Objective The purpose of the study was to investigate the causes of hemoptysis and ex-plore the diagnostic procedures for hemoptysis in children. Methods The medical records of 42 children with hemoptysis admitted to the Respiratory Department of Hunan Children′s Hospital from June 2012 to June 2015 were collected by a retrospective study. The causes of hemoptysis were classified by pathogenesis,and the diagnosis of hemoptysis was evaluated in this study. The final diagnosis was divided into clear diagnosis and the cause was unknown. Results A total of 41(97. 6%) cases were diagnosed,1(2. 4%) case was not diagnosed. In 42 cases of hemoptysis,infection was the main cause of the disease,including 8(19. 0%) cases of pneumonia and 5(11. 9%) cases of bronchitis,and the following causes were bronchial artery fistula(10/42,23. 8%),idiopathic pulmonary hemosiderosis(8/42,19. 0%),bronchiectasis(5/42,11. 9%),pulmonary vascular malformation with pulmonary hypertension(3/42,7. 2%),pulmonary tuberculosis(2. 4%),bronchi-al foreign body(1/42,2. 4%) respectively. Thirteen cases of respiratory tract infection,and 5 cases of bron-chiectasis were diagnosed by chest CT,10 cases with pulmonary artery fistula were diagnosed by digital sub-traction angiography,8 cases of pulmonary hemosiderosis,1 case of pulmonary tuberculosis,and 1 case with bronchial foreign body were diagnosed by fiberoptic bronchoscopy. Three cases of pulmonary vascular malfor-mation and pulmonary hypertension were diagnosed by row helical CT angiography and cardiac color ultra-sound. Conclusion Hemoptysis in children is a heterogeneous group of respiratory disorders. Most causes could be identified by using the diagnostic procedures. Other factors, including medical history, CT, fiber bronchoscopy,multidetector CT angiography, cardiac color ultrasound and digital subtraction angiography, play important roles in the diagnosis of hemoptysis in children.

OBJECTIVE:To observe therapeutic efficacies and safety of diltiazem combined with ciclosporine in the treatment of nephrotic syndrome complicated with acute renal injury. METHODS:A total of 66 patients with nephrotic syndrome and cute kid-ney injury were randomly divided into control group(30 cases)and observation group(36 cases). Control group was given routine treatment;observation group was additionally given Diltiazem hydrochloride tablet 5 mg orally,twice a day,and Ciclosporin soft capsules 1.5 mg/(kg·d)orally,twice a day. Treatment course of 2 groups lasted for 20 d. Clinical efficacies of 2 groups were ob-served. The serum creatinine and kidney injury molecule 1(KIM-1),24 h urine volume,24 h urine protein levels,AKI classifica-tion,follow-up and recurrence were observed before and after treatment as well as the occurrence of ADR. RESULTS:The remis-sion rate of observation group was significantly higher than that of control group,and recurrence rate was significantly lower than control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in the serum creatinine levels,KIM-1,24 h urine pratein,24 h urine and AKI classification between 2 groups (P>0.05). After 2 weeks and 1 month of treatment of observatiom groups,and after 1 month of treatment of control group,serum creatinine levels,KIM-1 and 24 h urine protein of observation group were significantly lower than before treatment,and the observation group was significantly lower than the control group;24 h urine and the ratio of gradeⅠby AKI classification were significantly more than before treatment,and the observation group was significantly more than the control group,with statistical significance(P<0.05). Follow-up rate in 2 groups were 100%,and there was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on routine treatment,diltiazem combined with ciclosporin shows significant therapeutic efficacy in the treatment of nephrotic syn-drome and acute renal injury with good safety.

Objective To explore the clinic effect of arthroscopic in the treatment of Haglund deformity.Methods Sixteen patients with Haglund deformity were treated with arthroscopy from June 2009 to December 2011,including 7 males and 9 females,with an average age of 28.8 years (range,17-39 years).All 16 patients were suffered ankle back pain,exacerbations of pain during active and passive plantar flexion.This group of patients was chosen arthroscopic surgery to treat Haglund deformity as conservative treatment was invalid.With the prone position for surgery,we selected two approaches next to the Achilles tendon.Use the C-arm X-ray fluoroscopy observed calcaneus orthopedic during the operation.From the posteromedial approach to the posterolateral approach to alternately use the shaver and ArthroCare to clean up the front of the inflammation of the Achilles tendon bursa,by which could form arthroscopic operations security zone.All operating equipment was on the back toward the Achilles tendon,which could maximize the protection Achilles tendon.Postoperative plaster or brace short brake was used for two weeks.16 cases of postoperative patients were followed up； the mean follow-up time was 13 months (9-18 months).According pain visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle (AOFAS),the clinic effects were evaluated.Results At the last follow-up,the AOFAS hindfoot score of 91.5±2.8 was significantly higher than the preoperative 71.0±3.7 (t=17.38,P=0.014),postoperative VAS score 1.3±0.6 was significantly lower than the preoperative 5.10±0.44 (t=19.20,P=0.022).Conclusion The treatment of Haglund deformity by means of arthroscopic minimally invasive,with smaller trauma,faster recovery and lower complications,is effective and safe in clinical practice.However,dues to its steep learning curve,this method requires doctors to carry out who had relatively large arthroscopic surgery experience.

