Objective To summarize the clinical experience of nasal endoscopic treatment for refractory epistaxis. Methods .A retrospective analysis was made on 258 patients with refractory epistaxis treated with intranasal endoscopic exploration and hemostatic treatment from January 1998 to December 2004 in this hospital. Results .Hemorrhage was found on the nasal septum and the lateral nasal wall in 118 and 47 patients, respectively. Nose bleeding resulted from intranasal tumor in 8 patients. The site of bleeding was not clearly identified in 85 patients. Of the 258 patients, 257 responded to the treatment (99.6%) and 1 died ( 0.4%).Recurrent bleeding occurred in 43 patients. The incidence of recurrent bleeding was significantly higher in patients with unknown bleeding sites than in clearly diagnosed patients (?2=17.689,P=0.000). Conclusions .The emphasis of nasal endoscopic treatment for refractory epistaxis should be laid on the initial management, during which the bleeding site should be carefully identified. For patients with repeated nose bleeding, a combination treatment, including endoscopic filling-up of the anterior nasal cavity, endoscopic embolization of anterior and posterior nose, or embolization of the internal maxillary artery, is necessary.

Objective: To investigate the CE fingerprint of Salvia miltiorrhiza . Methods : Separation was performed on a 50?m?50cm uncoated capillary with 20mmol?L -1 borate solution as CE buffer. The run voltage was 15kV and the UV detection was set at 210nm. Results : Fingerprint consisted of 11 common peaks. The validation of methods meet the requirements for SDA's technical regulations. Conclusion : The method was accurate and simple for quality control of Salvia miltiorrhiza.

Objective To explore the effects of electro-acupuncture combined with surface gastric pacing on gastrointestinal dysfunction for patients with spinal cord injury (SCI).Methods Seventy-five SCI patients with gastrointestinal dysfunction were divided randomly into an electro-acupuncture group (group A),a gastric pacing treatment group (group B) and a group for which electro-acupuncture was combined with gastric pacing (group C).There were 25 cases in each group.Members of group A were given 30 minutes of electro-acupuncture per day ; those of group B had 30 minutes of gastric pacing treatment twice per day ; group C was provided with both 30 minutes of electro-acupuncture and one 30-minute gastric pacing treatment per day.All of the interventions lasted ten days.Before and after the treatment,all patients were assessed using a clinical symptoms score and with electrogastrograms,and any adverse effects were observed.Results There was a significant improvement in upper abdominal pain and epigastric discomfort,bloating and early satiety,nausea,vomiting,as well as belching and loss of appetite in each group after treatment.Before treatment there was no significant difference in the average clinical symptom scores of the three groups.After treatment the values had decreased,and those of group C were significantly lower than group A or B.The average scores of groups B and A were not significantly different.The electrogastrogram results showed than after treatment there was significant improvement in N％ and T％ in groups A and B,and also significant improvement in N％,B％ and T％ in group C compared to before treatment.Group C's improvements were all significantly greater than those observed in groups A and B.Conclusion Electro-acupuncture or gastric pacing alone can give some improvement in gastrointestinal function and its electrophysiological indicators,but their combined effects are better than when either is used alone.

ObjectiveTo observe the effect ofTong Du acupuncture-moxibustion, conventional acupuncture, and medication on the bone marrow stem cells (BMSCs) mobilization markers CD34+and CD133+, neurological deficit score in patients with ischemic stroke.Method Totally 120 eligible subjects with ischemic stroke were randomized into aTong Du acupuncture-moxibustion group (group A), a conventional acupuncture group (group B), and a medication group (group C), 40 in each group. In addition to the conventional medication given to all three groups, patients in group A also received moxibustion at Baihui (GV20), bloodletting at Dazhui (GV14), and acupuncture at Fengchi (GB20), Quchi (LI11), Hegu (LI4), Zusanli (ST36), and Sanyinjiao (SP6); patients in group B also received acupuncture at Fengchi, Quchi, Hegu, Zusanli, and Sanyinjiao; group C received patent Chinese medicine Tong Xin Luo capsules. The intervention lasted 14 d in all three groups. The CD34+and CD133+and neurological deficit score were evaluated and compared before and after intervention.Result The three treatment methods all significantly increased the level of CD34 + and CD133+in peripheral blood (P<0.05,P<0.01); the intergroup comparisons showed significant differences among the three groups (P<0.05), and the level in group A was significantly different from that in group B and C (P<0.05), while there was no significant difference between group B and C (P>0.05); the three treatment methods all improved the neurological deficit score to various extent, and the result in group A was significantly different from that in group B and C (P<0.05,P<0.01), and there was also a significant difference between group B and C (P<0.05).ConclusionsTong Du acupuncture-moxibustion, conventional acupuncture, and medication can influence the BMSCs and neurological deficit to different extent; the effect ofTong Du acupuncture-moxibustion on the BMSCs and neurological deficit is more significant than that of the conventional acupuncture and medication, suggesting thatTong Du acupuncture-moxibustion method should have advantage in treating cerebral infarction.

