Adrenal Cortex Diseases ; etiology ; Child ; Humans ; Sepsis ; complications ; physiopathology ; Shock, Septic ; complications ; physiopathology

The study on medical education directly affects the quality of education and cultivation of medical professionals as well as the level of running school.It is very important for the medical colleges to take some measures to solve these problems existing in medical teaching reform and research,such as renewing teachers' ideas,enhancing the standardization of management,increasing the enthusiasm of the teachers etc.

Teaching Inspection is the important part of the Inspective system for teaching quality in medical universities and colleges,which acts on inspection,instruction and consultation for teaching.Teaching Inspection system has been set up in medical universities and colleges.

Objective Build the hospital scientific research management platform.Methods According to expenditure process and the management standard requirements,the establishment of a fund management system platform to achieve budget、accounted for,spending and audit feedback function.Results Scientific research funds management platform is mainly composed of project application,project establishment and review,the report query and remittance receipt of financial department.Full consideration of the personnel,project,financial and other related system interface.In the construction of data using the standards of the state and the university scientific research information.Conclusions Through building the hospital scientific research management platform,improving the working efficiency,reducing the labor intensity of the management and financial personnel,realizing the accuracy and effectiveness of management.

Objective To summarize the experience of intraoperative rapid parathyroid hormone (PTH) detection by immunochromatography in thyroid surgery.Methods Patients undergoing thyroid surgery in Shanghai Tenth People's Hospital from Nov.2016 to Jul.2017 were collected and the clinical data including level of blood calcium,serum phosphorus and PTH,and pathological findings were analyzed.Results In this study,im munochromatographic assay was used in 45 cases (experimental group) and nano carbon method was used in 47 cases (control group).In benign cases,levels of blood calcium and PTH in experimental group were higher than those in the control group ((2.07±0.09) vs (2.04±0.06) and (3.41±1.82) vs (3.34±1.84),P＞0.05).In malignant cases,blood calcium level in experimental group was higher than that in the control group ((2.02±0.13) vs (1.99±0.38),P＞0.05) and PTH level was significantly higher than that in the control group ((2.22±1.27) vs (1.44±1.44),P＜0.05).Serum phosphorus level in experimental group group was much lower than that in the control group ((1.02±0.17) vs (1.14±0.23),P＜0.05).Conclusions Using intraoperative rapid PTH detection by immunochromatography can identify parathyroid and avoid accidental injury of parathyroid gland,which can reduce the postoperative incidence of hypocalcemia.

Objective To evaluate the effects of teriipressin on perioperative renal function in patients undergoing liver transplantation. Methods Forty ASA Ⅲ or Ⅳ patients (31 males and 9 females) aged 35-55 yr and weighing 46-81 kg were randomly divided into2 groups (n=20 each): terlipressin group and control group. The patients were premedicated with intramuscular midazolam 2- 3 mg and atropine 0.5 mg. Swan-ganz catheter was placed via the right internal jugular vein and the radial artery was cannulated. Electrocardiography (ECG), blood pressure (BP), heart rate (HR), central venous pressure (CVP) and pulmonary arterypressure (PAP) were monitored during general anesthesia. General anesthesia was induced with midazolam (0.1-0.2 mg/kg), fentanyl (5-10 μg/kg), propofol(1-2 mg/kg) and vecuronium (0.1 mg/kg) and maintained with 0.5%-1.5% isoflurane, propofol infusion at 2-5 mg·kg-1·h-1 and intermittent i.v. boluses of fentanyl and vecuronium. The patients were mechanically ventilated after tracheal intubation. In the terlipressin group, 2 mg of terlipressin was added to 50 ml of normal saline (NS) and was continuously infused at 10 ml/L from beginning of operation until the end of anhepatic phase, while in the control group, NS was infused only. Blood and urine samples were taken before operation(T0), at the end of anhepatic phase (T1), at the end of operation (T2), and on the 1st and 2nd day after operation (T3, T4)for determination of plasma angiotensin Ⅱ (AT- Ⅱ ), serumβ2-microglobulin (MG), blood urea nitrogen (BUN) and creatinine (Cr) concentrations and N-acetyl-βd-glucosaminidase (NAG) concentrations in the urine. Urine output was measured during pre-anhepatic, anhepatic and neo-hepatic phase and on the 1 st and2nd day after operation. Results The urinary NAG and serum β2-MG concentrations were significantly increased at T1 as compared with the baseline at T0in both groups. The urinary NAG, plasma AT-Ⅱ, serum β2-MG, BUN and Cr concentrations were significantly lower and theurinary output was significantly higher during T2-4 in the terlipressin group than in the control group. Conclusion Terlipressin has protective effects on renal function in patients undergoing orthotopic liver transplantation.

