Objective To observe the clinical efficacy of low-dose erythromycin combined with salmeterol-fluticasone in the treatment of stable COPD, focus on the quality of life and respiratory function of patients.Methods 87 patients with stable COPD admitted to Hangzhou Red Cross Hospital from January 2014 to January 2016 were selected.Patients were divided into two groups by therapeutic methods, observation group ( salmeterol-fluticasone+erythromycin) 46 cases and control group (salmeterol-fluticasone) 41 cases.Six months of treatment, the quality of life of two groups of respiratory function assessment, acute COPD and peripheral inflammatory factor and other indicators of change.Results After treatment, both of the two groups got significantly decreased in SGRQ and MMRC scores, while the observation group was significantly lower than the control group, the difference was statistically significant(P<0.05).After treatment, FEV1/FVC%levels were significantly increased in both groups, but the observation group was significantly higher than the control group, the difference was statistically significant(P <0.05).The cumulative incidence of acute exacerbation of COPD was 10.87%(5/46) in the observation group, which was significantly lower than that in the control group 29.27%(12/41), the difference was statistically significant(Log-rankχ2 =4.833, P=0.028).After treatment, the levels of IL-1βand TNF-αin the peripheral blood of the patients in the observation group were significantly lower than those in the control group, the difference was statistically significant (P <0.05).Conclusion In the treatment of stable COPD, low-dose erythromycin could significantly improve the clinical efficacy, improve the quality of life and respiratory function.

Objective:To discuss the applicative value of 1.5TMR-diffusion weighted imaging (DWI) sequence and apparent diffusion coefficient (ADC) measurement in the diagnosis and differential diagnosis of endometrial carcinoma.Methods: Thirty seven cases were collected in endometrial carcinoma group, 11 cases were selected in benign group and other 20 normal volunteers. Data of the DWI and ADC value, common-MRI(c-MRI) sequence in the 48 patients and 20 normal volunteers was contrasted and analyzed.Results: The differences between endometrial malignant tumors, benign lesions and the normal have statistical significance.Conclusion: 1.5 T MR-DWI sequence and ADC value has a superior ability in detecting endometrial lesions. It can be used to differentiate the endometrial carcinoma from either benign or normal cases, it can provide reliable assistance in the clinical cure.

A total of 65 patients of condyloma acuminatum (CA) received cryotherapy plus 5-aminolevulinic acid-photodynamic therapy (ALA-PDT) or ALA-PDT alone.During cryotherapy,handling was gentle with a moderate depth.The nursing of PDT was both meticulous and comprehensive.Patients with adverse reactions received Kangfuxin liquid for wet packing and topical antibiotic ointment.The combination group received cryotherapy for 2 sessions and then PDT for 1-3 sessions while PDT was administered for 1-4 sessions in single PDT group.Then all patients received PDT once for consolidation therapy.For groups 1 and 2,the effective rates were 83％ and 70％ and the recurrent rates 17％ and 30％ respectively.Cryotherapy plus ALA-PDT is feasible for CA and it offers better efficacies and lower recurrent rates.And comprehensive,meticulous and comfortable nursing may achieve clinical efficacies,reduce the recurrent rate and minimize discomforts during treatment.

Objective To understand the clinical medicine graduates competency status of Kunming Medical University in the past 5 years and provide important reference for cultivating students in medical university. Methods The questionnaire results in the relevant departments responsible person of Yunnan provincial municipal and district 26 hospitals were system analyzed by fuzzy comprehensive evaluation method. Results In the past 5 years, the graduates occupation competence of clinical medicine in Kunming Medical University is good. Among them, the graduates’core competency gets the lowest score, but the graduates’post competency gets the highest score. Conclusion The graduates’core competency should be strengthened in training of doctor-patient communication skills and quality evaluation of clinical practice for medical students.

