Objective To evaluate the quality control standard and check system of clinical using of antibiotics based on the change of the constituent ratio of antibiotics. Methods In this retrospective study, we compared consumption of the ten mostly prescribed antibiotics, constituent ratio of national essential drugs, antibiotics utilization ratio and antibiotics use density between the third quarter of 2012 and that of 2013. Results Compared with 2012, the usage of antibiotics was reduced by 39.91%, and the usage of national essential drugs rose by 71.46%, whereas the consumptions of cefoxitin, aztreonam, cefminox were reduced by 84.56%, 89.99%, and 56.52%, respectively, in 2013.The consumptions of cefazolin, cefuroxime, ceftriaxone rose by 36. 39%, 363. 50% and 24. 06%, respectively. The amount of used antibiotics was reduced by 35. 41%, and the application frequency of antibiotics was reduced by 36.62%. Conclusion The establishment, running and implement of the quality control standard and check system of clinical using of antibiotics make constituent ratio of antibiotics used in the first people's hospital of Jining City more reasonable, which will help to promote the rational use of antibiotics in clinic.

OBJECTIVE: To explore the clinical efficacy of functional endoscopic sinus surgery (FESS) associated with radiofrequency ablation on chronic sinusitis. METHOD: Fifty-four patients with chronic sinusitis were divided randomly into two groups: the study group and the control group, The study group received FESS associated with inferior turbinate lateral fracture and radiofrequency ablation treatment, while the control group received FESS associated with inferior turbinate lateral fracture treatment. RESULT: The SNOT-20 score, Lund-Kennedy score, mucociliary clearance time and nasal airway resistance of the patients in the two groups after treatment were significantly improved than those before treatment (P < 0.05), and the sense of nasal congestion, headache and face pain, purulent rhinorrhea, postnasal drip, and other symptoms were also relieved. After treatment, the scores of SNOT-20 and the scores of Lund-Kennedy in the study group were significantly lower than those in the control group (P < 0.05), but no significant difference was found in mucociliary clearance time between the two groups after treatment. CONCLUSION FESS associated with radiofrequency ablation surgery is safe and effective for chronic sinusitis.
Catheter Ablation ; Chronic Disease ; Endoscopy ; Humans ; Mucociliary Clearance ; Rhinitis ; surgery ; Sinusitis ; surgery ; Turbinates ; surgery

Objective To perform PCR site-directed mutagenesis of nine novel PAH gene mutations (Y154H, R157I, Y206C, G247R, D282G, G346R, S349A, A389G, R400K) identified in northern Chinese and construct mutant recombinant plasmids of PAH gene. Methods 1) Every mutant recombinant plasmid was constructed according to the site of the mutation localized in functional domain of PAH gene and the related clinic phenotype of patients with the gene mutation. 2) Using the wild-type PAH expression vector as a templet, the mutant recombinant plasmids were directly amplified by PCR with Platinium Taq DNA polymerase and nine pairs of primers which were designed according to the human PAH cDNA sequence and the requirement for site-directed mutagenesis technology. 3) The positive strains were selected by Amp resistant test, PCR and restriction endonuclease analysis. The Mva Ⅰ, Mva Ⅰ, Hind Ⅲ, Rsa Ⅰ, Rsa Ⅰ sites exist in the sequences near the mutant sites of S349A, D282G, G247R, Y206C, Y154H, respectively, but not in the related sequence of wild-type PAH expression vector. Restriction endonuclease digestion could be directly used in identifying the mutant sites. However, the amplification created restriction site (ACRS) analysis was supplied in the followed identification of R157I, G346R, A389G, R400K. Finally the sequences of mutant recombinant plasmids of PAH gene were confirmed by DNA sequence analysis. Results Every sequence analysis showed that the mutant nucleic acids were introduced at the expected sites of PAH gene, suggesting that the mutant recombinant plasmids of PAH gene were constructed successfully. Conclusion PCR site-directed mutagenesis is accurate and highly efficient. The successfully mutagenized plasmids of PAH gene lay the foundation for the functional analysis of phenylalanine hydroxylase in mammalian cell system.

