Objective To investigate the status and correlation between fatigue and health locus of control in patients with chronic obstructive pulmonary disease ( COPD ) . Method The multidimensional fatigue symptom inventory-short form and health locus of control questionnaire were used to investigate the fatigue and health locus of control among 150 COPD patients. Results The score on fatigue was 78.82 ± 1.50, in the middle-high level. The two factors scored the higher were physical fatigue and activity. The total score on health locus of control was 61.76 ± 5.02, at a middle-low level. The dimensions of health locus of control, ranked in a descending way in scores, included external control by destiny and authorities and internal control. The scores on external control by destiny and authorities were positively related that of total score on fatigue (P<0.05 for both) and the score of internal control was negatively correlated (P<0.05). Conclusion The fatigue of COPD patients was at high level and the health locus of control was at middle level. In the clinical practice, nurses should pay attention to the enhancement of patients′health locus of control to help them take up health behaviors for the purpose of lowering their fatigue.

Hepatitis C virus (HCV) is a blood-borne virus transmitted through contact with blood and blood products,and it is a major cause of liver cirrhosis and hepatocellular carcinoma.Many epidemiological studies have confirmed the association between HCV infection and renal disease.Membranoproliferative glomerulonephritis associated with mixed cryoglobulinemia is the most common type of HCV-related renal disease manifesting as nephropathy or nephritic syndrome,proteinuria,hematuria,and reduced glomerular filtration rate.The treatment of HCV-related renal disease includes antiviral therapy,B cell clearance,and non-specific immunosuppressive therapy.At the same time,the launch of rnew antiviral drugs has brought hope to the patients who cannot tolerate conventional regimens.This article reviews the research advances in epidemiology,clinical manifestations,pathogenesis,and treatment of HCV-related renal injury.

Objective To understand the feedback of seven-year students of clinical medicine about the application of PBL teaching method and investigate its related factors.Methods Four classes of seven-year students of clinical medicine of Nanjing Medical University which had received PBL teaching method were randomly selected in grade 2009 and 2010 (243 students)and 233 valid questionnaires were analyzed statistically.The questionnaire has four main parts and they are about basic situation,factors that may affect the PBL Teaching,students' subjective attitude,their effect evaluation and suggestion for improvements.SPSS 11.0 was used to analyze the first part of the resuhs withx2 analysis(P＜0.05).Results 233valid questionnaires were recovered and 79.0％(184/233) of students held a favorable position toward PBL application in their course.It is irrelevant to no other related factors but the accessibility of information(P=0.000).More than half of the students think it is suitable for PBL on the clinical medical students(57.5％,134/233),PBL teaching is more free and easy(51.9％,121/233)and can improve their awareness of participation(72.5％,169/233).However more students (193) are in favor of more traditional teaching combined with PBL,with the former dominated.Conclusion PBL teaching method in seven-year clinical medical program has been proved to be quite effective.Though with certain drawbacks,it is a good supplement to the traditional teaching methods in many aspects,and it is definitely of great significance in improving the quality of teaching.

Objective To evaluate the value of imaging examination and diagnosis of airway foreign body in children. Methods 218 of airway foreign bodies confirmed by bronchoscopy were retrospectively analyzed in terms of clinical and imaging data. Results 218 patients included 140 males and 78 females. Their ages ranged 6 months to 12 years(mean,19.2 months). All patients had conventional radiographs on frontal chest films,neck lateral films and fluoroscopy. 34 cases underwent 64-slice spiral chest CT examination. According to the location of the foreign bodies,29 cases were in throat and subglottic,55 cases in trachea and 134 cases in bronchus(79 cas-es in the right,55 cases in the left). According to the character of the foreign bodies,5 cases were metal,29 cas-es in bone,93 cases in peanuts,59 cases in seeds,22 cases in fruits and vegetables and 10 cases in others respec-tively. Thirty-fourcases showed a direct sign of the foreign body and 177 cases showed the indirect signs. 34 cases on CT examination directly were showed foreign body in the tracheal bronchi. The diagnostic accuracy of CT exami-nation was 100%. Conclusions X-ray photograph and fluoroscopy were the first choice for aspiratory foreign bod-ies in children. CT examination is an important supplementary method when conventional X-ray examination is neg-ative.

