Objective To assess the clinical feature of older-onset systemic lupus erythematosus.Methods A retrospective study was carried out.Clinical and laboratory findings were collected from 48 patients with older-onset (＞ or =50 years) SLE as well as 424 patients with younger-onset (＜ 50 years) SLE hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2008 to January 2011.Results Among the 472 hospitalized patients with SLE,the ratio of male to female was 1 ∶ 8.08,and older-onset SLE accounted for 10.17％.No significant difference was observed in the incidence of fever,arthritis,decrease in hemoglobin level,increase in erythrocyte sedimentation rate and reduction in complement C4 level,or the positivity rate of anti-ribonucleoprotein (RNP) or anti-Sm autoantibodies (all P ＞ 0.05) between the older-onset and younger-onset SLE patients.The patients with older-onset SLE showed a statistically higher incidence of myalgia,myasthenia,serositis,heart damage and lung damage,decrease in white blood cell count and platelet count,but a significantly lower incidence of butterfly rash,alopecia,renal damage,Raynaud's phenomenon,photosensitivity,decrease in complement C3 level,as well as the positivity rate of anti-dsDNA and anti-nucleosome antibodies in comparison with those with youngeronset SLE (all P ＜ 0.05).Conclusions It is likely that older-onset SLE has mild and atypical clinical manifestations,with a relatively low positivity rate of specific immunological indices.Hence,clinicians should pay more attention to older-onset SLE so as to avoid the misdiagnosis or missed diagnosis of it.

Objective To compare the effect of carvedilol and motoprolol on high altitude chronic congestive heart failure (CHF). Methods Ninety patients with high altitude chronic CHF were divided into three groups randomly:Twenty patients in the regular treatment group treated with angiotensin-converting enzyme inhibitor (ACEI) ,diuretics and digoxin; motoprolol (50 mg twice daily) was given in the motoprolol group( 34cases) additional to regular treatment; carvedilol (25 mg twice daily) was given in the carvedilol group(36cases ) additional to regular treatment. All the patients were followed up for six months and measured the changes of cardiac function by echocardiography. Results Left ventricular end-diastolic dimension (LVEDD) was ( 57. 3 ± 6. 5 ) mm and (57.2 ± 6. 9) mm in the carvedilol group and the motoprolol group respectively, and left ventricular end-systolic dimension (LVESD) was (46. 6 ± 7.0) mm and (44. 0 ± 6. 9 ) mm in the carvedilol group and the motoprolol group respectively, which were all significantly smaller than that in the regular treatment group ([64.7 ±9. 1]mm and [53.4 ±9.8]mm for LVEDD and LVESD,respectively) (Ps ＜0.05). Left ventricular ejection fraction (LVEF) in the carvedilol group and the motoprolol group ( [47.5 ± 8. 1] % and [52. 9 ±8.5] % ,respectively) was higher than that in regular treatment group( [42. 8 ±9. 2]% ) (Ps ＜0. 05).The improvement of LVEF in the carvedilol group was better than that in the motoprolol group (P ＜ 0. 05 ). One case died in the motoprolol group and no death in the carvedilol group,4 cases died in the regular treatment group,the mortality in the motoprolol group and the carvedilol group was significantly lower than that in the regular treatment group. Conclusion Carvedilol and motoprolol significantly improved cardiac function in high latitude CHF patients,and the effect of Carvedilol is slightly better than that of motoprolol.

