Objective:To study the curative efficacy of budesonide combined with huaiqihuang granules in the treatment of children with asthma and its effects on the serum leukotriene D4(LTD4),nerve growth factor (NGF),tissue inhibitor of metalloproteinase-1 (TIMP-1) levels.Methods:90 cases of children with asthma who were treated from March 2014 to March 2015 in our hospital were selected and divided into the observation group (n=45) and the control group (n=45) according to the random number table.Both groups of children were given bronchial antispasmodic agent,oxygen,antibiotics,glucocorticoid and other conventional treatment after admission,the control group was given budesonide atomization inhalation treatment on the basis of conventional treatment,0.5 mg budesonide were add in 3ml saline for continuous inhalation,twice a day,while the observation group was treated with Huaiqihuang Granules on the basis of the control group,twice a day.After 12 weeks of treatment,the curative effect,disappearance time of wheezing,cough relief,pulmonary rales,wheezing and other symptoms,forced vital capacity (FVC),serum LTD4,NGF,TIMP-1 levels,CD3+,CD4+,CD8+ of both groups were compared.Results:After treatment,the total effective rate of observation group was significantly higher than that of the control group [93.33％(42/45) vs 77.77％(35/45)](P＜0.05);disappearance time of breath,cough,moist rales and wheezes were significantly shorter than those of the control group[(4.32± 1.03)d vs (6.08± 1.24)d,(5.60± 1.12)d vs (7.21± 1.30)d,(3.19± 0.98)d vs (4.98± 1.02)d,(3.25± 1.03)d vs (5.89± 1.35)d](P＜0.05);the FEV1,FEV1/FVC were significantly higher than those of the control group [(92.63± 10.01)L/s vs (78.36± 9.19)L/s,(95.37± 11.72)％ vs (80.19± 10.23)％](P＜0.05);the serum LTD4,NGF,TIMP-1 levels were significantly lower than those of the control group [(7.24± 0.86)ng/mL vs (12.68± 1.01vng/mL,(68.18± 9.01)pg/mL vs (80.78± 10.24)pg/mL,(34.16 ± 5.06)ng/mL vs (49.76 ± 5.47)ng/mL] (P ＜0.05);the CD3+,CD4+ were significantly higher than those of the control group [(66.15± 7.20)％ vs (62.03± 6.85)％,(45.13± 7.90)％ vs (37.42± 7.06)％],CD8+ was significantly lower than that of the control group[(34.16± 5.06)％ vs (49.76± 5.47)％] (P＜0.05).Conclusion:Budesonide combined with Huaiqihuang granules was effective for children with asthma,which could enhance the immune function,improve the lung function,reduce the serum levels of LTD4,NGF,TIMP-1.

Objective To discuss the clinical application of the nursing management mode of doctornurse same group responsibility system in treating patieuts who are receiving transjugular intrahepatic portosystemic shunt (TIPS).Methods A total of 70 TIPS patieots,who were admitted to a certain level Ⅲ hospital during the period from January 2016 to December 2016,were enrolled in this study.Using the table of random number,the patients were equally divided into the control group and the study group with 35 patients in each group.Traditional nursing group management mode was adopted in the control group,while doctor-nurse same group responsibility system was carried out in the study group (including the hospitalization period and the follow-up visit after discharge).Complications during hospitalization,postdischarge incidence of hepatic encephalopathy,readmission rate,and patient's satisfaction with medical staff were calculated,and the results were compared between the two groups.Results After the implementation of doctor-nurse same group responsibility system,the post-TIPS complications,the post-discharge incidence of hepatic encephalopathy and the readmission rate were significantly decreased and the patient's satisfaction with medical staff was remarkably improved,the differences were statistically significant (P＜0.05).Conclusion The implementation of doctor-nurse same group responsibility management mode for TIPS patients in the interventional ward can effectively reduce postoperative complications,post-discharge incidence of hepatic encephalopathy and the readmission rate,meanwhile,the patient's satisfaction with medical staff are obviously improved.Therefore,the implementation of doctor-nurse same group responsibility management mode for TIPS patients is of great value in clinical practice.

