Respiratory tract infection remains a hot clinical topic.Disappointingly, routine microbiology tests do not meet the needs of target antimicrobial therapy.Widespread practice of antibiotic empiricism has lead to dramatic use of broad-spectrum antibiotics and antimicrobial resistance.The application of new clinical microbiology tests to identify the offending pathogen may allow administration of narrow spectrum antibiotic therapy.To do so,the full clinical microbiology armamentarium with newer point-of-care tests and polymerase chain reaction tests must be exploited.The return of the sputum gram stain and introduction of newer molecular tests would provide information for judicious selection of antimicrobials.

OBJECTIVE:To provide reference for rational use of antidepressant drugs in the clinic. METHODS:By DDD anal-ysis recommended by WHO,the utilization of antidepressant drugs in 34 hospital from Nanjing area during 2011-2014 were ana-lyzed statistically in respects of main type,consumption sum,DDDs and DDC,etc. RESULTS:The consumption sum and DDDs of antidepressants were increased year by year in 34 hospital from Nanjing area during 2011-2014,with the average annual growth rate of 18.21% and 19.25% respectively. The top 2 drugs by DDDs were paroxetine and setraline;DDC of tomoxetine,trazodone and dutoxetine took up the first 3 place;consumption sum of paroxetine,setraline,venlafaxine and escitalopram took up the first 4 places;consumption sum of paroxetine,mirtazapine and citalopram synchronized with their DDDs,and serial number ratio was close to or equal to 1.00. CONCLUSIONS:The use of antidepressant drugs in 34 hospitals from Nanjing area is rational in struc-ture and level;selective 5-hydroxytryptamine(5-HT)reuptake inhibitors(SSRI)and selective 5-HT noradrenaline reuptake inhibi-tor(SNRI)take up the predominant place;new type of antidepressant drugs are used widely and of great use potentiality in the fu-ture.

Animals ; Curcumin ; pharmacology ; therapeutic use ; Humans ; Liver Cirrhosis ; drug therapy

AIM: To analyze the clinical value of femtosecond laser in vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation.
METHODS: We selected 100 patients ( 102 eyes ) undergoing vitrectomy combined with phacoemulsification and IOL implantation in our hospital from October 31 2013 to October 31 2015. They were divided into routine operation group, 50 cases (52 eyes), and femtosecond laser group, 50 cases (50 eyes). The parameters were compared between the two groups, including total operation time, postoperative complications ( elevated intraocular pressure, uveitis, vitreous hemorrhage, and retinal detachment ), postoperative intraocular pressure and postoperative half of the visual acuity ( near visual acuity, visual acuity, uncorrected visual acuity, corrected visual acuity).
RESULTS: The difference on total operation time of the two groups was statistically significant ( P < 0. 05). The differences between the two groups on postoperative intraocular pressure, uveitis, vitreous hemorrhage, retinal detachment were not statistically significant ( P >0. 05). There were no significant differences on internal pressure, near visual acuity, far visual acuity, uncorrected visual acuity, corrected visual acuity at 6mo after surgery (P>0. 05).
CONCLUSION: Femtosecond laser in vitrectomy combined with phacoemulsification and IOL implantation has a high safety and efficacy with the advantages as accurate, efficient.

Expression of major histocompatibility complex class 1(MHC-1)and thyroid specific transcription factor-1(TTF-1)in thyroid follicular epithelia of Graves'disease and Hashimoto's thyroiditis measured by immunohistochemistry technique were all significantly increased as compared with those in normal controls,suggesting that TTF-1 and MHC-1 seem to contribute to the development of autoimmune thyroid diseases.

Objective To explore economic valuation of the minimally invasive esophagectomy.Methods The cases undergone esophagectomy were studied retrospectively.Monofactorial analysis was done to evaluate the impact of various factors on the overall hospitalization costs.The correlated factors then were used as independent variables to carry out the multiple linear regression aimed at the hospitalization costs.Results The results of monofactorial analysis showed that the accompanying diseases,days during hospitalization,modes of esophagectomy,postoperative complications were correlated factors of the overall hospitalization costs.According to the multiple linear regression,it were sorted based on descending order duing to its effect of largenning the hospitalization costs:postoperative complications (β =0.439,P =0.000),days during hospitalization (β =0.397,P =0.000),accompanying diseases(β =0.257,P =0.000),modes of esophagectomy(β =0.132,P =0.000).The expenses caused immediately by the operations were statistically more of the minimally invasive surgery than that of the open procedures whatever the numerous or proportion of the overall costs (P =0.000).Conclusion Combined thoracoscopic and laparoscopic esophagectomy was more expensive than open operation.Nevertheless,impact of the other factors,such as postoperative complications,were more significant than that of the different procedure.h was a strategy to minimally invasive osophagectomy that hospitalization costs could be reduced by means of controlling complications and diminishing hospitalization days.

