Objective To evaluate the accuracy of stoke volume variation (SVV) determined using FloTrac/Vigileo and Picco-plus technologies in prone position for assessment of the blood volume in the patients undergoing spine surgery,Methods Forty-three ASA physical status Ⅰ-Ⅲ patients of both sexes,aged ＞ 18 yr,weighing 40-100 kg,scheduled for elective posterior approach to lumbar spinal fusion or scoliosis surgery were studied.After induction of anesthesia,a volume expansion was performed in supine and prone positions.Hydroxyethyl starch 130/0.4 sodium chloride injection 5 ml/kg was rapidly infused intravenously over 10 min to carry out the test for fluid responsiveness.Picco-plus and FloTrac/Vigileo systems were simultaneously applied in every subject to measure SVV (SVVP and SVVF).Positive fluid responsiveness was defined as the changing rate of stroke volume index ≥ 10％ as measured by using Piccoplus system.The patients were divided into response group (Rs group) and non-response group (NRs group) according to the changing rate of stroke volume index ≥ 10％ and ＜ 10％.The receiver operating characteristic (ROC) curve for SVV was plotted,and the diagnostic threshold,area under the ROC curve and 95％ confidence interval (CI) were calculated.Results Forty-one patients were included for analysis in this study.In supine position,the area under the ROC curve for SVV in predicting the fluid responsiveness was 0.740 (95％ CI:0.568-0.913),the diagnostic threshold was 12％,and the sensitivity and specificity in determining fluid responsiveness were 86％ and 54％,respectively,for SVVF,and the area under the ROC curve was 0.637 for SVVP.In prone position,the area under the ROC curve was 0.451 for SVVF,and 0.634 for SVVP.Compared with Rs group,the baseline value of SVVFwas significantly lower,and no significant change was found in the other hemodynamic parameters before volume expansion in supine position in NRs group.There was no significant difference in the hemodynamic parameters before volume expansion in prone position between the two groups.Conclusion SVV determined by using FloTrac/Vigileo and Picco-plus systems in prone position can not accurately assess the blood volume in the patients undergoing spine surgery.

Objective To study the clinical significance of 3 dimensional time of flight magnetic resonance angiography(3D-TOF-MRA) for the pathogenesis of hemifacial spasm (HFS) and trigeminal neuralgia(TN).Methods 48 patients with HFS and 46 patients without HFS and 42 patients with TN and 40 patients without TN were examined by MRI and 3D-TOF-MRA by the enhancement of DTPA. Diagnosis of the presence of compressions in the root exit zone(REZ) of facial nerves and trigeminal nerves were done by two radiologists on an independent console. Results (1)In the patients, compression of the REZ of the facial nerves and trigeminal nerves were detected on 45 spastic sides (93.8%,neurovascular on 44 sides and tumor on 1 side) and 36 spastic sides ( 85.7%,neurovascular on 32 sides and tumor on 4 sides ), 8 and 4 on the asymptomatic sides (16.7% and 9.5%, all neurovascular ). In the controls, 4 and 5 sides ( 4.4% and 6.3% ) were found in the compression of the REZ of the facial nerves and trigeminal nerves. ( 2 ) The offending vessels of compression of the REZ of the facial nerves were the anterior inferior cerebellar artery (AICA) in 17 cases ( 38.6% ), the posterior inferior cerebellar artery (PICA) in 12 cases (27.3%), the vertebral artery (VA) in 6 cases (13.6%). The offending vessels of compression of the REZ of the trigeminal nerves were the superior cerebellar artery ( SCA ) in 18 cases ( 56.3% ), the anterior inferior cerebellar artery in 5 cases (15.6%), the difficult identified vessels (DIV) in 4 cases (12.5%). (3)The relative risks of microvascular compressions which cause HFS and TN were 26.6 and 9.84. (4) The compressions of the REZ of the facial nerves and trigeminal nerves were proved in 4 cases (neurovascular 3 cases and tumor 1 case) and 10 cases (neurovascular 6 cases and tumor 4 casee) in the operation.Conclusion MRI and enhanced 3D-TOF-MRA appeare to be the best imaging technology for the pathogenesis of HFS and TN now. The major causes of HFS and TN may be different neurovascular compressions in the REZ of the facial nerves and trigeminal nerves, some cases are caused by tumor compression.

