Adolescent ; Adult ; Eustachian Tube ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Otitis Media, Suppurative ; complications ; surgery ; Tympanoplasty ; Young Adult

OBJECTIVE:To study the classification of deviation in drug production. METHODS:From the perspective of dom-inant and hidden deviation,combining with the theory of risk management,risk of deviation was evaluated with different risk man-agement tools to define the severity of the deviation,and it was handled by different methods. RESULTS & CONCLUSIONS:Ac-cording to the identifiability of deviation in actual management,the deviation was divided into dominance and hidden deviation. The dominant deviation can be divided into deep and shallow level. Whether the causes of deviation could be cleared and the conse-quences could be estimates were judged after the shallow level classification,and the deviation was further divided into simple and complex deviation. As for deviation complex,it could be evaluated with the tools of risk management to define the deviation severi-ty. As for hidden deviation,it needed beforehand preventing with the tools of risk management directly to define deviation levels and provide reference for preventive measures. In the process of deviation management,key point is to relay on the scientific meth-od to identify and classify deviation,and divide the influence levels. Combining the theory of risk management to select and use risk tools is the effective way to solve the problem.

Objective:To explore the clinical effect of Pingchuan Decoction combined with routine western medicine therapy in the treatment of acute attack of bronchial asthma in children. Methods:From January 2017 to June 2019, 118 children with acute attack of bronchial asthma were selected from the Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, and they were randomly divided into control group (59 cases) and observation group (59 cases) according to the random number table. The control group was treated with routine western medicine therapy, and the observation group was treated with Pingchuan Decoction on the base of control group, and both groups were treated for 14 days. The main symptom scores before and after treatment were evaluated. The percentage of forced vital capacity expressed as percent predicted (FVC% pred) and the forced expiratory volume in 1 second expressed as percent predicted (FEV1% pred) were measured by pulmonary function meter. The levels of CD3 +, CD4 + and CD4 +/CD8 + in peripheral blood were detected by flow cytometry. The adverse reactions during the treatment were recorded and the clinical efficacy was evaluated. Results:The total clinical effective rate was 93.2% (55/59) in the observation group and 71.2% (42/59) in the control group, where the difference between the two groups was statistically significant ( χ2=9.790, P=0.002). After treatment, the scores of cough, wheezing and wheezing rale in the observation group were significantly lower than those in the control group ( t=27.695, 17.573, 32.827, P<0.001). After treatment, FVC% pred [(80.21 ± 4.06)% vs. (71.71 ± 3.95)%, t=11.526], FEV1% pred [(78.84±3.92)% vs. (72.26 ± 3.59)%, t=9.508] in the observation group were significantly higher than those in the control group ( P<0.01). The levels of CD3 + [(74.05 ± 5.13)% vs. (67.44 ± 4.98)%, t=7.101], CD4 + [(48.43 ± 4.31)% vs. (42.20 ± 4.06)%, t=8.082] and the ratio of CD4 +/CD8 + (1.67 ± 0.29 vs. 1.34 ± 0.25, t=6.620) in the observation group were significantly higher than those in the control group ( P<0.01). During the treatment, the incidence of adverse reactions was 10.2% (6/59) in the observation group and 6.8% (4/59) in the control group, and there was no significant difference between the two groups ( χ2=0.437, P=0.509). Conclusion:The Pingchuan Decoction combined with routine western medicine therapy can reduce the clinical symptoms of children with acute attack of bronchial asthma, improve lung function, improve organism immunity and clinical effect with safety.

