Objective To discuss the common deviation in TCM dispensing and corresponding measures. Methods Totally 103 cases of TCM deviation happened in the TCM dispensary of outpatient clinic in our hospital from September 2012 to September 2014 were selected. Retrospective analysis was conducted to analyze case related data collation and factors that affect the quality of TCM dispensing. Corresponding measures for each factor were designed.Results Age and gender of all the 103 cases showed no influence on the statistics of TCM deviation in the study. Among the 103 cases of TCM deviation, 41 cases were caused by factors about medicine. Among the 41 cases, 9 cases were about similar packaging; 12 cases were about similar medicine names; 2 cases were about quality problems; 18 cases were about lack of standardization in medicine placement. 33 cases were caused by factors about deployment, among which, 8 cases were about dosage error, 8 cases were about waste in the preparation process of TCM decoction pieces, 17 cases were about replacement of TCM decoction pieces. 29 cases were caused by factors about prescriptions, among which, 13 cases were about errors of prescription entering deviation, 11 cases were about prescription examining deviation, 5 cases were about ignorance of prescription footnotes. Conclusion Common deviation in TCM dispensing and the reasons are complicated. Timely and correct measures targeting them should be taken to improve the quality of TCM dispensing and guarantee safety.

Objective To explore the mechanism of hypoxic-ischemic brain damage(HIBD) and provide new ideas for clinical treatment of hypoxic-iscbemic encephalopathy.Methods Neonatal 7-day-old Wistar rats were randomly divided into sham-operation control group,HIBD 6 h,12 h,24 h,48 h and 72 h groups(n =6 per group).The model of HIBD was induced by unilateral carotid ligation followed by timed exposure to 8% oxygen.The expression of MMP-9 mRNA and TIMP-1 mRNA in brain tissue of neonatal rats was measured by Real-time Q-PCR method.Results (1) The ligatod brainhemisphere of HIBD groups showed obvious edema from 12 h to 48 h after hypoxia -ischemia in the neonatal rats.(2) The expression of MMP-9 mRNA was very low in the sham-operation control group,but in HIBD groups,it began to increase at 6 h,and reached a peak at 24 h,then gradually decreased,but still maintained at high level at 72 h(P＜0.01).(3) The expression of TIMP-1 mRNA was aslo very low in the sham-operation control group.But in HIBD group,it increased slightly at 6 h,12 h and 24 h,compared to the sham-operation control group,each group was statistically significant(P＜0.05),with no significant difference among the three groups(P＞0.05),then decreased at 48 h and 72 h,but with no significant difference from sham-operation control group (P＞ 0.05).(4) The ratio of MMP-9 mRNA/TIMP-1 mRNA was normal in the sham-operation control group and HIBD 6 h group,it began to increase at 12 h,and reached a peak at 48 h,then gradually decreased,but still maintained at high level at 72 h(P ＜0.01).Conclusion Hypoxia-ischemia increases the expression of MMP-9 mRNA in brain tissue of nenatal rats,and the imbalance in the expression of MMP-9 mRNA and TIMP-1 mRNA possibly is one cause of brain edema induced by HIBD.

Objective To observe the clinical efficacy of treating congestive heart failure with the combination of Astragalus,Danhong and Nitroglycerin injection.Methods 73 cases with congestive heart failure were selected.randomly recruited into a control group and a treatment group.The control group was treated with conventional therapy,and the treatment group was treated with Astragalus injection,Danhong and nitroglycerin injection on the basis of conventional mompy.Both groups were treated for one course of therapy of 21 days.Such indexes as clinical signs and symptoms,cardiac function,the amount of output per bo(SV),each sub-output(CO),cardiac index(CI),left ventricular ejection fraction(EF),and blood the rheology were observed before and after the treatment.Reselts The total effective ratewas 97.29%and 88.89%in the treatment group and the control group respectively,showing statistically differences between the two groups(P＜0.05):SV CO,CI and EF showed significant difference in both groups after the treatment(P＜0.01 or P＜0.05),and significant difference between the two groups(P＜0.05).Blood theology wag decreased after the treatment,and such clecreasing in the treatment was greater than that in the control group(P＜0.01).Conclusion The combination therapy of astragalus,Danhong injection and nitroglycerin injection is effective in treating congestive heart failure.

