Objective To investigate the effect of Azithromycin combined with terbutaline on the treatment of pneumonia in children and its effect on symptom improvement.MethodsThe clinical data of children with pneumonia treated in Taizhou Hospital of traditional Chinese and Western medicine from January 2014 to December 2016 were retrospectively analyzed, according to the treatment methods,the patients were divided into control group and observation group, the control group was given azithromycin treatment, the observation group on this basis to give terbutaline atomization treatment.The therapeutic effects of the two groups were observed, and the differences of clinical symptom score, inflammatory factor level were compared between the two groups before and after treatment.ResultsThe effective rate of the observation group was 98%, which was significantly higher than that of the control group (84%);The clinical symptom score had no difference between the two groups before treatment, after treatment, the observation group of cough, expectoration, fever and rales were lower than those in the control group;The two groups had no difference between the levels of proinflammatory cytokines, after treatment, the observation group IL-6, IL-8, TNF-and CRP levels were lower than the control group.ConclusionAzithromycin combined with terbutaline in the treatment of children with pneumonia has a better therapeutic effect, can significantly improve the clinical symptoms, reduce the level of inflammatory factors, has a good clinical value.

Objective　To investigate the changes and its clinical significance of plasma neuropeptide Y(NPY) concentration in patients with pregnancy induced hypertension (PIH). Methods　Plasma NPY levels were detected by radioimmunoassay in 30 patients with PIH, 20 normal non-pregnant women and 23 normal pregnant women. The PIH group was subdivided into mild, moderate and Severe subgroups, and the NPY concentration was also measured in these subgroups respectively at admission and one week after delivery. Results　The plasma NPY levels in patients with PIH ［(164.16±68.32) ng/L］ were significantly higher than those of normal non-pregnant women and normal pregnancies ［(86.60±20.65) ng/L, (82.42±12.46) ng/L, P<0.01, respectively］. There was significant difference among plasma NPY levels among the patients with mild, moderate, and severe PIH at admission (P<0,01). At one week after delivery the concentrations of plasma NPY were significantly decreased in the moderate and severe subgroups compared with the value measured at admission (P<0.01). Moreover, the NPY levels in patients with severe PIH after delivery were still higher than those of normal non-pregnant women. Conclusions　The results suggested that the level of NPY in plasma is increased in women with PIH. Elevated plasma NPY levels may play a key role in the development of PIH.

Objective To establish the PDGF-BB-induced proliferation of rat pulmonary artery smooth muscle cells(PASMCs), and investigate the effects of the AMPK agonist AICAR on the cell cycle of PASMCs, in order to search new drugs for prevention of pulmo-nary vascular remodeling. Methods 20ng/ml PDGF-BB was used to induced the proliferation of PASMCs, and the effect of 0. 5mmol/L AICAR on the proliferation of PASMCs was observed. Western blot was used to detect the total and phosphorylated AMPK. The prolifer-ation of PASMCs was determined by CCK-8. The mRNA expression of cyclinD1, cyclinE and CDK2/4/6 were detected by flow cytometry analysis cell cycle,quantitative real-time PCR. Results Western blot Results indicated AICAR could promote the activation of AMPK. CCK-8 test Results showed that AICAR blocked the proliferation of PASMCs induced by PDGF-BB. Flow cytometry analysis indicated that AICAR arrested the cell cycle in G0/G1 to S phase. RT-PCR Results demonstrated that AICAR inhibited the mRNA expression of cy-clinD1, cyclinE and CDK2/4/6. Conclusion The AMPK agonist AICAR can block the proliferation of PASMCs induced through arrest cell cycle in G0/G1-S phase by regulation the mRNA expression of cyclin D1, cyclinE, CDK2/4/6, and AICAR has a potential applica-tion in preventing pulmonary vascular remodeling.

Objective To investigate the risk factors of incidence of premature rupture of membranes and provide reference for prevention of premature rupture of membranes.Methods 890 cases of infants and maternal were studied,analyzing and screening the risk factors of premature rupture of membranes by Logistic.Results The single-factor analysis showed that the pregnant women with diabetes,pregnancy-induced hypertension,multiple preg-nancy and vaginifis had certain degree of contact with incidence of premature rupture of membranes.Multivariate Lo-gistic regression analysis showed that the multiple pregnancy and vaginitis were risk factors of incidence of premature rupture of membranes.Conclusion The multiple pregnancy and vaginitis were risk factors of incidence of premature rapture of membranes,assessment and control these risk factors could prevent and reduce the incidence of premature rupture of membranes.

