Objective To explore the changes and clinical significance of serum cystatin-C, β2- mieroglobulin (β2-MG) and renal hemodynamic in children with Henoch-Schoenlein purpura(HSP). Method Forty-six patients with HSP are in HSP group, 40 healthy children are in control group. Serum cystatin-C was determined by enzyme-linked immunosorbent assay, β2-MG was detected by radioimmunoassay, renal hemodynamie was detected by colour Doppler ultrasound. Results Serum cystafin-C and β2-MG in HSP group [(3.96±1.52 ), (2.74±0.82)mg/L] were higher than those in control group [(1.67±0.61), (1.89±0.47)mg/L] (P<0.01). Frequenee spectra showed high velocity and resistance, and maximum crest flow rate[(1.068±0.348) m/s] and resistance index (0.894±0.125) in systolic phase of main renal arteries were obviously higher in HSP group than those in control group [(0.859±0.357) m/s and 0.726±0.078] (P<0.05). Conclusions The level of serum cystatin-C and the change of renal hemedynamie can act as the significant indicators of early diagnosis of HSP nephritis.

A simple method for the isolation and purification of ginkgolide A, B and bilobalide(ginkgo terpene trialctone) was developed. A commercially available extract of leaves of Ginkgo biloba L.containing ＞6％ ginkgo terpene trilactone was used as the raw material. After partition in EtOAc, the en-riched extract was separated to give individual terpenes by preparative liquid chromatography. GinkgolideA, B and bilobalide could be isolated with high purity by recrystallizing in MeOH-H2O.

Objective To assess the value of dual-energy computed tomography myelography (CTM) on detecting leaks of cerebrospinal fluid (CSF) in patients with spontaneous intracranial hypotension (SIH). Methods Six patients with SIH underwent spinal CTM on a 2nd generation dual-source CT with tube voltage set at 100 and 140 kVp(with tin filter). The virtual non-contrast (VNC) and iodine map images were calculated from dual-energy images. The average weighted (AW) CTM images were mixed from two kVp images with mix factor of 0. 5. Two radiologists evaluated CSF leak using two sets of images respectively: VNC + iodine map images and AW-CTM images. The results from two reading methods were compared. The level of CSF leaks along the nerve roots, C1-2 retrospinal CSF collections, epidural CSF collections and spinal epidural venous plexus were marked. The consensus about leak sites and CSF collections was made by two radiologists in the third session Kappa statistics were used to measure the agreement between the two methods. Results Forty-one leaks were detected using VNC + iodine map images. Forty-three leaks were detected on AW images. The agreement between two methods was excellent (Kappa =0. 997 ,P ＜0. 01). There were no differences in the detection of C1-2 retrospinal CSF collections (n = 2), epidural CSF collections(n = 3) or spinal epidural venous plexus (n = 1). VNC and iodine map images demonstrated superior visual effects than AW images. Conclusion Dual-energy CTM can be used to diagnose spontaneous spinal cerebrospinal fluid leaks in SIH patient.

Objective To evaluate the application of CT myelography (CTM) in detecting the site of spontaneous cerebrospinal fluid (CSF) leaks and analyze it's imaging features.Methods Six patients (3 women and 3 men) with spontaneous intracranial hypotension (SIH) were included, who met the criteria of the International Headache Classification (2nd edition, 2004). Five patients subsequently underwent whole spine MRI and all 6 patients underwent CTM. Autologous blood mixed with omnipaque (300 mg/ml) was injected followed by selective puncture at the leak site indicated by CTM. Results MRI was failed to find leak site in the 5 patients, whereas CTM successfully found leak sites in all 6 patients. There were 1 to 7 leak sites respectively with an average of 4.2 sites (totally 25 points). Leak sites at cervical (12 sites) and thoracic (12 sites) were more frequent than at lumbar (1 site). CTM was featured by linear leakage of the contrast medium along the spinal nerve roots, paraspinal collections of hyper-density contrast medium and beak-like enlargement of the nerve sleeves. All patients responded well to the treatment, with complete resolution of symptoms. Conclusion CTM has been shown to be a study of choice to accurately define the location and extent of a CSF leak.

