Persistent pulmonary hvpertension of newborn(PPHN) is a life-threatening condition which occurs at a rate of 2/1 000-6/1 000.The etiology of PPHN is still unknown and its treatment remains a major challenge for neonatologist.Impaired pulmonary artery relaxation,reduced blood vessel density and pulmonary vascular remodeling are the main pathological changes in PPHN.The general managements include mechanical ventilation,sedation,surfactant and hemodynamic support.Inhaled nitric oxide is the main vasorelaxant used in the treatment of PPHN.Several other vasorelaxants have been studied such as phosphodiesterase inhibitors,prostacyclin,endothelin-1 inhibitors.Even with the introduction of several new therapeutic modalities there has been no significant change in survival rate.

Objective:To analyze the probability of breast cancer with skin involvement and discuss the extent of removal of skin.Methods:Skin of the tumor surface was examined by series section in 40 cases of breast cancer.Results:Of the 40 patients,except 1 Paget disease,none of the rest was confirmed with skin involvement.The rate of skin involvement was 2.5%.Conclusion:If there are no abnormal clinical manifestation in skin,the extent of removal of skin shall not be enlarged and subcutaneous mastectomy with skin preservation can be accepted for early stage breast cancer.

AIM: To establish a method for determining isofraxidin and formononetin in Aidi Freezing Dried Powder for Injection(Radix et Rhizoma Ginseng,Radix Astragali,Radix et Rhizoma seu Caulis Acanthopanacis senticosi,etc.) by HPLC. METHODS: Chromatographic assay was performed on Hypersil C_(18) column(200 mm?4.6 mm,5 ?m).The mobile phase consisted of acetonitrile(A) and water(B).Gradient program was adopted as follows:0-15 min:16% A,15-45 min:40% A.The flow rate was 1.0 mL/min and the detection wavelength was 344 nm and 254 nm. RESULTS: Isofraxidin had a good linearity(r=(0.999 7)) in the range of 36.80-184.0 ?g/mL.The average recovery was 97.2%,and RSD=2.1%(n=9).Formononetin had a good linearity(r=0.999 7) in the range of 36.40-182.0 ?g/mL.The average recovery was 98.8%,and RSD=2.1%(n=9). CONCLUSION: The above method is simple,sensitive and accurate.It can be used for quality control of Aidi Freezing Dried Powder for Injection.

Objective To investigate the association of insulin dose with clinical factors of type 2 diabetes. Methods We reviewed the data of 214 type 2 diabetic patients who received insulin regimens.We compared the insulin dose and period at the targeted blood glucose levels among 6 groups according to different type of oral hypoglycemic agents. Results There existed statistically significant correlations of the glucose-targeted insulin dose with course,FPG,BMI,combination therapy with oral hypoglycemic agent(P<0.1,test level P=0.1).Merely metformin failure group took less insulin than the group admitted due to combination therapy failure (P=0.016, 0.53(0.35～0.62)U/kg and 0.63(0.51～0.75)U/kg respectively).The longest targeted period existed in the later. Relationship between the targeted bedtime insulin NPH dose and FPG level can be demonstrated by equation Y=0.255X+7.8. Conclusions The targeted insulin dose is influenced by synthetic factors. Patients admitted due to combination oral hypoglycemic drug failure have the maximal targeted insulin dose and the longest titration period. The final bedtime insulinNPH dose can be predicted by FPG level.

Objective To investigate the clinical and imaging features of the reversible posterior leukoencephalopathy syndrome(RPLS).Methods The clinical and imagig data of 9 patients with RPLS were analyzed retrospectively.Results Among the patients,4(44%)were secondary to pregnancy-induced hypertension syndrome,1(11%)was second to short bowel syndrome,1(11% )was second to acute lymphoblastic leukemia,1( 11% )was second to IgA nephropathy,and 2(22%)were second to hypertensive encephalopathy.Their mean age of symptom onset was 23.4 ± 9.9 years.Their main clinical manifestations were headaches,seizures,blurred vision,and consciousness disturbance.Magnetic resonance imaging(MRI)showed symmetrical lesions of bilateral white matter in posterior brain.T1 weighted imaging and diffusion-weighted imaging showed low or isointense signal.T2 weighted imaging,fluid attenuated inversion recovery(FLAIR),and apparent diffusion coefficient(ADC)map showed high-intensity signal.The symptoms of the patients disappeared after the treatment.MRI reexamination showed that the lesions disappeared completely or almost completely.Conclusions The causes of RPLS were different.The imaging mainly showed the signal of vasogenic brain edema on the posterior white matter of the brain.After timely treatment,the symptorms and imaging features were improved rapidly.The patients with young-onset RPLS are their important clinical feature.[Key wonds]Posterior leukoencephalopathy syndrome;Magnetic resonance imaaging;Hypertension;Age factors were improved rapidly.The patients with young-onset RPLS are their important clinical feature.

Objective To explore the curative effect of the pressure sore treated by iodophors associating with oxygen and peptide. Method 36 cases with pressure sore in stage Ⅲ and stage Ⅵ were randomly divided into the observation group and the control group. After ebriding was carried out in both groups, the control group was trea-ted with the rout change dressing and the other group was treated by iodophors associating with oxygen and peptide es-pecially. Result The cicatrization time of the observation group was remarkablely shorter than the control group. Conclusion Treating the pressure sore by iodopbors associating with oxygen and peptide has the advantage of less passion, shorter course of treatment, better curative effect, economy and mote convenience which is worth for the pro-moting of clinical usage.

