Objective:To investigate the clinical efficacy and safety of antibiotic de-escalation therapy in the treatment of severe pneumonia.Methods:Sixty patients with severe pneumonia who received treatment in The First People's Hospital of Yongkang,China from January 2015 to January 2018 were included in this study.They were randomly assigned to receive either conventional antibiotic therapy (control group, n = 30) or antibiotic de-escalation therapy (observation group, n = 30).The clinical efficacy,symptom relief time,antibiotic treatment time,length of hospital stay,pulmonary ventilation function index,serum levels of inflammatory factors and the incidence of adverse reactions were compared between the control and observation groups. Results:Total effective rate in the observation group was significantly higher than that in the control group [93.33% (28/30) vs.73.33% (22/30), χ2 = 4.320, P < 0.05].The time to disappearance of cough,fever and abnormal lung sounds in the observation group was (2.10 ± 1.25) d,(2.19 ± 1.24) d,(2.01 ± 0.56) d,respectively,which was significantly shorter than that in the control group [(3.73 ± 1.92) d,(3.68 ± 1.70) d,(3.36 ± 0.78) d, t = 3.897,3.878,7.701,all P < 0.05].The antibiotic treatment time and length of hospital stay in the observation group were (2.89 ± 1.06) d and (4.08 ± 1.23) d,respectively,which were shorter those in the control group [(4.27 ± 1.45) d and (5.76 ± 1.69) d, t = 4.208 and 4.402,both P < 0.05].The forced expiratory volume in one second (FEV 1) and the ratio of FEV 1 to forced vital capacity (FVC) in the observation group were (2.09 ± 0.69) L and (58.94 ± 15.67)%,respectively,which were significantly higher than those in the control group [(1.43 ± 0.57) L,(43.12 ± 11.03)%, t = 4.039 and 4.522,both P < 0.05).Serum levels of C-reactive protein,interleukin-6 and procalcitonin in the observation group were (5.84 ± 2.09) mg/L,(20.05 ± 2.76) ng/L,(2.18 ± 0.78) ng/L respectively,which were significantly lower than those in the control group [(8.50 ± 2.67) mg/L,(23.24 ± 3.07) ng/L,(3.11 ± 0.97) ng/L, t = 4.297,4.232,4.092,all P < 0.05].There was no significant difference in the incidence of adverse reactions between the observation and control groups (6.67% vs.10.00%, χ2 = 0.218, P > 0.05). Conclusion:Antibiotic de-escalation therapy for the treatment of severe pneumonia can shorten the time of disappearance of clinical symptoms,improve pulmonary ventilation function,and inhibit systemic inflammatory reaction without increasing adverse reactions.

The development of molecular biology techniques makes important contributions to the researches of heritable varia-tion of Schistosoma. In recent years,the molecular genetic analysis in the Schistosoma variation researches mainly includes the re-striction fragment length polymorphism(RFLP),random amplified polymorphism technology(RAPD),microsatellite anchored PCR(SSR-PCR),and polymerase reaction single-strand conformation polymorphism(PCR-SSCP). This article reviews the re-search progress of molecular genetic analysis in Schistosoma variation in recent years.

Objective:To establish a method to determine the residual solvents in salvianolic acid B. Methods: The headspace GC was carried out on an HP-5 capillary column(30 m × 0. 32 mm,0. 6 μm). The inlet temperature was 180℃. The injection volume was 0. 1ml and the separation ratio was 1:10. The column temperature was programmed:the initial temperature was 40℃, malntalned for 6 min, ralsed to 180℃ with a rate of 15 ℃·min-1 , and malntalned for another 5 min. The detector was FID with the temperature of 250℃. The carrier gas was N2 with the flow rate of 1. 7 ml·min-1 . DMSO was used as the solvent for salvianolic acid B. Results:All solvents could be separated completely. The linear range of ethanol, acetone and ethyl acetate was 12. 650-1. 012 × 103 μg·ml-1 (r=0.999 3),12.750-1.012 ×103 μg·ml-1(r=0.999 7) and 12.550-1.004 ×103 μg·ml-1(r=0.999 7), respectively. The average recovery of ethanol, acetone and ethyl acetate was 96. 89% (RSD=3. 81%,n=9), 99. 56% (RSD=4. 05%,n=9) and 97. 21% (RSD=4. 95%,n=9), respectively. Conclusion:The method is simple, reproducible and accurate enough for the determi-nation of residual solvents in salvianolic acid B.

Thyroid microsomal antigen-antibody(TMAg-Ab)system plays an important role in the pathogenesis of autoimmune thyroid diseases.TMAb are involved in the complementmediated cytotoxicity and antibody-dependent cytotoxicity,resulting in thyroid follicle epithelial cell and basement membrane injury,followed by thyroiditis and hypothyroidism,and they may also cause hyperthyroidism through some unknown mechanisms.In recent years,indirect hemagglutination,radioimmunoassay and enzyme-inked immunosorbent assay have been used to detect TMAb in thyroid disease patients'sera,indicating the incidence as high as 90%.Measurements of T3,T4 and TSH alsoreveal that serum TMAb level is related with the variation of T3,T4 and TSH.It ispostulated that TMAg might be the lipoprotein on smooth endoplasmic reticulum ofthyroid follicle epithelial cell.Due to the difficulties to purify TMAg,its nature stillremains unclear.

