Objective To explore the clinical effect of pulmonary infection control window for sequence ven-tilation on treatment of severe pneumonia with respiratory failure,and to observe and analyze the prognosis.Methods 102 severe pneumonia patients complicated with respiratory failure were selected.They were divided into the observation group and the control group by the random number table method.The patients of the observation group were treated with pulmonary infection control window for sequence ventilation treatment,the control group were treated with conven-tional sequence ventilation treatment.The change of blood oxygen partial pressure(PaO2 ),carbon dioxide partial pres-sure(PaCO2 )and blood oxygen saturation (SaO2 )before and after ventilation,and the treatment time and symptoms improve time and the complications such as ventilator associated pneumonia(VAP)of the two groups were observed. Results PaO2 and SaO2 of the observation group after the ventilation were (75.60 ±2.89)mmHg and (0.78 ± 0.09),which were higher than control group after the ventilation (70.48 ±3.16)mmHg and (0.71 ±0.11),and data of two groups after ventilation were higher than those before the treatment,differences were statistically significant (t =11.30,10.92,13.26,14.08,all P <0.05).PaCO2 of the observation group after the ventilation was 49.21 ±3.22 mmHg, which was lower than that of control group after the ventilation of 54.35 ±3.82 mmHg,and data of two groups after treatment was lower than before treatment,the differences were statistically significant(t =12.44,11.85,14.16, 13.42,all P <0.05).The total mechanical ventilation time of the observation group,respiratory difficulty relief time, lung then disappear time and hospital stay time were (5.24 ±1.83)d,(38.13 ±2.91 )h,(6.72 ±0.40)d and (15.33 ±3.18)d,which were lower than those of control group,the differences were statistically significant (t =9.87,10.21,10.46,11.08,all P <0.05).The general adverse reaction and the death rate of the observation group was 9.80% (5 /51),which was lower than 19.61% of the control group(χ2 =9.85,P <0.05).Conclusion There was effect of pulmonary infection control window for sequence ventilation treatment of severe pneumonia with respirato-ry failure,and it could improve effectively lung function and the prognosis and reduce the incidence of complications.

Objective To understand the differences of competency assessment of residents from the hospital director of clinical departments and resident physicians and to explore residency training mode for future ability training of the residents .Methods Study was performed in a third-grade class-A hospital in Beijing to understand the difference of capacity ,creativity evaluation be-tween the directors of clinical department and resident physicians through a questionnaire survey and statistical analysis .Results Results showed no statistically significant differences between the directors of clinical department and resident physicians in com-puter application ,and the remaining capacities were lower in the directors of clinical department than in the resident physicians .Be-sides ,the resident physicians hold that the residents were poor in research capacity ,creativity and legal awareness .Conclusion The study prompts us to strengthen the clinical expertise and skills training of residency ,also we should pay attention to the training of comprehensive ability .

Objective To describe the health literacy level and to explore the effect of health literacy level on education retention of patients with stroke.Methods Totally 100 stroke survivors were selected as the subject by convenience sampling.They were evaluated by Short Test of Functional Health Literacy in Adults on admission,and they accepted 60-90 minutes education intervention during hospitalization.Evaluation retention were measured before discharge.Results The score of the overall health literacy was (15.60±1.36) points,among of them,low level was 37 cases,general level was 24 cases,high level was 39 cases.Age,education level and Mini-Mental Status Exam score had a significant effect on the health literacy of patients with stroke (x2/F=14.248,12.082,11.329,P＜ 0.05).After education intervention,the score of education retention was (6.69±2.00)points,and the score of education retention in low,general,high level health literacy were (5.08±2.06),(7.46±1.61),(7.51± 1.76) points,and there were significant differences(F=14.223,P ＜ 0.05).Heahh literacy had a effect on education(P ＜ 0.01).Conclusions The level of health literacy of stroke patients has the effect of improving the education retention.Improving and maintaining the health literacy of stroke patients should be the development direction of the prevention and treatment of stroke diseases.

