Objective To investigate the caregivers' difficulty in taking care of the elderly and the related factors. Method A self-designed questionnaire was used to investigate the difficulties in care giving among 1,517 caregivers. Results The total score on the difficulties was (16.16 ±5.79). The preventive factors were good care-related knowledge and family income and the risk factors were advanced age, poor health condition of the patients ( all P<0.01). Conclusions The difficulty in caring the elderly are varied. We should attach importance to those caregivers of advanced age, with lower income and lack of care-related knowledge. Meanwhile, we should provide consultation, education and training for caregivers according to their different situation, and carry out targeted and multi-level support services so as to solve their problems in care to the patients.

Objective To study the effects of Qingjinkangkuoyin (QJKKY) on TNF-α and NE in rats with bronchiectasis.Methods Models were established by intrabronchially injecting with pseudomonas aeruginosa,and divided into 5 groups by random:the QJKKY high dose treatment group (given high dose of QJKKY into stomach),the QJKKY low dose treatment group (given low dose of QJKKY),the levofloxacin group (given levofloxacin),the model group (given normal saline),and the normal contrast group (given normal saline).After 2 weeks of treatment,the histopathology of lung tissue,the levels of TNF-α and inflammatory cells in peripheral blood and NE in rats' lung tissue were detected.Results Compared with the model group (160.425±9.9293)ng/L,QJKKY could decrease the level of TNF-α in blood significantly [high dose of QJKKY treatment group was (137.133±6.1646)ng/L,P＜0.05]; the expression of inflammatory cells in serum were decreased significantly by QJKKY [high dose of QJKKY treatment group was (1.106± 0.3580) 109/L,P＜0.05].Low dose of QJKKY treatment group was (1.086 ±0.2433) 109/L,(P＜0.05) ; the expression of NE in lung tissue were decreased remarkably by QJKKY [high dose of QJKKY treatment group(80.697 ±4.5877)ng/L,P＜0.05]; low dose of QJKKY treatment group is (80.747±3.6925)ng/L,(P＜0.05); and the histopathologic change of lung tissue in QJKKY treatment groups were ameliorated under light microscope by HE staining.Conclusion Qingjinkangkuoyin could cure bronchiectasis by decreasing the expression of TNF-αin peripheral blood and NE in rats' lung tissue.

Objective To investigate the relationship between the levels of intedeukin(IL)-6, IL-15 and endometriosis (EM). Method The levels of IL-6, IL-15 in the peritoneal fluid (PF) and serum of 74 patients with EM (EM group) and 46 patients without EM (control group) were measured by double-an-tibody ELISA. Results Higher levels of IL-6 in PF and serum were observed in EM group [(1017.81±361.98) ng/L,(455.47±161.52) ng/L]than those in control group [(284.63±70.50) ng/L,(149.37± 43.09) ng/L], and there was significant difference (P<0.01). The levels of IL-6 in PF and serum in EM group with stage Ⅲ-Ⅳ [(1253.44±189.63) ng/L, (556.50±93.34) ng/L]were significantly higher than those in patients with stage Ⅰ-Ⅱ [(582.81±107.75) ng/L, (268.96±63.48) ng/L](P < 0.01). There was positive relationship between the levels of IL-6 in PF and serum (r=0.950, P=0.01). The levels of IL-15 in PF in EM group [(333.45±63.94) ng/L]were significantly higher than those in control group[(203.85± 70.52) ng/L](P<0.01). No significant difference was found in the levels of serum IL-15 between EM group and control group (P>0.05). No significant difference was observed either in the levels of IL-15 in PF and serum between patients with stsge Ⅲ-Ⅳ and stage of EM Ⅰ-Ⅱ (P>0.05). Conclusions The increase of IL-6, IL-15 in PF may contribute to the development of EM. Serum IL-6 levels are of clinical diagnostic value in patients with EM.

Objective To observe the protective effect of Vdvet-feeling on phlebitis in rabbit ears induced by Fluorouracil.Methods The models of Fluorouracil induced phlebitis in rabbit ears were established.24 rabbits were randomized into three groups:group A used Velvet-feeling for wet dressing,group B was the blank control group C was coated with Hirudoid.The vein was assessed before and after the intervention,and the changes in appearance of vein and the occurrence of phlebitis were observed.The samples of local vein and surrounding tissues were cut off 24 hours after intravenous injection of Fluorouracil and were made pathological sections,HE staining.The pathological damage degree of the vein and surrounding tissues were evaluated by light microscopy.Results The degree of phlebitis in group A and C were lower than group B,there was significant difference.There was significant difference between group A and C at the degree of phlebitis,especially in infiltration of inflammatory cells of vessel wall and perivascular edema.Conclusions Early application of the Velvet-feeling or Hirudoid coating were better in prevention of Fluorouracil induced phlebitis,and wet dressing of Velvet-feeling was better than Hirudoid coating.