Objective To investigate the expression of IgG4 in liver tissues of patients with type Ⅰ autoimmune hepatitis (AIH) and to analyze the clinical manifestation,biochemical indexes,immunological genetic features,pathological characteristics and the effects of immunosuppressive therapy.Methods From March 2012 to July 2013,45 patients diagnosed as type Ⅰ AIH were enrolled.Immunostaining of CD38,IgG and IgG4 in liver tissue slices was performed,inflammation grade G and fibrosis stage S were determined.At the same time,serological indexes (alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),IgG,antinuclear antibody (ANA) titer,antibodies to asialoglycoprotein receptor (ASGPRAb)) of the patients were collected,serum IgG4 was tested and the response to immunosuppressive therapy was observed.Wilcoxon rank sum test and t test were performed for quantitative data comparison.Spearman correlation coefficient was used for correlation analysis.Results Among 45 patients with type Ⅰ AIH,five patients (11.1％) were IgG4 associated AIH (IgG4-AIH group).There were no significant differences in age,gender,biochemical indexes (serum levels of ALT,AST,ALP),immunity indexes (serum levels of IgG,ANA titer,ASGPRAb) and degree of liver fibrosis between patients with IgG4-associated AIH and classical AIH (40 cases) (all P＞ 0.05).Compared with classical AIH group (18.3(6.7) mg/L).The serum level of IgG4 of IgG4 AIH group was 25.8(9.2) mg/L,which significantly increased (Z=-2.041,P＜0.05).However,there was no significant difference in serum level of IgG4 between the two groups (P＞0.05).There was no correlation between the number of infiltrated IgG4 positive plasma cells and the serum level of IgG4 (r=0.311,P=0.279).The inflammation in the liver tissues of IgG4-AIH group was more significant compared with that of classic AIH group (H=4.120,P＜0.05).The number of CD38' or IgG+ plasma cells was larger compared with that of classical AIH (CD38(39.3(13.5)/high power field (HPF) vs (21.3(8.8))/HPF,IgG(39.3 (14.0))/HPFvs (18.5(8.9))/HPF;Z ＝-3.561 and-3.584,both P＜0.01).The number of IgG4+ plasma cells in liver tissues was positively correlated with the number of CD38+ or IgG+ plasma cells (r=0.884 and 0.791,both P＜0.01).Conclusions Among patients with type Ⅰ AIH,the incidence of IgG4-associated AIH was not high.The serum level of IgG4 did not significantly increase in these patients.However,the histological inflammation activity was significant along with many CD38+ or IgG+ plasma cells infiltration.

Abstract?AIM: To analyze the clinical effects of partial rectus muscle transportation procedure for paralytic strabismus due to single rectus muscle paralysis.?METHODS:The conditions of 22 patients (25 eyes) who underwent partial rectus muscle transportation procedure for paralytic strabismus due to single rectus muscle paralysis were retrospectively reviewed. The following data were analyzed:1 ) the angle of deviation of primary position; 2 ) the presence of diploma in the primary position;3) the presence of compensatory head posture;4) the motility of the affected eye.All of the patients attended 6mo postoperative follow-up examinations.?RESULTS: According to the results of examinations before and during operation, different operations were performed:2 eyes were treated with partial rectus muscle transportation, 20 eyes were treated with recession of antagonistic muscle of paralytic rectus muscle combined with partial rectus muscle transportation, 3 eyes were treated with recession of antagonistic muscle, partial rectus muscle transportation and recession of yoke muscle.Twenty patients were orthotropia in the primary position, the diploma and abnormal head posture were eliminated. Two patients with binocular lateral rectus muscles paralysis were in mild undercorrection which were resolved by wearing 8△and 10△prisms respectively. The procedure improved strabismus of 25 eyes from 100.23△ ± 42.61△ preoperatively to 0.82△ ± 2.67△postoperatively ( t=10.797,P<0.001).Ocular movement was improved from -4.52 ±0.51 preoperatively to -2.68 ± 0.63 postoperatively (t=-19.468, P<0.001).? CONCLUSION: Partial rectus muscle transportation procedure for paralytic strabismus due to single rectus muscle paralysis can effectively correct the primary position in paralytic strabismus, eliminate the presence of diploma in primary position and abnormal head posture, and improve the ocular motility, which provides content clinical effects.

Different teaching methods were chosen based on different teaching contents in pharmacological theory teaching.Then teaching contents seem simple,interesting and acceptable.The students were more interested in the subject.The results of investiga- tion showed that teaching quality had improved through using this technology.

To state the importance of scientific research capability and general practitioners training for the poor scientific innovation conditions of general practitioner standardization training by the analysis of several ways to improve the scientific research capacity and the probe of the impact on strengthening the consciousness of scientific research to help general practitioner to better work in the areas of primary care and public health.