Objective:To analyze the rationality of off-label drug use in nephritic syndrome prescriptions to provide scientific basis for clinical rational drug use and further regulate the off-label drug use in our hospital. Methods:Totally 1 908 outpatient prescriptions of nephritic syndrome selected from our hospital during November 2014 to April 2015 were analyzed, and all the off-label drugs were listed . The rationality of the off-label drug use was analyzed and evaluated by searching the related kidney disease guidelines and litera-tures. Results:The off-label drug use of tacrolimus capsules, mycophenolate mofetil capsules, cyclophosphamide for injection, ciclos-porin soft capsules, dipyridamole tablets, hydroxychloroquine sulfate tablets and warfarin sodium tablets were recommended by domes-tic and overseas guidelines with better evidence of evidence-based medicines. Tripterygium glycosides tablets and leflunomide tablets were supported by the literatures on clinical studies at home and abroad. The above 9 kinds of off-label drugs were rational drug use. Lumbrokinase enteric-coated capsules, salvia miltiorrhiza and ligustrazine injection and pidotimod dispersible tablets were reported only by a handful of journals. Bacteria lysate capsules and boric acid powder had no related information support, which belonged to the em-pirical prescriptions of physicians. The above 5 kinds of off-label drugs were not rational drug use. Conclusion:It is a widely existing phenomenon that the medication in nephrotic syndrome is beyond the instruction, the most of off-label drug use are reasonable, and cli-nicians should prescribe medicines carefully. Our hospital needs to further standardize the management of off-label drug use supported by higher evidence in order to improve the level of clinical rational drug use and the reasonable rate of prescriptions.

BACKGROUND: Blood-letting puncture on 12-well points of hand is a kind of effective emergent approaches on cerebral apoplexy. It is testified in animal experiment that bleeding on 12-well points of hand can dilate cerebral vessels, enhance blood flow in brain, improve acute anoxic state in ischemic brain tissue and relieve acid toxin due to accumulation of lactate.OBJECTIVE: To explore the effects and mechanism of blood-letting puncture of 12-well points of hand nitric oxide (NO) contents and nitricoxide synthase (NOS) activity after cerebral ischemia in rats.DESIGN: Randomized controlled animal experiment was designed.SETTING: Department of Physiology of Medical Institute of Xianning College.MATERIALS: The experiment was performed in Department of Physiology of Medical Institute of Xianning College from March 2003 to February 2004. Totally 84 Wistar rats were employed in the experiment, aged of 2 or 3 months, of either sex, body weighted (230±20) g and provided from Experimental Animal Center of Medical Institute of Xianning College.METHODS: Totally 84 rats were randomized into sham operation group,ischemia group and ischemia + bleeding group, 28 rats in each one. Modified Longa method [3] was applied to prepare the model of embolism of cerebral middle artery in rat. In ischemia + bleeding group, after cerebral ischemia, blood-letting puncture was applied with three-edged needle on Shaoshang (LU11), Shangyang (LI1), Zhongchong (PC9), Guanchong (TE1),Shoochong (HT9) and Shaoze (SI1) in sequence firstly on the left foreleg,and then on the right one, corresponding to the analogy of 12-well points of hand of human. One blood drop was just required. NO content and NOS activity were assayed in 30 minutes, 1 hour, 2 hours and 4 hours of ischemia in brain tissue successively in each group.MAIN OUTCOME MEASURES: NO content and NOS activity in brain tissue in each group.RESULTS: ① NO content in 30 minutes, 1 hour, 2 hours and 4 hours of ischemia in ischemia group was (116.16±26.63), (118.94±24.47),(115.65±25.29) and (108.87±26.52) μmol/L successively and NOS ac tivity was (507.22±92.52), (502.08±92.52), (510.71±96.63) and (495.29-±88.41) μkat/L, which was higher significantly than the sham operation group (t=2.474-4.731, P ＜ 0.05 or 0.001). ② In ischemia + bleeding group,, NO content was (91.8±11.51), (93.55±13.88), (92.52±11.62) and (84.3±11.51) μmol/L successively and NOS activity was (337.6±88.41),(340.99±96.63), (344.48±84.3) and (337.6±90.46) μkat/L, indicating significant difference in comparison with ischemia group (t=2.199-3.507,P ＜ 0.05-0.01).CONCLUSION: Blood-letting puncture on 12-well points of hand inhibits the increased NO content and NOS activity in ischemic brain tissue and alleviates the injury of free radical to brain tissue so that the focal brain ischemia of rats is protected.