Objective To investigate the clinical effects of lactobacillus acidophilus combined with glutathione in the treatment of nonalcoholic fatty liver disease.Methods 120 patients with nonalcoholic fatty liver disease were selected,and they were randomly divided into control group (60 patients used glutathione alone) and observation group (60 patients received lactobacillus acidophilus on the basis of control group).The clinical efficacy,liver function index,blood lipid index and the ultrasonography grading of fatty liver before and after treatment of the two groups were compared.Results The clinical total effective rates of the control group and the observation group were 76.67％,91.67％,respectively.The total effective rate of the observation group was significantly higher than that of the control group(x2 =10.52,P ＜ 0.05).The levels of AST,ALT and GGT of the observation group after treatment were significantly lower than those of the control group and before treatment [(36.89 ± 7.14) U/L,(36.89 ± 7.14) U/L,(36.89 ±7.14) U/L vs.(49.36 ± 11.08) U/L,(45.91 ± 10.24) U/L,(90.28 ± 20.70) U/L;(36.89 ± 7.14) U/L,(36.89 ± 7.14) U/L,(36.89 ± 7.14) U/L vs.(92.90 ± 24.3) U/L,(81.11 ± 17.37) U/L,(147.27 ± 34.19) U/L,t =2.88,2.54,2.91;3.01,3.36;3.18,3.48;3.41,3.87;all P ＜0.05).The levels of TG,TC,HDL-C and LDL-C of the observation group after treatment were significantly better than those of the control group and before treatment [(1.66 ± 0.42) mmol/L,(4.05 ± 0.77) mmol/L,(1.69 ± 0.60) mmol/L,(2.44 ± 0.38) mmol/L vs.(2.13 ± 0.80) mmol/L,(4.64 ± 0.94) mmol/L,(1.45 ± 0.48) mmol/L,(2.97 ± 0.57) mmol/L;(1.66 ± 0.42) mmol/L,(4.05 ± 0.77) mmol/L,(1.69 ± 0.60) mmol/L,(2.44 ± 0.38) mmol/L vs.(2.71 ± 1.33) mmol/L,(5.42 ± 1.27) mmol/L,(1.08 ± 0.36) mmol/L,(3.49 ± 0.71) mmoL/L,t =2.43.2.13,2.55,2.07;3.02,3.41;3.11,3.65;2.81,3.30;2.87,3.15;all P ＜ 0.05).In the control group,normal in 6 cases,mild in 24 cases,moderate in 21 cases and severe in 9 cases as fatty liver degree;in the observation group,normal in 13 cases,mild in 30 cases,moderate in 13 cases and severe in 4 cases as fatty liver degree.The ultrasonography grading of fatty liver of the observation group after treatment were significantly better than those of control group and before treatment (U =3.74,5.20,all P ＜ 0.05).Conclusion Lactobacillus acidophilus combined with glutathione in the treatment of nonalcoholic fatty liver disease can efficiently promote the recovery process of liver function,regulate blood lipid levels and is helpful to improve the imaging grading.

Objective To analyze the distribution of common chromosomal karyotypes of patients with Turner syndrome (TS), and to explore the correlation between the age and height standard deviation scores (HSDS) on diagnosis.Methods Retrospective investigation was performed for the data of age and HSDS on diagnosis in 273 TS girls(≤ 18.0 years old)diagnosed by chromosomal karyotypes.The main statistical methods were analyzed with t-test and Pearson correlation test by using the SPSS 18.0 statistical software.Results (1) There were 4 kinds of common chromosomal karyotypes in the TS :45, X (87/273 cases,31.9％),46, X, i (Xq) (43/273 cases, 15.7％) ,45, X/46, X, i (Xq) (36/273 cases, 13.2％) and 45, X/46, XX (23/273 cases, 8.4％), respectively, the adolescent TS all had delayed puberty.For the cases with 45, X karyotypes ,3 cases presented mental retardation and 2 cases with organs deformity.(2)The patients with 45 ,X/46,X,i(Xq) karyotypes or with 46,X,i(Xq) karyotypes had the maximum(12.56 age) or the minimum(9.70 age) mean age on diagnosis, respectively, there was a significant difference between 2 groups (t =3.019, P =0.004).The maximum deviation from normal height was found in the patients with karyotypes of 46, X,i (Xq) (HSDS =-4.04), and the minimum deviation was in the patients with karyotypes of 45,X/46, XX (HSDS =-3.16), and there was a significant difference between 2 groups (t =-2.95, P =0.004).(3) More than 75.7％ of TS patients was diagnosed when their heights deviated above 3 SD,and their mean age on diagnosis was 12.10 age,which was 3 years later than those patients within 2 SD.(4) There was a significant negative correlation between the age and HSDS on diagnosis in the groups of common chromosomal karyotypes[45,X、46,X,i(Xq) and 45,X/46,XX] (r =-0.551,-0.560,-0.622,all P ＜ 0.01), except for the group with the 45, X/46, X, i (Xq).Conclusions (1) In this study, the consti-tuent ratios of these 4 common chromosomal karyotypes were different from those in Europe and America's.(2)Patients with 45 ,X may have more severe symptoms than others.(3)The mean age on diagnosis was at least 3.0 years earlier when considered HSDS below-2.00 as an indicator for chromosomal karyotype screening,which would facilitate earlier diagnosis.

