Intensifying the continuing education of doctors in hospitals at primary level is one of the important measures for increasing their specialized skills and improving the condition of primary care.In recent years,following the trend of national medical reform,the Fourth Military Medical University (FMMU) has made full use of its advantages to provide training for civilian doctors in hospitals at primary level.In the training,with the reform measures of ‘ four focuses' and ‘ five combinations',FMMU actively advanced teaching reform to make innovations in curriculum system and teaching methods,which was approved by teachers and students.These measures were very effective,which in turn greatly enhanced the ability of the doctors and training quality.This practice obviously pushed forward development of primary-level medical and health-care service in Shanxi province.

Objective To evaluate the effects of different doses of lidocaine on suppressing fentanyl-induced cough and determine a safe suppressing dose.Methods Two hundred patients undergoing general anesthesia were randomized to four groups evenly.The following medications were given within ten seconds:normal saline 10ml (groupⅠ,control group),lidocaine 1 mg/kg (groupⅡ),lidoeaine 1.5 mg/kg(groupⅢ),lidocaine 2mg/kg (groupⅣ).Toxic symptoms of lidocaine were recorded within lmin after the administration of lidocaine,then fentanyl 3?g/ kg was given intravenously within 5 seconds.Cough incidence and cough grade were recorded within 2rain after the administration of fentanyl.Systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rates (HR),and satu- ration of pulse oximeter(SpO2) were recorded during different time points of induction,all recorded data were anal- ysed by the statistical software,P value

BACKGROUNDElevation of intraocular pressure is usually associated with primary open angle glaucoma and caused by increased outflow resistance. A two-color fluorescent tracer technique was developed to investigate the hydrodynamics of aqueous humor outflow with changing intraocular pressure within the same eye, to better understand the relationship between outflow facility and effective filtration area.

METHODSEighteen enucleated bovine eyes were first perfused at 30 mmHg with Dulbecco's phosphate-buffered saline containing 5.5 mmol/L D-glucose. After a stable baseline facility, red fluorescent microspheres (0.5 microm, 0.002% v/v) were exchanged and perfused. Eyes in the one-color control group (n = 6) were immediately perfused with fixative. In the experimental group (n = 6), eyes were perfused with green tracer after intraocular pressure reduced to 7 mmHg, while in the two-color control group (n = 6), eyes were perfused with green tracer with intraocular pressure remaining at 30 mmHg. All 12 eyes were then perfusion-fixed. Outflow facility was continuously recorded in all eyes. Confocal images were taken along the inner wall of the aqueous plexus and the percent of the effective filtration length (PEFL; length of inner wall exhibiting tracer labeling/total length of inner wall) was measured. The relationships between outflow facility and PEFL were analyzed statistically.

RESULTSNo significant differences were found in baseline facilities (microl x min(-1) x mmHg(-1)) among the three groups (the experimental group: 0.93 +/- 0.12; the two-color control group: 0.90 +/- 0.19; the one-color control group: 0.98 +/- 0.13). In the experimental group, the outflow facility was significantly higher at 7 mmHg (4.29 +/- 1.01) than that at 30 mmHg (1.90 +/- 0.67, P < 0.001), which corresponded to a significant increase in the PEFL at 7 mmHg (54.70 +/- 8.42) from that at 30 mmHg ((11.76 +/- 4.56)%, P < 0.001). The PEFL labeled by red fluorescent microspheres in the experimental group ((11.76 +/- 4.56)%) showed no significant difference from that of the one-color control group ((13.39 +/- 2.19)%, P = 0.473) or the two-color control group ((11.49 +/- 4.95)%, P = 0.930). The PEFL labeled by green fluorescent microspheres in the experimental group ((54.70 +/- 8.42)%) was significantly higher than that of the two color control group ((37.34 +/- 8.17)%, P = 0.010). A positive correlation was found between outflow facility and PEFL (r = 0.897, R(2) = 0.804) in the experimental group.

CONCLUSIONSChanges in aqueous humor outflow patterns before and after a change in intraocular pressure can be successfully distinguished within the same eye using our newly developed two-color tracer perfusion technique. The PEFL showed positive correlation with the outflow facility.

