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.

Objective To study the clinical effect of low-molecular-weight heparin combined with edaravone in the treatment of progressive cerebral infarction.Methods 60 patients with acute progressive cerebral infarction in 72 hours were randomly divided into treatment group received edaravone combined low-molecular-weight heparin(n=30)and control group received low-molecular-weight heparin(n=30).The primary efficacy was evaluated by NIHSS(the National Institutes of Health Stroke Scale).ADL(Activities of daily living)and clinical effect.Results Our study showed that the score of NIHSS on 7th day post-therapy and 14th day post-therapy in treatment group was lower than that in control group(t=15.987 and 11.756,both P＜0.01).However,the score of ADL in the theatment group on 14th day post-therapy was higher than that of control group(t=62.56,P＜0.01).The overall clinical responserate of treatment group was higher than that of control group(x2=13.695,5.769,all P＜0.01).Conclusion Edaravone combined with low-molecular-weight heparin has remakable effect on the treatment of progressive cerebral infarcti.

RCP is a new technique of cerebral protection that perfuses oxygenated blood from the venous system to cerebral tissue. When the corporeal circulation is arrested during the cardiovascular operation ,this method can be applied to delivery blood full of oxygen to cerebrum so as to prolong the tolerance time of cerebral tissue to ischemic injury and then gain abundant time for operation. Simultaneously,this method can reduce the reperfusion time of cerebrum significantly for a stroke patient so prolong the treatment time window of stroke and improve the treatment effect ion of medicine. This report summarizes the development and clinical application of this technique in recent twenty years and prospects its development direction in the future.

Objective To evaluate the outcomes of the standardized general practice training program in Shanghai Zhongshan Hospital,Fudan University.MethodsTotal 183 graduates of 11cohorts completed general practice standardized training in Shanghai Zhongshan Hospital,Fudan University since 2000.A questionnaire survey on the career status was conducted and 173 graduates were responded successfully with a respond rate of 95％.ResultsAmong 173 responded graduates,55 were males and 118 females with an average age of 33.8 y.One hundred and sixty nine graduates (98％) were still engaged in general practice,including 148 working in Shanghai and 21working in other cities.For professional ranks,3 of them were chief physicians,17 vice-chief physicians,81attending physicians and 72 residents (34 of them would be soon promoted to attending physician).Among the 173 graduates,39 were heads of GP teams and 49 held administrative positions.Up to February 2011,81graduates had published 184 papers as firstauthor,32 were successful in grant application and 33 research grants were awarded with a total fund of 2.487 million Yuan.Thirteen graduates obtained the chance for further study of general practice in Hong Kong,Taiwan or abroad.ConclusionThe follow-up study shows that the outcomes of general practice standardized training program in Shanghai Zhongshan Hospital are satisfactory.

In order to investigate the occurrence of chronic hepatitis B virus(HBV) infection in HB vaccine inoculated infants born to HBsAg positive mothers and its affecting factors and also to study the effect of combined use of HB immunoglobulin (HBIG) and HB vaccine on the blocking of perinatal transmission of HBV, we divided 624 infants born to HBsAg positive mothers into two groups randomly. The first group of infants were simply vaccinated with HB vaccine 20μg at,0, 1, 6 months old. The second group of infants were inoculated with HBIG 100 IU at their birth and further vaccinated with HB vaccine 20μg at 1,2,7 months old. The HBsAg of the two groups of infants was tested at the age of 1,3,6,12,18,24 months old and every year by EIA. They were all followed up for 6.34±1.71 years averagely. The follow-up results showed that there were 89 childeren infected chronically by HBV, among them 82% appeared to be HBsAg positive, firstly seen before the age of 6 months mainly attributing to uterus infection. The HBV chronic infection rate of infants born to HBsAg, HBeAg positive mothers (HB vaccine immunized, 24.5%; HBIG+HB vaccine, 10.6%, P<0.005) was higher than that of infants born to HBsAg positive mothers (HB vaccine immunized, 10.7%; HBIG+HB vaccine 3.8%, P<0.025). Moreover, the chronicity rate of the infants whose HBsAg firstly appeared within 6　　months and were born to HBsAg, HBeAg positive mothers was higher than that of the infants born to HBsAg positive months (68%,40% respertively in HB vaccine inoculated group, P<0.025). Infants immunized combinely with HBIG and HB vaccine had their chronic HBV infection decreased from 17.6% to 5.0% at l year old as compared with that of HB vaccine inoculated infants. The total chronic HBV infection rate in children born to HBsAg, HBeAg positive mothers decreased from 24.5% to 10.6% (P<0.005) and that in children born to HBsAg positive mothers decreased from 10.7% to 3.8% (P<0.025). The HBV chronicity rate of HBsAg positive infants born to HBsAg, HBeAg positive mothers also decreased and that of infants born with HBsAg negative, but became positive after 1-6 months decreased from 40.9% to 0% (P=0.0315). The HBsAg seronegative conversion rate in l month old infants born to HBsAg positive mothers increased from 26.4% to 58.8% (P<0.025). All these data indicated that infants born to HBsAg positive mothers, though had been HB vaccine immunized, still had chronic infection, that was chiefly due to chronic uterus infection by HBV. The single use of HB vaccine can not completely block the uterus infection of HBV, but when combinatively used with HBIG, the blocking effect is more efficient, the chronicity of HBV infection also can be avoided.

The two-way referral system is an inevitable step in the health reform,as it could effectively channel patients,promote rational use of healthcare resources,and improve the quality of care at primary medical institutions.Only by means of resources integration for improvement of existing policies,and building a healthcare system comprising partnering medical institutions of all levels with proper division of responsibilities,can the two-way system come into practice smoothly.This will alleviate the difficulty in seeing doctors and expensiveness of treatment.

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