Objective To investigate the association between concentrations of environmental air pollutants and the daily number of outpatient visits for urticaria in Beijing. Methods Time series analysis in combination with distributed lag non?linear model(DLNM)and Spearman′s rank correlation test was used to analyze the association between PM2.5 concentrations and the daily number of outpatient visits for urticaria. All effect estimates were expressed as a risk ratio(RR)for the daily number of outpatient visits with an interquartile range(IQR)increase of 82.8 μg/m3 in PM2.5. Results From January 1st 2013 to June 30th 2014, the daily average PM2.5 concentration, temperature, relative humidity and number of visits for urticaria were 89.3 μg/m3, 12.7 ℃, 51.9% and 27.3 respectively. Spearman′s rank correlation test showed that the daily average PM2.5 concentration and number of visits for urticaria were correlated with daily mean temperature(rs =-0.21, 0.36, respectively, P < 0.05)and relative humidity(rs = 0.49, 0.31, respectively, P < 0.05), but no correlation was observed between daily average PM2.5 concentrations and daily number of visits for urticaria(rs=0.01, P>0.05). There was no significant correlation between daily number of outpatient visits for urticaria and daily PM2.5 concentration lagged by 0-14 days(RR=1, 95%CI:0.89, 1.13). After potential confounding factors were adjusted, an 82.8μg/m3 increase in daily PM2.5 concentration at lag 0-20 days was significantly associated with a 22%(95%CI:3%, 46%)increase in daily number of outpatient visits for urticaria, suggesting that the lagged effect of PM2.5 was obviously increased. Conclusion The association between PM2.5 concentrations and the number of visits for urticaria is easily affected by meteorological factors and biological confounding factors, and relative humidity and mean temperature are both positively correlated with the number of visits for urticaria.

Objective To investigate the association between air pollution and the daily number of outpatient visits for dermatitis in Beijing city, and to evaluate the sensitivity to air pollution in populations of different gender and age. Methods Time-series data on daily outpatient visits for dermatitis between April 2012 and April 2014 were collected from Air Force General Hospital of PLA. The daily average concentrations of sulfur dioxide (SO2), nitrogen dioxide(NO2), and particulate matters(PM2.5, PM10)were obtained from Beijing Municipal Environmental Monitoring Center, and routine meteorological data (including daily mean temperature, relative humidity and wind speed)were collected from the China Meteorological Data Sharing Service System. A generalized additive model was used to analyze the association between daily average concentrations of air pollutants and the number of daily outpatient visits for dermatitis. Results In single-pollutant models, an increase of 10 μg/m3 in daily concentrations of PM2.5, PM10, SO2, and NO2 was associated with the number of outpatient visits for dermatitis with the relative risk being 1.003 1 (95% CI, 1.001 6 - 1.004 5), 1.0025 (95% CI, 1.001 4 - 1.003 7), 1.0057 (95% CI, 1.001 5 - 1.009 9)and 1.009 7 (95% CI, 1.005 6 - 1.013 8)respectively. Similarly, multipollutant models showed that air pollutant concentrations were significantly associated with the daily number of outpatient visits for dermatitis. Distributed lag models showed that the effects of PM2.5, PM10 and NO2 on daily outpatient visits for dermatitis were mainly observed on the day of exposure, while the effect of SO2 increased along with the increment of lag days. Stratification analysis showed that people aged less than 60 years and females were relatively more sensitive to particulate matters (PM2.5, PM10), while NO2 affected all groups of people at the same degree, and SO2 mainly affected people aged 35 - 60 years. Conclusion Air pollutants PM2.5, PM10, SO2 and NO2 may all increase the risk of dermatitis in Beijing area.

This paper summarized the common medical ethical issues in clinical pharmacy service and analyzed them from the perspective of medical ethics.It put forward some countermeasures to solve these problems,such as helping clinical pharmacists to establish a patient-centered service mode,improving their occupation accomplish-ment,and avoiding moral issues and medical disputes caused by ethical issues under the premise of ensuring pa-tients' safety and rational use of drugs,and thus to comprehensively improve service level of clinical pharmacists.

Objective To investigate the surgical outcomes and strategies selection of endoscopic endonasal approach and craniotomy in the treatment of cranial base chordomas.Methods Thirty-one patients diagnosed pathologically with cranial base chordoma in Tianjin huanhu hospital from Jan.2010 to Sep.2020 were analyzed retrospectively.The patients were divided into the endoscopic endonasal group and the craniotomy microscope group according to the different surgical approaches.The surgical results and follow-up between the two groups were compared.Results In the endoscopic endonasal group,there were 7 cases of gross total resection,9 cases of subtotal resection and 2 cases of partial resection.The main complications included death in 2 cases,cerebrospinal fluid leakage in 8 cases,cranial nerve injury in 2 cases and hypopituitarism in 1 case.In the craniotomy microscope group,there were 2 cases of gross total resection,10 cases of subtotal resection,and 1 case of partial resection.The main complications included cerebrospinal fluid leakage in 1 case,cranial nerve injury in 3 cases,epilepsy in 1 case and epidural hematoma in 1 case.There was no statistical significance in the resection rate between the two groups(P＞0.05).The rate of cerebrospinal fluid leakage in the endoscopic group was significantly higher than that in the craniotomy microscope group,and the comparison was statistically significant(P＜0.05).There was no statistically significant between the two groups for tumor recurrence or progression.Conclusions The endoscopic endonasal approaches for resection of cranial base chordomas have improved the gross total resection rate,but craniotomy is still an important surgical method for tumor resection.It is necessary to select an appropriate surgical approach according to the lesion location and pattern of tumor growth.

