Objective To observe the clinical Resultsof ambroxol combined with glucocorticoids in the treatment of otitis media with effusion.Methods 81 cases fron June 2015 to 2016 October, were randomly, double-blind principle divided into observation group(42cases)and control group(39cases).The control group glucocorticoid therapy observation group were treated with ambroxol combined with glucocorticoid treatment, pure tone was observed before and after treatment were compared listen valve measured air conduction hearing level, hearing recovery and clinical efficacy.ResultsThe observation group were pure tone hearing valve after treatment was measured air conduction hearing level was significantly higher (P<0.05);drum pipe tobacco functioning proportion of patients in the observation group after treatment was 85.71%, significantly higher than 48.72% (P<0.05);The observation group total effective rate was 92.86%, significantly higher than 74.36% (P<0.05).Conclusion Ambroxol combined with glucocorticoids be effective in treating secretory otitis media, otitis media with effusion improve the clinical efficacy, and easy to operate, and is worthy of clinical application.

Objective To investigate the altered expression of TLR4 in alveolar macrophages of diabetic rats after lipopolysaccharide (LPS) stimulation and the effect of these changes on defending the infection. Methods Thirty-two male Wistar rats were divided into 4 groups, group A: the control group; group B: the diabetic group; group C: the LPS stimulated group; and group D: the diabetic group with LPS stimulation. TLR4 in alveolar macrophages were measured by immunocytochemistry, RT-PCR and Western blot analysis. Results The expressions of TLR4 in group B and group C were higher than that in group A (P < 0. 001). The expression of TLR4 in group D was obviously higher than that of group B and group C (P < 0.001). Conclusion The expression of TLR4 of diabetic rats was higher than that of normal rats and became more higher after LPS stimulation, which is indicated that diabetic bodies were in the proinflammatory state, the mechanism remains to be explored in detail.

Objectives To investigate the incidence rate of asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome(ACOS)in elderly male patients with stable COPD by following-up,and to explore the characteristics and clinical significance of pulmonary function for ACOS.Methods According to GOLD and Spain's guidelines for the diagnosis and treatment of COPD,we screened ACOS patients in 299 elderly male patients with stable COPD by following up in Beijing Hospital between 2003 and 2014.All patients were divided into 2 groups of 51 ACOS patients and 248 non-ACOS patients with COPD.All patients underwent pulmonary function tests and bronchial dilation test in the stable condition.The differences in pulmonary functions were compared between stable ACOS patients and non-ACOS patients with COPD.Results Among 299 elderly male patients with stable COPD,ACOS patients accounted for 17.1 ％ (51/299).Compared with nonACOS patients with stable COPD,ACOS patients had significantly lower baseline values in forced expiratory volume in 1 seconds(FEV1) [(61.0 ± 14.5) ％ pred vs.(74.4 ± 20.0) ％ pred],in forced expiratory volume in 3 seconds(FEV3) [(71.6± 14.3)％ pred vs.(82.7± 19.6)％ pred]and in forced vital capacity(FVC) [(84.6 ± 16.4)％ pred vs.(93.8 ± 20.6)％ pred],and also had significantly higher values in residual volume(RV)[(139.4±55.8)％ pred vs.(118.8±46.6)％ pred]and in RV/total lung capacity(TLC) [(52.7±10.7)％ pred vs.(48.1±10.9)％ pred],all P＜0.05.After bronchodilation test,there was no significant difference in FEV1,FEV3 and FVC between the two groups(all P＞0.05).Patients with stable ACOS had lower value in forced expiratory flow rat (FEF25％±75％)than those with non-ACOS in baseline [FEF25％-75％ ％ pred(26.8± 11.5) ％ vs.(36.1 ±17.5) ％ (P＜0.05)],and the improvement of small airway function was significantly better in ACOS patients than in non-ACOS patients after bronchodilation test (P＜0.05).Conclusions ACOS is very common in the elderly patients with COPD,stable ACOS patients have lower time vital capacity as compared with non-ACOS patients with stable COPD.But after bronchodilation test,the two groups have similar ventilation function,and the small airway function in ACOS patients improves more significantly.The ACOS patients have unique characteristics of pulmonary functions and suitable treatment may improve the prognosis.

