OBJECTIVE:To observe the effectiveness and safety of azelastine combined with fluticasone in the treatment of allergic rhinitis(AR). METHODS:A total of 135 AR patients were selected from 3 hospitals during Jan. 2015-Jul. 2016, and divided into azelastine group,fluticasone group and drug combination group according to random number table,with 45 cases in each group. On the basis of decongestant Oxymetazoline hydrochloride spray,azelastine group was given Azelastine hydrochloride nasal spray,1 spray each nostril,morning and night;fluticasone group was given Fluticasone propionate nasal spray,1 spray each nostril,morning and night;drug combination was given Azelastine hydrochloride nasal spray combined with Fluticasone propionate nasal spray,with the same usage and dose. Three groups were treated for consecutive 30 d. Total nasal symptom score (TNSS) and total ocular symptom score (TOSS) decline indexes,nasal minimal cross-sectional area (NMCA),total nasal resistance(TNR)and the occurrence of ADR were compared among 3 groups. RESULTS:Some pa-tients were withdrawal from the trial;finally,127 patients were included in full analysis set,and 130 patients were included in safety set. After treatment,TNSS decline index of drug combination group was significantly higher than azelastine group and fluticasone group,with statistical significance(P<0.05). There was no statistical significance in TNSS decline indexes be-tween azelastine group and fluticasone group,as well as TOSS decline indexes among 3 groups(P>0.05). Before treatment, 3 groups suffered from nasal ventilation disorder to different extents,but there was no statistical significance in TNR or NMCA among 3 groups(P>0.05). After treatment,NMCA and TNR at 75,150 Pa of 3 groups were significantly lower than before,and TNR of drug combination group was significantly lower than azelastine group and fluticasone group,with statisti-cal significance(P<0.05). There was no statistical significance in NMCA among 3 groups(P>0.05). There was no statistical significance in the incidence of ADR among 3 groups(P>0.05). CONCLUSIONS:Both azelastine and fluticasone can effec-tively relieve nasal symptom as well as improve nasal ventilation disorder in AR patients;therapeutic efficacy of drug combi-nation is better than single drug,and it doesn't increase the incidence of ADR.

Objective To observe the relationship between hemoglobin (Hb) and vascular endothelial growth factor (VEGF) in serum of the patients with cancer. Methods Enzyme linked immunosorbent assay (ELISA) was used to detect VEGF levels in serum of the patients with cancers. Results The serum level of VEGF in the cancer group are significantly higher than that in the control group. The serum level of VEGF in patients with low level of hemoglobin ( 123.5 g/L) ( P

Sixty patients who had hemodialysis over half year were randomly divided into 3 groups with 20 cases in each group:group A received conventional hemodialysis,group B received hemodialysis with oral administration of compound danshen (salvia miltiorrhiza bunge) tablets and vitamin E,group C had the same treatment as group B but the dialyzer was pretreated with solution containing 5 g vitamin C ; 20 healthy adults served as normal controls. Serum levels of advanced oxidation protein products (AOPP) and superoxide dismutase (SOD) were measured in all groups.The levels of AOPP in groups A,B,C were higher and SOD levels were lower than those of normal controls ( all P ＜ 0.01 ).The levels of AOPP in groups B,C were lower and SOD were higher than those in group A at the same time points (P ＜0.01 ).The levels of AOPP in group C were lower and SOD were higher than those in group B at the same time points (P ＜0.0l ).The results suggest that pretreatment of the dialyzer with high dose vitamin C plus vitamin E and compound danshen tablets can alleviate oxidative stress in patients with maintaining hemodialysis.