This study aimed to investigate the method of conserving the mice skin for long time in vitro,and forty clean male KM mice of 8-week old were divided into two groups by random digit table,namely vitrified skin transplantation group(n =30) and fresh skin transplantation group(n =10) .The skin was vitrified quickly with freezing solution EFS40 by the two-step method,and then was thawed with 0.5 mol/L glucose,which was followed by self-transplanted.The vitrified skin transplantation group was self-transplanted after the skin was vitrified for 2 weeks.A piece of skin which was smaller than the vitrified one was cut off on the other side of the spine,and the thawed skin were laid smoothly to coincide with the edge of the cut skin which was sutured then.In fresh skin transplantation group,fresh skins were prepared to put in Dulbecco phosphate-buffered saline for 15 minutes and then be transplanted to original position.The outcomes of transplantation were valuated on day 14 and day 28 after transplantation.And the results indicated that the survival rate of the fresh skin transplantation group was 100%(10/10) .The survival rate of the vitrified skin transplantation group was 77%(23/30) on day 14 and 70%(21/30) on day 28,respectively.But the surfaces of the mice skin and part of the hair follicle cells were damaged during vitrification.However,the method of vitrifying the mice skin quickly in this paper may be used to conserve the skin in vitro.

Objective To explore the clinical value of dual-energy CT lung perfusion imaging and perfusion scintigraphy in acute pulmonary embolism (PE) rabbit models. Methods Acute PE models were established in 20 rabbits with femoral vein injection of sponge as embolus materials, and 4 rabbits were injected saline as control group. Two hours after embolization, dual-energy CT and perfusion scintigraphy imaging were performed respectively. Taking the pathologicall findings as the reference standards, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both imaging methods were compared. CT values and enhancement degree (overlay value) of the embolic areas and normal pulmonary parenchyma were measured in DEPI image after embolization. Results Normal lung was color-coded as homogeneously yellowish red, perfusion scintigraphy displayed rarefaction or absence. The sensitivity, specificity, PPV, NPV of DEPI was 100%, 97.50%, 95.24%, 100%, and of perfusion scintigraphy was 67.50%, 81.25%, 64.29%, 83.33%, respectively. Increased CT values and overlay values of embolism areas in DEPI images were lower than those of normal pulmonary parenchyma (P<0.05). Conclusion DEPI has higher sensitivity and specificity than perfusion scintigraphy for detection of pulmonary emboli in an acute PE rabbit models.

OBJECTIVE: Adopting methods of cell culture to explore the effects and mechanisms of Jianpi Bushen Huoxue Prescription (JPBSHXP), a traditional Chinese compound herbal medicine for strengthening spleen, reinforcing kidney and activating blood circulation, in inhibiting hematopoietic cells apoptosis in a mouse model of aplastic anemia (AA). METHODS: Blood serum of AA mice was made from an AA mouse model. Blood serums containing different traditional Chinese compound herbal medicine were made from rats after intragastric administration of JPBSHXP and its related decoctions, respectively. Bone marrow cells of normal mice were incubated by these blood serums for 24 hours, respectively. The apoptosis of the bone marrow cells were assayed by flow cytometry and transmission electron microscopy (TEM). RESULTS: It was indicated that the bone marrow cells of normal mice incubated with blood serum of AA mice displayed typical apoptosis. The apoptosis rates of bone marrow cells of the AA mice incubated by blood serum containing different traditional Chinese herbal medicine were decreased. The effect of Bushen (reinforcing kidey) Recipe was better than Jianpi (strengthening spleen) Recipe and Huoxue (activating blood circulation) Recipe, while the effect of JPBSHXP was the best. TEM results showed that the effect of Bushen Recipe was better than that of the Jianpi Recipe and the Huoxue Recipe, while the effect of JPBSHXP was the best. CONCLUSION: JPBSHXP and its related decoctions can significantly decrease the apoptosis rate of bone marrow mononuclear cells of the AA mice. It is inferred that JPBSHXP can promote bone marrow hematogenesis.

