Objective To evaluate left ventricular function in the way of intracavitary flow dynamics by vector flow mapping (VFM) with echocardiography, and to discuss its clinical usefulness. Methods Twenty-six patients with dilated cardiomyopathy(DCM) and 44 healthy controls were involved. The velocity distribution imagings on the section plane of the flow in the left ventricle were obtained by VFM,and series parameters of velocity and distance were measured with DSA-RS1 software,including systolic parameters,such as velocity gradient from cardiac apex to the aortic valve(△Vs) ,distance from cardiac apex to the aortic valve(Ds), velocity according to half distance (Vs1/2), and diastolic parameters, such as velocity gradient from the mitral orifice to the apex(△Vd), distance from mitral orifice to cardiac apex(Dd),velocity according to half distance(Vd1/2). Results Compared with the values in the control group, parameters of systolic velocity(△Vs, Vs1/2 ) and parameters of diastolic velocity ( △Vd, Vd1/2 ) were significantly lower, parameter of systolic distance (Ds) and parameter of diastolic distance (Dd) were significantly longer( P ＜0.05). Ds,Dd were positive correlated with left ventricular(LV) end-diastolic volume(EDV), end-systolic volume (ESV) ,LV diameter ( r ＞0.4, P ＜0.01 ), and negtively correlated with LV ejection fraction(EF) ( r ＞0.3, P ＜0.01 ). Vs1/2, Vd1/2 were negtively correlated with EDV, ESV, LV diameter ( r ＞0.3, P ＜0.01 ),and positive correlated with EF( r ＞0.3, P ＜0.01 ). Conclusions The velocity of DCM group was lower than that of control group, VFM is a new noninvasive and clinically useful parameter for the evaluation of intracavitary flow dynamics.

AIM:To observe the effect of Rheum emodi Wall on expess level of TNF-?、IL-1? and IL-6 on acute ischemic stroke(ACI)at high altitude. METHODS: 65 patients aith ACI at high altitude(2 260 m)were randomly divided into treatment group(34) and control groups(31).both groups received danshen-safflower injection.Meanwhile treatment group took Rheum emodi decoction orally for 4 weeks,while control group doesn't.Serum levels of TNF-?、IL-1? and IL-6 were measured by radioimmumoassay. RESULTS: The treatment group showed much higher rates of improvement than control group(88.24%;70.97%)after weeks.Serum levels of TNF-?、IL-1? and IL-6 decreased significantly in patients with ACI at treatment group as compared with those of control group. CONCLUSION: Rheum emodi Wall can improve the nervous function of ACI by reducing TNF-?、IL-1? and IL-6 content in serun.

Objective To investigate problem-based learning(PBL)in clinical teaching of pediatric interns.Methods To compare and analyze the grades of pediatric interns’case writing before and after PBL.Results There was significant difference between the two groups and the grades of interns by PBL were notably higher.Conclusion PBL can improve the interns’ability of case writing,clinical thoughts,operation ability,and enhance their enthusiasm in learning.

Objective To investigate the relation between symptoms/pulmonary function and airway inflammation of asthmatic children through follow-up investigation on the pulmonary function and airway inflammatory,in order to provide basis for regular asthmatic therapy.Methods The pulmonary function and histamine challenge test of 32 cases of 7～14 years old asthmatic children under regular inhalation corticosteroid(ICS) therapy were carried out and the relation between the symptoms/pulmonary function and airway reactivity were evaluated.Results During the remission period after regular ICS therapy,the mean of one second force expiratory volume(FEV_1),25% and 50% of vital capacity of force expiratory flow(FEF_ 25 and FEF_ 50 ) predicted improved significantly when comparing with those prior to the therapy(P

