Objective To study the relevance of peripheral blood mononuclear cell (PBMC) IL- 18 level in patients with chronic HBV infection and the activity of chronic hepatitis B as well as the ex- tent of hepatic tissue inflammation. Methods Flow cytometry was applied to measuring IL-18 level in PBMCs isolated from 147 patients with HBV infection; meanwhile, 22 cases with hepatitis B patients or HBV carriers underwent needling biopsy of liver for liver histopathologic examination. Results IL- 18 level was rising step by step in moderate chronic hepatitis, severe chronic hepatitis, chronic serious hepatitis and acute fatal hepatitis. Elevation of IL-18 level was correlative to the activity of hepatic tis- sue inflammation. Conclusion The expression level of IL-18 is different in various HBV infection states, which is correlative to the activity of chronic hepatitis B as well as the extent of hepatic tissue inflammation. Therefore, IL-18 may be used as an important index of evaluating therapeutic effect and prognosis.

The literature retrieval course is the main form of current domestic medical infor-mation literacy education. But students have no interest in it, so it's difficult to realize the goal of in-formation literacy education. Information literacy education has the same ideas and goals with PBL in developing students' ability to ask questions, analyze and solve problems, as well as in improving students' autonomous learning and life-long learning ability. To study the model of medical information literacy education embedded in PBL from three stages that early course preparation, mid implementa-tion and later evaluation. The research is aimed at the improvement of students' information literacy and their lifelong study ability. It suggests that there are coordinated effects between PBL and informa-tion literacy.

Objective To compare the therapeutic effects with different dosages of sertraline on patients suffering from idiopathic premature ejaculation. Methods IIEF-5 and CIPE questionnaires were completed before the treatment, and 86 patients who met the diagnostic standard of idiopathic premature ejaculation were finally recruited. Subjects were administered sertraline 50 mg/d combined with behavior therapy at stage Ⅰ for 4 weeks. Then, according to the therapeutic effects and the adverse events, all of the patients were divided into 3 groups for stage Ⅱ (another 4 weeks) as ①subjects with good effectiveness but with no or slight adverse events,would continue the treatments ②subjects with no therapeutic effects and with no obvious adverse events were allowed to increase the dosage of sertraline to 100 mg/d;③patients with effectiveness and obvious adverse events were al follows:lowed to reduce the dosage of sertraline to 25 mg/d. Those who had obvious adverse events and no effectiveness quit the study. Results During stage Ⅰ , 63 of 86 patients were effective (73.3%), and 23 patients had no improvement (26. 7%). Thirty-three patients had adverse events (38. 4%), and the remaining 53 patients had no obvious adverse events (61.6%). During stage Ⅱ , of the patients that responded to treatment, 35 patients who had no adverse events and 12 who had slight adverse events continued the treatment. Furthermore, 16 with intolerable adverse events were allowed to reduce the dosage to 25 mg/d. Meanwhile, of those without improvement, 18 subjects without obviousadverse events were allowed to increase the dosage to 100 mg/d, and 5 patients discontinued the treatment. Eight weeks later, among the patients taking 50 mg/d, 47 subjects were effectively with no obvious adverse events. Among the patients taking 25 mg/d, 10 showed improvement, 6 showed no improvement, and 2 had tolerable slight adverse events. Among the patients taking sertraline 100 mg/d,8 witnessed effectiveness, 13 had tolerable adverse events and 2 discontinued the treatment, with 1 having neither effectiveness nor obvious adverse events. The adverse events rate was 21.0% and the total effective rate of 8 weeks of treatment was 80.2 %. Conclusions Sertraline administration is an effective and safe way to treat idiopathic premature ejaculation. Although the effectiveness of the individualized treatment had no obvious improvement comparing routine therapy, there was a notable reduction in the adverse events rate, which increased the patient compliance.

