Objective To study the clinical features, laboratory findings and therapy of patients with bullous pemphigoid. Methods Clinical data of 89 cases of bullous pemphigoid were retrospectively analyzed. Results The male female ratio was 1.07∶1. The mean age of first onset was 58 years old. Patients presented erythema multiforme and dermatitis herpetiformis like lesions besides typical bullae and erythema. Oral mucosal lesions occurred in 33.7% of patients, and oral bullae and erosions were the inital symptoms in 6.7% of patients. Nikolsky′s sign was present in 18% of patients. Direct and indirect immunoflorescence were positive in 95% and 74.4% of patients, respectively. The patients were mainly treated with corticosteroids or the combination of corticosteroids with immunosuppressive agents. The mean dose of coricosteroid needed to control lesions was 65.5 mg (equivalent of prednisone), except patients treated with pulse therapy of corticosteroids. Conclusions Histopathological and immunofluorescent findings are the most important evidence for the diagnosis of bullous pemphigoid. The maximum doses needed to control lesions vary greatly in different individuals.

Objective To explore effective nursing intervention through clinical analysis of middle ear function of children with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Tympanogram was obtained from both pre-operation and post-operation in 413 OSAHS cases(the OSAHS group).Audiogram was conducted if the tympanogram was abnormal.There were 279 cases of normal children in the control group.The incidence of middle ear function loss of two groups were compared.Results 288 cases(328 ears) had some degree of middle ear dysfunction,accounting for 69.73％.69 cases had some degree of hearing loss,accounting for 16.71％.The incidences of middle ear dysfunction and degree of hearing loss in the OSAHS group were higher than 7.53％ and 1.43％ of the control group.The hearing ability was gained after operation in both groups.Conclusions The incidence of middle ear dysfunction is higher in children with obstructive sleep apnea hypopnea syndrome.But the bad influence alleviated with age.Therefore,early detection,timely treatment and effective nursing can achieve good effect.

Objective To investigate the pathogenic features and antibiotic resistance profile of nosocomial and community-acquired spontaneous bacterial peritonitis (SBP) in liver cirrhosis patients.Methods Two hundred and twenty-six cirrhotic patients with SBP who were admitted to Beijin Ditan Hospital from January 2001 to December 2008 were recruited into this study. The bacterial identification and drug susceptibility were performed. The data were analyzed by Chi square test and t test. Results Eighty-six(38.0% ) patients were diagnosed with nosocomial SBP and 140 (62.0%)were diagnosed with community-acquired SBP. The proportion of Child-Pugh Class C cases in patients with nosocomial SBP was higher than patients with community acquired SBP (97.7% vs. 82.8%; x2= 11. 489, P=0.001). Mortality rate in patients with nosocomiat SBP was also higher than patients with community acquired SBP (50. 0% vs. 30. 0%; x2 =9. 081,P=0. 003). Total 28 species (232strains) of bacteria were isolated from these patients. 77.5 % (69/89) of the nosomial SBP cases and 76.9% (110/143) of community-acquired SBP cases were caused by Gram-negative bacteria (mainly were Escherichia coli and Klebsiella pneumoniae). 19.1% nosocomial SBP cases and 21. 8%community-acquired SBP cases were caused by Gram-positive bacteria. Fungus infections accounted for 3.4% and 1.4% of these two population, respectively(P＞0.05). In patients with nosocomial SBP,19 out of 32 Escherichia coli stains and 5 out of 14 Klebsiella pneunmoniae strains were extended spectrum β-lactamase (ESBL) positive, while among 60 Escherichia coli stains and 32 Klebsiella pneunmoniae strains, only 11 Escherichia coli stains were ESBL positive (P＜0.05). The resistance rates of Gram-negative strains to cephalosporin and quinolone in nosocomial SBP patients were both higher than those in community-acquired SBP patients(P＜0. 05), but all Gram-negative isolates were sensitive to imipenem (P＞ 0. 05). No Gram-positive isolates resistant to vancomycin were found.Conclusions The liver cirrhosis patients with Child-Pugh Class C are vulnerable to nosocomial SBP and the prognosis is poor. Although the pathogenic spectrum are similar in cirrhotic patients with nosocomial and community-acquired SBP, which mainly are Escherichia coli and Klebsiella pneumoniae, the percentage of ESBL producing strains is higher in nosocomial SBP patients compared to that in community-acquired SBP patients.

The five flavours of traditional Chinese medicine(TCM)stand for five tastes,such as pungent,sweet,sour,bitter and salt.The five flavours not only stand for the actual tastiness of herbs,but also the effect characteristic of TCM according to traditional medical theory.So this kind of situation led to a disorder of the marking standardization of five flavours.So the authors think that we should mark herbs(or TCM)based on their true tastiness,and this way maybe help us to solve the problem and to research the relationship between the flavours and the effect of the herbs(or TCM).

