Objective To compare the clinical efficacy of carvedilol and metoprolol in the treatment of dilated cardiomyopathy patients with heart failure (DCM).Methods According to the different treatment method,90 DCM patients with heart failure patients were divided into the observation group and the control group,45 cases in each group.Both groups were given a diuretic,vasodilator,cardiac and other drug treatment,and the control group were added with metoprolol,and the observation group were added with carvedilol.The treatment lasted 4 to 6 months.Before and after treatment,the levels of left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter (LVESVI),left ventricular diastolic diameter (LVEDVI),left ventricular fractional shorteningrate (FS),largest peak velocity (hCFV),coronary flow reserve (CFR),simultaneous detection of serum levels of endothelin (ET) and nitric oxide(NO) content were observed and compared betweon the two groups.Results After the treatment,the levels of LVEF,LVESVI,LVEDVI,FS,hCFV,CFR,ET,NO of the observation group were (44.0 ± 3.4) ml/m2,(45.2 ±6.9)mm,(20.9 ±5.4)mm,(30.4 ±5.3),(78.2 ±31.6) cm/s,(3.12 ±0.36),(52.2 ±5.6) ng/L,(5.2 ± 0.67) μmol/L,respectively,which were better than those of the control group[(37.9 ± 3.5)mL/m2,(51.1 ± 7.6)mm,(20.7 ±6.3) mm,(25.2 ±7.3),(70.5 ± 31.8)cm/s,(2.85 ±0.23),(63.5 ± 1.8)ng/L,(2.55 ± 0.33) μmoL/L] (t =8.386,-3.856,-4.487,3.867,-1.152,-4.239,12.887,-23.802,all P ＜ 0.05).Conclusion Carvedilol is an effective drug for the treatment of DCM consolidated psychological failure,which can improve heart function and coronary flow reserve capacity and endothelial function in patients,which is worth in the clinical with satisfactory results.

OBJECTIVE:To systematically evaluate the efficacy and safety of cetuximab in the adjuvant chemotherapy treat-ment of advanced non-small cell lung cancer(NSCLC),and to provide evidence-based reference for clinical treatment. METH-ODS:Retrieved from Cochrane Library,PubMed,CJFD and Wanfang database,randomized controlled trials (RCT) about cetux-imab adjuvant chemotherapy (test group) versus single chemotherapy (control group) in the treatment of advanced NSCLC were collected,and Meta-analysis was performed by using Rev Man 5.2 statistical software after extracting data and evaluating quality. RESULTS:A total of 8 RCT were included,involving 2 367 patients. Results of Meta-analysis showed survival rate in 1 year [OR=1.33,95%CI(1.08,1.64),P=0.006],partial remission rate [OR=1.48,95%CI(1.23,1.78),P<0.001],total effective rate [OR=1.34,95%CI(1.19,1.51),P<0.001],incidence of leucopenia [OR=1.50,95%CI(1.23,1.83),P<0.001],incidence of rash [OR=53.26,95%CI(13.09,216.65),P<0.001] and incidence of infusion reactions [OR=3.72,95%CI(1.86,7.42),P<0.001] in test group were significantly higher than those of control group,there were significant differences in 2 groups. However,there were no significant differences in the complete remission rate [OR=1.57,95%CI(0.91,2.70),P=0.11] and incidences of other ADR(P>0.05). CONCLUSIONS:Cetuximab has good efficacy in the adjuvant chemotherapy treatment of advanced NSCLC,however,the incidence of ADR should be prevented in clinic. Duo to the methodology limit of included studies,large-scale and high quality RCT are required for further validation of the conclusions.

Objective To investigate the clinical features and the gene mutation of patients with spinocerebellar ataxia type3 and type7.Methods The trinucleotide repeat mutations were detected by polymerase chain reaction (PCR),agarose gel electrophoresis method,and DNA sequencing in 13 patients,4 related members and 4 common members from 3 spinocerebellar ataxia families.Results Among the 13 patients,four patients had SCA3/MJD(CAG) n expansion mutation(n = 65 ～ 74),nine patients had SCA7 allele expansion for 40 ～ 52 times.Patients with type 3 or 7 showed significant difference in nervous system injury.Conclusion The difference of clinical feature might be used in diagnosis of SCA3/MJD and SCA7,but genotype determination would be the only method of definite diagnosis.