Objective To evaluate magnetic resonance imaging (MRI) for breast-conserving surgery. Methods In this study, 52 cases of breast cancer eligible for breast-conserving surgery judged by traditional screening methods from May 2004 to December 2007 were inspected preoperatively with MRI in order to detect the cases of muhicentric breast cancer. At the same time, tumor size and invasive extent was measured accurately with enhanced magnetic resonance sequence combined with fat-suppression to determine the minimally extent of the surgical excision required. Results In the 52 cases of breast cancer patients, 3 cases of multicentric breast cancer and 49 cases of single breast cancer were diagnosed by MRI ,there were 3 cases with extensive intraductal carcinoma in the cases of single breast cancer. The primary negative margin rate was 93.6% (44/47) in the 47 cases with breast-conserving surgery. Conclusions MRI has thesuperiority to detect the muhicentric disease and the extensive intraductal carcinoma of breast cancer.Therefore MRI is useful in determining the indication and the extent of surgical excision of breast-conservingsurgery.

Objective To measure the average value of CT lung density at the phase of end inspiration and end expiration in children under 5 years.Methods Sixty patients with normal lungs who underwent chest CT for reasons caused by trauma etc.in our institute from January 2010 to March 2012 were enrolled to the study.All of the patients were divided into end inspiration group and end expiration group through random number table.CT images of the phase of end inspiration and end expiration were taken.Three levels of CT images were chosen to measure the lung density,which were 2 cm above the arch,1 cm below the carina and 2 cm above diaphragm.Lung density was measured at anterior,posterior,lateral,medial and central of the images at each level in each lung.The average lung density of each and entire lung were respectively calculated.The influence of phase,level,location was quantified using analysis of variance methods and LSD method.Results The average lung density at end inspiration was (-766 ±56)HU for the left,right and both lung.At end expiration,the average lung density of the left,right and both lungs was (-625 ± 86),(-647 ± 85) and (-636 ± 86) HU respectively.The average densities at anterior,posterior,lateral,medial and central of the left lung at end inspiration were (-798±63),(-733±68),(-767±64),(-754 ±65),(-775 ±63)HU respectively.The average densities at anterior,posterior,lateral,medial and central of the right lung were (-796 ± 70),(-736 ± 65),(-769 ± 64),(-754 ± 62),(-776-± 59) HU respectively.At end expiration phase,the average densities at anterior,posterior,lateral,medial and central of the left lung were (-692±91),(-555±116),(-639±91),(-598±103),(-640±98) HU respectively.The average densities at anterior,posterior,lateral,medial and central of the right lung were (-712 ± 90),(-575±121),(-657±90),(-619±95),(-670±87) HU respectively.The statistical differences of these five measurement areas were significant at both inspiration and expiration phase (F=12.55,11.29,23.31,25.47,P＜0.01).The posterior lung density was the highest and the anterior was the lowest.As for the other measurement areas,in descending order were medial,lateral,and central.Conclusion The lung density at end inspiration and end expiration in children under 5 years old is described to provide reference for the clinical work.

