Objective To investigate the correlation of platelet activating factor(PAF)with cortisol(Cor) ,as well as their rela-tionship with patients after sepsis prognosis .Methods 102 patients with sepsis admitted in the ICU of Chongqing Emergency Med-ical Center from April 2012 to August 2013 were enrolled into sepsis group ,and 40 cases of volunteers served as control group .All the patients were divided into survival group and non-survival group ,according to their prognosis during hospitalization .Plasma PAF and Cor level in control group ,survival group and non-survival group were compared with each other ,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)in survival group and non-survival group were compared .The correlations of plasma PAF with Cor level in control group ,survival group and non-survival group were analyzed ,respectively .Results Plasma PAF and Cor level in survival group and non-survival group were significantly higher than that in control group(P<0 .05) .Plasma PAF ,Cor lev-el and APACHEⅡ scores were higher in non-survival group than that in survival group(P<0 .05) .The correlation of plasma PAF with Cor level in control group was not significant(P>0 .05) ,while the plasma PAF level positively correlated with Cor level in survival group and non-survival group(P<0 .05) .Curves of receiver operating characteristics(ROC)showed that PAF ,Cor and A-PACHEⅡ score could be used as predictors of mortality during hospitalization(Area=0 .708 ,0 .715 ,0 .787) .Conclusion The plas-ma PAF level positively correlates with Cor level in patient with sepsis .PAF ,Cor and APACHEⅡ score have certain guiding signif-icance for the assessment of prognosis during hospitalization in patients with sepsis .

BACKGROUND:The creep characteristics of cancellous bone from necrotic femoral head are important for clinical artificial joint replacement.Therefore,it is necessary to study mechanical properties of cancellous bone at 45°direction.OBJECTIVE:To compare creep properties of normal femoral head and necrotic femoral head at 45°direction based on three-parameter model established creep equation METHODS:A total Of 8 normal and 8 necrotic femoral heads were used.The cancellous bone was harvested at 45° and subjected to creep test on electronic universal testing machine.With simulated temperature field of human body temperature at36.5℃.stress was imposed on the samples by an increase of 5%/s for 7 200 seconds.100 experimental data were collected,and stress relaxation equation was calculated using three-parameter model.RESULTS AND CONCLUSION:The creep curve of the femoral head of normal and necrotic changes was exponential relation.Changes were fast in the first 600 seconds,and strain increased slowly with time,finally entered into balance stage.7 200 s creep of cancellous,bone from necrotic femoral head was less than normal femoral head cancellous bone.Three-parameter model calculation is simple and can well fit the creep of changes in the femoral head.The establishment of such idealized equation quantitatively shows poor visco-elasticity of the necrotic femoral head.

SUMMARY Peripheral T cell lymphomas-unspecified(PTCL-U) is an uncommon malignant tumor, accounting for 5%-7% of non-Hodgkin’s lymphoma. Clinical feature of a case of PTCL-U was investigated and the optimal treatment protocol was proposed. The clinical presentation of this case was progressing limbs weakness with sudden paralysis. Multiple superficial lymph nodes swelling and decreased sensation in all modalities below T10 level were found in physical examination. Bilateral leg paralysis (Grade 0/5) with high muscle tension, overactive knee reflex, bilateral Babinski sign (+) were present. Magnetic resonance imaging(MRI) showed the mass, which was around spinal cord located in T6-T8 vertebra canal, with intense enhancement after the administration of gadolinium diethylenetriamine penta-acetic acid. Abnormal signal in multiple centrums and accessories could also be found in MRI scan. Initial diagnosis was lymphoma, multiple systems involved. Laminectomy and epidural tumor resection were performed immediately. The dural sac was narrowed obviously by surrounding tumor. The result of pathological examination was PTCL-U. After operation, the level of pain sensation was descent, and touch sensation recovered. The patient received chemotherapy and his muscle strength was partly recovered in 4 months. Early diagnosis of peripheral T cell lymphomas-unspecified was difficult and easily misdiagnosed with poor prognosis. A review of literature showed central nervous system lesions occurred in advanced stage. However, the report of representation of intraspinal mass as initial symptom like the case was rare. For acute paraplegia, laminectomy and tumor resection should be performed as soon as possible. Regular radiotherapy and chemotherapy should be considered after operation. However, the value of local chemotherapy need to be further investigated.

