Objective:To explore the effectiveness and safety of levosimendan treating severe decompensated heart failure (SDHF) .Methods :A total of 80 patients with SDHF caused by various caused were selected ,randomly and equally divided into levosimendan group and dobutamine group .Both groups received intravenous drip of corre‐sponding drug based on routine treatment ,and the course was 24h .After two weeks ,therapeutic effects were com‐pared between two groups .Results:After two weeks ,total effective rate of levosimendan group was significantly higher than that of dobutamine group (95.0% vs .72.5% , P= 0.005) .Compared with dobutamine group ,after two weeks , there were significant reductions in dyspnea status score [ (2.57 ± 0.80 ) scores vs . (1.89 ± 0.70 ) scores] ,general status score [(3.23 ± 0.65) scores vs .(2.95 ± 1.29) scores] ,respiratory frequency [(24.32 ± 0.98) times/min vs .(20.6 ± 1.58) times/min] and level of brain natriuretic peptide [(1584 ± 325.63) mg/ml vs .(1011.92 ± 302.31) mg/ml] ,and significant rise in left ventricular ejection fraction [(40.16 ± 4.85)% vs .(46.53 ± 3.37)% ] in levosimendan group , P<0.05 or <0.01. Conclusion:In short-term therapeutic effect on severe decompensated heart failure ,levosimendan is superior to dobutamine ,it possesses good safety and tolerance ,which can be used as an effective drug for severe decompensated heart failure .

Objective To understand the clinical profiles of arthritis after human parvovirus B19(B19) infection.Methods Four cases were described and the clinical and laboratory characteristics were analyzed. Results The median onset age of the 4 patients(2 females and 2 males)was 34 years old.Typical clinical manifestations included joint symptoms,flu-like malaise and erythematous rash.Anti-Bl9 IgM antibodies were all positive in 4 patients.B19 DNA was detected in blood samples of 3.Other types of arthritis were excluded. No relapses were noticed after followed-up of 1～3 years.Conclusion The Anti-B19 lgM and B19 DNA should be detected in patients suffer from arthritis with unknown origin.

Abstract A suspected case of cutaneous anthrax was reported by Gongliu County Disease Control and Prevention Center, Ili Kazak Autonomous Prefecture, Xinjiang Uygur Autonomous Region on August 19, 2021. Then, an epidemiological survey was performed by a joint investigation team consisting of professionals from Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, intermediate-level trainees from the Field Epidemiology Training Program of Chinese Center for Disease Control and Prevention, and professionals from Ili Kazak Autonomous Prefecture Center for Disease Control and Prevention. A total of 11 cutaneous anthrax cases were identified, including 8 suspected cases and 3 clinically diagnosed cases, and all cases were villagers in Y Village, X Township, Gongliu County, without severe case or deaths found. The onset of the first case occurred on July 27, and the onset of the last case occurred on August 16. The main clinical manifestations included ulcerative eschar on hands and exposed skin of the upper extremity. A Bacillus anthracis isolate was detected in meat samples from infected cattle. Epidemiological surveys showed that villagers did not report infected cattle to related sectors and privately slaughtered and ate meat from infected cattle without any effective protective measures, resulting in this outbreak. It is recommended to strengthen health education for people raising, selling and slaughtering livestock, and publicize zoonotic disease control knowledge, including anthrax, and establish an effective surveillance and response system for anthrax for immediate identification and treatment of epidemics.

Objective To evaluate the diagnostic value of intraductal ulstrasonography(IDUS)in non-opaque bile duct stones.Methods Between January 2009 and August 2010 in the Department of Gastroenterology at Shanghai 10th People's Hospital,a total of 183 patients(male:102 cases,mean age 69 years； female:81 cases,mean age 71 years)were enrolled,who were suspected of bile duct stones or stenosis which could not be diagnosed by abdominal CT,MRI,and abdominal B-mode ultrasound.All the patients underwent endoscopic retrograde cholangiopancreatography(ERCP)first,and then patients with non-opaque bile duct stones followed by IDUS.Results A total of 134 cases (73.2％)of bile duct stones were diagnosed by ERCP,49 cases(26.8％)were negative.And then the 49 patients underwent IDUS,of whom 24 patients with sand-like stones,11 patients with lowdensity stones,6 patients with ampullary cancer,2 patients with pancreatic cancer,6 patients with sclerosing cholangitis.The diagnostic accuracy of IDUS in the position and quality of bile duct stones was 100％,higher than that of ERCP,which was 80％.After ERCP,pancreatitis occurred in 3 patients and improved after conservative treatment,there was no complications like perforation and bleeding.Conclusion The diagnostic accuracy of IDUS in the position and quality of bile duct stones is high,which can make up for the misdiagnosis by ERCP without increasing the complications.IDUS can provide reliable basis for the diagnosis of clinical bile duct stones.

