[Objective]To explore and analyse the treatment strategy for tic disorder (TD) from the perspective of surface theory,and provide clinical insights for the diagnosis and treatment of TD based on syndrome differentiation.[Methods]Based on collating and collecting literature,following the mentor's clinical diagnosis and treatment,and observing the curative effect,this paper discussed the traditional Chinese medicine(TCM) category of TD and the pathogenesis advocated by various schools,then analysed the theory of treating TD from the perspective of surface and summarized the etiology,pathogenesis,staging and corresponding treatment methods of TD.Two experimental cases were attached to support this.[Results]TD belongs to the category of "convulsion" of TCM,and many doctors advocate that it is related to internal wind.However,the classic Chinese medicine system attaches particular importance to the exterior and interior view,namely "distinguishing the exterior and interior with a particular emphasis on the exterior syndrome",which reveals that the clinical manifestations of TD are closely related to the pathogenic characteristics of pathogenic wind.Through clinical practice,the tutor finds the main cause of TD is external wind and the initial symptoms of the disease are all based on the urgency and bitterness of the exterior,which can be treated from the exterior.According to the progression of the disease,the pathogenic factor enters the interior from the exterior gradually,and the disease pathogenesis can be divided into three stages.In the initial stage,it is invaded by pathogenic wind,and the upper energizer and surface are mainly characterized by obstruction of the organs.In the middle stage,the main focus is on water and fire attacking and flushing,and the internal Qi movement is abnormal.In the later stage,it is mainly due to deficiency of blood and body fluids,and the loss of warming and nourishing organs.Therefore,in clinical practice,the main treatment is to relieve exogenous pathogenic factor,balance water and fire,and nourish blood and body fluids,so as to cause internal pathogenic factor to emerge from the surface.In this paper,two experimental cases with significant clinical effects were presented,which reflected that the symptoms of TD can be controlled or even disappeared.[Conclusion]Treating TD from the perspective of surface theory deepens the understanding of TD's etiology,pathogenesis and clinical treatment.Paying attention to the surface symptoms through syndrome differentiation,and using exterior-releasing medicinal to treat TD in order to remove internal pathogenic factor,have a certain degree of efficacy,which can provide a certain idea for the clinical use of TCM to leverage its advantages in treating TD.

[Objective]To explore and analyse the treatment strategy for tic disorder (TD) from the perspective of surface theory,and provide clinical insights for the diagnosis and treatment of TD based on syndrome differentiation.[Methods]Based on collating and collecting literature,following the mentor's clinical diagnosis and treatment,and observing the curative effect,this paper discussed the traditional Chinese medicine(TCM) category of TD and the pathogenesis advocated by various schools,then analysed the theory of treating TD from the perspective of surface and summarized the etiology,pathogenesis,staging and corresponding treatment methods of TD.Two experimental cases were attached to support this.[Results]TD belongs to the category of "convulsion" of TCM,and many doctors advocate that it is related to internal wind.However,the classic Chinese medicine system attaches particular importance to the exterior and interior view,namely "distinguishing the exterior and interior with a particular emphasis on the exterior syndrome",which reveals that the clinical manifestations of TD are closely related to the pathogenic characteristics of pathogenic wind.Through clinical practice,the tutor finds the main cause of TD is external wind and the initial symptoms of the disease are all based on the urgency and bitterness of the exterior,which can be treated from the exterior.According to the progression of the disease,the pathogenic factor enters the interior from the exterior gradually,and the disease pathogenesis can be divided into three stages.In the initial stage,it is invaded by pathogenic wind,and the upper energizer and surface are mainly characterized by obstruction of the organs.In the middle stage,the main focus is on water and fire attacking and flushing,and the internal Qi movement is abnormal.In the later stage,it is mainly due to deficiency of blood and body fluids,and the loss of warming and nourishing organs.Therefore,in clinical practice,the main treatment is to relieve exogenous pathogenic factor,balance water and fire,and nourish blood and body fluids,so as to cause internal pathogenic factor to emerge from the surface.In this paper,two experimental cases with significant clinical effects were presented,which reflected that the symptoms of TD can be controlled or even disappeared.[Conclusion]Treating TD from the perspective of surface theory deepens the understanding of TD's etiology,pathogenesis and clinical treatment.Paying attention to the surface symptoms through syndrome differentiation,and using exterior-releasing medicinal to treat TD in order to remove internal pathogenic factor,have a certain degree of efficacy,which can provide a certain idea for the clinical use of TCM to leverage its advantages in treating TD.