Objective The aim of this study was to investigate the diagnostic value of the intravoxel incoherent motion (IVIM) for discriminating nonmetastatic from metastatic mediastinal lymph nodes in lung cancer.Methods IVIM was performed preoperatively on 66 patients with lung cancer during October 2015 to June 2016 in Capital Medical University Affiliated Beijing Chaoyang Hospital.Preoperative examination including the chest MRI scan,chest CT,head MRI,bone scan-ning and the cardiopulmonary function.None of the patients was undergone any kind of treatment about the cancer before the examinations,the neoadjuvant chemotherapy or radiation therapy,immunotherapy and gene targeted therapy were included.Measured the short axis diameter and the IVIM parameters of the mediastinal lymph nodes,apparent diffusion coefficient(ADC),diffusion coefficient(D),pseudo-diffusion coefficient(D *),and perfusion fraction(f).All the patients underwent the lobectomy or wedge resection and lymph node dissection or systematic sampling.By comparing the IVIM parameters of the nonmetastatic and metastatic mediastinal lymph nodes according to the pathological examination,draw the ROC curves to find the best cutoff value for diagnosis.And 42 cases were used to comparing the value of the MRI and CT in differential diagnosis.Results MRI measured 184 groups mediastinal lymph nodes,including 164 groups without metastasis,20 groups with metastasis.The ADC,D,D *,f values and short axis diameter of the nonmetastatic lymph nodes(n =164) were(2.880 ± 0.785) × 10-3 mm2/s,(0.670 ± 0.179) × 10-3 mm2/s,(0.383 ± 0.123) × 10-3 mm2/s,0.422 ± 0.119,(6.546 ± 1.932) mm,respectively,and (1.897 ±0.657) × 10-3 mm2/s,(0.472 ±0.210) × 10-3 mm2/s,(0.354 ±0.130) × 10-3 mm2/s,0.412 ±0.090,(7.510 ± 2.773) mm respectively for the metastatic lymph nodes (n =20).The ADC and D value of the nonmetastatic lymph nodes were significantly higher than the metastatic lymph nodes(P ＜0.01).While the other paraneters(D *,f,and short axis diameter) between the two groups did not show significantly different.Optimal cutoff values(area under the curve,sensitivity,and specificity) for distinguishing metastatic from nonmetastatic lymph nodes were as follows:ADC =1.890 × 10-3 mm2/s (0.871,92.7％,80.0％);and D =0.648 × 10-3mm2/s(0.740,70.0％,84.1％).Conclusion IVIM is useful to distinguish metastatic from nonmetastatic lymph nodes in lung cancer.The ADC and the D values are significant higher in metastatic lymph nodes,which more sensitive than the other parameters(D *,f,and short axis diameter).As a result,IVIM can be used in the N-stage diagnosis of lung cancer.

BACKGROUND: Alendronate has been recently used for treating osteoporosis by inhibiting the activity of osteoclasts, but further clinical observation is necessary to compare its therapeutic effect with exclusive use of calcium supplement.OBJECTIVE: To observe the therapeutic effect of oral alendronate (tianke tablet) on the clinical symptoms and bone mineral density (BMD) of middle-aged and elderly patients for comparison with calcium gluconate.DESIGN: A self-controlled study and controlled trial with concurrent patients.SETTING: Department of Orthopedics, Shenzhen Hospital, Peking UniversityPARTICIPANTS: Sixty-eight middle-aged and elderly patients with osteoporosis were admitted in the Department of Orthopedics, Shenzhen Hospital of Peking University between July 1999 and July 2000. From these patients 62 at the age over 45 years without secondary osteoporosis were selected for this study, who were randomly divided into oral alendronate group (n=32) and oral calcium gluconate group (n=30).INTERVENTIONS: On the basis of comprehensive therapies, the patients in the alendronate group were given 10 mg alendronate daily and those in calcium gluconate group had 20 mL oral calcium gluconate solution (containing 100 mg calcium gluconate, equivalent to 9 mg calcium in every 10 mL) three times daily for three months. According to bodily pain relief, occurrence of new fracture and improvement in BMD, the therapeutic effect was assessed in three grades.RESULTS: Thirty patients in the alendronate group and 26 in the calcium gluconate group completed the study. Alendronate treatment for 3months significantly increased BMD of the patients [(0.716±0.082) g/cm2in comparison with that before treatment [(0.667±0.083) g/cm2, t= 2.473,P ＜ 0.01], whereas the BMD underwent no obvious changes after treatment with calcium gluconate [(0.671±0.081) g/cm2 before vs (0.680±0.073) g/cm2after treatment, t=1.812, P ＞ 0.05]. Significant difference in BMD after treatment was noted between the two groups (t=2.384, P ＜ 0.01). The effective rate was significantly higher in alendronate group than in calcium gluconate group (X2=14.9, P=0.005), but 7 patients complained of abdominal discomfort in the former group and the patients in calcium gluconate group reported no adverse effects.CONCLUSION: Alendronate can inhibit bone absorption, promote the recovery of bone matrix, and increase the bone mass, producing better effect than exclusive use of calcium gluconate oral solution in treatment of the osteoporosis in the middle-aged and the elderly.

Objective To investigate the adjunctive therapeutic effect of recombination growth hormone(rhGH) on the elderly patients with pulmonary infection.Methods 53 elderly patients with pulmonary infection were randomly divided into rhGH group(n=25) and control group(n=28).The rhGH group were received hypodermic introl group were received standard therapy.Clinical efficacy were compared between two groups.The level of albumin (ALB),growth hormone (GH),insulin-llke growth factor-1 (IGF-1),leptin (LP) were measured and the body mass index(BMI) was observed in all cases before and after treatment.Results The overall efficacy of rhGH group and control group was 88.0% versus 60.7%.The results showed significant statistical difference between both groups(P＜0.05).After treating with rhGH for 10 days,the level of BMI,ALB,GH,IGF-1 and LP were increased in the rhGH group,which were(26.1±4.1)kg/m2;(38.4 ±6.6)g/L;(7.0 +0.9) μg/L;(27.3 ±6.1)μg/L;(6.9 ± 1.1)μg/Lrespectively.And the level of BMI,ALB,GH,IGF-1 and LP were (21.8 ± 3.4 ) kg/m2 ;( 29.5 ± 5.1 ) g/L;( 4.0 ±0.4) μg/L;( 22.0±3.8 )μg/L;( 3.8±0.8 )μg/L in the control group after treatment.The results showed significant statistical difference between both groups(P＜0.05).Conclusion There was obvious adjunctive therapeutic effect of rhGH to the elderly patients with pulmonary infection by improving the nutritional state of these patients.