Traditional Chinese Medicine (TCM) treating allergic diseasesis effective and with few adverse reactions. The effects of TCM compound, TCM extracts and Chinese herbal monomers played the anti-allergic role in multiple stages. Such as reducing and preventing target cell degranulation, releasing biologically active mediators, and inhibiting the conduction of signal pathways. Recent studies have found that in addition to anti-allergic effects by regulating cellular and humoral immunity, TCM can also enhance the body’s non-specific immune function to different degrees and help eradicate certain intractable allergic diseases. The development of new therapeutic agents for allergic diseases with good effect and less adverse reactions from Chinese herbal medicine will become a trend in the future research and have broad medical prospects.

Objective To evaluate the effectiveness of clinical pathways for pediatric asthma.Methods The literatures on the application of clinical pathways for pediatric asthma were collected in the databases such as PubMed,Cochrane Library,Ovid,ScienceDirect,EBSCOhost,CNKI,Wanfang and CBM while a manual search was added.The search was performed from 1980 to 2014.Two reviewers independently screened references,extracted data and assessed the risk of bias.Data was pooled and analyzed by using Revman 5.2 version.Results Eleven studies involving 2 207 participants from nearly 1 048 relevant studies met the inclusion criteria.1 174 participants were in the clinical pathway group while the other 1 033 participants were in the control group.Meta-analysis result showed that patients with asthma in a clinical pathway had a shorter length of stay,less medical cost,reduced rate of emergency room visits,and improved health education.However,clinical pathway did not appear to reduce readmission.Conclusions Clinical pathway can significandy reduce the length of hospital stay,cost,rate of emergency room visits and improve health education.

Objective To systemically analyze the effect of continuous aspiration of subglottic suction (CASS) on the incidence of ventilator-associated pneumonia (VAP) and other outcomes in mechanical ventilated patients.Methods PubMed,Cochrane Library,Ovid,EBSCOhost,ScienceDirect,Google scholar,CNKI,CBM and Wanfang Database were searched for the RCTs about the effect of CASS on the outcomes of mechanical ventilated patients from July 1994 to July 2014,and the relevant journals were also hand-searched.Data were extracted independently by two reviewers.Meta analysis was conducted using RevMan 5.1 software.Results Data extracted from 7 RCTs with a total of 1 566 patients were analyzed.The risks of developing clinically diagnosed VAP were significantly lower among the patients receiving CASS [RR =0.54,95％ CI(0.43,0.65),P＜0.01],episodes of VAP occurred later in patients receiving CASS [MD=3.52,95％CI(1.98,5.06),P＜0.01],the duration of mechanical ventilation [MD=-2.03,95％CI(-2.23,-1.73),P＜0.01]and length of ICU stay were reduced [MD=-2.99,95％CI(-3.75,-2.23),P＜0.01],while no significant differences were detected between the two groups regarding the mortality rate [RR=0.98,95％CI (0.80,1.20),P＞0.05].Conclusion This study proved that the CASS did have effect in reducing the incidence of VAP,but it is limited by lack of enough RCTs with high quality.Large sample of high quality RCTs is necessary to examine the wider applicability of CASS.

Objective To describe the burden of caregivers of children with asthma,and to provide reference for the development of family care support program.Methods Qualitative research was used to carry out semi-structured interviews with 13 caregivers of children with asthma in the pediatric outpatient of the First Affiliated Hospital of Guangzhou Medical University.The data collected were analyzed with Colaizzi 7-step analysis method.Results The carcgiver burden was classified into 4 themes,including time and energy exhaustion,heavy economic burden,insufficient knowledge of care and negative emotions.Conclusions The burden of caregivers of children with asthma has a relatively great impact on the daily work and life,even the physical and mental health.Care workers should be concerned about the status of caregiver burden and provide targeted interventions,which could help caregiver adapt to their roles,maintain and promote the health of children patients and their families.

