Objective To study the efficacy and safety of low-dose azithromycin with tiotropium bromide in the treatment of stable chronic obstructive pulmonary disease.Methods A hundred and ten patients were randomized into three groups:tiotropium bromide group (36 cases,group A),azithromycin with tiotropium bromide group(38 cases,group B)and control group(36 cases,group C).Patients in group A were given tiotropium bromide (18 μg,q,d )in addition to conventional treatment.The patients in group B were given lowdose azithromycin (250 mg,twice a week) in combined with tiotropium bromide.The patients in control group were given the conventional treatment only.The courses of treatment lasted for six months.Results Compared with the control group,the frequency of acute exacerbation in patients treated with azithromycin and tiotropium bromide was reduced remarkably ( 2.1 ± 0.6 and 4.9 ± 0.7,t =18.5061,P ＜ 0.05 ).The severity of clinic symptoms ( Cough 1.3 ± 0.5 vs.2.2 ± 0.6,P ＜ 0.05 ),expectoration ( 1.0 ± 0.2 vs.1.7 ± 0.3,P ＜ 0.05 ),anhelation ( 1.5 ± 0.8 vs.2.1 ± 0.6,t =3.6342,P ＜ 0.001 ) ],life quality ( 29 ± 8 vs.42 ± 11,P ＜ 0.05 ) and six-minutes walking distance( [ 370.00 ± 14.26 ] m vs.[ 290.00 ± 12.85 ] m,P ＜ 0.05 ) of the azithromycin with tiotropium bromide group were improved significantly when compared with control.Compared with the tiotropium bromide group,the frequency of acute exacerbation ( 2.1 ± 0.6 vs.3.2 ± 0.8,P ＜ 0.05 ),the severity of clinic symptoms (Cough 1.3 ±0.5 vs.1.8 ±0.4,P＜0.05),expectoration( 1.0 ±0.2 vs.1.3 ±0.3,P ＜0.05) and anhelation( 1.5 ±0.8 vs.1.9 ± 0.6,P ＜ 0.05 ) ],life quality ( 29 ± 8 vs.36 ± 10,P ＜ 0.05 ) and six-minutes walking distance ( [ 370.00 ± 14.26 ] m vs.[ 330.00 ± 13.76 ] m,P ＜ 0.05 ) were improved over those of tiotropium bromide group.Conclusion The long-term low-dose azithromycin in combinned with tiotropium bromide is good and safe in treating stable COPD.Therefore,it is worth of further clinical evaluation.

OBJECTIVETo investigate the anxiety disorders and influence factors that occur in adolescent patients with cleft lip and palate and to provide theoretical foundation for mental intervention.

METHODSA total of 120 adolescent patients with cleft lip and palate were investigated using a general information questionnaire, the self-rating anxiety scale, and the social support rating scale (SSRS). The influence factors of anxiety disorders were analyzed.

RESULTSThe effective questionnaires were 119. The occurrence rate of anxiety disorder in adolescent patients was 49.6% (59/119), and the occurrence rates of mild, moderate, and severe anxieties were 41.2% (49/119), 7.6% (9/119), and 0.8% (1/119), respectively. The gender, residential area, disease category, family status (one child or no children), and incidence rate of anxiety disorder in patients were statistically different (P<0.05). The SSRS scores of patients with anxiety disorder were lower than those of patients without anxiety disorder (P<0.05). Multiple regression analysis showed that gender and social support were predictive factors of the occurrence of anxiety disorder (R=0.318).

CONCLUSIONA high anxiety disorder rate occurred in adolescent patients with cleft lip and palate. dender and social support were important influencing factors for anxiety disorder. In the after-mental intervention, considerable attention should be given to the anxiety disorders of patients and improve their mental health.

