OBJECTIVE: To improve the dispensing efficiency of TCM decoction pieces. METHODS: Based on two main line of "time" and "investment" for efficiency, dispensing process and outside condition of TCM decoction pieces were analyzed to find out optimized elements. They would be classified according to causation figure then finally resolved. RESULTS: Systematic countermeasures were summarized and put forward. The dispensing efficiency was improved significantly. CONCLUSION: The effective control of time elements in the dispensing process and reasonable outside condition are the guarantee of the improvement of dispensing efficiency of TCM decoction pieces.

Postoperative cognitive dysfunction (POCD) is a serious central nervous system complication after general anesthesia and surgery. Its risk factors are very complex, and the mechanisms of POCD are still unclear. Recently, the role of inflammation, especially cancer related inflammation, in the development of POCD is of great interest. In this review, we focus on inflammation, and try to clarify the effect of anesthetics and anesthesia on inflammation and POCD. This review aimed to provide a theoretical basis of choosing appropriate anesthetics and anesthesia for these patients, especially the cancer patients, who are vulnerable to inflammation and POCD.

OBJECTIVE:To discuss the intradermal test of ?-lactam antibiotics.METHODS:The status quo,laws & regulations and mechanism of allergy about intradermal test of ?-lactam antibiotics were expounded.Suggestions on method of performing intradermal test of ?-lactam antibiotics and the judgment criteria were put forward.RESULTS & CONCLUSIONS:The intradermal test must be performed before using penicillins.The intradermal test must be done with active compound before using cephalosporins in patients allergic to pinicillins.

OBJECTIVE:To investigate the consumption of antibiotics and the trend of antibiotic resistance rate in our hospital for clinical reference of rational application of antibiotics. METHODS:The consumption of antibiotics in our hospital from 2007 to 2008 was investigated by DDDs analytical method,and the synchronous isolation results of the pathogens and the resistance rates of pathogens to different kinds of antibiotics were analyzed comparatively to search a countermeasure for clinical treatment with antibiotics. RESULTS: In terms of DDDs,leading the list was ?-lactam,followed by macrolides. The infection in our hospital was mostly induced by Escherichia Coli,followed by Pseudomonas aeruginosa and Staphylococcus aureus. The resistance rates of pathogens to penicillins and macrolide antibiotics were the highest. Drug resistance rate was correlated to consumption of antibiotics. CONCLUSION: Anti-infective treatment should be carried out based on the drug susceptibility test;the use of antibiotics should be used rationally according to their clinical efficacy,and the consumption of antibiotics should be controlled to prevent or delay the production of antibiotic resistance.

Objective To explore the effect of pathways intervention based on TCM syndrome differentiation on the self-care skills of patients with peptic ulcer.Methods 84 cases of peptic ulcer patients were divided into the observation group(n=42)and the control group(n=42) from October 2013 to October 2014 randomly.Routine health education was used in the control group,while the pathways intervention based on TCM syndrome differentiation was used in the observation group.The health education,disease knowledge,self-care skills and quality of life of two groups were analyzed before and after the intervention.Results The dietary knowledge,sports knowledge,medication knowledge,knowledge of health behavior score of the observation group was (4.23±0.92),(4.39±0.98),(4.29±0.86),(4.38±0.92) scores respectively,which was higher than that in the control group at the same time and themselves level before the intervention,P＜0.05.The self-concept,self-care responsibility,self-care skills,health knowledge and self-care ability scores of observation group was (29.12±4.98),(29.85±5.47),(40.22±3.89),(46.25±5.98),(112.85±12.48) scores respectively,which was higher than that in the control group at the same time and themselves level before the intervention,P＜0.05.Conclusions Pathways intervention based on TCM syndrome differentiation can effectively improve peptic ulcer patients' self-care skills and disease-related knowledge,and then improving the quality of life of patients.