Objective To evaluate the application effect of standardized communication mode, which was based on the situation, background, assessment and recommendation (SBAR communication mode), in interventional ward. Methods SBAR communication mode was implemented in interventional ward. Through the discussion of doctors and nurses, the SBAR communication template of common symptoms of specialized diseases was revised. The training, examination, utilization and evaluation of the SBAR communication template were conducted for all nurses. The medical adverse events caused by poor medical and nursing communication, the patients' recognition of the professional abilities of medical teams and the doctors' satisfaction with nurses were recorded before and after the implement of SBAR communication mode, and the results were compared. Results After the implementation of SBAR communication mode, both the patients' recognition of the professional abilities of medical teams and the doctors' satisfaction degree with nurses were significantly improved, the differences were statistically significant (P<0.05); and the incidence of medical adverse events caused by poor medical and nursing communication was remarkably decreased, the difference was statistically significant (P<0.05) . Conclusion The implementation of SBAR communication mode in the intervention ward can significantly improve the patients' recognition of the professional abilities of medical teams and the doctors' satisfaction degree with nurses, and decrease the incidence of medical adverse events caused by poor medical and nursing communication, thus, the safety of patients can be guaranteed, meanwhile, the establishment of a harmonious medical and nursing team is promoted.

Objective:To investigate the effect of CHI3L1 on the biological function of chondrocytes and its role in lumbar facet joint degeneration.Methods:The human lumbar facet joint articular cartilage were collected, and the relative mRNA expression of CHI3L1 gene detected by quantitative fluorescence PCR. Then explored the correlation between joint degeneration and gender, age and relative mRNA expression of CHI3L1. Human chondrocytes were cultured in vitro. The effects of CHI3L1 on chondrocyte proliferation, cycling, and apoptosis, as well as expression of related inflammatory factors, were investigated. The mechanism by which CHI3L1 regulates the degeneration of articular cartilage was investigated using the signal transduction pathway protein chip.Results:There was a positive correlation between the grade of degeneration in lumbar facet joint and the relative expression of CHI3L1 gene mRNA ( r=0.76, P<0.001). There was no correlation with the patient's gender ( r=-0.12, P=0.500). A positive correlation between the age of patients and the relative expression of CHI3L1 gene mRNA was found ( r=0.47, P=0.005). Compared with the non-degenerative group, the expression of CHI3L1 gene mRNA significantly increased in the degenerative group, and the expression of CHI3L1 gradually increased with the aggravation in the grade of degeneration ( F=18.90, P<0.001). Compared with the non-degenerative group, the chondrocytes in the CHI3L1 group had significantly lower proliferation at 48 h (OD 490/fold=7.132), 72 h (OD 490/fold=4.803), 96 h (OD 490/fold=2.431) and 120 h (OD 490/fold=0.009). The ratio of chondrocytes in G1 phase, S phase and G2/M phase were 85.03%±3.05%, 12.78%±2.29% and 0.90%±0.76% in the CHI3L1 group, and 73.93%±2.73%, 22.81%±1.93% and 0.99%±0.87% in control group, respectively. There were significant differences in the percentage of chondrocytes in G1 phase ( t=4.70, P<0.001) and S phase ( t=5.80, P<0.001) between the two groups. The percentages of apoptosis in chondrocyte in CHI3L1 group and control group were 8.64%±0.76% and 5.68%±1.13%, which has a statistically difference ( t=4.47, P<0.001). The expression of IL-6 in chondrocytes of CHI3L1 group was 49.60±0.01 pg/ml, which was higher than that of 47.88±0.01 pg/ml in the control group ( t=132.70, P<0.001). The expression of TNF-α was 95.93±0.02 pg/ml, which was higher than 90.69±0.02 pg/ml in the control group ( t=376.10, P<0.001). There was significant difference in expression of IL-6 in chondrocytes between the CHI3L1 group and the control group ( t=132.72, P<0.001). The expression of TNF-α ( t=376.10, P<0.001) was statistically difference. Protein chip detected 53 proteins with significant differences in expression and 43 proteins with significant differences in protein phosphorylation levels. Bioinformatics analysis was used to identify 16 signaling pathways in which the above different proteins might be involved, including ErbB, PI3K, Akt, Ras, JAK, STAT3, MAPK pathway. In the MAPK pathway, the expression of MAPK1 and RAF1 proteins was higher in the chondrocytes of the CHI3L1 group than in the control group (1.094±0.00 vs. 0.814±0.00, 0.988±0.00 vs. 0.786±0.00; t=103.16, P<0.001; t=54.32, P<0.001). Compared with the control group, the expression of MAPK1 and RAF1 proteins was significantly increased in the chondrocytes of the CHI3L1 group. Conclusion:The expression of CHI3L1 is corrected to articular cartilage degeneration. CHI3L1 is able to inhibit the proliferation of articular chondrocytes, which regulated the cycling of chondrocytes from G1 phase to S phase, promote the apoptosis of chondrocytes, and promote the expression of IL-6 and TNF-α in chondrocytes. Regulation of chondrocytes biological function through the MAPK pathway, which is a potential biomarker for the clinical diagnosis and treatment of lumbar joint degeneration.