Group B Streptococcus ( GBS) is a conditional pathogenic bacteria related to late-term abortion, premature delivery, premature rupture of membranes, perinatal infection, neonatal sepsis and other diseases.Prevention and treatment guidelines by the US Centers for Disease Control and Prevention ( CDC) suggest that all the pregnant women at 35-37 gestational weeks should screen for GBS .The detection methods for GBS include microbiology , immunology, molecular biology, etc.The appropriate method should be chosen depending on circumstances .Penicillin is recommended for the preventive treatment of GBS , and the treatment for the insensitive should base on the antibiotic susceptibility results .No vaccine against GBS is currently available for clinical use .

Recently,staging,chemoradiotherapy schedule,new chemotherapy agents and application of targeted therapy drugs are widely investigated in small cell lung cancer(SCLC).Some progresses are achieved in prophylactic cranial irradiation of extensive stage and some new chemotherapy agents such as irinotecan,oral topotecan and pemetrexed etc are widely investigated.There are still some disputes about staging,the timing of chemoradiotherapy in localized SCLC and so on.

ATP-tumor chemosensitivity assay(ATP-TCA)is a tumor chemosensitivity assay in vitro.Beacause of the special merites of A11P-TCA,it is seemed to be the most promising and effective method of tumor chemosensitivity in vitro.Application of ATP-TCA in clinic has got significant effects.ATP-TCA is a good method for individualized chemotherapy.

Objective To explore the correlation between nurses' job burnout and social support and the source of job stress. Methods 138 doctors and 162 nurses from 4 general hospitals were investigated by different questionnaires. The nurses were investigated by Maslach Burnout Inventory(MBI),perceived social support scale(PSSS)and Chinese nurse job stress source scale. While the doctors only underwent investigation using Maslach Burnout Inventory (MBI).The results were collected and analyzed. Results The MBI results showed that the scores of emotional exhaustion and non-humanity were apparently higher, while the score of sense of working achievement was lower in nurses than those in doctors. The level of job burnout in nurses was higher than that of doctors with statistical difference. The score of social support was lower and the score of source of job stress was higher in nurses with increased level of job burnout than those with decreased level. Conclusion The status of nurses' job burnout should cause the attention of nursing managers. Prompt and selective measures should be adopted to improve the psychological health of nurses.

Objective:To further investigate the effects of three kinds of material on the level of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in gingival crevicular fluid (GCF). Methods:The anterior teeth and the premolar teeth of 30 patients were divided into three groups randomly for Co-Cr alloy PFM, Ti PFM and all ceramic crown. Before tooth preparation, 1, 3 and 6 months after cementation, GCF was collected at the same sites. The levels of AST and ALP were detected by automated chemical analyzer, and analyzed the variation between the pre-restoration and post-restoration. Results:Before tooth preparation and 1 month after cementation, all indexes showed no difference among three groups. The level of GCF, AST and ALP of Co-Cr alloy group showed conspicuous difference with Ti PFM and all ceramic crowns after 3 months and 6 months. However, the levels of GCF, AST and ALP of Ti PFM group showed no difference with all ceramic crowns. Conclusion:Co-Cr based PFM crowns which clinically accepted have lead to changes of the levels of GCF, AST and ALP. Co-Cr based PFM crowns have negative influences on periodontal tissue. The Ti PFM and all ceramic crown may affect periodontium less than the Co-Cr PFM in observation period of this study.

Chromosome 22qll deletion syndrome(22q11DS) is a common chromosomal microdeletion syndrome. Its clinical manifestation is complex, comprising congenital heart disease, dysmorphic facial, immunodeficiency, endocrine dysfunction and so on. The syndrome has a population prevalence of approximately 1/2500-1/4000. There have been many recent advances in understanding of the clinical manifestation, behavior and psychiatric problems and the mechanisms leading to the specific phenotypic features in chromosome 22q11 deletion syndrome. Asymmetric recombination of homologous low copy repetitives in the deletion region causes the deletion of 22q11. TBX1 is the dominant gene contributing to the phenotype.