Objective To investigate the clinical efficacy and safety of Xiao'er Chiqiaoqingre granule in the treatment of acute upper respiratory tract infection.Methods From January 2017 to December 2017,a total of 116 children with upper respiratory tract infection in Taizhou Integrated Traditional Chinese and Western Medicine Hospital were selected and randomly divided into control group and observation group according to different treatment regimens,with 58 cases in each group.The control group was given ribavirin granules,ibuprofen suspension drops for treatment.The observation group was given Xiao'er Chiqiaoqingre granule on the basis of the control group.The two groups were treated for 5 days,then the clinical effect,the improvement of clinical symptoms,the time of cure,the level of serum cytokines and safety were compared between the two groups.Results After treatment,the cure rate of the observation group was 96.6％,which was significantly higher than 81.0％ of the control group (P ＜0.05).The antipyretic time,cough disappeared time,healing time in the observation group were (1.4 ± 0.5) d,(2.1 ± 0.4) d,(4.5 ± 1.4) d,respectively,which were significantly shorter than those in the control group[(2.6 ± 0.9) d,(3.4 ± 1.1) d,(5.8 ±1.9) d] (all P ＜ 0.05).The throat irritation subsided time of the observation group was (3.5 ± 1.1) d,which of the control group was (3.8 ± 1.3) d,the difference was not statistically significant (P ＞ 0.05).The serum levels of IL-6,IL -10 and TNF-in the observation group were (108.45 ± 25.61) μg/L,(34.88 ± 9.07) μg/L,(1.26 ± 0.86) mg/mL,respectively,which were significantly lower than those in the control group[(129.27 ± 28.31) μg/L,(43.27 ±10.09)μg/L,(2.11 ± 1.03)mg/mL] (all P ＜ 0.05).There were no other serious adverse reactions in the two groups.Conclusion Xiao'er Chiqiaoqingre granule in the treatment of acute upper respiratory tract infection can significantly improve clinical symptoms,improve clinical curative effect,and has good safety and certain clinical value.

If we can add how to avoid medical dispute into clinical education,it must be very helpful to young doctors in their medical work after graduation.The article analyzed the cause of medical dispute,and proposed how to enhance the education of medical dispute avoiding,and prove a efficient way to improve clinical education.

Objective To discuss the clinical features,management,pregnancy outcome and prognosis of obstetric mirror syndrome.Methods The clinical data of 12 cases with obstetric mirror syndrome at Shenzhen Maternity and Child Healthcare Hospital from April 2008 to December 2010 were collected to retrospectively analyze the clinical features, management,pregnancy outcome and prognosis.Results ( 1 ) Etiology:12 cases with obstetric mirror syndrome included 9 cases of Bart's hydrops fetalis,2 cases with fetal complicated congenital cardiac anomalies,and 1 case of unknown etiology.(2)Gestational age at diagnosis and at delivery:gestational age at diagnosis ranged from 28 to 36 weeks [ mean (31.5 ±4.7) weeks],and gestational age at delivery ranged from 28+3 to 38 weeks [ mean (32.9 ±2.9)weeks].There were no significant differences between the gestational age at diagnosis and at delivery in consistented with severe preeclampsia group and mild preeclampsia group [ (31.8 ± 2.3 ) weeks vs.(30.9 ± 7.2) weeks,(32.5 ± 2.3 ) weeks vs.(33.5 ± 3.9 ) weeks,P ＞ 0.05 ].( 3 ) The patients with obstetric mirror syndrome can present a preeclampsia-like syndrome:maternal extremity edema in 12 cases,headache and visual disturbance in 1 case,proteinuria in 11 cases,elevated blood pressure in 5 cases,elevated uric acid in 9 cases,hypoproteinemia in 12 cases,elevated creatinine in 3 case,elevated liver enzyme in 1 case,thrombocytopenia in 2 cases.The major complications included 1 case of HELLP syndrome,acute pulmonary edema,placental abruption,amnionic fluid embolism,DIC respectively,3 cases of acute kidney failure and 6 cases of postpartum hemorrhage.(4) Sonographic findings:① Hydrops fetalis:fetal ultrasound revealed pleural fluid,fetal ascites,skin edema,scalp edema,encephalocolele enlargement, hydropericardium and increased cardio-chest ratio.②Placenta megaly:the placental pathological examination revealed edematous and large in 12 cases.Placental thickness was beyond 4 cm in all cases [ (6.3 ± 1.9) cm ].③Hydramnios:hydramnios could be found in 11 cases [ amniotic fluid index ( 19.7 ± 3.1 ) cm ]. (5) Postnatal conditions:all blood pressure and laboratory findings including urine protein normalized within 5 to 7 days after delivery. (6) Pregnancy outcome:all 12 patients survived,however the perinatal mortality rate was 100％.Two of 12 cases with mirror syndrome underwent cesarean section,and 10 were vaginal delivery,of which 1 need uterine artery embolisom due to postpartum hemorrhage.Conclusions Obstetric mirror syndrome seems to simulate preeclampsia although there are distinguishing features,such as hemodilution,placental edema,and polyhydramnios.When the specific cause of obstetric mirror syndrome can not be identified and corrected,the decision for delivery should be made as soon as possibly.

