Objective To study the effects of combination therapy (psychological intervention+clopidogrel+aspirin) for coronary heart disease. Methods 88 cases were selected from January 2016 to April 2017 in patients with coronary heart disease in our hospital. In a randomized approach, patients were divided into treatment groups and control groups, with 44 cases per patient. Patients in the control group were treated with aspirin, and the treatment group was treated with a combination therapy (psychological intervention+clopidogrel+aspirin). The treatment effect, angina and adverse reaction were observed and compared. Results Comparing the therapeutic effect of two groups of patients, the treatment group total effective rate was 97.73%, control group total effective rate was 79.55%, significant difference was statistically significant (P<0.05); Compared two groups of patients with angina, the treatment group patients with onset time (4.32±1.18) shorter, longer time interval (5.03 ±1.34), less number of attacks (1.67±0.49), with statistical significance (P<0.05); Compared to the adverse reactions in the two groups, the incidence of adverse reactions in the treatment group was 4.55%, compared with 18.18% in the control group. Statistical significance (P<0.05). Conclusion Psychological intervention in combination with clopidogrel and aspirin enteric-coated metformin hydrochloride in the treatment, in the clinical treatment of patients with coronary heart disease angina pectoris, shows good therapeutic effect, has higher application value.

OBJECTIVE:To determine the contents of heavy metals in commercial Chinese crude drugs and to provide reference for the monitoring of heavy metals in the crude drugs.METHODS:UV spectrophotometry was established to determine the contents of heavy metals in 6 vegetable drugs(Panax quinquefolium,Panax ginseng,Lycium barbarum,Radix et Rhizoma Glycyrrhizae,Bulbus Fritillariae Cirrhosae and Salvia miltiorrhiza)and 2 animal-source drugs(Scolopendra subspinipes mutilans and Bombyx Batryticatus).RESULTS:The linear range of heavy metal plumbum(reference substance)was 0.01～0.50 ?g?mL-1(r=0.997 7),and the average recovery rate was 99.49%(RSD=1.41%).The contents of heavy metals in Panax quinquefolium,Panax ginseng,Lycium barbarum,Radix et Rhizoma Glycyrrhizae,Bulbus Fritillariae Cirrhosae,Salvia miltiorrhiza were 26.13,28.96,26.99,29.98,26.63 and 28.06 ?g?g-1 respectively,and the contents of Scolopendra subspinipes mutilans and Bombyx Batryticatus were on the high side(47.62 and 59.24 ?g?g-1 respectively).CONCLUSION:The method is easy,highly accurate,and it can be used for detection of heavy metals in Chinese crude drugs.

OBJECTIVE:To isolate and purify three principal degraded impurities of mitiglinide calcium (impurity A,B,C) and identify their structures,establish HPLC method for content determination of impurity A,B,C. METHODS:Mitiglinide calci-um was used as raw material and reacted with acid;3 impurities were then separated by HPLC and their structures were elucidated by IR,MS,1H NMR,13C NMR,LC-ESI-MS and ORD. 3 impurities of 3 batches of mitiglinide calcium were determined,and the determination was performed on Agilent Extend-C18 column with mobile phase consisted of 0.01 mol/L sodium acetate solution-ace-tonitrile-triethylamine(60:40:0.1,pH=3.0)at the flow rate of 1.0 ml/min. The detection wavelength was set at 210 nm and sam-ple size was 20 μl. The response tests of 3 impurities and mitiglinide calcium were conducted. RESULTS:After treated with acid, impurity A,B,C had been obtained,and their purity were 99.05%,98.87%,99.98%,respectively after isolation and purifica-tion;after identifying the structure, 3 impurities were S-2-bezylsuccinic acid, S-2-bezylsuccinic acid-4-methyl ester, methyl (2S)-2-benzyl-3-(cis-hexahydroisoindolin-2-ylcarbonyl) propionate;methodological study of content determination of impurities were all up to the requirement. The linear range of impurity A,B,C were 0.387 5-3.875,0.395-3.95 and 0.392 5-3.925 μg/ml(all r were 1.000 0). The response value of impurity A,B,C and mitiglinide calcium were 2.316 1,2.636 1,2.617 8 and 2.620 4,re-spectively. CONCLUSIONS:The structures of 3 principal degraded impurities of mitiglinide calcium have been identified and con-firmed;the content of them can be determined by HPLC main component self-comparison method.

