Objective To evaluate the effect of initial empirical antibiotherapy in CAP since the practice of the clinical path -way and the classification management of antibiotic and the analysis of sputum culture .Methods One hundred and sixty patients with CAP consistent with the clinical pathway were divided according to the preferred choice of empiric antibiotherapy , the results of disea-ses distribution, objective, number, therapeutic effect, drug distribution and sputum culture were listed .Results The most preferred antibiotic of initial empiric antibiotherapy were penicillins with a β-lactamase inhibitor, bibasic cephalosporin and respiratory fluoro -quinolone, it was identical with the recommendation of guideline and indirectly demonstrated that the pathogen of CAP was identical with the guideline.Conclusions The initial therapy of CAP is still depended on empirical antibiotherapy , the most CAP are cured by correct empirical antibiotharepy according to the guideline , the instruction effect of the pathogen detection of sputum to the therapy of CAP is limited.

BACKGROUND:Adipose-derived mesenchymal stem cels have rich sources that are easily obtained, which can be used to treat acute myocardial infarction. OBJECTIVE: To investigate the therapeutic effect of adipose-derived mesenchymal stem cel transplantation on acute myocardial infarction in rats. METHODS:Rat models of acute myocardial infarction were made and subjected to adipose-derived mesenchymal stem cel transplantation in comparison with model and control (sham operation) groups. RESULTS AND CONCLUSION:Echocardiography findings showed significant improvement in the left ventricular end-systolic diameter, left ventricular end-diastolic diameter and ejection fraction in the cel transplantation group compared with the model group (P < 0.05). Hematoxylin-eosin staining showed that myocardial infarction was evident in the model group, in which, there were rarely viable myocardial tissues and few vessels in the infarcted region, but in the cel transplantation group, there were evident survived myocardial tissues and transplanted cels. The percentage of infarct size was significantly lower in the cel transplantation group than the model group (P < 0.05). Immunohistochemical staining showed that adipose-derived mesenchymal stem cels were able to survive in the infarcted myocardial tissues, and the expression of cardiac troponin T in the cel transplantation group was significantly higher than that in the model group (P < 0.05). Experimental data show that adipose-derived mesenchymal stem cel transplantation can protect the myocardial tissues after myocardial infarction, and effectively improve the myocardial function.

Diabetes is a chronic noncommunicable disease,which is can't be cured,and only can be suppressed by long-term treatment and self-management.The clinical decision support system can simulate the thinking process of diabetes specialists in disease diagnosis,and can provide the regular medical treatment plans and recommend the optimal plans to doctors.Most of the existing clinical decision support systems are based on clinical guidelines,rule-based and case-based reasoning as well as ontology-based systems.The big data technology can acquire and process multiple heterogeneous data,and provide a more scientific personalized treatment plan.In recent years,a variety of big date processing methods have been applied to the clinical diagnosis of diabetes based on decision tree,neural network,fuzzy logic,support vector machine,APRIORI association rules and multidimensional analysis,and timing mining.However,these methods are still in preliminary stage.The framework of diabetes clinical decision support system based on big data technology was analyzed,and the future diagnostic and treatment methods were forecast.

OBJECTIVEThe aim of the present study was to prepare uniform-sized silybin loaded poly (lactic-co-glycolic acid) (PLGA) microspheres in study of silybin with stainless steel membrane.

METHODSilybin PLGA microspheres were prepared by stainless steel membrane emulsification. The preparation conditions were optimized by single-factor test and orthogonal experiment, and evaluating the mean diameters, the particle size distribution, drug loading, entrapment efficiency and morphology of microsphere.

RESULTPrepared microspheres were round and surface was smooth. The mean diameter was (4.961 +/- 0.56) microm. The span was (1.75 +/- 0.18). The entrapment efficiency was (54.997 +/- 4.05)% and the average drug loading was (23.6 +/- 1.70)%.

CONCLUSIONThe stainless steel membrane emulsification can be used to prepare the silybin PLGA microspheres. The mean diameters of the silybin PLGA microspheres can be controlled in certain level. Stainless steel membrane emulsification has great potentiality exploitation and utilization.