Objective To evaluate the effects of different depths of anesthesia with sevoflurane on cerebrovascular autoregulation in infants.Methods Twenty pediatric patients,of ASA physical status Ⅰ,aged 1-3 yr,undergoing elective hypospadias plasty surgery,were enrolled in the study.Single tube laryngeal mask was inserted after anesthesia was induced with 6％ sevoflurane inhalation.Caudal block was performed with 1 ml/kg of 0.2％ ropivacaine.Anesthesia was maintained with sevoflurane inhalation.The end-tidal sevoflurane concentration was adjusted to 1.8％,2.5％,3.3％ and 4.0％,and each concentration was maintained at this level for 15 min.The cerebral blood flow was collected from the middle cerebral artery immediately before adjusting the next concentration to record the Doppler spectrum and transient hyperemic response ratio (THRR) was measured.Results THRR at different depths of anesthesia with sevoflurane was larger than 1.09,and was within the normal range.THRR was significantly lower when the end-tidal concentration was 2.5％,3.3％ and 4.0％ than that obtained when end-tidal concentration was 1.8％.No significantdifference was detected in THRR between 2.5％ and 3.3 ％.THRR was significantly lower when the end-tidal concentration was 4.0 ％ than that obtained when the end-tidal concentration was 2.5％ and 3.3％.Conclusion Although the inhibitory effect on cerebrovascular autoregulation provided by sevoflurane anesthesia provides no obvious clinical significance,it shows statistical significance in infants.

Objective To detect the dynamic Th17 cells in a murine model of irritable bowel syn-drome ( IBS) and to study the effect of aryl hydrocarbon receptor ( Ahr) on Th17 cells activation .Methods Thirty BALB/c male mice were randomly divided into three groups including experiment group ,control group and Ahr antagonist group .A murine model of IBS was established by perfusing three nitrobenzene sulfonic acid (TNBS) into the colon of mice.Equal volume of saline was used to set up the control .The mice in Ahr antagonist group were intraperitoneally injected with 10 μg Ahr antagonist for four consecutive days .All mice were evaluated for visceral hypersensitivity and colonic mucosal inflammation .Mesenteric lymph nodes (MLNs) and peripheral blood mononuclear cells (PBMCs) were detected by flow cytometry through staining Th17 cells.The distribution of Ahr and IL-17A in colon and the number of Th17 cells activated by Ahr (Ahr and IL-17A double positive ) were detected by double immunofluorescence staining .Results ( 1 ) The percentage of Th17 cells in MLNs was significantly increased in experiment group followed by those in Ahr antagonist group and control group (P<0.05).(2)Compared with control group,the number of Th17 cells in peripheral blood samples was significantly increased in experiment group and Ahr antagonist group ( both P<0.05 ) ,but there was no difference between Ahr antagonist group and experiment group ( P=0.642 ) .( 3 ) The number of Ahr-activated Th17 cells ( Ahr+IL-17A+) was significantly increased in experiment group (10.00±1.58) as in comparison with that in control group (3.80±0.83,P<0.05),but the number was de-creased with Ahr antagonist intervention ( 5.80 ±0.83 , P<0.05 ) .Conclusion The number of activated Th17 cells was increased in MLNs and peripheral blood samples from mice with IBS .Ahr played an important role in the activation of Th17 cells in intestines.However,the number of Ahr-activated Th17 cells in intestinal mucosa and the proportion of Th 17 cells in MLNs could be down-regulated through blocking Ahr .