Objective To compare the detection results by bacteria pathogenic rate of ventilatorassociated pneumonia (VAP) pipeline and ventilator patients with mechanical ventilation,to investigate whether need to replace the ventilator weaning patients underwent another test of pipeline during mechanical ventilation.Methods This study selected using the ventilation mechanical ventilation for more than 48 hours,try (48 ± 4) hours required to mechanical ventilation in 69 patients.They were divided into two groups according to admission time,group A was in need of replacement ventilation pipeline of new again during mechanical ventilation,group B used the original pipeline.In offline,try again during mechanical ventilation after mechanical ventilation,once daily for 4 days to collect ventilator pipe air outlet samples for bacterial culture counts were observed,while offline,use again after 2 hours,12 hours of ventilator,24 hours,2 days,3 days,4 days of body temperature,white blood cell count,neutrophil classification and other indicators.The incidence of VAP was compared between two groups.Results The temperature,white blood cell count,neutrophil classification were (38.5 ± 1.6)℃,(11.8 ± 3.5)×109/L,0.85±0.16 in group A,while (38.4 ± 2.0) ℃,(12.1 ± 3.7)×109/L,0.84 ± 0.20 in group B,and there were no significant differences between two groups,P＞0.05.The incidence of VAP was 37.1％(13/35) and 35.3％(12/34) in group A and group B,and there was no significant difference,P＞ 0.05.Conclusion There is no necessary for trial offline patients without respiratory infection to change the ventilator pipe when to re-ventilate during the 7 days using period of the ventilator pile.

Objective To explore the epidemiologic and clinical features of hand, foot and mouth disease (HFMD) caused by Coxsackie virus A16 (CA16) in Suzhou from 2010 to 2014, and analyze the relationship between the SNPs of oligoadenylate synthetase 1 (OAS1) and HFMD caused by CA16 infection.MethodsThe clinical data of children diagnosed with HFMD caused by CA16 during 2010 and 2014 were collected. The epidemiological characteristics were analyzed. Among them, 167 cases were selected to make comparison of the clinical features with 166 cases of HFMD caused by EV71 infection in the same period. The genotyping ofOAS1 rs10774671 was detected by TaqMan probe technique in 167 cases of CA16 infection children, 166 cases of EV71 infection children with HFMD and 163 healthy children. The relationship between polymorphism of gene and infection of CA 16 was analyzed.ResultsA total of 9 016 children with HFMD were included. CA16 nucleic acid detected to be positive in 762 cases. The detection rate was 8.45%. CA16 infection was most commonly in summer. Children under 5 years old accounted for 94.62% infected. Compared with EV71 infected children, CA16 infected children had shorter fever time, severer oral herpes, ulcer, and rash in hand, foot and hip, lesser nervous system involvement, fewer cases of high lactate dehydrogenase, high C reactive protein, high IgM or IgG, and signiifcant changes in the percentage of CD3+, CD3+CD4+, CD3+CD8+ and CD3-CD19+ (P all?

Objective To investigate the clinical manifestations and treatment regiment of children with juvenile dermatomyositis(JDM).Methods The clinical manifestation,changes of serum muscale enzyme,myopathic laboratory examination,treatment and prognosis of 15 children with JDM retrospectively admitted from Jan.1990 to Jan.2004 were analyzed.Results All of the children had symmetrical weakness of the proximal muscles.The most frequent features were heliotrope and Gottron's papules.Elevated muscle enzymes were noted in all cases.Electromyography revealed typical change of myopathic type and muscle biopsy was compalible with myositis in all cases.Most of patients achieved normal muscle enzymes within 1 month and had improved muscle strength with 2.5 monthes of the initiation of corticosteroid therapy.Conclusion It is very important to know the clinical features of JDM,and prompt diagnosis and treatment will result in an improved prognosis.

Objective:To investigate the role of interleukin-10 (IL-10) and IL-12 in the differential diagnosis of tuberculous and malignant pleural effusion through measuring the serum and pleural effusion IL-10 and IL-12 levels of tuberculous and malignant pleural effusion patients.Methods: Forty-eight inpatients with exudative pleural effusion who didn''t receive any treatment before were selected.According to the pathogeny, the patients were divided into tuberculous pleural effusion group (n=25) and malignant pleural effusion group (n=23).The levels of IL-10 and IL-12 in peripheral blood and pleural effusion of the patients in two groups were detected by Cytometric Bead Array (CBA).The differences in IL-10, IL-12 levels and IL-12/IL-10 ratio were compared between two groups.The ROC curves of the above indexes, cast-off and adenosine deaminase (ADA) were used to compare the effects in differential diagnosis of tuberculous and malignant pleural effusion.Results: There were no statistical differences in the levels of serum IL-10, IL-12 and IL-12/IL-10 ratios of the patients between tuberculous and malignant pleural effusion groups (P>0.05),and the IL-12 level in pleural effusion and the IL-12/IL-10 ratio of the patients in malignant pleural effusion group were lower than those in tuberculous pleural effusion group (P<0.005).The area under the ROC curve for the levels of IL-12 in pleural effusion (0.984) was higher than those for the ratio of IL-12/IL-10, cast-off and ADA (0.744, 0.804 and 0.911, respectively) in the differential diagnosis of tuberculous and malignant pleural effusion.Conclusion: The detection of IL-12 levels in pleural effusion is helpful for the differential diagnosis of tuberculous and malignant pleural effusion, and the pleural effusion is easy to obtain, therefore the detection of IL-12 in pleural effusion is worth to be widely applied in clinic.

