Objective To discuss which is more efficient between Needle-knife precut and Plough-knife precut in difficult biliary cannulation. Methods The difference in the average time of cannula, percentage of cannula achieve-ment and the complication rate between the two kinds of operation were compared. Results The percentage of can-nula achievement about the Needle-knife precut is higher than Plough-knife precut, while there is no notable differ-ence in average time of cannula and the complication rate between the two precuts. Conclusion Needle-knife precut is more efficient than Plough-knife precut in difficult biliary cannulation, if guide wire can not get into pancreatic duct.

Objective To evaluate the clinical effect of salmeterol xinafoate and fluticasone propionate powder for inhalation combined ipratropium bromide aerosol in patients with stable chronic obstructive pulmonary disease (COPD).Methods One hundred and twenty patients with stable COPD was randomly divided into control group and observation group with 60 patients each.The control group was received ipratropium bromide aerosol inhalation,and the observation group was given salmeterol xinafoate and fluticasone propionate powder for inhalation and ipratropium bromide aerosol for 6 months.BODE index,SGRQ scores,plasma cortisol and bone mineral density were compared between two groups before and after treatment.Results BODE index scores had no significant difference between two groups before treatment (P＞0.05).After treatment,BODE index scores,dyspnea scale,FEV1％,6MWD and BODE index total scores in observation group were superior to those in control group [ (1.9 ± 0.5) grades vs. (2.3 ± 0.5)grades,(58.5 ± 7.3)％ vs.(50.4 ± 6.2)％,(411.1 ± 56.8) m vs.(347.5 ± 60.4) m,(3.3 ± 1.0) scores vs.(3.8 ± 1.3 ) scores ],there were significant differences (P＜0.05 ).SGRQ scores had no significant difference between two groups before treatment (P＞0.05 ).After treatment and in SGRQ scores,respiration symptom,limitation of activity,disease influence scores in observation group were significantly lower than those in control group [ (20.7 ± 10.3 ) scores vs.(37.9 ± 14.4) scores,(20.7 ± 9.5 ) scores vs.(34.8 ± 13.0) scores,(16.3 ± 6.7) scores vs.(27.2 ± 11.8) scores,(17.5 ± 7.0) scores vs. (34.6 ± 12.3) scores],there were signiticant differences (P＜0.01 ).There were no significant difference of plasma cortisol and bone mineral density between two groups (P＞0.05).Conclusions Salmeterol xinafoate and fluticasone propionate powder for inhalation and ipratropium bromide aerosol in patients with stable COPD can greatly improve the lung function and life quality and with less adverse reaction.

Objective To study experienced doctors’ treatment of senile dementia based on association rule. Methods Databases, such as CNKI, CSCD, CBMdisc, CPD, and Wanfang Data were searched for articles about senile dementia. SPSS17.0 and Clementine12.0 software were used for frequency and correlation analysis of prescription. Results In total of 67 articles about TCM therapy for senile dementia were included, containing 112 prescriptions, 178 Chinese herbal medicines, 1589 frequency, and 14.2 entries for each prescription. The first three frequently used herbal medicines were Acori Tatarinowii Rhizoma, Polygala Radix, and Salviae Miltiorrhizae Radix et Rhizoma. Accoring to association rule, the first three medicine pairs were Citrus Reticulatae Pericarpium→Pinelliae Rhizoma, Dioscoreae Rhizoma→Rehmanniae Radix Praeparata, and Codonopsis Radix→Citrus Reticulatae Pericarpium. The first three thriple herbal medicines were Dioscoreae Rhizoma+Lycii Fructus→Corni Fructus, Acori Tatarinowii Rhizoma+Corni Fructus→Rehmanniae Radix Praeparata, and Carthami Flos + Hirudo→Bupleuri Radix. Conclusion The results based on association rule effectively summarized all the doctors’ treatment experience in senile dementia, and provided the beneficial reference for the clinical treatment of senile dementia.

Objective To compare the serum index after colonoscopy high-frequency electric snare combined with nylon cord ligation and high-frequency electric resection in treating broad pedicle polyps. Methods 70 cases of broad pedicle polyps patients from July 2012 to May 2016 were chosen as research object. The operation methods and laboratory examination results of all the patients were reviewed. All patients were divided into observation group (n = 37) and control group (n = 33). Patients in observation group were treated by colonoscopy high-frequency electric snare combined with nylon loop ligation, while patients in control group were treated by high-frequency electric resection only. The blood loss and related indexes of the two groups were recorded. Before and after operation, stress hormones and acute phase proteins in serum was determined. Results Intraoperative blood loss of observation group was less than that in control group, postoperative hemoglobin levels was higher than that in control group, postoperative early bleeding rate, postoperative delayed bleeding rate of observation group were lower than that in control group (P < 0.05); 1 hour after surgery, Cor, ACTH, AT II, NE, CRP, SAA, AAT in serum were lower than those in control group (P < 0.05). Conclusion Through colonoscopy high-frequency electric snare combined with nylon cord ligation can reduce bleeding during and after surgery, relieve stress and inflammation.

