Objective To investigate the efficacy of Ganju Bingmei Pill combined with voice therapy in the treatment of vocal nodules .Methods A total of 72 patients with vocal nodules and 60 health people in our hospital were included .Patients were randomly divided into two groups :Group A (36 cases) with Ganju Bingmei Pill thera‐py ,group B (36 cases) with Ganju Bingmei Pill combined with voice therapy .Taking method of Ganju Bingmei Pill was three times a day ,2 tablets every time ,two weeks as one course of treatment with a total of four courses .Voice therapy in Group B was two weeks for one course with a total of four courses .The results were evaluated by voice handicap index ,voice acoustic analysis and laryngostroboscopy .Vocal nodules disappear or significantly reduce indi‐cated that the treatment was effective .Statistical analysis was performed using t - test and chi - square test .Results In group A ,the scores of T ,F ,P ,E were reduced compared with before treatment (P < 0 .05) ,however ,com‐pared with normal control group ,the score of F ,E ,T were still higher than those of normal group (P < 0 .05) .In group B ,the score of T ,F ,P ,E were reduced compared with before treatment (P< 0 .05) ,and compared with normal control group ,the score of F ,P ,E ,T were close to normal(P> 0 .05) .The VHI score in group B were significantly lower than those of in group A (P < 0 .05) .In Group A compared with before treatment ,jitter ,shimmer ,NHR were lower ,F0 was higher(P < 0 .05) ,however ,compared with the group of normal control ,F0 ,jitter ,shimmer , NHR were still statistically significant (P < 0 .05) .In group B with before treatment jitter ,shimmer ,NHR were lower ,F0 was higher (P< 0 .05) ,and jitter ,shimmer were already close to normal(P> 0 .05) .The F0 of group B after treatment was higher than group A ,jitter and shimmer were lower than group A after treatment (P< 0 .05) . After treatment ,there were 28 cases of group A (77 .78% )of patients with vocal nodules disappear or significantly reduce .There were 35 cases of group B(97 .22% ) of patients with vocal nodules disappear or significantly reduce , the effective rate between group A and group B was statistically significant (P< 0 .05) .Conclusion Ganju Bingmei Pill therapy and Ganju Bingmei Pill therapy combined with voice therapy all have curative effect for the treatment of vocal nodules however ,Ganju Bingmei Pill therapy combined with voice therapy is more efficient .

objective To summarize the clinical characteristics of AIDS phobia patients and establish the preliminary clinical diagnostic criteria.Methods The clinical information of 46 AIDS phobia patients was collected and summarized.General demographic data,clinical manifestations and laboratory results were analyzed.Results The clinical characteristics of AIDS phobia patients include:(1)With or without high-risk behavior of HIV-1 infection;(2)Patients repeatedly demanded HIV/AIDS related laboratory tests,suspected or believed in HIV-1 infection with daily life affected;(3)The main complaints were non-specific including influenza-like symptoms(headache,sore throat and so on),fasciculation,formication,arthrodynia,fatigue and complaint of fever with normal body temperature;physical examination did not reveal any positive physical sign except white coated tongue;(4)Symptoms mainly appeared 0-3 months after the high-risk behavior while HIV-1 antibody kept negative;(5)T lymphocyte subsets test was carried out in 23 patients and showed 19(82.6%)with CD4+ T lymphocyte count>500/μl,the remaining 4 were 300-500/μl,with the lowest count of 307/μl.Few patients had inversed CD4+/CD8+ ratio but without excessive CD8+T lymphocyte activation.Conclusion AIDS phobia is a complicated physical and mental disease,whose diagnosis and treatment still need further investigation.

One hundred and eighty three women with high risk of breast cancer identified in Baoding First Central Hospital from June 2007 to June 2014,were enrolled in the study.In these 183 cases,41 received preventive therapy (22.4％),142 did not.Factors associated with acceptance of chemoprevention included older age,menopause,comorbidities,lower level education,being married,higher BMI,having high level hyperplasia of ductal epthelia and counseling to breast specialists (P ＜ O.05);whilenot informed by doctors was the main reason for failed taking preventive agents(95.1％,135/142).Thirteen of 41 women receiving chemoprevention discontinued the therapy (31.7％);no-insurance,no side-effects and higher BMI were related to the discontinuing (P ＜ 0.05).The 1-,2-,3-,and 5-year adherence rates of chemoprevention was 86.1％ (31/36),65.4％ (17/26),59.1％ (13/22),8/13 and 5/10,respectively.The results show that chemoprevention rate is low among Chinese women at high risk of breast cancer,and the long-term adherence to preventive therapy is poor.Corresponding measures should be taken to strengthen the chemoprevention of breast cancer.

