Objective To investigate the effect of dexmedetomidine ( Dex) combined with ropivacaine in brachial plexus block ( BPB) on serum basic fibroblast growth factor ( bFGF) levels of upper limb fracture patients in the perioperative period. Methods 80 patients ( ASA gradeⅠ~Ⅱ) scheduled for selective upper extremity surgery were randomly divided into the dexmedetomidine combined with ropiva-caine group ( RD group) and the ropivacaine group ( R group) with 40 patients in each group. BPB was performed at the point of 2 cm below coracoid directed by nerve stimulator. Ropivacaine (200 mg) was diluted into 40 mL in group R and ropivacaine (200 mg) +1 μg/kg dexmedetomidine were diluted into 40 mL in group RD. Drew 5 mL blood at T0~T4 points respectively,and serum bFGF concentration were determined. Results Compared with group R,MAP and HR at T1~T3 points were significantly lower in group RD (P<0. 05). SpO2 in the two groups at each point had no statistical significance (P>0. 05). Compared with T0 points,bFGF concentration were increased in two groups at T1~T4 points (P<0. 05),and it was higher in group RD compared with group R (P<0. 05). Conclusion Dex combined bra-chial plexus block promote the secretion of bFGF more than simple brachial plexus block,which is conducive to fracture healing after opera-tion,but it should be cautious to apply for patients with bradyarrhythmia.

Objective To investigate the diagnosis and treatment methods of traumatic renal infarction.Methods A retrospective analysis was performed on 6 cases of traumatic renal infarction treated between September 2008 and February 2013.There were 5 males and 1 female,at age of 5-65 years (average,36.2 years).Causes of injury included vehicle collisions in 4 cases and high falls in 2.Out of 6 cases,segmental renal infarction was identified in 2 and total infarction in 4.According to American Association for the surgery of trauma renal trauma grading system,2 cases were classified to grade Ⅳ and 4 to grade Ⅴ.Results Three cases were managed conservatively,which showed segmental infarction in 1 case and total infarction in 2.Three cases underwent surgical exploration,followed by partial nephrectomy in 1 case,left kidney removal plus partial pancreectomy in 1 and right kidney removal in 1.There were no major complications intraoperatively or postoperatively and no cases received blood transfusion.Period of follow-up was 3-34 months.In conservative management,there were no renal atrophies in segmental renal infarction cases and some degree of atrophies in total renal infarction cases,but none presented with arterial hypertension.Conclusions Enhanced CT is the preferred diagnostic tool for evaluation of traumatic renal infarction.Conservative therapy is the optimal option for most cases,but nephrectomy is reserved for cases of infection or renal hypertension.

ObjectiveTo analyze the development mechanism and investigate the more effective therapeutic method of the multiple system organs failure (MSOF) after severe craniocerebral injury.MethodsThe clinical data of 21 MSOF cases after severe craniocerebral injury was analyzed retrospectively.ResultsOf all 21 cases, 2 cured, 7 mended and 12 died with death rate 57% and deformity rate 33.3%.ConclusionTo severe craniocerebral injury, comprehensive, timely and effective therapeutic method is the key to reduce the occurrence of MSOF and the rate of death and deformity.

Objective:To analyze the antimicrobial resistance characteristics of 538 Neisseria meningitidis isolated from 2005 to 2019 in China. Method:Total of 538 Neisseria meningitidis strains collected from 30 provinces in China from 2005 to 2019. Antimicrobial susceptibility test were performed based on the standards of clinical and laboratory standardization association (CLSI) including 11 recommended antibiotics. Gradient diffusion method was used to detect the antibiotic sensitivity of Neisseria meningitidis. Results:All 538 strains were sensitive to azithromycin, meropenem, chloramphenicol, rifampicin and ceftriaxone. As to other six antibiotics, the antibiotics sensitivity rates were cefotaxime (97.4%, 524 strains), ampicillin (87.7%, 472 strains), penicillin (84.8%, 456 strains), minocycline (95.2%, 512 strains), ciprofloxacin (24.9%, 134 strains) and trimethoprim/sulfamethoxazole (11.2%, 60 strains) respectively.Conclusions:Neisseria meningitidis isolated from 2005-2019 in China were all sensitive to azithromycin, meropenem, chloramphenicol, rifampicin and ceftriaxone. It should highlight Neisseria meningitidis resistant to cefotaxime, ampicillin and penicillin. Ciprofloxacin and sulfamethoxazole are not recommended as the priority choice for clinical treatment and prophylactic medication.

Objective:To analyze the antimicrobial resistance characteristics of 538 Neisseria meningitidis isolated from 2005 to 2019 in China. Method:Total of 538 Neisseria meningitidis strains collected from 30 provinces in China from 2005 to 2019. Antimicrobial susceptibility test were performed based on the standards of clinical and laboratory standardization association (CLSI) including 11 recommended antibiotics. Gradient diffusion method was used to detect the antibiotic sensitivity of Neisseria meningitidis. Results:All 538 strains were sensitive to azithromycin, meropenem, chloramphenicol, rifampicin and ceftriaxone. As to other six antibiotics, the antibiotics sensitivity rates were cefotaxime (97.4%, 524 strains), ampicillin (87.7%, 472 strains), penicillin (84.8%, 456 strains), minocycline (95.2%, 512 strains), ciprofloxacin (24.9%, 134 strains) and trimethoprim/sulfamethoxazole (11.2%, 60 strains) respectively.Conclusions:Neisseria meningitidis isolated from 2005-2019 in China were all sensitive to azithromycin, meropenem, chloramphenicol, rifampicin and ceftriaxone. It should highlight Neisseria meningitidis resistant to cefotaxime, ampicillin and penicillin. Ciprofloxacin and sulfamethoxazole are not recommended as the priority choice for clinical treatment and prophylactic medication.

