Objective To observe and compare the clinical effect of aerosol inhaled and systemic glucocorticoid treatment and its influence on the expression of procalcitonin ( PCT) and hyper-sensitive C reactive protein ( hs-CRP) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods 146 elderly patients with AECOPD were enrolled prospectively.The patients were divided in three groups randomly, including inhalation group (48 cases referred as 2 mg of budesonide nebulization every 8 hours with therapeutic course of 5 days), intravenous group (50 cases referred as 40 mg methylprednisolone intravenous injection once daily with therapeutic course of 5 days), and control group (48 cases with no glucocorticoid ) .All the patients were treated with routine oxygen therapy, anti-inflammation, bronchodilators (β2 receptor agonist and doxofylline) and mucolytics, and so on.The levels of serum PCT and hs-CRP were detected before and after five days treatment, and also the clinical parameters such as symptoms, blood gas analysis, lung function, hospital days, fasting blood glucose and adverse reaction were simultaneously recorded. Results The general clinical data demonstrated no significant difference among the groups.Compared with the control group, the total effective rate, improvement rate of lung function (FEV1%pred and FEV1/FVC) and of blood gas parameters (pH value, PaO2 and PaCO2) in the inhalation group and intravenous group were higher, with shorter hospital days(P<0.05), while with no obvious difference between the two group.The levels of the serum PCT and hs-CRP were decreased in the patients enrolled after treatment, compared with the prior treatment (P<0.05).Compared with the control group, the levels of serum PCT and hs-CRP in the inhalation group and intravenous group decreased significantly, while with no obvious difference between the two groups.The levels of fasting blood glucose in the intravenous group were the highest;compared with the control group, the adverse effect incidence of the inhalation and intravenous groups were higher obviously, with the most obvious in the intravenous group ( P<0.05 ). Conclusion Application of glucocorticoid is benefit to improving the clinical symptom and lung function, and to rectifying hypoxemia and to shortening hospital days.The aerosol inhaled and systemic glucocorticoid application shows equivalent clinical efficiency on anti-airway inflammation.The glucocorticoid inhalation has fewer adverse effects and is recommended to treat the elderly patients with AECOPD .

Objective: To discuss the therapeutic regimen for warfarin resistant patients with the help of clinical pharmacists. Methods:The pharmacist analyzed the cause of warfarin resistance and provided the dose adjustment for a pulmonary embolism pa-tient. Results:The genotype of the patient was identified as VKORC1-1639AG by gene test. The patient was diagnosed as hereditary warfarin resistance excluding other causes. With the assistance of pharmacist, the problem of warfarin resistant was solved. Conclu-sion:For warfarin resistant patients, clinical pharmacists must definite the reason of warfarin resistant firstly and then carry out the therapeutic strategy. Gene detection may be used as an important guide for warfarin resistance.

ABSTRACT:Objective To explore the risk factors for maternal adverse pregnancy outcomes.Methods An unmatched case-control study based on hospital was performed.Univariate and multivariate Logistic regression were used to analyze the related factors of maternal adverse pregnancy outcomes,including general condition,history of fertility,abnormal symptoms and diseases during pregnancy.Results Univariate analysis results showed that high education level of gravida might be the protective factors of adverse pregnancy outcomes.The risk factors for adverse pregnancy outcome might include advanced maternal age,intensive workload,frequent pregnancy,history of spontaneous abortion,severe morning sickness,and sickness during pregnancy or progestation.Multivariate Logistic regression analysis showed that high education level of gravida (OR=0.63,95% CI:0.50-0.80)was the protective factor of adverse pregnancy outcomes;severe morning sickness (OR=2 .1 3 ,9 5% CI:1 .6 3-2 .7 9 )and sickness during progestation (OR=2.25,95% CI:1.06-4.77)were the risk factors for maternal adverse pregnancy outcomes.Conclusion The level of maternal education should be improved.We should attach great importance to preventive education and thorough treatment of severe morning sickness. Couples should be encouraged to have physical examination before marriage and pregnancy.Corresponding pregnancy care guidance should be given to pregnant women with different physical conditions so as to effectively reduce the occurrence of adverse pregnancy outcomes.