Objective To perform mutation analysis of survival motor neuron gene 1 (SMN1 in two spinal muscular atrophy (SMA) patients and their parents to evaluate the effects of the two SMN1 gene mutations on the transcript levels of the gene and preliminarily predict their effects on the structure and function of SMN protein.Methods Mutation analysis of SMN1 gene was carried out by multiplex ligationdependent probe amplification,reverse transcript-polymerase chain reaction (RT-PCR) and cloning sequencing.Transmission of the mutations was confirmed by the mutation analysis in patients' parents.The full-length SMN1 (SMN1-fl) transcript levels of the patients carrying these subtle mutations were detected using quantitative RT-PCR.Results The two patients were diagnosed as SMA Ⅱ and SMA Ⅲ.They carried p.Val19GlyfsX21 and p.Ala2Gly SMN1 mutations in SMN1 gene,respectively.Both of the two mutations were originated from their fathers.Compared with the healthy individuals (23.5 ± 4.9),the two patients had a significant reduction in the level of SMN1-fl transcripts (t =3.322,P =0.011 (p.Ala2Gly) ;t =6.964,P =0.000 (p.Val19GlyfsX21)).However,compared with the healthy carriers (14.1 ±4.5),the patient with p.Ala2Gly mutation had no significant reduction in the level of SMN1-fl transcripts (13.9 ±3.6,t =0.058,P =0.955) ; however,the patient with p.Val19GlyfsX21 mutation had a significant reduction (4.9± 2.4,t =3.725,P =0.004).Conclusions Two SMN1 gene mutations are identified in our study.The mutation p.Val19GlyfsX21 is a novel mutation and p.Ala2Gly is firstly reported in Chinese SMA patients.p.Val19GlyfsX21 may possibly lead to decreased SMN1-fl mRNA by nonsense-mediated messenger RNA decay,however,p.Ala2Gly has no obvious effects on the amount of the SMN1-fl transcripts,indicating that its deleterious effect may be occurring at SMN protein level or the function of SMN protein.

Objective To explore the application value of near infrared spectrum (NIRS) in the detection of epidural and subdural hematoma in clinic.Methods Thirty-four patients with subdural and epidural hematomas (study group) confirmed by CT or MRI and 14 healthy volunteers (contrast group) were selected.The NIRS equipment which was produced by Institute of Automation of Chinese Academy of Sciences were used to assess the intracranial hematomas.Taking CT or MRI results as the golden standard,the diagnostic efficiency of NIRS for subdural and epidural hematomas were evaluated.Results For the diagnosis of subdural and epidural hematomas,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 91.18％(31/34),71.43％ (10/14),85.42％(41/48),88.57％(31/35) and 76.92％ (10/13),respectively.Conclusion NIRS is a good device to predict intracranial subdural and epidural hematomas with high sensitivity and positive predictive value,which is helpful for early diagnosis and therapy in clinic.

Objective To evaluate the efficacy of alendronate sodium combined with dietary and exercise intervention in postmenopausal osteoporosis. Methods 88 postmenopausal osteoporosis patients were enrolled and treated with alendronate sodium and Vitamin D combined with dietary and exercise intervention for 12 months. Bone mineral density (BMD) of lumber spine and femur neck were measured before and after the treatment. Results Medication combined with dietary and exercise intervention significantly increased bone mineral density of postmenopausal osteoporosis patients, and the serum levels of bone alkaline phosphatase (BLAP), alkaline phosphatase (AKP) and tartrate resistant acid phosphatase (TRACP) were significantly higher than those pre-treatment, with significant differences (P<0.05). Conclusion Compared to simple medication treatment, medication combined with dietary and exercise intervention is more effective to enhance medication efficacy and BMD level.