Objective:To efficiently amplify NK cells and determine their cytotoxic activity against a variety of tumor cell lines in vitro,thereby providing evidence for potential clinical application.Methods: PBMCs were isolated from adult peripheral blood and co-cultured with K562 cells that were genetically modified to express 4-1BBL,IL-15 and IL-21 on the surface for 15 days to effectively amplify NK cells.The total cell number and Purity of CD3-CD56+ cells were measured.Granzyme B and perforin expression of the amplified NK cells were detected by flow cytometry and real-time PCR.The anti-tumor effect on different cancer cells was evaluated.Results: This method obtained a more than 1.1×1010 CD3-CD56+ NK cells with 95% purity over a 15 day amplification procedure.The expanded NK cells could efficiently release granzyme B and Perforin.The cytotoxicity against different tumor cells was followed the order from strong to weak:gastric,pancreatic,cervical,ovarian and renal cancer cells,with the highest activity against gastric cancer cell line A549 (90% at E∶T=10∶1) (P<0.05).A time-dependent killing effect of activated NK cells on cervical,liver and pancreatic cancer cells was observed.Conclusion: This amplification procedure can consistently generate large amounts of pure NK cells with effective cytotoxic function against a variety of tumor cells.

ObjectiveTo investigate the associations of plasma homocysteine (Hcy) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels with dementia.MethodsThe patients with dementia admitted to hospital were enrolled retrospectively.They were divided into a vascular dementia (VaD) group, a mixed dementia (MD) group, and an Alzheimer's disease (AD) group according to the Hachinski Ischemic Score, and the dementia severity was further divided into a mild group, a moderate group and a severe group according to the Mini-Mental State Examination.The non-demented patients hospitalized during the same period were selected as controls.The demographics, vascular risk factors, and plasma Hcy and Lp-PLA2 levels in each group were compared.Logistic regression analysis was used to determine the independent associations of the plasma Hcy and Lp-PLA2 levels with the risk of dementia and severity.ResultsA total of 125 patients with dementia were enrolled, including 52 (41.6%) in the VaD group, 21 (16.8%) in the MD group, and 53 (41.6%) in the AD group.There were 49 patients (39.2%) in the mild group, 51 (40.8%) in the moderate group, and 25 (20%) in the severe group.A total of 40 non-demented patients were enrolled as control group.The plasma Hcy and Lp-PLA2 levels in VaD, MD and AD groups were significantly higher than those in the control group (all P<0.001).Multivariable logistic regression analysis showed that the advanced age (odds ratio[OR] 1.12, 95% confidence interval [CI] 1.03-1.21;P=0.010), high plasma Hcy level (OR 1.44, 95% CI 1.21-1.71;P<0.001), high Lp-PLA2 level (OR 1.01, 95% CI 1.00-1.02;P=0.006), and previous stroke (OR 4.29, 95% CI 1.50-12.36;P=0.007) were the independent risk factors for dementia;high Hcy level (OR 1.48, 95% CI 1.21-1.82;P<0.001, high Lp-PLA2 level (OR 1.01, 95% CI 1.00-1.03;P=0.002), and previous stroke (OR 152.78, 95% CI 20.41-999.97;P<0.001) were the independent risk factors for VaD;advanced age (OR 1.10, 95% CI 1.02-1.17;P=0.008) and high Hcy level (OR 1.41, 95% CI 1.25-1.58;P<0.001) were the independent risk factor for severe dementia.ConclusionsThe increased plasma Hcy and Lp-PLA2 levels are associated with dementia.Reducing the plasma Hcy and Lp-PLA2 levels may be beneficial to the treatment and prevention of dementia.

