Objective To investigate the concentration of blood uric acid and the prevalence of hyperuricemia in staff of a univer-sity so as to provide scientific basis for prevention and treatment of hyperuricemia.Methods Uric acid(UA)of 4 893 persons were detected by enzymatic method.For male whose UA>428 μmol/L,For female whose UA>357μmol/L were considered as hyperuri-cemia.People enrolled in the study were grouped according to age and analyzed.Results The average UA of males was (357.23± 75.17)μmol/L and was significantly higher than that of females(P <0.05).The average UA concentration and hyperuricemia rati-os in males of 20-<30,30-<40 years old groups were the highest,that of 60 -<70 group was the lowest,the difference was statistically significant(P <0.05).The average UA and hyperuricemia ratios of the male group decreased with age before 70 year old.But The average UA and hyperuricemia ratios of 70-<80 and ≥80 groups were higher than that of the 60-<70 group,the difference was statistically significant(P <0.05).The average UA and of hyperuricemia ratio of the female group increased with age.Conclusion The average UA concentration of males was significantly higher than that of female,in addition to that,hyperuri-cemia patients become younger and younger in male population.

Objective To compare the effects of 2 kinds of frequency of transcutaneous electrical nerve stimulation (TENS) on urinary incontinence after stroke. Methods 81 patients with post-stroke urinary incontinence were randomized into group A (n=27), group B (n=27) and group C (n=27), who accepted TENS (biphasic square waves with pulse durations of 150 μs) in 20 Hz, 75 Hz and medcine only, respectively, for 90 days. They were assessed with Overactive Bladder Symptom Scores (OABSS), Barthel Index (BI), and voiding diary before and after treatment. Results The OABSS, BI and voiding diary improved significantly after treatment (P<0.05) in groups A and B, and improved more in the group A than in the group B. There was not significant improvement in the group C (P>0.05). Conclusion TENS of 20 Hz is more effective to reduce the incontinence post stroke.

This article described systematically the design basis,passing standard and influential factor of test score of the assessment scale of simulated clinical skills examination.Through developing and modifying OSCE examination scale design for many years,we have found that the use of 360-degree assessment for designing OSCE assessment rating scale can effectively reduce the impact on the score of examinee owing to the environment,the candidates,raters and question design,which has an important role for scientific development of OSCE assessment scales,as well as improving the reliability and validity for development of a scientific OSCE assessment.

ObjectiveTo screen the colonization of multidrug resistant organisms (MDROs) and determine their risk factors in intensive care unit (ICU), so as to provide the basis of prophylaxis and treatment of MDROs colonization.Methods A prospective single-center study was conducted in ICU of China-Japan Friendship Hospital from June 2008 to December 2014. The nostril and anal swabs for each patient who stayed in ICU over 24 hours were collected. Each specimen was cultured and tested for drug sensitivity. Clinical findings and relative risk factors were collected. The risk factors of MDROs colonization were analyzed with univariate analysis. The independent risk factor was selected from the risk factors withP< 0.05 with logistic regression analysis to analyze the related factors of MDROs colonization in ICU.Results 1 672 patients were enrolled. At ICU admission, MDROs colonization was present in 604 cases (36.12%), of whom 62 cases (3.71%) were found to be colonized with methicillin-resistantStaphylococcus aureus (MRSA), 529 (31.64%) were colonized with extended-spectrumβ-lactamase (ESBL) enterobacteria, 7 (0.42%) were colonized with multidrug resistantAcinetobacter baumannii (MDR-AB), and 6 (0.36%) were colonized with multidrug resistantPseudomonas aeruginosa (MDR-PA). ICU acquired MDROs colonization were 197/1 068 (18.45%), among whom 24 patients (1.44%) were colonized with MRSA, 118 (7.06%) were colonized with ESBL enterobacteria, 50 (2.99%) were colonized with MDR-AB, and 5 (0.30%) were colonized with MDR-PA. By multivariable analysis, prior administration of more than two kinds of antibiotics [odds ratio (OR) = 2.352, 95% confidence interval (95%CI)=1.847 - 4.464,P = 0.002], prior use of broad spectrum antibiotics within 3 months (OR = 2.862, 95%CI = 1.458-5.631,P = 0.014), duration of prior antibiotic administration (OR = 1.781, 95%CI = 1.152 - 3.413,P = 0.003) and hospitalization days prior to ICU admission> 9 days (OR = 1.766, 95%CI = 1.235 - 3.986,P = 0.021) were independent risk factors of MDROs colonization on admission to ICU.ConclusionsHigh prevalence of MDROs colonization in ICU patients was found in our hospital, and ESBL enterobacteria was the predominant bacteria. ICU acquired MDROs colonization is also worth considering, especially for MDR-AB. Identification of risk factors for MDROs colonization may help identify and screen patients with high risk, and it is also instructive in prophylaxis of MDROs colonization/infection and restriction of the use of broad spectrum antibiotics.