Objective To investigate the optimal ultrasound exposure parameter on H22 neoplasms of mice meditated by ultrasound exposure combined with self‐made nanobubbles ,and then observe their therapeutic effect combined with cisplatin and their possible mechanism of anti‐tumor . Methods Thirty mice engrafts models with subcutaneous H22 neoplasms were established and divided into 6 groups randomly ,which received ultrasound exposure at different intensity and exposure time . The contrast enhanced ultrasound imaging ( CEUS ) was performed in every group at the four time points of before treatment and at 0 h ,24 h ,72 h after treatment . To obtain the optimal ultrasound parameters ,the tumor inhibitory effect was assessed by enhanced intensity ( EI) and microvascular density ( MVD) . The H22 tumor were treated by ultrasound exposure nanobubbles combined with cisplatin to observe their tumor growth inhibition rate ,and the microvessels density and nuclear associated antigen Ki‐67 proliferation index were measured by immunohistochemical staining . Results There was a statistically difference in enhanced intensity (EI) between the experimental groups and control group ( P < 0 .05) . With the increasing of ultrasound intensity and exposure time ,the tumor inhibitory effect was more obvious ,with an increasing side reactions . Except the simple ultrasound group ,there was a statistical difference in tumor inhibition ,the mean MVD and the tumor cell proliferation index (KI‐67) between control group and the other ultrasound therapy groups ( P<0 .05) . The tumor inhibitory rate was the highest ( tumor inhibition rate 70 .0% ) and the mean MVD and KI‐67 expression were the lowest ( P <0 .05) in the combination group comparing with the others . Conclusions The ideal ultrasound exposure parameter of tumor inhibition showed that exposure intensity chose 1 W/cm2 and exposure time chose 1 min or 3 min intermittence . The ultrasound exposure self‐made nanobubbles combined with cisplatin could enhance the tumor inhibitory effect .Its mechanism may be related to the decrease of microvascular density ,the inbition of tumor cell proliferation and the increase of tumor cell necrosis .

Objective The effect of intermittent iron supplementation weekly and twice weekly was studied in children with iron deficiency anemia(IDA). Methods Subjects were 58 children who were randomly divided into two groups. One group received a dosage of 2mg/kg Fe every 3d for 9 weeks. The other group received the same dose Fe once a week for 12 weeks. Results Hemoglobin and serum ferritin increased significantly after treatment in both groups (P ＜0.05), and zinc protoporphyrin decreased significantly (P ＜0. 05). But serum ferritin of both groups was different after 6 weeks of treatment (P ＜0. 01). The side effect of the group supplemented once every 3d was higher than that of the group once a week, but there was no statistically significant difference. Conclusion Iron sup plementation every 3d has a similar effect to once a week for treatment of IDA. The former should be used for the se rious patients for 6 weeks. The later should be used for infants and the patients whose resistance of intestines and stomach are not good.

Objective To establish the theoretical basis of the probiotic application among very low birth weight(VLBW) infants,the efficacy of probiotics on the gut microbiota of VLBW infants on the 14th postnatal day was studied.Method The VLBW infants admitted to BaoAn Maternal and Child Care Hospital from January 2015 to December 2015 were randomly assigned into probiotics group and placebo group.From the first feeding to corrected gestational age of 36 weeks,probiotics group was treated with a combination of Bifidobacterium and Lactobacillus while placebo group with placebo.Fecal samples were collected on the 1st and 14th postnatal day.Total bacterial DNA was extracted and sequenced using high-throughput 16S rRNA gene sequencing on MiSeq sequencing platform.Result A total of 21 VLBW infants were enrolled,9 in probiotics group and other 12 placebo group.No significant differences of clinical data existed between the two group (P ＞ 0.05),The abundance and diversity of microflora (P ＞ 0.05) on the first day between the two group were similar.Compared with placebo group,the relative abundance of Bifidobacterium and Lactobacillales in stool samples on the 14th day was significantly increased,while the Halomonas was significantly decreased.The relative abundance of the Shannon-index was increased,but without significant difference (P =0.16).Conclusion Enteral supplementation of probiotics in VLBW infants may increase probiotic bacterium and microflora diversity.

Objective To compare the perioperative outcomes of laparoscopic liver resection (LLR) versus open liver resection (OLR) for hepatocellular carcinoma (HCC).Methods A total of 89 HCC patients undergoing liver resection between January 2012 and November 2016 were enrolled.Nonparametric tests were employed to compare the clinicalpathological characters and preoperative outcomes.Results No significant difference was observed in clinicalpathological features and postoperative morbidity.LLR group had shorter hospital stay (Z =4.642,P ＜0.01),lower serum ALT level in 1st,3rd and 5 day (Z =2.157,3.089,2.384,all P ＜0.05) and AST level in 1st-and 3rd-day postoperatively (Z =2.688,2.566,all P ＜0.05).The growth rate in serum total protein (TP) and albumin (ALB) postoperatively is higher for LLR group (y =2.348 4x + 51.696 vs.y =0.902 9 + 35.532),(y =1.539 9x + 29.68 vs.y =0.732 9x + 30.406).Conclusion LLR allows quicker liver function recovery and shortens patients' postoperative hospital stay.

