Objective To evaluate the skills in using inhalers among the asthmatic patients who visited the out-patient clinic and whether or not the nursing intervention could further improve the efficacy of the drug delivery device. Methods 321 asthmatic patients who had visited the clinic and prescribed inhalers from April to December 2009 were investigated of the basic status, former medication history and skills in using metered dose inhaler (MDI) and dry powder inhaler (DPI). Nursing intervention had been carried out and the results were analyzed. Results Subjects belonging to different educational level groups were significantly different in mastering skills using MDI and DPI after reading instructions. There also existed significant difference between MDI and DPI users. Among patients who had already used inhalers, there was significant difference between subjects who had received instruction from medical personnel and subjects who had only read paper directions. Nursing intervention could significantly improve the skills in handling the device. Conclusions Proper skills in using inhalers could not be possessed just by reading paper directions. Instructions or even multimedia presentation from medical personnel are vital for asthmatic patients to master the skills in using MDI and DPI.

Two hundred and twenty-four patients with metabolic syndrome (MS) and 200 subjects as normal controls were included in this study.Genotyping of +276G/T,+45T/G SNPs in apM1 gene was made by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique,and then the distribution and differences in genotypes and allele frequencies in the population were observed.It was found that the G/T polymorphism of +276 site was associated with MS,while +45 T/G polymorphism had nothing to do with MS.It is suggested that the +276G/T polymorphism may be a predisposing factor of MS.

Objective To study the X-ray imaging characteristics of gouty arthritis. Methods The X-ray plates from gouty arthritis were analyzed. Results The gouty arthritis usually occurred in the first metatarsophalangeal joint. The X-ray findings were dissymmetric swellings of soft tissue,bony erosion defect with sharp and hard edge,narrowed joint space and irregular articular surface,emergence of fiber stiffness,even joint malformations and sublimation or dislocation, associated with hyperosteogeny and nearby osteoporosis. Conclusion Diversification was presented in X-ray findings of gouty arthritis, which could be easily confused with other single or multiple bone joint diseases. As a result, accurate diagnosis should be based on careful analysis about X-ray findings.

Objective: To study the relationship between plasma level of N-terminal B-type natriuretic peptide (NT-proBNP) and ventricular diastolic dysfunction in elder hypertensive patients without target organ damage.
Methods: A total of 66 relevant patients treated in our hospital from 2012-03 to 2014-03 were studied. According to the standard of ventricular diastolic dysfunction, the patients were divided into 2 groups: Study group, n=27 patients with diastolic dysfunction and Control group, n=39 patients without diastolic dysfunction. The patients in Study group were further divided into 3 sub-groups based on Doppler classification of diastolic dysfunction:Grade 1, the patients with E/A<1.0, DT≥240 ms, IVRT>90 ms, n=8. Grade 2, the patients with E/A>1.5, DT (150-220) ms, IVRT<90 ms, n=13. Grade 3-4, the patients with E/A>1.5, DT≤150 ms, IVRT<70 ms, n=6. Plasma levels of NT-proBNP and Doppler ultrasound findings were compared to study the relationship between
NT-proBNP and ventricular diastolic dysfunction.
Results: Plasma level of NT-proBNP was higher in Study group than that in Control group. NT-proBNP level in Grade 3-4 sub-group was obviously higher than those in Grade 1 and Grade 2 sub-groups, NT-proBNP level in Grade 2 sub-group was higher than that in Grade 1 sub-group. Pearson correlation analysis indicated that NT-proBNP level was positively related to systolic blood pressure, diastolic function and E/E’ (r=0.211, P=0.037, r=0.442, P=0.004 and r=0.556, P=0.000), while negatively related to E’/A’ (r=-0.372, P=0.000).
Conclusion: The increased plasma level of NT-proBNP are highly support for ventricular diastolic dysfunction in elder hypertensive patients without target organ damage, NT-proBNP level is related to ventricular diastolic function.

HM(hibernating myocardium)is an adaptive phenome-non of myocardium against sustained ischemia,which maintains its tissue vitality through balancing energy supply and demand.It widely exists in patients suffering from coronary heart disease. HMhas its own metabolic pattern,instead of regular FAO(fatty acid β-oxidation)-based metabolism,glycolysis became main pro-cedure.Reduction of FAO,TCA (tricarboxylic cacidcycle),ETC (electron transport chain)enzyme has been observed,ROS(reac-tive oxygen species)and UCP2(uncoupling protein 2)have been up-regulated.UCP2,which promotes proton leak across innermembrane of mitochondrial and leads to ATP reduction,has e-merged as an important regulator of the energy production.It is regulated by up-stream proteins such as AMPK,PPARs,PGC-1α,and other factors like FFA(free fat acid),ROS and purine nucleotide.HM has potential function of ischemic myocardium, which can improve cardiac function through reasonable interven-tion.Modulation of UCP2 can optimize energy production,and is essential to HM metabolism.