OBJECTIVE:To establish fingerprint of Zhizi jinhua pills(ZZJHW)and analyze the relationship of it with in vitro antioxidant activity,in order to provide the basis for the quality control of them. METHODS:HPLC method was adopted. The sep-aration was performed on a Sinochrom ODS-BP C18(200 mm×4.6 mm,5 μm)column with mobile phase consisted of 0.2% acetic acid(containing 3 mmol/L sodium heptanesulfonate solution)-acetonitrile(gradient elution)at the detection wavelength of 254 nm and flow rate of 0.8 ml/min. The column temperature was controlled at 38 ℃,and injection volume was 10 μl. The“Chromato-graphic Fingerprint Similarity Evaluation System for TCM”(2012.130723 edition) issued by Chinese Pharmacopoeia Commission was used to evaluate the similarity of the 12 batches of ZZJHW using baicalin as reference peak so as to attribute the common peak of fingerprint. DPPH free radical scavenging assay was used to investigate the in vitro antioxidant activity of 12 batches of ZZJHW,and the relationship between its fingerprint and antioxidant activity was studied. RESULTS:The fingerprint of 12 batches of ZZJHW was established and the similarity between the fingerprint of ZZJHW with their reference fingerprint were all above 0.9 (except S1,S2,S3,S12). 30 common peaks were marked,all of which were assigned to the herbs. Antioxidant experiment result showed the differences in the antioxidant capacity among different batches of ZZJHW;spectrum effect relationship showed that 13 common peaks were positively related with oxidation activity and 17 common peaks negatively related with it;among known com-ponents,oxidation activity components were mainly from Lonicera japonica,Scutellaria baicalensis and Rheum palmatum. CON-CLUSIONS:The spectrum effect relationship of established fingerprint with its antioxidant activity can provide reference for the quality control of ZZJHW.

Objective To investigate vitamin D ( VD) level and its influencing factors in 4-15-year-old children in southwest of Zhejiang province, so as to guide intervention strategy for improving VD level. Methods A total of 2 620 4 -15-year-old healthy children who visited Lishui People's Hospital for regular physical check-up between January and December 2014 were divided into 4 age groups, namely 4 -6 years (kindergarten), 7 -9 years (lower grades in primary school), 10 -12 years (higher grades in primary school), and 13-15 years (junior middle school).We randomly selected 200 children from each age group using a random number table.A survey using self-developed questionnaire was conducted to obtain information regarding diet, exposure to sunlight, and VD supplement.Serum 25-( OH) D level was measured with electro-chemiluminescence.VD nutritional status and composition, diet, sunlight exposure, VD supplement were com-pared among the groups.Results In southwest Zhejiang, the mean VD level in primary and middle school students was ( 24.76 ±8.39 ) μg/L, clinical deficiency rate was 31.5%, subclinical deficiency rate was 45.0%, and only 23.5% reached the appropriate level, which was even lower ( 14.5%) in junior middle school students.The VD deficiency rate elevated significantly along with the growth of age (P=0.036).The level of VD was positively correlated with sunlight exposure and VD supplementation, and showed significant in-ter-group differences ( all P<0.05 ) .Conclusions The nutritional status of VD is unfavorable and sunlight exposure insufficient in primary and middle school students in southwest Zhejiang province.We should encour-age students to take more outdoor activities and increase sunlight exposure to improve their VD nutritional sta-tus.Children >7 years should be given more attention to in the intervention of increasing sunlight exposure. Students with difficulties in getting adequate sunlight exposure need VD supplements.

64 ?g/mL, turbinafine 0.125 ?g/mL, ketoconazole 4.0 ?g/mL, and miconazole 8.0 ?g/mL. Conclusion Based on the morphology of colony on SDA and the characteristic structures under the microscope, this is a case of subcutaneous infection caused by Arthrinium phaeospermum.