Objective To investigate the relationship between clinical types and related risk factors in female patients with post-adolescent acne.Methods Female outpatients with post-adolescent acne aged more than 25 years were enrolled from Department of Dermatology of Renji Hospital between January and October 2016.A questionnaire survey was conducted to investigate related risk factors for post-adolescent acne in the females.Skin lesions and clinical types were evaluated by dermatologists.Statistical analysis was carried out by t test for comparison of means between two groups and by chi-square test for comparison of ratios.Results A total of 312 female patients with post-adolescent acne completed the survey,including 268 (85.9％) with mild to moderate acne and 44 (14.1％) with severe acne,241 (77.2％) with persistent acne and 71 (22.8％) with late-onset acne,or 102 (32.7％) with comedonal post-adolescent acne (CPAA) and 210 (67.3％) with papular post-adolescent acne (PPAA).Survey on related risk factors showed that 121 patients reported seasonal factors and 59 (18.9％) patients became worse in summer,and spicy,sweet and fried foods can aggravate the condition in 131 (42％),93 (29.8％) and 85 (27.2％) patients respectively.Other risk factors such as premenstrual period (62.8％,196/312),psychological factors (51.6％,161/312) and exogenous chemical exposures (43.6％,136/312) were complained of by the patients.Furthermore,premenstrual period,diet and constipation were found to be more associated with PPAA compared with CPAA (x2 =4.523,4.068,3.910,respectively,all P ＜ 0.05).Exogenous chemical exposures,such as the use of cosmetics,exposure to polluted air environment and occupational hazards,were more associated with CPAA compared with PPAA,as well as with late-onset acne compared with persistent acne (x2 =6.579,9.057,both P ＜ 0.05).In addition,premenstrual exacerbation occurred more frequently in patients with persistent acne compared with those with late-onset ache (x2 =4.512,P ＜ 0.05).Conclusions The risk factors for the occurrence of female post-adolescent acne are very complex.Premenstrual exacerbation plays a major role in the aggravation of papular and persistent post-adolescent acne,diet and constipation are more associated with PPAA,and exogenous chemical exposures are still be considered in the aggravation of comedonal and late-onset post-adolescent acne.Thus,clinical types should be considered in the diagnosis and treatment of post-adolescent acne in females.

Objective To investigate the clinical significance of homocysteine(Hcy) and glycated hemoglobin (HbA1c) in patients with diabetic retinopathy.Methods From March 2013 to February 2015,a total of 168 patients with diabetes from Beijing Jishuitern Hospital were divided into diabetic retinopathy group (76 cases,32 male,44 female,average age 62.97 ± 12.46) and non-diabetic retinopathy group (92 cases,46male,46 female,average age 58.14 ± 13.71),and 65 cases of healthy subjects (46male,46 female,average age 60.24 ± 10.85) were enrolled as normal control group as well.Hcy and HbA1c were detected in all groups.Multiple independent samples nonparametric tests were used to compare the difference between groups.The concentrations of Hcy and HbA1c between DR group and NDR group were analysised by ROC curve analysis.Result The Hcy levels in normal control group,NDR group and DR group were 7.00 (4.55-10.50) μmol/L,12.45 (10.30-15.10) μmol/L,20.10 (16.63-25.68) μmol/L respectively.The HbA1c levels in normal control group,NDR group and DR group were 5.30 (5.00-5.70) ％,6.80 (5.83-8.03) ％,7.25 (6.50-8.60) ％ respectively.There was no significant difference in Hay and HbA1c levels between groups (P ＜ 0.01);Compared with non-diabetic retinopathy group,levels of Hcy,HbA1c in diabetic retinopathy group were obviously higher;The optimal diagnostic cut-off values of Hcy was 14.35 μmol/L,at this cut-off value,the sensitivity was 96.05％,specificity was 68.48％;The optimal diagnostic cut-off values of HbA1c was 6.05％,at this cut-off value,the sensitivity was 98.68％,specificity was31.25％.Conclusion Patients with Diabetic retinopathy might have hyperhomocystinemia,and detection of Hcy may contribute to the early diagnosis of diabetic retinopathy.