Background and purpose:Five-year survival rate of post-operation patients with non-small cell lung cancer(NSCLC)is less than 40%.Treatments after recurrence are difficult.Our study aimed to evaluate the efficacy of pemetrexed on postoperative recurrence of NSCLC.Methods:From Jan.2006 to Sep.2008,40 NSCLC with postoperative recurrence were observed.All patients had received pemetrexed(ALIMTA)500 mg/m2 or carboplatin eonbined.Results:Among the 40 patients,partial response in 10 patients(25.00%),stable disease in 19 patients(47.50%),progressive disease in 11 patients(27.50%).The total response rate was 25.00%and clinical benefit control rate was 72.50%.Pemetrexed had significantly better disease control rate in female than in male (9 1.30% vs 47.06%,P=0.034),in adenocarcinoma patients than in non-adenocarcinoma's(87.10% vs 22.22%,P=0.001).Median overall survival time(MST)was 10.70 months.Progression-free survival time(PFS)was 5.18 months.Adenocarcinoma patients had longer PFS than non-adenocarcinoma patients.Conclusion:Pemetrexed demonstrates significant antitumor activity and good tolerance in these patients.

Objective To explore the distribution characteristics of TCM syndrome and clinical relevant factors of benign prostatic hyperplasia (BPH).Methods Totally 781 cases of BPH patients were collected. Chi-square test, analysis of rank and inspection were used to detect the distribution characteristics of TCM syndrome. The multiple classification logistic regression was used to analyze related factors.Results BPH 14 kinds of distribution of syndromes were statistically significant (P<0.01). One of the highest incidence is qi deficiency and blood stasis syndrome (24.97%), and lung heat obstruction is the lowest (1.15%). Composite syndromes (529 cases) were more common than single syndrome (252 cases); syndromes of intermingled deficiency and excess (453 cases) were more common than simple excess (169 cases) or deficiency syndromes (159 cases). BPH single syndrome distribution was different in prostate volume, residual urine volume, maximum urine flow rate, and showed no difference in the serum PSA level. 3 logit model was established successfully. It was found that the patients with the features of 50 to 60 years old, the course < 3 years, I-PSS score for 8 to 19 points showed higher positive incidence of excess syndrome than intermingled deficiency and excess syndromes and deficiency syndrome.Conclusion This study reveals the BPH distribution characteristics and clinical related factors, which has guiding significance to improve TCM clinical level.

Objective To kxplork thk valuk of dktkcting brain mktabolitks of prktkrm infants at full tkrm for prkdicting thk nkurodkvklopmkntal lkvkl,and to providk thk basis for karle clinical intkrvkntion. Methods Thirte casks of prktkrm infants wkrk collkctkd from thk Nkonatal Intknsivk Cark Rnit and Nkuro - Akhabilitation Dkpartmknt of Guangzhou Zomkn and Childrkn＇s Mkdical Ckntkr bktwkkn Mae 2015 and March 2016,thkn thke wkrk chkcckd be adopting brain magnktic rksonanck imaging and magnktic rksonanck spkctroscope at corrkctkd full tkrm,and assksskd be using Llbkrta Infant Motor Scalk(LIMS)and Gkskll dkvklopmkntal scalk kvaluation at corrkctkd agk of 6 months and corrkctkd of agk 1 ekar old. ResuIts In thk 30 casks of prktkrm infants,19 casks wkrk malk,11 casks wkrk fkmalk,and thk gkstational agk was 27+3 -31 wkkcs,and avkragk gkstational agk was(28. 8 ± 1. 0)wkkcs,and thk birth wkight was 800-1 400 g[(1 176. 3 ± 145. 1)g]. Thk stude found that meo-inositol( MI),MI╱crkatink( Cr)in basal ganglia wkrk nkgativkle corrklatkd with thk dkvklopmknt quotiknt at corrkctkd agk of 1 ekar old(r﹦ -0. 465,-0. 532;all P＜0. 05). Factic acid(Fac)╱Cr in hippocampus was nkgativkle corrklatkd with dkvklopmkntal quotiknt at corrkctkd agk of 6 months(r﹦ -0. 420,P＜0. 05);Fac,Fac╱Cr in pkrivkntricular wkrk nkgativkle corrklatkd with dkvklopmkntal quo-tiknt at corrkctkd agk of 1 ekar old(r ﹦ -0. 405,-0. 386;all P ＜0. 05). Fac╱Cr in pkrivkntricular was nkgativkle corrklatkd with LIMS scorks at corrkctkd agk 1 ekar old(r﹦ -0. 380,P＜0. 05);Fac,Fac╱Cr in ckrkbkllum wkrk nkga-tivkle corrklatkd with dkvklopmknt quotiknt at corrkctkd agk of 1 ekar old(r﹦ -0. 393,-0. 394;all P＜0. 05). Thkrk was no corrklation bktwkkn frontal lobk mktabolitks and nkurodkvklopmkntal lkvkl(P＞0. 05). ConcIusions Prktkrm infants brain mktabolitks at full tkrm contributk to prkdicting nkurodkvklopmkntal lkvkl. MI,Fac,MI╱Cr,Fac╱Cr ark of valuks for prkdicting nkurodkvklopmkntal lkvkl,and MI╱Cr is thk bkst prkdictor. Lmong frontal lobk,basal ganglia, hippocampus,pkrivkntricular and ckrkbkllum,thk pkrivkntricular is thk bkst arka for prkdicting nkurodkvklopmkntal lkvkl. Corrkctkd agk of 1 ekar old maebk thk bkst timk to prkdicting nkurodkvklopmkntal lkvkl.

