This article discussed characteristics of current off-label drug use in China and other countries,and analyzed the current administration and future development,making valuable reference for off-label drug use.

Objective To explore the effect of appreciation intervention on anxiety and complications in patients with renal biopsy. Methods A total of 197 cases of renal biopsy patients were divided into the control group (n=96) and the observation group (n=101). The observation group was given comprehensive nursing intervention with appreciation, the control group was only given comprehensive nursing care, the two groups were evaluated with Zung Self-rating Anxiety Scale (SAS) upon admission and 1 week after puncture. Results After intervention, the SAS score of the observation group was 30.87 ± 4.52, and the SAS score of the control group was 32.32 ± 3.72, and the difference between the two groups was statistically significant (t=2.45,P<0.05). Totally 97 patients in the observation group and 78 cases in the control group received bed urination exercises, and the difference between the two groups was statistically significant (χ2=9.412,P<0.01). The complications of two groups were collected, the complications in the observation group were 27 cases, and the complications in the control group were 50 cases, the difference between the two groups was statistically significant (χ2=13.285,P<0.01). Among the postoperative complications, 8 of the patients in the observation group had urinary retention, and 19 of the control group had urinary retention (t=2.446,P=0.015). In the observation group, 3 cases had abdominal distention, and 10 cases in the control group suffered from abdominal distension (t=2.117, P=0.035). In the observation group, 1 case had low back pain, and 6 cases in the control group suffered from lumbago (t=2.004, P=0.047); the difference was statistically significant. Conclusions Appreciate intervention for patients with renal puncture biopsy has a positive impact on the bed urination exercise in puncture before surgery. It can alleviate the anxiety of patients received renal biopsy, reduce urinary retention, abdominal distension and pain complications, and improve bedridden experience.

Objective To establish blood screening and genetic detection of thalassemia trait in pregnant couples in Chang‐shou area so as to provide guidance for aristogenesis and prenatal diagnosis .Methods A total of 1 760 pregnancy in maternal and child health hospital treated from January 2013 to October 2014 were selected for study .The component of hemoglobin was ana‐lyzed as primary screening and genotype of pregnant couples were ensured in which primary screening result is positive .Results There were 27 cases suspected as α‐thalassemia (positive rate was 1 .53% ) and 25 cases suspected as β‐thalassemia(positive rate was 1 .42% ) in the primary screening(n=1 760) .The positive rate of gene carrier were 31 .51% (n=438) in women and 33 .33%(n=27) in men .Conclusion The routine screening of thalassemia could guide aristogenesis in high incidence area and provide terms of prenatal diagnosis and genetic counseling .

Objective To observe the effects of creatine phosphate sodium on heart function and B -type natriuretic peptide in patients combination with ischemic cardiomyopathy and intractable heart failure .Methods 70 cases of coronary heart disease combined with ischemic cardiomyopathy and intractable heart failure were randomly ( with the random number table ) divided into the control group ( n=33) and the creatine phosphate sodium treatment group (n=37).The control group treated with conventional therapy (digitalis,diuretics,vasodilator,ACEI,et al) ten days;the treatment group with creatine phosphate sodium treatment on the basis of conventional therapy .The symp-tom,sign of the heart failure patients of the two groups before and after treatment were observed .NYHA cardiac func-tional grading were estimated.Echocardiography was used to detect left ventricular end -systolic diameter(LVESD), left ventricular end diastolic diameter ( LVEDD ) and left ventricular ejection fraction ( LVEF ); amino terminal pro brain natriuretic peptide (NT-proBNP) tested by laboratory of the two groups.Drug treatment for 10 days,the chan-ges of the indicators before and after treatment were observed .Results After treatment , compared with the control group[(50.63 ±4.67) mm,(61.30 ±4.58) mm].LVESD,LVEDD of the creatine phosphate sodium treatment [(47.16 ±4.30)mm,(57.92 ±4.30)mm]significantly decreased(t=5.73,4.96,all P<0.01),LVEF[(40.57 ± 4.51)%,(37.63 ±4.53)%]increased significantly(t =5.53,P<0.01).After ten days of treatment levels of NT-proBNP decreased in both two groups [(1 659.±248.18) pg/mL,1 899.3 ±205.45] than before treatment [2 043.46 ±217.04,(2 105.46 ±239.09)pg/mL](t=3.23,3.64,all P<0.05),and the decrease degree of the creatine phosphate sodium treatment group was more obvious than those of the control group (t=4.11,P<0.05). Conclusion Creatine phosphate sodium can improve the cardiac function and left ventricular ejection fraction of ischemic cardiomyopathy and intractable heart failurepatients ,enhance the clinical symptoms of patients .