At present, the cultivation of exploratory thinking and the ability to use medical public big data is easy to be ignored, which leads to the obvious lack of the ability of graduate students in oncology to use public big data to discover and confirm new clinical phenomena and new laws in scientific research. This study introduces the access and download tools of common medical big databases such as TCGA, introduces the learning method of repeated classic analysis cases, and proposes research methods to verify clinical hypothesis using public big data. It is expected to provide useful enlightenment and reference for improving the research ability of graduate students in oncology specialty to find clinical problems and summarize scientific laws.

Utilizing of the WeChat Mini Programs (WMPs) in optimizing the paradigm of Continuing Medical Education (CME) is a promising avenue to improve training mode for physician. Here, we introduce the development status of WMP, and classify them into professional societies, hospital departments, academic institutions, pharmaceutical technology companies and individuals according to the operation subjects. This paper also analyzes the advantages and disadvantages of WMPs, and puts forward the establishment of authoritative and highly recognized mini programs that can be awarded CME credits. Through the "Internet plus medical care" strategy, we should integrate network resources to enhance the overall level of continuing medical education, so as to provide a good platform for related medical workers.

Objective:To explore the effect of a new teaching mode, which includes bridge-in, outcome, pre-test, participation, post-test and summary (BOPPPS), on the online teaching of radiobiology related knowledge for cancer radiotherapy practitioners.Methods:Taking the cell survival curve, cell cycle and radiosensitivity as examples, the radiotherapy practitioners in multiple university-affiliated hospitals were organized to carry out a multicenter prospective randomized control study. All practitioners were randomly divided into BOPPPS group and control group. The courses for BOPPPS group were designed as an online classroom, consisting of pre-class preparation, online teaching and post-class stages. The online teaching stage included video viewing, basic knowledge learning, literature discussion, group discussion and others. The control group employed the traditional teaching mode. The χ2 test was used to compare the consistency of general conditions between the two groups, and nonparametric test was used to compare the differences in scores between two or more groups. Results:The score of the pre-class test was 58.56 ± 0.99. Post-class average score for BOPPPS group was 85.48±0.85 and for control group 77.79±1.10, with the former being higher 7.69 ( Z=5.31, P<0.001) than the latter. The average answer time was (296.62±15.40) s for BOPPPS group and (386.41±21.27) s for control group, with the former being shorter 89.79 s ( Z=3.34, P=0.001) than latter. Subgroup analysis shown that the scores of BOPPPS group were significantly rising, regardless of whether or not the students had studied radiobiology courses. Among the students who have not studied these courses, the scores were rising greatly. Moreover, From the analysis of different positions, it was found that both the scores of BOPPPS group and control group have risen, especially for doctors, deputy chief doctors, physicists and technicians. There were also statistically differences between different degrees, with significantly rise in scores for undergraduate and doctoral students ( Z=3.64, 4.18, P<0.001). Conclusions:The flexible application of BOPPPS teaching mode to the online education of such boring disciplines, like radiobiology, is of great significance to raise the theoretical basis of radiotherapy practitioners.

Objective To investigate the value of spectral CT-based quantitative analysis in the differential diagnosis of liver cancer and liver abscess.Methods A total of 70 patients with space-occupying lesions in the liver (45 with liver cancer and 25 with liver abscess) underwent spectral CT scans to obtain spectral images in the arterial phase and portal venous phase.The solid constituents of lesions and the iodine and water concentrations in necrotic or cystic parts of lesions,normal hepatic tissue,and abdominal aorta in the arterial phase and portal venous phase were measured,and the normalized iodine concentration (NIC) and lesion-to-normal hepatic tissue ratio (LNR) of iodine concentration were calculated.The two samples t-test and the receiver operating characteristic (ROC) curve analysis were performed for the quantitative indices above.Results The patients with liver cancer had higher NIC and LNR in solid constituents in the arterial phase than those with liver abscess (NIC:0.15±0.06 mg/ml vs 0.14±0.02 mg/ml,P ＞ 0.05;LNR:2.78±0.65 vs 1.45±0.88,P ＜ 0.001).The patients with liver abscess had significantly higher NIC and LNR in solid constituents in the portal venous phase than those with liver cancer (NIC:0.65±0.08 mg/ml vs 0.52±0.08 mg/ml,P ≤ 0.001;LNR:1.22±0.23 vs 0.95±0.15,P ≤ 0.001).There were no significant differences in NIC in the arterial phase or NIC and LNR in the portal venous phase in necrotic or cystic parts of lesions between the patients with liver cancer and liver abscess (P ＞ 0.05).The optimal quantitative value for the differential diagnosis of liver cancer and liver abscess was LNR in arterial phase,and the cut-off value of 1.53 had a sensitivity of 100％ and a specificity of 92％.Conclusion Quantitative iodine concentration analysis in spectral CT imaging has a certain value in the differential diagnosis of liver cancer and liver abscess and can improve the accuracy of diagnosis.

Post-traumatic tetanus is the main type of non-neonatal tetanus.To reduce the incidence and mortality rateof tetanus and guide the primary medical institutions to prevent and control tetanus after trauma,the National Immunization Planning Technical Working Group of the Chinese Center for Disease Control and Prevention has compiled this document in the reference with Position Paper by World Health Organization,and the latest research progress both at home and abroad.The guidelines focus on the basic procedures for the prevention and treatment of post-traumatic tetanus,the application of tetanus vaccines and immune preparation,and pre-exposure immunization in high-risk populations of trauma.