Objective To study the influence of long-term use of BZDs on the process and prognosis of elderly CAP.Methods The clinical information of the patients was retrospectively analyzed.According to whether the long-term use of BZDs was divided into the observation group (84 cases) and the control group (103 cases),there was no significant difference between the two groups (P ＞ 0.05).Two groups of patients were treated with conventional CAP,compared the two groups of patients with treatment,progress and prognosis of pneumonia.Results There was significant difference (P ＜ 0.05) in the therapeutic effect between the two groups;CPIS of the observation group after the treatment of 7d was significantly lower than that before treatment (P ＜ 0.05),later than that of the control group.The mortality rate,ICU ratio,hospitalization cost and days of the observation group were significantly higher than those of the control group (P ＜ 0.05).Adverse reactions were no significant difference (P ＞ 0.05) between the two groups.Conclusion Long-term using BZDs is not beneficial to the elderly CAP patients and worsen the prognosis situation.Therefore the clinical application of BZDs to elderly CAP patients should be made with cautiousness.

Objective To research effect of esomeprazole,mosapride,hydrotalcid treatment of gastroesophageal reflux disease(GERD),and find effective treatment methods.Methods 90 cases diagnosed as GERD patients were divided into the three groups:group A(30 cases),B group(30 cases),C group(30 cases).A group was treated with esomeprazole 40mg qd,B group was treated with esomeprazole 40mg qd,mosapride 5mg tid,C group was treated with esomeprazole 40mg qd,mosapride 5mg tid,three scenarios Hydrotalcid 1.0g tid treatment.The treatment methods remained for 4 weeks and 8 weeks and symptom remission were evaluated.Results The clinical remission rates were 66.7％,83.3％ and 90.0％ after four weeks treatment in A group,B group,C group; the clinical remission rates were 73.3％,90.0％ and 96.7％ after eight weeks treatment in A group,B group,C group.The total effective rate of group A and group C in eight weeks were significantly difference (P ＜ 0.05),A group and B group,B group and C group showed no significant difference(P ＞ 0.05).Conclusion Esomeprazole combined with mosapride,Hydrotalcid treated with GERD can get better efficacy,which can improve symptom relief rates.

Objective To explore the effect and utilization of comprehensive treatment on intrahepatic recurrence after hepatic resection for hepatocellular carcinoma.Methods One and two year recurrent rate of 60 patients with hepatocellular carcinoma who underwent hepatic resection in a two-year follow up were analyzed retrospectively,control group 30 cases,comprehensive treatment group 30 cases.Results One and two year intrahepatic recurrent rate of comprehensive treatment is 13％(4/30)and 40％(12/30)respectively.The difference was statistically singnificant(x2=4.176,4.310,all P＜0.05).Conclusion The effect of comprehensive treatment on postponing intrahepatic recurrence after hepatic resection for hepatocellular carcinoma is obvious.

Abstract: To investigate the factors affecting lean non-alcoholic fatty liver disease (NAFLD), so as to provide the reference for the prevention and treatment of lean NAFLD. Methods: Individuals who underwent physical examination at Huzhou Central Hospital from January 1, 2023 to March 31, 2024 and had a body mass index (BMI) <23 kg/m2 was selected. Demographic information, lifestyle behaviors, dietary habits and physical examination data were collected through questionnaire surveys. Lean NAFLD was assessed using abdominal ultrasonography combined with BMI. Factors affecting lean NAFLD were analyzed by using a multivariable logistic regression model. Results: A total of 627 individuals were surveyed, with a mean BMI of (20.83±2.01) kg/m2. There were 349 males (55.66%) and 278 females (44.34%). Lean NAFLD was detected in 74 cases, with a detection rate of 11.80%. Multivariable logistic regression analysis identified BMI (OR=1.830, 95%CI: 1.165-2.869), gender (male, OR=2.615, 95%CI: 1.402-4.875), triglycerides (OR=3.062, 95%CI: 1.613-5.812), alanine aminotransferase (OR=1.587, 95%CI: 1.106-2.277), vegetable and fruit intake (150-300 g/d, OR=0.416, 95%CI: 0.230-0.752; >300 g/d, OR=0.303, 95%CI: 0.141-0.649), dairy product intake (≥300 mL/d, OR=0.369, 95%CI: 0.195-0.701) and sugared beverage intake (1-250 mL/d, OR=1.601, 95%CI: 1.071-2.393; >250 mL/d, OR=2.438, 95%CI: 1.363-4.354) as factors affecting lean NAFLD. Conclusion The risk of lean NAFLD is associated with BMI, gender, triglyceride, alanine aminotransferase, and the vegetable and fruit, dairy product and sugared beverage intake.