Objective To measure the expression of granulocyte colony-stimulating factor receptor (G-CSFR) in human melanocytes and to evaluate the biologic effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on human melanocytes.Methods Melanocytes were obtained from circumcision specimens of healthy males,and neutrophils were isolated from heparin-andcoagulated peripheral blood of healthy human followed by a primary culture.Then,the melanocytes in third passage were cultured with or without the presence of various concentrations (200,400,600,800 μg/L) of rhG-CSF for 72 hours.The growth and morphology of melanocytes were observed.Flow cytometry was performed to detect the expression of G-CSFR in untreated human melanocytes,neutrophils and erythroleukemia cells (HEL 92.1.7).Western blot and reverse transcription PCR (RT-PCR) were carried out to measure the expression of G-CSFR protein and mRNA respectively in the neutrophils,HEL 92.1.7 cells,treated or untreated human melanocytes.Methyl thiazolyl tetrazolium (MTT) assay was performed to evaluate the proliferation,and dopa-oxidation assay to estimate the tyrosinase activity,of treated melanocytes.Results The expression rate of G-CSFR was 76.81％ ± 10.70％ in human melanocytes,significantly higher than that in the HEL 92.1.7 cells (2.53％ ± 1.54％,P ＜ 0.01 ),but lower than that in the neutrophils (85.76％ ± 15.71％,P ＜ 0.05).Both G-CSFR protein and mRNA were expressed in melanocytes,and there was no significant differences in the expression level of G-CSFR protein and mRNA among melanocytes treated with different concentrations of rhG-CSF (both P ＞ 0.05).The expression levels of G-CSFR protein and mRNA in the melanecytes were significantly higher than those in the HEL 92.1.7 cells (both P ＜ 0.01 ),but lower than those in the neutrophils (P ＜ 0.05 or ＜ 0.01 ).rhG-CSF at 200-800 μg/L displayed a significantly promotive effect on the proliferation of melanocytes (P ＜ 0.01 or ＜ 0.05 ),and the effect was in a dose-dependent manner when rhG-CSF ranged from 200 to 600 μg/L (P ＜ 0.01 ).The rhG-CSF at 600 μg/L and 12-O-tetradecanoyl-phorbol-13-acetate (TPA) at 20 μg/L showed an equivalent effect on the proliferation of melanocytes (164.04％ ± 13.0％ vs.165.62％ ± 10.6％,P ＞ 0.05).However,rhG-CSF from 200 to 800 μg/L had no significant impact on the tyrosinase activity of melanocytes (all P ＞ 0.05 ).Conclusions G-CSFR is expressed in human melanocytes. rhG-CSF can promote the proliferation of cultured human melanocytes,but has no obvious influence on the tyrosinase activity of melanocytes.

Objective To explore the predictive value for coronary heart disease by epicardial adipose tissue(EAT) thickness and carotid intima-media thickness(IMT) measured with high-frequency ultrasound.Methods According to the results of coronary angiography, the cases were divided into the normal control group (29 patients),coronary artery disease group with single-vessel lesion (43 patients),coronary artery disease group with multi-vessels lesion (28 patients), respectively. EAT and IMT were measured by high-frequency ultrasound. Results The EAT in the three groups were (4.8 ± 1.3) mm, (7.6 ± 1.8) mm,(10.1±2.6) mm respectively, and the IMT were (0.8±0.1)mm,(1.0±0.2)mm,(1.1 ± 0.2)mmrespectively. In either coronary artery disease group with single-vessel lesion or multi-vessels lesion, the EAT and IMT were significantly higher than those in the normal control group ( P＜ 0.01 ). And the difference between groups of single-vessel lesion and multi-vessels lesion was also statistically significant (P＜ 0.01). The areas under receive operating characteristic(ROC) curve to predict coronary heart disease by EAT and IMT was 0.947 and 0.917, respectively, there was no significant difference between the two areas. For patient with coronary artery stenosis＞50%, the sensitivity and specificity of EAT＞6 mm were 90.1% and 86.2% ,respectively,the sensitivity and specificity of IMT＞0.85 mm were 87.3% and 82.8%,respectively. Conclusions EAT and IMT measured by high-frequency ultrasound can precisely predictcoronary heart disease. EAT can be a new predictor to diagnose coronary heart disease.

Objective To investigate the clinical characteristics of tuberculous pleurisy(TP) in children in order to provide a good solution to the diagnosis and treatment of this disease.Methods Retrospective analysis was performed on the clinical data of 113 cases confirmed with TP who were admitted to Children's Hospital of Chongqing Medical University from January 2009 to December 2014.Results Among the 113 pediatric inpatients with TP,85 cases (75.2％) were sick for less than 1 month;92.9％ (105/113 cases) age ≥≥5 years old by onset;and 21.2％ (24/113 cases) patients demonstrated the contact with tuberculosis ,among whom 70.8％ (17/24 cases) attributed to linear relatives.The primary clinical manifestations included fever[96.5％ (109/113 cases)], cough [76.1％ (86/113 cases)] and chest pain[38.9％ (44/113 cases)] ,with as high as 89.0％ (87/109 cases) of the patients experiencing moderate or ardent fever.The positive rates of acid-fast bacilli smear and mycobacterium tuberculosis culture were 12.2％ (17/139 cases) and 22.7％ (15/66 cases), respectively;among the 41 patients who received pleural biopsy,40 cases (97.6％) were identified with the typical pathological changes in tuberculosis;and all 11 patients who received acid fast stain test on pleural tissues were positive to the test.Pulmonary parenchymatous lesions were revealed on CT examination in 89.1％ patients(98/113 cases),82.4％ (90/109 cases) of the patients had normal body temperature within a short period,and reduced effusion was revealed in 86 out of 98 patients who received repeated chest imaging examinations.Conclusions TP in children has acute onset typically, and the diagnosis of TP in children is more difficult than in adults,requiring considering multiple factors.Contact history with tubercular patients, etiological examination, pleural biopsy and chest CT are essential for the diagnosis of this disease.

