Gastroesophageal reflux disease(GERD),a common disorder in the West,is less seen in Asian countries.No nationwide epidemiological study of GERD has been conducted in China up to now and the population distribution of GERD remains unknown.Many factors are believed to be responsible for GERD.In addition to some recognized factors,the influences of factors like obesity,smoking and so on are till unclear.Furthermore,GERD is believed to be associated with many diseases.This article reviews the disease distribution,risk factors and associated diseases of GERD.

Objective To investigate the clinical features of X-linked agammaglobulinemia (XLA)in children,and to improve the early diagnostic rate.Methods The medical records of 11 children with XLA between Dec 2003 and Nov 2011 were reviewed.Results The smallest age of 11 cases with XLA presenting the first symptoms was 0.4 years old and the oldest age was 4 years old with a mean of 2.4 years old.The first diagnosis time was at the age of 3.5 to 13 years old,with a mean of 7 years old.The age at first diagnosis in 63.6％ ( 7/11 ) of patients was more than 7 years old.Two patients ( 18.2％ ) had the family history of the similar disease.Two patients were died from the infection and 1 patient was missed.The other 8 patients were survived.Respiratory infections occurred in 100％ of the 11 patients.54.5％ (6/11 )of the patients were suffered with otitis media and digestive infections were seen in 36.4％ (4/11 ) of the patients.The levels of lgA,IgM and IgG in the serum of the pauents were all decreased.The levels of IgG in the serum of 9 patients were less than 2 g/L and in the serum of the other 2 patients were less than 2.4 g/L.The levels of CD19 in the serum were all less than 1％ and an inversed ratio of CD4/CD8 was observed in 9 patients.Eight patients were diagnosed as XLA by gene detection.Conclusion The age presenting first symptoms in children with XLA in this study is earlier than the reported data and the age at first diagnosis is later.Respiratory infection is the most common manifestation.High prevalence of otitis media and digestive infections are common.The patients with XLA rarely have the family history.The early diagosis and long-term treatment with the intravenous immunoglobulin may improve the prognosis of XLA.

Prof. SUN Guang-rong holds that how to define the representative clinical case records out of regular ones,what to learn from it,and how to direct other people to learn from it are the key questions to answer before moving to the study; in research process of the project of the Representative Clinical Case Records Collection and Study of Contemporary Eminent and Experienced Chinese Medicine Practitioners,conventional study method and modern information technology are used in conjunction on all the clinical case records of the screened eminent and experienced doctors from all over the country,the defined representative case records are studied and sorted out according to disease or symptom,highlights before and notes and comments following the case record details,guiding people easily to read each great Chinese medical talents,their academic thought and clinical technology; the academic analysis on each eminent and experienced practitioner is the most important part of the project and with it the academic whole story can be seen in a natural and close related way.

OBJECTIVE:To provide reference for antibiotics use. METHODS:A retrospective study was conducted to analyze the detection of pathogens and antibiotics use in 93 children with bronchiolitis in our hospital between Jan. 2013 to Dec. 2014. Pathogens detection mainly included respiratory virus,pneumonia mycoplasma IgM antibody and pneumonia chlamydia IgM anti-body and sputum culture. RESULTS:Among 93 cases,22 cases (23.66%) were positive in respiratory virus IgM antibody test, mainly for respiratory syncytial virus;17 cases(18.28%)were positive in sputum culture test,mainly for the Moraxella catarrha-lis,Haemophilus influenza and Streptococcus pneumonia;10 cases(10.75%)were positive in Atypical pathogens test,mainly for mycoplasma pneumonia. There were 47 cases(50.54%)of antibiotics;Among them,only 12.77%(6/47)had clear indications for using antibiotics;the children who were 1-3 months old had the highest percentage of antibiotics,accounting for 81.82% at the same age;the duration of disease was significantly prolonged in the cases who used antibiotics,with average duration of(8.27± 3.32) d. CONCLUSIONS:Bronchiolitis is still usually caused by virus infection in our hospital,the ratio of antibiotics use are high and most of them don't have bacterial infection indications.

The effects of positive end-expiratory pressure (PEEP) on pulmonary shunt were studied during gen- eral anesthesia and postoperative period.Twenty cholecystectomy patients were randomly divided into experiment group (group P) and control group (group Z). PEEP and ZEEP were used separately after induction. Artery blood and mixed blood from the right ventricle were taken for blood gas analysis and determine the amount of pulmonary shunting before anesthesia. half and hour, one and half an hour and two and half an hour after anesthesia and one hour after the operation.The results showed that shunt in group P decreased gradually during general anesthesia and returned to the level of preoperation at an hour after operation. Shunt in group Z was increased continually and the level was significantly higher than preoperation an hour after operation. Shunt between two groups was significant difference (P

ObjectiveTo describe the status of depressive symptom among children and adolescents with type 1 diabetes mellitus(T1DM) and explore the related factors.MethodsThis was a multi-plot cross-sectional survey.136 cases in Hunan province were investigated by questionnaires.The questionnaires included General Information Questionnaire,Depression Self-Rating of Children( DSRS),Quality of Life Scale for Children and Adolescents.ResultsThe DSRS score of all subjects was (9.51 ± 5.19),24 cases suffered from depressive symptom (17.6％).The multi-factor non-condition logistic regression analysis showed that age(OR =2.831 ),current education status (OR =9.822 ),parents' current marital status (OR =0.061 ),yearly household income (OR =0.415 ),hospitalization in the past 6 months (OR =8.797 ),peer relationship (OR =0.133 ),parent-child relationship(OR =0.182 ),FBS(OR =0.061 ) and sample source(OR =8.366 ) were factors which independently predicted depressive symptom in children and adolescents with T1DM.ConclusionThe influential factors of depressive symptom among children and adolescents with T1DM include age,current education status,parents' current marital status,yearly household income,hospitalization in the past 6 months,peer relationship and parent-child relationship,FBS and sample source.