ObjectiveTo observe the effect of Buzhongyiqi decoction on post stroke fatigue.Methods60 stroke patients with fatigue were given Buzhongyiqi decoction for 4 weeks continuously. Chinese New Drug Clinical Guidelines was to evaluate the effect for patients according to improvement of symptoms.ResultsIn 60 cases, markedly effective in 47 cases (78.33%), effective in 10 patients (16.67%), invalid in 3 cases (5%). Symptoms of malaise, anorexia, muscle soreness were significantly improved.ConclusionBuzhongyiqi decoction can improve post stroke fatigue of stroke patients.

Objective To observe the effects of a decoction of buzhong yiqi in conjunction with rehabilitation training in relieving post-stroke fatigue.Methods A group of 115 stroke patients was enrolled and randomly divided into a simple rehabilitation group and a combination therapy group.Both groups received conventional rehabilitation treatment and appropriate treatment of any primary diseases.In addition,those in the combination therapy group were given a decoction of buzhong yiqi twice daily for a total of 4 weeks.EMG signals,subjective evaluations of fatigue severity,active rehabilitation exercise duration,motor function and ability in the activities of daily living (ADL) were assessed before treatment and after 4 weeks of treatment.The slope of the surface electromyogram's mean power frequency (KMPF) and median frequency (KMF) were used to quantify fatigue.Subjective fatigue severity was estimated using a fatigue severity scale (FSS).The active rehabilitation exercise lasted,on average,90 minutes daily.The Fugl-Meyer assessment (FMA) was used to evaluate motor function and the modified Barthel index (MBI) ADL ability.Results There were no statistically significant differences between the groups before treatment.After 4 weeks of treatment all the outcomes in both groups had improved (except the FSS scores of the simple rehabilitation group).The KMPF,KMF,FSS,exercise duration,FMA scores and MBI scores in the combination therapy group were all significantly better than those in the simple rehabilitation group.Conclusion Taking buzhong yiqi can significantly improve the clinical effects of conventional rehabilitation training on post-stroke fatigue.It helps relieve fatigue,improve active participation in rehabilitation exercise,and also improve motor function and ADL ability.

Objective To evaluate the clinical application of multimodality treatment of brain arteriovenous malformation (BAVM) with Onyx embolization and microsurgery.Methods There were 48 patients with BAVM treated by combination of Onyx embolization and microsurgery.The clinical features,therapeutic process,complications and discharge status (by MRI,DSA and Glasgow outcome scale,GOS) were recorded in detail.The prognosis was estimated by modified Rankin scale (mRS) with 6-42 months' follow-up.Results The total resection rate was 97.9％.The therapy-related complications happened in 8 patients (16.7％).Among them,4 cases had dysfunction of central nervous system (8.3％),2 cases with intra-cerebral hemorrhage (4.2％),and 2 suffered from severe cerebral edema (4.2％).Good recovery was seen in 38 cases (79.2％) evaluated by GOS when discharged from hospital.The follow-up result mRS ＜ 3 was 97.9％.Conclusion Multimodality treatment of BAVM with Onyx embolization and microsurgery should be a good therapeutic strategy.