Objective To study the immobilization effect and keep the accurate treating position of Body-Fix (R) device in the patients with vertebral metastatic tumor treated by hypofractionated intensitymodulated radiotherapy.Methods From October 2008 to February 2010,six nasopharyngeal carcinoma patients with 10 treated lesion with vertebral metastasis who were treated by hypofractionated intensitymodulated radiotherapy and immobilized by the Body-Fix (R) device were enrolled in this study.Three sets cone beam CT images were taken and recorded when patient was underway the initial setup,position correction and after radiation delivery.Comparing these images with the planning CT images to get the setup errors and the intrafractional position shifting,and the immobilization effect of Body-Fix (R) device was analyzed.Results In the upper,middle and lower sections of the vertebrae,the intrafractional setup errors in the left-right direction were (-0.6±0.5) mm,(-0.1 ±1.0) mm,(0.0±0.4) mm,with in the superior-inferior direction (1.0 ± 1.4) mm,(4.8 ± 5.7) mm,(0.0 ± 0.3) mm and in the anterior-posterior direction (1.2 ± 5.2) mm,(-0.3 ± 0.3) mm,(0.0 ± 0.5) mm,respectively.Conclusions With Body-Fix (R) device,the intrafractional setup errors can be minimized within 2 mm which make the accurate spinal radiosurgery technique possible.

Objective To evaluate the characteristics and treatment of ovary torsion after controlled ovarian hyperstimulation.Methods Between Jan.2008 and Dec.2011,5 cases with ovary torsion who underwent ovarian hyperstimulation were retrospectively studied.Results Five cases presented intermittent lower abdominal from I to 38 days after oocyte retrieval.Enlargement of ovary and decreased or absent venous and/or arterial flow were demonstrated by Doppler sonography.Two torsions at left side,two torsions at right side,and one on bilateral side were observed.Three cases give up embryo transplantation,2 cases were pregnant after surgical treatment.One case with partial torsion was successfully treated with simple conservative treatment.Two cases with complete torsion were performed adnexectomy by laparotomy.One case with complete torsion with early pregnancy was managed by laparoscopic adnexectomy.One case with chemical pregnancy was managed by laparoscopic detorsion for left side and excision for right side.Postoperative pathology of ovary tissue all confirmed haemorrhage and necrosis.Conclusions Ovary torsion might occur after controlled ovarian hyperstimulation.The early management on ovary torsion will be benefit for preserving ovarian function.

Obgective To analyze the relevant risk factors of recurrent wheezing(≥3 attacks) in the first 3 years of life.Methods Wheezing,respiratory sounds,risk factor were used as key words to retrieve papers in Chinese literature databases including Sinomed,Wanfang and Weipu databases.The same strategy was used to retrieve English papers in English literature databases including PubMed,Cochrane library and Embase.Time range was from 31th May 2004 to 1 rd June 2014.The execution of quality evaluation of the included documents was in compliance with Newcastle-Ottawa Scale and cross-sectional study standard recommended by Agency for Healthcare Research and Quality.The evidence quality evaluation was conducted with GRADEpro and followed by the Meta analysis with RevMan 5.2.R~ults A total of 13 studies were included in this Meta-analysis.Several factors were related to recurrent wheezing episodes,including risk factors such as maternal smoking during pregnancy (OR =1.47,95％ CI:1.30-1.66),asthma in parents (OR =1.94,95 ％ CI:1.72-2.19),family history of atopy (OR =1.94,95％ CI:1.72-2.19),male (OR =1.42,95 ％ CI:1.19-1.69),history of eczema (OR =2.36,95 ％ CI:1.69-3.30),colds (＞ 6 times) (OR =2.02,95 ％ CI:1.54-2.64),history of bronchopneumonia (OR =1.85,95 ％ CI:1.46-2.34),exposure to cigarette smoking(OR =2.30,95％ CI:1.68-3.14),daycare attendance(OR =2.27,95％ CI:1.97-2.60);Education received by the mother ＞ 12 years (OR =0.80,95％ CI:0.70-0.92) was the protective factor.Conclusions The risk factors of recurrent wheezing(≥3 attacks) in the first 3 years of life are maternal smoking during pregnancy,asthma in parents,family history of atopy,male,history of eczema,colds (＞ 6 times),history of bronchopneumonia,exposure to cigarette smoking and daycare attendance.The protective factor is education received by the mother ≥ 12 years.The prerequisite in precaution of infants recurrent wheezing is to ensure the utmost avoidance of hazardous factors and reinforcement of protective factors.

