Asthma is one of the most chronic airway inflammatory disease,threating the children's health.Bronchiolitis significantly increased the risk of childhood asthma,and many studies have focused on looking for the related factors between bronchiolitis and asthma in recent years.It may be helpful to understand the pathogenesis of the asthma,so as to find new measures for asthma's prevention and treatment.In present studies,bronchiolitis influenced the development of asthma in genetics,immunity,environmental factors and so on.So far,whether bronchiolitis directly causes the development of the childhood asthma,the prevention of bronchiolitis could reduce the asthma morbidity or not,both need more evidences yet.

Objective To investigate the effect of thyroxine on elder patients with chronic heart insufficiency. Methods 82 elder patients with chronic heart insufficiency were divided into 2 groups randomly . 46 cases of observation group and 36 cases of control group. All of them were received routine treatment, including vasodilators, diuresis and cardiotonic etc anti-heart failure ways.The group of observation plus thyroxine (20mg/d oral,for 2 weeks ).Cardiac function degree,heart/lung ratio and change of cardiac ejection fraction(F) were observed before and after treatment. Results The value of EF,increased heart/lung ratio reduced,and function of heart were notably improved,as compared with those of the control group (P

Bronchial asthma (also called asthma) is the most common chronic respiratory inflammatory disease in childhood.With the increased incidence of asthma in recent years,the guidelines for diagnosis and treatment of asthma have been also updated quickly at both domestic and overseas.Acute exacerbations of asthma will result in unscheduled medical attendances in emergency department or hospitalizations,and the severe one may be life-threatening,which brings a heavy burden to the families and society.Several guidelines,Meta analysis,and studies in treatment of childhood asthma exacerbations are reviewed in this article,so as to provide recommendations in the treatment of childhood asthma exacerbations for physicians.

Objective To evaluate the early diagnosis value of blood neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) in patients with sepsis-induced acute kidney injury (AKI). Methods A prospective case controlled study was conducted. Fifty-six patients with sepsis but without renal disease admitted to intensive care unit (ICU) of Shanxi People's Hospital from April 2014 to April 2015 were enrolled. Blood lactic acid and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score at ICU admission were recorded. The urine output, blood urea nitrogen (BUN), serum creatinine (SCr), NGAL, IL-18 and tumor necrosis factor-α (TNF-α) were continuously monitored for 48 hours. The patients were divided into AKI group and non-AKI group according to the diagnostic criteria of Kidney Disease: Improving Global Outcomes (KDIGO). The changes trend in above parameters between the two groups at different time points were compared. The early diagnostic value of NGAL, IL-18, and SCr for sepsis-induced AKI was evaluated by receiver operating characteristic curve (ROC). Results Compared with non-AKI group, with the time prolongation after ICU admission, the traditional parameters reflecting AKI urine output in sepsis-induced AKI group was decreased gradually, BUN and SCr were gradually increased, and a statistically significant difference was found at 12 hours between the two groups [BUN (mmol/L): 11.8±3.5 vs. 8.2±3.5, SCr (μmol/L): 88.6±11.3 vs. 74.0±11.0, both P < 0.01]; but the new indicators NGAL and IL-18 reflecting AKI had a statistically significant difference at 6 hours [NGAL (μg/L): 426.7±90.7 vs. 382.3±67.9, IL-18 (ng/L): 75.7±9.3 vs. 70.9±7.3, both P < 0.05]. It was shown that in AKI group, NGAL and IL-18 compared with BUN and SCr increased at least 6 hours ahead of schedule. The area under ROC curve (AUC) of 6-hour NGAL and IL-18 in patients with sepsis-induced AKI were 0.821 [95% confidence interval (95%CI) = 0.713-0.931] and 0.719 (95%CI = 0.584-0.853) respectively, superior to SCr (AUC = 0.677, 95%CI = 0.528-0.825). The cutoff value of NGAL was 363.58 μg/L, and the sensitivity and specificity were 88.0% and 86.7% respectively. Conclusions NGAL and IL-18 in the early prediction of sepsis patients with AKI are better than SCr, and NGAL was most sensitive. Therefore, NGAL can be used as an early biomarker for the diagnosis of AKI in patients with sepsis.

