Objective To investigate the effect of three kinds of low molecular weight heparin combined with methylprednisolone on the high coagulation state and renal function in patients with refractory nephrotic syndrome.Methods 140 cases of refractory nephrotic syndrome were divided into four groups, 35 cases in each group.The control group were treated with methylprednisolone.Small, medium, and large dose group in the control group on the basis of the treatment, were given low molecular weight heparin on once every other day, once daily, twice daily treatment, 3075 AxaIU per times.The improvement of renal function and high coagulation state were compared between the four groups before and after treatment.In the course of treatment, the occurrence of adverse reactions was recorded.Results Remission rate in large, medium and small dose group remission rate was higher than the control group(χ2 =4.375,P<0.05); there was no significant difference in remission rate of three different dose groups.The 24h urine protein and ALB of the four groups after treatment were significantly increased, BUN and SCr were significantly lower(P<0.05).The 24h urine protein, ALB, BUN, SCr of improvement of large, medium and small dose group were significantly better than the control group( P<0.05).The 24 h urine protein, ALB, BUN, SCr in large dose group improved significantly better than those in small dose group(P<0.05).The APTT, PT in large, medium and small dose groups after treatment increased significantly, FIB decreased significantly(P<0.05).The improvement of FIB, APTT, PT in large, medium and small dose group were significantly better than the control group after treatment ( P <0.05 ).The FIB, APTT, PT in large dose group improved significantly better than those in medium and small dose group ( P <0.05 ) .Conclusion The low molecular weight heparin combined with methylprednisolone can significantly improve hypercoagulable state and renal function in the patients with refractory nephrotic syndrome, and the large dose of low molecular weight heparin effect is the best, and no significant adverse reactions occurred.

Objective To discuss the treatment and prognosis of multifocal osteosarcoma. Methods Between January 1998 and June 2005, nine patients(seven males and two females), six with synchronous multifocal osteosarcoma and three with metachronous multifocal osteosarcoma were treated in our department. The diagnosis of multifocal osteosarcoma was confirmed by clinical presentation, radiology and pathology. Eight of the nine patients received chemotherapy with adriamycin(60 mg/m2), cisplatinum(100 mg/m2), high-dose methotrexate(8-12 g/m2), vincristine(1.4 mg/m2), ifosfamide(12.5 g/m2), and G-CSF. Based on the response to primary chemotherapy, further chemotherapy plans were made, and different operations were done to control local lesions or to relieve symptoms. Arsenous acid, paclitaxel and VP-16 were used in patients who responded poorly to primary chemotherapy. Results One patient who given up remedy was died in systematic fail due to the cancer after 5 month, five patients who were diagnosed synchronous multifocal osteosarcoma died from progressive disease in 3.5 to 17 months (mean time was 9.8 months). Only two of them had a good response to chemotherapy and had finished at least four cycles of chemotherapy,and they had a better survival time of 15 and 17 months respectively. Three patients with metachronous multifocal osteosarcoma had a better prognosis. After a two-year follow-up, two lived with disease and one lived without disease. Conclusion The prognosis of patients with multifocal osteosarcoma is poor, and patients with metachronous multifocal osteosarcoma have a relatively better prognosis. To improve the prognosis of patients with multifocal osteosarcoma, aggressive chemother-apeutics are needed.

OBJECTIVE:To study the correlation of inorganic elements and active ingredients in Paris polyphylla. METH-ODS:HPLC was adopted for contents determination of polyphyllinⅠ,Ⅱ,Ⅵ and Ⅶ:the column was Phenomenex C18 with mo-bile phase of acetonitrile-water(gradient elution)at a flow rate of 1.0 ml/min,detection wavelength was 203 nm,and column tem-perature was 30 ℃. ICP-MS was adopted for contents determination of Na,Mg,K,Ca,Cr,Mn,Fe,Ni,Zn,Se,Sr,Mo,Pb, Cd,Hg,Cu and As:RF power was 1.55 kW,sampling depth was 10 mm,the plasma gas flow was 15.0 ml/min,carrier gas flow rate was 0.86 L/min,spray chamber temperature was 2 ℃,helium collision mode was He,gas flow was 4.5 ml/min,measurement points/peak was 6,sampling mode was hopping peak collection(repeated 3 times). And SPSS 21.0 software was adopted for step-wise regression analysis of correlation between the two above-mentioned. RESULTS:The linear range was 0.939-4.697 μg(r=0.999 8)for polyphyllinⅠ,1.124-5.620 μg(r=0.999 6)polyphyllinⅡ,0.784-3.918 μg for polyphyllin Ⅵ,0.976-4.880 μg for poly-phyllinⅦ.RSDs of precision,stability and reproducibility tests were lower than 2%,recoveries were 96.53%-100.71%(RSD=1.69%,n=6) for polyphyllinⅠ,98.19%-99.55%(RSD=0.58%,n=6) forⅡ,95.45%-100.83%(RSD=1.87%,n=6) for poly-phyllin Ⅵ,96.11%-102.01%(RSD=2.07%,n=6)for polyphyllin Ⅶ . The linear range was 0-195.984 3 mg/kg(r≥0.999 3),de-tection limit was no higher than 65.201 ng/kg. PolyphyllinⅠshowed positive correlation with Mg and negative correlation with Pb;polyphyllin Ⅱ showed positive correlation with Cu and negative correlation with As;polyphyllin Ⅵ showed positive correlation with Sr and Hg and negative correlation with Mn;polyphyllin Ⅶ showed positive correlation with Na and Ni and negative correla-tion with As;the total contents of the 4 polyphyllins showed positive correlation with Ni and Sr and negative correlation with Fe. CONCLUSIONS:The contents of inorganic elements and P. polyphylla have certain correlation with active ingredient.