Objective To study the cardiac function effect of allopurinol for hypemricemia combined with dilated cardiomyopathy patients.Methods One hundred and twenty hypemricemia combined with dilated cardiomyopathy patients were divided into allopurinol group and control group according to the treatment method with 60 cases each.All the patients were given conventional treatment,the control group was added the nitroprusside treatment,and the allopurinol group was added the allopurinol and nitroprusside treatment.The treatment period was 3 months.Results The total effective rate in allopurinol group was significantly higher than that in control group [90.0％ (54/60) vs.75.0％ (45/60)],there was statistical difference (P ＜ 0.05).After treatment,the left ventricular ejection fraction and left ventricular posterior wall thickness at end-systole in allopurinol group were significantly higher than those in control group [(67.85 ± 7.12)％ vs.(30.78 ±7.00)％ and (1.40 ±0.20) mm vs.(1.16 ±0.18) mm[,but the left ventricular internal diameter at end-systole,left ventricular internal diameter at end-diastole and left ventricular posterior wall thickness at end-diastole were significantly lower than those in control group [(4.72 ± 0.41) mm vs.(6.48 ± 0.47) mm,(2.93 ± 0.32) mm vs.(5.56 ± 0.62) mm and (0.77 ± 0.13) mm vs.(0.92 ± 0.18) mm],there were statistical differences (P ＜ 0.05).After treatment,The uric acid,urea nitrogen and creatinine were significantly lower than those in control group [(45.43 ± 11.24) μ mol/L vs.(167.23 ± 19.22) μ mol/L,(10.23 ± 7.12)mmol/L vs.(40.93 ± 8.09)mmol/L and (32.01 ± 8.34) mmol/L vs.(78.09 ±9.11) mmol/L],there were statistical differences (P ＜ 0.05).Conclusion Allopurinol used for treating hyperuricemia combined with dilated cardiomyopathy patients can reduce uric acid,early reversal the atherosclerosis and improve heart function,it should be widely applied research.

Department of General Medicine in Zhongshan Hospital,Fudan University was founded in 1994,which was the only unit established in a tertiary hospital in the country at that time,engaged in clinical practice,teaching and research of general practice.Zhongshan Hospital won the second prize of National Teaching Achievement in 2014 forExploration and innovation of training system of general practitioners in China,which contributed to development of standardized training system of general practitioners suitable to China's national conditions.This article summarizes the experience in training general physician,development of disciplines and enhancing influence of Zhongshan Hospital over years,hopefully it will be of reference value for medical educators.

Objective To explore the expression of ErbB3 in osteosarcoma cell lines Saos-2 and its significance.Methods Real-time quantitative PCR was used to detected ErbB3 mRNA expression in osteosarcoma cell lines Saos-2 and normal human osteoblasts cell lines N704,and Western blotting was used to detected ErbB3 protein expression.Short hairpin RNA was used to construct ErbB3 knockdown cells and the cell count in 0-3 d was detected.The 48 h survival rates of ErbB3 knockdown cells and normal Saos-2 cells were detected in the presence of 0-100 μmol/L paclitaxel.Results Real-time quantitative PCR showed significant enhanced ErbB3 mRNA expression in Saos-2 cells compared with N704 [(4.15 ± 0.04) times,t =7.31,P ＜0.05],and Western blotting showed significant enhanced ErbB3 expression in Saos-2 cells compared with N704.As compared with normal Saos-2 cells,ErbB3 knockdown could reduce the Saos-2 cells proliferation,at the first three days in culture,the Saos-2 cell number of ErbB3 silent was (22.2 ± 2.9) thousand,and the control was (45.8 ± 4.1) thousand,with statistical significance (t =8.23,P ＜ 0.05).Moreover,ErbB3 knockdown could reduce the Saos-2 cells tolerance to paclitaxel,when treated with 20 μmol/L paclitaxel,surviving cells in ErbB3 silent group was (43.2 ± 4.7) ％,and the control was (61.4 ± 5.9) ％,with statistical significance (t =6.74,P ＜ 0.05).Conclusion ErbB3 highly expresses in Saos-2 cells,ErbB3 expression can enhance the proliferation of Saos-2 cells and the tolerance of Saos-2 cells to paclitaxel.

Talent training is the foundation for discipline construction and it is also the fundamental guarantee of hospital's sustainable development.The affiliated Zhongshan hospital of Fudan university launched investigations from the teaching management,teaching staff,resident and clinical skills to look for problems in clinical teaching and to propose improvement measures aiming at improving the clinical teaching and promoting hospital resident and specialists training.