The serum thyroid microsomal antibodies (TMAb) and thyroglobulin antibodies (TGAb) were measured in 103 normal persons and 183 patients with different thyroid diseases by enzyme-linked immunosorbent assay (ELISA). The serum T3 and T4 were also tested. The results showed that the incidence of these two autoantibodies were obviously increased in Hashimoto's thyroiditis, hyperthyroidism and hypothyroidism, and normal in simple goiter and thyroid adenoma. The TMAb and TGAb levels in subacute thyroiditis and thyroid cancer were moderately increased. There were also a negative correlation between TMAb and T3, T4, TGAb and T4 in Hashimoto's thyroiditis.

Hyperlipidemic pancreatitis (HLP) has an increasing incidence.Primary HLP is common in patients with familial difficiency of lipoprotion lipase or apo-C Ⅱ.While for secondary HLP,the common reasons are excessive drinking,diabetes,obesity,fat-rich diet and special medications.Lipidlowering drugs,plasma exchange (PE) or continuous veno-venous hemofiltration (CVVH),low molecular heparin as well as insulin,have been widely used for the treatment of HLP.Changing of diet and lifestyle,in addition to controlling risk factors are the keys to preventing HLP.This article summarizes the latest perspectives and research progress of HLP.

Objective To observe the clinical effects of Bufei Yishen treatment on quality of life of patients with chronic obstructive pulmonary disease in stable period. Methods Sixty-four patients were randomly divided into two groups, the control group (32 cases) received Atrovent metered dose inhaling and Mucosolvan po. The treatment group (32 cases) received the fluid extract of Bufei Yishen besides the routine treatment. Both groups were treated for three months. The changes of scores of TCM syndrome and cardinal symptom, quality of life (QOL), lung function were observed before and after the treatment. Results The scores of TCM syndrome and cardinal symptom, quality of life of the treatment group were significantly higher than the control group (P0.05). Conclusion Bufei Yishen treatment has significantly effect on quality of life of patients with chronic obstructive pulmonary disease in stable period.

Objective To investigate the CT and MRI features of solid-cystic papillary tumors(SCPTs) of the pancreas.Methods Eight cases of SCPTs confirmed by operation and pathology underwent both plain and contrast-enhanced CT examination,and MR examination in three cases and contrast-enhanced MRI in two cases.Results In the eight patients,the mean tumor diameter was 7.6 cm and the lesions were found mainly in the body and tail of the pancreas,only one at the pancreatic head.On plain CT scan,the tumors appeared as huge solid-cystic mass with definite margin and an integritied capsul,the solid areas were papillary or irregular components,and the cystic areas in central were low attenuation.On contrast-enhanced CT,the cystic wall and solid part were slight enhancement in arterial phase,and moderate or obvious enhancement in parenchymal phase.Irregular ringed and punctate calcification could be seen in five cases,the acute hemorrhage occurred in one case,slight dilation of the pancreatic duct was noticed in one patient.MRI showed an ovoid solid-cystic mass of the pancreas with distinct border.On T1WI,heterogeneous iso-and hypo-intensity was observed.One case showing the high signal intensity in tumor was subacute hemorrhage.On T2WI,the tumors were mixed hypo-,iso-and hyperintensity.The papillary or flocculent solid portion and the cystic wall were enhanced after gadolinium was used.Conclusion SCPTs is of certain clinic,CT and MRI characteristic findings,which can aid in reaching a proper diagnosis.

Objective To study the mechanism of gastric bypass operation on treatment of type 2 diabetes mellitus,recognize the etiology and pathogenesy of the disease and frame therapy strategy for type 2 diabetes mellitus.Methods The literatures about gastric bypass operation on treatment of type 2 diabetes mellitus,including clinical cases reports and evidence-based studies were reviewed.Results Gastrointestinal bypass operation was regarded as an effective treatment for type 2 diabetes mellitus.There were three hypotheses of therapy mechanism: early delivery of nutrients to the distal intestine,exclusion of the proximal intestine and incretin/anti-incretin.Conclusion Gastrointestinal bypass operation is now considering as an effective treatment,there is still a lack of basic experimental studies to clarify the mechanism.

Objective To determine the levels of serum FSH and E 2 in the patients with uterus preserved or hysterectomy so as to guide the selection of operative modality for the patients with hysteromyoma and hormone replacement therapy for the patients with hysterectomy. Methods Radioimmunoassay (RIA) was used to detect the levels of serum FSH and E 2 in the patients with uterius preserved or after hysterectomy and control group. There were 60 subjects in each group. Results Before operation, there was no significant difference in the levels of serum FSH and E 2 among myomectomy group, hysterectomy group and control group. The level was higher of serum FSH and lower of serum E 2 in the hysterectomy group 7 days after operation than those in the myomectomy group and the hysterectomy group before operation (P