Objective To discuss the features of nosocomial infection in patients with multiple trauma in intensive care unit and the preventive measures. Method The nosocomial infections occurred in 137 patients with multiple trauma were analyzed including site of infection, pathogenic organisms and bacterial strains. Results The rate of nosocomial infection was 62.8%, mainly the lower respiratory tract infection and wound infection, the G-negative bacteria infection accounted for 67.8%, mostly Escherichia Coli, Pseudomonas aeruginosa and A cinctobacter baumanni I. The G-positive bacteria infection accounted for 32.2%, mainly Staphylococcus aureus and Coagulase negative staphylococcus. The positive detection rates of Klebsiella and pseudomonas aeruginosa were increasing year afer year. Conclusions The incidence of nosocomial infection in patients with multiple trauma is high, suggesting some appropriate preventive measures should be taken to reduce the rate of infection.

Objective To explore the effect of practicing Chinese gymnastic Qigong-Yijinjing on the infrared radiant track along meridian course (IRRTM)of Ren Meridian stimulated by moxibustion on CV-8 among dysmenorrhea patients.Methods Twenty dysmenorrhea undergraduate patients were recruied and practiced Chinese gymnastic Qigong-Yijinjing for 3 months.The numbers of patients of mild,moderate and severe symptoms were collected before and after the intervention.The effects of IRRTM stimulated by moxibustion on CV-8 were compared before and after practicing Chinese Gymnastic Qigong-Yijinjing.Results After practicing Chinese Gymnastic Qigong-Yijinjing,symptoms of 15 patients (including 11 with moderate dysmenorrhea and 4 with severe dysmenorrheal)were relieved to different extent.After the practice,all IRRTM of Ren Meridian turn to be more continuous,clear and regular either the Ren Meridian was stimulated with moxibustion or not.The average surface temperature along Ren Meridian rose significantly after the practicing.The conduction time to achieve the best states of IRRTM along Ren Meridian significantly shortened compared to before the intervention.Conclusion Chinese Gymnastic Qigong-Yijinjing can effectively enhance the transmission of IRRTM along Ren Meridian on dysmenorrhea patients,and may have a positive effect on dysmenorrhea treatment.