Objective To study dIe ESBLs and plasmid-mediated AmpC enzymes in E.Coli and Klebsiella spp. with CLSI ESBL-screening test positive,confirmation test negative but cefepime susceptible.Methods Antimierobial susceptibility testing were performed by Kirby-Bauer(K-B)method.The genes encoding ESBLs and plasmid-mediated AmpC enzymes were detected by PCR Transfer of ESBLs or plagmid-mediated AmpC resistance was studied by conjugation experiments.The homology of donor (E.coli),recipient(E.coli J53)and their transconjugants were analyzed by ERIC-PCR DNA fingerprints of E.coli and Klebsiella pneumoniae were analyzed by PFGE as recommended bv PulseNet protocoL Results Of 18 isolates from Huashan Hospital,11 were E.coli.6 were Klebsiella pneumoniae and 1 was Klebsiella oxytoca.Antimicrobial susceptibility testing indicated all of 18 isolates were positive on the CLSI ESBL screening test but negative on the confirmation test.and all of isolates were susceptible to cefepime(a zoneof-inhibition diameter of≥18 mm wag considered to indicate susceptible).PCR results indicated that 9 of the 11 E.coli isolates predued CMY-2 AmpC enzyme.TEM,SHV,CTX-M,PER,VEB or SFO type β-lactamages were not identified.Of 6 Klebsiella pneumoniae isolates.5 were DHA-1 AmpC-producing strains.4 of the 5 DHA-1 AmpC-producing strains were coexistence of broad-speetrumβ-lactamaae or extended-spectrumβ-lactamase.including two producing SHV-11 and two producing CTX-M-14 and SHV-62 type ESBL respectively.One Klebsiella oxytoca wag also DHA-1 AmpC producing strain.Conjugation experiments indicated that both ESBLs and AmpC enzymes could be transfefred from donor to recipient.PFGE indicated that the DNA fingerprints of K.pneumoniae were difierent but seven CMY-2 AmpC-producing E.coli isolates from general surgieal ward were similar.Concluslons The main mechanism of antibiotic resistance in CLSI ESBLs-screening test-positive but eefepime.susceptible E.coli and KIebsiellaspp.is production of plagmid-mediated AmpC enzymes.Some strains produce both AmpC enzyme and ESBLs.Such strains should be reported as resistant to cefepime.The results suggest that laboratories should routinely conduct research on the ESBLs and plnsmid.mediated AmpC enzymes in Enterobacteriaceae in order to report antimicrobial susceptibility testing results more correcdy.

Objective To analyze the clinical results of mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation for old thoracolumbar compression fractures combined with kyphosis deformity.Methods A retrospective case series study was made on 14 patients with old thoracolumbar compression fractures combined with thoracolumbar kyphosis undergone mini-incision Schwab grade 4 osteotomy plus percutaneous pedicle screw fixation from January 2014 to May 2015.There were 5 males and 9 females,with mean age of 64.5 years (range,58-70 years).The period between injury and surgery ranged between 6 and 14 months (mean,8.6 months).At the time of surgery,the fracture was already healed in 10 patients,while non-healing was found in other 4 patients.Preoperative visual analogue score (VAS) of back pain was (8.5 ± 1.1)points (range,6.5-10 points).Three patients were associated with neurological dysfunction [American Spinal Injury Association (ASIA) grade D].Apex of kyphosis located at T12 in 6 patients and at L1 in 8 patients.Preoperative kyphosis Cobb angle was (42.5 ± 6.0)° (range,39.5°-47.2°).Operation time,blood loss,perioperative complications,postoperative kyphosis Cobb angle,bone fusion,state of implants,neurological function and VAS were determined.Results Operation time was (280 ± 50) min,and blood loss was (110 ±70)ml.No segmental vessels injury,neurological deficit or dural disruption occurred during the surgery and after surgery.Compared to the preoperative detection,kyphosis Cobb angle was improved to (9.3 ±1.7) ° (range,6.2°-12.1 °) after operation (P ＜ 0.05),with the correction rate of 78.1％.Postoperative CT showed 7 screws (6.3％,7/112) were grade 1 screws.The follow-up was lasted for mean 25.2 months (range,14-28.9 months).At the latest follow-up,the kyphosis Cobb angle was (9.6 ±4.1)°(range,6.0°-13.1°),revealing no correction loss.Interbody bone fusion was good,with no instrumentation-related complications observed.Three patients with neurological dysfunction (ASIA grade D) were recovered to ASIA grade E.Compared to the preoperative detection,back pain was improved with the VAS of (2.6 ± 1.0) points at the latest follow-up (P ＜ 0.05).Conclusion Mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation of old thoracolumbar compression fractures with kyphosis deformity can attain satisfactory and reliable efficacy and bone fusion,with low incidence of complications.

