Objectives A rare case of juvenile dermatomyositis (JDM) complicated by myelodysplastic syndrome (MDS) was reported in order to improve the understanding of the disease in its clinical signs, differential diagnosis and treatment. Meth-ods The course of the disease, clinical characteristics and the process of diagnosis and treatment were analyzed. Specimens of bone marrow, lymph nodes, muscles were examined by histopathological or immunohistopathological means and lfow cytometry. Results The diagnosis of JDM complicated by MDS was made based on the clinical manifestations, related laboratory results and the accompanying changes in hematological and bone marrow examinations. Conclusions JDM complicated by MDS is very special and rarely seen in China and its pathological mechanism and strategy of diagnosis and treatment should be further explored.

OBJECTIVE:To explore the effect of dexmedetomidine with different doses combined with ropivacaine on the bra-chial plexus block. METHODS:Totally 90 patients with upper extremity surgery of brachial plexus block were randomly divided in-to test group,control group 1 and control group 2. Test group was treated with 0.375%ropivacaine 40 ml+dexmedetomidine 100μg, brachial plexus injection;control group 1 was treated with 0.375% ropivacaine 40 ml+dexmedetomidine 50 μg,brachial plexus in-jection;and control group 2 was treated with 0.375% ropivacaine 40 ml,brachial plexus injection. Onset time of sensory and motor nerve block,block duration,postoperative pain time for the first time and pain score,analgesia duration,quality of analgesia and muscle relaxant,before anesthesia induction(T0),plasma cortisol concentrations in nerve block 10 min (T1),the start of surgery (T2)and incidence of adverse reactions were observed. RESULTS:The onset time of sensory and motor nerve block and postopera-tive pain score for the first time in test group werecontrol group 1>control group 2,plasma cortisol concentrations at T1 and T2 were higher than T0,and T2>T1>T0,test group0.05). CONCLUSIONS:Ropivacaine combined with 100 μg dexmedetomidine can effectively im-prove brachial plexus block and shorten the onset time of sensory and motor nerve block,with good safety.

Objective To evaluate the accuracy of prediction equations in calculating energy expenditure in elderly patients with type 2 diabetes mellitus (T2DM).Methods In 75 elderly T2DM patients hospitalized in our hospital between August 2014 and August 2015,the resting energy expenditure (REE)measured with indirect calorimetry was compared with those calculated with six different prediction equations.Statistical analysis was performed with paired t-test,the percentage of individual coincidence,and BlandAltman method.Results The measured REE of the patients was (1 513.2 ± 240.6) kcal/d.There were statistically significant differences between the measured REE and the values predicted with Harris-Benedict,Owen,Mifflin,and Liu equations (all P ＜ 0.05),while no statistically significant differences were observed between the measured REE and the values predicted with FAO/WHO/UNU and Schofield equations (both P ＞0.05).FAO/WHO/UNU equation showed the smallest average difference from the measured value (-18.9 kcal/d),but the 95％ consistency limit (-363.3 kcal/d,325.5 kcal/d) was still beyond the acceptable clinical range.Conclusion The accuracy of prediction equations in estimating REE in elderly patients with T2DM may be dissatisfactory.

Objective To evaluate the effect of pronase on amoxicillin and metronidazole concentrations in gastric tissue. Methods C57BL/6 mice were randomly divided into experimental group ( n = 70 ) and control group ( n = 70 ) . Amoxicillin ( 28. 6 mg/kg ) , metronidazole ( 22. 5 mg/kg) and omeprazole (138.2 mg/kg) were administered orally to C57BL/6 mice, combined with pronase (110 mg/kg) or same amount of sterile PBS. Gastric tissue and blood plasma samples were taken at 10 point-in time (7 mice/time) from 15 min up to 360 min after administration. Concentrations of amoxicillin and metronidazole were detected by high performance liquid chromatography. Gastritis index of gastric mucosa ( hematoxylin-eosin staining) and the gastric tissue expressions of mucin 5 AC (Western blot) were detected at 120 min and 360 min after administration. Results The time to peak concentration of amoxicillin and metronidazole in gastric tissue appeared earlier than that in blood plasma (15 min vs 60 min). Tissue concentrations of amoxicillin and metronidazole of experimental group were significantly higher than those of control, and they were mainly at 15 min to 90 min (P ＜0. 05). Plasma concentrations of amoxicillin and metronidazole of experimental group at 15 min and 30 min were higher than those of control ( P ＜ 0. 05 ). There was no difference in gastritis index between experimental group and control at 120 min and 360 min after administration (0.28±0. 18 vs 0. 14 ±0. 14,P＞0.05; 0. 43 ±0. 20 vs 0. 28 ±0. 18,P ＞0. 05). The expressions of mucin 5 AC in experimental group were lower than those of control ( 0. 036 ± 0. 006 vs 0. 197 ± 0. 058; P ＜0. 05; 0. 039 ± 0. 008 vs 0. 208 ± 0. 072, P ＜ 0. 05 ). Conclusions Pronase can significantly enhance the drugs penetration from mucus into gastric tissue. Concentrations of amoxicillin and metronidazole of experimental group in local gastric tissue and plasma are higher than those of control, especially in improving concentrations of gastric tissue and prolongation of exposed time.

