Objective To observe the effect of ulinastatin on NT -proB -NP and Picco in patients with severe sepsis.Methods 50 patients with severe sepsis were randomly divided into the control group and observation group,25 patients in each group.The control group received the routine treatment,and the observation group received ulinastatin additionally.The venous blood was collected to determine cTn -I,NT -proBNP,TNF -αand Lac before treatment and 7 days after treatment.The APACHE Ⅱ and CFI were observed before treatment and 7 days after treat-ment.Results The differences of CFI,cTnI,NT -proBNP in the two groups before treatment were not significant (t =0.419,0.321,0.335,all P >0.05),after treatment,cTnI and NT -proBNP decreased more significantly(t =2.976,2.910,all P <0.05),while lifting more apparent CFI[(3.98 ±0.95)vs.(2.39 ±0.85),t =6.237,P <0.05]in the observation group than in the control group.The differences of TNF -αand Lac in the two groups before treatment were not significant (t =0.602,0.848,all P >0.05 ),after treatment,TNF -αand Lac decreased significantly faster in the observation group than in the control group(t =8.478,3.104,all P <0.05).After treat-ment,APACHE Ⅱ score decreased significantly in observation group than in the control group(t =2.321,P <0.05). Conclusion Ulinastatin had protective effects on heart function in patients with severe sepsis.

ObjectiveTo investigate the practicability and maneuverability of applying partical hydroxylaptite artificial bone to rehabilitate saddle nose as well as removing materials from the malposition of nasal implant.MethodsWe used the incision beside nasal columella and detached atunnel in deep of nasal aponeurosis.Then we put hydroxyapatite into the detached tunnel,at the same time press position of operation from skin to obtain a nice form.At last we sewed up the incision.Results In 15000 cases of nasal implant operations with follow-up within last 18 years,the successful cases were 94 ％,while the failing ones were 6 ％.ConclusionsApplying partical hydroxylaptite artificial bone to saddle nose and nasal implant can obtain a satisfactory,long-tcrm and stable result.It can he an optional surgical method in nasal augmentation.

Objective: To study the curative effect of Shengmai injection(生脉注射液) and composite Danshen injection(复方丹参注射液) on acute septic cardiomyopathy(ASC).Methods: Sixty patients(clinically) diagnosed as ASC were randomly divided into two groups: treatment group and control group.All the patients received western routine treatment,and Shengmai injection and composite Danshen injection were added to the patients in the treatment group once per day for 14 days.Cardiac troponin(cTn),electrocardiogram(ECG),clinical synthetic curative effect and amelioration rate of traditional Chinese medicine syndrome scores as well as inflammatory indexes including C-reactive protein(CRP),procalcitonin(PCT) and white blood cell count(WBC) were observed after treatment.Results: The levels of cTn,ECG,clinical synthetic curative effect and amelioration rate of traditional Chinese medicine syndrome scores were more improved in the treatment group than those of the control group(all P

To explore the relationship between maternal insulin levels and fetal insulin resistance.Maternal blood and venous cord blood samples were collected in gestational diabetes mellitus (GDM) mothers and control subjects.The glucose and insulin levels were measured and insulin resistance levels estimated.Maternal levels of insulin and homeostasis model of assessment for insulin resistance index (HOMAIR) were significantly higher in the GDM group than those in the control group (P ＜ 0.05) ; fetal levels of insulin and HOMA-IR were significantly higher in the GDM group than in the control group (P ＜ 0.05).Maternal insulin level positively correlated with fetal insulin (r =0.326,P ＜ 0.05) and HOMA-IR levels (r =0.378,P ＜0.05).In this study,a higher level of fetal insulin resistance was reported in the GDM group.And maternal hyperinsulinemia might affect fetal insulin resistance in pregnant women with GDM.

Objective To compare the efficacy after conventional radiotherapy and late course accelerated fractionation radiotherapy for nasopharyngeal carcinoma (NPC).Methods A total of 200 NPC patients were enrolled and randomly assigned to conventional radiotherapy (CF) group with 99 cases or late course accelerated fractionation radiotherapy (LCAF) group with 101 cases,who received irradiation to 60Co γ or 6 MV X-rays.In the CF group,the total dose of nasopharynx was 70 Gy/35 fractions at 2 Gy daily.In the LCAF group,for the first two-thirds of the treatment,two daily fractions of 1.2 Gy were given to the primary lesion and the total dose was 48 Gy/40 fractions.For the last one third of the treatment,the dose per fraction was increased to 1.5 Gy and the total dose was 30 Gy/20 fractions.Results There were 25,16,25 in CF group and 16,13,18 patients in LCAF group who had recurrence of nasophaynx,cervical lymph nodes,and distant metastasis,respectively.The 5-year nasopharyngeal control and overall survival rates was 75.9％ and 87.6％ in CFgroup (x2 =4.066,P＜0.05),58.0％ and 74.1％(x2 =5.076,P ＜ 0.05) in LCAF group,respectively.Cervical lymph nodes local rates and distant metastasesfree rates at 5 years were 8 1.5％ and 90.0％ in CF group (P ＞ 0.05),74.1％ and 83.3％ (P ＞ 0.05) in LCAF group,respectively.Conclusions Compared with CF,LCAF can improve nasopharyngeal control and overall survival rates,but there are no significant difference in the recurrence rates of cervical lymph nodes and distant metastasis.

Objective: To investigate the relationship between prognosis and alteration of oxygen(utilization) coefficient(O_2UC) in patients with sepsis.Methods: Sixty critically ill patients were divided into(sepsis)(n=30) and nonsepsis(n=30) groups,and 30 healthy controls were selected as normal control group.Gas analysis of arterial blood and central venous blood and calculation of O_2UC(O_2UC=arterial oxygen(saturation-venous) oxygen saturation/arterial oxygen saturation) were carried out at 8 o′clock in sepsis and(non-sepsis) groups on admission and 1,2,3,5,7 and 10 days after admission,and gas analysis of arterial blood and central venous blood was carried out only once in the controls.Results: On admission and 1 day(after) admission,O_2UCs in sepsis and non-sepsis groups were significantly higher than that of control group(both P0.05)).When O_2UC in critically ill patients persisted higher than 55% for 12-24 hours,the prognosis of the patients was poor and had a tendency to die in a short time.From the 2 nd day after admission,O_2UCs in sepsis and non-sepsis groups were lower than that in control group,and O_2UC in sepsis group was obviously lower than that in non-sepsis group(all P0.05),but from the 2 nd day after admission,O_2UC in sepsis group remained at a lower level compared with that in control group(all P

Objective:To compare the self-evaluated learning behavior and achievement of eight-year-program clinical medical students on online and offline problem-based learning (PBL), and to provide references and suggestions for successful implementation of online PBL teaching.Methods:During the three semesters of September 2020 to January 2022, a survey was performed on 100 clinical medical students of 2018 eight-year program on online or offline PBL teaching in Xiangya School of Medicine, Central South University. At the end of PBL courses, the students received questionnaires to self-assess their learning behavior and achievement in online or offline PBL teaching. The data were analyzed using the paired rank sum test with the use of SPSS 26.0.Results:Before class, there were no significant differences in learning behaviors including preparation time, communication with classmates, and materials collecting and sorting between students on online and offline PBL teaching ( P>0.05). In class, no significant differences were found in students' initiative of speaking and degree of satisfaction with classmates' speaking between online and offline teaching ( P>0.05), but the students on offline teaching showed significantly better concentration of attention ( Z=-4.24, P<0.001), listening to classmates' speeches ( Z=-3.42, P=0.001), and classmates' interaction ( Z=-3.11, P=0.002) compared with those on online teaching. No significant differences were observed between online and offline PBL teaching in students' self-evaluated learning achievements including improvements in autonomous learning ability, problem-solving ability, and literature inquiry skills ( P>0.05). Conclusion:Students on online PBL teaching have generally as good pre-class preparation and in-class learning performance as those on offline PBL teaching, indicating that the online PBL mode can be well implemented, and it can also ensure almost the same learning achievement as offline teaching.

Objective:To analyze the online learning behaviors and learning results of students under different teaching modes with different learning motivations, and to provide a reference for optimizing the development of online teaching.Methods:Samples of students taking the physiology small private online course (SPOC) in 2019 and 2020, and students taking the massive open online courses (MOOC) in the same year were selected in the study to discuss the differences in learning behaviors of students under different teaching modes and learning effects on students with different learning motivations. The online learning behaviors of students were analyzed based on their learning engagement, interactive behavior and learning motivation. SPSS 25.0 was used to analyze the data with statistical methods such as function calculation, frequency statistics, regression analysis, rank sum test, correlation test and chi-square test.Results:The learning participation level ( z=14.36, P<0.001), and the human-machine and interpersonal learning interaction level ( z=-11.70, -16.18, both P<0.001) of SPOC learners in 2020 were higher than those in 2019. The overall interactive level was moderately correlated with performances of students ( r=0.42, 0.52, both P<0.001), and the correlation between interpersonal behavior and grades was much more stronger ( r=0.60, 0.55, both P<0.001). The performance composition of SPOC and MOOC learners in 2019 was completely different ( χ2=857.45, P<0.001). The learning effect of externally motivated students was significantly better than that of internally motivated students ( z=-28.42, P<0.001). Conclusion:The teaching mode adopted by the school can affect the learning effect by influencing the students' online learning engagement and interactive behavior. Besides, students' own learning motivation also plays a key role in their academic performance.

OBJECTIVETo evaluate the role and value of Changhai fulcrum bending radiograph(CH-FBR) in curve flexibility assessment of adolescent idiopathic scoliosis(AIS) patients.

METHODSThirty-seven AIS patients treated between June 2012 and August 2013 were enrolled, including 31 female and 6 male patients whose age ranged from 10 to 19 years, averaged of 15.0 years. The assessment of radiographs included preoperative standing posterior-anterior radiograph, supine side-bending radiograph, traditional fulcrum bending radiograph, Changhai fulcrum bending radiograph and postoperative standing posterior-anterior radiograph. Postoperatively, radiographs were assessed at one week. The CH-FBR was performed at the lowest height and the optimized height which means the weight on the fulcrum touch the maximum. All measurements of angle were made with use of the Cobb method. The flexibility of the curve as well as the correction rate and fulcrum bending correction index (FBCI) were calculated for all patients. The maximum height of CH-FBR, basic weight and maximum weight were measured for all AIS. Paired t-tests were used to assess differences between preoperative and postoperative curves within group samples. The Pearson correlation coefficients were calculated using bivariate analysis between CH-FBR flexibility rate and correction rate, the maximum height of CH-FBR and maximum weight, the height changes of CH-FBR and weight changes.

RESULTSA total of 46 curves were involved in this study, including 28 thoracic and 18 thoracolumbar/lumbar curves. Preoperatively, the mean Cobb angle of the 46 structural curves was 47° ± 11°. Postoperatively, the mean Cobb angle was 11° ± 5°. Cobb's angle in supine side-bending(t = 7.2, P = 0.001), traditional fulcrum bending (t = 7.1, P = 0.001) and lowest height of Changhai fulcrum bending (t = 6.5, P = 0.001) were significantly different from the postoperative Cobb angle; Cobb's angle in traditional FBR (t = 11.0, P = 0.001) and lowest height of Changhai fulcrum bending (t = 13.6, P = 0.001) were significantly different from the optimized height CH-FBR Cobb angle. There was no significant difference found between traditional FBR Cobb angle and lowest height CH-FBR Cobb angle (t = 2.0, P = 0.051), optimized height CH-FBR Cobb angle and postoperative Cobb angle (t = 0.9, P = 0.36), lowest height CH-FBR Cobb angle and traditional FBR Cobb angle(t = 2.0, P = 0.051). The maximum height of CH-FBR, basic weight and maximum weight were (29.6 ± 1.4)cm,(20 ± 6)kg, and (40 ± 6) kg. Preoperatively, the mean Cobb angle of the 28 structural curves(main thoracic curves) was 46° ± 11°. Postoperatively, the mean Cobb angle was 12° ± 6°. Preoperatively, the mean Cobb angle of the 18 structural curves(thoracolumbar/lumbar curves) was 49° ± 12°. Postoperatively, the mean Cobb angle was 10° ± 5°. The results were same in 28 structural curves, 18 structural curves as well as 46 curves. Correlation analysis of 46 curves indicated that the maximum height of CH-FBR positively correlated with maximum weight (r = 0.69, r(2) = 0.47, P = 0.001), the height changes of CH-FBR positively correlated with weight changes on CH-FBR (r = 0.62, r(2) = 0.38, P = 0.001).

CONCLUSIONSCH-FBR is a more reliable and effective method than traditional FBR and supine side-bending for curve flexibility evaluation in AIS patients. Moreover, compared to the traditional FBR and side-bending radiograph, the flexibility suggested by the optimized height CH-FBR more closely approximates the postoperative result made by pedicle screws fixation and fusion.

Adolescent ; Child ; Female ; Humans ; Male ; Prospective Studies ; Radiography ; Range of Motion, Articular ; Scoliosis ; diagnostic imaging ; surgery ; Young Adult

Objective To explore the application value of telepathological consultation in helping grassroots hospitals.Methods 578 cases of intraoperative telepathology consultation were reviewed,and the accuracy and the timely rate of diagnosis were calculated.The systematic distribution,benign and malignant distribution,and the distribution difference in different primary hospitals were analyzed,so as to evaluate the popularization value of the intraoperative telepathology consultation.Results The accuracy rate of 578 cases of intraoperative telepathology consultation was 99.83％.The timely rate of consultation in 30min was 96.02％,and most reports could be diagnosed in 2 to 5 mins.The source of tissues involved in consultation were thyroid,breast,ovary/fallopian tube and lung.In all cases,24.39％ of the malignant tumors were found.Among the diseases of different systems,the proportion of malignant tumors is the highest in breast diseases,followed by lung,thyroid and ovary.Among the four hospitals with most of the consultations,the rate of malignant tumor in Renmin Hospital of Jianli County was the highest,followed by Renmin Hospital of Yingshan County,Renmin Hospital of Xiaochang County,and Fifth Division Hospital of Xinjiang.Conclusion Intraoperative telepathology consultation can provide accurate and timely expert consultation for grassmots hospitals,avoid the "second operations" of the patients,improve the access of medical treatment for people living in relatively remote areas,solve the shortage of pathologists at the grassroots hospitals,and improve the level of doctors' diagnosis and treatment at the grassroots hospitals,which is worth popularizing and applying in Pathology Department of the grassroots hospitals.