Objective To observe the expression of Na+/I- symporter(NIS) in cultured lactating mammary cells with different levels of iodine and the effect of tumor necrosis factor-α(TNF-α). Methods Original generation of mouse lactating mammary cells cultured in vitro were divided into low iodine group Ⅰ (LI-Ⅰ), low iodine group Ⅱ (LI-Ⅱ), adequate iodine group(AI), high iodine group Ⅰ(HI-Ⅰ), and high iodine group Ⅱ(HI-Ⅱ). Cells were cultured in DEME/F12 culture medium for 24 h with different concentrations of iodine (0,5,50,3000 and 10 000 μg/L, respectively), and TNF-α( 10-2 mg/L) was added to some of cultured cells for 24 h. The expression of NIS mRNA of lactating mammary cells was determined by real-time quantitative PCR and the expression of NIS protein was detected by In-Cell Western. Results In iodine alone group, the expression of NIS mRNA in LI-Ⅰ group [ (64.66 ± 14.99) x 10-4] was higher than that of AI group[ (22.76 ± 7.36) × 10-4, P ＜ 0.01 ]; HI-I group[ (10.18 ±3.53) × 10-4] and HI-Ⅱ group[ (8.59 ± 2.89) × 10-4] were lower than that of AI group(all P ＜ .0.05); With increased iodine concentration, the expression of NIS mRNA decreased. The expression of NIS mRNA in LI-Ⅰ group [(2.72 ± 0.45) × 10-4], LI-Ⅱ group[ (2.69 ± 0.68) × 10-4] and AI group[(1.80 ± 0.67) × 10-4] with iodine plus TNF-o were all lower than that of LI-Ⅰ group, LI-Ⅱ group[ (29.82 ± 4.47 ) × 10-4], and AI group without TNF-α (all P ＜ 0.01). In iodine plus TNF-α, the expression of NIS mRNA in HI-Ⅰ group[(6.58 ± 2.87) × 10-4] and HI-Ⅱ[(7.04 ± 1.36) × 10-4] group were all higher than that of AI group(all P ＜ 0.05); With increased iodine deficiency or iodine excess, the expression of NIS mRNA increased. With increased iodine concentration, the expression of NIS protein decreased in iodine alone group. The expression of NIS protein in iodine plus TNF-α was all lower than that in iodine alone group. In iodine plus TNF-α, the expression of NIS protein increased in both iodine deficiency and iodine excess conditions. Conclusions Iodine may decrease the expression of NIS mRNA and protein of lactating mammary cells. The expression of NIS mRNA and protein of lactating mammary cells was inhibited by TNF-α under different levels of iodine.

ObjectiveTo study the morphological and functional changes of thyroid in lactating rats and their offspring in iodine deficiency and iodine excess animal models.MethodsOne hundred and twenty Wistar rats(30 males and 90 females) were selected.Based on their body weight,the 90 females were stratified and randomly divided into five groups( 18 in each group):low iodine group 1 and group 2(fed with low iodine feed and deionized water containing iodine of 0,5 μg/L) ; high iodine group 1,group 2 and control group(feed with normal diet and deionized water containing iodine of 3000,10 000,50 μg/L).After fed for 3 month,all female rats were mated with males in a ratio of 3 ∶ 1.After birth for 10 days,8 female rats and their offspring in each group were sacrificed.Changes of thyroid were observed by naked eyes.The thyroid weight was measured and pathological changes of thyroids were observed under light microscope.Results①Absolute and relative weight of lactating rats thyroid in low iodine group 1 and group 2 [ (92.02 ± 24.40 ),(77.11 ± 23.32 )mg,(0.509 ± 0.072),(0.384 ± 0.089) mg/kg] were much higher than that of control group[ (17.41 ± 9.25)mg,(0.102 ± 0.016)mg/kg,all P＜ 0.05].Absolute and relative weight of lactating rats thyroid in high iodine group 1 and group 2[(8.22 ± 0.41 ),(9.42 ±0.43)mg,(0.047 ± 0.006),(0.035 ± 0.005)mg/kg] were lower than that of control group(all P ＜ 0.05).Absolute and relative weight of lactating rats and their offspring thyroid was decreased with increase of iodide intake in the diet.②Thyroid enlargement of lactating rats in low iodine group 1 and group 2 was evident,but that of high iodine group 1 and group 2 was not.③Epithelial cell hyperplasia and smaller follicular cavity were observed in low iodine group 1 and group 2 under light microscope.Epithelial cell deformation and mostly flat were observed in high iodine group 1 and group 2.ConclusionsThyroid morphology is changed with iodide intake in the lactating rats and their offspring,and the changes are consistent between female rats and their newborns.