Objective To explore the value of somatostatin receptor scintigraphy(SRS) in evaluating the immune activity of orbital inflammatory pseudotumor associated with systemic vasculitis.Methods Twenty-five patients with orbital inflammatory pseudotumor associated with systemic vasculitis (10 males,15 females,average age:(51.2± 14.2) years) underwent SRS.The uptake ratio (UR) of orbital inflammatory pseudotumor was obtained.(1) Patients were divided into group A (with immune activity) and group B (without immune activity) according to Birmingham vasculitis activity score (BVAS).The difference of UR between the 2 groups was compared by two-sample t test.The difference of UR before and after treatment in 12 patients was also compared.(2) Based on the results by BVAS,ROC curve was used to obtain the cut-off value of UR,as well as the diagnostic efficiency and Youden index.The consistency between SRS and BVAS was calculated.(3)Patients were divided into two groups according to the cut-off value of UR and the prognosis difference between them was compared by Fisher exact test.(4)The expression of SSTR2 and SSTR5 was observed by immunohistochemistry.Results (1) UR in group A was significantly higher than that in group B (2.09±0.44 vs 1.32±0.46,t =5.94,P＜0.01).After glucocorticoids treatment,the UR in group A reduced significantly (t=4.07,P＜0.01),but not in group B (t=1.76,P＞0.05).(2)ROC curve analysis identified UR cut-off value as 1.66,with the sensitivity of 87.5％,specificity of 95.7％,positive predictive value of 95.2％,negative predictive value of 88.0％,accuracy of 91.3％ and Youden index of 83.2％.The consistency between SRS and BVAS was strong (Kappa =0.840).(3) The prognosis was significantly different between patients with UR≥ 1.66 and UR＜1.66 (P＜0.05).(4) The immunohistochemical results revealed high expression of SSTR2 and SSTR5 in inflammatory cells in patients with immune activity.Conclusion SRS has potential value in evaluating the immune activity of orbital inflammatory pseudotumor associated with systemic vasculitis.

Objective To know the effects of living with the elderly on nursing students' willingness engaging in aged nursing and attitude towards the elderly so as to provide references for nurturing professionals for caring for the aged.Methods 231 nursing students were surveyed.The questionnaire included four parts,general information,life experience with the elderly,willingness engaging in aged nursing,attitude towards the elderly and cognition of aging.Results 45.9 percent of the nursing students were willing to engage in aged nursing.Living with elderly and relationship with the elderly affected their willingness.Conclusions Creating more opportunities for nursing students in touch with the elderly can help nursing students to have a good impression of the elderly and stimulate them to choose aged nursing.

Objective To know the nursing students' willingness engaging in geriatric nursing and analyze affecting factors so as to provide references for nurturing professionals for caring for the aged.Methods 231 nursing students were surveyed.The questionnaire included general information,life experience with the elderly,willingness engaging in geriatric nursing,attitude towards the elderly and cognition of aging.The investigation results underwent analysis.Results Single factor analysis showed that whether ever living with the elderly (x2=6.027),time living with the elderly and relationship with the elderly (x2=4.928) influeced the nursing students' willingness engaging in geriatric nursing.Multiple correspondence analysis indicated that nursing students living with elderly more than one year and having good relationship with the elderly had positive willingness.Conclusions Geriatric nursing curriculum should be optimized and more opportunities should be created for nursing students to be in touch with the elderly.At the same time,we must pay attention to occupation guide and moral education about how to respect and care for the elderly.

Objective To investigate the effect of progressive decompression elasticity socks therapy on life quality of the lower extremity deep vein thrombosis patients.Methods 50 qualified patients were divided into 2 groups receiving respectively compression therapy or not.Analysis and comparison were made based on results of SF36 questionnaire.Results There were no demographic differences between the two groups.Average follow-up time was (5.6 ± 2.4) months,the cronbach α coefficient was 0.8652 in compression therapy group,there was significant improvement on every evaluated stage and in every dimension after standard treatments (P ＜ 0.01),while in control group,only 4 dimensions (PF,RP,RE,BP) improved (P ＜ 0.05),there were statistical differences on every dimension between the two groups (P ＜ 0.01).Conclusions Progressive decompression elasticity socks therapy helps make the recovery of patients of acute deep vein thrombosis of the lower extremities.

Objective To assess the risk factors of postphlebitic syndrome(PS)after deep vein thrombosis of the lower extremities. Method In this study,102 DVT patients managed by conservative therapy were recruited.Data including age,sex,etiopathogenesis,anticoagulation,pathogenesis, elasticstocking therapy,degree of lower extremity exercise,INR,WBC,PT%and FIB were analyzed by single factor analysis and COX analysis. Result PS developed in 67.60%cases,single factor analysis shows:sex(P=0.025),anticoagulation(P=0.000),elastic-stocking therapy(P=0.000),degree of lower extremity exercises(P=0.000),INR(P=0.033),WBC(P=0.012),PT%(P=0.000),FIB(P=0.002)are related to the occurrence of PS.COX regression shows that anticoagulation(P=0.011),the degree of lower extremity exercise(P=0.019),elastic-stocking therapy(P=0.000)are related to PS.Age (P=0.299),etiopathogenisis(P=0.838)and pathogenesis(P=0.2 17)are not statistically PS related.Conclusion DVT is a multi-factors related disease.Multivariant analysis revealed that elastic-stocking (P=0.000),anticoagulation(P=0.011)and the degree of lower extremity exercises(P=0.019)are related to the development of PS.