Objective To explore the influence of minimally invasive puncture drainage on blood brain barrier (BBB) function and its mechanism.Methods Ninety-two patients with hypertensive intra-cerebral hemorrhage (HICH) in the Department of Neurosurgery of Jiaxing Affiliated Second Hospital of Zhejiang Province were divided into a control group and an observation group, according to random number table method, 46 cases in each group. In the control group, the conventional craniotomy was performed, while in the observation group, minimally invasive puncture drainage was carried out to remove the hematoma. The National Institute of Health Stroke Scale (NIHSS) were used to evaluate the neural function, the level of serum myelin basic protein (MBP) was detected by enzyme linked immunosorbent assay (ELISA), the central nervous specific serum protein S100 level was measured by electrochemical luminescence method, the albumin levels in serum and cerebrospinal fluid were determined by automatic biological analyzer, and the BBB index was calculated. After 14 days of surgery, the curative effect and incidence of complications of two groups were observed.Results After surgery, the NIHSS scores of two groups were obviously lower than those before surgery, and the degree of descent in observation group was more significant than that in the control group (score: 3.68±2.39 vs. 5.43±3.89,P < 0.05); after surgery, the levels of MBP, S100, albumin in cerebrospinal fluid and BBB in two groups were higher than those before surgery [MBP (μg/L): 3.02±0.28 vs. 3.81±0.29, S100 (μg/L): 0.95±0.24 vs. 1.34±0.27, cerebrospinal fluid albumin (μg/L): 9.89±0.78 vs. 21.43±1.14, BBB index: 0.22±0.04 vs. 0.48±0.05], the differences being statistically significant (allP < 0.05), but the change values in the observation group were less significant than those in the control group. The total effective rate in observation group was significantly higher than that in the control group [84.78% (39/46) vs. 65.22% (30/46),χ2 = 4.696,P = 0.030]. The incidence of wound infection, gastrointestinal bleeding in observation group was markedly lower than that in the control group [16.67% (6/46) vs. 36.96% (17/46), χ2 = 4.120,P = 0.042].Conclusion The minimally invasive puncture drainage has unequivocal clinical curative effect in treatment of patients with HICH, it can protect the nerve and BBB functions and reduce the incidence of complications.

Objective:To explore relationship among severity of cerebral infarction (CI) ,arteriosclerosis and serum level of cystatin C (CysC) in young and middle‐aged patients with atherosclerotic cerebral infarction (ACI) .Methods:A total of 82 young and middle‐aged ACI patients treated in our hospital from Feb 2013 to Sep 2015 were enrolled .According to CI volume ,they were divided into small infarction group (n=36 ) , medium infarction group (n=22 ) and large infarction group (n=24);according to CI severity ,they were divided into mild CI group (n=54) and severe CI group (n=28);ac‐cording to atherosclerotic plaque nature ,they were divided into stable plaque group (n=45) and unstable plaque group (n=37) .Another 46 healthy people were regarded as healthy control group .Serum CysC level during emergency period and recovery period and carotid intima‐media thickness (IMT) were measured and compared among all groups .Results:Com‐pared with emergency period ,there was significant reduction in serum CysC level in all subgroups of ACI during recovery period , P<0. 01 all;compared with healthy control group ,there were significant rise in serum CysC level [recovery peri‐od:(0.81 ± 0.24) mg/L vs .(1.03 ± 0.13) mg/L vs .(1.09 ± 0.19) mg/L vs .(1.18 ± 0.10) mg/L] during emergency period and recovery period in small ,medium and large infarction group ,and that of large infarction group was significantly higher than those of small and medium infarction group (P<0.01 all) .Compared with healthy control group ,there was significant rise in serum CysC level [recovery period:(0.81 ± 0.24)mg/L vs .(1.07 ± 0.15)mg/L vs .(1.19 ± 0.16)mg/L] during emergency period and recovery period in mild and severe infarction group ,and that of severe infarction group was significantly higher than that of mild infarction group ,P<0.01 all .Compared with healthy control group ,there were sig‐nificant rise in serum CysC level[(0.81 ± 0.24)mg/L vs .(1.18 ± 0.15)mg/L vs .(1.39 ± 0.27)mg/L]during emergency pe‐riod and IMT [(0.72 ± 0.10) mm vs .(1.24 ± 0.17) mm vs .(1.30 ± 0.14) mm]in stable plaque group and unstable plaque group ,and those of unstable plaque group were significantly higher than those of stable plaque group ,P<0. 01 all .Conclu‐sion:The serum CysC level significantly rises in ACI patients ,it can be used as an index for ACI prevention and treatment .

Purpose To compare the mammography and ultrasound imaging features of triple-negative breast cancer (TNBC) and non-triple-negative breast cancer (NTNBC), and to improve TNBC diagnosis. Materials and Methods Using immunohistochemical staining technique, 387 patients with pathologically conifrmed breast cancer were divided into TNBC group (n=54) and NTNBC group (n=333). Mammography and ultrasound ifndings as well as pathological data were retrospectively reviewed. Results TNBC was associated with higher tumor grades. There were signiifcantly more grade III inifltrating ductal carcinomas and axillary lymph node involvement in TNBC group than in NTNBC group (χ2=47.009, P<0.001;χ2=4.658, P<0.05). On mammography, TNBC most frequently presented with a mass (n=37, 69.8%) and was less associated with microcalciifcations (n=10, 18.9%). TNBC masses were mostly round or oval (n=28, 62.2%) with circumscribed margin (n=16, 35.6%). Spiculated margins were rare (n=5, 11.1%). NTNBC most frequently presented as a mass with calciifcations (n=138, 42.1%), and was more irregular in shape (n=119, 46.5%). Spiculated margins were common (n=77, 30.1%). There was statistically signiifcant difference between these two groups in mass, microcalcification, shape and margin (χ2=24.618, 19.889, 32.605 and 21.102, P<0.001). On ultrasonograhy, TNBC most frequently presented as a mass (n=52, 96.3%) with less microcalciifcations (n=5, 9.3%). TNBC masses were more frequently round or oval (n=27, 51.9%) with circumscribed margins (n=25, 48.1%). Spiculated margins were rare (n=3, 5.8%). TNBC was less likely to show attenuating posterior echoes (n=5, 9.6%);NTNBC most frequently presented as a mass (n=318, 96.1%) with microcalcifications (n=135, 40.8%). NTNBC masses were more frequently irregular in shape (n=243, 76.4%) with spiculated margins (n=76, 23.9%). NTNBC was more likely to show attenuating posterior echoes (n=78, 24.5%). There was statistically signiifcant difference between these two groups in microcalciifcation, shape, margin and posterior echo (χ2=19.006 and 18.339, P<0.001;χ2=16.170 and 8.429, P<0.05). Conclusion TNBC demonstrates round or oval mass with circumscribed margin and is less likely to show attenuating posterior echoes on mammography and ultrasound with benign imaging features. NTNBC frequently presents as irregular mass with spiculated margin, and is more associated with microcalciifcations. These imaging ifndings are useful in early diagnosis of TNBC.