ObjectiveTo observe the influence of iodine on mRNA expression of iodide transporter (NIS),insulin-like growth factor Ⅰ (IGF- Ⅰ ) and transforming growth factor beta(TGF-β) in thyroid and mammary glands of lactating rats and to explore the role of NIS,IGF- Ⅰ and TGF-β mRNA in iodine uptake in thyroid and mammary glands of lactating rats.MethodsOne hundred and one Wistar rats(80 female and 21 male),weighting 8 - 100 g were selected.These female rats were randomly divided into five groups according to their body weight:control group(NI,normal feed,drank deionized water containing iodine 50 μg/L) ; low iodine group 1 and 2(LI-1,LI-2,low iodine feed,drank deionized water containing iodine 0 and 5 μg/L,respectively); high iodine group 1 and 2(HI-1,HI-2,normal feed,drank deionized water containing iodine 3000 and 10 000 μg/L,respectively),16 rats in each group.After feeding for 3 months,the female and male rates were mated 3:1.The female rats in each group were sacrificed at the fifth and tenth day after postpartum.Thyroid and mammary glands were taken.The mRNA levels of NIS,IGF- Ⅰ and TGF-β in thyroid and mammary glands of lactating rats were determined by real time quantitative PCR.ResultsThe fifth days after postartum,NIS,IGF- Ⅰ and TGF-β mRNA expression levels of thyroid and lactating mammary glands were different between groups,and the differences were statistically significant ( NIS:F =631.46,64.91,all P ＜ 0.01 ; IGF- Ⅰ:F =11.45,6.56,all P ＜ 0.01 ; TGF-β:F =291.83,304.53,all P ＜ 0.01).Compared with control group [NIS:0.0066 ± 0.0023, (0.1481 ± 0.0711 ) × 10-2; IGF- Ⅰ:0.0419 ± 0.0062,0.0542 ± 0.0044; TGF-β:0.1416 ± 0.0277,0.1670 ± 0.0499],regardless of thyroid or mammary gland,the NIS,IGF- Ⅰ and TGF-β mRNA expression of LI-1 [NIS:0.0447 ± 0.0110,(0.3030 ± 0.1831) × 10-2;IGF- Ⅰ:0.0662 ± 0.0078,0.0902 ± 0.008; IGF- Ⅰ:0.5514 ± 0.0508,0.6942 ± 0.0367],LI-2[NIS:0.0317 ±0.0081,(0.3017 ± 0.1601) × 10-2; IGF-I:0.0645 ± 0.0054,0.0894 ± 0.0093; TGF-β:0.5292 ± 0.0332,0.6704 ± 0.0277 ] was significantly increased (all P ＜ 0.01 ); the NIS mRNA expression of HI-1 [0.0043 ± 0.0011,(0.1233 ± 0.0954) × 10-2],HI-2[0.0037 ± 0.0017,(0.1058 ± 0.0854) × 10-2] was decreased(all P ＜ 0.05),while the expression of IGF-Ⅰ mRNA [0.0521 ± 0.0910,0.0715 ± 0.0026; 0.0516 ± 0.0078,0.0697 ± 0.0038] and TGF-β mRNA [0.2087 ± 0.0425,0.2361 ± 0.0425; 0.1971 ± 0.0237,0.2257 ± 0.0752 ] was increased (all P ＜ 0.05 ).The tenth days after postpartum,the mRNA expression levels of NIS,IGF- Ⅰ and TGF-β of thyroid and lactating mammary gland in rats were different between groups,and the differences were statistically significant (NIS:F =103.55,116.32,all P ＜ 0.01; IGF-Ⅰ:F =67.67,11.98,all P ＜ 0.01; TGF-β:F =74.30,381.30,all P ＜0.01 ).Compared with the control group[NIS:0.0069 ± 0.0011,(0.1337 ± 0.0599) × 10-2; IGF-Ⅰ:0.0390 ±0.0071,0.0534 ± 0.0056; TGF-β:0.1351 ± 0.0336,0.1534 ± 0.0320],the mRNA expression levels of NIS,IGF- Ⅰ and TGF-β of LI-1 [ NIS:0.0432 ± 0.0165,(0.2962 ± 0.0985 ) × 10-2; IGF- Ⅰ:0.0643 ± 0.0088,0.0873 ± 0.0055 ; TGF-β:0.5042 ± 0.0912,0.6408 ± 0.0420],LI-2[NIS:0.0287 ± 0.0111,(0.2873 ± 0.0862) × 10-2; IGF- Ⅰ:0.0621 ± 0.0094,0.0862 ± 0.0038; TGF-β:0.4893 ± 0.0504,0.6372 ± 0.0389] were significantly increased(all P ＜ 0.01 ); the NIS mRNA levels of HI-1 [ 0.0042 ± 0.0029,(0.1006 ± 0.0909) × 10-2],HI-2[0.0035 ± 0.0020,(0.0890 ± 0.0119) × 10-2] were decreased(all P＜ 0.05),while the expression of IGF-Ⅰ mRNA[0.0516 ± 0.0078,0.0668 ± 0.0071; 0.0508 ± 0.0089,0.0621 ± 0.0064] and TGF-β mRNA[0.2007 ± 0.0546,0.2175 ± 0.0370;0.1959 ± 0.0393,0.2097 ± 0.0425] were increased(all P ＜ 0.05 ).In thyroid and mammary glands,the comparisons of NIS,IGF,TGF-β mRNA expression of the fifth and tenth day after postartum,between each group were not statistically significant(all P ＜ 0.05).ConclusionsThere are regulatory mechanisms of thyroid and mammary glands of lactating rats in response to low or high iodine conditions.In low iodine,the expressions of NIS,IGF- Ⅰ and TGF-β mRNA in thyroid and mammary glands increase and iodide uptake ability is enhanced to meet the body needs.In high iodine,the expression of NIS mRNA decreases in thyroid and mammary glands.Due to the reduced ability of iodine uptake,iodine intake is reduced,thereby reducing the hazards of high iodine in filial rats.