The clinical data and ultrasound findings of 185 patients with thyroid nodules undergoing thyroidectomy from June to December 2015 were retrospectively reviewed.Postoperative pathology confirmed malignant thyroid nodules in 86 cases and benign nodules in 99 cases.The ultrasonographic findings showed that there were significant differences in obscure boundary [51％ (44/86) vs.16％ (16/99)],hypoecho [(95％ (82/86) vs.27％ (27/99)],internal micro-calcification [63％ (54/86) vs.21％ (21/99)] and lymph node enlargement [33％ (28/86) vs.5％ (5/99)] between malignant and benign nodules (all P ＜ 0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of thyroid imaging reporting and data system (TI-RADS) in differentiation of malignant and benign thyroid nodules were 77％ (66/86),86％ (85/99),83％ (66/80),81％ (85/105) and 82％ (151/185),respectively.The positive rates of thyroid globulin antibody(TGAb) and thyroid peroxydase antibody (TPO-Ab) in malignant nodules [6％ (5/79) and 25％ (20/79)] were significantly higher than those in benign nodules [0 (0/94) and 12％ (11/94)] (both P ＜0.05).There was no significant difference in free T3 (FT3),free T4 (FT4) and TSH between the two groups [(4.91-± 0.78) vs.(4.93-± 1.98) pmol/L,(13.57 ±2.22) vs.(13.58 ±2.17)pmol/Land(1.78±1.40) vs.(1.88±2.36)mU/L] (allP＞0.05).The results indicate that TI-RADS grading and thyroid immunity index are valuable for differential diagnosis of thyroid nodules.

Objective To evaluate the diagnostic efficacy of the reformatted unenhanecded spiral CT of ureter for ureterolithiasis. Methods 39 patients were examined using nonenhenced spiral CT from the top of the kidneys to symphysis pubis in a single breath hold. The postprocessing method used in our studies was curved planar reformatting(CPR). Results Reformatted CT displayed clearly the entire course of ureter in all 39 cases . The diagnosis of ureterolithiasis was made on CPR views by definitive demonstration a calculus actually within the ureter, including the stone size, shape, location and the obstruction degree of ureter in 33 patients. The CPR views also demonstrated the ureter and the structures around clearly to aid greatly in differentiating the other 6 cases miscellaneous urinary tract conditions. Conclusion Our findings suggest that the reformatted nonenhanecded spiral CT of ureter has potential as an imaging tool for the ureterolithiasis and other urinary tract abnormalities.

Hospital acquired pneumonia (HAP) and ventilatorassociated pneumonia (VAP) are common hospital-acquired infections with higher mortality, longer hospital stay and more hospitalization expenses. With the latest research results and evidence-based guideline methodology, Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) have collaborated to create updated guidelines for the diagnosis and treatment of HAP and VAP in 2016. It is worth critically reading and thinking that most recommendations are supported by low-quality or very-low quality evidence and some strong recommendations is different from the actual clinical work in China. We will focus on these topics that are associated closely with clinical practice and inconsistent with the current implementation in China to provide better understanding of the guideline.

Alzheimer's disease( AD) , a neurodegenerative disease, can result in memory loss, cognitive and behavioral deficits. The pathological hallmarkes are β amyloid plaques and neurofibrillary tangles which lead loss of neurons in brain. As the extension of the central nervous system, retina has a similar tissue anatomy with central nervous system. The β amyloid plaques have also been detected in retina of AD. Furthermore, according to eye examinations of AD patients, we have found the loss of retinal ganglion cells, the attenuation of retinal nerve fiber layer thickness, the smaller changes of macula lutea, the decline of vascular density and so on. And then, there occurs the visual field loss and the decline of contrast sensitivity and so on in AD patients. Thus, the retina has occurred nerve degenerative changes in AD. Meanwhile, there has been proved that the retina nerve degeneration is even earlier than senile plaques formation in brain. In addition, curcumin, a natural and safe fluorescent dye, can be used to label β amyloid plaques in retina. The above suggests that retina can be a window for the early diagnosis of AD.

TLC method for the identification of triterpenoids polyphenols in Fructus Chebulae was established .The results showed that this method had a plentiful chromatogram and good specificity,and can distinguish Fructus Chebulae immaturus from Fructus Chebulae.Determination of gallic acid, one of the hydrolysates of Fructus Chebulae, by HPLC was also reported.The linear range of gallic acid is from 0.17?g to 1.36?g(r=0.9998),and the average recovery is 102.9 %. The results showed that the method is simple, accurate and with good reproducibility.It can be used to determine gallic acid in Chinese herbal medicine that contains hydrolysable tannins.