Objective To observe the effect of monochromatic infrared energy(MIRE)on diabetic periphe- ral neuropathy(DPN).Methods Seventy-four subjects with diabetic peripheral neuropathy who were tested by Semmes-Weinstein monofilaments(SWM)were randomized into 2 groups:a conventional management group and a conventional management plus MIRE group.Then the patients'sensory function and other DPN symptoms were evalu- ated by the SWME and the score of Michigan Neuropathy Screening Instrument.Results After treatments,there was a decrease(P＜0.01)in the number of the sites insensitive to SWME(grade 5.07),and MNSI scores were sig- nificantly decreased(P＜0.01).The MIRE management was more effective than conventional management.Con- clusion Monochromatic infrared energy is perhaps a safe,non-pharmaceutical and non-invasive method for the treat- ment of diabetic peripheral neuropathy.

The diagnosis of myocardial damage in systemic lupus erythematosus(SLE) is mainly based on clinical symptoms,physical examinations and electrocardiographic abnormality,echocardiographic changes,and myocardial enzymologic diversity in general.In recent years,it has been suggested that cardiac troponin I possesses high sensitivity and specificity in the diagnosis of myocardial damage.Lupus myocardial damage is diagnosed definitively depending on endomyocardial biopsy.Its treatment has been empirical,and hormone combined with immunodepressive is routine treatment.According to pathogenetic condition,there are still several therapies such as intravenous immunoglobulin therapy,blood purification and autologous hematopoietic stem cell transplantation,extracorporeal membrane oxygenation,and so on.Most often,myocardial dysfunction in SLE is of subclinical progression,and that early diagnosis and prompt treatment may play an important role in relieving patients' condition,raising quality of life and improving prognosis.

Objective To analyze the causes of medical disputes and to find an effective way to reduce medical malpractice and medical dispute.Methods The complete identification files of 251 cases of medical malpractice obtained from corresponding Offices of Technical Identification of Medical Malpractice in three cities at prefecture level in Shandong province were analyzed to compare the cause of medical malpractice identified by patients with that identified by experts.Results The main causes that identified by patients included violation(36.41%),default(35.60%),illegality(13.05%),tort(11.89%),and absence of management(3.05%).Among the litigation claims,58.53%were identified as existed factors causing disputes.Among the identified factors,72.66%should have been prevented and controlled.Conclusion Medical malpractice and medical dispute can be effectively prevented and controlled by putting management site forward,ensuring the implemention of the policies,and strengthening the substantive responsibility of the leadership.

Objective To evaluate the correlation between the endolymphatic hydrops in vestibule and symp‐toms ,audiovestibular functions in patients with Meniere's disease .Methods Twenty -four hours after bilateral intra-tympanic 8 times diluted gadolinium administration , three - dimensional fluid - attenuated inversion recovery MRI ,using a three-Tesla unit ,was performed in 34 patients .The extent of endolymphatic hydrops in the MRI images was assessed and compared the hydrops with age ,duration ,stage of the disease ,frequency of attacks ,pure tone audiometry ,caloric test ,electrocochleography and vestibular evoked myogenic potentials .Results Thirty -four patients showed different levels of enhancement of perilymth in the inner ears .In these patients ,obvious signs of endolymphatic hydrops were visualized ,including 8 slight hydrops ,11 mild hydrops and 15 significant hydrops . In all 34 patients ,the results of PTA were 9 dB HL to 90 dB HL ,with average of 43 .56 dB HL and there were 21 abnormal and 13 normal patients in caloric test with a diagnostic rate 61 .76% ;17 normal ,7 abnormal and 10 not elicited patients in VEMP with a diagnostic rate 50% ;22 abnormal and 12 normal patients in electrocochleography with a diagnostic rate 64 .71% .There were almost no complications in all 34 patients after bilateral intra-tympanic injec‐tion except short vertigo among 5 of them .A statistically significant correlation was found between degrees of en‐dolymphatic hydrops in vestibule and age ,stage of the disease and VEMP (P<0 .05) ,whereas no significant corre‐lation was found between the extent of endolymphatic hydrops and duration ,frequency of attacks ,pure tone audi‐ometry ,caloric test ,electrocochleography(P> 0 .05) and the correlation coefficient were 0 .494 ,0 .568 ,0 .590 , 0 .495 ,respectively .Conclusion The degree of endolymphatic hydrops in Ménière's disease has significant correlation with age ,VEMP ,stage of the disease and pure tone audiometry .No significant correlation was found between hy‐drops and duration ,frequency of attacks ,functional level scale ,caloric test and electrocochleography .

A 64-year old man was admitted on July 2011 with masses both in liver and right kidney.After PET-CT and blood test examination,dual primary advanced cancers were speculated to be co-existed in this patient,which having poor prognosis.By evaluation with comprehensive geriatric assessment,the patient also had hypertension,diabetes and atherosclerosis,liver and renal insufficiency.After multidisciplinary consultation and detailed discussion with the patient,the decision of no surgery and just keep the follow-up was made.The patient has been followed up for 18 months and the functional evaluation is the same as before.It is very important to evaluate the risk/benefit equation and improve the standard of care,and make the decision as patient centered rather than disease-centered in the elderly patients.