Objective To investigate the morphological changes of the head,body and tail of the hippocampus in patients with Alzheimer's disease (AD).Methods Totally 30 AD (AD group),30 mild cognition impairment (MCI) patients (MCI group) and 30 normal old persons (normal control group) underwent brain MR scan.Based on the MR images,the head,body and tail of the hippocampus were segmented and the volume was measured.The difference of the volume in total,head,body and tail of hippocampus in AD group,MCI group and normal control group were compared.The correlation between hippocampal volume and the scores of neurological assessment scale was analyzed.Results The left total,head,body and tail volume were greater than those of the right side in 3 groups (all P＜0.05).For the comparison of total volume of left and right sides among the 3 groups,AD group was less than normal control group (both P＜0.01) and MCI group (both P＜0.05),MCI group was less than normal control group (both P＜0.05).Compared with the normal control group,the head,body and tail volume of hippocampus of both sides were decreased in AD group (all P＜0.05) and the volume of left head,body and right head of hippocampus in MCI group were decreased (all P＜0.05).Both sides hippocampus's head and body volume of AD group were less than those of MCI group (both P＜0.05).The scores of minimum mental state examination (MMSE) were positively correlated with the total and the head,body,tail volume of bilateral hippocampus.Except volume of left tail,there were negative correlations between the scores of activities of daily living (ADL),clinical dementia rating (CDR) and the volume of total and head,body,tail of bilateral hippocampus,which were positively correlated with Montreal cognitive assessment (MoCA) score.Conclusion The volume of bilateral hippocampus was significantly reduced in AD patients.The head of hippocampal volume was significantly reduced and the body and tail was not obvious.

Because of ignoring the basic knowledge training, the medicine graduates lack ba-sic knowledge of clinical pathology, which has seriously affected their improvement of medical skills. The paper analyzes the status of pathology teaching in clinical medicine graduates and the necessity to strengthen clinical pathology general education. Then it proposes measures about enhancing clinical pathology general education, so as to increase the basic clinical pathology knowledge of medical grad-uates.

Objective To study whether there is a correlation between the content of neutrophil gelatinase-asociated lipocalin (NGAL) and extravascular lung water index (EVLWI) in patients with acute lung injury (ALI) induced by septic shock.Methods We prospectively collected 110 patients with septic shock from December 2013 to June 2015,who had already completed the initial fluid resuscitation within 6 hours according to the guide.In accordance with whether combined with ALI,patients were divided into two groups:non ALI group was A group (n =61),and ALI group was B group (n =49).Baseline information,EVLWI and other indexes of hemodynamic monitored by PICCO of each group was collected prior to admission in intensive care unit.EVWI and the content of NGAL in alveolar lavage fluid,which detected by ELISA,were gathered after the initial fluid resuscitation.Results There were no significant differences at the baseline level between the two groups (P ＞ 0.05).The risk factors of EVLWI in patients with septic shock were analyzed by multivariate linear regression analysis.The risk factors contained fluid balance,NGAL,cardiac index (CI),Global end diastolic volume index (GEDI),human albumin (ALB),globulin (GLO).The results showed that EVLWI had linear regression with NGAL and GEDI.The equation of linear regression were Y(NGAL) =2.017 + 0.035X,and Y(GEDt) =-0.671 + 0.004X,respectively.Correlation analysis indicated that there was significantly positive correlation between EVLWI and GEDI (r=0.835,P=0.000)and between NGAL and GEDI (r=0.489,P=0.000).In contrast,after immobilization of GEDI,we did not find any significant correlation between EVLWI and NGAL (r =0.381,P =0.060).Conclusions In case of fluid infusion volume is relatively too much,there is a strong correlation between NGAL in alveolar lavage fluid and EVLWI levels for early fluid resuscitation in patients with sepetic shock.