Objective To report a peliosis hepatic in child and review literature and discuss.Methods Case history was inquired.Physical,labtoratory,imagement and histopathology of liver biopsy(HE staining) were examed.Results A 4-year old girl appeared dermatitis with erythema and herpes at local skin where was bit by insect before onset.The girl appeared fever,cough,then abdominal pain,hepatomegaly,pleural effusion and ascites.Lab examination revealed slight elevation of aspartate transaminase,?-glutamyltranspeptidase and alkaline phosphatase.The liver B-mode ultrasonography and CT scan revealed hepatomegaly with density heterogeneity of the parenchyma.The liver biopsy revealed many small capsule filled with blood cells.Conclusions Clinical characteristics of the disease are fever,upper abdomen pain,janundice,ascites and hepatomegaly.The diagnosis shall be combined with the pathologic biopsy of liver.

OBJECTIVETo analyze current stroke prevention measures for elderly patients with atrial fibrillation.

METHODSA retrospective analysis was conducted of the clinical records of elderly patients with atrial fibrillation treated in our hospital within the recent 5 years. The distribution of high risk factors for different age levels was studied, and the incidence of stroke and complications such as hemorrhage were compared between patients treated with warfarin and aspirin therapy.

RESULTSCompared with patients of 65 to 75 years old, the incidence of complications with other high risk factors was increased in advanced age group (over 75 years). Of these patients, 19.0% were treated with warfarin and 73.4% with aspirin. Compared with the aspirin group, stroke incidence was decreased significantly in warfarin group, which had simultaneously increased nonfatal hemorrhage.

CONCLUSIONWarfarin can be more effective than aspirin for stroke prevention in elderly patients with atrial fibrillation, but in clinical practice, the usage rate of warfarin still remains low with insufficient monitoring.

Aged ; Anticoagulants ; therapeutic use ; Aspirin ; therapeutic use ; Atrial Fibrillation ; complications ; drug therapy ; China ; epidemiology ; Female ; Humans ; Male ; Retrospective Studies ; Stroke ; complications ; epidemiology ; prevention & control ; Treatment Outcome ; Warfarin ; therapeutic use

Adult ; Chronic Disease ; Female ; Humans ; Placenta ; pathology ; Placenta Diseases ; diagnosis ; pathology ; Pregnancy

Objective To study the clinical characteristics, diagnosis, treatment and its effectiveness of vulvar intraepithelial neoplasm Ⅲ(VIN Ⅲ).Methods Clinical data, including age of the patients, mode of surgical operation, pathological features, results of post-operation follow-up, of 12 cases of VIN Ⅲ admitted to the Peking Union Medical College Hospital(PUMCH)during January 1984 to December2006 were retrospectively analyzed.Results Mean age of the 12 cases was 40.3(ranging from 23 to 56)years.All the patients had symptoms of vulvar itching, three with VUlVar ulcer and one with vulvar pain.There was single neoplasm focus in two cases and multiple focuses in 10 cases, five cases with neoplasm in other sites and five with human papilloma virus(HPV)infection.All the 12 patients received surgical operation, three with simple vulvectomy(one with some residue at perianal incisal edge)and other nine with lumpectomy(four with some residue at incisal edge).Eight cases were followed-up for 9.0 months in average(ranging 1～22 months)after surgical operation, including three with some residue at incisal edge.Relapse was found in two cases three and 11 months after operation, respectively, who received re-operation, including one with residue at incisal edge and one without residue.Conclusions It is necessary to attach more importance to biopsy for the cases of suspected VIN Ⅲ, as well as colposcopic diagnosis for those with vaginal or vulvar neoplasm and testing for HPV infection.Surgical operation, including simple vulvectomy and lumpectomy with or without adjunctive measures, are main treatment for patients of VIN Ⅲ and follow-up is also important for all those with VIN Ⅲ.