observe the impact of cigarette cessation on anxiety and depression in patients with coronary heart disease (CHD).Methods A total of 690 cigarette smoking patients with CHD identified by coronary angiography (CAG) were included and analyzed in the study.The mental state were scored with Hamilton anxiety (HAMA) and depression (HAMD) scale both on admission and at 6-month follow-up.The patients were divided into two groups based on the cigarette cessation.The score of mental state between the two groups were compared.The patients were treated with percutaneous coronary intervention (PCI),coronary artery bypass grafting (CABG),or medicine therapy (MT).Results The clinic data and score of mental state were similar at the time of admission (HAMA:10.66±5.53 vs 11.09 ±5.61,P =0.311;HAMD:29.81 ± 10.13 vs 28.94 ± 10.22,P =0.266 4) between the two groups.After 6 months,the proportions of subjects in smoking cession group with anxiety (24.2％ vs 32.3％,P ＜0.05),depression (18.0％ vs 27.5％,P ＜0.05),and anxiety and depression (7.0％ vs 16.2％,P ＜0.001) decreased significantly compared with those in smoking group irrespective of the treatment strategy.Both the HAMA and HAMD scores were lower in smoking cessation group (HAMA:9.83±3.40;HAMD:24.91 ±7.90) than in smoking group (HAMA:10.98 ±4.87;HAMD:27.70 ± 11.16) (all P ＜ 0.001).Conclusions Smoking cessation is good for the relief of anxiety and depression in CHD patient.

Objective To explore the etiologies of fever of unknown origin(FUO)and methods for confirming di-agnosis in patients at a hospital,and provide reference for clinical diagnosis and treatment of FUO.Methods Pa-tients with FUO admitted to a hospital between January 2008 and July 2014 were performed clinical diagnosis with methods of serology,bacteriology,molecular biology,bone marrow aspiration,tissue biopsy,and diagnostic thera-py,the etiologies and final diagnosis of 224 patients were analyzed retrospectively.Results Of 224 FUO cases,189 (84.38%)eventually got confirmed diagnosis,35 (15.62%)were not confirmed.The percentage of infectious dis-eases,connective tissue diseases,malignant tumor,and other diseases were 50.45%,18.75%,9.82%,and 5.36%respectively.Among infectious diseases,the major pathogens were bacteria,followed by virus.The major connec-tive tissue diseases were systemic lupus erythematosus and polyarteritis nodosa;the main malignant tumor was he-matological tumor,lymphoma was the main form.Among 189 patients with confirmed diagnosis,30.16% and 24.34% were performed pathogenic and pathologic detection respectively,and 20.11% were performed the other (compre-hensive)methods.Conclusion Infectious diseases,connective tissue diseases,and tumor are major etiologies of FUO.

Objective:To review the experience of closure of the left-main-bronchial stump fistula using endoscopic liner cutter staplers through the right thoracic approach and I stage or staged treatment for the left pyothorax.Methods:6 patients with the left-main-bronchial stump fistula after left pneumonectomy combined with pyothorax were treated by closing the left-main-bronchial stump using endoscopic liner cutter staplers through the right thoracic approach, and pleura was used to cover the distal and proximal incisional margin of the stump respectively. The thoracic T-tube drainage was used in the I stage or staged treatment for the left pyothorax.Results:All patients were survived without recurrence of the bronchopleural fistula. 4 patients were observed to have no recurrence of pyothorax when 1 patient had recurrence of pyothorax and was treated with intermittent T-tube drainage.1 patient operated with left-thoracic fenestration in the past was treated with drainage waiting for secondary operation.Conclusion:The right thoracic approach seemed to be a safer and more effective method than the transsternal transpericardial approach in cases with the left-main-bronchial stump fistula combined with pyothorax. The use of endoscopic liner cutter staplers reduced the risk of bleeding, infection and recurrence of fistula. The T-tube drainage in the I stage or staged treatment for the left pyothorax was considered to be an easier way for treatment.

Objective To summarize the experiences of diagnosing and treating acute pancreatitis (AP) after kidney transplantation .Methods From September 2007 to December 2017 , clinical data were retrospectively analyzed for 12 AP patients after kidney transplantation .Results They were diagnosed as AP within 72 h after an onset of abdominal pain .Among 4 recurrent cases within 1 week post-transplantation ,the curative interventions included non-operative therapy (n=2) and peripancreatic puncture & drainage (n=2) .AP occurred at 1 year post-transplantation (n=8) . Three cases were cured non-surgically while another 5 cases underwent surgery . The procedures included laparoscopic cholecystectomy ( n = 1 ) , endoscopic retrograde cholangiopancreatography (ERCP) for cholelithiasis (n=1) and peripancreatic puncture & drainage (n= 2) .One patient died after surgical debridement for adjacent pancreatic tissue .Conclusions After kidney transplantation , the occurrence of AP may be associated with immunosuppressants interfering with triglyceride metabolism and pancreatic microcirculation .For those with cholelithiasis-related pancreatitis ,surgical removal of precipitating factor is required .Mini-invasive puncture and drainage are preferred for severe non-gallstone pancreatitis while surgery is performed whenever necessary .

The glymphatic system is a unique network of the central nervous system that facilitates the removal of metabolic waste from the brain and maintains homeostasis.The glymphatic system is relatively active during sleep,and its physiological function is affected by many factors.The application of non-invasive imaging techniques to evaluate the function of the glymphatic system has promoted the development of clinical studies.More and more studies have demonstrated the association between the function of glymphatic system and the pathogenesis of neurodegenerative diseases,cerebrovascular diseases and other central nervous system diseases.The glymphatic system is expected to become a novel target for predicting prognosis of central nervous system diseases and clinical effects.