Objective To evaluate the value of polymerase chain reaction (PCR) combined with probe detection method in diagnosis of Mycoplasma pneumonia (MP) pneumonia (MPP) in children and to analyze the factors influencing the diagnostic accuracy,and to identify the rate of MP mutation for drug resistance and the involving factors.Methods Two hundred and twenty-five children with MPP hospitalized in the Department of Respiratory Medicine,Beijing Children's Hospital,Capital Medical University between June 2015 and March 2016 were enrolled in this study.Nasopharyngeal swab samples from the participants within 24 hours of admission were detected by using PCR combined with fluorescence probes for MP-DNA and macrolide-resistant mutations.The information of age,sex,clinical symptoms,course of disease,duration by admission,the history of macrolide treatment and the increase or decrease of quadruple or more serum MP antibody titer were extracted from medical records within 4 weeks of treatment,which received further correlation analysis with the detection rate of MP-DNA and the drug resistance mutation.Results The sensitivity of the MPP by using the method of PCR combined with fluorescence probes was 80.4％ (181/225 cases),while the specificity was 98.0％ (99/101 cases).The MP-DNA positive rate for patients with double MP antibody 4 times increased during treatment was 88.8％ (71/80 cases),which was significantly higher than that of patients with antibody titer ≥1 ∶ 160 [75.9％ (110/145 cases)],and the difference was sigmficant(x =5.443,P =0.020).The positive rate of MP-DNA of patients had no obvious association with gender,age,and disease duration and macrolide treatment history before admission.Macrolide-resistant mutation rate of MP-DNA was 85.1％ (154/181 cases),macrolide-resistant mutation rate of MP for patients finishing one course of macrolide treatment when admission(89.6％)was higher than that of the patients without using macrolide and the patients treated with macrolide but not finishing one course of treatment (71.9％ and 86.6％),and the significant difference among the three groups was observed(x2 =4.454,P =0.035).Conclusions PCR combined with fluorescence probe for MP-DNA detection has a high accuracy for the diagnosis of MPP,and the overall mutation rate is high,suggesting that the clinical treatment of MPP needs to be adjusted according to drug resistance in children.

BACKGROUND: Therapist-assisted treadmill training is good gait training, but it consumes great physical strength of therapists, and requires many persons. Clinical application was limited. Robot-assisted treadmill training has been paid great attention. OBJECTIVE: To summarize the role of robot in recovery of walking after spinal cord injury (SCI) and its influence on muscle activation patterns and kinematic patterns.RESULTS AND CONCLUSION: Although there is currently no evidence that robot-assisted gait training improves walking function more than other locomotor training strategies. Several advantages of robotic devices are obvious for applications targeting gait rehabilitation. Robotic devices are passive in nature and focus primarily on repeated movements of the limbs via fixed kinematic trajectories. These types of training abolish the cycle-to-cycle variation in the kinematics and the sensorimotor pathways. They also cannot sensitively monitor important characteristics of the training as therapists do. Therapists need to know the robot devices, understand how to change parameters to continuously challenge the subjects, and are able to assess when the workload is inappropriate for the subject's abilities so that they can maximize voluntary locomotor performance during assisted stepping to augment the recovery of functional walking.