Objective: To identify the clinical features and prognostic factors in relation to extremity osteosarcoma with pathological fracture. Methods: The clinical data from 244 patients with extremity osteosarcoma between October 2003 and October 2011 were retrospectively reviewed. These patients were divided into two groups: patients with pathological fracture group and the patients without pathological fracture group. The differences in the clinical features of the two groups were analyzed. The survival analysis was performed using Kaplan-Meier method. For patients with pathological fracture, a univariate analysis (log-rank) was used to determine the prognostic factors related to the survival, and a COX proportional hazards regression model was used to identify the independent prognostic factors. Results: A higher proportion of patients with larger tumor size (P = 0.012), humeral osteosarcoma (P = 0.004) or local recurrence (P = 0.002) was observed in patients with pathological fracture. Additionally, more patients with pathological fracture received an amputation surgery, as compared with patients without pathological fracture (P = 0.032). The median survival time of patients with pathological fracture was significantly shorter than that of patients without pathological fracture (16 vs 21 months, P = 0.006). The univariate analysis showed that the significant prognosis-related factors were the tumor size, Enneking's surgical staging, KPS (Karnofsky performance status) score, cycles of adjuvant chemotherapy, local recurrence and metastasis (P < 0.05). The multivariate analysis revealed that the factors of KPS score, cycles of adjuvant chemotherapy and metastasis were the independent prognostic factors of extremity osteosarcoma with pathological fracture. Conclusion: Compared with the patients without pathological fracture, a higher proportion of patients receiving amputation surgery or having larger tumor size, humeral osteosarcoma or local recurrence was observed in patients with pathological fracture, and the prognosis of these patients was poor. The KPS score, cycles of adjuvant chemotherapy and metastasis were independent prognostic factors of extremity osteosarcoma with pathological fracture. Copyright © 2012 by TUMOR.

Objective To explore the clinical value of serum procalcitonin(PCT)and C-reactive protein(CRP)combination detec-tion in early diagnosis of liver cirrhosis complicating spontaneous bacterial peritonitis(SBP).Methods The peripheral blood sam-ples were collected from 30 cases of liver cirrhosis complicating SBP,30 cases of simple ascites liver cirrhosis (non-SBP)and 45 healthy subjects as control group.The serum PCT level was detected by the dry immunofluorescence quantitation method and the serum CRP level was detected by the immunoturbidimetry.The sensitivity and specificity of PCT,CRP and PCT combined with CRP in diagnosing liver cirrhosis complicating SBP were compared and the relationship between PCT levels and prognosis was ana-lyzed.Results Compare with the healthy control group and the non-SBP group,the serum PCT and CRP levels in the SBP group were markedly increased(P <0.05).The sensitivity of PCT,CRP and PCT combined with CRP in diagnosing liver cirrhosis compli-cating SBP was 93.3%,90.0% and 96.6% respectively,and the specificity was 90.0%,75.0% and 95.0% respectively.Conclusion The combination detection of serum PCT and CRP can increase the sensitivity and specificity of the diagnosis and has more clini-cal value in early diagnosing liver cirrhosis complicating SBP.

Objective To research the most commonly used five method to evaluated the difficulty airway , and compare which methods were more suited for the pregnant woman in general anesthesia. Methods 214 patients with full-term pregnancy who requested emergency or elective caesarean-section were assigned. During the pre-anesthetic visit,we evaluated patients from Mallampati score, thyromental distance, body mass index (BMI), inter-incisor gap, and upper lip bite test. After endotracheal intubation ,patients were divided into 2 groups based on Cormack classification. Results Five ways sensitivity descending order were upper lip bite test (79.5%)、Mallampati score (76.9%)、BMI (56.4%)、inter-incisor gap (51.3%)、thyromental distance (35.9%); specificity descending order were upper lip bite test (93.1%)、Mallampati scores (86.3%)、inter-incisor gap (85.1%)、thyromental distance (76.6%)、BMI (62.3%). Conclusions In pregnant women ,Mallampati score and the upper lip bite test are the better indicators to predict difficult airway.

