Laryngopharyngeal reflux (LPR) is gaining extensive attention in recent years because of the high incidence. But because of the complex symptoms and signs, there exist no diagnostic consensus. In this paper, the available objective diagnostic methods so far are reviewed, in the purpose of discussing the approach of objective and accurate diagnosis of LPR.
Humans ; Laryngopharyngeal Reflux ; diagnosis

Objective: To prepare voriconazole albumin nanoparticles and evaluate the characteristics of pharmacokinetics and tissue distribution in rats.Methods: Voriconazole albumin nanoparticles were prepared by a new ultra-high pressure microfluidization technology.The physicochemical properties of voriconazole albumin nanoparticles were studied, such as the particle size distribution, zeta potential and particle shape.The release of voriconazole from albumin nanoparticles was investigated in pH7.4 phosphate buffered saline.The concentrations of voriconazole in plasma and the other different tissues were determined after the tail-vein injection of voriconazole albumin nanoparticles in rats.Results: Voriconazole albumin nanoparticles were homogeneous small spheres as seen under a transmission electron microscope.The average particle diameter was (121.9±41.6) nm, the polydispersity index was 0.197, and the zeta potential was (-42.1±0.9) mV.In 0.5% Tween-80 phosphate buffered saline (pH7.4), the in vitro cumulative release of voriconazole albumin nanoparticles reached up to 67.5% in 24 h.AUC0-24 of voriconazole albumin nanoparticles and voriconazole injection was (98.27±1.42) and (105.32±1.45) g/L/h, and MRT0-24 was (4.48±0.38) and (4.86±0.51) h, respectively.Conclusion: Voriconazole albumin nanoparticles can prolong the circulation time, and exhibit promising targeting ability in liver, spleen and brain.

Government Subsidized Student Loan is a policy adopted by the government,which aims to help the poor students to go to college.However,the result turns out that the policy doesn't achieve the expectant target for many reasons.This paper analyses the reasons and introduces three methods for promoting the healthy development of the Government Subsidized Student Loan.They are: establishing the personal credit system for college students,ensuring the remedy right of loan and designing reasonable procedure of Government Subsidized Student Loan.

BACKGROUND:The function was poor in middle aged and elderly patients with total knee replacement. If there was no ideal anesthesia during the operation, the prognosis of patients would be poor. Therefore, it is necessary to explore the analgesic drugs for artificial knee joint arthroplasty. OBJECTIVE:To investigate clinical analgesic efficacy of tramadol and paracetamol in total knee arthroplasty and the drug safety. METHODS:200 cases undergoing unilateral total knee arthroplasty in the Department of Orthopedics of Huaian First Hospital Affiliated to Nanjing Medical University from December 2013 to January 2015 were enroled in this study. According to the different methods of analgesia, patients were divided into control and experimental groups, with 100 cases in each group. Control group received intravenous patient controled analgesia. Experimental group received paracetamol and tramadol oraly. Clinical analgesic efficacy and safety of tramadol paracetamol in total knee arthroplasty were analyzed. RESULTS AND CONCLUSION: No significant difference in visual analogue scale score was detected immediately, 4 and 5 days after replacement in both groups. Visual analogue scale score was significantly lower in the experimental group than in the control group at 1-3 days after replacement. Hospital for Special Surgery scores at 7 and 12 months after replacement and Special Surgery scores at 24 and 72 hours after replacement were significantly higher in the experimental group than in the control group. The twice doses of tramadol and paracetamol were significantly lower at 24 and 48 hours after replacement in the experimental group than in the control group. The incidence of complications was significantly lower in the experimental group than in the control group. These data verify that during perioperative analgesia, the effects of tramadol and paracetamol were ideal, could lessen patient’s pain, contribute to the recovery of knee function, have less adverse reactions, and have a certain clinical application value.