Objective To observe the effects of the drug pair of Rhizoma Polygoni Cuspidati ( Huzhang) and Ramulus Cinnamomi ( Guizhi) on the Toll-like receptor 4 mediated myeloid differentiation factor 88 ( TLRs/MyD88) signaling pathway of rats with acute gouty arthritis induced by monosodium sodium urate (MSU) , so as to explore its therapeutic mechanism. Methods Forty-eight male SD rats were divided into normal group, modele group, blank plasmid group, positive plasmid group, Huzhang- Guizhi herb-pair (7 g/kg) group, and Huzhang-Guizhi herb-pair ( 7 g/kg) siRNA group, 8 rats in each group. The normal group, plasmid groups and model group were given physiological saline, and the left groups were given the corresponding drug by intragastric administration for 10 continuous days ( once daily ) . On the seventh day of intragastric gavage, acute gouty arthritis were induced by injection of MSU into the rat ankle joint, and normal group was injected with the samevolume of normal saline. Positive plasmid group and Huzhang-Guizhi herb-pair siRNA group were injected with the constructed siRNA-TLR4 plasmid targeting TLR4 gene ( TLR4-siRNA) to inhibit the in-vivo TLR4 gene expression. Pathological changes of the synovial tissues were detected, the contents of peripheral blood tumor necrosis factor alpha ( TNF-α) and interleukin 1 beta ( IL-1β) were detected by double antibody sandwich method, and the mRNA and protein expression levels of TLR4, MyD88, TNF receptor-associated factor 6 ( TRAF-6) in peripheral blood mononuclear cells of rats were detected by real-time fluorescence quantitative polymerase chain reaction ( PCR) and Western blot methods. The nuclear factor kappa B ( NF-κB) p65 immunoactivity was assayed by immunohistochemistry. Results Compared with the normal group, the model group had obvious hyperplasia of synovial cells and the inflammatory cell infiltration ( dominated by lymphcytes and monocytes) , and had amount of cellulose adhesive on the synovial membrane surface. Compared to the model group, positive plasmid group, Huzhang- Guizhi herb-pair group and Huzhang-Guizhi herb-pair siRNA group could obviously relieve the inflammatory cell infiltration, and improve synovial cell proliferation reaction. Compared to the normal group, serum levels of TNF-α and IL-1β, and the expression levels of TLR4, MyD88, TRAF-6 mRNA and protein in the peripheral blood mononuclear cells as well as the synovial NF-κB p65 ex pression in the model group were significantly increased ( P<0.01). Compared to the model group, positive plasmid group, Huzhang-Guizhi herb-pair group and Huzhang- Guizhi herb-pair siRNA group showed significant decrease in the levels of TNF-α, IL-1β, TLR4 MyD88, TRAF-6 and NF-κB p65 ( P<0.05 or P<0.01) . Conclusion Huzhang-Guizhi herb-pair can regulate the cytokines of the synovial membrane tissue in acute gouty arthritis rats, which may be related with its effect on inhibiting abnormal activation of TLR4-MyD88-NF-κB pathway in synovial tissue.

Objective To study the expression and clinical significance of Livin ( anti-apoptosis protein) and Smac (promoting apoptosis factor) in patients with the non-Hodgkin lymphoma (NHL).Methods The expression of Livin and Smac were detected by immunohistochemical staining(SP) assay in 31 patients with NHL, and the relationship between Livin/Smac and clinical staging, IPI and prognosis were analyzed. Results The patients with positive expression of Livin had B symptom, high risk IPI, late clinical staging (Ⅲ/Ⅳ stage) and short survival time, while the ones with positive expression of Smac had no B symptom, early clinical staging( Ⅰ /Ⅱ stage), low risk IPI and good prognosis. The expressions of both Livin and Smac were not related to gender and age. Expression of Livin was not correlated to that of Smac (r =0.003,P ＞0.05). Conclusion For patients with NHL, the expression of Livin protein was related to poor prognosis and adverse clinical features, whereas the expression of Smac protein was related to good prognosis and clinical feature.

Objective To investigate the relationship between spontaneous miscarriage and embryonic chromosome abnormalities,and to evaluate the clinical application of karyotype analysis by chorionic villus cell culture. Methods The chorionic villus karyotype of 1983 cases of miscarriage from January 2010 to July 2016 in Guangzhou Women and Children′ s Mecical Center were analyzed retrospectively. The miscarried chorionic villi were obtained by curettage under sterilized condition. The chromosome specimens were prepared after chorionic villus cell culture. Karyotype analysis was performed by G-banding technique. Results In the 1983 samples, successful karyotype analysis was performed in 1770 cases, with the successful rate of 89.98%. Chromosomal abnormalities were found in 1038 cases (58.64%,1038/1770). Chromosomal structural abnormalities were found in 37 cases. The numeral abnormalities were more common than structural abnormalities, and most of the numeral abnormalities were aneupoidies. In turn, they were trisomy 16, 45,X, trisomy 22, trisomy 2, trisomy 21, trisomy 15. The most common structural abnormality was balanced translocation, including Robersonian translocation. Female embryoes accounted for 61.02%(1080/1770) miscarriages and for 57.4%(596/1770) of chromosomal abnormalities, while male embroyes acoounted for 61.02%(1080/1770),57.4%(596/1770)respectively. The proportion of female embryoes was higher than male embryoes. The median age of the patients was 30 years old(16-46 years old). As the maternal age increased, the proportion chromosomal abnormalities increased. The incidence of chromosomal abnormalities in the advanced age group (≥35 years) was 68.38%(240/351), which was significantly higher than that in the younger group (56.24% ,798/1419; χ2=17.10, P<0.01). Conclusions Embryonic chromosomal abnormalities are the most common cause of early spontaneous miscarriage. The abnormalities centralize in some karyotypes. There is certain relationship between maternal age and the incidence of miscarriage, as well as the embryonic gender. Chorionic villus cell culture and karyotype analysis are helpful in finding the cause of miscarriage and counsel the patients.