Drug Compounding ; methods ; Emulsions ; chemistry ; Lactic Acid ; chemistry ; Microspheres ; Particle Size ; Polyglycolic Acid ; chemistry ; Silymarin ; chemistry ; Stainless Steel ; chemistry

Objective: To analyze the current situation and effect of vertical integrated of rural health services in Dafeng County. Method: Policy documents and data are collected and interviews are implemented for studying the integrated situation. Results: The vertical integration in Dafeng County is virtual joint form with forming 6 city-level medical volunteer service teams and 52 health management teams. With the imple-mentation of fully integrated management, signing service with rural doctor mode is carried out, which pro-mote the establishment of rural unified service standards and regulations. Using health card of residents which promote the regional shared of treatment information. Conclusions: Vertically integrated mode had connection in health management teams, supported by fully integration, developed by signing service with rural doctor and carried by residents’ health card, which could provide reference for implementing vertical integration of rural health service. But strategies needed to be strengthened in improving health services’ ability of township hospitals, clarifying interest relationship as well as integrating health service regulations and strengthen the health information system for sharing and docking.

Objective To explore the clinicopathological characteristics and prognosis of invasive micropapillary carcinoma of the breast (IMPC),and the distinction between IMPC and invasive ductal carcinoma of the breast (IDC).Methods From February 2004 to November 2013,195 IMPC patients and 420 IDC patients were analyzed retrospectively.Results There were significant differences in mammilla invasion,lymph vessel invasion,orange peel sign,soft tissue encroachment,neoadjuvant chemotherapy,radical mastcctomy,lymph node metastasis,clinical stages,tumor size,lymph node staging,estrogen receptor (ER),progestin receptor (PR),human epidermal growth factor receptor 2 (HER2),molecular subtyping,ratio of radiation,ratio of endocrine therapy,disease-free survival (DFS),overall survival (OS)between the two groups,all P ＜0.05.Patients with IMPC had lower 5-year DFS and OS rates (68.2％ and 73.8％,respectively) than IDC patients (85.7％ and 88.6％,respectively),all P ＜ 0.05.In IMPC patients with positive ER/PR,HER2-negative,smaller tumor volume,less lymph node metastasis,negative nipple invasion,negative lymphatic vessel tumor thrombus,negative orange peel change had higher 5-year DFS and OS rates than those with negative ER/PR,HER2 overexpression,larger tumor volume,more lymph node metastasis,positive nipple invasion,positive lymphatic vessel tumor thrombus,positive orange peel change,all P ＜ 0.05.Besides,the patients with pathologic stage Ⅰ had higher OS than those with stage Ⅲ (P ＜ 0.05).Cox regression analysis found that orange peel change,lymph vessel invasion and HER2 were the independent risk factors for the survival time of patients with IMPC.Conclusions IMPC patients have lower DFS and OS compared with IDC.

Objective To study the expression of leukemia-related protein 16 (LRP16) in human pituitary prolactin adenomas (PRL adenomas), and the relationship between LRP16 and estrogen receptorα (ERα).Methods From October 2009 to September 2014, thirty-one adult patients diagnosed and pathologically confirmed as pituitary prolactin (PRL) adenomas (observation group) and 22 pituitary non-PRL adenomas (control group) in the Chinese PLA General Hospital were verified by the pathological examination. Immunohistochemical method was used to detect the expression levels of LRP16, PRL and ERα.Results Of the patients in observation group, those aged under 30 were predominantly females, while male patients were more common in those aged over 30. LRP16 positively existed in 26 cases (83.9%, 26/31), and ERα was positive in 28 cases (90.3%, 28/31), the both ratios were significantly higher than those in control group. ERα and LRP16 increased synchronously both in expressive content and intensity, showing a certain positive correlation between them.Conclusions Higher body mass index may be a high-risk factor badly affected the occurrence, development and prognosis in male patients with pituitary PRL; LRP16 may take part in the proliferation and formation of pituitary PRL adenomas through ERα.