Objective　To study the association of plasma von willebrand factor (vWF) and endothelin-1(ET-1) levels in patients with pregnancy induced hypertension (PIH). Methods　Plasma vWF and ET-1 were studied by ELISA method and immunoradiological method respectively in 36 patients with PIH, 18 normal pregnant women and 19 normal non-pregnant women. Results　Circulation levels of vWF and ET-1 were increased with increasing severity of the PIH. In mild PIH patients, the levels of plasma vWF ［(135.9±30.9)%, （P>0.05)］ weren′t significantly higher than those in healthy pregnant women ［(131.6±39.2)%,（P>0.05)］，but the levels of ET-1 ［(63.7±4.8) pg/L］ were significantly higher than those in healthy pregnant women ［(47.1±4.7) pg/L,（P<0.01)］. There were significant differences between groups of moderate-severe PIH ［vWF (174.4±35.4)%, ET-1 (92.6±19.1) pg/L］. There was a positive correlation between the plasma vWF level and ET-1 level. Conclusion　The results suggested that plasma vWF and ET-1 concentration could be used as indicators for the severity of PIH.

Objective To study the effects of hypotensive resuscitation on microvascular perfusion in a clinically relevant model of uncontrolled hemorrhagic shock in pregnancy. Methods Thirty New Zealand white rabbits at 15 -25 days, pregnanal age were randomly divided into three groups; Group normal saline traditional aggressive resuscitation ( NS), traditional aggressive resuscitation in the prehospital phase with a large quantity of normal saline and Ringer's solution to maintain mean arterial pressure (MAP) at the approximately 80 mm Hg ( 1 mm Hg = 0.133 kPa) level: Group normal saline hypotensive resuscitation (NH) and group hypertonic hyperosmotic hypotension resuscitation (HHH), hypotensive resuscitation in the prehospital phase with a bolus dose of 4 ml/kg normal saline or hypertonic hydroxyl ethyl starch (10% hydroxyl ethyl starch + 7.5% NaCl), followed by Ringer's solution to maintain MAP at 60 mm Hg.Production pregnant rabbit model with hemorrhagic shock. The experiment consisted of four phases:basic phase (0 miniutes), shock phase (0- 30 miniutes), prehospital phase (30- 90 miniutes) and hospital phase (90- 180 miniutes). Measurements: (1) arteriole and venule diameter were continuously monitored by microcirculatory detecting instrument; (2) functional capillary density (FCD) of each phase was expressed by the percentage of opening capillaries segments relative to basic phase; (3) blood pH, BE PCO2, PO2 in pregnant rabbits were determined with a Medica Easy Blood Gas Analyzer. Results ( 1 )There were no significant differences among three groups in arteriole and venule diameter at baseline ( P ＞0.05 ). After hemorrhagic shock arteriole diameter were NS ( 50.8 ± 5.6) μm, NH (47.6 ± 3.7 ) μm, HHH (51.3 ±2.4)μm, respectively, with no significant differences between groups(P ＞0.05). At the end of prehospital resuscitation phase and hospital resuscitation phase, significant differences were found in arteriole diameter in group NS(52.8 ± 4.9, 56.0 ± 3.8 )μm, NH (61.3 ± 2.9, 65.4 ± 3.2 )μm and HHH group (67.0 ± 4.1,74.1 ± 4.8 )μm ( P ＜ 0.05 ); after hemorrhagic shock venule diameter were NS(79.6 ± 7.0)μm, NH (75.3 ±5.3)μm and HHH(76.2 ±5.8)μm, respectively, with no significant differences between groups(P ＞0.05 ). At the end of prehospital resuscitation phase and hospital resuscitation phase,venule diameter were NS(81.1 ± 6.7, 84.4 ±6.0)μm, NH(82.8 ± 3.3, 85.4 ±4.3) μm and HHH (86.9 ± 5.8, 89.4 ± 6.8)μm, respectively, with