OBJECTIVE:To investigate clinical efficacy and safety of oral loratadine combined with physiological seawater na-sal irrigation in the treatment of intermittent allergic rhinitis. METHODS:Totally 300 patients with intermittent allergic rhinitis were chosen from the Second Hospital of Hebei Medical University during Jan. 2013-Jun. 2015,and then divided into group A,B,C ac-cording to lottery method,with 100 cases in each group. Group A was given Loratadine tablets 10 mg,po,qd. Group B received nasal irrigation with physiological seawater nasal spray,every morning and evening. Group C was given oral loratadine combined with physiological seawater nasal irrigation. Treatment courses of 3 groups lasted for 28 d. Clinical efficiencies of 3 groups were compared as well as symptom and sign scores,respiration function indexes and inflammatory factor levels before and after treat-ment,and the clinical recurrences were followed up for 12 months. RESULTS:The total response rates of group A,B,C were 80.00%,78.00%,96.00%,respectively,and that of group C was significantly higher than that of group A and B,with statistical significance(P<0.05). Before treatment,there was no statistical significance in symptom and sign scores,respiration function in-dexes and inflammatory factor levels among 3 groups(P>0.05). After treatment,symptom and sign scores,the rates of PEF diur-nal variation,TNF-α,INF-γ and IL-4 in 3 groups were significantly lower than before treatment,and the levels of PEF and IL-12 were significantly higher than before treatment. Above indexes of group C were significantly better than those of group A and B, with statistical significance (P<0.05). Clinical recurrence rates of group A,B,C were 21.00%,23.00%,6.00%,and group C was significantly lower than the group A and B,with statistical significance (P<0.05). There was no statistical significance in above indexes between group A and group B (P>0.05). CONCLUSIONS:Oral loratadine combined with physiological seawater nasal irrigation in treatment of intermittent allergic rhinitis can efficiently relieve the nasal symptoms and signs,improve expiratoryfunction,reduce the inflammatory response levels and be help-ful to reduce the long-term recurrence risk.

BACKGROUND AND PURPOSE: Tafamidis functions to delay the loss of function in transthyretin familial amyloid polyneuropathy (TTR-FAP), which is a rare inherited amyloidosis with progressive sensorimotor and autonomic polyneuropathy. This systematic literature review and meta-analysis evaluated the efficacy and safety of tafamidis in TTR-FAP patients, with the aim of improving the evidence-based medical evidence of this treatment option for TTP-FAP. METHODS: A systematic search of the English-language literature in five databases was performed through to May 31, 2018 by two reviewers who independently extracted data and assessed the risk of bias. We extracted efficacy and safety outcomes and performed a meta-analysis. Statistical tests were performed to check for heterogeneity and publication bias. RESULTS: The meta-analysis identified six relevant studies. The tafamidis group showed smaller changes from baseline in the Neuropathy Impairment Score–Lower Limbs [mean difference (MD)=−3.01, 95% confidence interval (CI)=−3.26 to −2.75, p < 0.001] and the Norfolk Quality of Life-Diabetic Neuropathy total quality of life score (MD=−6.67, 95% CI=−9.70 to −3.64, p < 0.001), and a higher modified body mass index (MD=72.45, 95% CI=69.41 to 75.49, p < 0.001), with no significant difference in total adverse events [odds ratio (OR)=0.69, 95% CI=0.35 to 1.35, p=0.27]. The incidence of adverse events did not differ between tafamidis and placebo treatment except for fatigue (OR=0.13, 95% CI=0.02 to 0.72, p=0.02) and hypesthesia (OR=0.16, 95% CI=0.03 to 0.92, p=0.04). CONCLUSIONS: This systematic review and meta-analysis has demonstrated that tafamidis delays neurologic progression and preserves a better nutritional status and the quality of life. The rates of adverse events did not differ between the patients in the tafamidis and placebo groups. Tafamidis might be a safer noninvasive option for patients with TTR-FAP.
Amyloid Neuropathies ; Amyloid Neuropathies, Familial* ; Amyloidosis ; Bias (Epidemiology) ; Body Mass Index ; Extremities ; Fatigue ; Humans ; Hypesthesia ; Incidence ; Nutritional Status ; Polyneuropathies ; Population Characteristics ; Prealbumin* ; Publication Bias ; Quality of Life

OBJECTIVE:To provide reference for guarantee the supply of short-landed drugs.METHODS:A questionnaire survey was conducted to investigate the drug shortage in 40 medical institutions in China.Based on the survey data,the econometric model was built to analyze the reasons for drug shortage in medical institutions.RESULTS:40 questionnaires were issued and 26 valid questionnaires were collected with effective recovery rate of 65.0％.The institutions surveyed received 87 samples of short-landed drugs,involving 33 drugs;82.8％ of short-landed drug samples were in short supply for more than 3 months,and even 21.8％ short-landed drug samples were in short supply for more than 12 months.The common reasons for drug shortage mainly included:not entering the provincial bidding directory;adopting the government pricing method;being redistribution system;not establishing provincial normal reserve mechanism.In addition to common reasons,there were some personality reasons for drug shortage based on the necessity of clinical needs,drug attributes and drug price.CONCLUSIONS:There are many reasons for the shortage of drugs in medical institutions.There are both common causes and personality reasons.It is necessary to solve many problems of drug shortage from the source,and it needs many policies and systems to cooperate with them.