Background and purpose:miR-196a2 functions as an oncogene during tumor initiation and pro-gression. The up-regulation promotes tumor cell proliferation, invasion and metastasis. Therefore, it is promising to be an important tumor biomarker. The aim of this study was to investigate whether rs11614913, a gene polymorphic site ofmiR-196a2, is associated with the risk of leukemia.Methods:A case-control analysis was employed. Bone marrow or periph-eral blood was collected from 210 leukemia patients diagnosed from Jan. 2009 to Jul. 2015 in Yantaishan Hospital (case group) as well as 250 healthy people who were physically examined during the same period (control group). Polymerase chain reaction-restriction fragment length polymorphism (PCR-PFLP) was used to detect the genotype of rs11614913. Application test was used to compare the difference in the frequency of each genotype between case group and control group. The odds ratio (OR) of SNP allelic genes was calculated using logistic regression analysis and 95%CI represented the risk of leukemia for each genotype.Results:The distribution differences in the frequency of T/T, C/C, C/T genotype of miR-196a2 rs11614913 between case group and control group were statistically significant (P<0.05). The risk of leukemia for individuals who carried mutant homozygous C/C was 2.661-fold higher than those carried wild-type homozygous T/T, and the difference was statistically significant (P<0.05).Conclusion:ThemiR-196a2 gene polymorphic site rs11614913 was associated with the risk of leukemia. Mutant homozygous C/C or C allelic gene carrying was probably a risk factor for leukemia.

Psoriasis is a chronic,non-infective inflammatory dermatosis characterized by erythemas covered with scales.Psoriasis is considered as a systemic disease,and several studies have confirmed that it is associated with many other diseases,such as cardiovascular diseases,obesity,diabetes mellitus type Ⅱ,dyslipidemia,nonalcoholic fatty liver disease,anxiety disorder,depression and inflammatory bowel disease.The occurrence and development of psoriasis is closely related to the immune response,and the immune dysfunction of T lymphocytes induced by the infiltration and activation of inflammatory cells has been confirmed as the key step in the pathogenesis of psoriasis.Various kinds of cytokines in the local microenvironment can promote the activation and proliferation of T lymphocytes,and regulate the differentiation of T lymphocytes into different subsets,which take an important part in the occurrence of psoriasis.In recent years,researchers have found that local microbes also play an important role in this process.Thus,this review summarizes the progress in the roles of human skin and gut microbiota in psoriasis.

Objective To study the changes in related parameters after secondary preparation of blood components,in order to further improve the quality of blood components.Methods Different centrifugation conditions were selected for the preparation of primary blood component red blood cells in additive solution leukocytes reduced,and the quality was tested.Then,using the red blood cells in additive solution leukocytes reduced as the initial blood for secondary preparation,and the red blood cells were washed through the Haemonetics ACP 215 device,and the quality was tested.The preparation pa-rameters of blood components were observed,compared and optimized.Results Under comparable centrifugation effects of different centrifugation conditions,the quality control items,which of primary blood components of red blood cells in additive solution leukocytes reduced and frozen plasma prepared by the separation,such as volume,hemoglobin,hematocrit and re-sidual white blood cells met the relevant national standards.And the quality control items of secondary blood components of washed red blood cells such as the hemoglobin and superalbumin content both met the relevant national standards,while vol-ume exceeded the standard by 7-14 mL,which can be operated to the standard range.In addition,the recovery rate of red blood cells and the clearance rate of plasma protein could reach 75%and 99%respectively.Conclusion There is a certain correlation between primary and secondary preparation of blood components,but the relevant parameters of secondary prepa-ration of blood components can be flexibly adjusted according to the actual situation to ensure that the quality of prepared blood component products meet the national standards,thus ensuring clinical treatment effect and safety.

Objective To assess the outcomes of ischemic stroke patients with atrial fibrillation (AF).Methods Six thousand six hundred and ninety-five patients with acute ischemic stroke,admitted to our hospital from May 2005 to December 2013,were recruited consecutively.These patients were divided into combined AF group (n=583) and non-combined AF group (n=6112).The clinical data,including stroke subtypes,stroke severity,risk factors of stroke,NIHSS scores and Barthel index,and outcomes,including mortality,unfavourable prognosis and recurrence at 3,12,and 36 months after stroke were analyzed.Results The prevalence rate of AF in the patients enrolled in this study was 8.7％ (583/6695).There was a higher frequency of AF in female than that in male,with significant difference (45.8％ vs.33.0％,P＜0.05).The patients from combined AF group were older than those without AF.The percentage of severe stroke in AF patients (34.8％) was significantly higher than that in non-combined AF group (8.3％,P＜0.05).The patients with AF were less likely than the patients without AF to have hypertension (63.8％ vs.73.3％),diabetes (24.9％ vs.32.3％),dyslipidemias (26.1％ vs.31.5％),artery stenosis (17.2％ vs.23.4％),current smoking (22.6％ vs.39.0％),and alcohol consumption (7.5 ％ vs.18.9％),with significant differences (P＜0.05).After adjusting age,gender,stroke subtype,and severity,and risk factors,multivariate analysis showed that there was a higher recurrence risk in combined AF group at 3 months after stroke than that in non-combined AF group (P＜0.05);patients with AF had significantly higher mortality,dependency,and recurrence rates at 12 and 36 months after stroke than those without AF (P＜0.05).Conclusion The long-term prognosis of patients with stroke complicated with AF is poor;therefore,normalized anticoagulant therapy should be taken to decrease the recurrence rate and burdens of stroke in China.