0. 05) . (3) The symptoms were ameliorated and the physically active ability was improved after 6 months exercise training. Conclusions Although the pulmonary function is not significantly improved, but the symptoms and the exercise endurance are improved after 6 months exercise training in the elderly outpatients with COPD.

Objective To investigate the evolution of nonspecific manifestations of pulmonary function in elderly people.Methods Retrospective analysis of the data of nonspecific pulmonary function(NSPF) on the initial PF testing in elderly people from the same PFT apparatus in Beijing Hospital were collected from January 2004 to December 2012.All the patients with complete clinical data and reexamination at least one time were enrolled into this analysis.NSPF was defined as normal FEV1/FVC and TLC combined with a decreased FEV1 or FVC or both.All the patients with complete clinical data were divided into blocking group,restricted group,NFSP group and normal group according to their PF.The comparison was performed among these groups.Kaplan-Meier was used for analysis of the turnover and outcome of elderly NSPF patients,log-rank test was used for comparing the difference of turnover and outcome and COX regression was used for analyzing single and multiple factors of different turnover and outcome.Results Overall 59 patients were diagnosed as NSPF,with male:female ratio of 52:7,the average age of(71.8 ± 8.8)years and at a median follow-up of 4 years.The statistically significant differences in age,sex,body mass index(BMI),smoking status,both the clinical manifestations and chest CT performance at first visit and during the following-up were not found among the groups(all P ＞0.05).The pulmonary functions of NSPF patients were transformed into an obstructive pattern(19.6 ％),into a restrictive pattern(7.6 ％)and into a normal pattern(8.8 ％) in 4 years cumulative incidence rate,with statistically significant in differences(x2 =7.411,P =0.024).An invariant pulmonary function in NSPF patients accounted for 64.0％ in the most,and the second was obstructive ventilation function disability.Monomial and multinomial Cox regression analysis showed that emphysema and bulla in the initial CT scan was the predictor of the change to the obstructive pattern from NSPF during follow-up(HR=4.325,P=0.045),age was the predictor of the change to the restrictive pattern(HR=1.143,P=0.020).And pleural thickening and disappearing of pleural effusion were the predictor of change to the normal pattern (HR =8.889,P =0.018) respectively.Conclusions Most NSPF in elderly people could exist consistently.Obstructive pattern is the maximal likelihood of NSPF changing to the other pattern.Emphysema and bulla in the initial CT scan is the predictor of the obstructive pattern.The change is related with emphysema and bulla in the initial CT scan.

Objective To explore the clinical phenotype of airways disease in elderly patients using hierarchical cluster analysis.Methods A total of 67 elderly patients with respiratory symptoms were enrolled in a prospective study.Demographic and clinical data,such as respiratory symptoms,cumulative tobacco cigarette consumption,acute exacerbation,atopic symptoms and peak flow diary were collected.Pulmonary function tests,blood tests (total serum IgE level and blood eosinophil level) were performed in each patient during the stable stage.Then patients with different clinical phenotype were identified by hierarchical cluster analysis.Results Four clusters were identified with the following characteristics by hierarchical cluster analysis:cluster 1,atopic patients with no smoking,normal lung function,but increased total serum IgE levels and asthma symptom;cluster 2,patients with no smoking and normal pulmonary function with wheezing but without chronic cough;cluster 3,patients with chronic obstructive pulmonary disease and smoking,severe airflow limitation and poor quality of life;cluster 4,patients with asthma-chronic obstructive pulmonary disease overlap syndrome and smoking,airflow limitation and increased total serum IgE levels.The forced expiratory volume in 1 second (FEV1) / forced vital capacity (FVC) ratio,FEV1/predicted value,rate of FEV1 change,maximal mid-expiratory flow (MMEF)/ predicted value,the diffusion lung capacity for carbon monoxide (DLCO)/alveolar volume (VA)/predicted value,residual volume (RV)/ predicted value,total serum Ig E levels,cumulative tobacco cigarette consumption,the St.George's Respiratory Questionnaire (SGRQ) score had significant differences in patients before versus after treatment (all P＜0.05 or P＜0.01).Conclusions Based on hierarchical cluster analysis,distinct clinical phenotypes of airways disease in elderly patients can be identified.Conclusions With patients having asthma or COPD alone,patients with Asthma-COPD overlap syndrome (ACOS) always experience a more rapid decline in lung function and frequent exacerbations,having poor health-related quality-of-life (HRQOL) outcomes,which deserve our high attention.