Objective To evaluate the earlier changes of degeneration discs in vivo using magnetic resonance diffusion tensor imaging (DTI).Methods From September 2010 to March 2011,88 consecutive outpatients [age 16-63 years,mean age (37 ± 13) years] were enrolled in this study.The excluded criteria were as follows: spinal deformity,spinal tumors and post-operation of spine.The mean diffusion (MD) and fractional anisotropy (FA) values on DTI images of 428 intervertebral discs which without susceptibility artifacts were measured.Fiber track (FT) images of annulus of intervertebral discs were analyzed.MD and FA were also measured on FT.The quartile and median were used to record the nonnormal distribution dates.The Chi-square test statistic was applied by SPSS1 1.0 software package.Results Annulus fibrosis type had closely related to the Pfirrmann grading.Three types were divided based on FT charts of degenerated intervertebral disc.Intact type was noted in 135 discs,Pfirrmann Ⅱ level has a high percentage(92 discs,68.15％) in this type; Scrambled type was noted in 195 discs,Pfirrmann Ⅲ and Ⅳ level were accounted for 63.07％ (123 discs) ; Conglomerate type was noted in 98 discs,the Pfirrmann Ⅳ and Ⅴ level were accounted for 83.68％ (82 discs) (Mantel-Haenszel test,x2 =183.90,P ＜ 0.01).Different annulus types had different MD and FA values.The median(range)of FA of complete,messy and clumps type fibrous ring were 0.32 (0.29-4.35),0.35 (0.33-0.38),0.54 (0.46-0.62).The corresponding median(range)of MD were 12.40(11.50-13.20) x 10-10,11.10(9.92-12.00) × 10-10,6.30(5.03-7.72) × 10-10 mm2/s.Scrambled annulus fibers had lower MD values and higher FA values,which had significant difference (x2 =219.74,243.88,P ＜0.01).Conclusions DTI is a non-invasive method to assess intervertebral disc structural changes in vivo.MD and FA values are helpful to evaluate the intervertebral disc degeneration.

Objective To investigate the effects of galantamine on the myocardial ischemia-reperfusion (I/R) injury in rats and the possible mechanism.Methods Fifty male SD rats weighing 225-275 g were randomly assigned into 5 groups (n =10 each):sham operation group (group SH); I/R group; galantamine + I/R group (group GAL); M receptor antagonist atropine + galantamine + I/R group (group AT); vagus nerve cut-off + galantamine + I/R group (group VGT).Myocardial I/R was induced by occlusion of left anterior descending branch of coronary artery for 30 min followed by 120 min reperfusion.Normal saline 2 ml/kg was slowly injected via the femoral vein at 30 min before ischemia in groups SH and I/R.Galantamine 4 mg/kg was slowly injected via the femoral vein at 30 min before ischemia in group GAL.Atropine 4 mg/kg was slowly injected via the femoral vein at 45 min before ischemia in group AT and the other procedures were the same as those in group GAL.Bilateral cervical vagus nerves were cut off at 45 min before ischemia in group VGT and the other procedures were the same as those in group GAL.At the end of reperfusion,the hearts were removed for determination of myocardial infarct size,MPO and SOD activities,and MDA contents.Results The myocardial infarct size was significantly larger,the MPO activity and MDA content were significantly higher,and the SOD activity was significantly lower in group I/R than in group SH,and in groups AT and VGT than in group GAL (P ＜ 0.05).The myocardial infarct size was significantly smaller,the MDA content and MPO activity were significantly lower,and the SOD activity was significantly higher in group GAL than in group I/R P ＜ 0.05).Conclusion Galantamine has protective effect on myocardium against I/R injury and regulation of peripheral vagus nerve tension may be involved in the mechanism.

Analyzing and discriminating incorrect cases is a good method in medical statistics teaching,which can not only help students review the knowledge they have learned but also guide their self-learning.Teachers can start teaching based on the reverse thinking,propose incorrect cases with moderate difficulty and in accordance with the reality and arouse students' creativity through introducing the incorrect cases,reviewing the incorrect cases and conducting group discussion.

This article analyzed the current problems existing in the public health master cur-ricula system, such as educational ideas being backward, tralning objectives not explicit, curricula teaching unsatisfactory and effects of practical curriculum needing to be improved. Based on the pro-fessional competencies, we discussed the ideas and principles of the new curricula system of master of public health, and proposed making sure of a refined professional competencies, making strict traln-ing standards, confirming tralning objectives, embodying advantages, setting up reasonable curricula, fostering practical abilities, strengthening cooperation and carrying on professional identification.