Objective To compare the CT findings of different phases in pediatric hepatoblastoma (HB) based on PRETEXT system in order to optimize pediatric HB CT scan protocol. Methods A total of 58 HB patients who were surgical and pathological diagnosed from January 2015 to December 2016 were analyzed. Pre-operation CT exams were analyzed respectively. Observing items included tumor size, intra-abdominal invasion, bleeding, intrahepatic metastasis, lymphatic metastasis, metastasis (except lymphatic in abdomen) main portal vein, three main hepatic vein, inferior vena cava (IVC) invasion, para-tumor hepatic arteries, and its branches. All image findings were compared to pathological and surgical findings to calculate the agreement rate. Exact Fisher test and R × C χ2 test were used. Results According to the surgery and pathological results, the agreement rate of tumor size was n=40 (68.9%) at non-contrast phase, n=43 (74.1%) at artery phase and n=52 (91.2%) at venous phase. Venous phase was adaptive for observing tumor size (χ2=8.16,P=0.018). For main portal vein, three main hepatic vein, and IVC invasion, none was found at both non-contrast and artery phase. N=12 (20.7%, P<0.001) was found at venous phase. For para-tumor hepatic arteries, and its branches, none was found at non-contrast phase. N=46 (79.3%) was found at artery phase. N=17 (29.3%) was found at venous phase. Artery phase was adaptive for observing (P<0.001). There was no statistical significant difference in intrahepatic metastasis, lymphatic metastasis and metastasis. Conclusions Suspected pediatric HB, artery and venous phase CT scan would meet the clinical requirement, there was no need for non-contrast pahse. Follow up cases, a single venous phase was enough. Venous phase contributed much more information on tumor size and high risk prognosis evaluation.

Objective To summarize the lung HRCT findings of lung Langerhans cell histiocytosis (LCH) in children. Methods A total of 54 children with lung LCH pathologically proved in our institute from September 2006 to December 2014 were retrospectively reviewed. Patients were subdivided into two subgroups, diffuse type (n=29) and localized type (n=25). In addition, 32 children with LCH but without pulmonary infiltration were selected as control group. HRCT findings of 54 LCH with lung involvement were reviewed and analyzed for distribution pattern. The age of onset, illness duration and pulmonary function were compared between the lung LCH group and the control group. The differences of HRCT findings in LCH patients between diffuse type and localized type were compared with χ2 test. The differences on the onset age, illness duration and pulmonary function between the LCH group with lung involvement and control group were compared with non-parametric test(Mann-Whitney U Test). The differences of pulmonary function between the LCH group with lung involvement and control group were compared with Fisher exact probability test. Results The signs of pulmonary LCH on HRCT included lobular hyperinflation (n=26), interlobular septa thickening (n=11), cystic lesions (n=11), ground?glass opacity (n=10), nodules (n=9), and centrilobular nodules (n=6). The signs presented in 21, 8, 7, 9, 4 and 6 cases in diffuse type group respectively and 5, 3, 4, 1, 5, 0 in localized type group. Among them, lobular hyperinflation, ground?glass opacity and centrilobular nodules were more prevalent in the diffuse group. The difference was statistically significant (χ2=14.77,2.01,0.55,4.84,0.06 and 3.91, P<0.05). The onset age of LCH group with lung involvement was younger than the other (Z=-2.40, P<0.05). However, there was no statistically significant difference in the illness duration (Z=-1.46, P>0.05) and pulmonary function between two groups (P>0.05). Conclusions Lobular hyperinflation, ground glass opacity and centrilobular nodules are the most common manifestations in LCH patients with lung involvement and the distribution is mostly diffuse. Nodules, cystic lesions and interlobular septa thickening may exist. Several signs may coexist simultaneously. Younger children with LCH are more vulnerable to lung involvement.

OBJECTIVE To compare the difference of testing cleaning effectiveness in the operation instrument between the eye measurement and hemoglobin enzyme test.METHODS Five batches of instrument after cleaning were tested by two methods.RESULTS By eye inspection,all tested samples were qualified.However there were only 76 percent of samples qualified according to enzyme test.CONCLUSIONS Compared with eye inspection,enzyme test is a more sensitive method.Enzyme test can better assess the cleaning effectiveness than others.