Objective:To explore the application and effect of the teaching of standardized residency training based on the skill module tutorial system.Methods:Through the selection and employment of skill module tutorial system, 45 pediatric residents of batch 2016 in Hunan Children's Hospital were trained from such aspects of their professional theoretical knowledge, the skill operation ability and comprehensive ability were compared and analyzed. In addition, through the questionnaire survey, the training residents gave feedback to the skill mentors, and the passing rates of graduation skills examination in 2017, 2018 and 2019 of Pediatric residents in our hospital were analyzed and compared. T test and chi-square test were performed by SPSS 17.0.Results:After the training of the skill module tutorial system, the professional theoretical knowledge score (86.45±7.59), skill operation score (89.78±6.04) and comprehensive ability score (84.09±8.43) were significantly higher than those before the training ( P<0.05). The passing rate of the first graduation skills examination in 2019 was 93.33%, which was significantly higher than 57.14% in 2017, with a significant difference between the two groups ( χ2=28.45, P<0.01), compared with the rate of 2018(80.00%), which also had a statistical difference ( χ2=6.365, P<0.05). Conclusion:The training method of skill module tutorial system is not only helpful to rapidly improve the professional skills and post competency for the residents, but also benefit for training of teachers and improvement of their comprehensive quality, which is worth popularizing and applying.

5-Hydroxytryptamine(5-HT)type 3 receptor(5-HT3R)is the only type of ligand-gated ion channel in the 5-HT receptor family.Through the high permeability of Na+,K+,and Ca2+ and activation of subsequent voltage-gated calcium channels(VGCCs),5-HT3R induces a rapid increase of neuronal excitability or the release of neurotransmitters from axon terminals in the central nervous system(CNS).5-HT3Rs are widely expressed in the medial prefrontal cortex(mPFC),amygdala(AMYG),hippocampus(HIP),periaqueductal gray(PAG),and other brain regions closely associated with anxiety reactions.They have a bidirectional regulatory effect on anxiety reactions by acting on different types of cells in different brain regions.5-HT3Rs mediate the activation of the cholecystokinin(CCK)system in the AMYG,and the γ-aminobutyric acid(GABA)"disinhibition"mechanism in the prelimbic area of the mPFC promotes anxiety by the activation of GABAergic intermediate inhibitory neurons(IINs).In contrast,a 5-HT3R-induced GABA"disinhibition"mechanism in the infralimbic area of the mPFC and the ventral HIP produces anxiolytic effects.5-HT2R-mediated regulation of anxiety reactions are also activated by 5-HT3R-activated 5-HT release in the HIP and PAG.This provides a theoretical basis for the treatment of anxiety disorders or the production of anxiolytic drugs by targeting 5-HT3Rs.However,given the circuit specific modulation of 5-HT3Rs on emotion,systemic use of 5-HT3R agonism or antagonism alone seems unlikely to remedy anxiety,which deeply hinders the current clinical application of 5-HT3R drugs.Therefore,the exploitation of circuit targeting methods or a combined drug strategy might be a useful developmental approach in the future.

Objective To explore the current situation and influencing factors on Classroom Mobile Phone Dependence Syndrome (CMPDS) among college students,and to provide scientific basis for guiding college students to use mobile phones reasonably and healthily.Methods Stratified cluster sampling method was used.Students from different majors and different grades in Lanzhou University were included as the research objects.Classes were recognized as a unit in receiving basic field investigation in this questionnaire related study.Informed consent principles were followed and process of survey was anonymously carried out.Results The overall rate of CMPDS in college students was 8.7％,including ‘mild rate'as 6.6％ and ‘seriously mild rate'as 2.1％.No significant differences were found on genders or grades.Factors as shopping in the classroom shopping (OR=3.720),being bored on courses (OR=1.740),WiFi coverage (OR=1.787),time of practice in the classrooms (OR=1.514),and the total time of daily mobile phone use (OR=1.513) etc,appeared as risk factors related to CMPDS among the college students.However.shooting courseware (OR=0.579) appeared as a protective factor.Conclusions Rate of CMPDS was high in college students and we suggested to form a joint task force among the college authority,teachers and students to work on the related problems.Hopefully,the serious CMPDS condition will be minimized and both physical and mental health of the college students be improved.

Primary biliary cholangitis (PBC) is an autoimmune liver disease manifesting as cholestasis and is often observed in the middle-aged and elderly women. About 50% of the patients have fatigue and itching, and 20% have depression or mood changes. In recent years, a number of studies have shown that the non-specific symptoms of patients with primary biliary cholangitis (PBC), such as fatigue, itching, and cognitive changes, are associated with the structural and functional changes of the central nervous system. Early identification of preclinical PBC patients through brain imaging changes may be one of the ways for the early diagnosis of this disease.