Objectives To study the psychological characteristics of children with attention deifcit hyperactivity disorder (ADHD). Methods Human ifgure drawings (HFD) as a projective technique was performed in 107 children with ADHD aged (8.69 ±1.48) years old (6.5~11.5 years), and 107 matched healthy children. Characteristic features of the HFDs in children with ADHD, and correlations between emotional indicators of the HFDs and factors of child behavior checklist (CBCL) were assessed and com-pared with the control group. Results Signiifcant differences in emotional index were found between ADHD and healthy chil-dren, including bad body composition, short arms, long arms, big ifgure, omission of hands and omission of feet (P<0.05). Nega-tive correlation was found between the HFDs emotional index and the factors of activity and social ability in the CBCL (P<0.05), but a positive correlation was found between the HFDs emotional index and behavioral problem (P<0.05). Conclusion Human ifgure drawings can relfect some emotional characteristics of children with ADHD, and when combined with CBCL, it can pro-vide evidence for diagnosis and intervention for ADHD.

Visiting doctors' training is a main part of medical education in general hospital,but it has not gained full attention.Based on the features of visiting doctors and the department,a new teaching method-tutorial system was applied to enhance the responsibility of tutors and the sense of belongings of visiting doctors.Individual teaching method was used to enhance the overall quality of visiting doctors and to guarantee the safety of anesthesia treatment for patients.The tutorial system clarified and enhanced the relationship between tutors and visiting doctors and it would be a new teaching mode for the visiting doctors' education in the department of anesthesiology.

Objective To compare the therapeutic effects of hyperbaric oxygen (HBO) therapy at different time points on patients with spinal cord injury. Methods A total of 284 cases of spinal cord injury (SCI) were divided into an HBO group and a control group. The control group was treated with routine interventions (including a dehydrator, medication for neurotrophy, rehabilitation management, acupuncture and supportive treatment). The HBO group was treated with HBO in addition to the routine treatments, initiated at different time points after onset of SCI ( from less than 8 hours to longer than 1 week). All of the patients were evaluated in terms of scores on the American Spinal Cord Injury Association (ASIA) assessment and Barthel's index (BI) before and after treatment.Results Both groups had excellent effects when the treatment was initiated within the first 8 hours after the onset of SCI. There was no significant difference between the two groups. Average ASIA and BI scores in both groups improved significantly within the first 24 hours, and over the 1 st week after the onset of SCI. The recovery of neurological function and ability in the activities of daily living (ADL) was significantly better when HBO treatment was initiated within 8 hours after SCI compared with that initiated after 24 hour and 1 week. The therapeutic effects in the HBO group patients were significantly better than in the control group when HBO was initiated at 8 and 24 hours after onset of SCI. Neither the HBO group nor the control group had significant further improvement in ASIA scores or ADL performance when treatments initiated after 1 week. Conclusions HBO can significantly improve neurological function and ADL performance after SCI if it is administered within 1-8 hours.

AIM: To explore the influence of CD47 molecules on the maturation and function of cultured dendritic cells (DCs). METHODS: Monocyte cell-derived DCs were propagated in granulocyte-macrophage colony-stimulating factor (GM-CSF) and lipopolysaccharide (LPS) plus interleukin (IL)-4, in the presence or absence of anti CD47 monoclonal antibodies (anti-CD47 mAbs). Flow cytometry was used to detect the cell surface phenotype. The concentration of IL-12P70 in supernatant was measured by ELISA technique. The antigen-presenting functions of DCs were determined in one-way mixed leukocyte reaction by Brdu-ELISA. Electrophoretic mobility shift assays (EMSA) was used to examine NF-?B activity. RESULTS: The anti-CD47 mAbs markedly suppressed the expression of CD80,CD86,CD83,CD1a,HLA-DR on the surface of DCs (P

Holistic education is an important philosophy of medical education.Medical graduate students can show their skills of medical specialties,improve their abilities of communication and cooperation,and promote their sense of social responsibility through social practice.Through conducting questionnaire among medical graduate students of Peking University Third Hospital who major in internal medicine,we have got to know the effect of social practice on holistic education philosophy.Meanwhile,social practice is a crucial approach to implementing holistic education.