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.

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 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.

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 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 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 discuss the lung protective effect of Shenfu injection on the legs' ischemia-reperfusion injury.Methods Sixty patients (6 males, 24 females, ASA grade Ⅰ or Ⅱ)with unilateral lower limb surgery, were randomly divided into Shenfu injection group (group SF, n=32) and control group (group C, n=28).All patients were treated by combined spinal epidural anesthesia, with the same dose of local anesthetic (0.75% bupivacaine 1.5 ml and the same pressure (300mm Hg) of tourniquet.Patients in group SF were given intravenous infusion of Shenfu injection with the dose of 1 ml/kg (added in normal saline 100 ml) 30 min before apply tourniquet and 1 ml/kg (added in nomal saline 50 ml) 5 min before tourniquet deflation.Patients in group C were injected with equal dose of compound sodium lactate at the same time.Recorded the hemodynamic changes before apply tourniquet (T0) and 5 min (T1), 15 min (T2) and 30 min (T3) after tourniquet deflation.Took venous blood to determine concentrations of plasma thromboxane B2 (TXB2) and malondialdehyde (MDA).Results Compared with T0, MAP in the two groups were significcantly lower at T1-T3 (P＜0.05).MAP in group SF at T2 and T3 were higher than those in group C (P＜0.05).There was no significant difference in HR between the two groups.TXB2 and MDA in group SF at T2 and T3 were significantly lower than those in group C (P＜0.05 or P＜0.01).Conclusion Shenfu injection with antioxidation has a protective effect on lower limb ischemia-reperfusion lung injury induced by tourniquet.

Objective To study the risk factors,clinical manifestations,drug sensitivity and outcomes of preterm infants with aerogenes infection in NICU.Method Preterm infants diagnosed to have infection of aerogenes in our NICU during July 2014 to October 2014 were selected as the infection group in our study.Uninfected preterm infants whose gestational age and birth weight were similar to the infants in infection group were selected as the control group.The ratio of number of infants in infection group and control group was 1 ∶ 2.The basic situation,clinical application of antibiotics before infection,defecation times,invasive manipulations,and parenteral nutrition time of the two groups were retrospectively collected.The clinical manifestations,drug sensitivity and outcomes of preterm infants with aerogenes infection were analyzed.Result There were 8 infants in infection group (male:female =3∶5).The birth weight ranged from 780 to 2 760 g;and gestational age from 28 to 33 w.There were 16 infants in the control group (male:female =1 ∶ 1).The birth weight ranged from 1 070 to 1 780 g,and gestational age,from 29 to 33 w.The incidence of prenatal infection in infection group was higher than that in the control group (3/8 vs.4/16,P ＜ 0.05).Comparing the two study groups,there were statistical differences between them in the following aspects (all P ＜ 0.05):non-invasive respiratory support time [11 (6,36) d vs.4 (0,6) d] and invasive mechanical ventilation time [(1 (0,6) d vs.0 (0,0) d].All the 8 infants in infection group had pneumonia,3 of them with sepsis (1 case was extremely low birth weight infant,and 2 cases were very low birth weight infants),and one of them died from septic shock.Drug sensitivity analysis showed that aerogenes were resistant to all the third generation cephalosporins,and were sensitive to Meropenem and Piperacillin/Tazobactam.The resistance rates of Imipenem were 1/6 in the first month,2/6 in the second month,9/11 in the third month,and 2/4 in the fourth month,respectively.Conclusion Avoidance of prenatal infection and shortening of the application of ventilator may reduce the incidence of aerogenes infection.Most of infants with aerogenes infection have favourable prognosis.The resistance rate of third generation cephalosporins is very high.Aerogenes could develop resistance quickly to the antibiotics which is sensitive initially.