Objective:To explore the effect of integrated treatment of Chinese and western medicine on muhiple organ dysfunction syndrome (MODS).Methods:129 cases of MODS were treated by syndrome differentiation of TCM with the“four syndrome and four methods”based on the routine western medicine treatment from 1997 to 2003,and their therapeutic effects were evaluated. Results:Of the 129 cases,75 were cured and 54 died,the mortality being 41.9%.After treatment of TCM,the state of illness of the patients were ameliorated,the level of blood endotoxin decreased and the clinical syndrome improved.Conclusion:Integrated with western medicine,the“four syndrome and four methods”has obvious therapeutic effect.

Objective:To study the efficacy and safety of saxagliptin or pioglitazone combined with metformin in the newly diag-nosed patients with type 2 diabetes mellitus(T2DM) with inadequate glycemic control by metformin alone. Methods:Totally 82 newly diagnosed T2DM patients with inadequately control by metfomin monotherapy for 12 weeks were randomly divided into two groups, sax-agliptin group ( saxagliptin combined with metforminc) and pioglitazone group ( pioglitazone combined with metformin) . The blood glu-cose control, homeostatic model assessment of insulin resistance index ( HOMA-IR) , body weight change and adverse reactions were assessed before and after the treatment for 12 weeks. Results:After the 12-week treatment,the level of fasting plasma glucose ( FPG) , two-hour postprandial plasma glucose (2hPG) and glyeosylated hemoglobin(HbA1c) in both groups were significantly decreased. Compared with the pioglitazone group,the level of 2hPG and HbAlc was lower while the level of FPG was higher in the saxagliptin group (P<0. 05). Compared with the saxagliptin group,the level of fasting plasma insulin(FINS) was significantly decreased and HOMA-IR was significantly improved in the pioglitazone group. The body mass index ( BMI) of the patients was increased in the pioglitazone group(P<0. 05) and showed no change in the saxagliptin group(P>0. 05). There was no statistical difference in the adverse reac-tions between the two groups(P>0. 05). Conclusion:The combination of saxagliptin or pioglitazone with metformin in the treatment of newly diagnosed patients with type 2 diabetes can improve glycemic control with low incidence of hypoglycemia and adverse reactions. Saxagliptin is more suitable for the patients with heart diseases or old patients.

Traditional Chinese medicine (TCM) is a great knowledge base that has been developed through thousands of years and has been accumulated a wealth of experience in diagnosis and treatment.TCM has advanced concepts,but lag behind the use of modern technology and means.With the progress of modern science and technology,the combination of TCM theory and moderm science and technology promotes the development of TCM engineering.TCM has been a breakthrough in diagnostic techniques and clinical treatment,especially modern TCM instruments.At present,diagnostic instruments of TCM mainly depend on pulse and tongue device,and gradually develop to four diagnostic comprehensive analysis platform.Therapeutic instruments of TCM include electroacupuncture device,meridian instrument,laser treatment device and magnetic therapy instrument.This article focuses on the current status,problems and trend on TCM diagnostic and therapeutic instruments,which mainly include diagnostic instruments,clinical treatment instruments,Chinese medical instruments.

Objective To explore the effects of lithium on expressions of cyclin-dependent kinase 5 (CDK5) and protein phosphatase 2A (PP2A) in the brains of chronic aluminum exposure rats so as to further understand the mechanism of lithium's inhibition on tau phosphorylation. Methods We divided 12 chronic aluminum chloride exposure rats into treatment group and non-treatment group (6 rats in each). Treatment group was given lithium chloride (200 mg/kg?d) via gastric perfusion daily for 6 weeks,while the non-treatment group sodium chloride at the same dosage and the normal group (6 non-aluminum exposure rats of the same month old) without intervention. Six weeks later,all the rats received Morris water maze test for learning memory function; CDK5 and PP2A expressions and phosphorylated tau protein level in rat hippocampus were determined by Western blotting. Results Compared with normal group,non-treatment of chronic aluminum exposure group showed higher phosphorylated tau protein level and CDK5 expression in the brain (P0.05). Conclusion Lithium may reduce tau phosphorylation and neurofibrillary tangle formation by inhibiting the expression of CDK5.