Objective To explore the titre of serum anti-phospholipase A2 receptor antibodies (anti-PLA2 R antibodies) detected by the enzyme-linked immunosorbent assay (ELISA) to provide a more specific serological index for clinical diagnosis and disease judgment of membranous nephropathy (MN).Methods Thirty-four cases of MN confirmed by kidney biopsy ,32 inpatients with autoimmune diseases ,nephrotic syndrome and renal insufficiency in the nephrology department of our hospital and 12 persons un-dergoing physical examination were selected.The serum was collected for detecting anti-PLA2 R antibodies level.Then its diagnostic performance for diagnosing MM was analyzed by combining with serum TP ,ALB ,IgG ,IgA ,IgM ,C3 and C4 indicators.Results The medians of anti-PLA2 R antibodies titres in the MN group ,disease control group and healthy control group were 22.1 ,2.0 ,2.0 RU/mL respectively ,which had statistical difference between the MN group and other two groups (P<0.05).Seventeen cases of anti-PLA2R antibodies positive were in the MN group(positive rate50% )and 17 cases were negative,the disease control group and healthy control group all were negative.Its specificity and positive predictive value were 100% ,TP ,ALB and IgG had statistical difference between the MN group with the disease control group and healthy control group (P<0.05);the relative coefficients of anti-PLA2 R antibodies with TP ,ALB and IgG ,IgA ,IgM ,C3 and C4 were in turn -0.382 ,-0.344 ,-0.502 ,-0.295 ,0.062 , 0.005 and 0.241 respectively ,anti-PLA2R antibodies were negatively correlated with TP ,ALB ,IgG and IgA(P<0.01) ,positively correlated with C4(P<0.05) and had no relation with IgM and C3(P>0.05).Conclusion Anti-PLA2 R antibodies have higher specificity for the diagnosis of MN and can serve as the necessary and specific serologic detection indicator in the patients unable to conduct renal biopsy.Quantitative detection helps to condition judgment.

Background Retinal hemorrhage in newborns is a common clinical finding,and serious retinal henorrhage resulting in poor prognosis.The factors affecting retinal henorrhage in newborns are unelucidated now.Identifying these factors is helpful for the early prevention and treatment.Objective This study was to explore the underlying maternal,obstetric,and neonatal clinical factors for degree of retinal hemorrhages in healthy full-term newborns.Methods A cross-sectional study was performed in the approval of Ethic Committee of Zhongshan City People's Hospital.A total of 1 311 full-term infants,with gestational age more than 37 weeks and Apgar ≥9 scores were included in this study.Infants with severe systemic diseases or any other eye diseases were excluded.Ocular fundus of the infants were examined with Ret Cam Ⅲ within 4 days of birth and were independently identified by 2 eye doctors.The newborns of retinal hemorrhage were divided into grade Ⅰ,Ⅱ and Ⅲ groups based on Egge criteria,and the infants without retinal hemarrhage served as the normal control group.Maternal,obstetric,neonatal parameters and general factors were analyzed and compared among different groups,and the risk factors that affected the newborns retinal hemorrhage were analyzed by logistic regression analysis.Results Retinal hemorrhage was seen in 28.30％ infants (371/1 311),and 152,116 and 103 infants were identified as grade Ⅰ,Ⅱ and Ⅲ,with the percentage of 11.59％,8.85％ and 7.86％,respectively.Among the factors that examined in the study,cord around fetal neck was the risk factor of aggravation of degree of retinal hemorrhage in newborns (OR =1.308,95％ CI:1.011-1.693,P =0.041).In the mode of delivery,spontaneous vaginal delivery appeared to be the positive factor of the incidence of retinal hemorrhage (OR=0.134,95％ CI:0.132-0.137,P＜0.001),but cesarean section was not a main risk factor.Conclusions Spontaneous vaginal delivery and cord around fetal neck are the potential risk factors for the aggravation of degree of retinal hemorrhage in full-term infants.Accordingly,infants with these risk factors should be paid more attention to prevent the progression of retinal hemorrhage.

ObjectiveTo explore the effect of Chinese Daoyingong method on knee osteoarthritis.Methods Eighty patients with knee osteoarthritis were randomly divided into the experiment group and control group in equal number.The control group was given the routine medicine combined with Chinese fumigation and the experiment group was treated with Chinese Daoyin method beside the treatment in the control group.The two groups were compared in terms of the score on visual analog scale of pain and the score on knee function before and after treatment.Results The visual analog scale of pain in the experiment group was significantly lower than that in the control group after intervention and the score on knee function was significantly higher than that of control group (P<0.001). Conclusion The intervention with Chinese Daoyingong method plus routine medication and Chinese herbal fumigation is effective in the treatment of knee osteoarthritis.