Adolescent ; Anxiety ; Anxiety Disorders ; epidemiology ; Child ; Cleft Lip ; epidemiology ; psychology ; Cleft Palate ; epidemiology ; psychology ; Humans ; Mental Health ; Parents ; Social Support ; Surveys and Questionnaires

Objective To investigate the significance of optimization of bedside Gram staining of sputum smear in the early diagnosis and antimicrobial treatment for ventilator-associated pneumonia(VAP)patients. Methods The data of patients with VAP undergoing mechanical ventilation over 48 hours in the Department of Critical Care Medicine of Tianjin Fourth Central Hospital from June 2009 to June 2014 were analyzed. The patients were divided into two groups according to whether or not bedside Gram staining of sputum smear was used or not. The sputum samples from lower respiratory tract of all VAP patients were collected daily with tracheal catheter. In empirical examination group(from June 2009 to December 2011,n=43),the patients received antibiotics at the time of onset of VAP, selection of antibiotics depended on the information of bacterial epidemiology of the intensive care unit(ICU),and also existence of high risk factors of multi-drug resistant bacteria. In target treatment group(from January 2012 to June 2014,n=43),the patients received antibiotics according to the results of bedside instant sputum smear examination and empirical antibiotic regime. The correlation between the results of sputum smear examination and culture result was analyzed. The levels of body temperature,white blood cell(WBC)count,procalcitonin(PCT)level,and high sensitivity C-reactive protein(hs-CRP)were measured on the 1st day and 3rd day. The length of antibiotics treatment, duration of mechanical ventilation,and the time of ICU stay were recorded for both groups. Results There were 512 qualified sputum specimens for culture,from which 336 pathogens were found,and 358 strains of pathogenic bacteria were found from microscopic examination of 512 qualified sputum smear. The coincidence rate of results of bedside examination of sputum smear and that of sputum culture was 78.32%(401/512). The diagnostic acumen of the former was 85.42%(287/336),specificity was 64.77%(114/176),positive predictive value was 80.17%(287/358),and negative predictive value was 74.03%(114/154). On the 1st day,no statistical differences in infection index between the two groups could be found,but on the 3rd day,the results were significantly improved in both groups. Compared with the empirical treatment group,the body temperature,WBC,PCT and hs-CRP in the target treatment group were significantly lower〔body temperature(℃):36.83±0.69 vs. 37.64±0.71,WBC(×109/L):7.91±2.75 vs. 9.66±3.39,PCT(μg/L):7.14±3.89 vs. 10.14±4.32,hs-CRP(mg/L):12.24±6.28 vs. 15.54±5.94,P<0.05 or P<0.01〕. Compared with the empirical treatment group,the time of antibiotics use(days:6.00±2.55 vs. 9.20±3.46), the duration of mechanical ventilation(days:5.00±1.73 vs. 7.00±1.94),and the length of ICU stay(days:7.43±1.72 vs. 12.57±4.16)were significantly shortened(P<0.05 or P<0.01). Conclusions The results of bedside sputum examination and sputum culture showed a good correlation,and the former is helpful in early diagnosis and treatment of VAP. The result of high quality sputum smear in significant in guiding the first choice of antibiotics,reduce the time of antibiotic use,shorten the duration of mechanical ventilation and the length of ICU stay,and improve the outcome of the patients.

Objective To assess the reliability and validity of the Tree-Drawing Test in medical college students.Methods The study randomly selected 312 aged 19 to 23-year-old medical students to take part in TreeDrawing Test.In addition,a total of 275 college students were selected to receive re-test,30 days late and Pearson correlation coefficient of two tests were calculated.The three raters were invited to assess 30 trees painting score,analyzing the Kendall coefficient of concordance between the scores to verify raters' reliability; parts of students also participated in the 16PF test,SAS,SDS test,analyzing the correlation coefficient between the various test results,in order to assess the effectiveness of the Tree-Drawing Test.Results The re-test reliability in different time was 0.570-0.733 and 0.341-0.713 (P＜0.05),the raters' reliability was 0.491 ～ 0.626(P＜0.05),there are some correlations between Tree-Drawing Test and 16PF,SAS,SDS.Conclusion The Tree-Drawing Test has good reliability and validity; it can be applied to the detection of college students' psychological assessment and psychological problems.

