Objective To investigate the diagnostic value of anti-cyclic citrullinated peptides ( CCP ) antibodies combined rheumatoid factors (RF) on elderly patients with rheumatoid arthritis.Methods From January 2012 to December 2014, 29 cases of elder patients in our hospital with rheumatoid arthritis (elder RA group, age >60 year), 47 cases of elderly health control group (elder RA group, age≥60), and 48 cases of elder patients without rheumatoid arthritis (non-elder RA group, age<60 year) were selected.The anti-CCP antibodies and rheumatoid factor (RF) levels of three groups were detected, and the significance of anti-CCP antibody combined RF on the diagnosis of elderly rheumatoid arthritis was analyzed.Results Diagnostic positive rate of anti-CCP antibodies +RF was significantly higher than that of anti-CCP antibodies, and the difference was significant (χ2 =7.632, P =0.006).Diagnostic positive rate of anti-CCP antibodies +RF was higher than that of RF, but the difference was not statistically significant (χ2 =3.107, P=0.078).The diagnostic positive rate of anti-CCP antibodies, RF, and anti-CCP antibodies +RF for diagnosis of elderly rheumatoid arthritis had no statistically difference with that of non-elderly RA group.The sensitivity and negative predictive value of anti-CCP antibodies +RF was higher than that of only anti-CCP antibodies and RF.The area under the ROC curve of detecting anti-CCP +RF was 0.786, which was higher than that of anti-CCP antibodies (0.699) and RF (0.663), indicated that the reliability of anti-CCP antibodies +RF was higher than that of anti-CCP antibodies and RF.Conclusion The anti-CCP antibodies and RF can diagnose elderly rheumatoid arthritis, and anti-CCP antibodies combined RF has more clinical significance.

Objective To analyze the clinical and pathological features of Wegener granulomatosis (WG) in children in order to improve the understanding of this disease. Methods Nine cases of WG,including two cases from our hospital and seven cases throughout the country,were analyzed in aspects of their clinical characteristics,laboratory examinations,X-ray and treatments. Results Of the nine cases,six cases were male and three cases were female with average age of twelve years old. The average time from the initiation of clinical symptom to diagnosis was 8.3 months. Patients had multiple systems and organs involvements. Lung and kidney involvement were the most common. Six out of seven were positive in c-ANCA and anti-PR3 antibody. Biopsy was conducted in eight patients,and pathological manifestations involved parenchymal necrosis,granulomatosis,vasculitis and so on. Most patients improved significantly after being treated with glucocorticoids and cyclophosphamide. Conclusion WG is a syndrome which involves many organs without distinctive clinical manifestation. An ANCA test should be performed to make an early diagnosis.

Objective:To understand the use of antibiotics in our hospital to provide clinical drug reference. Method:The hospital outpatient and emergency prescriptions in 2007 were randomly selected and according to clinical pharmacology knowledge and literature material,sorting of the antibiotics use frequency and category was carried out,and the statistics and rationality about the antibiotics prescriptions were classified and analyzed.Result:According to the use frequency(DDDs),the top 3 kinds were ornidazole,levofloxacuin and azithromycin.Cephalosorins,quinolones and macrolides were most frequently used in clinic.In the total 10,800 prescriptions audited,3842 antibiotic prescriptions and 409 irrational prescriptions were used respectively in the drug solvent which presented problems in the dosage regimen,pharmacological effects and rational drug use.Conclusion:The use of antibiotics in the hospital was basically reasonable,but there were still some problems and the need to further improve the prescription audit would be helpful for the rational use of antibiotics.

Objective To determine the added clinical applications of MR virtual endoscopy (MRVE) plus MRCP in cholangiopancreatography. Methods In 14 month, 44 patients with obstructive jaundice and symptomatic bile trace were assessed by MRVE in biliary tract.The 2D data of heavily T 2 weighted images with FSE(non breath hold, respiratory trigger) and SSFSE(breath hold, multi slice single shot fast spin echo) sequence were transferred to the computer workstation. Navigator software (GEMS) was used to display intraluminal views of the pancreaticobiliary tract with a surface rendering technique. Results Patients suffered from neoplasm ( n =18), bile stone (17), postoperative complications of cholecystectomy( n =3), and other disease of biliary tract( n =6). MRVE could clearly demonstrate the anatomical structures in biliary tract, extended pancreas tract,biliary meatus narrowing and obstruction, bile duct stones, duct branches, and the inner wall of pathological obstruction.The main limitation of virtual endoscopy was inability to evaluate mucosa and lack of histological diagnosis. Sensitivity for detection of bile duct dilatation and site of obstruction was: 2D FSE 91 7%, and SSFSE 97 9%. Conclusion MRVE provided noninvasively endoscope like display of biliary tract.Its display ability was a supplement to image biliary trace. MRVE effect of multi slice SSFSE sequence was better than that of fast spin echo.

