Objective To observe the effect of continuous blood purification ( CBP ) in treatment of patients with severe viral encephalitis (SVE) combined with status epilepticus (SE).Methods Twenty-four SVE patients combined with SE were collected.Of which 15 cases received conventional treatment was control group, while 9 cases received CBP on the basis of conventional therapy was treatment group.The two groups were observed for curative effects.Results Compared with the control group, the remission time of fever, consciousness recovery, status epilepticus and mechanical ventilation were significantly shortened in treatment group ( all P<0.05 ) .The curative effects between the two groups were no significantly different.Conclusion For SVE patients with SE, the CBP treatment combined with conventional treatment can quickly relieve symptoms and improve the prognosis.

Objective To develop a high performance liquid chromatography(HPLC)method for the determination of active components,sodium ascorbic phosphate,?-arbutin,hydroquinone,niacinamide,brillian-280 and phenol,in the whitening and Freckle-removing cosmetics.Methods Whitening and freckle-removing active components were separated on a C8 column(250 mm?4.6 mm,5 ?m)by using triethanolamine solution(11.15g triethanolamine dissolved in 1 L water,pH=7.7 adjusted with 1.75 ml H3PO4)+methanol=70+30 as the mobile phase at a flow rate of 1.2 ml/min,using diode array detector(DAD)with the detection wavelengh of 273 nm and the column temperature of 25℃.Results The coefficient of variation was less than 4.7% and the recovery rates were 87.3%-112.9%.Conclusion The method introduced in this paper is simple,rapid,accurate and is suitable for the analysis of various cosmetic samples.

To investigate the status of application of Chinese Hypertension Prevention and Treatment Guideline (Guideline) by general practitioners (GPs) in Shanghai.A questionnaire survey was conducted among 260 GPs from 8 communities in Xuhui District of Shanghai during March 2011 to December 2012.Among all participants,94.2％ knew the Guideline.The overall correct rate was 56.2％; that of epidemiology,diagnosis,treatment,two-way referral and community management of hypertension was 49.2％,54.5％,60.6％,56.9％ and 32.3％,respectively.There were significant differences in correct rates of the questionnaire between GPs with different age,gender,education and community (P =0.000,0.035,0.000,0.000).The correct rates of epidemiology and treatment in GP teaching bases (58.5％ and 62.6％) were higher than those in non-teaching bases (39.2％ and 58.4％) (P =0.002,0.040).But there was no difference in overall correct rate between these two groups (P =0.095).The results indicate that the understanding and application of Hypertension Guideline by General practitioners in community is insufficient.Teaching hospitals should carry out systematic,comprehensive,sustained,targeted training course in order to improve the diagnosis and treatment levels of hypertension for general practitioners in community.

Objective To explore establishment of indicator system to evaluate basic capacities of trainers of training for community general practitioners (GPs) to standardize their capacity building and management.Methods Questionnaire survey was conducted among 190 trainers of training for community health managers and GPs who were involved in community health-care and health-care service management in 12 districts of Shanghai to investigate what basic capacities the trainers should have.Delphi expert consultation method was used to construct an evaluation indicator system.Firstly, an evaluation form was formulated based on the preceding questionnaire.Then, two rounds of expert consultation were carried out with 28 experts specialized in general practice, training for GPs, public health and health management.The last step was to set up an evaluation indicator system based on experts' opinions with statistical analysis.Results The newly-established system consisted of five first-grade indicators including comprehensive performance, capacities and personal willingness, background of education and career, personal potential for professional development, capacity in general practice and capacity in training for GPs, and 57 second-grade indicators.Activity coefficient of the experts was all 100%, authority coefficients of the experts were 0.85,and harmonious coefficient of importance of the evaluation was 0.190 and 0.225 ( all P ＜ 0.01 ),respectively, in two rounds of Delphi consultation.Conclusions The preliminarily established indicator system to evaluate capacities of trainers of training for community GPs in diverse aspects can be used as reference for quality critria in selection of trainers of training for community GPs.