Objective To study efficacy and safety of large dose of pamidronate disodium in treatment for patients with painful bone metastasis of prostate cancer. Methods A total of 100 patients with painful bone metastasis of prostate cancer were randomized into large dose group and conventional dose group, with 50 cases each. Pamidronate disodium was administered by intravenous infusion, 90 mg on the first day and 60 mg on the second day for large dose group, and 60 mg on the first day and 30 mg on the second day for conventional dose group, respectively, every 4 weeks for two courses. Changes of pain,mobility, quality of life and adverse effect in patients before and after treatment were observed. Results After treatment, pain was relieved in 43 of 50 patients ( 86% ) in large dose group, significantly more than that in conventional dose group (21/50, 42% ) (χ2 = 22.79, P ＜ 0. 01 ). Both mobility and quality of life were improved in 39 and 33 patients ( 87% and 66% ), respectively in large dose group and 21 and 18 (46% and 36% ), respectively in conventional dose group (χ2 = 17.04 and 9. 00, P ＜0. 01 ). No severe adverse effect in both groups was observed. Conclusions Pain in patients with bone metastasis of prostate cancer can be significantly relieved with large dose of pamidronate disodium, as well as their quality of life improved.

Objectives To explore the differences in therapeutic efficacy between decitabine combined with low dose HAG(D+ HAG)and CAG in elderly patients with acute myeloid leukemia (AML).Methods Totally 32 elderly patients with AML in our department from July 2012 to July 2015 were retrospectively analyzed.15 patients were on a therapy of decitabine combined with low dose HAG,and 17 patients with CAG.Efficacy and side effects were compared between the two groups.Results In(D+HAG)versus CAG groups,the complete remission(CR)was 10 cases(66.7％)vs.6 cases (35.3 ％),partial remission(PR) was 2 cases (13.3％) vs.1 case(5.9 ％),non-remission(NR) was 3 cases(20％)vs.10 cases(58.8％),and the total efficacy rate(CR+PR)was 80％vs.41.2％ (P＜0.05).The side effects in two groups mainly included bone marrow depression,respiratory tract infection,gastrointestinal reaction,which were all alleviated after symptomatic treatments.The incidence rate of side effects had no statistical difference (P ＞ 0.05).Conclusions The treatment of decitabine combined with low dose of HAG is prior to CAG,and the side effects are all tolerated.So decitabine combined with low dose of HAG can be served as the first-line therapy for elderly AML patients.

Objective:To understand the current situation of physicians′ competency in China and statistically analyze its influencing factors, hence providing referential evidences for promoting their competency.Methods:The evaluation scale for Chinese physicians′ competency was developed by referring to sophisticated overseas evaluation frameworks. Based on the electronic platform of the medical alliance, stratified sampling was conducted at 39 hospitals in 13 provinces, from which 2 156 physicians were surveyed, and statistical analysis was made on the current situation and influential factor of their competency in 6 dimensions(medical knowledge, diagnosis and treatment, scientific research and teaching, interpersonal communication, spirit of professionalism, population health)Results:The score range in multiple dimensions of physicians′ competency was between 2.85 and 3.89(5 in total), among which spirit of professionalism dimension scores the highest, and teaching and research dimension scores the lowest. Logistic regression analysis shows that their competency level in 6 dimensions is correlated to a range of factors, including gender, degree, title, supervisor qualifications, standardized training program of specialist physicians, and affiliation or not to teaching hospitals( P<0.05). Conclusions:Their overall competency is expected to be elevated. To name a few, they are lack of teaching and research abilities, and need to conduct clinical-oriented scientific research; they are expected to enrich knowledge structure, and need to embrace a wider concept of health; they need to improve their non-technical service abilities, and should further emphasize their humanistic quality; physicians′ practice competency depends upon their extent of medical education, and ensuring the quality of standardized training becomes the key measure.