Animals ; Aqueous Humor ; physiology ; Cattle ; Intraocular Pressure ; Luminescent Proteins ; metabolism ; Microscopy, Confocal ; Microspheres ; Perfusion ; methods

BACKGROUND: Diarrhea is frequently seen in developed and developing countries, and severe diarrhea is characterized by the high risk of death. Thus, it is very important to assess the severity of diarrhea early. We conducted a multi-center study to identify risk factors for the severity of diarrhea in adult patients and formulate an adult diarrhea state score (ADSS) for out-patient clinicians. METHODS: A total of 219 adult patients with acute diarrhea were divided into two groups: 132 patients with mild diarrhea and 87 with severe diarrhea. Logistic regression was used to determine risk factors for the severity of diarrhea. The risk factors were assessed and an ADSS was formulated. Receiver operating characteristic (ROC) analysis was made to evaluate the diagnostic accuracy of ADSS, and the Kappa test was used to confirm the diagnostic reliability. RESULTS: Five risk factors for evaluating the severity of diarrhea in adults included age (P<0.05), axillary temperature (P<0.01), mean arterial pressure (P<0.01), white blood cell count (WBC; P<0.01), and WBC in stool (P<0.01). The area under the ROC curve for ADSS was 0.958 when the cut off value was 4 (a sensitivity of 0.909; a specificity of 0.874), and the Kappa value was 0.781 (P<0.05). CONCLUSION: The risk factors associated with the pathogenic condition of diarrhea were identified, quantified and formulated into an ADSS, which has high diagnostic accuracy and reliability for the early identification of patients with severe acute diarrhea.

OBJECTIVETo investigate the effects of long-term high-protein, low-carbohydrate diet on body weight and the expression of gastrointestinal hormones in diet-induced obesity rats.

METHODSTwenty-four diet-induced obesity rat models were established by feeding fat-enriched diet, then were randomly divided into two groups by stratified sampling method by weight: the high-protein diet group (HP, 36.7% of energy from protein), and the normal chow group (NC, 22.4% of energy from protein), 12 rats in each group. The total calorie intake of each rat per day was similar and was maintained for 24 weeks, then body weight, visceral fat mass, fasting plasma ghrelin and glucagon-like peptide-1 (GLP-1) were determined, as well as protein expression of ghrelin in stomach, GLP-1 in ileum were detected by immunohistochemistry.

RESULTSAfter 24 weeks, body weight of HP, NC groups were (490.92 ± 39.47) g and (545.55 ± 31.08) g, respectively (t = -3.664, P < 0.01); visceral fat mass were (22.42 ± 7.04) g and (32.33 ± 9.27) g, respectively (t = -2.503, P < 0.05); plasma ghrelin level were (2.36 ± 0.82) and (1.95 ± 0.64) ng/ml, respectively (t = 1.337, P > 0.05), and plasma ghrelin level was negatively correlated to body weight (r = -0.370, t = -1.899, P < 0.05), visceral fat mass (r = -0.454, t = -2.52, P < 0.01); plasma GLP-1 concentration were (0.52 ± 0.13) and (0.71 ± 0.19) ng/ml, respectively(t = -2.758, P < 0.05); ghrelin protein expression in stomach were 25 473 ± 8701 and 10 526 ± 6194, respectively (t = 2.501, P < 0.05); GLP-1 protein expression in ileum were 27 431 ± 5813 and 36 601 ± 5083, respectively (t = -1.833, P = 0.081).

CONCLUSIONLong-term isocaloric high-protein, low-carbohydrate diet can reduce body weight and visceral fat, increase the expression of ghrelin, and decline GLP-1 expression in diet-induced obesity rats.

Animals ; Body Weight ; Diet, Carbohydrate-Restricted ; Dietary Proteins ; administration & dosage ; Gastrointestinal Hormones ; metabolism ; Ghrelin ; blood ; metabolism ; Glucagon-Like Peptide 1 ; metabolism ; Intra-Abdominal Fat ; metabolism ; Male ; Obesity ; metabolism ; Rats ; Rats, Wistar

AIMTo report the clinical experience during collecting sperm samples in the Fragile X syndrome (FXS) male patients.

METHODSTwo different polymerase chain reaction (PCR) based methods were used for the molecular diagnosis of FXS. Sperm collection was done mostly according to the laboratory manual of the World Health Organization.

RESULTSWe failed to collect sperm samples from five Fragile X subjects aged 18-60 years as a result of an unexpected erectile dysfunction (ED). Multiple examinations of the same subject at different times, and of different subjects from different provinces examined by different physicians, showed the same result consistently in all the five subjects.

