OBJECTIVE:To compare therapeutic efficacy and safety of dexamethasone with different administration routes in the treatment of chronic secretory otitis media. METHODS:A total of 150 patients with chronic secretory otitis media were random-ly divided into control group(75 cases)and observation group(75 cases). Control group was given Dexamethasone sodium phos-phate injection 5 mg by auripuncture under endoscope. Observation group was given Dexamethasone sodium phosphate injection 5 mg via eustachian tube under endoscope. Both groups were given relevant medicine every 2 days,for 3 times in total. Clinical effi-cacies of 2 groups were observed as well as bone conduction threshold under 1,2,4,8 kHz,the levels of water channel protein 1 and water channel protein 4,recurrence,the occurrence of tympanic cavity effusion before and after treatment. The occurrence of ADR was recorded. RESULTS:The total response rate of observation group(93.33%)was significantly higher than that of control group(80.00%);recurrence rate and the incidence of tympanic cavity effusion of observation group were significantly lower than those of control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in bone con-duction threshold,the levels of water channel protein 1 and water channel protein 4 between 2 groups(P>0.05). After treatment, the levels of bone conduction threshold in 2 groups were significantly lower than before;the observation group was significantly lower than the control group. The levels of water channel protein 1 and water channel protein 4 in 2 groups were significantly high-er than before;the observation group was significantly higher than control group,with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:The administration of dexa-methasone via eustachian tube under endoscope is significantly better than auripuncture in terms of therapeutic efficacy for chronic secretory otitis media,relieving clinical symptom,improving bone conduction threshold,up-regulating water channel protein level, reducing the risk of recurrence and tympanic cavity effusion. The two routes of adimistration have similar safety.

Congenital hydronephrosis is the main cause of childhood chronic renal disease and renal failure,which is also one of the most common anomalies in pediatric urology division.Although the operation is performed to treat obstruction,the renal function of patients get worse and worse,postoperatively.Up to date,there are lots of controversies in evaluation of hydronephrosis and treatment at prenatal and postnatal.According to recent articles,the recent examinations,evaluation system,follow-up and treatment strategies of hydronephrosis are introduced.

Objective To detect serum levels of 25 ? hydroxyvitamin D (25 [OH] D) and matrix metalloproteinase 9(MMP?9)in patients with chronic spontaneous urticaria(CSU), and to explore their significance. Methods Totally, 56 patients with CSU and 25 healthy controls were enrolled into this study. High?performance liquid chromatography tandem?mass spectrometry(LC?MS/MS)and enzyme?linked immunosorbent assay(ELISA) were performed to measure serum levels of 25(OH)D and MMP?9 respectively in these subjects. Statistical analysis was carried out by two independent samples t?test or Wilcoxon rank sum test for comparisons of the above indexes between the two groups, and by Spearman rank correlation analysis for assessment of relationships between the serum levels of 25(OH)D and MMP?9 as well as between the two indexes and disease severity. Results Of the 56 patients, 19 were diagnosed with mild CSU, 26 with moderate CSU and 11 with severe CSU. Compared with the control group, the patient group showed significantly lower serum levels of 25(OH)D(21.74 ± 6.04 vs. 30.17 ± 2.21μg/L, P<0.05), but significantly higher serum levels of MMP?9(Median[P25-P75]:291.55[166.18-594.46]vs. 138.46[94.27-233.12]μg/L, P<0.05). In the patient group, the serum level of 25(OH)D was negatively correlated with that of MMP?9 (rs=-0.26, P<0.05), but uncorrelated with the severity of CSU(rs=-0.20, P>0.05);the serum level of MMP?9 was positively correlated with the severity of CSU(rs=0.27, P<0.05). Conclusion Vitamin D and MMP?9 may play a role in the occurrence of CSU.

Objective To investigate the clinical characteristics,treatment options and prognosis of duplex kidneys in children.Methods Data were retrospectively collected from all patients who were hospitalized at Shengjing Hospital Affiliated to China Medical University from January 2008 to May 201 5.The surgery to retain moie-ty nephron was performed in 30 cases:1 2 cases underwent non common sheath ureter reimplantation,4 cases of the patients had common sheath ureter reimplantation,1 2 patients underwent transurethral resection of the cyst,1 case of them had pyeloureterostomy,and the other patients underwent lower -pole pyeloplasty.Removal of renal moiety was performed in 52 cases:43 patients underwent upper -pole heminephrectomy,8 patients underwent upper pole hemi-nephrectomy and lower -pole ureter reimplantation,and 1 case of the patients had upper -pole heminephrectomy and lower -pole ureteroplasty.Results A total of 54 cases were followed up,the follow -up rate reached 65.9%,the follow -up time lasting 2 months to 4 years,with an average time of 9.53 months.All clinical symptoms disappeared after remove moiety operation.There were small ureteral cysts but compared with the preoperative condition,the symp-toms reduced significantly in 4 cases.All clinical symptoms disappeared in patients whose nephron was retained after operation,and hydronephrosis was alleviated.De novo 2 degree of vesicoureteral reflux was found in 3 out of 1 2 pa-tients who underwent transurethral puncture of the cyst.Conclusions The clinical manifestations of duplex kidney have some characteristics which include recurrent urinary tract infection,normal intermittent voiding urine dripping, abdominal pain,urethral orifice mass,abdominal mass and aggravation of hydronephrosis.Duplex kidney is often asso-ciated with cardiac malformation and cryptorchidism.The preoperative testicular examination and echocardiography should be performed.The choice of operation depends on the clinical manifestation,auxiliary examination results and comprehensive analysis.The prognosis of duplex kidney is well,but patients need to be further followed up af-ter operation.