ObjectiveTo explore the relationships among atrial natriuretic peptide (ANP) and cerebral vasospasm (CVS) following subarachnoid hemorrhage (SAH) and hyponatremia.MethodsPlasma ANP levels and serum natrium and blood flow rate of intracal major arterial were assessed at different times (1 to 3 days, 7 days and 14 days after SAH) in 42 patients with SAH. Correlation analysis was carried out among plasma ANP, blood sodium level and blood flow rate of intracal major arterial.Results28 patients had CVS. Plasma ANP levels in CVS patients significantly elevated compared with non-CVS and control subjects (P<0.05). Hyponatremia in CVS patients also significantly elevated compared with non-CVS subjects (P<0.05). Plasma ANP level had significant negative relationship with serum natrium level at the 7th day and 14th day (r2=-0.778,r3=-0.653;P<0.01,P<0.05) in SAH patients. Plasma ANP level had significant positive correlation with middle cerebral artery mean flow velocity on the 7th day (r3=0.702,P<0.05) in SAH patients. Middle cerebral artery mean flow velocity had significant negative relationship with serum natrium level on the 7th day and 14th day (r2=-0.693,r3=-0.653 , both P<0.05) in SAH patients.ConclusionANP might cause hyponatremia following SAH and play an important role in pathogenesis of earlier period CVS.

Objective To use functional magnetic resonance imaging (BOLD-fMRI) to observe the efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with speech training in treating those with lateral fissure aphasia.Methods Forty-eight persons with lateral fissure aphasia were divided randomly into a control group and a treatment group,each of 24.The treatment group was treated with repetitive transcranial magnetic stimulation combined with speech training,while the control group was given only speech training.Before the treatment and 2 weeks and 8 weeks after the treatment,BOLD-fMRI images were collected to observe any changes in the language areas of the brain activated.A Chinese aphasia examination (CRRCAE) was used to assess speech function before and after treatment for both groups.Results The average CRRCAE scores of the two groups were not significantly different right before the treatment and at the end of 2 weeks of treatment,but at the end of 8 weeks of treatment the average score of the treatment group was significantly better.The biggest improvement was among those with Broca's aphasia,followed by those with Wernicke aphasia and conduction aphasia.No such differences were observed in the control group.After the 8 weeks of treatment,the average CRRCAE score of the treatment group patients had improved significantly,but in the control group only those with Broca's aphasia had improved significantly.In the treatment group,after 2 weeks and 8 weeks of treatment the activated language areas of the right hemisphere were significantly smaller than before treatment and significantly smaller than the activated areas in the left hemisphere at the same time points.Conclusions Low-frequency,repetitive transcranial magnetic stimulation combined with speech therapy is an early intervention which may promote recovery from lateral fissure aphasia through restoring lingual function after stroke.

Objective To explore an effective method for enhancing basic clinical skill of students.Methods Selective course of basic clinical skill was launched for the fourth grade clinical medicine students by using simulation-based medical education (SBME).Elective courses have 21 class hours,involving 15 items of basic clinical skills in internal medicine,surgery and nursing.Training methods include preparation,explanation,demonstration,operation,group competition,examination and questionnaire.Selective course examination includes class activation and final examination,accounting for 20％ and 80％ of the final scores,respectively.Scores were classified into A (excellent),B (good) and C (moderate) levels.Scores and questionnaire data were processed by Microsoft Office Excel 2007 software and percentages of score and questionnaire feedback were calculated.Results Results suggested that the scores of 70％ students were more than 90.Results of questionnaire indicated that the basic clinical skills of 76.6％ of the students were improved a lot.79.2％ considered that it was useful for their clinical practices.Conclusion Clinical-skill course based on SBME is conducive to enhancing basic clinical skills of students.