Objective To analyze the relevant risk factors of recurrent wheezing(≥3 attacks) in the first 3 years of life in Shanghai Pujiang.Methods A case-control study was conducted.Two hundred and sixty-two research children were chosen for clinical visits (＜ 3 years old) with wheezing at the Pediatric Department of Shanghai Renji Hospital (South Campus),School of Medicine,Shanghai Jiaotong University,from January to December 2014.According to the frequency of wheezing,the subjects were divided into 75 cases of recurrent wheezing group (≥ 3 attacks),110 cases of occasional wheezing group(1-2 attacks) and 77 cases of no wheezing group.Probable risk factors were inquired by using face-to-face questionnaire.The passive agglutination method was used to detect the Mycoplasma pneumoniae antibody immunoglobulin M (IgM).The indirect immunofluorescence was used to detect the respiratory pathogens.The Western blot was used to detect 20 items of serum allergen.Chi-square test was firstly used for univariate analysis,and then the multivariate stepwise Logistic regression was used to analyze the independent risk factors associated with infant recurrent wheezing.Results A total of 20 factors were found relevant to infant recurrent wheezing by univariate analysis,which included boys (OR =4.030,95％ CI:1.937-8.388),personal atopy (OR =13.125,95％ CI:5.951-28.946),allergic dermatitis (OR =9.833,95％ CI:4.663-20.737),allergic rhinitis (OR =40.327,95％ CI:5.300-306.842),like rubbing eyes or nose(OR =6.487,95％ CI:3.190-13.191),food allergy (OR =6.689,95 ％ CI:1.860-24.051),premature birth (OR =3.795,95 ％ CI:1.001-14.385),low birth weight (OR =9.075,95％ CI:1.106-74.450),parental atopy (OR =10.667,95％ CI:4.824-23.587),parental allergic dermatitis (OR =8.072,95 ％ CI:2.634-24.734),parental allergic rhinitis (OR =6.524,95 ％ CI:2.920-14.577),parental allergic conjunctivitis (OR =1.087,95％ CI:1.017-1.162),parental asthma history (OR =1.119,95％ CI:1.035-1.210),colds ＞ 6 times (OR =9.111,95％ CI:3.970-20.909),history of bronchopneumonia(OR =7.554,95％ CI:3.588-15.903),age at first time use of antibiotics less than 6 months (OR =2.388,95％ CI:1.129-5.052),exposure to cigarette smoking (OR =1.922,95 ％ CI:1.004-3.681),maternal passive smoking during pregnancy (OR =2.508,95 ％ CI:1.298-4.848),living close to wood stove (OR =3.342,95 ％ CI:1.427-7.827) and positive results of inhaled allergens (OR =1.821,95 ％ CI:1.420-2.336).Keeping cats was the protective factor(OR =0.922,95％ CI:0.864-0.984).The forward Logistic regression analysis showed that personal atopy (OR =10.278,95 ％ CI:2.503-42.202),like rubbing eyes or nose (OR =1 0.316,95 ％ CI:2.722-39.101),food allergy (OR =10.370,95％ CI:1.248-86.145),parental atopy (OR =5.402,95％ CI:1.340-21.778),colds ＞ 6 times (OR =7.048,95 ％ CI:1.688-29.423),history of bronchopneumonia (OR =7.876,95 ％ CI:2.040-30.407) and maternaal passive smoking (OR =3.696,95 ％ CI:1.013-13.494) during pregnancy were the independent risk factors of infants recurrent wheezing.Conclusion Personal atopy,like rubbing eyes or nose,food allergy,parental atopy,colds ＞ 6 times,history of bronchopneumonia,maternal passive smoking are the independent risk factors of recurrent wheezing in infants less than 3 years old.

Objective To explore the effects of salmeterol/fluticasone propionate complicated or combined with N-acetylcysteine on the pulmonary function and arterial blood gas analysis of the patients with chronic obstructive pulmonary disease (COPD), and to evaluate its curative effect.Methods 84 cases of COPD patients were randomly divided into combination treatment group (n=44)and simple treatment group (n=40).The patients in combination treatment group were treated with salmeterol/fluticasone propionate combinated with N-acetylcysteine while the patients in simple treatment group were treated only with salmeterol/fluticasone propionate, both of which were followed up for 6 months.The changes of pulmonary function (FEV1%FVC,FEV1%Pred,PEF daily variation rate:ΔPEF%)and the arterial blood gas analysis indexes (PaO2 and PaCO2 )of the patients in two groups were recorded before treatment, 3 months after treatment, and 6 months after treatment. Results The FEV1%FVC,FEV1%Pred and PaO2 of the patients in combination treatment group and simple treatment group were obviously increased 3 and 6 months after treatment compared with before treatment (P<0.01 ), and the PaCO2 were obviously decreased (P<0.01).And there were significant differences of the indexes mentioned above of the patients between two groups (P<0.05 );but the indexes of each group had no significant differences between 3 months and 6 months after treatment (P>0.05).TheΔPEF% of the patients in two groups had no significant differences between inter-group and intra-group before and after treatment (P > 0.05 ). Conclusion Combination of salmeterol/fluticasone propionate and N-acetylcysteine can obviously improve the pulmonary function and arterial blood gas analysis indexes of the COPD patients, which is superior to the simple application of salmeterol/fluticasone propionate and has definite and lasting curative effect on the treatment of COPD.