Objective To investigate the anti-tumor effect and mechanism of Plumbagin against human large cell lung cancer cell line NL9980.Methods Plumbagin in different concentrations were set up to administrate NL9980 cell line.MTT test was performed to detect the inhibiting effects against tumor proliferation and IC50 concentration was identified.The influence of tumor apoptosis was observed by flow cytometry and the inhibiting effect against invasive ability was detected by Boyden chamber test.IC50 group and control group were set up and tumor cells were harvested 6 h,24 h and 48 h after administration.Realtime PCR was used to detect mRNA expression changes of bcl-2,bax,VEGF and CYCD1.Results MTT test showed obvious inhibiting effects of proliferation in NL9980 cell line and IC50 was 7.5 μmol/L.Plumbagin induced the apoptosis of tumor cells and showed a significant anti-invasive effect.Mean membrane-spanning cells were 161.59±47.32 and 26.58±9.07 in control group and IC50 group correspondingly.Down-regulations of bcl-2,VEGF and CYCD1 were detected and expression of bax gene increased.The effect of Plumbagin showed obvious time dependance (P ＜0.05).Conclusion Plumbagin has displayed the powerful antitumor effects against NL9980 cell line and it might work via multiple pathways.Plumbagin exhibits the prospect of being an effective drug against large cell lung cancer.

Objective To discuss the application of Chinese version of Speech intelligibility rating (SIR) in e-valuating the speech intelligibility of Chinese children with hearing disorder ,and analyze its scorer reliability .Meth-ods 50 children with cochlear implants or hearing aids were interviewed using SRI Chinese version .Each child was rated by a parent and a speech and language therapist .The reliability of scores was analyzed with Spearman correla-tion coefficient ,Kendall's coefficient of concordance and Kappa coefficient .Results The complete agreement was foud in 34 cases(68% ) ,with a disagreement of one category in 14 cases(28% ) ,and a disagreement of 2 categories was found in 2 cases (4% ) .Spearman correlation coefficient was 0 .885 ,Kendall's coefficient of concordance was 0 .801 ,Kappa coeffi-cient was 0 .593 ,the result was statistically significant (P<0 .001) .Conclusion SRI Chinese version has good reliability and is helpful in evaluating Chinese speech producing ability of children with hearing disorder in everyday life .

Objective To observe the effects of Shenqi Fuzheng injection on peripheral blood T lymphocyte subsets, T-cell apoptosis and cytokine in patients with sepsis and approach their significance.Methods Forty patients with sepsis admitted into Department of General Surgery of the General Hospital of Tianjin Medical University were randomly divided into two groups: routine group (20 cases, received routine western medicine treatment) and Shenqi Fuzheng treatment group (20 cases, received routine western medicine treatment and intravenous drip of Shenqi Fuzheng injection 250 mL per day), 7 days as a course of treatment in both groups. On the 1st, 3rd and 7th day after treatment, evaluation of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores was carried out in the two groups. The percentages of peripheral blood T-lymphocyte subsets CD4+, CD8+, CD4+/CD8+ and apoptosis were measured by flow cytometry. Meanwhile, tumor necrosis factor-α (TNF-α), interleukins (IL-6 and IL-10) levels were detected by enzyme linked immunosorbent assay (ELISA).Results APACHE Ⅱ scores of two groups on the 3rd day were apparently decreased in comparison with those on the 1st day after treatment, and this situation persisted until the 7th day after treatment; meanwhile, the decrease in APACHE Ⅱ score in Shenqi Fuzheng treated group was more notable than that in routine group (10.05±3.71 vs. 13.15±4.65,P < 0.05). Along with the prolongation of time, in both groups, the peripheral blood TNF-α and IL-6 levels were gradually decreased; the IL-10 level was gradually increased, until the 7th day it began to decrease. On the 7th day, the TNF-α and IL-6 levels in Shenqi Fuzheng treated group were decreased more significantly than those in routine group [TNF-α (ng/L): 204.6±18.1 vs. 218.9±21.3, IL-6 (ng/L): 3.68±0.30 vs. 3.95±0.49, bothP < 0.05]. There was no significant difference between Shenqi Fuzheng treated group and routine group in the IL-10 level on the 7th day (ng/L: 173.8±23.3 vs. 174.8±18.9,P > 0.05). On the 1st, 3rd and 7th day after treatment, the percentage of CD4+ T cells and CD4+/CD8+ ratio were firstly fallen and then elevated up, the percentage of CD8+ T cells was gradually decreased, and the percentages of CD4+ and CD8+ apoptosis showed a trend of rise up first and then fall in the two groups. On the 7th day after treatment, there were significant differences between Shenqi Fuzheng treated group and routine group in terms of the percentage of CD4+, CD4+/CD8+ ratio and the rate of CD4+ apoptosis [CD4+ T cells: (38.3±4.7)% vs. (35.5±5.5)%, CD4+/CD8+: 1.55±0.29 vs. 1.36±0.27, CD4+ T apoptosis: (11.2±3.8)% vs. (14.1±5.5)%, allP < 0.05]. There were no statistically significant differences between routine group and Shenqi Fuzheng treated group in the percentages of CD8+ T cells and CD8+ apoptosis at each time point (allP > 0.05).Conclusion Shenqi Fuzheng injection can effectively reduce the percentage of CD4+ T cell apoptosis, increase the percentage of CD4+ T cells and CD4+/CD8+ ratio, lower the inflammatory factors, improve the immune function and disease severity in patients with sepsis.