Objective To observe the influence of octreotide(OCT)on plasma ALT and AST and hepatic tissue protein expression of Bcl-2,Bax,GRP78 and CHOP in rats liver with fibrosis,to explore whether it relieves liver injury in rats with hepatic fibrosis by relieving endoplasmic reticulum stress(ERS)reaction. Methods For-ty Sprague-Dawley rats were randomly divided into Con group ,Mod group and OCT-treatment groups at high and low doses(1,10 mg/kg/12 h respectively). Except for rats in Con group,all rats were injected with 40%CCl4 sub-cutaneously twice a week for 8 weeks to establish hepatic fibrosis ,and those in OCT-treatment groups were injected at different doses of OCT twice a day at the same time. Plasma ALT and AST was assayed;the isolated livers were evaluated for histopathological changes by HE staining and Masson staining;hepatic histological grading and stag-ing were assessed by Ishak scoring system;Bcl-2,Bax,GRP78 and CHOP protein expression levels were deter-mined by Western blot. Results Compared with those in Con group ,the degrees of inflammatory cell infiltration and fibers,hepatic histological grading and staging,plasma ALT,AST activities and Bax,GRP78,CHOP protein levels were significantly increased in Mod and OCT-treatment groups ,but Bcl-2 protein level was significantly de-creased at the same time(P<0.01). Compared with those in Mod group ,the degrees of inflammatory cell infiltra-tion and fibers,hepatic histological grading and staging,plasma ALT,AST activities and Bax,GRP78,CHOP protein levels were significantly decreased in OCT-treatment groups ,but Bcl-2 protein level was significantly in-creased at the same time(P < 0.05). There was no significant difference between 2 OCT-treatment groups(P >0.05). Conclusions OCT can reduce the level of liver injury in rats with hepatic fibrosis ,thus the mechanism may be related to relieving the ERS reaction in liver.

Animals ; Carbon Radioisotopes ; Diabetes Mellitus, Experimental ; genetics ; metabolism ; Diabetes Mellitus, Type 1 ; genetics ; metabolism ; Gene Expression Regulation ; Glucose ; administration & dosage ; metabolism ; Lipid Metabolism ; Liver ; metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Transcriptome

To establish an EDTA complexation extraction pretreatment combining with GFAAS method for the determination of residual aluminium ion in Huoxiang zhengqi pellets without digestive treatment, systematical investigation was made on sample preparation, and EDTA was used for the complexation extraction of residual aluminium ion in samples. The pH, concentration and volume of extraction solution, the temperature and time of microwave extraction, and graphite furnace temperature program were investigated. The results were compared with the microwave digestion. It was showed that, 0.1 g of sample weight was added in 20 mL 0.05 mol x L(-1) EDTA solution (pH 3.5), followed by heating at 150 degrees C for 10 min in the microwave extraction device. The determination of GFAAS was performed at optimized detection wavelength (257.4 nm) as well as graphite furnace temperature program, the detection limits and quantification limits were 2.37 μg x L(-1) and 7.89 μg x L(-1), respectively. The precision (RSD) was less than 2.3%. The average recovery was 96.9% -101%. The present method is easy, rapid and accurate for the determination of residual aluminium ion in Huoxiang zhengqi pellets.
Aluminum ; chemistry ; isolation & purification ; Drug Contamination ; Drugs, Chinese Herbal ; chemistry ; Edetic Acid ; chemistry ; Graphite ; chemistry ; Spectrophotometry, Atomic ; methods ; Temperature

OBJECTIVETo explore the clinical efficacy of self-made Kirschner wire hook in the treatment of severely displaced proximal humerus fractures in children.

METHODSFrom January 2007 to February 2012,35 children with severely displaced proximal humerus fractures were treated with self-made Kirschner wire hook fixation,including 25 boys and 10 girls with an average age of 13.2 years old ranging from 5 to 17. The duration from injury to operation was 1 to 10 days with an average of 4.5 days. Preoperative diagnoses were confirmed by X-ray films as type III in 26 cases and type IV in 9 according to the Neer-Horwitz classification of the proximal humerus fractures. All fractures were close fracture without nerve or vascular injuries. Anatomical reduction was achieved by open reduction and the fractures were fixed by self-made Kirschner wire hook. Intra-operative and postoperative complications, postoperative radiographic examination, upper extremity length and range of shoulder motion were observed and recorded. Neer score system was used to evaluate shoulder function.