Objective To explore the lowest effective dosage of mifepristone combined with misoprostol in terminating ultra-early pregnancy.Methods All the cases of ultra-early pregnancy classified by amenorrhea days,β-hCG and vaginal B-ultrasonic were randomly divided into two groups.One hundred cases in G1 group (minimized dosage) were orally administered 25 mg mifepristone once a day for 2 days and combined with 200 μg misoprostol 48 hours later,while 150 mg mifepristone combined with 600 μg misoprostol 48 hours later were given to 100 cases in G2 group (normal dosage).All cases were observed for 6 hours after taking misoprostol and returned for assessment three days later.Results None missing.Expulsion of conceptus:G1 and G2 group were 22 (22.0％,22/100) and 25 (25.0％,25/100;P ＞ 0.05).Failure rate:cases with incomplete abortion were 1 (1.0％,1/100) and 2 (2.0％,2/100) in G1 and G2 group,hospitalization for suspected ectopic pregnancies both was 1 (1.0％).Bleeding:bleeding cases during the administration of mifepristone in G1 and G2 group were 71 (71.0％,71/100) and 78 (78.0％,78/100; P＞0.05); the mcan bleeding time were (5.3 ± 1.4) days and (6.0± 1.5) days (P ＜0.01).Other side effects:in G1 group,majority showed light nausea (7.0％,7/100) and light abdominal pain (20.0％,20/100).Menses recovery:99 (99.0％,99/100) for G1 group and 98 (98.0％,98/100) for G2 group to recovery on scheduled time.Satisfactions:both were 99 (99.0％,99/100).Except mean bleeding days and side-effects,the differences above showed no significance (P ＞ 0.05).Conclusion It is safe and effective treatment with the lowest dosages of mifepristone and misoprostol to terminate ultra-early pregnancies.

ObjectiveTo explore the relationship of the fragmented QRS (fQRS) and the fQRS time limit with ventricular arrhythmia in old myocardial infarction (OMI) patients through contrasting the incidence of ventricular arrhythmia in OMI patients whether fQRS or not and ventricular arrhythmia in different fQRS time limit.MethodsAccording to the routine electrocardiogram,321 OMI patients were divided into group A (fQRS appearance,167 cases) and group B(fQRS non-appearance,154 cases).The lead with fQRS extense was ehosen and traced another 50 mm/s electrocardiogram,and 3 consecutive fQRS time limit were measured and them average was taken in group A.According to the fQRS time limit,the patients in group A were divided into 3 groups: group X( ≤0.100 s,96 cases),group Y (0.101-0.119 s,54 cases) and group Z( ≥0.120 s,17 cases).All the patients were continuously monitored with 24 hours dynamic electrocardiogram,and the incidence of ventricular arrhythmia was analyzed.ResultsThe incidence of ventricular arrhythmia in group A [ 78.4％ ( 131/167 ) ] was higher than that in group B [ 63.6％(98/154) ] (P＜ 0.01 ).The incidence of premature ventricular contraction(PVC) ＞ 720/24 hours in group A [ 28.7％(48/167 ) ] was higher than that in group B[ 17.5％(27/154) ] (P ＜ 0.05 ).The incidence of multifocal PVC,coupled PVC,nonsustained ventricular tachycardia and Lown 3-5 grades PVC was 16.2％ (27/167),33.5％ (56/167),12.0％ (20/167),34.1％ (57/167) in group A,7.8％ (12/154),21.4％ (33/154),4.5％(7/154),23.4％(36/154) in group B,there were significant differences between two groups (P＜ 0.05 ).The incidence of ventricular arrhythmia in group Z [ 100.0％( 17/17 ) ] was significantly higher than that in group Y [79.6％(43/54)] and group X [74.0％(71/96)](P＜ 0.05).The incidence of Lown 3-5 grades PVC in group Z[ 70.6％( 12/17 )] was significantly higher than that in group Y[ 42.6％(23/54)] and group X [ 22.9％(22/96) ],and the incidence of Lown 3-5 grades PVC in group Y was significantly higher than that in group X (P＜ 0.05).ConclusionsOMI patients with fQRS have higher incidence and severe degree in ventricular arrlhythmia than those without fQRS.With the fQRS time limit widened,PVC and Iown 3-5 grades PVC significantly increased.So fQRS is a new predicting index of OMI,and fQRS time limit has definite value in predicting the heart event for OMI patients.