CONCLUSIONErectile reflex is an instinctive response in all healthy males. The absence of erection can be caused by hormonal, physical or neuronal malfunction. As hormonal profiles were reported to be generally normal in Fragile X men, we propose that an unknown physical factor or the neuronal circuit, or both, underlying the erection is compromised. The finding of this symptom in Fragile X patients may help better understand the clinical spectrum and pathogeneses of the disease.

Adolescent ; Adult ; Base Sequence ; DNA Primers ; Erectile Dysfunction ; Female ; Fragile X Syndrome ; physiopathology ; Humans ; Male ; Middle Aged ; Pedigree ; Polymerase Chain Reaction ; methods ; Spermatogenesis ; genetics

AIMTo study the chemical constituents of Dioscorea parviflora.

METHODSThe chemical constituents were isolated by silica gel and RP-18 column chromatography, and their chemical structures were elucidated by IR, NMR and MS.

RESULTSEleven steroides have been isolated from EtOH extract of Dioscorea parviflora and identified as isonarthogenin 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-glucopyranoside (I), diosgenin-diglucoside (II), prosapogenin A of dioscin (III), dioscin (IV), deltonin (V), deltoside (VI), methyl deltoside (VII), diosgenin 3-O-beta-D-glucopyranosyl (1-->3)-beta-D-glucopyranosyl-(1-->4)-[alpha-L-rhamnopyranosyl-(1-->2)]-beta-D-glucopyranoside (VIII), parvifloside (IX), methyl parvifloside (X), diosgenin (XI), and a mixture of beta-sitosterol and stigmasterol.

CONCLUSIONCompound X is a new compound. Compounds VII and X were methyl ethers of VI and IX, respectively, and may be produced during isolation. Compound I is isolated from Dioscorea L., and II, IV from Dioscorea parviflora for the first time.

Dioscorea ; chemistry ; Diosgenin ; analogs & derivatives ; chemistry ; isolation & purification ; Molecular Conformation ; Molecular Structure ; Plants, Medicinal ; chemistry ; Rhizome ; chemistry ; Saponins ; chemistry ; isolation & purification ; Steroids ; chemistry ; isolation & purification

OBJECTIVETo investigate the failure of internal fixation on displaced femoral neck fractures in adults under fifty-five years old retrospectively inorder to pay more attention to the treatment of these fractures.

METHODSFrom Junary 2007 to June 2010,18 failed cases of internal fixation on displaced femoral neck fractures in adults under fifty-five years old were treated,there were 13 males and 5 females with an average age of (48.0 +/- 6.0) years old ranging from 27 to 55. Among them, 17 patients were treated with cannulated screws and 1 patient was treated with intramedullary nail; 16 patients were diagnosed as osteonecrosis and 2 patients as osteonecrosis associated with nonunion.

RESULTSThe average time from internal fixation to failure was 23 months (ranged, 8 to 32 months). The quality of fracture reduction in Garden index was poor. The Harris Hip Score was (56.0 +/- 12.5) (ranged,33 to 80). Eight cases of osteonecrosis and 2 cases of nonunion combinated osteonecrosis were received total hip arthroplasty. Hip resurfacing arthroplasty were performed for other 5 osteonecrosis. Because of no evident clinical symptoms,the other 3 cases received conservative treatment. The patients with total hip arthroplasty and hip resurfacing arthroplasty were followed-up for 34 months ranging from 12 to 53 months. After operation,the Harris score was (94.0 +/- 3.0) ranged 89 to 96.

CONCLUSIONOsteonecrosis is a common complication after internal fixation on displaced femoral neck fracture in adults under fifty-five years old. More attention should be paid to the treatment of displaced femoral neck fracture in those patients.

Adult ; Female ; Femoral Neck Fractures ; diagnostic imaging ; physiopathology ; surgery ; Fracture Fixation, Internal ; adverse effects ; Humans ; Male ; Middle Aged ; Recovery of Function ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Failure

OBJECTIVETo summarize experience of using screws and cement to rebuild tibial bone defect in primary total knee arthroplasty (TKA) and to discuss the relationship between the number of required screws and the severity of tibial bone defects.