OBJECTIVE:To evaluate the effectiveness and security of Yishen huashi granules in the adjuvant treatment of chronic nephritis systematically,and to provide evidenced-based reference. METHODS:Retrieved from CBM,CJFD,Wanfang database,VIP,Medline,PubMed,EMBase and Cochrane library,randomized controlled trials(RCTs)about Yishen huashi gran-ules in the treatment of chronic nephritis were collected and related magazines were retrieved by hand. After selection and data ex-traction by 2 researchers independently,the quality of included literature was evaluated according to Jadad rating scale,and Me-ta-analysis was conducted by using Rev Man 5.3.5 software. RESULTS:A total of 8 RCTs were included,involving 1028 patients. Total response rate of trial group [RR=1.33,95%CI(1.24,1.42),P<0.001] was significantly higher than that of control group. 24 h urine protein quantity [MD=-0.32,95%CI(-0.40,-0.24),P<0.001],serum creatinine [MD=-22.38,95%CI(-23.37,-21.39),P<0.001],blood urea nitrogen [MD=-1.45,95%CI(-2.05,-0.84),P<0.001] were significantly lower than control group,with statistical significance. CONCLUSIONS:Based on routine treatment,Yishen huashi granules have good therapeutic ef-ficacy for chronic nephritis,can reduce 24 h urine protein and improve renal function.

OBJECTIVE To explore the infection rate with identifying test of vancomycin-resistant enterococci(VRE) from clinical samples,that is 3.7 percent and to genotype VRE. METHODS vanA,vanB and vanC were detected by PCR in six isolates of VRE which were identified by the broth microdilution susceptibility test and Etest.The one of vanB was further analyzed with DNA sequence and ermB,qacE△1-sul1 gentypes were detected. RESULTS Seventeen isolates of enterococci(MIC≥4 ?g/ml) were obtained of 160 isolates of enterococci which came from Jiangxi Children′s Hospital by microdilution methods.while 6 isolates were gotten by Etest.It demonstrated that susceptibilities of VRE were different in four in vitro susceptibility testing methods.VRE showed resistance to erythromycin(10/17),disinfectant/sulfanilamide(0/17). CONCLUSIONS VRE screening test and the determination of MIC are reliable in finding VRE.VRE genotype is valuable on further research and epidemiological survey of our province.

Objective To investigate the value of microsurgical management for the diagnosis and treatment of pigmented villonodular synovitis(PVNS)of the knee.Methods Thirty-eight patients with PVNS of the knee that were confirmed by arthroscopy were treated in our unit between January 2002 and April 2006.Among the patients,5 were referred from other hospitals because of postoperative recurrence.Villusectomy was performed in each of the patients by using arthroscopy.In the cases with larage extra-articular lesions,small auxiliary incision was made for complete resection.All the resected masses were examined pathologically after the surgery,and the patients received intra-anticular drainage,local ice therapy,and functional exercises afterwards.Results Unilateral surgery was performed on this group of patients.Under an arthroscope,the synovium showed characteristic yellow-brown color.Patholgocial examination confirmed PVNS in all the cases,including 20 cases of local PVNS and 18 diffused lesions.Open surgery was performed on 6 patients owing to large lesion at the popliteal fossa.According to the International Knee Documentation Committee(IKDC)Scoring Forms,the mean IKDC score increased from 60.4?6.1 to 89.3?7.2 in one year after the operation.The 38 patients were followed up for 1 to 4 years(mean 2.1 years),none of them had recurrence during this period.Two of the patients,who had been treated by open surgery and then were referred to our hospital,could not flex their knees to 90? after the microsurgery.Whereas,all the others achieved normal knee flexion.Conclusions Arthroscopy is reliable for the diagnosis and treatment of PVNS.For large extra-articular lesions,open surgery using small auxiliary incision is necessary for complete resection and avoidance of recurrence.