Objective To analyze the clinicopathological characteristics, immunophenotypes and immu-noglobulin heavy chain gene rearrangement of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Methods The clinical data of 35 patients with gastric MALT lymphoma who had been admitted to Southwest Hospital from January 1984 to June 2003 were retrospectively analyzed. The specimens of the gastric MALT lymphoma were obtained and their pathomorphological classifications were studied. The immunophenotypes and immunoglobulin heavy chain gene rearrangement were detected by immunohistochemistry and polymerase chain reaction, respectively. All the data were analyzed by chi-square test and Mann-Whitney U test. Results The main manifestations of patients with gastric MALT lymphoma were epigastric discomfort and abdominalgia. The percentage of patients with age≥40 accounted for 74% (26/35). The gastric MALT lyrnphoma has low differentia-tion in 32 patients, and high differentiation in 3 patients. There were 31 patients in Ⅰ E stage, 2 in Ⅱ E1 stage and 2 in Ⅳ stage. Pathological examination showed that gastric MALT lymphoma was composed of centrocyte-like cells and mononuclear-like B cells or lymphoplasma cells. Twenty-nine specimens were with lymphoepithelial lesions (83%), 2 with follicular colonization (6%), and 11 with plasma cells segregated beneath the surface epithelium (33%). All the 35 specimens were B cell immunotype. Restrictive expression of κ and λ light chains of the immunoglobulin was found in 19 cases, and Bcl-2 positive expression was found in 16 cases. High expres-sion of proliferating cell nuclear antigen was found in gastric MALT lymphoma with transformed blasts, which indicated that gastric MALT lymphoma with transformed blasts was more active in proliferation than those of low grade. A monoclonal pattern of immunoglobulin heavy chain gene rearrangement was detected in 33 patients (94%). Conclusions Digestive symptoms are the main manifestations of patients with gastric MALT lymphoma. The incidence of gastric MALT lymphoma increases with age. The final diagnosis of gastric MALT lymphoma depends on the pathological, immunohistochemical examination and laboratory test.

Objective To establish a reference range of cancellous bone ultrasonic backscatter coefficient (BSC) in term neonates,and to determine the significance of BSC in bone nutritional status in term newborns and infants.Methods Six hundred and sixty-five term newborns,who were born in Shanghai First Maternity and Infant Hospital from July 2014 to August 2014,were enrolled.On the third day and the 42nd day after birth,all infants underwent ultrasonic measurement of the calcaneum bone using a broadband-non-focus ultrasonic transducer at three frequencies (2.25,3.5 and 5 MHz).MATLAB software was used to analyze the backscatter signals.Clinical data of the infants,including gestational age,birth weight and birth age,were recorded at the same time.Statistical analyses of the data included variance analysis,Tukey's test,rank sum test,Dunn test and Pearson or Spearman correlation analysis.Results (1) Of the 665 infants,335 were male.The mean gestational age at birth was (38.0± 1.9) weeks,and the mean birth weight was (3 1524±226) g.(2) On the third day,there were significant differences in BSC values acquired at 2.25 and 3.5 MHz among the groups with different gestational ages or birth weights (2.25 MHz:H=9.842 and 17.271;3.5 MHz:H=6.275 and 21.450,respectively,all P＜0.05).At 3.5 and 2.25 MHz,BSC values were positively correlated with gestational age (r=0.047 and 0.035,respectively,both P＜0.05) and birth weight (r=0.125 and 0.186,both P＜0.05).(3) On the 42nd day,significant differences in BSC were observed at each frequency among the groups with different gestational ages or birth weights (gestational age:H=76.832,16.498 and 32.756;birth weight:H=70.014,18.095 and 34.126;all P＜0.01).Gestational age and birth weight were positively correlated with BSC value acquired at each frequency (r=0.397,0.286 and 0.272 for gestational age,0.451,0.223 and 0.196 for birth weight;all P＜0.01).Conclusions A preliminary BSC reference percentile in term-born infants is established.There are positive correlations between BSC value and newborn gestational age and birth weight at certain frequencies,which can reflect the status of the newborn's cancellous bone.Determination of BSC value should be performed during the follow-up period to assess the nutritional status of neonatal bone.