Objective To investigate the accuracy of careful clinical evaluation in hemodynamic status and guidance of PiCCO monitor in clinical treatment.Methods A total of 96 hemodynamic unstable cases were evaluated prior to the insertion of the PiCCO catheter.The attending physician in charge of the patient was required to complete a questionnaire to predict the range of key hemodynamic variables for CI,GEDI,SVRI and EVLWI.Additionally,the attending was also asked to indicate a plan for therapy based on the predicted hemodynamic profile and decide if the predicted therapy plan was altered after the the first measurement of hemodynamic variables.Results The accurate prediction of hemodynamic variables was CI (55.2％),GEDI(60.4％),SVRI(63.5％) 和 EVLWI (78.1％),among which EVLWI had a higher accuracy(P ＜ 0.05).49％ doctors altered their planned therapy according to the result of the PiCCO information.Doctors had more difficulty in accurately predicting hemodynamic values in critical patients which APACHE Ⅱ scored 15 ～25 (42.3％ vs 67.9％ and 42.3 ％ vs 75.0％,x2 =4.755,5.231,P ＜ 0.05).The prediction of patients with acute myocardial infarction was more accurate than those of without acute myocardial infarction,and less to alter the planned therapy(21.1％ vs 55.8％,x2 =7.382,P =0.007).The patients of impaired oxygenation had less accurate predictions and less therapy alterations(32.3％ vs 56.9％,x2 =5.110,P =0.024).Attending was able to predict the hemodynamic status more accurately(63.9％ vs 40％,x2 =5.152,P =0.023) and alter the predicted therapy less(39.3％ vs 65.7％,x2 =6.189,P =0.013) in patients who were enrolled later.Conclusions Clinical evaluation in hemodynamic status of critically ill patients had a lower accuracy,the information obtained by PiCCO often instruct clinical doctors to choose the optimal treatment.

Objectives To investigate the distribution of Schistosoma japonicum infected Oncomelania snails in the marshland of Dangting Lake region,and explore the effects of gradient and vegetation on the distribution of the infected snails.Methods Three marshland areas in upstream and downstream of Dongting Lake were selected.The snail distribution was investigated and the ground elevation was assessed (Wusong's elevation of zero)and the vegetation types were also recorded from 1987-1989 and 2009.Results In the 3 types of snail habitats of the marshland,the average rate of areas with infected snails was 35.5%,and the snails mainly distributed beside the embankment and slope zone.More infected snails were found in the high altitude and steep slope zone,while no infected snails were found in the low altitude and flat slope zone,and reed areas as well.Conclusion The Schistosoma japonicum infected snails in the marshland of Dongting Lake mainly distribute beside the embankment and slope zoon,and are correlated with the water level in flood seasons and the activities of definitive hosts.

OBJECTIVE:To observe the efficacy and safety of edaravone combined with nimodipine in the treatment of acute large area cerebral infarction. METHODS:78 patients with acute large area cerebral infarction were randomly divided into control group (38 cases) and observation group (40 cases). Control group received aspirin platelet aggregation,reduced intracranial pres-sure,maintained water and electrolyte balance,decreased cerebral edema,Xuesetong for injection,Ginkgobiloba injection,lipid and blood pressurelowering,maintained blood sugar and other conventional treatment;observation group additionally received 30 mg Edaravone injection,adding into 100 ml 0.9% Sodium chloride injection by intravenous infusion (drip completed within 30 min),twice a day+12 mg Nimodipine injection,adding into 500 ml 0.9% Sodium chloride injection by intravenous infusion,once a day,with drip rate of 0.5-1 mg/h,for continuous 10 d,then received 40 mg Nimodipine tablet,orally,3 times a day. The treat-ment course for both groups was 15 d. Clinical efficacy,blood oxygen saturation (SpO2),hemoglobin (Hb),total hemoglobin (HbT),reduced hemoglobin(MHb)before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in observation group was significantly higher than control group,the incidence of adverse reac-tions was significantly lower tahn control group,the differences were statistically significant (P<0.05). Before treatment,there were no significant differences in SpO2,Hb,HbT and MHb in 2 groups (P>0.05). After treatment,the SpO2,HbT and MHb were significantly higher than before,and observation group was higher than control group,the differences were statistically signifi-cant(P<0.05);Hb was significantly lower than before,the differences were statistically significant(P<0.05),but there was no significant difference between 2 groups (P>0.05). CONCLUSIONS:Based on the conventional treatment,edaravone combined with nimodipine shows significant efficacy in the treatment of acute large area cerebral infarction,it can effectively recovery neuro-logical function damage and protect the brain tissue,which can reduce the incidence of adverse.