Objective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus.Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study.According to their IVS,the patients were divided into normal group (IVS≤ 11 mm) and higher IVS group (IVS ＞ 11 mm).All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml· min-1 · (1.73 m2) 1 group and eGFR ＜ 60 ml· min-1 · (1.73 m2)-1 group.The demographic characteristic,biochemical examination,eGFR,and proteinuria of different groups were compared.Pearson or spearman correlation was used to analyze the relationship between eGFR,IVS and other parameters.eGFR ＜ 60 ml · min-1 · (1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression.Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis.Results Compared with normal group,patients in the higher IVS group had higher systolic pressure (P=0.002),their level of Scr,BUN,24 h urinary protein were increased (all P ＜ 0.05),while the level of eGFR,albumin (ALB),hemoglobin (Hb) and fasting blood glucose were decreased (all P ＜ 0.05).The prevalence of hypertension was increased (81.16％ vs 58.67％,x2=11.273,P=0.001),and there was also a difference in the proportion of patients in each stage of CKD (x2=34.593,P ＜ 0.001).Correlation analysis showed that IVS was positively correlated with BMI,systolic BP,Scr,BUN,24 h urinary albumin,24 h urinary protein (all P ＜ 0.05),while negative correlation was observed between the thickened degree of IVS and Hb,albumin,eGFR and total calcium (all P ＜ 0.05).It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P ＜ 0.01).Logistic regression analysis showed that longer duration of diabetes,higher systolic pressure and BUN were independent risk factors for eGFR ＜ 60 ml·min-1·(1.73 m2)-1 (all P ＜ 0.05),while higher Hb and Alb were independent protective factors for eGFR ＜ 60 ml· min-1· (1.73 m2)-1 (all P ＜ 0.05).Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P ＜ 0.05),while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P ＜ 0.05).Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396,95％ CI=1.098-1.774,P=0.006).Conclusion Interventricular septum thickness is closely related to the state of renal function,as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.

OBJECTIVE： To evaluate the efficacy and safety of progesterone in the treatment of acute traumatic brain injury systematically， and to provide reference for clinical use. METHODS： Retrieved from Cochrane library， ClinicalTrials， Web of Science， PubMed， Embase， CBM， CNKI and Wanfang database， randomized controlled trial （RCTs） about progesterone （trial group） versus placebo or blank control （control group） in the treatment of acute traumatic brain injury were collected. After literature screening， data extraction and quality evaluation by risk bias evalution tool of Cochrane systematic evaluator manual 5.1.0， Meta-analysis was performed by using Rev Man 5.3 statistical software. RESULTS： A total of 10 RCTs were included， involving 2 652 patients. Results of Meta-analysis showed that there was no statistical significance in mortality[RR＝0.77，95％CI（0.56，1.07），P＝0.12]， the incidence of septicemia [RR＝1.11，95％CI（0.77，1.60），P＝0.59] or elevated liver enzymes[RR＝1.30，95％CI（0.68，2.50），P＝0.43]. The number of patients with favorable neurological outcome[RR＝1.23，95％CI（1.05，1.43），P＝0.008] in trial group was significantly more than control group. Results of subgroup analysis of mortality showed that there was no statistical significance in the mortality of patient’s GCS≤8 [RR＝0.79，95％CI（0.57，1.10），P＝0.16]， that of patient’s GCS≤12[RR＝0.69，95％CI（0.23，2.10），P＝0.52] or that of patient’s GCS ranging from 9 to 12 [RR＝0.78，95％CI（0.26，2.35），P＝0.65] between 2 groups. Results of subgroup analysis of neurological outcome showed that there was no statistical significance in the number of favorable neurological outcome of patient’s GCS≤8 [RR＝1.18， 95％CI（0.98，1.43），P＝0.09]， the number of favorable outcome of patient’s GCS≤12[RR＝1.15，95％CI（0.87，1.51），P＝0.32] and the number of favorable neurological outcome of patient’s GCS ranging from 9 to 12[RR＝2.07，95％CI（0.24，17.71），P＝0.51]. CONCLUSIONS： Progesterone can improve the prognosis of neurological function in patients with acute traumatic brain injury with good safety but cannot reduce mortality.

Adult ; Anemia, Hemolytic ; diagnosis ; drug therapy ; Anti-Bacterial Agents ; therapeutic use ; Humans ; Male ; Mycoplasma pneumoniae ; pathogenicity ; Pneumonia, Mycoplasma ; diagnosis ; drug therapy