Dear Editor, Acute promyelocytic leukemia (APL) is a subtype of acute myelocytic leukemia, characterized by the chromosomal abnormality t(15:17) coding a PML/RAR alpha fusion protein that affects differentiation of the promyelocyte cell in bone marrow. All-trans retinoic acid (ATRA), a key treatment for APL, acts as a differentiating agent in combination with other induction chemotherapy. Differentiation syndrome (DS) is a complication in APL patients undergoing induction chemotherapy with ATRA or arsenic trioxide [1]. The pathophysiology of DS is not understood precisely; however, it appears to be associated with a large pool of leukemic blasts, massive tissue infiltration of cells, cytokine increase, and systemic capillary leak syndrome, clinically presenting as dyspnea, fever, peripheral edema, weight gain, pleural, pericardial effusion, and acute kidney injury [2,3]. We present the case of a 66-year-old woman experiencing visual discomfort after starting ATRA treatment. This case highlights that visual symptoms can arise earlier than other well-known life-threatening symptoms of DS. A 66-year-old female patient presented with a fourmonth history of headaches, nausea, and vomiting. Blood tests revealed pancytopenia, and bone marrow examination confirmed PML/RARA gene positive. She was diag-nosed with APL for the first time and was admitted to the Department of Hematology and Medical Oncology at Ewha Womans University Mokdong Hospital for induction chemotherapy, where she received cytarabine, idarubicin, and ATRA as her induction chemotherapy treatment. Five days after ATRA treatment, she was referred for visualdimness and peripheral blurred vision. Her medical history included hypertension and branched retinal vein occlusion in her left eye, which had been treated with intravitreal injections three times two years prior. Her corrected visual acuity was 20 / 40 in the right eye and 20 / 32 in the left eye. Anterior segment finding was normal except for mild nuclear sclerosis in both eyes. Funduscopic examination revealed multiple retinal hemorrhages on the posterior pole in both eyes and Roth’s spot appearance in the left eye. Spectral-domain optical coherence tomography showed subretinal fluid (SRF) in the macula area of the right eye (Fig. 1A). Two days after ocular symptoms appeared, systemic DS symptoms, such as fever, weight gain, and dyspnea appeared, and pulmonary edema was evident in her chest x-ray. As a DS treatment protocol, intravenous dexamethasone was administered for 12 days. Two weeks later after the diagnosis of DS, SRF in macula became more aggravated, with involvement of the fellow eye, while ocular symptoms persisted. Twenty days after DS diagnosis, bilateral serous retinal detachment (SRD) was observed.However, fluorescein angiography showed no significant abnormality, with the exception of a previous branch retinal vein occlusion lesion in her left eye (Fig. 1B); the anterior segment was not remarkable. Her symptoms continued for about 1 month under ATRA treatment and slowly regressed with visual recovery in parallel with discontinuing ATRA (Fig. 1C). Two days after discontinuing ATRA, minimal SRF remained on her right eye. Two weeks later, her corrected visual acuity was 20 / 20 in the right eye and 20 / 25 in the left eye. She achieved complete remission of SRD with improvement in visual symptoms (Fig. 1D). We report the case of DS with ocular manifestation as a first symptom. Ocular manifestation of DS has been reported several times in previous case reports, involving retinal hemorrhage, SRD with intraretinal fluid, choroidal effusion, pseudotumor cerebri, and optic disc edema [2,4,5]. SRD can also appear in ocular infection, inflammatory disease, retinal vascular disease, malignancy, and leukemic retinopathy. Therefore, differential diagnosis should be considered. However, in this patient, the ocular symptom had developed after using the differentiating agent, ATRA. Systemic symptom appeared later. Anterior segments and fluorescein angiography findings were unre-markable to consider other differential diagnoses. After ceasing ATRA, bilateral SRD on optical coherence tomography was regressed, and the patient’s symptom was also relieved.In conclusion, patients receiving ATRA treatment may first present with acute visual symptoms, followed by life-threatening complications such as fever, dyspnea, peripheral edema, and weight gain. Thus, careful observation of ocular symptoms in APL patients is of the utmost importance if the patient is undergoing ATRA treatment.