no significant differences between groups ( P ＞ 0.05 ). (2) The values of FCD in every groups were all 100%. After hemorrhagic shock FCD were NS(39.8 ±6.8)%, NH (43.9 ±4.0)%, HHH(44.0 ± 4.8)%, respectively, with no significant differences between groups(P ＞0.05); at the end of prehospital resuscitation phase and hospital resuscitation phase, FCD were NS(54.5 ±7.3,59.7 ±4.8)%,NH(63.1 ±5.8,70.3 ±5.6)% and HHH (80.5 ±6.9, 91.7 ±4.7)%,respectively, with significant differences between groups( P ＜ 0.05 ). (3) Blood gas parameter: the values of blood pH, BE, PO2, PCO2 in pregnant rabbits in all groups were within normal bounds at basic phase. Shock phase induced typical hyperventilation in all groups, with increase of arterial PO2 and decrease of PCO2; at the end of hospital resuscitation phase, there were no significant difference among the three groups in the values of blood PCO2 ( P ＞ 0.05 ); the values of blood PO2 at the hospital resuscitation phase were significantly lower in NS groups than corresponding values in the other groups (P ＜ 0.05 ). After hemorrhagic shock there was significant metabolic acidosis as shown by decrease of pH, BE; at prehospital resucitation phase, pH, BE values tended to increase in all the groups but not reach to base period. At the end of hospital resucitation phase. The pH, BE value was significantly higher in NS group than those in the other two groups( P ＜ 0.05 ) . (4) Median survival time in NS (2.1 ± 0.2) days group was significantly shorter than NH(3.0 ±0.3) days and HHH(3.6 ± 0.3) days group( P ＜ 0.05). FCD at the end of the hospital resuscitation were significantly related with survival time ( r = 0.655, P = 0.000 ). Conclusion Compared with traditional aggressive fluid resuscitation, hypotensive resuscitation reduce constriction of arterial and venule diameter, increase FCD, alleviate metabolic acidosis and improve long-term survival Hypertonic hydroxyl ethyl starch resuscitation ameliorate microcirculation without improving survival rate.

BACKGROUND:Mesenchymal stem cels isolated from cord blood and bone marrow have multi-directional differentiation ability under a certain condition of induction. OBJECTIVE:To compare the difference of differentiation of umbilical cord blood and bone marrow mesenchymal stem cels into osteoblasts. METHODS:Human umbilical cord blood and bone marrow mesenchymal stem cels were isolated and cultured by density gradient method. When reached 90% confluency, mesenchymal stem cels were digested by trypsin for subculture. At the third passage, umbilical cord blood mesenchymal stem cels and bone marrow mesenchymal stem cels at 8×104/wel were incubated. When reached 80% confluency, cels were treated with low-glucose DMEM supplemented with 10% fetal bovine serum, 0.1 μmol/L dexamethasone, 50 μmol/L vitamin C and 10 mmol/L β-sodium glycerophosphate. RESULTS AND CONCLUSION:There was no significant difference in morphology and biological properties of the two kinds of mesenchymal stem cels. Cels were highly expressed CD44, CD29, but did not express CD34. They had the ability to differentiate into osteoblasts, which had a positive staining for known markers: alkaline phospatase and calciumin vitro mineralization. There was no significant difference in the activity of osteoblasts of two kinds of cels. Results verify that umbilical cord blood and adult bone marrow mesenchymal stem cels can be induced into osteoblasts with a similar ability, and they can be used as seed cels for bone tissue engineering.