Mother-to-child transmission (MTCT)is an important way of hepatitis B virus (HBV)transmission.Blocking the HBV MTCT has a great significance for the prevention and treatment of hepatitis B.This article reviews the current blocking strategies implemented in the antepar-tum,peripartum,and postpartum stages,and summarizes the controversies existing in the blocking strategies in different stages.The significance of HBV occult infection and germ cell transmission in the HBV MTCT is analyzed.The results indicate that the current strategies for the prevention of hepatitis B MTCT need further improvement.Attentions should be focused on HBV occult infection and germ cell transmission.

Objective To evaluate the safety and effects of feeding very low birth weight infants and extremely low birth weight infants with human donors' milk in China.Methods One hundred and ninety-nine very low birth weight infants and extremely low birth weight infants (VLBWI/ELBWI) admitted to NICU in Nanjing Maternity and Child Health Care Hospital were analyzed retrospectively (from August 1,2013 to July 31,2014) one year before and one year after the establishment of human donors' milk bank.Only 1 infant's parents(1/199 cases) refused to use donor milk,and 198 infants were fed with donors' milk since their own mothers' milk was unavailable.One hundred and forty-eight infants admitted to NICU from August 1,2012 to July 31,2013 were chosen as the control group,who were fed with formula milk since their own mothers' milk was unavailable.The mortality,incidence of necrotizing enterocolitis (NEC) and sepsis,time to full enteral feeding and hospital stay between 2 groups were analyzed.Results One year before the establishment of breast milk bank,there were 148 cases of very low or extremely low birth weight infants receiving mixed feeding,and 16 cases of them had neonatal necrotizing enterocolitis,the incidence rate was 10.81％.Since the establishment of human milk bank,187 women donated breast milk in the first year and 260 555 mL of human milk were collected and delivered.Only 1 infant (1/199 cases) refused to use donor milk,and 198 infants were fed with donors' milk since their own mothers' milk was unavailable.Nine babies with VLBWI/ELBWI were diagnosed as NEC in donor milk feeding group,and 16 cases were diagnosed as NEC in formula-feeding group.The incidence rate of NEC was lower in the donor-milk-feeding group (4.52％ vs 10.81％,x2 =5.02,P ＜ 0.05).Donor-milk-feeding group reached full enteral feeding[(16.4 ± 5.3) d vs (18.2 ± 6.2) d,t =2.84,P ＜ 0.05] and had shorter period of hospital stay[(35.1 ± 9.5) d vs (37.3 ± 10.4) d,t =2.05,P ＜ 0.05] compared with formula feeding group.The mortality and incidence of sepsis had no difference between 2 groups (all P ＞ 0.05).Conclusions Donors' breast milk is associated with a lower risk of NEC,sooner full enteral feeding and shorter hospital stay.Further research is needed to confirm these findings and measure the growth and long term neurodevelopment effects of donors' breast milk.

Objective To grasp the development of private hospitals of traditional Chinese medicine (TCM) from a macro level;To provide reference for stakeholders by analyzing the underlying database of TCM private hospitals. Methods By analyzing the TCM database of hospital health agency annual statement from“National Health Statistical Investigation System”, current status of TCM private hospitals were analyzed from the aspects of organization, personnel, beds, number of service, and patient burden. The developing level of TCM was reflected by comparison with public hospitals. Results By the end of 2013, there were 938 TCM private hospitals, accounting for about 26.13% of TCM hospitals. Average annual growth rate of beds, health technicians, outpatient visits, and discharged patients exceeded 10%, while the hospital degree, bed utilization ratio, physician burden, and average length of stay for discharge patients were only 70%of TCM public hospitals. Conclusion TCM private hospitals have achieved rapid development in the number of these indicators, but the service efficiency, scale and level are still far behind TCM public hospitals.

Objective To investigate the distribution and antimicrobial resistance of clinically isolated pathogens from geriatrics department of a hospital in 2013,so as to provide reference for clinical antimicrobial use.Methods Distribution and antimicrobial resistance of pathogens isolated from patients in a geriatrics department between Janu-ary and December 2013 were analyzed statistically.Results Of 1 896 pathogenic strains,1 289(67.99%)were gram-negative bacteria,439 (26.00%)were gram-positive bacteria,and 114(6.01%)were fungi;the top 4 isolated pathogens were Klebsiella pneumoniae ,Pseudomonas aeruginosa ,Acinetobacter baumannii ,and Escherichia coli .Extended-spec-trumβ-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae accounted for 53.26% and 31.10% of Escherichia coli and Klebsiella pneumoniae respectively;Of Staphylococcus aureus and Staphylococcus epidermidis strains,methicillin-resistant isolates (MRSA and MRSE)accounted for 22.47% and 80.00%,respectively,of Enterococ-cus strains,vancomycin-resistant isolates (VRE)was 3.10%,Klebsiella pneumoniae and Enterobacteriaceae were highly sensitive to imipenem,meropenem and ertapenem.Resistant rate of Acinetobacter baumannii to imipenem and meropenem was 79.48% and 80.35% respectively,Pseudomonas aeruginosa had the lowest resistant rate to amikacin (10.70%). Gram-positive bacteria were highly sensitive to vancomycin and linezolid.Conclusion The major pathogens isolated from the elderly patients are gram-negative bacteria,and antimicrobial resistance is serious,surveillance of antimicrobial resist-ance is important for rational use of antimicrobial agents and control of pathogen resistance.