Objective To use the new technique of seeding cells labeled with fluorescent protein for monitoring the construction process of tissue-engineering bone in vitro.Methods Human bone marrow stromal cells(BMSCs)were isolated and culture-expanded from femoral marrow.BMSCs were transfected with the recombinant retrovirus pLEGFP-Nl containing enhanced green fluorescent protein(EGFP).Those expressing EGFP were cultured in the experiment groups,and the unmarked BMSCs were in the control groups.The cell-scaffold complexes were constructed with BMSCs and hydroxyapatite in vitro.Some complexes were used to assess the adhesion efficiency and the others were cultured and observed under fluorescence microscope for four weeks.Results EGFP was successfully expressed after BMSCs were transfected with the retroviral vector pLEGFP-N1.The labeled cells were easy to observe while the cell-scaffold complexes were constructed and cultured.The adhesion efficiency was(90.3?2.1)%for the group of labeled BMSCs and(92.0?1.5)%for the control group,so there was no significant difference between the two groups(P=0.236).Conclusions After BMSCs are transfected with the recombinant retrovirus containing EGFP,the adhesion of cells will hardly be affected so that seeding cells labeled with fluorescent protein can well be used for monitoring the construction and culture of tissue-engineering bone in vitro.

BACKGROUND:In the repair of urinary tract defects, we have been actively trying to construct the urinary tract substitutes with normal physiological function through combining ideal seed cel s and proper scaffold materials by tissue engineering method. OBJECTIVE:To investigate the biocompatibility of bone marrow mesenchymal stem cel s with rabbit bladder acel ular matrix scaffold. METHODS:Rabbit bone marrow mesenchymal stem cel s were isolated and cultured using density gradient centrifugation method. Passage 3 rabbit bone marrow mesenchymal stem cel s were cultured on the rabbit bladder acel ular matrix. The cel s were counted every day for 12 days, to drawn a cel growth curve. Bone marrow mesenchymal stem cel s cultured alone were used as control group. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cel s were successful y seeded onto the bladder acel ular matrix. Under the inverted microscope, the cel s grew out of the bladder acel ular matrix, and a great amount of long spindle-shaped cel s were found around the bladder acel ular matrix. With 5 days of inoculation, the cel s in the two groups grew gently;at 6-9 days, the cel growth curve gradual y became steeper, and the cel division and growth were increased exponential y;at 10-12 days, the cel s recovered to a gentle state. Cel growth curves in the two groups were basical y coincident, suggesting that rabbit bone marrow mesenchymal stem cel s have good biocompatibility with the bladder matrix.

General practice is a clinical practice which integrates a variety of disciplines and aims at providing basic health care services for individuals, families and communities. General prac-tice in China is now experiencing increasing development. In 2011, the Academic Degrees Committee of the State Council approved of the addition of general practice under the category of clinical medicine, initiating the education of postgraduates with professional degree majoring in general prac-tice. Through analyzing supervisor instruction, curriculum, skill training and assessment of postgrad-uates majoring in general practice, this paper thoroughly explored its training mode.

Objective To investigate effect of arthroscopic ankle arthrodesis in the treatment of endstage post-traumatic ankle arthritis.Methods Between July 2007 and December 2010,21 patients with post-traumatic ankle arthritis underwent arthroscopic arthrodesis in our hospital.There were 14 males and 7 females,aged from 21 to 68 years (average,37 years).Before operation,conservative treatments were unsuccessful in all patients.During operation,the articular cartilage was removed completely,and then micro-fracture was made in bone near articular surface.Then,the operating ankle were reduced and fixed provisionally with Kirschner wires.A C-arm X-ray system was used to confirm the reduction of operating ankle,and the operating ankle was fixed with cannulate screws if the reduction was satisfactory.Two patients also underwent arthroscopic subtalar arthrodesis.After operation,the affected ankle was fixed with plaster for six weeks.Then partial weight-bearing were allowed and gradually increased until bone union.Results All patients were followed up for 1 to 4 years (average,1.8 years).All affected ankle achieved bone union after 10 to 16 weeks (average,12 weeks).No early complications occurred,such as poor wound healing and infection.Subtalar arthritis with pain occurred in 3 patients; the symptom relieved in 2 of them after conservative treatment and in 1 patient after subtalar arthrodesis.The VAS score improved from preoperative 8.1±1.5 to 2.7± 1.1 one year postoperatively,which showed statistical significance (t=3.153,P=0.005).Conclusion Arthroscopic ankle arthrodesis provides an alternative method for treating end-stage post-traumatic ankle arthritis,which has some advantages,such as less surgical trauma,more beautiful incision and higher fusion rate.However,it needs special equipments and a learning curve.