Objective To investigate the efficacy and safety of amisulpride and clozapine in schizophrenia patients with predominantly negative symptoms.Methods Totally 166 cases of schizophrenia patients with predominantly negative symptoms from May 2013 to May 2016 in The Sixth People's Hospital of Hebei were divided into observation group and control group,83 cases in each group.Patients in the observation group were treated with amisulpride,and control group were treated with clozapine.The clinical effect,SANS scores,and occurring rate of abnormal electrocardiogram were compared.Results The clinical effect,emotional insipid (blunting),and attention dysfunction scores from SANS of observation group were significantly better than those of control group on week 4,8,and 12,respectively (P ＜ 0.05);The occurring rate of abnormal electrocardiogram in observation group was significantly lower than that of control group on week 12 (P ＜ 0.05).Conclusion Compared with clozapine,amisulprid has better efficacy and safety in schizophrenia patients with predominantly negative symptoms,and can effectively improve of symptom of insipid (blunting) and attention dysfunction.

Objective To discuss the method and efficiency of less invasive stabilization system (LISS) in treatment of comminuted tibia[ fractures. Methods A total of 14 patients with comminuted tibial fractures were treated with LISS between January 2005 and July 2006. There were 10 males and four females, at age range of 19-61 years (mean 34 years). Of all, 11 patients were with proximal fractures of tibia and three with distal ones, including six with open fractures and eight with closed ones. The period from injury to operation was 2-13 days. An observation was done on postoperative soft tissue recovery and fracture healing. Results The average period of follow-up was 9.4 months (4-16 mouths). All frac-tures were healed up after average 7.8 months (4-12 months). All incisions were healed up at one stage, with no complications on nerves, blood vessels or soft tissues. The axes of tibia were good, with sound function of knee and ankle joints. Conclusion LISS is characterized by easy operation, minor trauma, high healing rate and low complications in treatment of comminuted tibial fractures.

Objective To explore the expression and clinical significance of CD 8 +CD28 -T lymphocytes in the patients with endometriosis ( EMT) complicating with pelvic fluid .Methods Eighty patients with endometriosis complicating with pelvic fluid ( ca-ses of ⅠtoⅣwere 15, 12, 22, and 31, respectively) were enrolled.The peripheral blood as well as the pelvic fluid were collected and flow cytometry was applied to detect the frequencies of CD 8 +CD28 -T lymphocytes and their intracellular cytokines , including transforming growth factor β1 (TGF-β1) and interleukin 10 (IL-10).Twenty health women with the same range of age were enrolled as the control group .Results Compared with the control ones , the frequencies of peripheral blood CD 8 +CD28 -T lymphocytes , TGF-β1, and IL-10 of the EMT subjects were increased significantly (all P <0.05), which presented the order Ⅳ>Ⅲ>Ⅱ>Ⅰand the difference between every two of the Ⅰ~Ⅳgroups was significant (all P <0.05).Similarly, the data of CD8 +CD28 -T lymphocytes, TGF-β1, and IL-10 in pelvic fluid also presented as Ⅳ>Ⅲ>Ⅱ>Ⅰ.Moreover, the difference of pelvic fluid TGF-β1 between any two groups was more apparent compared with CD 8 +CD28 -T lymphocytes and IL-10 ( P <0.05 ) .Spearman correlation analysis showed that any one of CD8 +CD28 -T lymphocytes, TGF-β1, and IL-10 positively correlated with any stage of ⅠtoⅣ( rs =0.791, 0.753,0.726 and all P <0.05).Conclusions CD8 +CD28 -T lymphocytes, TGF-β1, and IL-10 were closely related to the stages and could be the negative roles in the pathogenesis of EMT .TGF-β1 played a vital role in the formation of pelvic fluid .