Objective To evaluate the emergency repair method and its effect for treatment of extensive avulsion injury of the lower extremity in the elderly patients.Methods From May 2008 to February 2015,11 patients aged over 60 years sustaining large avulsion injury (across the knee or ankle joint) of the lower limb in traffic crushes were treated by emergency debridement and one-stage repair with the procedures of autologous skin replantation,arteriovenous anastomosis and vacuum sealing drainage (VSD).Two patients sustained injury to both lower limbs,and nine patients sustained a unilateral injury.Effect of wound repair was evaluated with skin flap survival area.Active and passive motility of the knee and ankle were recorded at postoperative 24 h.Results One patient with multiple fracture and extensive muscular inactivity due to severe crush injury to the lower limbs had poor blood supply after the replantation and was amputated at postoperative 24 h.The remaining ten patients with large skin avulsion showed 90％ of the avulsed skin survived after operation.At the follow-up of 3-24 months,the ten patients showed no obvious pigmentation or scar tissue,were satisfied with the function recovery in knee (106°-110° in flexion and 0°-5°in extension) and ankle joint (15°-20°in dorsiflexion and 30°-35° in plantar flexion),and could walk freely,including excellence outcomes in 3 patients and good outcomes in 6 patients.Conclusion The emergency repair methods including autologous skin replantation,arteriovenous anastomosis and VSD combined with one-stage in situ repair can attain satisfactory clinical effect.

BACKGROUND:Coracoclavicular ligament reconstruction with transclavicular-transcoracoid driling is an effective surgical technique to treat acromioclavicular dislocation. A good driling in the clavicle leads to a perfect bony tunnel and a good surgery. OBJECTIVE: To observe the effects of different driling positions of the clavicle on the location of bony tunnels in coracoclavicular ligament reconstruction. METHODS:Sixty three-dimensional digital models of the clavicle and coracoid process were constructed by Mimics13.0. Virtual transclavicular-transcoracoid bony tunnels were established according to different surgical planes with different driling positions in the clavicle. Parameters of these bony tunnels were measured, and the safety was evaluated. Option 1: The driling was made 30 mm distal to the clavicle, located in the center of the front and rear edges of the clavicle surface. Option 2: The driling was made 40 mm distal to the clavicle, located in the center of the front and rear edges of the clavicle surface. Option 3: The driling was made at the straight line of tapered nodule tip and the midpoint of the base of the coracoid process, located at the rear edge of the clavicle upper surface. RESULTS AND CONCLUSION: Bony tunnels in option 1 were extremely on the inside of the coracoid. Bony tunnels in options 1 and 2 were not in the center of clavicle. Bony tunnels in option 3 were in the center of both clavicle and coracoid. The method of locating the driling position with a certain distance to the distal clavicle leads to different results in man’s and woman’s models. To ensure that the bony tunnel can pass through the center of clavicle and coracoid, it is suggested to dril at the straight line of tapered nodule tip and the midpoint of the base of the coracoid process and nearby the rear edge of the clavicle upper surface.

Objective To apply 360 degree evaluation in competence assessment of community general practice trainers.Methods The 360 degree evaluation questionnaire was designed by authors and the evaluation was applied to assess the personal comprehensive quality,competence in general practice and teaching of 16 general practice trainers in Fenglin Community Health Service Center of Shanghai Xuhui District.Results The scores of personal comprehensive quality,competency in general practice and teaching were 7.73 ± 0.73,6.91 ± 0.91 and 6.44 ± 1.38,respectively.The total scores from different evaluators were 6.93 ± 0.12 for peers,6.68 ± 0.74 for hospital executives,8.17 ± 0.12 for nurses and 6.43 ± 0.89 from self evaluation (F =27.91,P =0.000).Conclusion The variance between different evaluators in 360 degree evaluation can avoid bias of single one.The results of 360 degree evaluation show that the teaching ability of community general practice trainer is relatively low,suggesting the training of teaching ability should be strengthened for these trainers.

