Objective To study the association of peptidylarginine deiminase 4 (PADI4) (padi4_94 and padi4_104) genetic single nucleotide polymorphism (SNP) and rheumatoid arthritis (RA) susceptibility in Han population of Hebei province. Methods This hospital-based case-control study included 115 RA patients and 106 healthy controls. All the individuals were recruited from Han Hebei residents and were randomly selected. The genotype and allele frequencies of PADI4 gene polymorphisms (padi4_94 and padi4_104) were analyzed by PCR-DNA sequencing method. Results The distribution of padi4_94 and padi4_104 genotypes between the two groups was not significantly deviated from that expected by Hardy-Weinberg equilibrium (P>0.05). The combined effect of padi4_94 and padi4_104 SNPs was analyzed and three haplotypos (AA, AG and GG) were found but without GA haplotype. The genotype and allele distribution of padi4_94 and padi4_104 in the patients with RA was not significantly different from that in healthy controls,and the analysis of haplotypes revealed that no haplotypes were risk factors for RA. Conclusion In Han population of Hebei province, the SNPs of PADI4 (padi4_94 or/and padi4_104) is no associated with RA susceptibility. Therefore, it should not be regarded as a genetic risk factor for RA.

Objective:To analyze the curative effect of discectomy under Quadrant expandable channel associated with annulus repair for the treatment of adolescent lumbar disc herniation (ALDH).Methods:10 ALDH patients received discectomy under Quadrant expandable channel associated with annulus repair (annulus repair group) and 12 patients received discectomy (control group) in Clinical Medical College of Yangzhou University from January 2013 to December 2017 were retrospectively collected. The length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared. The degree of pain was assessed by visual analogue scale (VAS) before operation, 24 h, 1 week and 1 year after operation, and the lumbar function was assessed by Oswestry disability index (ODI) before operation, 1 week and 1 year after operation. At the last follow-up, the curative effect was evaluated by MacNab Scale, and the recurrence of lumbar disc herniation during the follow-up was recorded.Results:There were no significant differences in the amount of intraoperative bleeding, operation time and duration of hospitalization between the two groups ( P>0.05). The skin incision length of the annulus repair group was less than that of control group ( P<0.05). The postoperative VAS score and ODI score at each follow up time point in both groups were significantly improved when compared with the preoperative ones ( P<0.05). There were no statistically significant difference between the two groups in the VAS score and ODI score 1 week postoperative and 1 year postoperative ( P>0.05). According to the MacNab criteria, there was no statistically significant difference between the two groups in the excellent and good rate (annulus repair group: 9/10, control group: 10/12; P>0.05). There was no recurrence case in the annulus repair group, but two cases of recurrence (one recovered by conservative treatment, the other needed second operation) in the control group ( P<0.05). Conclusions:Discectomy under Quadrant expandable channel associated with annulus repair can achieve early satisfied outcome, reduce surgery related trauma, pain in the early period postoperative and recurrence rate after operation in the treatment of ALDH.

Objective To investigate the clinical characteristics of hospital infection and the pathogen type,distribution and drug resistance,in the intensive care unit of our hospital,to direct proper antibiotics use and supply the scientific basis for hospital infection control. Methods The clinical data of 392 inpatients in our intensive care unit from April 2008 to March 2010 were monitored prospectively and analyzed retrospectively. Results Of the 392 impatients,78 cases had hospital infection (19.89% 78/392),112 time-case infection (28.57% 112/392). The most common infection was the main respiratory tract infections accounted for 54.46% (61/112) ,followed by urinary tract infections accounted for 15. 19% ( 17/112 ), blood infection accounted for 11.61% (13/112). 152strains pathogens were identified in the study,in which G- bacilli accounted for 69.7%, G+ bacteria accounted for 17. 8% and fungi accounted for 12.5%. Main pathogens such as acinetobacter baumannii ,pseudomonas aeruginosa,klebsiella pneumoniae, staphylococcus aureus showed multiple drug resistance in different degrees. Conclusions Intensive care unit has a high nosocomial infection rate,lower respiratory tract infection is the most frequent type and the main pathogens have different degrees of multi-drug resistance. Standardized, rational use of antibiotics,prevention of the multi-drug resistant bacteria spread may help to reduce the occurrence of hospital infection in intensive care unit.