Objective To understand the present status and explore the influencing factors of quality of life(QOL)among medical students,so as to provide a reference for the improvement of the QOL. Methods A total of 1 898 medical students sampled by stratified cluster sampling method were recruited and investigated by wHO-BREF scale. The influencing factors were assessed by t-test and one-way ANOVA. The data were analyzed by SPSS 19.0. Results Scores of the physical,psychological,social relationship,environmental domain of quality of life were 64.99±13.28,61.85± 13.79,61.58±14.53,and 54.91±13.91,respectively. The results indicated grade,monthly income of family,physical training,quality of sleep and history of trauma were the influencing factors of QOL among medical students,and the differences were all statistically significant(P<0.05). Con?clusion The score of environmental domain of QOL among medical students was the lowest. In order to improve the QOL of medical students, schools should take different measures to them according to different grades or monthly income.

Objective To study the interobserver variabilities and the differential diagnosis value of Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-US) lexicon for small ( ≤ 2 cm) breast nodules. Methods Between January 2009 and December 2011, 289 patients with small (≤2 cm) breast nodules (n=317) were included. According to sizes, the lesions were divided into two groups, i.e., 0-1 cm (n=160) group and 1-2 cm (n=157)group. Each lesion was described independently by 3 radiologists using BI-RADS-US lexicon. Interobserver variabilities were assessed by Kappa test. Chi-square test was used to compare the frequency difference of the descriptors between malignant and benign lesions. Sensitivity, speciifcity, accuracy, positive predictive value and negtive predictive value were calculated. Results (1)Moderate agreements were obtained for lesion shape, orientation, margin, echo pattern, surrounding tissue and calciifcations (κ=0.44, 0.57, 0.48, 0.43, 0.51 and 0.57) in 0-1 cm group. Substantial agreements were obtained for lesion shape, orientation, margin and echo pattern (κ=0.65, 0.61, 0.64 and 0.63) in 1-2 cm group. (2)Irregular shape, non-parallel orientation, non-circumscribed margin, echogenic halo and microcalciifcations were more frequently found in malignant nodules than in benign nodules in 0-1 cm group [52.3% (34/65) vs 20.0% (19/95), 38.5%(25/65) vs 13.7%(13/95), 75.4%(49/65) vs 32.6%(31/95), 18.6%(12/65) vs 0 (0/95) and 10.8%(7/65) vs 2.1%(2/95);χ2=18.19, 13.08, 28.22, 16.39 and 3.95;P=0.000, 0.000, 0.000, 0.000 and 0.047]. Similarly, irregular shape, non-parallel orientation, non-circumscribed margin, echogenic halo, shadowing, changes of Cooper′s ligament and microcalciifcations were signiifcantly more frequent found in malignant nodules than in benign nodules in 1-2 cm group [74.2%(49/66) vs 12.1%(11/91), 36.3%(24/66) vs 5.5%(5/91), 93.9%(62/66) vs 22.0%(20/91), 37.9%(25/66) vs 3.3%(3/91), 30.3%(20/66) vs 7.7%(7/91), 15.2%(10/66) vs 0 (0/91) and 16.7%(11/66) vs 4.4%(4/91);χ2=62.59, 24.21, 79.40, 31.22, 13.73, 12.30 and 6.67;P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000 and 0.010]. (3)In both groups, a good sensitivity was demonstrated (75.4%&93.9%) when using the non-circumscribed margin as a criterion for malignancy, and high speciifcity was achieved in two groups (80.0%-100%and 87.9%-100%) when other descriptors including irregular shape, non-parallel orientation, echogenic halo, shadowing, changes of Cooper′s ligament and microcalciifcations were used as differentiation criteria. Conclusions Good interobserver agreement can be achieved using the BI-RADS-US lexicon in the diagnosis of small breast nodules. Non-circumscribed margin are proved as the most valuable sign for screening malignant breast lesions ≤ 2 cm. High speciifcity was found for irregular shape, nonparallel orientation, echogenic halo, shadowing, Cooper′s ligament changes and microcalciifcations, which can help biopsy and preoperative diagnosis.

OBJECTIVETo explore the clinical efficacy of moxibustion on rheumatoid arthritis (RA) in the patients and the impacts on the inflammatory indices.

METHODSForty RA patients were randomized into an observation group and a control group, 20 cases in each one. In the control group, diclofenac sodium sustained release tablets were used, 0.3 g each time, twice a day; methotrexate tablets were used, 10 mg each time, once a week; folic acid was used, 5 mg each time, once a week. In the observation group, on the basis of the treatment as the control group, moxibustion was added specially on the swelling and painful joints, once a day, 15-20 min each time till: the local skin turned slightly red. The treatment was given once a day, at the interval of 1 day after every 6 treatments. In the two groups, the efficacy was observed after 30-day treatment. Before and after treatment, the rheumatoid factor (RF), high sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), disease activity score-28 (DAS-28) and the score of joint symptom and physical signs were observed.

