Objective To identify the reason and preventive methods from misdiagnosed cases of multiple myeloma(MM) initially manifested as lumbago.Methods Medical history and clinical data of 25 MM patients in department of hematology in our hospital were retrospectively analyzed to explore the clinical characteristics,misdiagnosis and prognosis of them.Results The 25 patients with initial presentation of lumbago were most misdiagnosed as bone and joint diseases,including 6 cases of lumbar disc,7 cases of lumbar compression fractures,6 cases of osteoporosis.And 1 cases of bone tuberculosis,3 patients of rheumatoid arthritis.And there were 2 cases of bone metastases,who were later diagnosed when anemia,neutropenia,thrombocytopenic and renal dysfunction appeared.The average misdiagnosed time was 7 months with a range of 3 months to 13 months.The median survival time was (29.2 ± 5.2) months in this group of patients.Conclusion MM,with the first manifestation of lumbago,has a single clinical manifestation and is often misdiagnosed as bone and joint diseases.Specialists who are not from hematology department should raise awareness and vigilance of the disease.Laboratory examinations results should be referred to in the diagnosis.Sum up experience in order to improve the early diagnosis of this disease and to effectively improve patient's prognosis and quality of life.

Food protein-induced enterocolitis syndrome(FPIES) is a series symptoms of recurrent vomiring and diarrhea caused by non-IgE-mediated food allergy to cow milk and soy in infants.The most common causative foods of FPIES are cow milk,soy and rice.Symptoms start within first days to 12 months of life.The sensitivity is usually outgrown by 3 years of age.The most common clinical symptoms observed include recurrent vomiting,diarrhea,fecal bloody,lethargy,pallor,etc.The diagnosis relies on history,clinical features,food eliminate,and oral food challenges.The food elimination is the mains treatment of FPIES management.

Early diagnosis,early treatment and the correct therapeutic approch are the keys for metastatic nasopharyngeal carcinoma(NPC) treatment.Currently,PET-CT is the best modality for distant metastasis staging of NPC.Cispalatin-based chemotherapy is the standard treatment method of metastatic NPC.Molecular targeted therapy is possible to further increase curative effect.When the lesions are limited,local palliative treatment may improve prognosis if patient's illness is controled by chemotherapy.

Objective To investigate the symptoms of diarrhea and the behavior of medical treatment after diarrhea in 2013 in Tianjin City, and provid background information for the future population monitoring. Methods A stratified sam?pling method was used to investigate the symptoms, medical treatment and self medication behavior of 4028 residents in Tianjin. Results The number of people who had diarrhea in 2013 was 324, and the incidence rate of diarrhea was 8.04%. Diarrhea was mainly occurred in May-October (n=241, 74.38%). The incidence of diarrhea was the highest in 60-74 years old group, followed by 75-years old and 0-14 years old groups. The incidence of diarrhea was the lowest in 15-29 years old grouop. A total of 121 patients with diarrhea chose to go to hospital (47.08%), 78 patients chose to buy medicine for treat?ment (30.35%) and 58 patients did not do any disposal (22.57%). Among the patients with diarrhea, the highest proportion of patients chose to go to the first grade and the following medical institutions (68.59%, 83/121). There were 14.05%(17/121) and 17.36%(21/121) patients chose to go to the second and the third levels of medical institutions for the treatment. The av?erage cost for patients with diarrhea was 60 (20, 200) yuan. The purchasing expenditure median was 20 (11,50) yuan. The medical spending was more than the purchase of medicines (Z=2.412, P<0.05). The average cost of medical treatment was more higher in the second and the third levels of medical institutions than that of the first medical institution ( Z=50.709,P<0.05). The average cost of medical treatment was in turn increased for patients with diarrhea treated in Baodi county, Xiqing county, Hangu county and Heping county (Z=74.282,P<0.05). There was no statistical significance in medical expenses be?tween patients with different ages and patient with or without medical insurance. Conclusion There are high incidence of diarrhea in patients under 15 years old and patients over 60 years old. Residents suffering from diarrhea mainly choose their own medicine and the treatment in the first and following medical institutions.