Objective To discuss the influence of different doses budesonide aerosol inhalation on serum cytokines levels in children with severe asthma.Methods 96 children with severe asthma aged 4 to 14 years old in our hospital were chosen,and they were randomly divided into the observation group and the control group,48 cases in each group.All patients were given conventional treatment, and the control group was given 1mg/time budesonide treatment on the basis of conventional treatment (3 times a day),while the observation group was given 2mg/time budesonide treatment (3 times a day).Before and 1 week after treatment,the clinical symptoms of two groups were observed and compared,as well as the changes of IL-4,IFN-gamma,IL-10 and TNF-α.Results In the obser-vation group,wheezes,coughing,wheezy sound and rales disappearance time were (2.10 ±0.77)d,(5.45 ±1.20)d, (3.46 ±1.03)d,(5.55 ±1.35),which were significantly shorter than (2.98 ±1.02)d,(7.48 ±1.19)d,(5.43 ± 1.06)d,(7.56 ±1.67)d in the control group (t=4.77,8.32,9.23 and 8.32,all P<0.01).4 weeks after treat-ment,the total effective rate of the observation group was 89.6%,which was significantly higher than 72.9% of the control group (χ2 =4.376,P<0.05).After treatment,the IL-4,IL-10,TNF-alpha,IFN-gamma levels in the observation group were (4.06 ±1.77)pg/mL,(12.77 ±2.05)pg/mL,(4.15 ±1.11)ng/mL,(26.23 ±2.78)pg/mL, which had significant changes compared with (9.02 ±2.23)pg/mL,(10.21 ±1.30)ng/mL,(6.66 ±1.62)pg/mL, (17.33 ±2.31)pg/mL before treatment(t=12.07,24.56,16.20,17.25,all P<0.01).After treatment,the IL-4, IL-10,TNF-alpha,IFN-gamma levels in the control group were (9.11 ±2.05)pg/mL,(6.80 ±1.23)ng/mL, (9.88 ±2.20)pg/mL,(21.22 ±2.80)pg/mL,which had significant changes compared with (9.11 ±2.05)pg/mL, (10.38 ±1.37) ng/mL,(6.71 ±1.77) pg/mL,(17.30 ±2.05) pg/mL before treatment( t=5.36,13.47,7.77, 7.83,all P<0.01).But IL-4,TNF-alpha levels in the treatment group were significantly lower than those in the control group (t=7.32,11.08,all P<0.01),while IL-10 and IFN-gamma levels were significantly higher than those in the control group (t=6.65,8.80,all P<0.01).The incidence of adverse reactions of the two groups had no statistically significant difference (χ2 =0.771,P>0.771).Conclusion High doses of budesonide aerosol inhalation in the treatment of children with severe asthma has obvious clinical curative effects,which could significantly improve the patients'clinical symptoms,and also has low incidence of adverse reactions,which is worthy of clinical promotion.

Purpose To explore the correlation between fetal cardiac function and interventricular septal thickness in fetuses of gestational diabetes mellitus (GDM) mothers. Materials and Methods Thirty-nine GDM mothers were involved in the study and divided into group MH (fetuses of GDM mothers with interventricular septal hypertrophy) and group NMH (fetuses of GDM mothers with normal interventricular septal thickness). Ultrasonic cardiogram was performed for both groups to assess such variables as interventricular septum thickness at end diastole (IVSd), left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), right ventricular fraction shortening (RVFS), the ratio of E and A of mitral flow (E/AMV), the ratio of E and A of tricuspid flow (E/ATV), peak velocity of aortic valve (VPAO), peak velocity of pulmonary valve (VPPA) and myocardial performance index (MPI). The results were further compared with those of control group. Results The VPAO, VPPA, LVEF and LVFS in group NMH were significantly higher than those in control group (P<0.05). The VPAO, VPPA, LVEF, LVFS and RVFS in group MH were significantly higher than those in control group whilst the E/AMV and E/ATV significantly lower than those in control group (P<0.05). The LVEF, LVFS and RVFS in group MH were significantly higher than those in group NMH whilst the E/AMV and E/ATV significantly lower (P<0.05). MPI in group MH was significantly higher than that in group NMH (P<0.05), whilst both were significantly higher than that in control group (P<0.05). The LVEF, LVFS, RVFS, VPAO and VPPA were positively correlated with IVSd (r=0.48, 0.51, 0.45, 0.30, 0.30;P<0.05). Conclusion Cardiac function in fetuses of GDM mothers may be associated with interventricular septal thickness.