Objective To analyze the outcomes and prognostic factors in patients with esophageal cancer after concurrent chemoradiotherapy.Methods A total of 135 patients with esophageal squamous cell carcinoma were enrolled in the clinical study from January 2008 to June 2015.The patients were treated with two-dimensional radiotherapy (56 patients) or three-dimensional radiotherapy (79 patients).The radiotherapy was delivered at a total dose of 60-64 Gy (1.8-2.0 Gy per fraction).The concurrent chemotherapy regimen consisted of fluorouracil plus cisplatin or paclitaxel plus cisplatin and was performed on days 1 and day 29 of radiotherapy.The Kaplan-Meier method was used to calculate overall survival (OS)and progression-free survival (PFS) rates,the log-rank test was used for survival difference analysis and univariate prognostic analysis,and the Cox model was used for multivariate prognostic analysis.Results The 1-,3-,and 5-year sample sizes were 96,31,16,respectively.The 1-,3-,and 5-year OS rates were 74.0％,39.0％,and 28.6％,respectively;the median OS time was 25 months.The 1-,3-,and 5-year PFS rates were 57.3％,27.3％,and 16.6％,respectively;the median PFS time was 15 months.The univariate analysis indicated that clinical stage,radiotherapy method,and M stage were prognostic factors for OS and PFS (P =0.006,0.000,and 0.032;P=0.017,0.004,and O.000).The multivariate analysis showed that clinical stage and radiotherapy method were independent prognostic factors for OS and PFS (P=0.006 and 0.000;P =0.033 and 0.023).Conclusions For non-surgical treatment of patients with esophageal cancer,concurrent chemoradiotherapy is a preferred strategy and has proven to be effective and tolerable.

Objective To analyze the MRI features of chordoid meningioma (CM),and to compare with other meningiomas. Methods Clinical and MRI features of 7 patients with CM confirmed by pathology were analyzed retrospectively.Featrues of every MRI sequence were investigated qualitatively.Meanwhile normalized signal ratios of each sequence were analyzed furtherly,including normalized T1 weighted image intensity ratios (NT1 ),normalized T2 weighted image intensity ratios(NT2 ),normalized ADC ratios (NADC)and normalized T1 WI contast enhancement intensity ratios (NCE).Fisher ’s exact test and Dunnett T 3 test were employed to analyze the difference of CM and nonchordoid meningiomas (34 cases of WHO grade Ⅰ meningioma,1 6 cases of nonchordoid WHO grade Ⅱ meningioma,and 5 case of WHO grade Ⅲ meningioma).Results The CM showed hyperintensity on T2 WI and meanwhile other nonchordoid meningiomas demonstrated isointensity,hypointensity or slight hyperintensity on T2 WI.Evaluations of DWI revealed variable signal intensities of CM.But all 7 cases had no obvious restricted diffusion,and increased signal was seen on the ADC map in each patient.The solid parts of CM enhanced markedly after contrast agent injection.Quantitative indicators NT2 , NADC and NCE of CM were higher than other meningiomas(P <0.01),but NT1 showed no statistic difference between CM and other meningiomas (P =0.889).Whether there was cyst,necrosis,orflow void sign on T2 WI,and no matter with or without perifocal edema,dural tail sign and a broader base among meningiomas had no significance in differentiating CM and other meningiomas.Conclusion CM has typical MRI features.The tumors show hyperintensity on T2 WI,especially have no obvious restricted diffusion and enhance markedly after contrast.The measurement of NT2 ,NADC and NCE enables reliable preoperative prediction of the atypical histopathologic diagnosis.

ObjectiveTo investigate influence on adults'visual function and fluid intelligence with N-back working memory training based on Gabor signal.MethodsControlling group including 13 adults had no training,training group including 14 adults received an eight-days training,half an hour a day.The stimulus was N-back training which has on improved Gabor signal with adjustable spatial frequency and contrast sensitivity.The contrast sensitivity and fluid intelligence were record using OPTEC 6500 and Raven's Standard Progressive Matrices before and after training,then the data was analyzed and processed by SPSS.ResultsContrast sensitivity:there was a siguificant different of the contrast sensitivity between pretest and posttest ( ( 1.93 ± 0.17 ) log,( 1.76 ±0.20 ) log) in training group ( t =-4.579,P =0.001 ).Fluid intelligence:there was a significant different of fluid intelligence between pretest and posttest( ( 129.9 ± 9.0 ) scores,( 113.7 4-16.0 ) scores ) in training group ( t =-4.373,P =0.001 ),and superior to controlling group,which also had a statistical significance (F =1.353,P =0.004).ConclusionThe method of N-back working memory training based on Gabor signal not only enhances working memory and fluid intelligence,but also improves the visual function effectively,and more various effect is acquired comparing to traditional training method.