Objective Understanding current situation of pharmaceutical service before and since the ongoing health reform in community health institutions of China,and providing practical evidences to the government.Methods Adopting some indicators to comparative study the pharmaceutical care in 2008 and 201 1 in community health service institutions of China.Results From 2008 to 201 1, pharmaceutical service quality in general has greatly improved in community health institutions of China. For example,average number of drugs per prescription descended from 2.5 1 to 2.23.Percentage of prescriptions with an antibiotic descended from 43.98 to 32.08.Percentage of prescriptions with a hormone descended from 7.13 to 4.67.Percentage of prescriptions with two or more antibiotics descended from 1 1.24 to 7.31.These four indicators before and since the reform have statistical significance (P values are:0.003,0.001,0.003,0.004 respectively).But there are still inadequacies:from 2008 to 201 1,the average prescription cost descended from 59.63 to 5 1.18 yuan.Percentage of prescriptions with an IV drip descended from 34.84 to 30.41.These two indicators have not statistical significance(P values are 0.182,0.236 ).Conclusion To improve the quality of pharmaceutical service in community health institutions,the government should increase financial input to the community health institutions.

Objective To study the enlightenments of precision medicine, personalized medicine, stratified medi-cine, individualized medicine, P4 medicine on the medical cause in China. Methods Core papers on precision medicine, personalized medicine, stratified medicine, individualized medicine, and P4 medicine were retrieved from SCI core collection and PubMed. The concepts of precision medicine, personalized medicine, stratified medi-cine, individualized medicine, P4 medicine were analyzed by the VOSviewer. Results The concept of personalized medicine and individualized medicine can be used alternatively and is a coverage concept. The concept of stratified medicine and precision medicine is similar and is an inclusive concept. P4 medicine is a participatory medical model for patients. Tumor, chemotherapy, cells, diabetes mellitus, pharmacogenomics, and variants are the hot spots in precision medicine. Tumor, genomics, and public policy have a tendency to be integrated. Conclusion The develop-ment of precision medicine in China needs the design at the national top level, scientific policy-making, integration of scientific research system and resources, implementation of step by step strategy, overcoming of medical difficul-ties in order to realize personalized medicine at last.

After a description of the 6 types of reference management software ( EndNote, Mendeley, F1000Workspace, NoteExpress, King of medical literature and NoteFirst), their basic functions were comparatively analyzed.

OBJECTIVE:To evaluate economic effectiveness of 3 kinds of antimicrobial drugs for acute lithiasic cholecystitis,and to provide reference for rational use of antimicrobial drugs in biliary disease surgery.METHODS:A multicenter prospective randomized controlled study was conducted in 493 clinical cases of acute lithiasic cholecystitis.Cost-effectiveness analysis of cefoperazone/sulbactam sodium(therapy A n=180),cefuroxime(therapy B n=148) and levofloxacin(therapy C n=165) for acute lithiasic cholecystitis were carried out.RESULTS:Effective rates of three kinds of therapeutic regimens 95.56%,73.65%,84.24%,respectively.CONCLUSION:Incremental cost-effectiveness analysis of three kinds of therapeutic regimens shows therapy A is economical and the best choice for acute lithiasic cholecystitis compared with group B and C.

The purpose of the medical moral education is to make medical undergraduates form stable feature of the medical moral education psychology.While the traditional medical moral education has not been achieving the aim.Many studies of psychology has presented that it is important for study,training and medical moral of medical undergraduates by using implicit learning.In order to achieve the aim and ensure the result of medical moral education.we should take advantage of implicit learning to develop the medical moral education.

Progress in Cocaine toxicology research,especially in i ts toxicological mechanisms on the central nervous and cardiac-cerebral vascular systems, was reviewed in the last 5 years.The main problems with the current resear ch work and the future research direction were pointed out.