Objective:To explore the functions of cytokines and TM in the pathogenesis of acute cerebral infarction.Methods:The levels of IL-1、IL-6 、TNF and TM were detected by ELISA in 55 patients with acute cerebral infarction.Results:The levels of IL-1、IL-6 、TNF and TM were increased significantly in the patients with acute cerebral infarction in comparision with the controls ( P

Objective To study the gene polymorphism at position padi4_94 in Chinese Han people of Hebei Province and the characters of distribution.Methods 106 healthy individuals and 115 rheumatoid arthritis patients in Hebei Province were randomly selected. Padi4_94 gene was screened by sequencing of the promotor. The correlations between the SNP site and anti-cyclic citrullinated peptide antibody (anti-CCP) was discussed.Results There were three genotypes: AA, AG and GG in Chinese Han people of Hebei Province. No significant differences of gene frequency and allele gene frequency were found between healthy individuals and RA patients, and no correlation between SNP and the production of anti-CCP.Conclusions Hebei Province The gene polymorphisms at position padi4_94 existed in Chinese Han people of Hebei Province,but possibly would not affect RA susceptibility and the production of anti-CCP.

OBJECTIVE To investigate the problems and countermeasures in the chemical disinfectants application.METHODS To analyze the existing problems in the chemical disinfectants application from 8 hospitals of different care levels at the same city and provide corresponding measures.RESULTS There were many problems in the use of chemical disinfectants,therefore the key points were enhencing the leadership and management standards,staff training,of corresponding knowledge and the correct methods,and strengthening the guidance,inspection and supervision by functional departments.CONCLUSIONS Medical personnel must properly use the chemical disinfectants to ensure the medical safety and prevent hospital infection effectively.

Objective To sum up the clinical experience in diagnosis and treatment of spinal primitive neuroectodermal tumor (PNET). Methods Thirteen patients with spinal PNET were included in the study from 1999 to 2009. There were 8 males and 5 females with the mean age of 26.9 years. The lesions involved the cervical spine in 6 cases, the thoracic segment in 1 case, the lumbar segment in 5 cases and the sacrum in 1 case. The diagnosis of PNETs was made in nine patients by postoperative pathological examination. Among them, 6 patients received a preoperative CT-guided percutaneous biopsy. The other four patients were diagnosed only by CT-guided percutaneous biopsy. Osteolytic bony lesions and obvious neurological deficit were found in ten patients, while the other 3 had complained of local pain only. Nine patients had received operation followed by chemotherapy and radiotherapy. The other 4 underwent only chemotherapy and radiotherapy. The changes of symptoms and time of survival were recorded. Results Eleven patients were followed up with the mean of 21.8 months. The back pain in 7 patients who underwent operation relieved one month after the operation. The bladder and bowel function returned to normal condition after the operation. Among them, four patients died postoperatively. The mean survival time was 11.3 months. The otherthree patients survived with an average of 36 months. Three patients who had only received chemotherapy and radiotherapy died with an average of 7 months, while the other patient survived for 5 months. Conclusion The diagnoses of spine PNET mainly depend on pathological examination. Percutaneous CT-guided biopsy is a reliable method to confirm diagnose of tumor before surgery. The mortality rate of spinal PNET which is a highly malignant tumor is high. Operation can relieve clinical symptoms and improve patients' life quality, but not prolong the survive time.