RESULTSAll patients were followed up from 6 to 18 months with an average of 12.1 months. The mean Neer score of the injured side was 94.2 +/- 4.8 (ranged, 84 to 99), 30 patients got an excellent result and 5 good according to the Neer scores. The X-ray showed all the fractures healed without shortening deformity or epiphyseal arrest at early stage. There were no complications related to the implant including loosening or breakage of the self-made Kirschner wire hook. The range of shoulder motion in the injuried side was similar to the normal side, except in abductor lift. All the patients could participate in normal physical activities.

CONCLUSIONThe method of open reduction and fixed with self-made Kirschner wire hook is a safe,effective,convenient treatment for severely displaced proximal humeral fractures in children.

Adolescent ; Bone Wires ; Child ; Child, Preschool ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; physiopathology ; surgery ; Male ; Range of Motion, Articular

OBJECTIVETo investigate the distributive path and proliferative rule of marrow mesenchymal stem cells (MSCs) in the rat transplanted via caudal vein from male rat to female rats model of chronic aristolochic acid nephropathy (CAAN).

METHODSCells taken from femoral bone marrow of male Wistar rats were made into single cell suspension, cultured, purified and identified as MSCs. MSCs were transplanted via caudal vein into 50 female Wistar CAAN model rats allocated in the test group, they were killed, 10 rats in a batch, at various time points (6 h, 48 h, 10 d, 30 d and 60 d after transplantation). Besides, 10 rats allocated in the control group were killed on the 30th day after received sham-transplantation. Kidney tissue of all rats was taken for detecting cells originated from the donors by fluorescence in situ hybridization test with FAM-labeled sex determining region of Y chromosome (SRY FISH) probe, and their number in SRY was counted using SRY PCR.

RESULTSMSCs were mainly distributed in the glomerular capillaries at the time points of 6 h and 48 h, but the number of MSCs in glomerular capillaries decreased and those in renal mesenchyma increased at the time points from 10 d to 60 d gradually, then tended to a steady state, meanwhile it showed a stable increasing trend in renal tubule. Cell colony of MSCs could be found in mesenchyma with a slowed down increasing between 30 d to 60 d, but the increasing in tubule was still steady.

CONCLUSIONMSCs originated from the donor can enter the kidney of acceptor and distribute from blood capillary to renal mesenchyma and tubule, and they can long time inhabit there and make propagation.

Animals ; Aristolochic Acids ; toxicity ; Bone Marrow Cells ; cytology ; Cell Proliferation ; Female ; Kidney ; pathology ; Kidney Diseases ; chemically induced ; pathology ; Male ; Mesenchymal Stromal Cells ; cytology ; Rats ; Rats, Wistar

Objective To observe the serum γ-glutamyltransferase (γ-GGT) levels in patients with chronic hepatitis B virus (HBV) infection in different immune status and investigate their relationship with HBV DNA loads and ALT levels. Methods Blood samples were collected from 191 patients with chronic HBV infection in different immune status, including inactive HBV carrier state (group B,n = 55), immune tolerance phase (group C, n=47), HBeAg-negative CHB (group D, n =17), immune-reactive phase (group E, n=72) and 61 healthy individuals ( group A) for the detection of the serum γ-GGT, ALT level and HBV DNA loads. Results γ-GGT level were obviously higher in groups D and E than those in groups of A, B and C (P<0.01). Correlation analysis showed that the γ-GGT levels were positively correlated with serum ALT , AST levels in HBeAg-negative CHB and immune-reactive phase , but not correlated with HBV DNA loads. Conclusions The levels of γ-GGT are different during different immune status in patients with chronic HBV infection. The increased serum γ-GGT level may be an indicator for patients with chronic HBV infection entering immune active phase. The liver inflammation is the major impact factor to the γ-GGT levels.