Objective To explore the effect of evidence-based medicine combined withcase based learning(CBL) in pediatric residency training.Methods Totally 52 residents were equally divided into two groups:experiment group and control group.Method of CBL combined with the evidencebased medicine (Taking two residents as one group,firstly teacher posed the questions and then residents searched for references when off duty and made evidence-based case presentation at fixed time when doing teaching ward around,after wards all personnel in the department made case discussion,finally teacher made the summary) was used in experimental group while traditional teaching method (teacher guided the residents to analyze the case by clinical experiences,residents took notes and sometimes asked questions,teacher directly gave the answers)was used in control group.The teaching effect is evaluated by questionnaire,theory test and clinical skills assessment.Statistical analysis was carried out on appraisal results with SPSS 16.0 software,test results and appraisal results were expressed as ((x-) ±s) and t test was performed,P ＜ 0.05 was taken as statistically significant.Results Residents in experimental group had more advantages in self-study ability,literature retrieval ability,physician teamwork spirit,clinical thinking,PowerPoint making and language expression after receiving CBL combined with evidence-based medicine.Theory examination showed that average score of experimental group was better than that of control group (75.46 ± 6.646) vs.(71.38 ±4.758),with statistically significantly differences (P =0.014),especially in subjective items.Clinical skills assessment showed that experimental group was better than control group in writing medical records and doing clinical thinking.Conclusions Teaching method of evidence-based medicine combined with CBL is significantly better than traditional indoctrination teaching in improving the abilities of self-study,cultivating clinical thinking,literature retrieval,language performance and other skills.This teaching method is more suitable for pediatric residency training.

A novel fluorescent switch was constructed based on poly 3-{[ 1-( 2-hydrazino-2-oxoethyl ) piperidin-4-ylidene] methyl}thiophene ( PMTH ) in the presence of Pb2﹢ or S-adenosylmethionine ( SAM ) . The switch turned off in the presence of Pb2﹢owing to complex effect, and the fluorescence intensity of PMTH solution was efficiently quenched by Pb2﹢ ions. Upon adding SAM to the Pb2﹢-PMTH solution, which was stronger Pb2﹢ chelators, it could form more stable SAM-Pb2﹢, the Pb2﹢ ion was displaced from PMTH and the fluorescence of PMTH was recovered. By triggering the turn-on signal of PMTH, a new discrimination ability toward SAM method for the determination of SAM was established. The effects of the interaction on the fluorescence spectral characteristics of these Pb2﹢-PMTH and Pb2﹢-SAM complexes in H2 O-CH3 CH2 OH(4:1, V/V) solution, suitable reaction conditions and influencing factors were investigated. This method offered good sensitivity and selectivity for detecting SAM in the presence of amino acids and metal ions. Under optimum conditions, the concentration of SAM in the range from 1. 0 × 10-8-2. 0 × 10-6 mol/L exhibited a linear relationship with the relative fluorescence intensity. The regression equation was △I = 68. 51﹢72. 32c (μmol/L), the correlation coefficient r=0. 9982. The limit of detection was 8. 72×10-9 mol/L. The system was successfully applied for detecting SAM in human serum, urine and injection samples.

Objective:To promote the rational drug use in the patients treated with ambulatory chemotherapy. Methods:A model of integrated pharmaceutical care was established using such service as the real-time prescription examination, configuration standardi-zation, active care and prescription review. Results:The integrated pharmaceutical care could effectively reduce the unreasonable drug use, optimize drug use structure, lower the medical expenses and provide supporting data for clinical decision-making. Conclusion:The development of integrated pharmaceutical care in the patients treated with ambulatory chemotherapy is an important field for phar-macists displaying professional skills, which can promote the rational drug use. The treatment efficacy and life quality of cancer patients can be improved with the cooperation of doctors, nurses and pharmacists.

Objective To explore the neutrophil to lymphocyte ratio (NLR) and its relationship with the effect of chemotherapy and prognosis in patients with diffuse large B-cell lymphoma (DLBCL).Methods The clinicopathological characteristics and outcome of 51 patients with DLBCL diagnosed by pathological biopsy and immunohistochemistry who received CHOP or R-CHOP regimen were collected and reviewed.According to the median of NLR,the patients were divided into low NLR group (NLR≤2.32) and high NLR group (NLR＞2.32).The prognostic influence of the NLR on overall survival (OS) was studied by Kaplan-Meier method and Log-rank test.To evaluate the independent prognostic relevance of NLR,univariate and multivariate Cox regression models were applied.Results The complete response (CR) rates of the low and high NLR groups were 71.4 ％ (20/28) and 39.1％ (9/23),respectively (P =0.02).The OS in the low NLR group was significantly better than that in the high NLR group (1,2 and 3-year OSs were 96.4 ％,90.4 ％ and 72.3 ％ vs 63.9 ％,52.7 ％ and 42.2 ％,respectively,P =0.009).Univariate and multivariate Cox regression models analysis showed that NLR ＞ 2.32 was an independent prognostic factor (P =0.016).Conclusion An elevated NLR before treatment indicates the poor effect of chemotherapy and prognosis of patients.NLR is an independent prognostic factor for DLBCL.

Pediatric surgery is the important part of the paediatrics,and the complicated content,limited time and many difficulties are the main problems of pediatric surgery teaching. The multimedia courseware is used in teaching of pediatric surgery,which is convenient for teachers'preparing lessons and teaching and is beneficial to students'review and summary. After the technique is used,the teaching efficiency and the quality are obviously improved.

Objective To explore the application conditions of 22 S rule (one of the Westgard rules) in single concentration quali‐ty control .Methods The application scope of 22 S rule was used into the same batch detection of single‐concentration quality control materials .Results The 22 S rule improved the detection rate of system errors .Conclusion 22S rule should be applied to two detec‐tions within a batch when using one quality control material ,as to improve the detection of system error more efficiency .