Objective:To explore the application value of three dimensional T 1 weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions (3D T 1-SPACE) combined with three dimensional time of flight MR angiography (3D-TOF MRA) in the follow-up of stent-assisted coil embolization for intracranial aneurysm. Methods:From December 2017 to October 2018, 25 patients with intracranial aneurysm who underwent stent-assisted coil embolization in Henan Provincial People′s Hospital were enrolled. All of them had wide neck intracranial aneurysms and were followed up for 6 to 10 months after endovascular treatment using 3D-TOF MRA, 3D T 1-SPACE sequence and DSA. The DSA and 3D-TOF MRA were performed to evaluate aneurysm remnants using Raymond grade scale. Meanwhile, 3D-TOF MRA and 3D T 1-SPACE sequence were performed to evaluate in-stent lumen visibility using the 4-point scale. The paired sample Wilcoxon test was used to evaluate the aneurysm remnants and the parent artery patency. DSA was used as the gold standard to calculate the specificity and accuracy of the aneurysm remnants evaluated by 3D-TOF MRA. Results:Six to ten months′ follow up after the procedure, for aneurysm occlusion, the Raymond grade scale of the 25 patients evaluated by DSA indicated grade 1 in 23 patients, 2 in 1 and 3 in 1. For patients evaluated by 3D-TOF MRA, the results demonstrated grade 1 in 21 patients, 2 in 3 and 3 in 1. There was no difference between the 2 methods ( Z=-0.557, P=0.577). The in-stent lumens of parent vessel evaluated by 3D-TOF MRA showed that there were 14 patients with grade 3, 8 patients with grade 2 and 3 patients with grade 1. However, 3D T 1-SPACE demonstrated that all 25 patients were grade 4. The 3D T 1-SPACE was superior to evaluate the in-stent lumens than 3D-TOF MRA ( Z=-4.484, P<0.001). Taking DSA as standard, the specificity and accuracy of the aneurysm remnants evaluated by 3D-TOF MRA were 86.9% (20/23) and 84.0% (21/25), respectively. Conclusion:3.0 T 3D T 1-SPACE MR sequence can be used to assess parent artery patency, with in-stent lumen being clearly visible. 3D-TOF MRA can evaluate intracranial aneurysm remnants. The combination of these two MRI imaging techniques can be used as an optional follow-up evaluation after the endovascular treatment of intracranial aneurysms.

Objective:To explore the survival prognosis of hepatocellular carcinoma patients over 60 years old with comorbidities treated with microwave ablation.Methods:A retrospective analysis of 267 patients with hepatocellular carcinoma aged 60 years or older admitted to the PLA General Hospital from April 2012 to September 2022 were analyzed, including 179 patients with preoperative comorbidities and 88 patients without comorbidities. The overall survival (OS) and progression-free survival (PFS) of the two groups were compared by the Log-rank test, and the Cox proportional hazards regression model was used to evaluate ablation-related risk factors.Results:A total of 267 patients were included (comorbidity group, n=179; no comorbidity group, n=88). There were no statistical differences in OS and PFS between the two groups (all P>0.05). Multivariate Cox regression analysis showed that comorbidities were not risk factors that affected the survival prognosis (OS and PFS) of patients with hepatocellular carcinoma after microwave ablation ( P>0.05). Total bilirubin (hazard ratio 0.356, 95% CI=0.174-0.731, P=0.005) was a risk factor affecting OS; tumor number (hazard ratio 0.538, 95% CI=0.365-0.793, P=0.002) and international coagulation normalized ratio (hazard ratio 1.022, 95% CI=1.001-1.043, P=0.040) were risk factors affecting PFS. Subgroup analysis showed that patients with a maximum diameter of >3 cm and female patients, the OS of the comorbidity group was significantly lower than that of the non-comorbidity group( P<0.05). Conclusions:Microwave ablation therapy remains an effective treatment modality in hepatocellular carcinoma patients over 60 years of age with comorbidities, and its survival prognosis is not inferior to patients with hepatocellular carcinoma without comorbidities.