Vaccination in children suffering neurological diseases is a troublesome issue that people es-pecially pediatricians are reluctant to mention. Due to worrying about the emergence of adverse reactions and concerning on the heat induced seizure,doctors and parents tend to cancel or do not recommend these children to be vaccinated. Additionally,the heat sensitive seizures,such as febrile seizure( FS) ,generalized epilepsy with fe-brile seizure plus(GEFS+),Dravet syndrome account for the largest proportion of the seizure related disease and epilepsy syndrome. Their pathogenesis has been proved relating to the mutation of SCN gene of the sodium channel. For children with FS,GEFS+,and Dravet syndrome,vaccination may lead to fever,which even may bring about convulsions,but it will not result in worse prognosis.

Objective To investigate the influence factors of cognitive impairment in epilepsy children with less than 6 years old. Methods Eighty-nine epilepsy children with less than 6 years old were selected. The neuropsychological detection was tested by Gesell developmental diagnostic scale (GDDS), and head imaging examination (CT or MRI) and ambulatory electroencephalogram (EGG) were checked. Results The scores of adaptive behavior, big sports behavior, fine motor behavior, language behavior and personal- social behavior were (82.98 ± 14.02), (85.86 ± 13.79), (83.14 ± 13.44), (84.75 ± 3.29) and (84.99 ± 14.37) scores, the average development quotient of the children with epilepsy were greater than 75 scores, and there were no statistical differences among them (P > 0.05). According to the test results of adaptive behavior, big sports behavior, fine motor behavior, language behavior and personal-social behavior, the rates of developmental delay children were 21.35% (19/89), 19.10% (17/89), 16.85% (15/89), 24.72% (22/89) and 22.47% (20/89), and the rates of moderate to severe developmental delay were 3.37% (3/89), 3.37% (3/89), 4.49% (4/89), 3.37% (3/89) and 3.37%(3/89). Multivariate analysis results showed that first onset age of epilepsy and head imaging performance were correlated with adaptive behavior, big sports behavior, fine motor behavior and personal-social behavior (P < 0.05). Conclusions The first onset age of epilepsy and head imaging performances are the major factors in cognitive performance in epilepsy children with less than 6 years old, so clinical attention should be paid to improve the prognosis of cognitive outcome of epilepsy children, and improve their life quality.

This article reviewed the application of different kinds of imaging methods combined with the analysis of brain connectome in mild cognitive impairment. Previous studies demonstrated that the brain worked as the small-world network. In patients with Alzheimer's disease or mild cognitive impairment, the structure of small-world of network might be changed. According to the different methods, the trend of those changes might be different. This paper reviewed the current situation of the study in mild cognitive impairment through brain network analysis, and emphasized its importance and prospects.

By analyzing the present condition of communication courses in some medical colleges and universi -ties and the clinical practice situation , this paper emphasized the significance of the clinical professional courses :it is beneficial to promote the reform of medical education , is advantageous to the medical students′humanistic spirit , to improve clinical teachers′humanistic quality , is helpful to reduce medical disputes .And on the future develop-ment of clinical communication course put forward the following suggestions: extended content , the integration of related courses , reform teaching methods , intensify communication course value .

Objective To investigate the nurses′ styles of handling interpersonal conflict and jobachievements,and analyze the relationships between them.Methods A total of 610 nurses in four hospitals were recruited by convenience sampling method and investigated with general state scale,the Rahim Organitional Conflict Inventory- Ⅱ and the Job Performance Appraisal Scale for nurses in four hospitals,the results underwent analysis.Results The factor scores of the Rahim Organitional Conflict Inventory- Ⅱwere sent in the descending order as integrating,avoiding,obliging and dominating.The factor scores of jobachievements were sent in the descending order as task,situation,anti-product.Integrating was positively correlated with task and situation,negatively correlated with anti-product,obliging was negatively correlated with task,positively correlated with anti-product.Conclusions Integrating styles of handling interpersonal conflict benefits to accomplish nurses′ job achievement.

Liquid therapy is a vital method of perioperative treatment.Choosing correct kinds of transfusion and reasonable therapy strategies can significantly reduce the perioperative complications and shorten days in hospital and improve the critical patients prognosis.The historical development of perioperative liquid therapy is a forward process,which is about crystalloids vs.cilloid,dry vs.wet,and other controversial problems continuing to be summarized,explored and discussed.In this process,there are some specific perioperative treatment strategies with the physician having a deeper cognitive,such as goal-directed therapy,early goal directed therapy and fast track surgery which have significant clinical curative effect.This article summarizes the advance of perioperative liquid therapy.