Objective: To investigate the effect of three different goals of blood glucose control by insulin therapy on protein metabolism in the patients with critically cerebral disease.Methods: We performed a prospective,randomized,controlled study.A total of 122 patients with critically cerebral disease were randomly divided into three groups according to the target glucose-control levels:Group A: 4.4-6.1 mmol/L(n=41),Group B: 6.1-8.3 mmol/L(n=42),and Group C: 10-11.1 mmol/L(n=39).The state of protein metabolism and ratio of hypoglycemia of three groups were compared.Results: The indicators of nitrogen balance,prealbumin and transferrin in group A and group B were significantly better than that in group C(P<0.05),but the ratio of hypoglycemia in group A was significantly higher than those in group B and group C(P<0.05).Conclusion: Maintaining the blood glucose level ≤8.3 mmol/L might improve the nutrition status in the patients with critically cerebral disease by decreasing catabolism and promoting synthesis of protein.

A questionnaire survey on learning motivation of standardized training and influence factors was carried out and 94 residents of general practice responded. The results indicated that over 80% respondents showed a positive attitude to study and hoped to obtain opportunity for continuing education;76% thought the training program was basically rational but still need to be improved; 94% felt that the training model should be adapted to the real conditions and work requirements of Chinese community health centers. The authors suggest some measures to improve the training including suitable textbooks, more rational training programs and further improvement of education system.

Cytokines is a kind of important factor on Pathogenic of hysteromyoma.Some study provides evidence that sex homone and its product of metabolism react up regulation/down regulation for hysteromyoma by growth factor. Apoptosis and oncogene and retinoid X have influence to the growth of hysteromyoma.

A total of 20 patients with massive hemorrhage for pelvic fracture, underwent angiographic embolization with gelfoam sponge embolization agents in 3-8 hours after admitted at the Department of Orthopedics, Changhai Affiliated Hospital of Second Military Medical University of Chinese PLA between January 2001 and August 2003 were selected. The patients aged ranged from 18-70 years (mean 43.4-year-old), including 12 male and 8 female. Conduits were inserted into the internal iliac artery embranchment of 8 cases with method of ultraselection, and gelfoam sponge grain and contrast medium were injected together. Conduits combined with gelfoam sponge grain and contrast medium were inserted into 12 cases’ pathic internal iliac artery bole. The whole 20 cases were performed endovascular embolization, and blood pressures turned to normal level after operation gradually without serious complications of embolization. One case died of deterioration after blood pressure stabilization. The result reveals that anglo-graphic embolization with gelfoam sponge embolization agents is a safe, quick and effective method of controlling the severe hemorrhage caused by pelvic fracture.

OBJECTIVE To discuss the mycology characteristic of two strains of Rhodotorula glutinis causing infection in ICU,and conduct molecular biological identification and antifungal agent sensitivity experiment.METHODS The methods used included conventional mycology identification and sequencing the ITS region of strains,and the in vitro antifungal agent sensitivity experiment were done by glutinis liquid-based dilution method(M27-A).RESULTS The two strains of R.glutinis were confirmed after mycology identification and sequenced the ITS region of strains.They were both sensitive to amphotericin B and 5-flucytosine,and insensitive to fluconazole,itraconazole and voriconazole.CONCLUSIONS The reasons causing Rh.glutinis infection include catheter related infections,(total parenteral nutrition TPN) and immunosuppressives.Using amphotericin B and removing intravenous catheter can be the first choices in the treatment of Rh.glutinis infection.Azole shows insensitive to Rh.glutinis in the in vitro antifungal agent sensitivity experiment,therefore it should be used very carefully.

Objective To analyze quality of life (QOL) and its related factors in community middle-aged and aged people with osteoporosis (OP). Methods A total of 152 OP patients in one community in Shanghai were surveyed and their QOL was evaluated with a questionnaire integrated with the QUALEFFO-41 questionnaire. Factors were analyzed using a Kruskal-Wallis test and stepwise multiple regression. Results The QOL scores of these middle-aged and aged people with OP were generally low (62.58 + 14.06). Age, education level, milk intake, a history of fractures or illness, OP grade and menopause time were significant factors predicting QOL scores. Stepwise multiple regression indicated that fractures, illness, education level and menostasis time had a linear relationship with QOL. Conclusion The key points in improving the QOL of middle-aged and aged people with OP in the community are health education, early diagnosis and comprehensive treatment.