Objective To analyze clinical value of enteral nutrition via a nasojejunal feeding tube placed endoscopically and total parenteral nutrition in severe acute pancreatitis( SAP) .Methods 35 patients with SAP were received nasojejunal enteral nutrition endoscopically(NENE),while other 35 patients were received total parenteral nutrition(TPN).After nutrtion support for 4 weeks the nutrition index,Ranson score,APACHE score and CT score and complications and mortality rate of occurrence between the two groups were compared.Results After nutrition support of 4 weeks,the levels of hemoglobin and serum albumin of NENE group were (108 ±21) g/L,(38.7 ±9.5) g/L, which were significantly higher than those of TPN group( t=3.928,3.684,all P<0.05),while the fasting blood glucose of(5.1 ±1.2)mmol/L was significantly lower than that of TPN group(P<0.05),the level of CRP,TNF-α, IL-1 and IL-6 in patients of NENE group were (32.1 ±12.3)mg/L,(34.4 ±12.3)ng/L,(22.4 ±11.3)ng/L, (32.4 ±11.3)ng/L,which were significantly lower than those of TNP group(t=3.927,4.925,4.258,4.825,all P<0.05);the incidence of multiple organ dysfunction,hyperglycemia of NENE group were 17.14%,8.57%,5.71%, 5.71%,which were significantly lower than those of TPN group(χ2 =4.167,4.529,5.082,4.926,all P<0.05). Conclusion Nasojejunal enteral nutrition endoscopically is safe in clinical application.Compared with TPN,NENE results in better control of the incidence of complication, and decreased the length of stay in hospital and the cost enteral nutrition were more beneficial than total parenteral nutrition.

There are many causes of proteinuria in children.Because proteinuria is mainly caused by glomerular diseases,renal tubulopathies are often ignored.Dent's disease is an hereditary renal tubulopathy characterized by low-molecular-weigh proteinuria,hypercalciuria,nephrocalcinosis,nephrolithiasis,and progressive renal failure.Dent's disease is mainly caused by mutations in CLCN5 and OCRL1 genes.Current treatments of the disease are still mainly symptomatic and supportive therapy,including reducing urinary calcium excretion,lightening nephrocalcinosis,and delaying the occurrence of renal insufficiency.

"Triple-negative"breast cancer patients who have special clinicopathological characteristics are defined by a lack expression of oestrogen,progesterone,and HER-2 receptors.Triple-negative patients usually metastasize early with worse prognosis,and have a higher incidence of visceral metastases than bony metas tases.This subgroup has no chance of hormone treatment and targeted therapy for HER-2,and chemotherapy is the main therapy.We discuss the predominant proliferative signals,molecular features of triple-negative breast cancer,and some basic studies and clinical trials.Furthermore,targeted therapy against EGFR,C-kit,and BRCA1 may show preferable anticancer activity.However,recent research is still unable to identify the biological characteristics of triple-negative Cancer,and special treatment is still not available.

Objective To study the effect of cognitive behavior intervention on negative self-concept and life quality of chronic heart failure patients. Methods 128 cases of patients with chronic heart failure were divided into the observation group (63 cases) and the control group (65 cases).The control group were treated with cardiology common nursing, the observation group received cardiology common nursing with cognitive- behavioral therapy. Negative self-concept and life quality of the two groups were compared. Results Compared with the control group, the negative self-concept alleviated and life quality improved in the observation group. Conclusions Cardiology common nursing with cognitivebehavioral therapy can alleviate the negative emotion and improve the quality of life in patients with coronary heart disease.

The minimally invasive surgery means treatment that can remain homeostasis, reduce tissue damage, benefit body recovery and prognosis. The typical techniques of minimally invasive surgery in gynecology are laparoscope and hysteroscope, which can replace nearly all kinds of traditional gynecology surgery and have superior curative effect. After 10 years clinical practice, we found that reasonable application of laparoscope play a significant role in ensuring the surgery quality and postoperative living quality, on account of the greater risk by new surgery instruments and various sorts of energy. The popularization of gynecology minimally invasive surgery is influenced by the regional economic development and update of doctor's ideology, so it is important to train the surgeons and change their ideas.

Objective To analyze clinical process and therapy means of drug induced liver disease(DILD).Methods The retrospectively study on the clinical data 40 patients of DILD was used.Results(1)18 patients with DILD are more 60 year(45.0%); 17 patients have chronic dease(42.5%); 3 patients are sensitive to drug.10 patients have unite using drug(25%); 4 patients have bibulosity; 20 patients had not cease drug when DILD happened with al- imentary tract symptom(50%);(2)72.7% DILD with antibiotics happened in 2 weeks,most cases are acute bile de- posit type.95.2%DILD with Chinese traditional medicine happened after 2 weeks,is are chronic hepatotoxicity,it is obvious that liver cell damage type and bile deposit type.and commix-type.Very few Chinese traditional medicine also lead to acute hepatotoxicity.By protect liver of therapy:6 patients cure,32 patients mend,2 have patients no change. Conclusion DILD is very normal in clinical,must be in advance know and guard for DILD,the key is to cease drug when DILD happened.