Objective To observe and analyze the causes and prognosis of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR).Methods A total of 160 PDR patients (171 eyes) were enrolled in this retrospective study.There were 85 males and 75 females.The patients aged from 33 to 73 years,with the mean age of (56.40±8.97) years.All the patients were performed 25G pars plana vitrectomy by the same doctor.Fibrovascular membrane peeling and panretinal photocoagulation were performed during the operation.Combined phacoemulsification was performed in one hundred and five patients.Vitreous tamponade was used at the end of surgery,including silicone oil (43 eyes),C3F8 (63 eyes),air or fluid (65 eyes).The follow-up ranged from 6 to 22 months,with the mean follow-up of (9.34±6.97) months.The features of PVH were observed.The difference of age,HbA1 c,creatinine level,the severity of the fundus lesions,whether received treatment of anti-vascular endothelial growth factor (VEGF),whether received combined cataract phacoemulsification were analyzed to find out the cause and prognosis of PVH.Results The corrected vision of all the patients after the primary PPV at the latest follow up was finger counting/1 meter.PVH occurred in 15 eyes of 15 patients,the incidence was 8.77％.The PVH occurred 2 weeks to 6 months after surgery.There were significant difference in age (t=2.551),proportion with tractional retinal detachment (x2=7.431),progressive fibrovascular proliferation (x2=4.987) and using anti-VEGF (x2=9.742) between the patients with and without PVH (P＜0.05).There was no significant difference in HbAlc (t=0.501),creatinine level (t=1.529),and the proportion of cataract phacoemulsification (x2=0.452) between the patients with and without PVH (P＞0.05).During follow-up,neovascularization of iris (NVI) occurred in 1 eye and neovascular glaucoma (NVG) occurred in 4 eyes.Seven eyes underwent reoperation,7 eyes were spontaneous recovered,1 eye with NVG give up treatment.Fibrovascular membrane was the major cause of recurrent hemorrhage.At the end of follow-up,hemorrhage was absorbed in all the 14 eyes which were treated,12 eyes had same visual acuity compared to that before postoperative hemorrhage,2 eyes with NVG had decreased vision.There was significant difference in the corrected vision between the patients with and without NVI or NVG (P=0.022).Conclusions PVH after PPV for PDR is closely related to the severity of diabetic retinopathy,fibrovascular membrane is the major cause of recurrent hemorrhage.NVG is an important factor related to vision acuity prognosis.

Objective To explore the influencing factors of disabled elderly caregivers' resilience,and to provide evidence for further intervention studies.Method Totally 221 caregivers in several communities were investigated with self-design general questionnaire,Activity of Daily Living Scale (ADL),ConnerDavidson Resilience Scale(CD-RISC) Chinese version,Simplified Coping Style Questionnaire(SCSQ),General Self-Efficacy Scale(GSES) and Perceived Social Support Scale (PSSS).Results The caregivers' resilience score was 59.99 ± 15.86,at a medium level and lower compared with normal population (t =-5.07,P＜0.01).It was positively correlated with the positive coping(r=0.468,P＜0.01),general self-efficacy (r=0.546,P＜0.01)and perceived (r=0.372,P＜0.01).Multiple stepwise regression analysis showed the positive coping,self-efficacy and social support of caregivers were influencing factors of caregivers' resilience (P＜0.01).Conclusion Disabled elderly caregivers' resilience is lower than the general population,and implementation of the intervention should be taken according to different resilience levels at clinical practice.

Objective To observe the histopathological and ultrastructural changes of the supraspinal ligaments in ankylosing spondylitis (AS).Methods The supraspinal ligaments were stained with HE,Sirius Red/saturated carbazotic acid and then observed nuder microscope,electyonic scanning microscope and transmission electron microscope respectively.The density of blood vessel and collagen fibril were analy-zed.Statistical analysis was carried out by using t test.Results In the AS group,under the microscope,the arrangement of in collagen fibers was in chaos,and hyalinosis,fatty infiltration could be seen.Vascular proliferation was predominant.Collagen-Ⅲ expression could be detected in this group.Under electron microscope,the distribution of collagen fibril was sparse,and the periodic strita was indistinct,the matrix was degraded,and some matrix vesicle could be seen.While in the control group,orderly arrangd collagen fibrils could be seen,and no change of blood vessels could be seen.The density of vascular structures in the AS group was (6.8±0.7)/HP,and (1.0±0.4)/HP of the control group.The density of collagen fibrils in the AS group was (122±22)/μm2,and that of the control group was (218±10)/μm2,the difference between the two groups was statistically significant (P＜0.05).Conclusion A series of histopathological changes have occurred in the supraspinal ligaments in AS patients.