Objective To explore the expression and clinical significance of Twist. E-cadherin and N-cadherin in gallbladder carcinoma. Methods From 2000 to 2008, in Zhejiang Provincial People's Hospital, the expression of Twist, E-cadherin and N-cadherin protein were detected in 79 surgically removed gallbladder carcinoma tissue specimens in paraffin blocks and 20 normal gallbladder tissue specimens by tissue microarray technique and immunohistochemistry. Results Compared with normal gallbladder tissues, the expression of Twist and N-cadherin was up-regulated in gallbladder carcinoma tissues and the positive percentage was 68.3％ and 49.4％ respectively, while which both were 1/20 in normal gallbladder tissues. The percentage of high E-cadherin expression in gallbladder carcinoma tissues was only 27.8 ％, which was significantly lower than that in normal gallbladder tissues (20/20;X2 ＝29.31, P＜0. 05). The expression of Twist was correlated with T classification, lymph node metastasis, distant organ metastasis, hepatoduodenal ligament invasion, lymphatic invasion and UICC stage of gallbladder carcinoma (P＜0.05). The expression of E-cadherin was correlated with T classification, distant organ metastasis, hepatoduodenal ligament invasion, differentiation degree and UICC stage of gallbladder carcinoma (P＜0.05). The expression of N-cadherin was only correlated with lymphatic invasion of gallbladder carcinoma (P ＜0.05 ). There was significant negative correlation between Twist and E-cadherin expression (P＜0. 01). All the 79 gallbladder carcinoma patients were followed up after the surgery, the mean follow-up time was 30.6±14.3months. The 3-year survival rates of patients with low or high Twist expressions were 66％ and 7％ respectively,there was significant difference between the two groups(P＜0. 01). The 3-year survival rates of patients with low or high E-cadherin expressions were 25 ％ and 86 ％ respectively, the difference of two groups was significant(P＜0.01). The 3-year survival rates of patients with low or high Ncadherin expressions were 39％ and 41％ respectively, there was no significant difference between the two groups(P＞0.05). The multivariate analysis indicated that the Twist expression was one of independent prognostic factors of gallbladder carcinoma. Conclusion The abnormal expression of Twist and E-cadherin was correlated with the development and progression of gallbladder carcinoma,and Twist expression was one of the independent prognostic factors of gallbladder carcinoma.

Objective To evaluate the efficacy of administration of ampicillin/sulbactam and imipenem/cilastatin in treatment of aspiration pneumonia in aged patients. Methods 26 aged patients was treated with aspira-tion pneumonia (2.25～3.00 g) through vessel injection twice perday,and another 26 patients was treated with imi-penem/cilastatin (0.5 g) through vessile injection every 6～8 hours. We evaluated the efficacy through assessing the temperature,the chest radiography,WBC and CRP,incidence of side effects,the time to cure and the clearance of bacteria. Results The cure rate was 84.6% (22/26) and 92.3% (24/26),respectively (χ2=0.19,P=0.66). The time to cure was 8.2±2.8 days and 7.5±1.6 days for the groups (t=1.107,P=0.274). Gastrointestinal side effects were observed in the group of ampicillin/sulbactarn;slight abnormality of liver function occurred in the group of imipenem/cilastatin ;all above adverse effects in two groups were rapidly and completely disappeared after therapy stopped. Conclusion Both ampicillin/sulbactam and imipenem/cilastatin are effective antibiotics to treat aspiration pneumonia in aged patients.

Objective:To analyze and investigate the clinical efficacy on repairing soft tissue defects of the thumb distal with dorsal neurocutaneous vascular flap.Methods:Select 100 cases of patients with soft tissue defects of the thumb distal from January 2014 to December 2016,who were randomly divided into two groups,the control group and observation group.Take the abdominal skin flap to repair soft tissue defects of the thumb distal in the control group,with the thumb distal with dorsal neurocutaneous vascular flap in the observation group.The survival condition,the indicators of feelings,the appearance of skin flap,as well as the DASH score of the hand fimction have been recorded and analyzed through follow-up patients,to observe the effects on repairing soft tissue defects in the two groups.Results:All transplanted tisssues were all survived in the observation group and control group.Compared with control group,the sense of touch,temperature sense,monofilament,two-point discrimination,scar contracture of the observation group were better(P＜0.05),the incidence of bloat was lower (P＜0.05).The DASH scores were 29.56± 2.14,38.13± 3.12 in the observation group and control group,which was significantly lower in the observation group than that of the control group(P＜0.05).Conclusion:The clinical efficacy of the dorsal neurocutaneous vascular flap is better than that of abdominal skin flap on repairing soft tissue defects of the thumb distal.For no injury for major vascular nerves,little influence on donor area,being simple to operate,being better feelings of the finger pulp,appearance,dorsal neurocutaneous vascular flap on repairing soft tissue defects of the thumb distal is an ideal choice.

Objective To evaluate the value of CT in diagnosis of cervical intervertebral disk herniation. Methods The observation of CT appearances of 146 cases and the size, type, position of cervical intervertebral disk herniation were analyzed. Results ①Cervical intervertebral disk herniation was always multi-segments,often lolated at C4,5and C5,6. ②C5,6was mostly seen (142 cases,97.3%). ③Among centric and lateral type,centic type was mostly seen { 135 cases,92.5%). ④Of 135 cases of centric type,54 cases were mild type (< 2 mm) ,66 cases were moderate type (2 ～ 4 mm) , 15 cases were severe type (> 4 mm). Conclusion CT scan is convenient, efficient,accuracte and the first choice method in diagnosing cervical intervertebral disk herniation.