METHODSFrom July 2009 to May 2015, 34 patients (40 knees) with varus knees underwent TKA, and the screw and cement technique was used to rebuild medial tibia plateau during operation. There were 8 males (8 knees) and 26 females (32 knees), and the average age was (65.00 +/- 7.25) years old (ranged,55 to 82 years old). One to 6 screws were used in each case. Extension stems were used in 2 cases (4 and 5 screws was used respectively). The area percentages of the bone defects measured as defect area/tibia plateau area, depth of each defect, the number of screws needed in each case, were all used to determine the relationship between the number of screws and the area percentage in certain depth of bone defect by statistic methods, as well as the relationship between screw number and defect depth.

RESULTSAll the patients were followed up and the average duration was 24 months (ranged, 1 to 72 months). The average preoperative HSS score was 43.33 +/- 6.11 (ranged, 32 to 51 scores). Whereas the average postoperative HSS score was 92.15 +/- 4.64 (ranged,83 to 96 scores). The preoperative individual scores including pain, function, activity, nuscle strength, flexion deformity and stability were all improved compared with preoperation,and the differences were statistically significant. All the patients received normal alignment postoperatively, femoraltibial angle was improved from (167.00 +/- 6.39) degrees preoperatively to (175.00 +/- 2.69) degrees postoperatively, the tibial angle was improved from (78.09 +/- 4.51) degrees preoperatively to (88.75 +/- 1.24) degrees postoperatively. Both area percentage and depth of bone defect in a fitting Ologistic model had a significant statistical relationship with the screw number, and a rectangular coordinate system could be formed according to the relationship.

CONCLUSIONScrews and cement technique is a simple, safe and convenient method to rebuild tibial bone defects in primary TKA and its short-term and midterm effect are both reliable. During opera- tion, according to the rectangular coordinate system, the screw number needed in the operation can be inferred form th area and depth of tibia defect, which could have a guiding function in surgery.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; instrumentation ; methods ; Bone Screws ; utilization ; Female ; Fracture Fixation, Internal ; Humans ; Knee Injuries ; surgery ; Knee Joint ; surgery ; Male ; Middle Aged ; Tibia ; surgery

OBJECTIVETo compare differences between Crowe IV developmental dysplasia of the hip (DDH) with secondary acetabulum and Crowe IV DDH without secondary acetabulum,and determine whether it is necessary to divide Crowe IV DDH into two subtypes.

METHODSFrom June 2007 to May 2015,145 hips of 112 Crowe N patients who underwent total hip arthroplasty (THA) using S-ROM stem were divided into two groups: secondary acetabulum formaton group (group A) and no secondary acetabulum formaton group (group B). In group A,there were 12 females, 96 males,with an average age of (39.38 ± 11.19) years old. In group B, there were 2 females, 35 males, with an average age of (38.19 ± 10.92) years old. All the patients were evaluated by using Harris Hip Score. Radiographic evaluations were made preoperatively and during follow up. The differences between two groups were compared on dislocation height, canal flare index (CFI), subtrochanteric shortening osteotomy (SSTO) usage, pre- and post-operation Harris scores, complications.

RESULTSThe dislocation height for group A was (4.74 ± 1.57) cm, while the dislocation height for group B was (3.12 ± 1.15) cm. Significantly difference was detected between two groups. The CFI for group A was 2.69 ± 0.68, while the CFI for group B was 3.42 ± 0.79, and the significantly difference was detected between two groups. Harris scores were totally improved from 58.18 ± 15.67 preoperatively to 91.20 ± 3.79 post-operatively and the difference was significant. Pre-operative Harris scores was 58.1 ± 15.3 in group A, 58.3 ± 16.9 in group B. Post-operative Harris scores was 91.0 ± 4.1 in group A, 91.0 ± 5.1 in group B. No significant difference was found on Harris scores between A and B preoperatively and post-operatively. Complications of 4 cases peri-prosthesis fracture, 4 cases dislocation and 4 cases nerve injury occur in group A; While only one case dislocation and one case nerve injury occur in group B. No statistical significance was detected.

CONCLUSIONCrowe IV DDH with secondary acetabulum is significantly different from Crowe IV DDH without secondary acetabulum on dislocation height and femoral morphology, which causes the different selections of surgical techniques (SSTO usage or not). These important differences in fundamental parameters indicate the necessity to further divide Crowe IV DDH into IVA and IVB two subtypes.

Adolescent ; Adult ; Aged ; Female ; Hip Dislocation, Congenital ; classification ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy