2012 Vol. 33, No. 10

Jiang Run Sheng
2012, 33(10)
Abstract(4586) PDF(7972)
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Proteomic Studies of Wild Type N2 and Hypoxia-sensitivity Strain (ia04) in Caenorhabditis Elegans
Li Hua Ling
2012, 33(10)
Abstract(2962) PDF(919)
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[Abstract]Objective To investigate the different proteins between wild type N2 and hypoxia-sensitivity strain(ia04) and lay the foundation for studying the response mechanism of C.elegans during hypoxia.Methods  The worms of two strains were cultured synchronously to L4 stage.Then the total proteins were extracted by using routine method. After that, two-dimensional electrophoresis was performed and the selected protein spots were then identified by MALDI/TOF/TOF tandem mass spectrometry and search the Swiss-Prot database. Go term (Gene Ontology) analysis was also performed.Results Twenty-five significantly different spots were finally identified by MS(ratio>2.0,P<0.05).The expression levels of main proteins identified in N2 were higher than those in ie04 strain: heat shock proteins (HSP-70 and HEP-60), Putative GTP-binding protein(TAG-210),Probable medium-chain specific acyl-CoA dehydrogenase(GN=T).The expression levels of main proteins identified in ie04 strain were higher than those in N2 strain: Elongation factor-1 alpha(EFT-3)and Iron-sulfur protein(ISP-1).The expression level of HSP in ie04 strain was obviously lower than in N2 strain,it may be the one reason why worms of ie04 strain were sensitivity to hypoxia. According to the Go term, most proteins identified were related to the development and DNA synthesis of C. elegans.Conclusions Proteomic research can offer the valuable reference data to study the hypoxia in C. elegans.Different proteins found in different strains may promote the understanding of the hypoxia responsive mechanism and uncover the mechanism of important phenotype gene expression at the protein level.
Expression of the Recombinant Adenovirus Carrying Enhanced Green Fluorescent Protein(EGFP)in Brain and Lung Tissues of Rats
Zhao Song Yue
2012, 33(10)
Abstract(2205) PDF(531)
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[Abstract]Objective To investigate the expression of the recombinant adenovirus carrying the enhanced green fluorescent protein(EGFP)in rats' brain and lung by nasal administration,so as to provide a basis for targeting tvansport of adenovirus by intranasal administration.Methods 12 rats were randomly divided into 3 groups(n = 4),rats in 3 groups were respectively given instillation of EGFP recombinant adenovirus fluid, EGFP recombinant adenovirus added by viscous fiber protein solution and control group instillation of saline by nasal administration. Rats in the adenovirus fluid group were given instillation of 20 μL adenovirus fluid from each nostril.Rats in the adenovirus added by viscous fiber protein liquid group were given instillation of 40 μL adenovirus added by viscous fiber protein liquid each nostril. Rats in the control group were given instillation of 20 μL saline.The administration was once a day and lasted for 7 days.Rats were given heart perfusion on the 9th day,and lung and brain tissues were collected for frozen section,and the fluorescence signals in frozen sections were observed by confocal fluorescence microscopy.Results We observed the expression of green fluorescent protein in the lung tissues of rats in the two treatment groups,but no green fluorescent expression in brain tissues. Conclusion Adenovirus can target rats' lungs by intranasal administration,so it can be used for the carrier of pulmonary targeted drug delivery system.
Effects of Ischemic Postconditioning on Myocardial Apoptosis in Non-infarct Zone in Pigs with Myocardium
Sun Hai Mei
2012, 33(10)
Abstract(3485) PDF(368)
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[Abstract]Objective To investigate the effect of ischemic postconditioning on myocardial apoptosis in non-infarct zone in pigs with myocardium.Methods Fifteen Diannan small-ear pigs were divided into three groups(n=5 pre group) randomly:(1)Sham-operated(S)group:A balloon catheter was positioned in the mid-distal left anterior descending(LAD)via right femoral artery under fluoroscopic guidance,without ischemia;(2)Ischemia-reperfusion (I/R) group: the balloon was inflated and occluded the LAD for 60 minutes;(3)ischemic postconditioning(Postcond)group: pigs were treated the same as I/R group and 8 cycles of 30 s R and 30 s I before reperfusion. After 72 h of reperfusion,infarction size were measured by 2,3,5-triphenyltetrazolium chloride(TTC)staining.The apoptotic cells in the non-infarct zone myocardium was determined with terminal deoxynucleotidyl transferase-mediated dUTP-fluorescence in nick end(TUNEL) method,and apoptosis-related molecules were studied by immunohistochemical analysis. Result After 72h of reperfusion,the infarction size,apoptotic index(AI)of non-infarcted zone,the levels of Bax protein expression,and Bax/Bcl-2 ratio were significantly lower in Postcond group than those in I/R group(P<0.05).Conclusion Ischemic postconditioning can reduce myocardial apoptosis in non-infarct zone and maybe play a myocardial protection effect.
The Relationship between HMGB1 and Serious Degree of Acute Pancreatitis in Rats
Long Kui
2012, 33(10)
Abstract(1917) PDF(417)
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[Abstract]Objective To explore the relationship between high mobility race protein B1(HMGB1)and serious degree of acute pancreatitis in rats.Methods Acute pancreatitis model in rats was established. Rats were divided into 3 groups: group A (severe acute pancreatitis group),group B(mild acute pancreatitis group),and group C(normal control group),and 10 rats in each group.Blood samples of rats in 3 groups were collected at 12 h,24 h and 48 h after establishing model,and the serum levels of HMGB1 were detected by enzyme linked immunosorbent assay(ELISA).Result The serum levels of HMGB1 of rats in group A were higher than group B,and in group B were higher than group C at different time points,the difference had statistical significance(P<0.05).Conclusion The serum levels of HMGB1 are positively related with the serious degree of acute pancreatitis.
Biotransformation of Corynoxeine and Isocorynoxeine in Rats
Huang Min Jie
2012, 33(10)
Abstract(2802) PDF(577)
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[Abstract]Objective To investigate the biotransformation of Corynoxeine and Isocorynoxeine in Rats. Methods Corynoxeine and isocorynoxeine were administered orally to rats, and the bile samples of rats were collected to analyze by LC-MS.Results It was found for the bile samples taken for first 30 mins that two phase I metabolites and two phase II ones were detected for corynoxeine by LC-MS.However for isocorynoxeine there were 4 phase II metabolites found but no phase I ones in the same sample.Conclusions There is a hepatic first-pass effect after their oral administration. According to analysis of samples in vivo and in vitro by LC-MS and comparison with the fate of rhynchophylline and isorhynchophylline in rats,corynoxeine and isocorynoxeine seem to have a similar biotransformation.Also incubation of the substrates with rat liver microsomes show that CYP450 plays a key role in their metabolic catalysis.
The Antimicrobial Activity of Snake Venom Antimicrobial Peptide Cathelicidin on E. coli
Li Si Man
2012, 33(10)
Abstract(3778) PDF(588)
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[Abstract]Objective To explore the antimicrobial activity of snake venom antimicrobial peptide(Cathelicidin)against E. coli.Method The two most common pathogens of the cephalosporin-resistant E. coli and E. coli ATCC 25922 in clinical infection were selected to evaluate the antimicrobial activity of snake venom antimicrobial peptide(Cathelicidin) against E. coli.Result The inhibitory activity of Cefoperazone and sulbactam on cephalosporin-resistant E. coli was not obvious,but was obvious on ordinary E. coli(E. coli ATCC 25922).The inhibitory activity of snake venom antimicrobial peptide(Cathelicidin)on cephalosporin-resistant E. coli and ordinary E. coli was obvious.Conclusion Snake venom antimicrobial peptide (Cathelicidin)has stable antibacterial activity
Development and Evaluation on Chinese Version of Measurement Instrument of Quality of Life for Patients with Stomach Cancer: EORTC QLQ-STO22
Meng Qiong
2012, 33(10)
Abstract(6066) PDF(2033)
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[Abstract]Objective To introduce how to develop the Simplified Chinese version of EORTC QLQ- STO22 and evaluate the psychometric characteristics of this instrument.Methods The Simplified Chinese version of the EORTC QLQ-STO22 was developed by translation and back-translation and cultural adaptation,and was evaluated after we measured the quality of life of 86 in-patients with stomach cancer by using this instrument.The statistic method included correlation analysis, exploratory factor analysis,and paired t-test.Result The test-retest correlation coefficients(r)for all domains were greater than 0.70.Cronbach's coefficients for all domains were greater than 0.70.There were strong correlations between items and their own domains,but weak correlations between items and other domains.9 principal components were abstracted from 22 items, and the contribution rate of accumulative total of variance was 84.7%.These 9 principal components basically reflected the 9 domains of the instrument after varimax orthogonal rotation.The instrument could find the change of the scores of the other domains except of body image domain after 4 weeks treatment. Conclusion The simplified Chinese version of EORTC QLQ-STO22 is of good validity,reliability and responsiveness and can be used as a measurement instrument for survey and evaluation of QOL in stomach cancer patients in China with the Chinese version of EORTC QLQ- C30.
Clinical Observation of Ocular Hypertension after Vitrectomy with Silicon Oil Plumbage
Ou Yang Ke
2012, 33(10)
Abstract(3241) PDF(501)
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[Abstract]Objective To explore occurrence factor and therapy of ocular hypertension after vitrectomy with silicon oil plumbage.Method A number of 82 eyes with intraolular pressure over 30mmHg were controlled by medicine or operation after vitrectomy with silicon oil plumbage.Results Ocular hypertension of 64 eyes had been controlled by single or associated drug treatment.Ocular hypertension of 2 eyes had been controlled by releasing few silicon oil.Ocular hypertension of 2 crystal eyes had been controlled by cleaning up silicom oil in anterionr chamber. Ocular hypertension of 6 eyes which retina was resetted had been controlled by silicon oil removal. Two aphakia peripheral iridectomy hole closed by laser to punch the intraoclular pressure control.Four eyes underwent anti-glaucoma filtering operation,where in the one eye cataract extraction.Conclusions Elevated intraocular pressure is the common complication after vitrectomy with silicom oil plumbage,its mechanism may be related to postoperative ciliary body edema and acute inflammatory reaction,and also related to primary diseas type,severity and the type of joint operation.The drug or operation can efftively control the ocular hypertension after vitrectomy with silicon oil plumbage.
One Case Analysis of Ex-vivo Liver Resection Combined with Partial Liver Autotransplantation for Hepatocellular Carcinoma
Wang Lin
2012, 33(10)
Abstract(3115) PDF(425)
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[Abstract]Objective To discuss the experience of ex-vivo liver resection combined with partial liver autotransplantation for hepatocellular carcinoma.Method Clinical data were retrospectively studied in 1 patient with massive hepatocellular carcinoma treated by ex-vivo liver resection combined with partial liver autotransplantation in the Second Affiliatted Hospital of Kunming Medical University on October,2011.Results  The patient underwent the operation successfully without severe complications such as hepatic failure,renal fail and hepatic encephalopathy.The liver function tests showed normal results with in 20 days after operation and the patient was discharged on the 22nd day postoperation.The patient had survived for 6 months and the liver function was normal without new neoplasms,and liver function without any abnormal sign of imaging.Conclusion Ex-vivo liver resection combined with partial liver autotransplantation can treat patients with unresectable hepatic space-occupying lesions with routine method efficiently.
Clinical Analysis of Penis Closed Injury in 32 Cases
Tan Yun Ling
2012, 33(10)
Abstract(2885) PDF(1105)
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[Abstract]Objective To explore the clinical manifestations,pathological characteristics,diagnosis and treatment of the penis closed injury.Method We retrospectively analyzed the clinical manifestations and combined literature review, and summarized the clinical manifestations,pathological characteristics,diagnosis and treatment of penis closed injury in 32 cases.Results 32 patients were given emergency operation to remove blood clot,expose the rupture mouth of tunica allbuginea, repair split. The wound was recovered in postoperative 7-10 days,the sexual life restored after 6 ~ 8 weeks.Conclusions The penis closed injury has obvious clinical features, is easy to diagnose, and can be treated effectively by surgical treatment with small trauma.
Liu De Sheng
2012, 33(10)
Abstract(3327) PDF(1555)
Abstract:
Analysis on Causes of Tuberculosis Patients and Suspects Failing to CDC in Yunnan
Chen Lian Yong
2012, 33(10)
Abstract(2256) PDF(341)
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[Abstract]Objective To explore the influencing factors on the reported tuberculosis(TB)patients and suspects failing to the CDC(Center for Disease Control and Prevention)in Yunnan province.Methods Twelve counties were selected in the study.A cross-sectional study was conducted on tuberculosis patients and suspects during September to November 2006 using questionnaires.Single-factor and multi-factor analysis were performed. Results A totle of 634 patients(including TB patients and suspects)were reported.560(male 71.6%,female 28.4%)had come to hospital for diagnosis and treatment.Sex,degree of education and marital status had no influence on the rate of TB patients coming to CDC for diagnosis and treatment(P>0.05).But patients whether knowing free treating poliey of TB,forms of medical insurance and whether doctors informed patients free treating poliey of TB significantly influenced the arrival rate.Conclusions The influencing factors on TB patients coming to CDC for diagnosis and treatment are as follows: forms of medical insurance, whether knowing free treating policy of TB and whether doctors informed patients free treating policy of TB. County level CDC should be integrated into one of the listed bodies of medical insurance and rural cooperative medical service. At the same time, we have to strengthen management and intervention on all levels of medical institutions.
Stem in Sells Remodeling Blood Flow for Diabetic Foot
Gao Xue
2012, 33(10)
Abstract(2103) PDF(431)
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[Abstract]Objective To investigate the clinical effect of the transplantation of autologous peripheral blood stem cells(TPBSC)for blood flow remodeling in ischemic tissue of diabetic foot.Methods 42 patients with diabetic foot from Yunnan Provincial Center of Vascular Surgery were enrolled in this study. 42 cases underwent the transplantation of autologous peripheral blood stem from march 2005 to December 2008.The multifunction monitoring device,dopplor ultrasound monitoring device,percutaneous oxygen partial pressure moni- toring device(TcPO2)and digital subtractionangiography(DSA)were used to assess the effect degree of limbs regional blood flow from cutaneous covering, blood vessel and blood between preoperative and post-operative, the follow-up time was one year.Results The effect indexes of limbs regional blood flow of the case by transplantation of autologous peripheral blood stem cells were as follows: skin temperature index(STI)was(1.6±0.3),percutaneous oxygen partial pressure monitoring device(TcPO2)was(37.6±9.5)mmHg,ankle-brachium index(ABI)was (0.9±0.2),photoplethysmography index(PPGI)was(0.8±0.1),saturation of blood oxygen(SaO2)was(79.4±20.4)percent,digital subtraction angiography score(DSAS)was(1.3±0.2),distance of intermittence limp was (46.2±10.6)meters.Conclusion Transplantation of autologous peripheral blood stem cells can improve the blood flow remodeling in ischemic tissue of diabetic foot .
Investigation and Evaluation of The Health Level of Medical Staffs in a Hospital in Kunming
Yang Min Li
2012, 33(10)
Abstract(2522) PDF(506)
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[Abstract]Objective To study the physical and mental health of medical staffs and to provide reference for improving their health.Method We selected 350 doctors,350 nurses and 180 medical technicians from a top three hospital in Kunming,SCL-90 and SRHMS scales were tested at the same time,and the results were analyzed and evaluated.Results SCL-90 test results showed that: the level of doctors,nurses,medical technicians, mental health scores were:(157.64±49.72);(156.45±48.64);(144.58±40.87),and higher than the national norm (129.96 ±38.76).Positive rates were as follows: 57.12%,54.36%,42.40%;There was no significant differences between doctors and nurses, but there was significant differences between both doctors and nurses and medical technical staffs(P<0.05).There was significant differences between medical staffs in different age groups(P<0.05).SRHMS test results showed that: there was no significant difference in physical health and mental health between doctors and nurses, but doctors and nurses had significant difference with medical and technical personnel (P<0.05);there was no significant difference among the three groups.There was significant difference in physical health and mental health between medical staffs with different ages(P<0.05),and there was significant difference in social health between medical staffs in 25-34 year-old stage and the 35-45 year-old stage and staff over 45 (P< 0.05),but no significant difference between 35-45-year-old stage and staff over 45. Conclusions The medical staffs' physical and mental health is worse than the general population.The SCL - 90 and SRHMS results have consistency,but there are also some differences.
Application of Multilayer Spiral CT Enhancement Scanning Combined with 3D Imaging in Diagnosis of Thyroid Common Disease
Liu Zai Qiang
2012, 33(10)
Abstract(3542) PDF(640)
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[Abstract]Objective To investigate the value of multi-layer spiral CT enhancement scanning combined with 3 d imaging in diagnosis of common thyroid diseases.Method We retrospectively analysed the spiral CT imaging characteristics of 72 cases of thyroid lesions confirmed by surgery and pathology.Results In 36 cases of nodular goiter,31 cases showed circular uniform or non-uniform slightly low density,3 cases showed equal density,2 cases showed mixed high and low density. 16 cases showed mild circle enhancement and 20 cases showed non-enhancement after enhancement scan lesions. 8 cases of thyroid adenoma showed circular uniform or non-uniform slightly low density after CT plain scan,and showed middle enforcement or uneven enforcement in solid after enforcement scan,among them, 2 cases showed enforced wall nodules,and 2 cases showed obviously enforced envelope,2 cases of cystic degeneration of adenoma and bleeding showed equal density without enforcement.In 14 cases of thyroid carcinoma,7 cases showed circular uneven slightly lower hybrid density,3 cases showed round like or irregular solid mass,and showed obviously uneven enforcement,no no envelope reinforcement or non-complete enforcement ring,2 cases showed neck lymph node metastasis.12 cases of nodular goiter with follicular adenoma or local adenomatoid hyperplasia and 4 cases of nodular goiter with tiny papillary carcinoma had similar performance,CT plain scan showed multi center circular uneven low,slightly lower hybrid density and showed local uneven light - moderate enforced nodules in the lesion area after enforcement scan. Conclusion Multi-slice spiral CT scanning combined with 3 d imaging can reflect the form,size,density,number of thyroid lesions,their relationship with the surrounding tissue structure,and lymph nodes in the neck,so has diagnostic value in identification of benign and malignant thyroid lesions.
Survey on the Prevalence of Dental Fluorosis in High Fluorine District in Zhaotong, Yunnan after Improving Ovens to Reduce Fluoride Pollution
Ji Juan Juan
2012, 33(10)
Abstract(2728) PDF(919)
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[Abstract]Objectives To provide some advice to the prevention and treatment of endemic dental fluorosis of Zhaotong by investigating the prevalence of dental fluorosis in high fluorine districe in Zhaotong.Methods According to the basic methods of diagnostic criteria for dental fluorosis of the third national oral health epidemiological survey,a sample survey of dental fluorosis and oral health status were carried out.The samples were randomly gotten from the 12-year-old students and 35 - 44 year-old adults of local residents.In accordance with the respective proportions of 30% of the two groups for the questionnaire survey.Results In 35-44 year old group,the detection rate of dental fluorosis was 100.0%, The dental fluorosis prevalence rate in 12 year-old students was 86.5%.Between the two groups there was a significant difference(P<0.01,χ2 = 29.67).The coal utilization rate and the baking food rate in urban areas were lower than in rural areas(P<0.01).The endemic fluorosis prevention and treatment knowledge rate was only 23.3%. 73.9% people thought dental fluorosis affecting their lives and aesthetics, and 91.1% of the population had an urgent treatment needs. 84.4% of the population had habit of brushing teeth, while 50.7% of the population still used fluoride toothpaste.Conclusions After improving ovens to reduce fluoride pollution in high fluoride areas in Yunnan Zhaotong,the prevalence rate of DF decreased, but Zhaotong is still the moderate prevalent district.Besides improving ovens,the health education,scientific management,local economic and cultural levels also need to be improved.
The Research on the Predictable Possibility of Cervical Lesion Outcome by High Risk HPV Virus Load
Liu Li Ping
2012, 33(10)
Abstract(2690) PDF(1231)
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[Abstract]Objective To investigate the relationship between the high-risk human papilloma virus (HR-HPV)infection load and cervical lesions,in order to explore the feasibility of HPV load to predict the outcome of cervical disease.Methods The HPV infection load in 143 cases of cervical intraepithelial neoplasia (CIN)and cervical cancer patients in Yunnan Province Cancer Hospital from 2010.6-2011.12 were detected by the second-generation hybrid capture(hc2 HPV DNA),to study the relationship between the high-risk HPV viral load and cervical lesions.Results High risk HPV loads in CIN I patients were significantly lower than that in CIN II, CIN III and cervical cancer patients (P<0.05), there were no significant difference among the CIN II,CIN III and cervical cancer patients (P>0.05).Conclusion The High-risk HPV viral loads in CIN I patients are low, which increase in CIN II, CIN III and cervical cancer patients.The viral load will not increase with the cervical lesions progress. High-risk HPV load can not predict the outcome of cervical lesions,but high HPV loads are associated with CIN II,CIN III and cervical cancer.
Analysis of Clinical Indicators in Impaird Glucose Regulation Population
Feng Qing
2012, 33(10)
Abstract(3659) PDF(468)
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[Abstract]Objective To observe the clinical indicators,including BMI,blood lipid levels and glycosylated hemoglobin of prediabetic population.Methods 450 subjects including 153 patients with type 2 diabetes mellitus(T2DM),148 people with impaired glucose regulation(IGR)and 149 normal volunteers(NGT)were recruited in the study.All subjects received oral glucose tolerance test.Body mass index(BMI), waist-to-hipratio(W/H),high density lipoprotein cholesterol(HDL-C), glycerin three greases(TG), total cholesterol(TC),low density lipoprotein cholesterol (LDL-C), and glycosylated hemoglobin(HbA1c) were surveyed.Results(1)Compared with NGT group,people in T2DM or IGR groups showed higher levels of BMI, TG,TC,LDL-C,HbA1c,and lower levels of HDL-C(P<0.05).(2)Compared with NGT group,female IGR people showed higher levels of BMI,TG,TC,LDL-C,HbA1C,and lower levels of HDL-C(P<0.05),however,male IGR people showed higher levels of HbA1c and lower levels of HDL-C(P<0.05).(3)Compared with NGT group, IGR people more than 40 years showed lower levels of HDL-C(P<0.05).People more than 50 years in IGR group showed higher levels of HbA1c.Conclusions Lipids disorder as well as adipose play an important role in the progress of impaired glucose tolerance.HbA1c should be mornitored in IGT people regularly.
The Curative Effect of Plug Mesh Hernia Repair on Inguinal Hernia in 176 Cases
Zhao Shu Hua
2012, 33(10)
Abstract(2238) PDF(539)
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[Abstract]Objective To explore the curative effect of Plug Mesh Hernia Repair on inguinal hernia.Methods We collected 176 patients with inguinal hernia who received Plug Mesh Hernia Repair in Anning People's Hospital from January 2008 to January 2012,and summarized the data and evaluated the curative effect.Results  Plug Mesh Hernia Repair for inguinal hernia was successfully completed in 176 patients. The operation time was 30-138 minutes,with an average of 52.3 minutes.The average length of hospital stay was 3.3 day.The incision pain was alleviated in 2 ~ 4 d. There were 3 cases with inguinal foreign body sensation,2 cases with numbness in operation region,3 cases with urinary retention,6 cases with scrotal edema and no cases of incision infection.The patients were followed up for 6 to 24 months without relapse cases.Conclusion Plug Mesh Hernia Repair is a safe and effective treatment for inguinal hernia with low recurrence rate, small trauma, short time, quick recovery, etc, and deserves popularization.
A Survey on Iodine Nutrition KAP of Boarding School-age Children in Wa Nationality
Wang Song Mei
2012, 33(10)
Abstract(1924) PDF(447)
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[Abstract]Objective To analyze the prevalence of iodine nutrition KAP of boarding school-age children in Wa nationality and its influencing factors in Shuangjiang county of Yunnan,then provide scientific evidence for the Wa nationality children to set up a healthy lifestyle.Methods Systematic random sampling method was used to select 650 boarding school-age children from 10 primary schools in ShuangJiang county, and their condition of iodine nutrition KAP was estimated by KAP questionnaire. Results The boys mastered as much iodine nutrition knowledge as the girls(P>0.05).High grade pupils mastered more iodine nutrition knowledge than low grade pupils (P<0.05).There was no sexual differences in actively iodine supplementation (P>0.05).High grade pupils supplemented iodine more actively than low grade pupils (P<0.05).Conclusion The present situation of nutrition KAP among boarding school-age children in Wa nationality is serious, more ways of health education on iodine nutrition are required for these children.
The Relationship between Nogo and Estrogen Receptor Gene Polymorphism and Multiple Sclerosis
Meng Li Hong
2012, 33(10)
Abstract(3454) PDF(375)
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[Abstract]Objectives To find the the association of Nogo and estrogen receptor gene polymorphism with multiple sclerosis.Methods(1)The blood samples prepared from 47 MS patients and 47 normal person who were matched in age,sex and ethnic were used in this study.(2)To identify the Nogo 3 UTR CAA insertion/deletion polymorphism,polymerase chain reaction(PCR)and polyacrylamide gel electrophoresis were employed. (3)To explore PvuⅡand XbaI restriction fragment length polylmorphism of estrogen receptor(ER) gene, polymerase chain reaction-restriction fragment length polylmorphism(PCR-RFLP)method was used.(4) Data analysis was performed using SPSS.Results Significant difference in Nogo 3 UTR CAA insertion/deletion allele frequencies was observed between the patients with multiple sclerosis and control (P<0.05).The gene polymorphism of Nogo and ER were also analyses using Logistics Regression, the results showed that ER PvuⅡ p allele was negatively associated with MS, the correlation coefficient was -1.670(P=0.013)with 95% confidence interval between 0.050 and 0.704. And Nogo Insert alletic gene was also negative associatied with MS,correlation coefficient was -1.248(P=0.013)with 95% confidence interval between 0.087 and 0.948.Conclusions This study confirms an association of Nogo 3 UTR CAA insertion/deletion polymorphism and PvuⅡrestriction fragment length polylmorphism of estrogen receptor(ER)gene with multiple sclerosis.In addition,ER PvuⅡ p and Nogo Insert alletic gene may be protection factors for MS.
Comparison of S-1 Combined with Radical Radiation Therapy and Single Radical Radiation Therapy in Treatment of Early Nasopharyngeal Carcinoma
Yang Jie
2012, 33(10)
Abstract(3919) PDF(1187)
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[Abstract]Objective To explore the curative effect and toxicity of radical radiation therapy combined with S-1 for early nasopharyngeal carcinoma.Methods From Jan.1st 2009 to Jan.1st 2010,88 cases of early early nasopharyngeal carcinoma were divided into two groups: the joint S-1 and radiotherapy group(experimental group) and the single radiotherapy group(control group), and 44 cases in each group. Patients in the control group only received radiation therapy,they were adopted ordinary radiation therapies,five times a week,2.0 Gy each time, total dose was 60 ~ 66 Gy.Patients in the experimental group took S-1 capsules orally while receiving radiation therapy, the initial dose was 65 mg/(m.d),bid,d1~d28 and the intermittent period was twoweeks.Results All of the 88 patients completed treatment, and were evaluated as CR,the effective rate was 100%.2-year local control rates were 100%(44 / 44)for experimental group and 90.9%(40/44)for control group,there was significant difference(P<0.05)between two groups.The main side effects were myelosuppression and gastrointestinal reactions.Conclusions Radiation therapy combined with S-1 get higher local control ratio than single radiation therapy.But the long-term outcomes and toxicities need to be further investgated.
Olecranon “V” Osteotomy Double-column Fixation for Humeral Condylar Fractures
Li Jun Chang
2012, 33(10)
Abstract(2436) PDF(433)
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Objective To investigate the efficacy of olecranon "V" osteotomy double-column fixation in treatment of humeral condylar fracture.Methods We gave surgical treatment to adult humeral condylar fracture in 18 cases, including 12 males and 6 females,aged 14-60 years, mean 40 years old,from March 2005 to June 2011 in The First People’s Hospital of Yunnan Province.AO/LASIF types analysis showed that A type in 2 cases, B type in 7 cases,C type in 9 cases.After brachial plexus and basal anesthesia,patients were given olecranon "V" osteotomy and exterior and interior plate fixation from outer margin of elbow approach.Patients were guided to functional training,and the regular follow-up was given to understand fracture healing.The elbow function was evaluated by Cassebaum system.Results All 18 patients with humeral condylar fracture and olecranon "V" osteotomy ere healed. The therapeutic effect was excellent in 12 cases, good in 4 cases and general I 2 cases,and the excellent and good rate was 88.9%.Conclusion For humeral condylar fractures,olecranon "V" osteotomy from outer margin of elbow approach,open reduction and double-column plate fixation may prevent bone conglutination,and restore elbow function,so it is an ideal operation way.

Analysis about the Differences in Pulmonary Function Performance between Children and Adults with Asthma in Acute Exacerbation
Ye Xiu Lin
2012, 33(10)
Abstract(2680) PDF(527)
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[Abstract]Objective To explore the differences in pulmonary function performance between children and adults with asthma in acute exacerbation.Methods JAEGER Master Screen Diffusion determinator was used to determine respiratory physiologic parameters respectively both in children and adults with asthma in acute exacerbation.Results(1)FEV1,PEF,FEF25,FEF50,FEF75 and MMEF were the sensitive indicators for children and adults.MVV and FEV1% are the sensitive indicators for adults, but not for children. (2)The children’s FET was quite shorter than the adult’s during acute exacerbation of asthma(P<0.05). (3)Children were mainly with restrictive ventilation function obstacle,while adults were mainly with obstructive ventilation function obstacle. Conclusion The short expiration time and little tidal volume make the restrictive ventilation function obstacle mainly occur in children with asthma in acute exacerbation.
Long Acting Sterile Antibacterial Materials for Protecting Skin After Intensity Modulated Radiotherapy on Nasopharyngeal Carcinoma
Huang Hua
2012, 33(10)
Abstract(2789) PDF(521)
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[Abstract]Objective To observe the protective effect of long acting sterile antibacterial materials on skins of patients with nasopharyngeal carcinoma after intensity modulated radiotherapy(IMRT).Methods 104 patients with nasopharyngeal carcinoma who received first intensity modulated radiotherapy were randomly divided into 2 groups: the observation group and the control group.Long-acting sterile antibacterial material was prophylactically sprayed on local skins of 56 patients in observation group after the first radiotherapy for 4 times/day.48 patients in the control group were only given keeping clean and dry in the local skin. Patients in both groups were given routine skin care and health education.Results In the observation group and the control group,the incidence rate of Ⅱand Ⅲ radiodermatitis was 28.5% and 66.7%,respectively.The serious degree of radiodermatitis in patients in observation group was less than that in control group,and the incidence of radiodermatitis in patients in observation group was later than that in control group,and the difference was statistically significant(P<0.05).Conclusion Long acting antibacterial materials can effectively prevent the occurrence of radiodermatitis,reduce the degree of skin damage, improve the life quality of patients and ensure smooth accomplishment of radiation therapy.
The Curative Effect of Polyethylene Glycol(peg)Interferon Alpha 2a Combined with Adefovir on HbeAg Positive Chronic Hepatitis B
Yang Yong Rui
2012, 33(10)
Abstract(2092) PDF(474)
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[Abstract]Objective To explore the curative effect of combination of polyethylene glycol interferon alpha 2 a and adefovir on HbeAg positive chronic hepatitis B.Methods 122 patients with HbeAg positive chronic hepatitis B were randomly divided into two groups: treatment group and control group. Patients in the treatment group were given oral administration of adefovir for 10 mg/d and subcutaneous injection of polyethylene glycol interferon alpha 2 a for 80 ug once a week for 48 weeks. Patients in the control group were only given subcutaneous injection of polyethylene glycol interferon alpha 2 a for 80 ug once a week for 48 weeks.Result There was statistically significant difference in the serology conversion rate of HbeAg and negative transfer rate of HBV-DNA in patients between two groups after treatment for 24 week and 48 week(P<0.05).Conclusion The antiviral effect of combination of adefovir and polyethylene glycol interferon alpha 2 a is better than single use of polyethylene glycol interferon alpha 2 a in treatment of HbeAg positive chronic hepatitis B.
Comparison of Clinical Efficacy between Holmium Laser and Pneumatic Ballistic Lithotripsy in Treatment of Kidney Stones
Tao Zhi Xing
2012, 33(10)
Abstract(3650) PDF(1191)
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[Abstract]Objective To compare the clinical methods and effects between holmium laser and pneumatic ballistic lithotripsy in treatment of kidney stone.Methods 99 patients with kidney stones from may 2011 to March 2012 were divided into 2 groups:study group and control group.The 44 patients in study group were given holmium laser lithotripsy,44 patients in contral group got pneumatic ballistic lithotripsy. We observed the patient operation time, intraoperative amount of bleeding,gravel rate,stones exhaust net time,clinical complications, the average hospitalization time and compared them between groups.Results The two groups in the operation had better therapeutic efficacy and safety,for pneumatic ballistic lithotripsy intraoperative,the amount of bleeding was (88.2±2.3), complication rate was 11.36%,for the holmium laser lithotripsy intraoperative amount of bleeding was(62.8±2.0)mL, complication rate was 4.55%,which were significantly lower than pneumatic ballistic lithotripsy (P<0.05);Holmium laser lithotripsy shortened hospitalization time(P<0.05),but had no change in operation time(P>0.05). Conclusion Compared with pneumatic ballistic lithotripsy,holmium laser lithotripsy in treatment of kidney stone has better efficacy and safety, can reduce the amount of bleeding and intraoperative complications,and shorten hospital stay.
The Curative Effect of Nedaplatin Concurrent Chemotherapy and Radiotherapy on Local Advanced Cervical Cancer
Wang Xiao Li
2012, 33(10)
Abstract(3494) PDF(456)
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[Abstract]Objective To investigate the effect and toxicity of nedaplatin concurrent chemotherapy and radiotherapy on local advanced cervical Cancer.Methods The nedaplatin was given at a dose of 30 mg(m2.w) once a week for 5 weeks in 35 patients. External radiotherapy was given at a dose 30 Gy firstly and then was irradiated for another 20 Gy under the condition of A point by linear accelerator 6Mev-X, the total radiotherapy dose was 50 Gy. From the 4th week post radiotherapy, intracavitary irradiation at DT 600cGy/time was given for twice a week, and lasted for 7 times to a total dose 4 200 cGy for A point. The curative effect and adverse reactions were observed.Results The total effective rate and clinical benefits rate were both 89%.The 24 months disease-free survival and overall survival rate was 80%and 94%, respectively.Conclusion Nedaplatin concurrent chemotherapy and radiotherapy can get better effects and tolerated side-effects
Transpedicle Screw Fixation in Treatment of Atlantoaxial Instability and Dislocation after Trauma
Ji Lin Song
2012, 33(10)
Abstract(3088) PDF(464)
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[Abstract]Objective To explore the surgical feasibility and clinical outcome of transpedicle screw fixation in treatment of atlantoaxial instability and dislocation after trauma.Methods From January 2006 to June 2011,8 patients with atlantoaxial instability and dislocation were treated with transpedicle screw fixation. There were 6 males and 2 females,with a mean age of 43 years(range,22-64 years).The Screw-rod fixation system made the atlas and axis stable.Results All patients were followed up for 3-18 months,with an average of 11.5 months.All screws were successfully placed in atlas and axis.No postoperative complications such as vertebral artery injury, dural rupture,exacerbation of neurological symptoms,wound infection,and broken srews were observed in 8 cases. Neurological symptoms in some patients were improved. Postoperative radiograph and CT showed that the position of screws were satisfied. Bony fusion was observed after 6 to 18 months of operation,and atlantoaxial rotational function in all patients restored satisfactorily,but axial rotation was partially lost.Conclusion Transpedicle screw fixation in upper cervical spine for treatment of atlantoaxial instability and dislocation is safe and reliable.
Value of High Frequency Ultrasound Parameters in Differential Diagnosis of Breast Phyllodes Tumor and Breast Fibroadenoma
Wu Li Zhen
2012, 33(10)
Abstract(3427) PDF(489)
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[Abstract]Objective To investigate the value of multiple parameters of high frequency color Doppler ultrasound in differential diagnosis of breast phyllodes tumor and breast fibroadenoma.Methods We retrospectively analyzed the data of 30 cases of breast phyllodes tumor and 120 cases of fibroadenoma patients who received preoperative ultrasound examination and postoperative pathology confirm( histopathological findings as a gold standard for diagnosis). Results Patients with breast phyllodes tumor were older than those with breast fibroadenoma,and the difference was statistically significant( P<0.05).Two-dimensional ultrasound showed there were statistically significant differences in tumor shape, capsular integrality,internal echo homogenety,the presence of cystic degeneration,posterior echo attenuation between breast phyllodes tumor and breast fibroadenoma(P<0.05).Color Doppler flow grading showed statistically significant difference between breast phyllodes tumor and breast fibroadenoma(P<0.05).Pulsed Doppler artery resistance index( RI )and peak systolic velocity(Vmax)had statistically significant difference between breast phyllodes tumor and breast fibroadenomae(P<0.05).Conclusions Breast phyllodes tumor and breast fibroadenoma have ultrasonographic features. For patients in older age, with lobular mass,incomplete envelope, uneven internal echo, cystic masses,rear echo attenuation and abundant blood flow in tumor,increase of arterial resistance index(RI )and peak velocity(Vmax ,breast phyllodes tumor may be considered, but high frequency ultrasound parameters for the differential diagnosis of benign tumor and malignant tumor still needs further research.
Clinical Study of Subclinical Hypothyroidism during Pregnancy
Chen Wei Wen
2012, 33(10)
Abstract(3333) PDF(714)
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[Abstract]Objective To observe the change of thyroid function and treatment effect of Levothyroxine for hypothyroidism during pregnancy.Method With high-sensitive chemical irradiance assay (CIA) technique analisis the FT3,FT4,TSH changes thyroid function of different pregnancy period and the 25~150 ug/d changes dose to treat in different dose use it.Results The levels of TSH in groups of patients with hypothyroidism & subclinical hypothyroidism were higher than those of the normal groups during pregnancy medium period(P<0.01).The levels of FT4 in the subclinical hypothyroidism patients were higher than those in hypothyroidism patients(P<0.05).In the 3rd trimester, the levels of FT3 and FT4 in hypothyroidism patients were lower than those in the normal subjects(P<0.05),and the levels of TSH were much higher than the normal groups(P<0.01).The required doses of Levothyroxine in both groups of patients were much higher the first pregnancy period(P<0.05).The groups of subclinical patients need more dose in first pregnancy period (P<0.01).The doses of both groups of patients after childbirth were lower than the groups in the 3rd trimester(P<0.05).Conclusions The doses of Levothyroxine in both groups of patients are increasing in the 2rd and 3rd trimester.All mothers with thyroid disease get adequate treatment in time and remain thyroid function normal,the adverse influence may be reduced to the least. So serial monitoring and therapeutic intervention may be necessary for the prevention of undesirable obstetric outcomes.
Clinical Analysis of 26 Cases of Ovarian Pregnancy
Zhang Hong Yun
2012, 33(10)
Abstract(3854) PDF(372)
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[Abstract]Objective To analysis the characteristics,clinical manifestations,diagnosis,treatment and risk factors of 26 patients with ovarian pregnancy who were treated in our hospital.Method We retrospectively reviewed the data of 26 cases with ovarian pregnancy from January 2003 to April 2012 in our hospital.Results  During the study period, the incidence of ovarian pregnancy was about 0.886%; average age was 29.9 years;average parity was 2.7 .The main clinical manifestation was abdominal pain(100%),the most common ultrasound results were abdominal cavity effusion(96.2%)and ovarian enlargement (88.5%). Operation was the maijor treatment way,and the most common risk factors were uterine or pelvic surgical operation history.Conclusion  Ovarian pregnancy is a rare disease which is difficult to diagnose, the causes of ovarian pregnancy are various,ovarian wedge resection or embryos removal of the ovaries suture primarily are the major treatment ways.
Duan Yuan Yuan
2012, 33(10)
Abstract(2605) PDF(420)
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Liu Feng Chun
2012, 33(10)
Abstract(3142) PDF(322)
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Xiao Zhong Xian
2012, 33(10)
Abstract(2389) PDF(710)
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Yu Mei
2012, 33(10)
Abstract(2599) PDF(468)
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Wang Ying
2012, 33(10)
Abstract(3113) PDF(759)
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Jiang Yan Ping
2012, 33(10)
Abstract(2186) PDF(396)
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Li Yan
2012, 33(10)
Abstract(1876) PDF(338)
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Chen Yong Sheng
2012, 33(10)
Abstract(4252) PDF(2050)
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Mu Ying
2012, 33(10)
Abstract(2212) PDF(403)
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The Potential Risk Factors Analysis of HIV/STD Infection in Vietnamese Cross-border Female Sex Workers
Zhu Jing
2012, 33(10)
Abstract(4916) PDF(2052)
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[Abstract]Objective To explore the HIV/STD related potential risk factors in Vietnamese cross-border female sex workers,and to lay the foundation for the cross-border cooperation.Methods We selected two fixed places of business in Hekou county,Yunnan province as survey sites.Census way was used to collect the data of Vietnamese cross-border female sex workers.Questionnaire survey and in-depth interview were used to collect data,including demographic characteristics,risk sexual behaviors,boss,whoremaster,language,companion and some other risk sexual behavior related influencing factors.Results The AIDS infection rate was 5.9%,STD infection rate was 31.6% in Vietnamese cross-border female sex workers. The causes of not using condom were whoremasters' refuse or procuress' intervention.Meanwhile, language barrier, the competition with companion contributed to the incidence of risk sexual behaviors.Conclusions Language barrier,the influence of companion, the manner of procuress and whoremaster are the potential risk factors to risk sexual behaviors in Vietnamese cross-border female sex workers.Chinese language training should be provided. Meanwhile,some intervention measures for procuress and whoremasters should be taken.
Application of Case-Based Learning in the Course of Lemology Teaching
Dai Hong
2012, 33(10)
Abstract(3049) PDF(381)
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[Abstract]Objective To evaluate the effect of case-based learning (CBL) in the course of lemology science teaching,and to construct the teaching case library.Method A total of 246 clinical undergraduates of medical faculty of Kunming Medical University were selected and randomly divided into CBL group(120)and lecture based learning(LBL)group(126)in the course of lemology science teaching. The educational differences of the two teaching methods were compared in several aspects. The teaching effect was evaluated by the results of the theoretical exames and questionnaires.Result The theoretical test results show that the average scores of the CBL group was significantly higher than that in the LBL group(P<0.05).The survey results show that students' interest in the case-based learning mothod was significantly higher than that in the control group.Conclusion The case-based learning method can stimulate students' enthusiasm,initiative,and improve the comprehensive ability to analyze problems and clinical thinking ability. Both subjective and objective indicators indicate that CBL teaching method can improve significantly the effectiveness and quality of teaching.
Application of Formative Assessment in Parasitology Teaching
Li Cui Ying
2012, 33(10)
Abstract(3283) PDF(471)
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[Abstract]Objective To explore the effect of formative assessment on curriculum of parasitology.Methods Taking Grade 2009 undergraduates majoring in medical laboratory as the research object,total performance was consisted of formative assessment(40%)and summative assessment(60%). Total performance,the score of theory, the excellent and good rate was compared respectively with students of Grade 2007. Questionnaire was used to investigate opinions of students on the formative assessment.Results Total performances,the score of theory, the excellent and good rate was higher than that of students in Grade 2007, respectively(P<0.05).98.27% students thought that formative assessment was good for fostering independent learning ability.Conclusion Formative assessment can evaluate performance of students in parasitology learning timely,scientifically and objectively, which can improve initiative in learning and comprehensive quality of students.