Obesity and obesity-related diseases have become the main threat to human health .Acid secreted proteins that are rich in cysteine mainly derived from fat tissue , and are associated with insulin resistance , diabetes and diabetic nephropathy .This re-view summaries molecular biology features such as resistance of cell adhesion , regulating cell proliferation , tissue differentiation and embryonic development and the latest research progress of its role in the obesity and obesity related diseases .

It had fertile countryside land,rich products,dense population and creeks and lakes in ancient Hangzhou and its neighbour area,where there is a good place for planting medicinal materials.It had long history of planting medicinal materials with abundant output,pure and good nature,and much varieties;among which,some famous and costly medicinal materials,such as "eight Zhe's" and "eighteen Hangs",were not only adopted broadly by court,royalty and doctors,but purchased by many businessmen and sold far to abroad as well;they seemed to be in the leading place in China.

By analyzing the problems existing in the practice of doctor -patient communication , respectively discusses the speech act theory before the implementation of the implementation of doctor -patient communication oral English training , implementation , and after implementation of the positive role: instant help medical students to master a large number of medical English vocabulary;In view of the students come from different areas , instant help correct the pronunciation and intonation;Benefit based on speech act theory to guide the student to carry on the different roles played in English oral practice helps students to adopt direct and indirect speech act theory and the method of the oral English practice for communication;To improve medical students′professional recognition;To strengthen the medical students′sense of mission .

Objective To evaluate the teaching effects of applying clinical pathway in clinical practice teaching of neurology. Methods The undergraduate interns majoring in clinical medicine were randomly divided into clinical pathway teaching method group (n=34) and traditional teaching method group (n=34). Both groups were taught by senior physicians with the same teaching content and teaching material. A control study between the two groups in theoretical knowledge, operational skills and satisfaction degrees of teaching was carried out. Results The results of clinical pathway teaching method group in theoretical knowledge[(55.2±3.70) vs. (51.8±4.6)] and operational skills [(36.3±3.2) vs. (31.3±2.19)] were both sig-nificantly better than those of traditional teaching method group (P<0.05). The satisfaction degree of teach-ing of clinical pathway teaching method group is relatively higher . Conclusions The clinical pathway teaching method enhances the scientific property and systematic property of teaching contents, obtaining a favorable teaching effect.

ObjectiveTo estimate the effect of azithromycin on lung function and transforming growth factor β1(TGF- β1) in patients with idiopathic pulmonary fibrosis (IPF). MethodsOne hundred and ten patients with IPF were divided into two groups by random digits table. Patients in azithromycin group(60cases) were treated by azithromycin tablets and thoee in placebo group ( 50 cases) were treated by placebo tablets, and they were observed for 12 weeks. Lung function was detected at beginning and after 6,12 weeks' treatment. TGF- β1 was tested by ELISA, meanwhile patient's condition was observed. ResultsAfter 6 and 12 weeks' treatment, the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), carbonmonoxide diffusion capacity (DLCO) in the two groups had no significant differences compared with those at beginning of treatment (P ＞ 0.05). After 12 weeks' treatment, the level of TGF- β1 in azithromycin group was significantly decreased compared with that at beginning and after 6 weeks' treatment (P ＜ 0.05) ,but there was no significant difference in placebo group (P ＞ 0.05). The ratio of acute exacerbation admission and infection was 8.3％(5/60) and 60.0％(3/5) in azithromycin group, 22.0％( 11/50) and 81.8％(9/11 ) in placebo group,and there were significant differences between the two groups(P ＜0.05 or ＜0.01). Conclusion Azithromycin may reduce the ratio of acute exacerbation admission and infection, decrease TGF- β 1 expression in patients with IPF by taking orally for a long time, but it may have no obvious effect on lung function.

Programmed cell death 4 (PDCD4) is a newly discovered tumor suppressor gene, whose expression is regulated by methylation of PDCD4 gene and many kinds of microRNAs.Protein of PDCD4 enco-ding can improve the sensitivity of tumor cells to anticancer agents, inhibit tumor development and metastasis process, and play an important role in a variety of tumors.It is expected to be a clinical indicator to determine the prognosis of tumor.