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.

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 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.

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.

Genome sequencing and bioinformatics is driving the discovery of drug targets and development of novel classes of broad spectrum antimicrobial compounds. The analysis of the complete genome sequences of microorganism available in the public databases offers the first insights into the drug targets discovery. This review discusses the use of genomic information in the finding of target genes for antimicrobial drug discovery.

Objective To investigate the rule of the aquaporin 4 (AQP 4) expression in the acute ischemic cerebral tissues, and to study the molecular biologic mechanism of diffusion weighted imaging (DWI). Methods Thirty six Wistar rats were divided into 2 groups randomly, including control group ( n = 12) and operation group ( n =24). The operation group was studied after the right middle cerebral artery was unilaterally occluded (MCAO) at an interval of 15 min, 30 min, 1 h, 3 h, 6 h, and 24 h, respectively ( n =4 for each sub group). The operation process of the control group was the same as the operation group except MCAO. All rats in both groups were examined with DWI. The relative ADC (rADC), relative density (rd), and relative area (rs) of the biggest hyperintensity signal layer on DWI were measured. After that, the animals were sacrificed and perfused with the mixture solution consisting of TTC at different time intervals. The biggest layer of the ischemic cerebral tissues stained with TTC and corresponding to that of DWI was examined with immunochemistry and in situ hybridization. The AQP 4 expression AQP 4 (△S and ?) was measured with the Image Analyzer. Meanwhile, histologic examination was performed at each group. Results There was no significant change of the DWI and the pathology, as well as the AQP 4 expression in the control group. In the operation group, abnormal high intensity was found in DWI of ipsilateral MCA territory at 15 min after MCAO, and rADC value decreased quickly within 1 h after MCAO, while the AQP 4 expression, the rd DWI, and the rs DWI increased rapidly in the stage. With the progress of the time, the rADC value further decreased at 3 h, and then began increasing slowly till 24 h . But the AQP 4 expression (△S and ?) and the rd as well as the rs continuously increased slowly between 1 h and 6 h after MCAO, then they had an increasing peak except the rd. The AQP 4 expression, rd DWI, and rs DWI all showed positive linear relationship with time, presenting as 2 peaks and a plateau. The corresponding sequential pathologic changes were gradual increase of intracellular edema (

Unregistered drug use,also called off-label drug use,has become a universal phenomenon in clinical practice worldwide.At present,there is still no definite laws and regulations in the field of off-label medication in China.The article gives an overview about the current criterion for prescription in China,the definition of off-label use,analysis of this situation and causes,how to regulate this practice to protect the patient's rights and safety,and also doctor's rights of prescription.

Abstact: Biqiu is equivalent to allergic rhinitis in modern medicine. Ancient and modern literature has shown that acupuncture has a good clinical efficacy on this disease. However, there is no uniform specification in the choice of acupuncture methods (such as acupuncture, moxibustion, warm acupuncture and so on) and the selection of acupoints. According to the etiology and pathogenesis of allergic rhinitis and its clinical manifestations, Biqiu can be classified as“fluid retention disease”in TCM. This article tried to provide a new idea for acupuncture treatment of Biqiu from the perspective of the treatment of“fluid retention disease”in TCM.

A Review] The neuroendocrine-immunoregulatory network is fundamental to the maintenance of homeostasis. In this article, the authors present an overview of the role of neuroimmunoregulatory mechanism in the occurance and development of some diseases, which may have important therapeutic implication for the clinics.