Objective To study the clincial effectiveness and safety of endoscopic sphincteropapillotomy combined with balloon dilation for decompensated cirrhosis accompanied with choledocholithiasis.Methods Data of 79 cases of decompensated cirrhosis patients with choledocholithiasis who underwent limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD,the ESBD group) and 42 cases who underwent endoscopic papillary balloon dilation(EPBD,the EPBD group)were retrospectively analysed and compared for complete stone clearance rate,one-time stone clearance rate and complications.Results The rate of complete stone clearance and one-time stone clearance were 94.9％ (75/79) and 77.2％ (61/79)in ESBD group,and those were 88.1％ (37/42) and 59.5％ (25/42) in EPBD group respectively.The rate of complete stone clearance was a little higher in ESBD group than that in EPBD group.In ESBD group,ERCP-related bleeding occurred in 3 patients (3.8％),post-ERCP hyperamylasemia in 3 (3.8％)and post-ERCP pancreatitis in 2 (2.5％) ; while in EPBD group,post-ERCP hyperamylasemia occurred in 8 patients(19.0％),post-ERCP pancreatitis in 6(14.3％) and ERCP-related bleeding did not occur.There were no significant difference in ERCP-related bleeding between ESBD group and EPBD group (P =0.551).However,the rates of post-ERCP pancreatitis and hyperamylasemia in ESBD group were significantly lower than those in EPBD group(P ＜ 0.05).Conclusion ESBD is a safe and effective procedure for choledocholithiasis accompanied by decompensated cirrhosis,with several advantages over EPBD in terms of higher one-time stone clearance rate,reduced risk of post-ERCP pancreatitis and hyperamylasemia,and without noticeable increase in the risk of bleeding related to ERCP.

To improve the effect of teaching practice of blood cell morphology,typical cases of peripheral blood erythrocyte,granulocyte and platelet were chosen,case show and problem-based teaching way were applied to encourage students to find information of autonomous learning.Then teacher organized the class discussion,and the information was analyzed and summarized.In the implementation of the case teaching,we should pay attention to improving students' learning initiative.At the same time,teachers need to have knowledge,comprehensive ability and ability in organization and leadership,to promote students' active participation in discussion in the teaching,pay attention to the information feedback,and improve the teaching details

OBJECTIVETo investigate the role of Src family kinases (Fgr, Hck, Lyn) and the major protein kinase C substrate SSeCKS in non-alcoholic steatohepatitis (NASH) and determine the possible mechanism regulating differential expression.

METHODSKupffer cells were stimulated with CCL4 and effect on SSeCKS, Hck, Fgr, and Lyn expression was detected by real-time reverse transcription-PCR. Male Sprague-Dawley rats were used to create a NASH model by feeing a high fat diet. The modeled rats were divided into a model group and a normal group. After sacrifice, the extent of hepatic steatosis and inflammation was assessed, and the expression levels of SSeCKS and Hck, Fgr, Lyn were detected by immunohistochemical staining.

RESULTSExpression of Lyn and Hck was decreased in the CCL4-stimulated Kupffer cells and the change in expression level was positively associated with levels of inflammatory stimuli (P < 0.01). The change in expression of SSeCKS in the CCL4-stimulated Kupffer cells was negatively correlated with inflammatory stimuli (P < 0.01). Fgr expression was very low in the unstimulated Kupffer cells and was not affected by the exposure to inflammatory stimuli. The number of inflammatory cells in the liver tissues of rars were negatively correlated with expression of Lyn, Hck and SSeCKS (P < 0.01), with low negative correlation for Lyn (r =-0.398, P < 0.01) and moderate negative correlation for Hck (r=-0.508, P < 0.01); the Lyn and Hck expression levels were highly positively correlated (r =0.942, P < 0.01).

CONCLUSIONSrc family kinases (Lyn, Hck and Fgr) and SSeCKS are involved in development and progression of NASH, and their differential expression patterns are associated to a certain extent. The factors may represent potential targets of therapy for NASH-related inflammation.