RESULTSCompared with those before treatment, the levels of RF, hs-CRP, ESR, DAS-28 and the symptom scale score were all reduced in the RA patients of the two groups after treatment (all P < 0.05). Compared with the control group, the levels of RF, hs-CRP, ESR, DAS-28 and the symptom scale score in the observation group were improved much apparently (all P < 0.05). The total effective rate was 85.0% (17/20) in the observation group and was 80.0% (16/20) in the control group. The total effective rate in the observation group was apparently better than that in the control group (P < 0.05).

CONCLUSIONMoxibustion as supplement relieves the joint symptoms, reduces the inflammatory reactive indices and improves the clinical efficacy in the RA patients.

Adult ; Aged ; Arthritis, Rheumatoid ; blood ; therapy ; C-Reactive Protein ; metabolism ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Rheumatoid Factor ; blood ; Treatment Outcome ; Young Adult

Objective To express and purify the pneumococcal surface adhesin A(PsaA) protein,discuss its application as a protein carrier in conjugates vaccine. Methods The gene encoding for the PsaA protein was amplified from the genomic DNA of Streptococcus pneumoniae using PCR. The PCR product was then cloned into the prokaryotic expression vector pET-28a and the recombinant was transformed into host cell E. coli BL21 (DE3). The expression of the recombinant protein(rPsaA) was induced by IPTG and purifled by using DEAE anion-exchange chromatography. The rPsaA was successfully conjugated with group A meningococcal polysaccharide(GAMP). The mice were immunized subcutaneously with the conjugate and the immune responses against GAMP and PsaA were detected by ELISA. Results The recombinant PsaA was expressed as a 37 × 103 soluble protein without His-Tag. The rPsaA was successfully conjugated with GAMP. In addition to the immune response against PsaA, The antibody response against GAMP was significant improved in the mice immunized with conjugate vaccine in comparison with those immunized with GAMP alone. Conclusion The recombinant protein PsaA without His-Tag was obtained and conjugated with GAMP. The strong antibody responses against PsaA and CAMP were obtained in the immunized mice at the same time which may provide the protection against pneumonia and meningitis simultaneously.

Objective To investigate the prevalence of plasmid-mediated quinolone resistance ( PMQR ) determinants [ qnr,aac ( 6' ) -Ib-cr and qepA ]and mutations in quinolone resistance-determining regions (QRDRs) of gyrA and parC and their association with fluoroquinolone susceptibility in clinical isolates of Serratia marcescens in Anhui.Methods The minimum inhibition concentration ( MIC ) of 104 strains of S.rnarcescens collected from various clinical specimens from 34 hospitals during 2005 to 2010 were determined by agar dilution method.The qnr,aac (6')-Ib,qepA,gyrA and parC genes were screened by polymerase chain reaction (PCR) in 31 strains resistant to ciprofloxacin,and positive results were subsequently confirmed by sequencing.The conjugation experiments were performed for qnr and aac(6')-Ib-cr positive strains.The MIC of S.marcescens isolates,recipient strains and conjugants were tested by agar dilution method for quinolones and other antimicrobial agents.Results Six strains of the 31 S.marcescens isolates harboured qnr and/or aac(6')-Ib-cr genes.Among those 6 strains,2 strains harboured a qnrB6 gene,1 harboured a qnrS2 gene,and 4 harboured aac( 6' ) -Ib-cr,whereas no qnrA-,qnrC- or qnrD-positive isolate was detected.None of the 31 isolates carried the qepA gene.Mutations in the QRDR of gyrA and parC genes were detected in 9 and 7 isolates,respectively.The conjugation experiments were successfully carried out in 5 isolates of 6 PMQR determinants-postive strains.The MIC of conjugants for quinolones were increased evidently compared to recipient strains.Conclusions Chromosome and plasmid-mediated resistance determinants play an important role in quinolone resistance in clinical isolates of S.marcescens.And more important is that the PMQR determinants can be horizontal transmitted.It is necessary to continuously survey and watch for the spread of PMQR in S.marcescens in public health control program.