Objective To explore the influence of the lactation exposure to fluoxetine on offspring's behavior and serotonin transporter (SERT) and tryptophan hydroxylase (TPH). Methods Six SD pregnant rats were randomly divided into 2 groups (n=3 each group). Experimental maternal rats were intraperitoneally injected with fluoxetine at a dose of 12 mg/kg from postnatal day 5 to 21. The control group were injected with the same amount of normal saline. In infancy, the offspring's weight, hair length, eye opening and auditory development were measured. The free suspension test and bur?ied food pellets test were applied to evaluate the offspring's behaviors. After postnatal day 21, all the offspring were wean. At early childhood (P35d) and adulthood (P75d), 6 offspring rats from each group were executed to examine SERT and TPH in the prefrontal cortex by immunohistochemistry. Results The offspring's weight of experimental group was significantly lower than control group (P<0.05). The sensitivity of auditory in experimental group was significantly higher than control group (P<0.01). The time of free suspension in experimental group significantly was decreased comparing to control group (P<0.01). The SERT and TPH in prefrontal cortex was significantly lower in experimental group than those in control group either at childhood (P35d) or at adulthood (P75d) (P<0.05). Conclusion Lactation exposure to fluoxetine re?sults in offspring's abnormal development and behaviors through down-regulation of SERT and TPH in the prefrontal cor?tex.

Objective To analyze clinical characteristics of pemphigoid nodularis. Methods Seven cases of pemphigoid nodularis were included in this retrospective study. The clinicopathological features of pemphigoid nodularis were retrospectively analyzed, including patients′gender, age at onset, clinical manifestations, treatment and follow?up. Results Of the 7 patients, 4 were female and 3 were male, with the median age at onset being 59 years. Clinical manifestations mainly included markedly pruritic prurigo?like lesions and nodular lesions with or without blisters. The most common misdiagnoses were nodular prurigo and eczema. Pathology showed epidermal hyperplasia and subepidermal clefts, collagen hyperplasia in the papillary dermis, and perivascular infiltration of lymphocytes and eosinophils in the superficial dermis in all the patients. Direct immunofluorescence assay showed linear deposition of IgG and C3 in the basement membrane zone, and indirect immunofluorescence was positive in 2 patients. Glucocorticoids combined with immunosuppressants were effective in all the patients. Conclusions Pemphigoid nodularis is easy to be misdiagnosed, and immunopathology is helpful for its diagnosis. Glucocorticoids combined with immunosuppressants appear to be effective for its treatment.

Objective:To explore the clinical characteristics of chronic kidney disease (CKD) at the stage 3-5D in children with renal anemia, and provide reference data for standardized diagnosis and treatment.Methods:A single-center retrospective study was conducted to collect clinical data in children with CKD at Beijing Children's Hospital Affiliated to Capital Medical University from January 2016 to December 2018. The patients were divided into CKD stage 3 group, stage 4 group and stage 5 group according to estimated glomerular filtration rate. The indexes of anemia among the groups were compared. Data on anemia indicators, treatment, and anemia improvement in maintenance dialysis children at stage 5D were analyzed.Results:A total of 171 children with CKD were included in the study. The hemoglobin levels in CKD stage 3 group, stage 4 group and stage 5 group were (126.4±20.5) g/L, (90.8±26.0) g/L and (78.7±18.4) g/L, respectively, and there was a statistical difference among the groups ( χ2=61.982, P<0.001; trend test F=71.061, P<0.001). The incidences of anemia in children with CKD stage 3, stage 4 and stage 5 were 27.3% (9/33), 83.3% (25/30) and 95.4% (105/108), respectively. Mild, moderate and severe anemia in children with CKD stage 3 accounted for 15.2%(5/33), 12.1% (4/33) and 0(0), respectively. Mild, moderate and severe anemia in children with CKD stage 4 accounted for 26.7% (8/30), 50.0% (15/30) and 6.7% (2/30), respectively. Mild, moderate and severe anemia in children with CKD stage 5 accounted for 21.3%(23/108), 60.2%(65/108) and 15.8%(17/108), respectively. Anemia type was mostly normocytic anemia. The hemoglobin of 30 children with CKD stage 5D at the initial stage of dialysis was (79.3±16.3) g/L. Twenty-three children with CKD stage 5D received erythropoietin combined with oral iron or intravenous iron therapy. The hemoglobin compliance rates in children with maintenance dialysis in initial phase, 1 month, 2 months and 3 months were 6.7% (2/30), 16.7%(5/30), 63.3%(19/30) and 90.0%(27/30), respectively. The correction time for anemia was (2.5±1.0) months. Twelve children with CKD stage 5D received iron sucrose infusion, and no adverse reaction occurred. Conclusions:Renal anemia has a high incidence in children with CKD. Early and standardized treatment is of great significance to improve outcome of renal anemia. Venous iron infusion is a safe and effective treatment method for children with maintenance dialysis.