Objective To respectively analyze the results and complications of hip arthroplasty for failed intertrochanteric hip fractures treating with internal fixation.Methods From July 2004 to June 2006,32 patients(24 males and 8 females)were treated with hip arthroplasty after the failed internal fixation of intertrochanteric fractures.The mean age was 71 years(range,57-81 years)at the time of the hip arthroplasty.The average interval from fracture to arthroplasty was 40 months(range,5-70 months).Fifteen patients had been treated with sliding hip screw,10 with intramedullary nail,5 with plate and screws,2 with multiple screws.The failure modes were nonunion in 8 patients,implant cut out from the femoral head in 9,avascular necrosis of the femoral head in 7,and traumatic arthritis in 8 patients.Cemented stems were used in 12 hips,and uncemented stems in 20 hips.Standard prostheses were used in 25,long-stem prostheses in 7.Results Twenty-eight patients were followed up for a minimum of 4 years after the hip arthroplasty,with the mean period of 5 years(range,4-6 yeas).For these 28 patients,the average preoperative Harris Hip Score was 37(range,32-45),and 88(range,84-95)at the latest follow-up.The average acetabular inclination was 44°(range,42°-48°).No loosing was found in cotyloid components.Nine of 10 cemented femoral components had cementation rated as grade C,and 1 as grade A.Three had heterotopic bone six months postoperatively,and 2 were Brooker type Ⅱ,one was type Ⅲ.Conclusion Hip arthroplasty is an effective salvage procedure after the failed treatment of an intertrochanteric fracture in an older patient.

AIM: To investigate the CPU86017 and its enantiomers inhibit abnormal gene expression of calcineurin and NFκB in rat cardiomyopathy induced by L-thyroxin and compare the effect of CPU86017 (racemate) with its 4 enantiomers: (7S, 13R), (7S, 13S), (7R,13S), and (7R,13R)-CPU86017 in this model. METHODS: The animals were randomly divided into 7 groups. The rat hypertrophied model was produced by treatment with L-thyroxin 0.2 mg·kg-1·d-1, sc for 10 d and treated with CPU86017 or its enantiomers 4 mg·kg-1·d-1, sc from d 6 to d 10. The changes in left ventricular (LV) weight index, redox system, and the NO and iNOS activity in the myocardium were investigated. The expression of mRNA of calcineurin、NF-κB in the left ventricle was measured. RESULTS: There were significant cardiac hypertrophy and oxidative stress in rats treated by L-thyroxin. The expression of calcineurin, NFκB mRNA were upregulated (P<0.05, compared with that of control). After treatment with CPU86017 (racemate and enantiomers), LV remodeling and the redox system were improved. CPU86017 and (7S,13R)-CPU86017 showed a better improvement on LV remodeling and the redox than the other isomers and restored the normal expression of calcineurin, NF-κB (P<0.05, P<0.01), respectively. CONCLUSION: It suggested that an up-regulation of calcineurin and NFκB possibly related to the altered intracellular calcium handling system plays a role in the progression of L-thyroxin induced cardiomyopathy and CPU-86017 and its 7S,13R-CPU86017 enantiomer effectively inhibit the abnormal expression of calcineurin and NFκB genes, the NOS enzyme and oxidant stress in the cardiomyopathy.

This paper explored the joint teaching model between universities and hospitals.Clinical practice teaching based on medical ethics was carried out,choosing academic leader of teaching and research section of medical ethics as the core and relying on ethic committee of affiliated hospital as the support.Three teaching methods were integrated:theoretical introduction-case analysis-multi-role discussion(doctor,patient's organization,medical ethic specialist),which rendered ethical teaching more practical and operational.Facing the dilemma of present hospital environment,introducing medical ethic and other human sciences into clinical practices and other medical organization was evidently a better choice than strengthening police forces in hospital.

Objective To investigate the effects and the mechanisms of tissue factor pathway inhibitor（TFPI）on no-reflow（NR）after acute myocardial infarction（AMI）and reperfusion in rabbits.Methods Rabbits were randomly divided into sham operation group,saline control group and TFPI group.The model of NR after AMI and reperfusion was induced by ligating coronary artery for 60 minutes and reperfusion for 90 minutes.The expressions of interleukin-6（IL-6）,tumor necrosis factor alpha（TNF-α）and tissue factor（TF）were determined by immunohistochemistry.No-reflow area（NRA）was evaluated by thioflavine S staining.The ligation area（LA）and necrosis area（NA） were evaluated by Evans blue and triphenyltetra zolium chloride（TTC）staining.Results After 90 minutes of reperfusion,the levels of IL6 and TF in saline control group were all singnificantly higher than those of TFPI and sham operation group（P 0.05）.There was no statistical difference in the expression of TNF-α（P 0.05）.There was no statistical difference of LA between saline control group and TFPI group（P 0.05）,while NRA and NA were markedly reduced in TFPI group compared with saline control group（P 0.05,P 0.01）.Conclusion No-reflow happened after ligating coronary artery for 60 minutes and reperfusion for 90 minutes in rabbits.TFPI could reduce NRA and NA,and the thrombosis and inflammation might be involved in the mechanisms.