As an anti-epilepsy drug,gabapentin plays an important role in the treatment of neuropathic pain through a variety of central and peripheral mechanisms.Studies have shown that gabapentin has better efficacy for post-stroke pain,spinal cord injury-related pain,postherpetic neuralgia,and pain in diabetic peripheral neuropathy.For mild adverse effects,good tolerance and lack of interactions,gabapentin is an ideal drug for the treatment of neuropathic pain.

Objective To observe the clinical effect of Sangao Decoction combined with Azithromycin in the treatment of mycoplasmal pneumonia in children.MethodsFrom August 2013 to August 2014, 76 children with mycoplasma pneumonia were enrolled in this study.The patients were randomly divided into observation group and control group.The control group was treated with azithromycin alone, and the observation group was given the treatment of Sanao Decoction on the basis of the control group.Comparison of the two groups of clinical efficacy, fever time, cough time, tonsil disappearance time, lung rales disappear time, length of stay and the incidence of adverse reactions.ResultsThe effective rate was 94.37% in the observation group and 76.32% in the control group, which was statistically significant (P<0.05).(2.45±0.90) d, duration of coughing (5.37±1.67) d, duration of disappearance of tonsil (6.23±2.47) d, disappearance of rales (7.18±1.58) d, duration of hospital stay (10.26±1.65) d were shorter than the control group, which was statistically significant (P<0.05).The incidence of adverse reactions was not statistically significant.ConclusionThe effect of Sangao Decoction combined with azithromycin in the treatment of mycoplasma pneumonia in children can significantly shorten the symptoms and signs of the patients, the time of disappearance of the signs and the length of hospital stay, promote the rapid recovery of children, high safety, and have good clinical application value.

Objective To investigate the effect of gamma globulin combined with glucocorticoid pulse therapy in the treatment of children with refractory mycoplasma pneumonia in CRP and safety.Methods 46 cases of children with refractory mycoplasma pneumonia from February 2012 to February 2016 were selected and randomly divided into the control group and experimental group,23 cases in each group.On the basis of the regular treatment,the control group was given azithromycin,10mg/kg,qd,intravenous drip,on the basis of the control group treatment,the experimental group was treated with methylprednisolone 2mg/kg+human immunoglobulin 400mg/kg,qd,intravenous drip.The levels of serum C-reactive protein(CRP),white blood cell count(WBC),lymphocyte count(LC),therapeutic efficiency and safety were measured before and after treatment.Results After treatment,compared with the control group,the serum levels of CRP、WBC、LC were lower in the experimental group,the difference was statistically significant(P<0.05).The treatment efficiency of the experimental group(91.31％)was significantly higher than that of the control group(65.22％),the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion The gamma globulin combined with glucocorticoid pulse therapy can significantly reduce the serum levels of CRP,WBC and LC in children with refractory mycoplasma pneumonia,improve clinical efficacy and the safety were good.

Adenocarcinoma ; metabolism ; pathology ; Aged ; Carcinoid Tumor ; metabolism ; pathology ; Chromogranin A ; metabolism ; Humans ; Immunohistochemistry ; Male ; Neoplasms, Multiple Primary ; metabolism ; pathology ; Phosphopyruvate Hydratase ; metabolism ; Rectal Neoplasms ; metabolism ; pathology ; S100 Proteins ; metabolism

To compare the degree of glycemic excursions by dynamic glucose monitoring in type 2 diabetes in the elderly when their HbA_1c≤6. 5, The mean blood glucose level and hypoglycemia incidence were observed. The amplitude of glycemic excursions revealed by DGMS was significantly lower in insulin glargine group than in mixed insulin group (P<0.05). The incidence of hypoglycemia were lower in glargine group than in mixed insulin group(P<0.05).

Objective To investigate the characteristics of clinical course in elderly patients and young-mid-dle-aged patients with upper gastrointestinal hemorrhage. Methods 417 hospitalized patients were divided into eld-edy group (≥60 yrs,198 cases) and young-middle-aged( <60 yrs,219 cases). All patients were diagnosed upper gastrointestinal hemorrhage by endoscopy. Results Endoscopy diagnosis included the first common cause to upper gastrointestinal hemorrhage was peptic ulcer, whereas more gastric ulcer were seen in elderly patients and more duo-denal ulcer were seen in young-middle-aged patients(23.7% vs 12.8%, 39.7% vs 21.7%, P <0.01). More eld-erly patients had a history of using Aspirin or NSMDs (17.1% vs 5.0%, P <0.01). The number of circulatory fail-ure and blood transfusion necessary were significantly increased, the mean duration of hospital stay was longer in eld-erly group than in young-middle-aged group(P<0.05). Conclusion The elderly patients have a more complicated clinical course than those young-mlddle-aged patients. Endoscopy is a necessary and effective method for both diagno-sis and treatment.

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.

The choledocho-pancreatico-duodenal junc-tion is located at the central part of choledocho-pancreatico-duodenal region. During early embryogenetic stage, the primary duodenum develops from the end of foregut and the beginning part of the midgut. The dorsal pancreas, hepatic diverticulum and the ventral pancreas which arises from the basic part of hepatic diverticulum are growing and rotating following the duodenum. During the course, the formations of the choledocho-pancreatico-duodenal region and the central part of choledocho-pancreatico-duodenal junction are complete. The injuries in cho-ledocho-pancreatico-duedenal junction may be caused by metal probe or lithotomy forceps for exploring, dilatating the distal bile duct or taking out the stones from the bile duct. Even if the injuries of choledocho-pancreatico-duodenal junction are deve-loped in a limited scope of several centimeters, several adjacent organs may be involved. Injuries in choledocho-pancreatico-duo-denal junction are hard to be identified during operation and may develop into serious pathological procedures.

The trial of two-way referral enrolled 26 patients with hypertension, including 20 cases of refractory hypertension, 3 new cases and 3 cases of secondary hypertension, the average length of follow-up was 22 d (10-35 d). The family physicians in Huaihaizhong Road Community Health Service Center communicated with specialists in the medical center (Ruijin hospital), appointments were made and medical information and other materials were sent in advance. When investigations and adjustment of medication were made, and the blood pressure was under control, patients were referred back to the community. This two-way referral system promoted the information exchanges between two side, doctors got prior knowledge about patients' condition and would spend more time with the patients; and patients' feeling of satisfaction and compliance of the treatment were increased. From our experiences, we suggest that the therapeutic regime made by the medical center should be feasible to the community, and more convenience should be given to the referred patients, so that the effectiveness and efficiency of the two-way referral can be further improved.