Objective To investigate the clinicopathologic characteristics and prognosis of medullary breast carcinoma.Methods We conducted a retrospective analysis on clinical and pathologic data of 166 patients with medullary breast cancer.Results All the patients were female with a median age of 52 years old.The proportion of patients with stage Ⅰ,Ⅱ and Ⅲ disease was 16.9％,68.1％,15.0％,respectively.The Luminal,HER-2 overexpressing and triple-negative subtypes constituted 31.3％,8.4％,and 60.3％,respectively.There was significant difference in regional lymph node status of medullary breast cancer patients with different molecular types (x2 =18.248,P =0.003),but not in tumor size,TNM stage,histological grade,and expression of Ki67 (all P ＞ 0.05).Multivariate survival analysis indicated that TNM stage was an independent predictor in the prognosis of medullary breast cancer (HR =5.664,P =0.001).All the patients were followed up from 15 months to 145 months with a median follow-up time of 108 months.The 5-year survival rate was 91.5％ and the 10-year survival rate was 87.2％.Conclusions The prognosis of medullary breast cancer is favorable.Personalized treatment according to the TNM stage and histopathologic characteristics achieve a favorable prognosis.

Objective To explore the association between ankylosing spondylitis(AS)with the poly- morphism in -308 site of tumor necrosis factor(TNF)-?promoter region. Methods The literature about AS and polymorphism in -308 site of TNF-?promoter region were searched and the meta analysis as performed. Results Eight studies enrolled 987 AS patients and 922 controls in total. The analysis showed that the fre- quencies of alleles and the genotypes had no statistical difference between AS group and the control group [OR=0.86(0.53, 1.38), P=0.53; OR=0.90(0.52, 1.55), P=0.69]. But the frequencies of alleles of western origin had statistical difference between AS group and the control group [OR=0.75(0.59, 0.96), P=0.02]; The TNF-?gene promoter polymorphism may play a role in the severity of sacroiliitis[OR=0.37(0.15. 0.90), P=0.03]. Conclusion The meta-analysis reveales that the alleles of -308 site of TNF-?promoter region may be associated with AS in western ethnical group and play a role in the severity of saeroiliitis.

The ankle is a complex, weight bearing joint and its injury result in a severe functional disturbance of complex anatomical characteristics. It is very important to understand the mechanism of trauma in order to make definite diagnosis and proper treatment. The authors analysed 52 cases(52 patients) of the ankle fractures which were admitted and treated in Orthopaedic department, Korea University Hospital from Sept. 1980 to Dec. 1986. The results obtained were as follows : l. Of the 52 cases, male was 32 cases(61.5%), female was 20 cases(38.5%) and average age of the patients was 32.9 years. 2. The causes of the injury were slipping down, traffie accident, falling down and sports injuries, in orders. 3. Open fractures were 8 cases(15.4%) and closed fractures were 44 cases(84.6%). The most common type of the ankle fracture was supination-extenal rotation type(18 cases, 34.1%) and next was pronation-external rotation type(15 cases, 30%), according to the classification of Lauge-Hansen. 4. 38 cases(73.1%) were treated by open reduction and 14 cases(26.9%) by closed reduction, and average duration of immobilization was 7.7 weeks in open reduction and 10.4 weeks in closed reduction. 5. The associated fractures other than ankle was 15 cases(28.8%). 6. The better results were obtained from open reduction and the worst results obtained from pronation-dorsiflexion type, according to the criteria of Meyer. 7. The complication was 7 cases(13.5%), traumatic arthritis 4 cases, malunion 2 cases and nonunion 1 case. 8. Accurate reduction and rigid internal fixation of the fractured lateral malleolus, distal fibular and distal tibiofibular diastasis was important in treatment of the ankle fracture.
Accidental Falls ; Ankle Fractures ; Ankle ; Arthritis ; Athletic Injuries ; Classification ; Diagnosis ; Female ; Fractures, Closed ; Fractures, Open ; Humans ; Immobilization ; Joints ; Korea ; Male ; Weight-Bearing