Objective To investigate the effect of transitional care on postpartum negative mood for puerpera. Methods One hundred sixty eligible puerperas were recruited between January 2013 and October 2014. By order of hospitalization, participants were randomly assigned into two groups. The control group (80 cases) received routine care. The study group received transitional care which consisted of predischarge assessment, structured home visits and telephone follow-ups, psychological rehabilitation group activities, phone and internet consulting services within six months after discharge. Screenings of predischarge depression and anxiety symptoms of the study group were done by Hospital Anxiety and Depression Scale (HADS). Evaluations of depression and anxiety symptoms of two groups were done by Edinburgh postnatal depression scale (EPDS) and Self-Rating Anxiety Scale(SAS)on postpartum forty-two days and six months. Results There were no differences in demographics, maternal indicators and completion of follow-up between groups (P > 0.05). On postpartum forty-two days, the study group had significantly better depression and anxiety scores (P < 0.05), the depression and anxiety scores of study group were 7.71 ± 2.61and 44.3 ± 6.1, those of control group were 8.31 ± 2.72 and 47.6 ± 5.4. There were no differences in the incidences of depression and anxiety between the two groups (P>0.05). On postpartum six months, the study group had significantly better depression and anxiety scores, less incidences of depression and anxiety than the control group (P<0.05). The depression and anxiety scores of the study
group were 7.13±2.52 and 42.6±6.0, those of control group were 8.87±2.66 and 48.8±5.9. The incidences of depression and anxiety of study group were 6.4%(5/78)and 7.7%(6/78), those of control group were both 26.0%(20/77). Analysis of multiple linear regression suggested that age, education level and family income would affect transitional care intervention on postpartum depression. Conclusions This study established a nurse-led transitional care model which selected the gynecology and obstetrics professional nurse as advanced practice nurse. Results demonstrated that transitional care was effective on improving maternal postpartum depression and anxiety.

Traditional Chinese medicine is the crystallization of civilization and wisdom of Chinese nation , in which the complex components exhibit unique advantages in anti-tumor therapy through multi-channel and multi-target.Through the summary of the litera-tures recently, the research on anti-tumor mechanism of traditional Chinese medicine was reviewed to provide reference for the deep re -search and clinical application of traditional Chinese medicine .

BACKGROUND:For the department of orthopedics, digital technology can be used for a three-dimensional reconstruction of the fracture site, and visual virtual reset. This not only can preoperatively plan the operation path, make reasonable operation plan, but also can predict the prognosis after surgery. OBJECTIVE:To discuss the feasibility and clinical effect of digital technology for three-dimensional measurement and preoperative design in intertrochanteric fracture patients undergoing proximal femoral nail antirotation. METHODS:Eighty patients of intertrochanteric fractures, who underwent proximal femoral nail antirotation in the Changyi People’s Hospital from January 2010 to January 2014, were selected in this study. According to the order of visiting, they were randomly divided into traditional treatment group and three-dimensional design group, with 40 cases in each group. Patients in the traditional treatment group received proximal femoral nail antirotation. Patients in the three-dimensional design group received preoperative CT scan to establish the digital three-dimensional model of intact femur. The analog was reset by technology. The length and diameter of medul ary cavity were measured. The appropriate specifications of intramedul ary nail were selected. On this basis, the plan of the operation and implementation of operation were made. Operation time, intraoperative bleeding volume and blood transfusion were recorded in the two groups. Hip function was evaluated by hip Harris score. RESULTS AND CONCLUSION:(1) Operations in the two groups were successful. Significant differences in operation time, intraoperative bleeding volume and blood transfusion were determined between the two groups (P<0.05). No significant difference in length of stay was detected between the two groups (P>0.05). (2) Al patients were fol owed up. Postoperative wound was healed. Broken nail or broken rod was not found at the end of the study. (3) At the end of the fol ow-up, the excel ent and good rate of Harris hip score was 95%in the traditional treatment group and 93%in the three-dimensional design group;no significant difference was detected between the two groups. (4) Results suggested that the application of digital department of orthopedics technology for the treatment of intertrochanteric fracture of femur in patients with preoperative three-dimensional measurement and surgical design can significantly shorten the operation time and improve hip function.