Resident standardization training is an important means of clinical physician training in our country. Critical care medicine has important status in the training process. It is the important link to ensure the quality of resident standardization training. Residents should grasp the identification and early detection of critical ill patients. Residents should also get the ability of general basic management for critical condition and the doctor-patient communication ability. In practice, we have explored the training mode of standardized training of resident doctors in critical care medicine by developing detailed training outline, a variety of teaching methods and emphasizing the cultivation of clinical work ability.

Objective:To explore the correlation among serum levels of resistin ,oxidized low density lipoprotein (ox‐LDL) ,high sensitive C reactive protein (hsCRP) and severity of acute ischemic cerebrovascular diseases .Methods :A total of 92 patients with acute ischemic cerebrovascular diseases ,who were treated in our hospital from Nov 2013 to Nov 2014 ,were selected ,including 36 cases with transient ischemic attack (TIA ,TIA group) ,29 cases with re‐versible ischemic brain damage (RIBD ,RIBD group) and 27 cases with focal cerebral infarction (FCI ,FCI group) . Another 70 healthy volunteers were regarded as normal control group .Serum levels of resistin ,ox‐LDL and hsCRP were measured and compared among all groups .Pearson correlation analysis was used to analyze the correlation a‐mong serum levels of resistin , ox‐LDL , hsCRP and severity of acute ischemic cerebrovascular diseases . Results:Compared with normal control group ,there were significant rise in serum levels of resistin [ (0.26 ± 0.42)μg/L vs . (0.63 ± 0.38)μg/L vs .(0.91 ± 0.45)μg/L ,(0.89 ± 0.42)μg/L] ,ox‐LDL [ (334.3 ± 142.5) mg/L vs .(451.7 ± 15.8) mg/L vs .(518.3 ± 205.7) mg/L ,(520.7 ± 198.9) mg/L] and hsCRP [ (5.8 ± 4.9) mg/L vs .(8.7 ± 7.6) mg/L vs .(13.5± 9.1) mg/L ,(13.6 ± 7.4) mg/L] in TIA group ,RIBD group and FCI group (P< 0.01 all);those of RIBD group and FCI group were higher than that of TIA group (P<0.01 all) ,and there were no signifi‐cant difference in above indexes between RIBD group and FCI group (P>0.05 all) .Pearson correlation analysis in‐dicated that serum levels of resistin , ox‐LDL and hsCRP were significant positively correlated with severity of acute ischemic cerebovascular disease (r=0.473~0.902 , P<0.01 all) .Conclusion:Serum levels of resistin ,ox‐LDL and hsCRP can reflect severity of acute ischemic cerebrovascular diseases ,which is worth extending .

Objective To analyze the possible association of psoriasis vulgaris with herpes simplex virus type 1 (HSV-1). Methods Polymerase chain reaction was used to detect HSV-1 DNA in lesional skin biopsies, periphery blood mononuclear cells (PBMCs)and throat swabs from patients with psoriasis vulgaris, and ELISA was used to detect IgM and IgG antibodies against HSV-1 in sera from these patients. Results The positive detection rates of HSV 1 DNA in lesional skin biopsies, PBMCs and throat swabs were 37.5%, 18.6%and 18.8%, respectively. Anti HSV 1 IgM and IgG antibodies were positive in 37.2%and 53.5%of serum specimens, respectively. The detection rates of HSV 1 DNA in lesional skin biopsies and PBMCs, and IgM antibody in sera were significantly higher than those in normal controls. In psoriatic patients of guttate type the positive detection rates of HSV 1 DNA and IgM antibody were significantly higher than those in the plaque type. Conclusions There is strong association of psoriasis vulgaris, especially the guttate type, with HSV 1, and there may be recent infection of HSV 1 in these patients.