Objective To improve the mode of clinical medicine postgraduates for specialty degree by OSCE. Methods Clinical medicine postgraduates for specialty degree of Grade 2010 and 2011 were enrolled as research objects. The OSCE scores of the students of Grade 2010 were analyzed and the problems in clinical skills training were summarized. In the last year of clinical training for the clinical medical students of Grade 2011, the reform of clinical skills training was implemented with such improvement measures as publishing last year achievement, analyzing OSCE assessment, strength-ening the supervision of the department of clinical skill training, strengthening the examination as-sessment efforts and organizing collective training. And finally the OSCE scores of the students of Grade 2011 were compared with the scores of the students of Grade 2010. SPSS 19.0 was used to analyze the OSCE scores. Quantitative data were expressed as x±s. T test and Chi-squared test were em-ployed to do statistical analysis, with the inspection level of α=0.05. Result The graduate exami-nation OSCE scores of clinical medicine professional master's degree postgraduates of Grade 2010 display that the failure rate of SP, Physical, Surgical Operation, CPR and Case analysis are more than 5%. After the improvement of clinical skill training, using independent samples t test and chi square test, and contrasting grade 2010, the failure rate of the OSCE score of Grade 2011 in physical examination, surgical operation, site emergency station, CPR station, and case analysis station is significantly improved (P<0.05). Conclusions Improving the mode of clinical skill training by OSCE and performance analysis can effectively enhance clinical competence.

Objective To elucidate the association of the susceptibility for rheumatoid arthritis ( RA )and peptidylarginine deiminase 4(PADI4) genetic single nucleotide polymorphism (SNP) in Han population in Hebei province.Methods This hospital-based ease-control study included 105 untreated RA patients and 96 healthy controls.The genotypes and allele frequencies of padi4_92 gene polymorphisms were analyzed by PCR-RFLP method,and the analysis of linkage disequilibrium and haplotype construction were performed for padi4_92,padi4_94 and padi4_104 SNPs.The Peason Chi-square test and Woolf statistic method were used to analyze the odds ration (OR) and 95％ confidence interval (95％CI).Results Significant differences in the frequency of PADI4 alleles and genotypes between the cases and controls were observed.The combined effect of padi4_92,padi4_94 and padi4_104 SNPs was analyzed by SHEsis snd Genehunter software,and got three haplotypes,CCC,GTT and GCC.There was significant difference in haplotypes distribution of 3 SNPs of padi4 between the two groups.This analysis of haplotypes revealed that haplotype of PADI4 was a risk factor for RA The ORs for these three haplotypes for RA susceptibility were 0.634 (95％CI=0.425-0.946),1.306 (95％CI=0.864-1.975),4.286 (95％CI=1.274-14.424),respectively.Conclnsion The SNPs of PADI4 may contribute to genetic susceptibility to RA in Han population in Hebei Province.

Objective To observe the perioperative complications for metastatic cervical tumor,and explore their possible risk factors.Methods From January 2012 to January 2016,57 patients undergoing surgery for cervical spine metastasis were retrospectively analyzed,who were followed-up for at least 12 months or until death.Data collected included pain (a 10-point visual analogue scale,VAS),Karnofsky performance status score,neurologic status according to Frankel scale,perioperative complications,postoperative mortality and so on.Results The VAS score decreased significantly postoperation (P＜0.001).The Frankel grade was significantly improved (P=0.025).The Karnofsky score was also significantly improved (P＜0.001).The rate of local recurrence was 12.3％.Perioperative mortality rate (30 days after surgery) was 3.5％.Perioperative complication incidence was 24.6％.Univariate analysis found that comorbidity,preoperative Karnofsky score ＜60,multisegmental resection,and intraoperative blood loss ＞300ml were significant risk factors for the complication.Multivariable analysis showed that iIntraoperative blood loss ＞300ml and preoperative Karnofsky score ＜60 were the independent predictors for the complication.Conclusions Surgical management for cervical spinal metastasis is effective in terms of neurological recovery,pain control,and performance status recovery.However,the surgery had a high risk of complications that special attention should be paid to.Furthermore,complications might be related to preoperative Karnofsky score and intraoperative blood loss.