Objective To study the distinct clinical phenotype of chronic airway diseases by hierarchical cluster analysis and two-step cluster analysis.Methods A population sample of adult patients in Donghuamen community,Dongcheng district and Qinghe community,Haidian district,Beijing from April 2012 to January 2015,who had wheeze within the last 12 months,underwent detailed investigation,including a clinical questionnaire,pulmonary function tests,total serum IgE levels,blood eosinophil level and a peak flow diary.Nine variables were chosen as evaluating parameters,including pre-salbutamol forced expired volume in one second(FEV1)/forced vital capacity (FVC) ratio,pre-salbutamol FEV1,percentage of post-salbutamol change in FEV1,residual capacity,diffusing capacity of the lung for carbon monoxide/alveolar volume adjusted for haemoglobin level,peak expiratory flow (PEF) variability,serum IgE level,cumulative tobacco cigarette consumption (pack-years) and respiratory symptoms (cough and expectoration).Subjects' different clinical phenotype by hierarchical cluster analysis and two-step cluster analysis was identified.Results (1) Four clusters were identified by hierarchical cluster analysis.Cluster 1 was chronic bronchitis in smokers with normal pulmonary function.Cluster 2 was chronic bronchitis or mild chronic obstructive pulmonary disease (COPD) patients with mild airflow limitation.Cluster 3 included COPD patients with heavy smoking,poor quality of life and severe airflow limitation.Cluster 4 recognized atopic patients with mild airflow limitation,elevated serum IgE and clinical features of asthma.Significant differences were revealed regarding pre-salbutamol FEV1/FVC％,pre-salbutamol FEV1％ pred,postsalbutamol change in FEV1 ％,maximal mid-expiratory flow curve (MMEF)％ pred,carbon monoxide diffusing capacity per liter of alveolar(DLCO)/(VA)％ pred,residual volume(RV)％ pred,total serum IgE level,smoking history (pack-years),St.George' s respiratory questionnaire (SGRQ) score,acute exacerbation in the past one year,PEF variability and allergic dermatitis (P ＜ 0.05).(2) Four clusters were also identified by two-step cluster analysis as followings,cluster 1,COPD patients with moderate to severe airflow limitation;cluster 2,asthma and COPD patients with heavy smoking,airflow limitation and increased airways reversibility;cluster 3,patients having less smoking and normal pulmonary function with wheezing but no chronic cough;cluster 4,chronic bronchitis patients with normal pulmonary function and chronic cough.Significant differences were revealed regarding gender distribution,respiratory symptoms,pre-salbutamol FEV1/FVC％,pre-salbutamol FEV1 ％ pred,post-salbutamol change in FEV1 ％,MMEF％ pred,DLCO/VA％ pred,RV％ pred,PEF variability,total serum IgE level,cumulative tobacco cigarette consumption (pack-years),and SGRQ score (P ＜ 0.05).Conclusion By different cluster analyses,distinct clinical phenotypes of chronic airway diseases are identified.Thus,individualized treatments may guide doctors to provide based on different phenotypes.

