Objective:To explore the interns' degree of lost basic science and the influence on studying clinical knowledge.Method:Medical students attending the third(n=100) and the fifth(n=100) of medical studies selected randomly from the Guilin Medical School were given the same test composed of 20 pairs of questions and each pair contains one basic and one clinical question which were correlative.The scores of the two groups were compared.Result:Third year students scored significantly higher in basic than clinical questions(P0.05).Conclusion:There is a positive relationship between mastery of basic knowledge and the ability of dealing with clinical problems.Quite a few basic knowledge of medical students is lost when they begin clinical practice.

[Objective] To discuss the clinical manifestations,treatment,and therapeutic efficacy of lumbar disc herniation complicated by lumbar spinal stenosis in elderly patients.[Method]Thirty-six elderly patients with lumbar disc herniation complicated by lumbar spinal stenosis were treated with surgical treatment,including multi-segment fenestration,laminectomy,resection of nucleus pulposus,and internal fixation of pedicle screws.The therapeutic efficacy was retrospectively assessed.[Result]All patients were followed up with an average time of 3 years and 6 months.The good to excellence results was 83%.[Conclusion]In elderly patients with lumbar spinal stenosis,there are patients have special clinical manifestations.Different operations should be adopted for different patients.There are several important factors that affect the efficacy of operation,including operation modes,sufficient decompression,restotation of spinal instability,and postoperative exercises of lumbodorsal muscles.

[Objective]To evaluated the clinical results of the ulnar osteotomy and external fixation for the treatment of chronic anterior dislocation of head of the radius in children.[Method]From 2002 to 2004,thirteen cases of children with chronic anterior dislocation of the radial head were treated by ulnar osteotomy,external fixation and close or open reduction of elbow joint but without repair of the annular ligament. Their mean age was 5.5 years(2 to 11) and the mean interval between the injury and reconstruction was 19 months(2 months to 3 years).[Result]All radial heads remained reduced at a mean follow-up of 14 months(2 months to 3 years).Normal ranges of movement for flexion,extension,pronation and supination were improved or unchanged in 12 patients.One patient had further decreased in 10? for supination.There were one superficial pin-track infections but with no serious complication.[Conclusion]Angular ulnar osteotomy and external fixation of the ulna can lead to stable reduction of the radial head with minimal complications.Reconstruction of the annular ligament is not necessary if satisfactory re-orientation of the ulnar is achieved in all planes.

Objective To probe into the value of MR imaging in evaluating the pulmonary artery hemodynamics and pulmonary artery pressure in acute massive pulmonary embolism.Methods MR studies were performed in 21 patients with acute massive pulmonary embolism (diagnosed by contrast enhanced MR pulmonary angiography) and 20 healthy volunteers. The pulmonary artery hemodynamic parameters, such as the diameters of main and right pulmonary artery, peak velocity, average velocity, flow volume, flow patterns, and ejection acceleration time in main pulmonary artery were measured. The findings in patients and volunteers were compared. The hemodynamic parameters in patients were correlated with mean pulmonary artery pressure acquired with right heart catheterization.Results The diameters of main pulmonary artery (2.93 vs 2.52 cm) and right pulmonary artery (2.49 vs 1.92 cm) in patients and volunteers showed significant differences (t=3.55, P

Objective Patient safety is key to quality of care in hospital management, for which drug safety is critical. General hospitals are challenged with how to monitor drug adverse reaction (ADR), and motivate their staff to report ADRs in building a hospital safety culture. Methods The PDCA cycle quality improvement process was called into play, to set the ADR criteria and analyze data of inpatients' ADRs from 2005 to 2009, which was followed by measures proposed for ADR continuous improvement. Results A total of 2850 ADR cases were reported in the past 5 years, averaging 570 cases per year. The ADR incidence rate was 3. 28%, of which 43 were severe ADR cases, or 0. 49% of the total cases, accounting for 1. 51% of all the ADR cases. Year to year, the quantity and quality of ADR reporting have been improving in the hospital, witnessing an initial culture of drug safety. In 2008, the hospital was awarded as an advanced ADR center in Beijing. Conclusion The PDCA cycle is an effective means for ADR management, as it can improve the awareness of the medical staff for proactive ADR reporting. Sustained circular management against ADRs can minimize risks and maximize patient safety.Under-reporting and the corrective measures shall be watched over by the hospital in the future.

Objective This study compared the cleaning effect of gastroscope by different cleaning mehtods and discuss practical and reliable evaluation method for the cleaning degree of gastroscope.Methods Three cleaning methods were selected and used in the cleaning of gastroscope.The Endocheck lumen was used to examine the cleaning degree of gastroscope and the effects of different methods were compared. Results The qualification rate by using ordinary cleaning method was 50.0%and it reached 60.0%and 73.3%by elevation of polyenzyme concentration and adding bedside pre-washing.which Was statistically different from that by using ordinary cleaning method(P＜0.05).Conclusions Bedside pre-washing could increase the cleaning degree of gastroscope;Endocheck lumen could be regarded as an evaluation method for the cleaning degree of gastroscope.