Nonunion remains a major complication after skeletal trauma. In the last decade, extracorporeal shock wave therapy has become a common tool for the treatment of delayed unions or non-unions. With the help of a review of the literature, the current author gave an overview of indications, choices of devices, success rates and complications for ESWT in the treatment of non-unions. The conceivable mechanism was also outlined.

OBJECTIVE:To improve the information system of Out-patient pharmacy intravenous admixture center (OUIVA) to improve the pharmaceutical service rendered to the transfusion patient and ensure the safety of drug use. METHODS:The defi-ciency in OUIVA information system of our hospital were analyzed,in which improvement was made with respect to ungrouped doctor’s orders,inconsistency between the total doses charged and the prescribed doses and the error of transfusion days that occurred fre-quently. The conformity rate of out-patient fluid transfusion prescriptions and the time of patients’waiting for transfusion before and after the improvement were compared and evaluated. RESULTS:Improvement was made to OUIVA information system through the optimization of transfusion process,the application of condition limit,the adding of logical operation and verification and the other measures. After improvement,the unconformity rate of out-patient prescriptions in our hospital descended from 11.24% in 2013 to 3.69% in 2014,with an obvious increase in the accuracy rate of dispensing for fluid transfusion;and the time of patients’waiting for transfusion was shortened from 30-40 min to 15-20 min,with an increase in the degree of satisfaction of transfusion patients. CONCLUSIONS:The OUIVA information system can reduce the errors of drug dispensing for fluid transfusion and improve pharmaceutical services.

The recent investigations have demonstrated that epigenetic such as DNA methylation and histone modification was closely associated with cell growth and malignant tumors, and epigenetic modification was responsible for an important cause of oncogenesis. However, for the recent years some observations have been also shown that the development of tumorigenesis was attributed to transformation expression in microRNA. The latest investigations have revealed that epigenetic was involved in modulation of microRNA expression, on the contrary some kinds of microRNAs could also control epigenetic, moreover, the reciprocal modulation between microRNA and epigenetic could regulate gene expression and induce tumorigenesis. At the same time the data likewise displayed that epigenetic adjusted microRNA expression principally in a way of DNA methylation or histone modification, nevertheless microRNA regulated epigenetic by way of methyltransferases expression, DNA methylation maintenance and histone modification. With regard to the reciprocal modulation between microRNA and epigenetic, a comprehensive and systemic review of reciprocal relationship in modulation of cell growth and oncogenesis was gived.

Objective: By taking the holism and differentiation concepts of traditional Chinese medicine (TCM) as the guidance, physical, mental and workplace factors were recruited in the observation of depression in employees, and were systematically classified to establish a workplace-related Liver Meridian-depression scale, for providing an evaluation index for depression in employees. Methods: NVIVO 11 software was adopted to assort ancient TCM classics. Based on the holism and differentiation concepts of TCM and well-developed scales, the item pool was determined via brain storm and screened by Delphi method after classified; a Wechat questionnaire was handed out 240 times via the online system 'Wen Juan Xing', and the results were statistically analyzed by the SPSS 17.0 version software. Results: Five dimensions consisting of 80 items were obtained after classification, and 60 items were selected by Delphi method; a total of 216 questionnaires were returned and the return rate was 90%. Of which, 215 questionnaires were valid ones, and the valid rate was 99%. By exploratory factor analysis (EFA), 44 items were obtained, and the aggregate split-half reliability coefficient was 0.922. The Cronbach's alpha coefficient for the five dimensions, i.e. Liver Meridian, relevant meridians, basic psychological activities, work cognition and emotional reactions, was respectively 0.841, 0.842, 0.914, 0.836 and 0.839, indicating a content internal consistency. The score of each item was highly correlated with the corresponding dimension, and the intercommunity was between 0.474 and 0.801. Nine factors were generated, 2 in the dimension of Liver Meridian, 3 in the dimension of relevant meridians, 2 in the dimension of basic psychological activities, 1 in the dimension of work cognition, and 1 in the dimension of emotional reactions, and the load of each factor was between 0.438 and 0.859. The reliability and validity of the scale were well examined. Conclusion: The scale can be applied to evaluate the qi activities of Liver Meridian and depression symptoms related to workplace.