Objective To investigate the correlation between liver-type fatty acid binding protein (L-FABP) and nonalcoholic fatty liver disease (NAFLD) extent and other clinical parameters.Methods Ninety-six patients of NAFLD (NAFLD group) and 100 cases of healthy controls (control group) were selected.The levels of serum L-FABP and blood biochemical parameters were measured by enzyme-linked immunosorbent assay.The lesion degree was assessed by ultrasound.The body mass index (BMI),waist to hip ratio (WHR) and homeostasis model assessment insulin resistance index (HOMA-IR) were calculated.Results The WHR,BMI,fasting plasma glucose (FBG),triglycerides (TG),alanine aminotransferase (ALT),HOMA-IR and L-FABP in NAFLD group were higher than those in control group,there were statistical differences (P ＜ 0.05).The result of correlation analysis showed L-FABP level was positively related with ALT,TG,FBG,WHR,BMI,HOMA-IR (r =0.735,0.728,0.681,0.713,0.699,0.673 ;P ＜0.05),and negative correlation with HDL-C (r =-0.607,P ＜ 0.05).The L-FABP level in control group was (15.42 ± 2.51) g/L,mild NAFLD was (15.96 ± 2.92) g/L,moderate NAFLD was (17.48 ± 3.91) g/L,serious NAFLD was (25.14 ± 5.37) g/L.There was statistical difference in L-FABP level between serious NAFLD and control group,mild NAFLD,moderate NAFLD (P ＜ 0.05).Conclusion Serum L-FABP level of serious NAFLD patient significantly increases,and L-FABP level is related with biochemical parameters of liver function.

Xuezhikang capsule (ethanol extract of red yeast rice) which produced by Beijing WBL Peking University Biotech Co., Ltd., is a traditional Chinese medication with 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibiting activity. Clinical trials indicated that Xuezhikang with lipid-lowering action could reduce the risk of cardiac events and total mortality of Chinese coronary heart disease patients. To exactly explain the clinical features of Xuezhikang, we undertook a complete study of the chemical constituents of Xuezhikang. This study resulted in the isolation of a new monacolin analogue, named alpha, beta-dehydromonacolin L (1), along with two known compounds: monacolin L (2) and 3-(2, 6-dimethyl-1, 2, 4a, 5, 6, 7, 8, 8a-octahydronaphthalen-1-yl)propanoic acid (3). The chemical structures were determined by extensive 1D and 2D NMR and MS spectroscopic analysis.

Objective To investigate the effect of robot-assisted walking therapy on gait of patients with incomplete spinal cord injury.Methods 10 patients with incomplete spinal cord injury accepted robot-assisted walking therapy with Lokomat for 12 weeks. The Lower Extremity Motor Scores (LEMS), step lenth (left and right), double support (left and right), single support (left and right), Symmetry Index (SI), overground gait speed, treadmill training speed, treadmill training distance and the amount of body-weight unload were recorded before,6 weeks and 12 weeks after training. Results All the patients finished the training. There was significant difference in all the indices among those were before, 6 weeks and 12 weeks after training (P<0.001). Conclusion Robot-assisted walking therapy with Lokomat facilitates to improve gait in patients with incomplete spinal cord injury.

OBJECTIVETo establish a perceived fatigue evaluating model during simulated load carriage that is based on objective variables through analyzing the characteristics and trends of shoulder force, shoulder pressure, waist pressure, back pressure, and perceived fatigue, and to provide an analytical technique for research on load carriage.

METHODSA 50-min simulated walking (at a speed of 5 km/h and a slope of 0%) experiment including 14 healthy male adults was conducted under four levels of backpack payloads (25, 29, 34, 37 kg). Shoulder force and trunk pressure were sampled simultaneously and analyzed with time- and frequency- domain methods. Multivariable linear regression was used to build a perceived fatigue evaluating model during load carriage.

RESULTSThe perceived fatigue evaluating model based on shoulder force, trunk pressure distribution ratio, load, and body mass index (BMI) was established. Its adjusted determination coefficient (aR2) was 0.709 and the absolute percentage error (APE) at the end of the experiment was less than 20%. The goodness of fit of the model based on frequency-domain independent variables was much higher compared with the model based on time-domain independent variables. The addition of BMI that represents the individual differences to the model obviously improved the goodness of fit.

CONCLUSIONThe perceived fatigue evaluating model established in this study does not rely on the physiological changes of individuals, and thus can be used to establish an evaluation system for human load carriage with dummy as a substitution for human in experiments and to provide a scientific basis for efficient human load carriage.

Objective To discuss the value of tension-free hernia repair to recurrent inguinal hernia in elderly patients.Methods 38 eases with recurrent inguinal hernia in elderly patients were treated with shaped polyproplene tension-free hernioplasty.Results All eases were operated successfully.In the follow-up period ranged from 6 to 42 months.No Serious postoperation complications were found,no recurrent case recurred.This treatment is effective.Conclusion Tension-free hernia repair has many advantages,such as safety,easily manipulation,minimal invasion,rapid recovery,lower recurrence.It is a perfect and ideal surgical operation for the recurrent inguinal hernia in elderly patients.