Objective To investigate the life quality (QoL) of end stage renal disease patients. Methods KDQOL-SFTM1.2 scale was used to assess the life quality of end-stage renal disease patients who received maintenance hemodialysis or Newly diagnosed but not yet received renal replacement therapy more than three months in the First Affiliated Hospital of Kunming Medical University or the Yunnan Kidney Disease Hospital from March 2011 to July 2012. Results (1) The QoL of maintenance hemodialysis group was significantly higher than not yet started renal replacement therapy group in the Physical functioning (PF),Role physical (RP),Body pain (BP) fields, the difference was statistically significant ( <0.05) . (2) The QoL of maintenance hemodialysis group was significantly higher than not yet started renal replacement therapy group in the Symptom/problem list (SPL), Sleep fields,but lower than not yet started renal replacement therapy group in the Effects of Kidney disease (EKD), Work status (WS) fields,the difference was statistically significant (<0.05) . Conclusion The life quality of maintenance hemodialysis patients is higher than newly diagnosed but not yet started renal replacement therapy patients in some aspects.

Objective To discuss the feature of the ultrasonic image and the clinical value of this test way.Methods six Cases of hypoplastie cartilage from 30 thousand fetus were detected.Results Shortened and widened long bone in four limbs,betl shape in chest,enlarged head and inflated abdomen are the main features of the ultrasonic image.Conclusion Ultrasound is superior to other methods in diagnosing fetus'hypoplastic cartilage.

Objective To obtain the most effective preventive management for corticosteroid-induced osteoporosis by the evidence-based medicine approach.Methods We attempted to find the current best evidence for the prevention of corticosteroid-induced osteoporosis by searching ACP Journal Club(1991-Sep.2005),USA Agency for Healthcare and Research evidence report,Cochrane Library(Issue3,2005)and MEDLINE(1990-Sep.2005),and further critically appraised the available evidence.Results We found that VitD or its analogues with calcium and bisphosphonates could improve bone mineral density significantly.But the effects on reducing the development of fracture were not concluded.Conclusion VitD or its analogues with calcium can be the preferential method as prevention for corticosteroid-induced osteoporosis,while bisphosphonates may be an alternative way.

Objective To research the reliability and validity of the N-QOL Chinese version system.Methods A total of 260 nocturia patients were surveyed by the Chinese version of N-QOL and the reliability and validity of the Chinese version of N-QOL were assessed.Results Cronbach's α of the total questionnaire and two dimensions were 0.899,0.672 and 0.799,respectively.The split-half reliability was 0.828 and re-test reliability was 0.796.The correlation coefficients of scores of the items with its subordinate dimensionality were 0.595～0.854,and those with the total scores were 0.578～0.754.Two common factors were found through exploratory factor analysis,which explained the percent of 57.20％ rotation sums of squared loadings.Conclusions The reliability and validity of the Chinese version of N-QOL were good,so it could be used to evaluate the life quality of nocturia patients.