Objective:To explore the value of clinical pharmacist in clinical treatment through the pharmaceutical care on a patient with Japanese B encephalitis complicated with pulmonary infection. Methods:Clinical pharmacist participated in the whole treatment process and gave suggestions on the selection,dosage and course of the drugs prescribed for anti-virus, anti-epilepsy and anti-infection by focusing on the drug interactions and adverse reactions. Results:The treatment course of the patient was smooth, and the pathoge-netic condition was brought under control gradually while no obvious adverse drug reactions occurred. Conclusion:The work of clinical pharmacist can help to optimize treatment programs to ensure the safety and effectiveness of medication.

Objective To investigate the transactivating effect of hepatitis C virus(HCV)core protein on inducible nitric oxide synthase(iNOS)gene promoter and the molecular biological mecha- nisms of HCV pathogenesis.Methods Polymerase chain reaction(PCR)technique was employed to amplify the sequence of iNOS promoter by using HepG2 genomic DNA as template,and the product was cloned into pGEM-T vector.The iNOSp gene was cut from T-iNOSp by KpnⅠand XhoⅠ,and then was cloned into pCAT3-Basic,the constructed vector was named as pCAT3-iNOSp,pCAT3-iN- OSp was transfected into the LO_2 cell line.LO_2 cell was also cotransfected with pcDNA3.1(-)-core and pCAT3-iNOSp by FuGENE 6 transfection reagents.The LO_2 cells transfected with pCAT3-Basic was used as negative control.The activity of CAT in LO_2 cells was detected by an ELISA kit after 48 hours,which reflected the transactivating function of HCV core protein to iNOS gene promoter.Re- sults The expressive vector pcDNA3.1(-)-core and report vector pCAT3-iNOSp had been construc- ted and confirmed by restriction enzyme digestion and sequencing.The expression of CAT in LO_2 cells transfected with pCAT3-iNOSp and peDNA3,1(-)-core was 11 times as higher as that of pCAT3-bas- ic,and 6 times as higher as that of pCAT3-iNOSp.Conclusion It is suggested that HCV core protein can transactivate iNOS gene promoter.

Objective:To explore the value of clinical pharmacists in the clinical treatment of a patient with Guillain Barré syn-drome through pharmaceutical care. Methods:Clinical pharmacists participated in the entire treatment process and gave rational sug-gestions about the selection,dosage and course of the drugs,such as glucocorticoid,immunoglobulin and antibiotics. Meanwhile,clini-cal pharmacists focused on the adverse drug reactions. Results:The patient′s condition was controlled and improved gradually. During the hospitalization,the patient developed skin rash and abnormal liver function,while the symptom was improved after the anti allergy and liver protection treatment,and no obvious effect on the primary disease was shown. Conclusion:Clinical pharmacists can help to optimize treatment regimen in order to ensure the safety and effectiveness of patients’medication.

In order to screen genes transregulated by core protein of hepatitis C virus, cDNA microarray technology was employed to detect the gene expression change between HepG2 cells transfected with pcDNA3 1(-) core and the empty vector, respectively. Among 1152 genes, there were 95 genes with different expressions, of which 45 genes were upregulated and 50 genes were downregulated in HepG2 cells transfected with core protein expression plasmid. These genes transregulated by HCV core protein included human genes encoding proteins involved in cell proliferation, differentiation, apoptosis, signal transduction and immune regulation. Therefore, the results provided some new clues for further clarifying the molecular biology mechanism of pathogenesis and tumorigenesis of HCV core protein

Hepatitis C virus (HCV) non structure 3 (NS3) protein and hepatitis B virus (HBV) X protein expressing plasmids were constructed with the vector pcDNA3 1(-). The plasmids were transfected into HepG2 cells and the viral proteins expressed in HepG2 cells were identified using Western blotting methods. Then the two recombined plasmids were transfected into HepG2 cells and were cotransfected into HepG2 cells with reporter plasmid pCAT3 promoter. The activity of CAT enzyme was detected by a CAT ELISA assay kit, which reflected the transactivating function of two proteins on SV40 early promoter. The findings indicated that the expression of two viral proteins were successfully detected in soluble protein cell extracts of transiently transfected HepG2 cells. HCV NS3 protein transactivated the CAT enzyme expressed at a value 3 5 fold higher than the control, while HBX protein transactivated at a value 4 4 times. It arrived at 8 5 times when transfected with two plamids simultaneously. The activating effect was increased in relation to the amount of plasmids. It was suggested that the two kinds of viral proteins had a transactivating effect on SV40 early promoter, and they acted synergistically. These results might contribute to explaining the mechanisms of liver injury or tumorigenesis induced by HCV or/and HBV infection