BACKGROUND: The observation of vascular endothelial growth factor gene expression of cerebrovascular diseases and ultrastructure of cells may be helpful to understand angiogenesis and its relative cellular factors involved in the pathogenesis at cellular and molecular levels. OBJECTIVE: To investigate the method of culture of human cerebral cap illary endothelial cell by separation of capillary fragment in vitro, and to ob serve vascular endothelial growth factor gene expression and ultrastructure of cells. DESIGN: A randomized controlled research on technique and method. SETTING: The neurosurgery department of a general hospital of a military area command of Chinese PLA and the neurosurgery department of a college hospital. PARTICIPANTS: Eighteen patients with arteriovenous malformation of brain(Spetzler Ⅱ-Ⅲ grade), as confirmed by aortocranial angiography before operation, in the Department of Neurosurgery, General Hospital of Shenyang Military Area Command of Chinese PLA were included. The material was obtained from fresh integrated specimen of arteriovenous malfor mation of brain with surrounding fresh brain tissues during the opera tion. Capillary endothelial cell was separated by homogenate, filtration and enzymatic digestion techniques. Cells grew well in culture flask and were divided into 4 groups(hypoxia state for 2, 4, 8 hours groups and control group). Each group contained four flasks.METHODS: Simulation of anoxia condition: volume faction 0.95 N2 and volume fraction 0.05 CO2. Expression of factor Ⅷ related antigen in cells was detected by immunohistochemistry. mRNA expression of vascular endothelial growth factor on endothelial in every group was observed by RT-PCR, protein content of vascular endothelial growth factor in supernatant detected by enzyme-linked immunoadsordent assay, and cellular ultrastructural change observed by transmission electron microscopy.MAIN OUTCOME MEASURES: mRNA expression of vascular endothelial growth factor on endothelial cell and protein content of vascular endothelial growth factor in supernatant in control group and every hypoxia groups; cellular ultrastructural changes.RESULTS: Under phase contrast microscope, cultured living cells had mono-layer pebble-like typical character. More than 90% of were factor Ⅷrelated antigen(FⅧ-RA) staining positive. mRNA and protein expression of vascular endothelial growth factor in hypoxia 4 hours group was 0.98 ±0. 19,( 180. 77 ± 20. 15) ng/L, which was significantly higher than in control group [0, (26. 20 ± 6.33) ng/L, P ＜ 0.01 ]. Eight hours later, expression decreased [(0. 35 ±0.07), (31.68 ±8.34) ng/L]; swollen mitochondrion, dilated endoplasmic reticulum, and lysosome vesiculation were found.CONCLUSION: Humane cerebral capillary endothelial cell can be cultured by separation of capillary fragment, which is easy to operate and the cellular purity is reliable. In the early stage of ischemia and hypoxia, expression of vascular endothelial growth factor is not enough to maintain cellular ultrastructure integrity. Cells may be injured along with the prolong of hypoxia.Zhao MG, Tang T, Gao YZ, Pu PY, Wei XZ. Culture of human cerebral capillary endothelial by separation of capillary fragment and the observation of vascular endothelial growth factor gene expression and cell ultrastructure. Zhongguo Linchuang Kangfu 2005; 9(21):211-3 (China) [www. zglckf. com]

Time to positivity(TTP) is a new parameter in blood culture field.The article shows us the concepts of TTP,differential time to positivity (DTTP),and introduces their relation with bloodstream infection (BSI),catheter-related bloodstream infection (CRBSI).Besides,it stresses TTP' s clinical application,including determining the severity of disease;identifying the isolates whether pollution or not; identification of isolate strains ; detection of the drug resistance of isolates ; evaluating the effect of antibiotic ; helping to adjust the therapeutic drug; diagnosing or excluding CRBSI by means of DTTP;deciding whether the catheter is the source of infection in patients with candidemia; understanding the epidemiological distribution of strain.At the same time,the article also describes the shortcomings and domestic current status.

Objective To investigate the gene expression of vascular endothelial growth factor(VEGF) and ultrastructural changes in cultured endothelial cells from human cerebral microvessels under hypoxic conditions.Methods Human cerebral microvessels were isolated from freshly obtained specimens of normal brain adherent to resected cerebral arteriovenous malformations.The expression of factor Ⅷ-relative antigen(FⅧ-RA) in cultured cells was observed with immunocytochemistry.The level of VEGFmRNA in cells and released VEGF protein in cell supernatant were determined by RT-PCR analysis and ELISA respectively when they were exposed to hypoxic conditions(95% N_2,5% CO_2;two hours,four hours,eight hours) or maintained in basal condition.Ultrastructural changes in cells were also observed by electron microscopy.Results In inverted microscope the cultured cells showed contact inhibition and a rounded cobblestone appearance.More than 90% of them were stained strongly with antibodies against FⅧ-RA.Significant VEGF mRNA and protein accumulated when these cells were exposed to hypoxia for 4 hours.However,their VEGF expression was down-regulated after hypoxia for 8 hours and a number of vesicles and swollen mitochondria were present in the cytoplasm.Conclusion The level of VEGF expression may havesignificant relationship with ultrastructural changes in human cerebral endothelial cells under hypoxic conditions.

OBJECTIVE To investigate the distribution and drug resistance of nosocomial infection pathogens.METHODS The data of pathogen′s origin and antibacterial resistance of Intensive Care Unit(ICU) inpatients from Apr 2008 to Mar 2009 in a Hospital were analyzed.RESULTS There were 226 strains pathogens isolated from 116 nosocomial infection cases,from which the Gram-negative bacteria were predominate(63.27%).The resistance rates of Acinetobacter baumannii was the highest in Gram-negative bacteria,more than 70% isolates resistant to almost antibacterial.The main Gram-positive bacteria were Staphylococcus aureus,and the rate of meticillin-resistant S.aureus(MRSA) was 41.3%.All S.aureus were sensitive to vancomycin and Linezolid.CONCLUSIONS To control the antibacterial resistance of pathogens and decrease the nosocomial infection,it is important to strengthen the appropriate use of antibiotics.