Objective To study the effect of selective COX-2 inhibitor NS398 on IL-10 and IFN-γexpression in human keratinocytes induced by UVA,and further to explore the effect on anti human skin photoaging.Methods HaCaT cells were divided into three groups:simple UV exposure group,NS398-intervene group and blank group.For UV radiation,simple UV exposure group and NS398-intervene group were irradiated with UVA at a dose of 30 J/cm2.In order to assess the effect of NS398,HaCat cells were treated with NS398 at the dose of 0,20,40,80μmol/L respectively and then incubated without irradiation for 2h,substrate changed and cultured for 24h,and then the expression of IL-10 and IFN-γ mRNA was detected via RT-PCR.Results Simple UV exposure group had obviously higher expression of IL-10 mRNA and lower expression of IFN-γ mRNA than that of control group,while NS398-intervened group had significantly lower expression of IL-10 mRNA and higher expression of IFN-γ mRNA than that of simple UV exposure group,and dose-dependency existed.Conclusions NS398 may delay photo-damage of human skin via inhibiting the expression of IL-10 mRNA and up-regulating the expression of IFN-γ mRNA in human keractinocytes.

Objective To investigate characteristic skin lesions and typical histopathological changes of adult-onset Still's disease(AOSD) for its early diagnosis and treatment.Methods Clinical data were collected from 8 patients with AOSD,and analyzed retrospectively.Results All the patients had transient rashes and persistent papules/plaques during the course of disease.Of the 8 patients,1 had urticaria-like rashes,3 had dermatomyositis-like rashes,and 1 had prurigo pigmentosa-like rashes.Biopsies were carried out at the sites where transient rashes or persistent papules/plaques occurred.Histopathological findings showed necrotic keratinocytes in the upper prickle cell layer,and perivascular infiltration of neutrophils and lymphocytes in the upper dermis.Conclusion The skin lesions and histopathological changes of AOSD are characteristic,which can provide clues to the early diagnosis of AOSD.

AimTo find out the comprehensive strength and trends in scientific research area,and to provide foundation for decision-making on pushing the paediatric research forward,we reviewed the achievements of the scientific papers publication and the professional background of the authors between 2001 and 2010. Methods We extracted data and described the distribution characteristics of the paper publication amount,degree in the 10 years,as well as age,construction of professional and technical title,the education qualification of the authors. Moreover,we statistically analyzed the variability of the publication conditions within statistical source journals among the authors with different technical title.ResultsThe amount of paper publication increased anually in the 10 years,but with few published in statistical source journals,and the core authors group have not formed yet.Meanwhile,the general internal medicine maintained the dominant propotion.Authors aged 30 -50 years old,with middle technical title and with bachelor degree published the majority of the papers.The propotion of the papers published in statistical source journals and in the Zhonghua series medical journals were significantly higher in authors with master degree and above.ConclusionsIn order to construct a stable core authors group and increase the amount of the paper publication,we should continue to encourage those author groups with high output rate and make greater support on the potential authors.Furthermore,we must take more effort on impoving publication quality in the future.

Objective To study the quality and effect of root cause analysis (RCA) on long-range video EEG monitoring on epilepsy patients.Methods The process of RCA long-range video EEG monitoring on patients with epilepsy was investigated to find out the root causes for quality of epilepsy capturing from pseudo differential of EEG and video effects.Then the measures were taken to improve the quality of monitoring.Result After the intervention,except canmera not clear enough,the incidences were significantly decreased compared with pre-intervention (all P ＜ 0.001).Conclusions Root cause analysis is effective in improving the quality of long-range video EEG monitoring on epilepsy patients.It is worth clinically promoting.