Objective To identify the risk factors of delirium in ICU by Meta-analysis. Methods Quality of the studies was assessed in terms of study design, definitions of main variables, statistics, and bias control. Analysis of sensitivity and heterogeneity were performed and cumulative effects were calculated using either fixed or random effects models by RevMan 4.2.Results Ten studies met all inclusive and exclusive criteria. Simple sizes range from 100 to 3308. Twenty-one risk factors of delirium in ICU were involved, but only alcohol abuse, respiratory disease, infection, APACHE Ⅱ,elevated level of serum urea nitrogen, hyponatremia, hyperbilirubinemia and using sedatives were identified as having a cumulative effect on delirium in ICU. Conclusions Infection, abnormality or disturbance of metabolism and intoxication or acute withdrawal from drug or alcohol are independent predictors of delirium in ICU, while advanced age and hypoxemia, which are commonly considered as independent risk factors of delirium in ICU, are still inconclusive.

ObjectiveToanalyzetheclinicalandimagingcharacteristicsinpatientswithcarotidsteal syndrome ( CSS ) and to investigate its compensatory pathw ays, diagnosis, and treatment. Methods The medical history and imaging data of the patients with CSS were colected. Their vascular lesions, colateral circulation, treatment, and prognosis w ere analyzed. Results A total of 11 patients w ith CSS (8 males and 3 females, mean age 66.7 ±5.1 years) were enroled in the study. Their clinical manifestations were posterior circulation transient ischemic attack (TIA) ( n=9, 81.8%), posterior circulation infarction ( n=1, 9.1%), and anterior circulation TIA ( n=1, 9.1%). A total of 19 pathological arteries w ere found:12 (63.1%) w ith occlusion, 2 (10.5%) w ith subtotal occlusion, 4 (21.0%) w ith severe stenosis and 1 (5.2%) w ith artery dissection. Seven patients (63.6%) w ere bilateral internal carotid artery lesions, 3 (27.2%) w ere unilateral bilateral internal carotid artery lesions, and 1 (9.1%) w as bilateral common carotid artery occlusion. Eleven patients had primary col ateral circulation, including posterior communicating artery patency in 10 patients (90.9%) and anterior communicating artery patency in 1 patient (9.1%). Four patients (36.3%) had secondary col ateral circulation and 1 (9.1%) had tertiary col ateral circulation. Al patients w ere treated w ith medication on the basis of the management of risk factors. Three patients w ere treated w ith stenting and tw o were treated with carotid endarterectomy. No stroke occurred in al patients during folow -up til September 2014. Conclusions The vascular lesions of patients w ith CSS often occur in the extracranial segment of internal carotid artery. Usual y the compensatory blood is through the circle of Wil is. The presentation is ischemia in the stolen arteries. Its diagnosis needs to be examined by digital subtraction angiography. On the basis of medication therapy, some patients may be treated w ith surgery or endovascular intervention.

Objective To study the prognostic role of plasma neutrophil gelatinase-associated lipocalin (NGAL) early after renal transplantation.Methods A total of 37 kidney recipients were enrolled from Department of Organ Transplantation,Guangdong Second Provincial General Hospital within a 12-month period of time.Plasma NGAL was measured immediately before and at 6 and 12 h post-transplantation.Changes of serum creatinine were documented daily within the first week postoperation.Acute kidney injury (AKI)/graft rejection during the first week after transplantation was the outcome variable.Results The levels of serum NGAL in the 37 patients were (311.14 ± 102.69),(317.81 ± 107.28) and (312.16 ± 134.80) μg/L respectively immediately before and at 6 and 12 h post-transplantation.There was no significant difference in serum NGAL levels before and 6 h or 12 h after operation (P =0.70,and P =0.96).There were no significant differences in gender and age between the two groups (P =0.29,and P =0.20).There was significant difference in creatinine levels between the AKI group and the non-AKI group (P =0.002) and between pre-operation and 6 or 12 h postoperation.The preoperative levels of serum NGAL in AKI group and non-AKI group were (333.58 ± 116.30) and (300.36 ± 96.15) μg/L (P =0.36),and those were (383.3 ± 147.16) and (286.32 ± 65.97) μg/L (P＜0.01) at 6 h,and (437.33 ± 164.16) and (252.08 ± 57.53) μg/L (P＜ 0.001) at 12 h after operation.The sensitivity and specificity of serumNGAL (317μg/L at 12 h after operation as the cutoff value) predicting AKI was 100％ and 92％ respectively,which was much better than that of serum creatinine at the corresponding time point (sensitivity =66.7％,and specificity =61.9％).Conclusion Plasma NGAL,particularly at 12 h after transplantation,is a very sensitive and specific biomarker for predicting AKI.