Objective:To select and extract the evidence of delivery mode decision making among repregnancy women with post cesarean section, and summarize the best evidence.Methods:Evidence-based nursing was used to retrieve the evidences on delivery mode decision making among repregnancy women with post cesarean section in the Chinese Guidelines Network, Guidelines International Network (GIN) , National Institute for Health and Clinical Excellence (NICE) , American GuidelineClearinghouse (NGC) , Joanna Briggs Institute Evidence-based Health Care Center of Australia, UpToDate, Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI) , WanFang data, Chinese Biological Medicine (CBM) and Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Excerpta Medica Database (Embase) . The evidences included the guidelines, systematic reviews, evidence summaries, recommended practices, best clinical practice information booklets and primary studies.The retrieval time was from the establishment of the database to 1st May 2019.Results:A total of 13 evidences were included, six guideline, one expert consensus and six systematic reviews, which involved 15 best evidences in four aspects, trial of labor after cesarean section (TOLAC) /vaginal birth after cesarean (VBAC) population, VBAC/uterine rupture influencing factors, delivery mode management and the delivery decision making tools.Conclusions:Evidences of clinical practice should be recommended according to the resource of medical institutions, promotion and barrier factors when medical staff apply evidences, reasonable judgments of clinician, clinical data provided by delivery women, will of delivery women and their family members. Users should continuously update evidences since the best evidences update over time to solve the problems of delivery mode decision making among repregnancy women with post cesarean section by scientific method so as to improve the nursing quality.

Objective To study the clinical characteristics of Japanese encephalitis (JE) in 34 adult patients and to improve the level of diagnosis of this disease.Methods The clinical manifestations,laboratory results and radiological features of 34 adult patients with JE in our hospital from July 2017 to September 2017 were summarized and the progonsis was observed.The modified Rankin Scale (mRS) was used to evaluate the progonsis.Results Eighteen patients were males and 16 patients were females with the average age of (45.39 ± 16.34) years in 34 patients who were diagnosed as JE.The major clinical features of JE patients included fever (34,100％) with the average temperature of (39.4 ± 1.1) ℃ on admission,headache (26,76％),seizures (7,21％),decreased consciousness (25,74％) on day 2.6 ± 1.4 after the onset,respiratory failure (9,26％) on day 3.8 ± 1.6 after the onset.The major features of laboratory results included white blood cells increase (15,44％),blood hematocrit decrease (25,74％),eosinophil absolute value decrease (29,85％),cerebrospinal fluid pressure increase (12,35％),cerebrospinal fluid protein increase (27,79％),cerebrospinal fluid white blood cells increase (30,88％).Brain MRI scan of abnormal signal was found abnormal in up to 54％patients (14/26),involving the thalamus,basal ganglia,mesencephalon,temporal lobe,hippocampus and occipital lobe,especially in the area of bilateral thalamus and mesencephalon.The follow-up showed three cases were dead;mRS score was 0 in twenty-one cases,1 or 2 in five cases,3 or 4 in three cases,5 in two cases five-six months after onset;the sequelaes were cognitive impairment in nine patients and movement disorder in five patients.Conclusions The clinical symptoms of JE in adults are severe.The main clinical manifestations of JE are hyperthermia,disturbance of consciousness,seizures and respiratory failure,with characteristic imaging findings on brain MRI.JE is a disease with high mortality and severe long-term sequelae.

Portal vein thrombosis （PVT） is one of the common complications during the natural course of liver cirrhosis and has an important influence on the progression of liver cirrhosis. This article mainly summarizes the research advances in the risk factors for PVT. There are many risk factors for PVT， and Virchow’s triad， namely venous stasis， hypercoagulability， and vascular endothelial injury and systemic inflammation caused by surgery or trauma， are considered the main reasons for the development and progression of PVT. At present， more prospective studies are still needed to validate the predictive models for the risk of PVT that have certain application prospects in clinical practice. Cirrhotic patients with PVT tend to have a poor prognosis， and complete obstructive PVT is associated with increased mortality after liver transplantation. Recent studies have shown that prophylactic anticoagulant therapy is safe and effective in patients with liver cirrhosis and can thus help with the prevention and treatment of PVT.