Objective To explore the clinical features of children infected with macrolide-resistant (MR) Mycoplasma pneumonia(MP) isolates and genetic typing of all isolates.Methods Polymerase chain reaction(PCR) of MP positive in 96 nasopharyngeal or bronchoalveolar lavage fluid (BALF) samples were collected from patients diagnosed as MP pneumonia in the Affiliated Children's Hospital of the Capital Institute of Pediatrics from January 2013 to October 2015.Fifty-five cases were male,41 cases were female;19 cases (19.8％) were 1 to 3 years old,18 cases (18.7％) were more than 3 to 5 years old,59 cases(61.5％) were more than 5 to 13 years and 2 months old.These samples were tested for MR associated mutations in the 23S rRNA of MP,and were divided into the MR group and the macrolide-sensitive (MS) group.Furthermore,the genotype of all the isolates were performed by conducting P1-restriction fragment length polymorphism(P1-RFLP) analysis and multiple-locus variable-number tandem-repeat analysis (MLVA) method.The clinical characteristics including the age,gender,hospitalization duration,symptoms,signs,fever duration,fever duration after macrolide therapy,white blood cell count,C-reactive protein (CRP),chest X-ray and/or chest computed tomography,which were compared between different groups.SPSS 11.5 software was used to analyze the statistical data.Statistical significance was determined at the 0.05 level of a two-tailed test.Results MR mutations were identified in the 23S rRNA gene in 81 specimens (84％),and the 96 specimens were divided into MR group(81 cases) and MS group (15 cases).There were statistical differences in fever duration,hospitalization duration,the incidence of complications and CRP level between the MR group and MS group (t =2.061,Z =-3.368,x2 =5.856,Z =-2.165,all P ＜ 0.05).There were no statistical differences in age,white blood cell count,consolidation percentage on chest radiography and fever duration after macrolide therapy(all P ＞ 0.05).All the 96 isolates were performed by adopting P1-RFLP typing,but 5 isolates were not typed successfully,while 81 cases (89.0％) isolates were typed as P1-Ⅰ and 10 isolates(11％) were typed as P1-Ⅱ c.The hospitalization duration and the fever duration after macrolide therapy in the P1-Ⅰ were longer than the P1-Ⅱ c group,and the difference was statistically significant (Z =-2.197,2.237,all P ＜ 0.05).There were no statistical differences in age,fever duration,white blood cell count,CRP level,consolidation percentage on chest radiography and the incidence of complications (all P ＞ 0.05).Seventy-three cases (90％) of P1-Ⅰ group were MR isolates,8 cases (10％) were MS isolates;3 cases (30％) of the P1-]Ⅱ c group were MR isolates,7 cases (70％) were MS isolates.The MR isolates in P1-Ⅰ group were much more than P1-Ⅱ c group.There was obvious statistical difference in the proportion of MR isolates between 2 groups (x2 =19.209,P ＜ 0.01).All the 96 isolates were performed by modified MLVA typing,82 cases(85.5％) were typed as M4-5-7-2,11 cases(11.5％) were typed as M3-5-6-2,1 case (1.0％) was typed as M4-5-5-2,and 2 cases (2.0％) were typed as M4-5-6-2.Because there were less cases of the M4-5-5-2 and M4-5-6-2 type,only the clinical data of M4-5-7-2 and M3-5-6-2 group were compared.The hospitalization duration and the fever duration after macrolide therapy in the M4-5-7-2 group were longer than the M3-5-6-2 group,and the difference was statistically significant(Z =-2.406,-4.472,all P ＜ 0.05).There were no statistical differences in age,fever duration,white blood cell count,CRP level,consolidation percentage on chest radiography and the incidence of complications(all P ＞ 0.05).Seventy-four cases (90％) of the M4-5-7-2 group were MR isolates,8 cases (10％) were MS isolates;4 cases (36％) of the M3-5-6-2 group were MR isolates,7 cases (64％) were MS isolates.The MR isolates in M4-5-7-2 group were much more than M3-5-6-2 group.There was obviously statistical difference in the proportion of MR isolates between 2 groups (x2 =17.022,P ＜ 0.01).Conclusions In the MR group,the children had longer fever duration and hospitalization duration,higher incidence of complications and higher CRP level than those in the MS group.The MR rates of MP in China was high.P1-Ⅰ and M4-5-7-2 are the predominate genotypes.There may be a correlation between genotype and MR.

OBJECTIVE To observe the influence of XueBiJing on apoptosis,apoptosis-associated proteins and activity of caspase 3 in spleen of sepsis rats.METHODS The sepsis models were produced by cecal ligation and puncture(CLP).Ninety-six Wistar rats were randomly divided into four groups:control group(n=8),sham operation group(n=8),model group(n=40),and XueBiJing treatment group(n=40).TUNEL method was used to assess the apoptosis,the activity of caspase 3 and the percent of CD3+ lymphocyte in spleen were tested,and the expressions of FasL and Bcl-2 in spleen were detected by immunohistochemistry methods.RESULTS The integrated optic density(IOD) of FasL expression in spleen for sham operation group was 4.54?1.41,but in model group was much higher(757.96?188.10 at 48 h) and the IOD of Bcl-2 in sham operation group was 594.05?183.32,but in model group was only 22.71?9.22 at 48 h.There were a few apoptosis appeared in sham operation group(0.87?0.51),the activity of caspase 3 was low(4.34?1.34),and the percent of CD3+ lymphocyte in spleen was 63.49%.At 4 h after the CLP operation,there were more apoptosis appeared in model group(8.88?3.68),the activity of caspase 3 reached to 12.22?3.15,and the percent of CD3+ lymphocyte in spleen decreased to 52.09%.After the intervention of XueBiJing,the expression of FasL reduced and Bax raised.The intervention also lightened the activity of caspase 3 and the apoptosis,and made the percent of CD3+ lymphocyte returned to normal level.CONCLUSIONS The activation of apoptosis pathway makes the apoptosis over-appeared,also induces the immune system out-of-balance.The intervention of XueBiJing can ameliorate the immune paralysis of sepsis by regulating the expression of apoptosis-associated proteins and lighten the apoptosis of lymphocyte.