Objective To investigate the effect of the serum obtained from rat with hepatopuimonary syndrome (HPS) on Akt mRNA and protein expression in rat pulmonary microvascular endotheliai cells (PMVECs) and the role of Akt signaling pathway in the proliferation of PMVECs in the HPS. Methods Healthy 3-4-month-old SD rats of both sexes were used in this study. HPS was produced by chronic ligation of common bile duct according to the method described by Fallon. liver cirrhosis and pulmonary microvascular proliferation were verified by microscopic examination of the liver and lung tissue 2 weeks after bile duct ligation. Serum was obtained from blood taken from aorta of HPS rats. Primary PMVECs were cultured and randomly divided into 2 groups: control group and HPS group. In HPS group serum was added to cultured PMVECs (final concentration was 10%) and incubated. Akt mRNA and protein expression was determined at 24, 48 and 72 h of incubation by RT-PCR and Western blot. The proliferation of PMVECs was detected by MTT and ~3H-TdR. Results The proliferation of PMVECs was significantly enhanced and the expression of Akt mRNA and protein was significantly increased in HPS group as compared with control group. Conclusion The Akt signaling pathway might play an important role in proliferation of PMVECs in the HPS.

Objective To learn the emergency response capacity of health authorities at city level in Shandong province in order to discover loopholes and make improvement. Methods The health emergency questionnaire designed by China Health and Family Planning Commission was used for survey of 1 7 city-level health authorities in Shandong province.Results 52.94% of the health authorities were found with health emergency reserve funding; 100.00% of them with public health emergency contingency plans;94.12% of them having health emergency supplies in kind;100.00% of them having health emergency training for all of the staff;100.00% of them with direct web reporting for public health emergency.Conclusion Such authorities were found with satisfactory health emergency capacity in general.Defects were found with emergency funding shortage,poor training and drilling outcomes, poor material reserves management,and insufficient health emergency personnel.

Objective To evaluate the Laparoscopic combined fiber choledochoscope common bile duct cho-lelithotomy for my own clinical experience in rencent five years.Methods Clinic data of 25 cases with choledocholi-thiasis undergoing laparoscopic common bile duct cholelithotomy from June 2010 to March 2014 were retrospectively analyzed.Results The operation was performed successfully in 24 cases,a case conversions to laparotomy,21 cases with T-tube drainage,3 cases with primary ductal submucosa closure.The operative time was 105 to 305min,mean (184.0 ±12.2 ) min, postoperative hospitalization time was 6 to 10 day, mean ( 7.7 ±0.2 ) day, a case residual stones,no bile leakage.Conclusion The beginning of Laparoscopic combined fiber choledochoscope common bile duct cholelithotomy,one-stage suture of common bile duct should be selected carefully, timely transfer laparotomy, should not aim for laparoscopic surgery success rate.

OBJECTIVE:To evaluate the curative efficacy of granulocyte macrophage colony stimulating factor (GM-CSF) as an adjunctive therapy for the treatment of acute myeloid leukemia (AML). METHODS: Randomized controlled trials (RCTs) of GM-CSF in the treatment of AML were retrieved from PubMed,EMBase,Cochrane Library,CBMdisc and CNKI database by computer as well as from the leukemia-related journals manually for a quality evaluation of the methodology and Meta analysis using RevMan5.0 software. RESULTS: A total of 10 RCTs were included,of which,3 RCTs were graded as A,5 as B and 2 as C. The results demonstrated that there were no significant differences of indexes among groups as complete remission (CR) rate,relapse rate,infection rate and length of hospital stay,etc. CONCLUSION: The available clinical research results showed that GM-CSF adjunctive therapy could neither increase CR rate,nor decrease the relapse rate,infection rate or length of hospital stay.