ObjectiveTo evaluate the efficacy of stereotactic body radiotherapy combined with coinstan taneous gemcitabine,and gemcitabine alone for advanced pancreatic cancer.Methods56 advanced pancreatic cancer patients were assigned into observation group,which accepted stereotactic body radiotherapy combined with coinstantaneous gemcitabine 500 mg/m2,d1,d8.Other 50 patients were assigned into the control group which only accepted gemcitabine 1 000 mg/m2,d1,d8,d15.Stereotactic body radiotherapy was delivered with a total dose of 4 000-4 500 cGy in 10 fractions.ResultsCT examinations were carried out 2 months after treatment.The response rate of the observation group and control group was 82％ and 16％ respectively,and the pain relief rate was 67％ and 17％ respectively.The time to progression of the observation group was 14 months,and was better than that of the control group(7.5 months,x2 =7.31,P =0.032).The median survival time of the observation group and control group was 15.8 months and 13.2 months,and the difference had no statistical significance(x2 =3.28,P =0.082).ConcolusionStereotactic body radiotherapy combined with gemcitabine has a better overall response rate and a pain relief rate.It can prolong the time to progression,but can't improve the overall survival.

Objective The technique of repetitive element-based polymerase chain reaction(rep-PCR)was used to track an epi- demic of nosocomial infection caused by Staphylococcus aureus in our hospital.Methods The 50 S.aureus isolates were identi fled by PHOENIX-100 automatic Microbiological Identification System.Oxacillin-salt-supplemented agar was used to screen methicillin-resistant S.aureus(MRSA)phenotype.The resistant gene mecA was tested by PCR.The technique of rep-PCR was applied to type S.aureus isolates.Results The mecA gene was identified in 22 of the 50 S.aureus isolates.Nineteen of the 22 strains were isolated from patients.Nine to eleven bands were observed in electrophoretic pattern of all the 50 S.aureus iso- lates by rep-PCR under the conditions of this study.These strains were accordingly classified into 11 different genotypes.Con- clusions The rep-PCR technique is a rapid,simple and reliable genotyping method.It is an ideal tool to track the source of noso- comial infections at molecular level.

Objective To detect anti-cell membrane DNA ( cmDNA) antibody with human B lym-phocyte Raji cells and human promyelocytic leukemia HL60 cells as substrates and to compare the diagnostic value of anti-cmDNA antibody with that of anti-nucleosome antibody ( AnuA ) , anti-Sm antibody and anti-double-stranded DNA ( dsDNA) antibody in juvenile systemic lupus erythematosus ( JSLE) patients. Meth-ods We recruited 92 JSLE patients and 71 patients with other rheumatic diseases. Anti-cmDNA antibody an-dantinuclear antibody ( ANA ) was detected in patient serum by indirect immunofluorescence assays ( IIF ) . Anti-dsDNA antibody were detected by combining enzyme-linked immuno sorbent assay ( ELISA) and IIF. Anti-Sm antibody were detected by double immunodiffusion assay and immunoblotting, while anti-nucleosome antibody ( AnuA) were detected by ELISA. We collected concurrent clinical data. Results Anti-cmDNA antibody demonstrated stronger intensity of fluorescent patterns in using Raji cells as substrate than HL60 cells. JSLE patients had a significantly higher positive percentage of anti-cmDNA than patients with other rheu-matoid diseases. The sensitivity of anti-cmDNA on cell line Raji was higher than that of anti-dsDNA and anti-Sm (P<0. 01), the specificity of anti-cmDNA was close to anti-dsDNA (P>0. 05) and was lower than anti-Sm and AnuA (P<0. 01). The sensitivity of anti-cmDNA was similar to AnuA (P>0. 05) and the specificity was lower than AnuA (P<0. 01). The sensitivities of anti-dsDNA, anti-Sm and AnuA by combining with an-ti-cmDNA were much higher than that of the above antibody detected respectively ( P<0. 05 ) . Anti-cmDNA had no correlation with SLE disease activity index ( P=0. 907 ) . Conclusion The high sensitivity and speci-ficity of anti-cmDNA antibody make it a valuable diagnostic tool for JSLE. Combined detection of anti-cmDNA and other autoantibody might further improve the sensitivity in JSLE. Anti-cmDNA detected with IIF on cell line Raji was better than cell line HL60.