Objective To investigate the infection status of Helicobacterpylori (HP) in the physical examination population and the contents of pepsinogen Ⅰ (PGⅠ),pepsinogen Ⅱ (PGⅡ) and gastrin-17 (G-17) in serumand the association with HP infection.Methods In this study,781 cases of physical examination were included.Serum HP antibody typing,PGl,PGⅡ and G-17 were measured by Helicobacter pylori antibody kit and enzyme-linked immunosorbent assay.The levels of PGⅠ,PGⅡ,PGⅠ/PGⅡ and G-17 were analyzed by SPSS22.0 analysis system,and the difference of HP infection rate between HP infection group and non-infected patients and different types of infection was analyzed.Analysis of the infection rate and the difference of each age group.Results There was no significant difference between the two groups (x2 =0.284,P=0.594),and there was significant difference between different age groups (x2 =8.523,P=0.014).The levels of PGⅠ,PGⅡ,PGR and G-17 in serum were statistically significant (Z=8.616～ 14.125,P=0.000) compared with those of HP positive and negative.There were significant differences in serum PGⅡ and PGR levels between HP Ⅰ type and HP Ⅱ type infection (Z=3.444,3.385,P=0.001).The levels of PGⅠ and PGⅡ in serum were significantly higher than those in other groups (Z=5.012,4.478,P=0.000).PGⅠ and PGⅡ were higher in women than in females (Z=0.444～0.941,P＞0.05),with the increase of age,PGⅠ,PGⅡ and G-17 has an upward trend,while PGR showed a downward trend.Conclusion The level of serum PG was closely related to gender,age and HP infection,and was closely related to HP infection classification.The combination of HP antibody typing and serum PG and G-17 as a routine test of gastric function is of great significance in the screening and evaluation of early gastric diseases.

Objective To explore the application value of interferon gamma release assay (IGRAs)in the clinical detection of tuberculosis infected T lymphocytes.Methods Used IGRAs method to detect the 11 968 outpatients and hospitalized pa-tients from 2013 to 2016 with tuberculosis screening.According to the distribution department analysis,also of positive case detection according to age and gender were analysis and comparison and analysis on the uncertainty of results,different methods were compared.Results Among the 11 968 cases,2 048 cases were positive,the positive rate was 17.11%,and the uncertain result was 107 cases,which accounted for 0.89% of the total number.The positive rates from 2013 to 2016 were 19.65%,21.35%,15.82% and 13.56%,respectively.In the detection and screening of pulmonary and pulmonary tuberculo-sis,the positive rates of the department of respiration,the digestive department,the oncology department,the department of neurology and the department of gynecology were 22.07%,20.27%,23.38%,12.84% and 11.86%,respectively.In the positive screening,men accounted for 62.11%,women accounted for 37.89%,men were significantly higher than women.By age group,was less than or equal to 15,16~25,26~45,46~65,was more than orequal to 66 years old,positive rate were 1.96%,18.51%,16.54%,21.25% and 25.73%,respectively.Analysis of uncertain outcome data,department of respira-tion,rheumatism,department of hematology,accounted for 1.99% and 2.35%,respectively.Compared with other laboratory methods,the IGRAs method had obvious advantages.Conclusion Tuberculosis occurs in various body organs,there were differences in gender and age of Mycobacterium tuberculosis infection.IGRAs is a sensitive and specific method for rapid de-tection of Mycobacterium tuberculosis infection,although it can not be used as a diagnostic indicator,but in patients with suspected tuberculosis IGRAs has a larger clinical application value for the further diagnosis of disease.

Objective To investigate the diagnostic value of the single detection and combined detection of Epstein-Barr virus (EBV) VCA-IgM ,aspartate transaminase (AST) and alanine transaminase (ALT) in EBV current infection .Methods The VCA-IgM positive simples tested by chemiluminescence from January to October 2016 were collected .EBV-DNA was detected by RT-PCR .AST and ALT were detected by using the enzyme rate method .Then samples were divided into the EBV-DNA positive group and EBV-DNA negative group .SPSS22 .0 was used for conducting the non-parametric test .Then each indicator was analyzed by the Logistic regression and receiver operating characteristic (ROC) curve .Results The levels of VCA-IgM ,AST and ALT in the EBV-DNA positive group were higher than those in the EBV-DNA negative group ,the difference was statistically significant (P<0 .05) . VCA-IgM ,AST and ALT showed a correlation with EBV-DNA (P<0 .05) .The areas under curve (AUC) of VCA-IgM ,AST and ALT single indicator detection curve were 0 .803(95% CI:0 .735 -0 .872) ,0 .788(95% CI:0 .708 -0 .868) ,and 0 .752(95% CI:0 .671-0 .832) ,respectively ;AUC of 3-indicator combined detection were 0 .830(95% CI:0 .765 -0 .896) ,which was high than AUC of each single indicator detection .Conclusion Among the indicators in EBV current infection ,VCA-IgM is of great diagnostic value ,and is superior to AST or ALT .Furthermore ,the combined detection of these three indicators is better than single indicator detection ,which contributes to the diagnosis and prevention of EBV infection and other complicating infection .