Objective To investigate the risk factors of hypersensitivity induced by compound sulfamethoxazole (Co-SMZ)in patients with human immunodeficiency virus (HIV)infection.Methods A retrospective study was performed in 111 patients with HIV infection receiving prophylactic Co-SMZ at the Department of Infectious Diseases,the Third People′s Hospital of Nantong City,Jiangsu Province from January 2014 to December 2014.Data including age,gender,interval time from diagnosis of HIV infection to hospitalization,history of drug allergy,and the counts of CD3 + T cell,CD4 + T cell,CD8 + T cell and natural killer (NK)cell on the day when the medicine was administrated for the first time were recorded. All the patients were followed up for two months.Student t test was used in data with normal distribution or approximate normal distribution.Rank sum test was used in data with skew distribution.The count materials were examined byχ2 test.Results Among the 111 patients with HIV infection,there were 107 males and 4 females with average age of (45 .7±11 .1)years old.The interval time from taking Co-SMZ to hypersensitivity was (14.0±7.6)d.There were differences in the counts of CD4 + T cell and NK cell between patients with hypersensitivity and without hypersensitivity (both P <0.05).Multivariate analysis showed that NK cell was a risk factor for inducing hypersensitivity (OR=1 .010,95 %CI :1 .005 -1 .017, P =0.001).The area under of receiver operating characteristic curve predicting hypersensitivity induced by Co-SMZ was 0.748 (95 %CI :0.647-0.850,Z =4.701 ,P =0.001).The best predictor was 109.80/μL with sensitivity of 63.2% and specificity of 84.7%.Conclusion In patients with HIV infection,NK cell might be associated with hypersensitivity induced by Co-SMZ.

The computerized imitating system constructed by the Second Affiliated Hospital of Guangzhou Medical University contains four blocks:administration of student infomation,administration of question bank,on-line tests and administration of score inquiry.It's designed to imitate typical pediatric cases,so that the medical students may put themselves into the practical clinical scenario and solve the challenges step by step in one-direction procedure.Teaching with computerized clinical scenario imitating patients can improve students' test resuhs and activate students' learning enthusiasm significantly.It not only helps to solve the contradiction between increasing number of medical students and clinical typical teaching case shortage but also improves the clinical thinking ability of the medical students.This system can also be used as a test bank for pediatric technical skills examination.

Objective A computerized clinical scenario imitating patients and clinical course variation for situation simulating teaching were established due to lack of typical patients,inadequacy of resourees in pediatric teaching probation and simplification in traditional teaching pattern.Methods Data of clinical typical patients were collected and recorded into video,and then these data were synthesized and put into computer,designing a computerized clinical setting imitating patients' set.216 uodergraduate students from grade 2008 were randomly divided into 2 groups.The patients in experimenial group were taught with computerized clinical scenario imitating patients,while traditional clinical probation in the hospital ward was carried out for those in the control group.Examination and questionnaire survey were performed at the end of the study.t test was used in statistical analysis.Results Comparison between the two groups using questionnaire survey showed that the learning motivation encouragement,active participation in teaching,guidance of clinical logical thinking and judgment,improvement of clinical thinking capacity,acceptance rate in classroom,preference rate were better in the experimental group than those in the control group (P ＜0.05).Student's performance in examination in the experimental group was higher than those in the control group ( P ＜ 0.05).Conclusion Teaching with computerized clinical scenario imitating patients is a teaching method closely related to clinical situation.It can significantly activate student's learning enthusiasm,improve clinical thinking and judgment capability,avoid risk of medical care and establish a new teaching setting for clinical pediatric teaching.