Teaching Quality Evaluation of Kunming Medical University Fine Course AIDS and Drug Abuse
Huang Ying
2012, 33(10)
Abstract(3423) PDF(787)
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[Abstract]Objective To evaluate the teaching quality of Kunming Medical University Fine Course AIDS and Drug Abuse and provide evidence for teaching improvement.Methods We combined quantitative research and qualitative research in this study.Questionnaire for students was used in quantitative research and observe and focus group discussion was used in quantitative research.Results The total score of students’evaluation was 92.7. 3 Single items of teaching method were lowest:vivid(score 2.71 points out of 3);interaction(score 2.71 points out of 3);and flexibility(score 2.72 out of 3).Conclusions The overall evaluation of students to teachers is satisfied. But in term of teaching method,some single-item score is low.So teachers and related sectors should pay more attention to teaching method improvement and teaching skill enhancing.
New Development in Role of BDNF in the Mechanism of Methamphetamine Dependence
Liu Ju Peng
2012, 33(10)
Abstract(2785) PDF(954)
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[Abstract]Brain-derived neurotrophic factor plays an important role in neuron growth, differentiation, survival, plasticity and damage repair, and it can effectively prevent the methamphetamine-induced neuronal death. The article describes the mechanism of the toxic effects of methamphetamine, BDNF physiological role, and the role of BDNF in methamphetamine-dependent mechanism. BDNF may play an important role in methamphetamine dependence. The clarification of role of BDNF in the methamphetamine-dependent mechanism may provide a theoretical basis for detoxification treatment.
Dressing Effect of Mesalt Dressing on Infected Wounds
Yu Qin
2012, 33(10)
Abstract(4873) PDF(2863)
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[Abstract]Objective To compare the dressing effect between new Mesalt dressing and conventional anti-infective treatment with iodine dressing for surgical infected wound.Methods From July 2010 to July 2011, 120 patients received dressing for infected wounds in our clinic dressing room were randomly divided into two groups: observation group and control group,60 patients in each group.Patients in observation group received Mesalt dressing,while patients in control group received iodine wet dressing.The amount of wound exudate,wound and surrounding skin conditions,anti-infection and debridement completion time,number of dressing changes and wound healing time completely change of patients in two groups were observed. The data were statistically analyzed by SPSS software.Results The amount of exudate in infected debridement and granulation phase had statistically significant difference between two groups(P<0.01).The repair period also had statistically significant difference between two groups(P<0.05).The dressing frequency and healing time had statistically significant difference between two groups(P<0.01).Conclusion Mesalt dressing for infected wounds can effectively shorten the debridement,granulation,the repair period and reduce the frequency of dressing changes,reduce wound healing time,the effect of observation group is significantly better than the control group.
The Problems of Undergraduate Nursing Students in the Vaccine Immunol Practice and Countermeasures
Wu Lei
2012, 33(10)
Abstract(5691) PDF(1165)
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[Abstract]Objective To learn the job psychograph and influencing factors of undergraduate nursing students in Vaccine Immunol practice and find out the countermeasures.Methods A questionnaire was used to learn the problems of undergraduate nursing students in Vaccine Immunol practice.The investigation was performed in 2011 and 2012 grade undergraduate nursing students who praticed in 10 teaching hospitals of our university. The data were collected and analyzed statistically.Results Before Vaccine Immunol internship,70% nursing students thought that the position and salary of Vaccine Immunol nurse was lower than clinical nurse,over 60% nursing students thought that the practice purpose was not definite in Vaccine Immunol internship.During Vaccine Immunol internship,over 65% nursing students thought the teachers lack of responsibility,over 85% nursing students reflected no opportunity of operating practice.There was no statistically significant difference in the job psychograph in Vaccine Immunol internship between 2011 grade and 2012 grade nursing students(P=0.08),and also no statistically significant difference in attitude to Vaccine Immunol position between students in two grades(P=0.346).Conclusion Vaccine Immunol internship for nursing students can improve the comprehensive quality of students and lay a good foundation for their future clinical work.
Application of Evidence-based Care in the Patients Received Enhanced Abdominal CT Scan
Chen Shi Gui
2012, 33(10)
Abstract(4123) PDF(1225)
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[Abstract]Objective To improve the care quality,relieve the patient's worry and increase their satisfaction by offering evidence-based care to the patients who received enhanced abdominal CT scan. Methods The 3600 patients who received enhanced abdominal CT were randomly divided into two groups: 1780 in control group and 1820 in experimental group.Patients in the control group were given routine care and patients in the other group were offered with evidence-based care.Result The patients in the experimental group remarkably relieved their worry (P<0.01);the awareness and satisfaction of patients in the experimental group was improved greatly than that in the control group(P<0.01).Conclusion The adoption of evidence-based care can effectively relieve the patient's worry and improve their awareness and satisfaction.
Effects of Liangxuehuoxue Drugs on Hyperoxia Induced Retinal Neovascular HIF-1 and NF-кB Expression in Mice
Ma Shan
2012, 33(10): 1-1.
Abstract(2777) PDF(376)
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[Abstract]Objective To study the intervention of liangxuehuoxue drugs on retinal neovascularization and the mechanism of action.Methods Retinal neovascularization model was established in young C57BL/6 mice by hyperoxia induction.Mice were divided randomly into 4 groups:normal control group,model group, liangxuehuoxue drugs high dose group and low dose group. The number of nucleus of endothelial cells which broke through the endangium in retinal section, and the expression of HIF-1 and NF-κB in retina was detected by immunohistochemistry.Results Comapred with normal control,after hyperoxia induction,the number of nucleus of endothelial cells significantly increased, and the expression of HIF-1 and NF-κB was upregulated, and the difference was statistically significant(P<0.05),suggesting the retinal neovascularization model was established successfully. Compared with model group, in liangxuehuoxue drugs groups,the number of nucleus of endothelial cells significantly decreased, and the expression of HIF-1 and NF-κB was downregulated,and the difference was statistically significant(P<0.05).Conclusion Liangxuehuoxue can inhibit the retinal neovascularization,and the mechanism may be related to downregulating the expression of HIF-1 and NF-κB related to the angiogenesis.