OBJECTIVE:To optimize the formulation of Mirabegron sustained-release tablets. METHODS:Using polyethylene oxide(PEO)and hydroxypropylmethyl cellulose(HPMC K4M)as the sustained release matrix,Mirabegron sustained-release tab-lets were prepared by powder direct compression technology. Using 1,3,5,7 h accumulative release rate as indexes,the amounts of PEO,HPMC K4M and OPADRY? were optimized by composite design-response surface method,and then validated. Accumula-tive release rates of sustained-release tablet and original tablet (MyrbetriqTM) were compared in different pH mediums (water,pH 1.0 simulated gastric fluid,pH 4.5 acetate buffer solution,pH 6.8 phosphate buffer solution) at different rotation rates (100,50 r/min),and similiar factor f2 was calculated to fit drug release model of sustained-release tablet. RESULTS:In the optimized firmu-lation each Mirabegron sustained-release tablet contained mirabegron 25 mg,PEO 108.02 mg,HPMC K4M 21.69 mg,OPADRY? 2.27%. Relative error of accumulative release rates at 1,3,5,7 h to predicted value were 4.78%,3.48%,0.69% and -1.41%, respectively. f2 of release curves of sustained-release tablet and original tablet were higher than 65 in different pH medium at differ-ent rotation rates. The drug release of sustained-release tablet was fitted to zero-order release equation. CONCLUSIONS:Mirabe-gron sustained-release tablet by optimized technology is similar to original tablet in drug release behavior.

Objective To analyze the clinical and pathological characteristics of breast carcinoma in elderly female patients and to offer the standard clinical diagnosis and treatment for breast carcinoma.Methods A total of 178 patients admitted to Breast Center of Beijing Hospital from January to December 2011 were enrolled in this retrospective study.Patients were divided into non-elderly group and elderly group.Clinical features,imaging diagnosis,operation patterns and pathological diagnosis were recorded.The data were analyzed by using SAS 9.1 software.Results The patients diagnosed as breast carcinomas in BI-RAD 4-5 categories by mammography were much more in the elderly group than in the non-elderly group (82.1％ vs.63.0％,P＜0.05).The diagnostic accuracy rates of ultrasonography and mammography in the elderly group were comparable(P＞ 0.05),while in the non-elderly group,the diagnostic accuracy rate of ultrasonography was higher than that of mammography (P＜0.05).The incidence of concurrent diseases was higher in the elderly group than in the non-elderly group (P＜0.05).The patients undergoing breast resection operation were much more in the elderly group than in the non-elderly group (14 cases vs.3 cases,P＜0.05).The pathological diagnosis analysis showed that there were no significant differences in the number of ER-positive cells and PR-positive cells,tumor size,histological grade,pathological stage between the two groups (all P＞0.05).The incidence of lymph node metastasis was lower in the elderly group than in the non-elderly group (P＜0.05).The percentage of Ki-67 positive cells was lower in the elderly group than in the non-elderly group (P＜0.05).The percentage of CerbB-2 strongly positive (+++) cells was lower in the elderly group than in the non-elderly group (5.1 ％ vs.24％,P＜0.05).The invasive ductal carcinoma was the major histological type of breast cancer in both two groups,but there were more mixed type and other type carcinomas in the elderly group than in the non-elderly group (P＜0.05).Conclusions Ultrasonograpy and mammography have better sensitivity for breast cancer in elderly female patients.The surgical protocols are often influenced because more concurrent diseases have occurred in the elderly.There are significant differences in some prognostic factors between the two groups,which may imply a better prognosis in elderly patients.