Objective:To explore the prognostic value of CysC and NT‐proBNP in patients with non‐ST elevation a‐cute coronary syndrome (NSTE‐ACS) .Methods :A total of 166 NSTE‐ACS patients hospitalized in our hospital from Jan 2012 to Dec 2012 were selected .They were followed up for 12 months ,then general data ,levels of CysC , NT‐proBNP ,hsCRP and cTnI etc .and incidence rate of MACE were recorded and measured .According to MACE occurrence during follow‐up or not ,156 cases were divided into non‐MACE group (n=137) and MACE group (n=19) ,risk factors for MACE in NSTE‐ACS patients were analyzed ,receiver operator characteristic curve (ROC) was performed ,and the optimal cutoffs of related indexes predicting MACE occurrence in these patients were analyzed . Results :Compared with non‐MACE group ,there were significant rise in age [ (60.26 ± 10.45) years vs .(64.16 ± 11.21) years] ,levels of CysC [ (1.02 ± 0.11) mg/L vs .(1.15 ± 0.12) mg/L] ,NT‐proBNP [ (251.97 ± 89.65) pg/ml vs .(347.93 ± 107.29) pg/ml] ,hsCRP [ (14.69 ± 3.53) mg/L vs .(17.13 ± 3.68) mg/L] and cTnI [ (0.36 ± 0.46) ng/ml vs .(0.90 ± 0.88) ng/ml] in MACE group ,P<0.05 or <0.01. Multi‐factor regression analysis indica‐ted that CysC ,NT‐proBNP and cTnI levels were independent predictors for MACE in NSTE‐ACS patients ( P<0.05 or <0.01) .ROC curves of CysC ,NT‐proBNP ,cTnI and hsCRP judging prognosis were drawn , only AUC of CysC and NT‐proBNP curves were >0.7 [CysC:0.784 ,95% CI:0.687~0.881 ;NT‐proBNP:0.753 ,95% CI :0.639~0.867] , and it′s analysis indicated that CysC=1.07 mg/L and NT‐proBNP=279.60 pg/ml were their optimal cutoff predicting MACE .Kaplan‐Meier survival curves with above two cutoffs as risk stratification cutoff indicated that survival time of high risk group was significantly shorter than that of low risk group (P<0.05) .Conclusion:Serum CysC and NT‐proBNP levels are independent predictors assessing prognosis in NSTE‐ACS patients .

Objective To learn students' satisfaction with the general education courses, discuss the problems in comprehensive general education courses in local medical colleges , and provide the basis and reference for the medical general education courses reform. Methods Using the stratified random sampling method, self-designed questionnaire to local medical colleges of 575 different professions stu-dents. The questionnaire had the total of 54 topics whose contents were related to the basic situation aware-ness and satisfaction, the demand for general education courses, general education curriculum problems and suggestions. The survey data were analyzed using SPSS 19.0 software and the results were expressed by the relative number(rate and percentage). The differences between different majors and different grade student satisfaction were analyzed by using rank-sum test, showing statistical significance(P<0.05). Results The total satisfaction was not very high, only 219 students(38%) were satisfied with general curriculum;256 students(45%) thought it didn't matter whether to set general education courses;100 students(17%) were not satisfied. In addition, satisfaction with different grades was undifferentiated (P=0.798), but there was a statistical difference among the students of different professions(P=0.007). Conclusion The general education curriculum of medical schools should not blindly pursue being wide and full. Instead, it should be built from three aspects such as core curriculum, flexible teaching methods, teaching methods reform to enhance teaching effectiveness.

Objective To provide a good anatomical foundation for transposition of the branch of median nerve superficial flexor muscle repairing the movement branch of ulnar nerve to recover the function of intrinsic muscle, by anatomic study of the muscle branch of the superficial flexor muscle of the median nerve and the movement branch of ulnar nerve. Methods Twenty adult upper limb specimens immersed fixed by formalin were elected and expose the midian nerve and ulnar nerve. Then every anatomical index was measured. Simulate to manipulate that the branch of superficial flexor muscle repair the motor b ranch of ulnar nerve. Calculate the number of myelinated nerve fibers of the branch of superficial flexor muscle. Results The distance between the position into muscle and styloid process of radius and styloid process of ulna: (21.4±1.8)mm, the distance that can be separated: (27.1±1.2)mm, the transverse diameter: (1.2±0.2)mm, anteroposterior diameter: (0.7 ± 0.1 )mm. No injury separated distance between the sensory branch and motor branch of ulnar nerve: (7.1 ± 0.7)cm. The 4th muscular branches of median nerve flexor digitorum superficialis was 1378.9± 107.9. Conclusion The 4th muscular branches of median nerve flexor digitorum superficialis can be used to repair the motor branch of the ulnar nerve to recover the function of intrinsic muscle of hand.