Objective To analyse imaging features of atypical meningioma.Methods There were 17 cases with atypical meningiomas proved by pathology,7 cases were male,10 cases were female,ranged in age from 34～69 years.17 cases all examined with CT,and 10 cases with CT enhanced scanning;12 cases examined with MRI and 8 cases with MR enhanced scanning,5 cases examined with DSA.Results The major imaging features of atypical meningioma included:the borders of tumors were mostly irregular,nonhomogeneous density or signal on plain CT and MRI,nonhomogeneous enhancement on enhanced CT and MRI.Cystic and necrotic changing and the invasion of cranial bone and adjacent structure could be seen.5 cases with dural tail sign on MRI,3 of them,this sign was short,thick and irregular.Heavy staining was showed on DSA.Conclusion Atypical meningiomas are of some clinical and imaging features.

Objective To explore the effect of ParidissaponinⅠ (PSⅠ) on the proliferation of coronary artery endothelial cells (CAECs).Methods CAECs were cultured with PSⅠ.CAEC growth rate was calculated by using blood cell counting plate.Cell viability was measured by MTT.The expressions of cadherin and caspase3 mRNA were detected by RT-PCR.Results PSⅠ slowed down growth rate of CAECs,reduced cell viability of CAECs,decreased the expression of cadherin mRNA and increased the expression of caspase3 mRNA in CAECs.Conclusion PSⅠ inhibits the proliferation of CAECs and induces CAECs apoptosis.

Objective To investigate the relationships between level of serum ferritin(SF)/blood lipid and the degree of coronary artery stenosis in elderly patients with acute coronary syndrome(ACS),and evaluate the value of SF in the diagnosis of coronary heart disease. Methods ①One hundred and twenty-five elderly patients with ACS(65 males,60 females)underwent coronary angiography examination,and the total cholesterol(TC), triglycerides(TG),high-density lipoprotein(HDL-C),low density lipoprotein(LDL-C)and SF were determined;according to the results of coronary angiography,the degree of coronary artery stenosis was obtained by using the Gensini score and the degrees of severity of stenosis were divided into three groups:light(42 cases),medium (45 cases)and severe(38 cases). The differences in levels of SF and blood lipids among the three groups were observed,and the relationships between the level of SF/blood lipids and various degrees of coronary artery stenoses were analyzed.②The elderly patients with ACS were divided into two groups,male and female,to compare the SF numerical value and Gensini score between the two groups. ③The SF numerical value and Gensini score of 65 senile male cases with ACS were compared to those of 60 middle aged male cases with the same disease. Results ①Variance analysis showed that SF,TC,LDL-C distribution had significant differences among light,medium and severe groups〔SF(μg/L):147.287±73.838,162.313±94.882,290.421±194.501;TC(mmol/L):4.423±0.900,4.998±0.740, 5.032±1.009;LDL-C(mmol/L):3.150±0.799,3.439±0.839,3.902±1.053,all P<0.01〕,while TG,HDL-C distribution among these groups had no such statistically significant differences(all P>0.05);in elderly patients with ACS,SF was positively correlated with Gensini score(r=0.355,P=0.000),while there was no correlation between Gensini score and any one of the following lipids:TC,TG,LDL-C,HDL-C(r=0.090,-0.170,0.256,-0.060,P=0.532,0.092,0.089,0.537).②The comparisons of SF value and Gensini score between senile male and senile female patients with ACS showed no significant differences(all P>0.05).③The comparisons of SF value and Gensini score between senile and middle aged male patients with ACS also showed no significant differences(all P>0.05). Conclusion The occurrence of ACS has certain correlation with SF and lipids,the degree of severity in coronary artery lesion is associated with SF,and there are no differences in age and sex in relation to the value of SF in the diagnosis of ACS.