OBJECTIVETo explore the efficacy and prognostic factors of induction therapy combined with autogenetic peripheral blood stem cells transplantation (APBSCT)in patients with multiple myeloma (MM).

METHODSFrom January 1998 to May 2015, 201 patients with MM were enrolled. All patients received APBSCT after induction therapy. With the follow up to 20 June 2015, the overall survival (OS), progression free survival (PFS)and prognostic factor were analyzed.

RESULTS① With a media follow up of 36.67 months, the median PFS and OS were 22.87 (17.48- 28.26)and 69.63 (63.57- 75.69)months, 5-year PFS and OS were 17% and 49%, respectively. ②After APBSCT, when the subgroup (n= 112) achieved complete response (CR)compared with the subgroup (n=89) not achieved CR, the median PFS were 32.93 (21.03-44.83) and 18.13 (14.46-21.80) months (P<0.001), respectively; And the media OS were 96.77 (71.79- 121.75)and 54.70 (49.53- 59.87) months (P=0.004), respectively. The risks for disease progression and death declined in CR subgroup. ③ Two subgroups included or not included bortezomib/thalidomide at induction therapy (123 patientsvs 21 patients), the media PFS were 31.67 (24.36- 38.98)and 15.20 (10.11- 20.29) months (P=0.013), respectively; And the media OS were 76.30 (55.44- 97.15)and 52.03 (33.76- 70.30) months (P=0.014), respectively. ④According to the ISS stage, the media OS of stageⅠ, Ⅱ, Ⅲ were 99.47 (59.58-139.36), 66.77 (52.17-81.37), 53.97 (28.71-79.23) (P< 0.001), respectively. The risk for death of stage Ⅱ, Ⅲ were 2.16 and 3.04 times higher than stage Ⅰ, with no difference in terms of PFS. ⑤ The media PFS in IgD (n=22) and IgG (n=101) type MM were 11.17 (10.27- 13.13)and 35.43 (22.69- 48.17)months (P=0.007) , respectively; The media OS were 30.83 (0.24-61.42)and 70.70 (53.52-87.88) months (P=0.039), respectively. The risk for disease progression of IgD type was 2.47 times higher than IgG type. ⑥ Patients received 1 line induction therapy (n=132) compared with more than 1 line (n=69), the media PFS were 25.43 (16.09- 34.77)and 20.27 (15.04- 25.50) months (P=0.042). ⑦Cox analysis showed that CR after APBSCT and ISS stage were independent prognostic factors for OS. IgD type MM and CR after APBSCT were independent prognosis factor for PFS.

CONCLUSIONCR after APBSCT and ISS stage were independent prognostic factors for OS in MM. CR after APBSCT was independent prognostic factor for PFS in MM. However, disease progression more likely occurred in IgD type MM, which was independent negative prognostic factor for PFS in MM.

Antineoplastic Combined Chemotherapy Protocols ; Bortezomib ; therapeutic use ; Disease-Free Survival ; Humans ; Multiple Myeloma ; diagnosis ; therapy ; Neoadjuvant Therapy ; Peripheral Blood Stem Cell Transplantation ; Prognosis ; Remission Induction ; Survival Rate ; Thalidomide ; therapeutic use ; Transplantation, Autologous ; Treatment Outcome

Objective:To evaluate the benefit of autologous stem cell transplantation (ASCT) as a consolidation therapy in the survival of multiple myeloma (MM) patients at different risks. Methods:A total of 67 MM patients who received ASCT as consolida-tion therapy between August 2006 and July 2011 were enrolled in the retrospective study. The cases were divided into three risk groups on the basis of the International Staging System and fluorescence in situ hybridization. Another 67 patients who accepted consolidation chemotherapy at the same period were selected as case-paired controls matched in terms of age, sex, optimal response after induction, and risk stratifications. All the patients received bortezomib-and/or thalidomide-based induction therapies. Results:No statistical differ-ences in non-complete remission (nCR)/complete remission (CR) rate were observed between the ASCT and chemotherapy groups (44.8%vs. 37.3%, P=0.380) after the induction therapy. The progression-free survival (PFS) was longer in the ASCT group than in the chemotherapy group (32.4 months vs. 15.1 months, P<0.001). The overall survival (OS) was longer in the ASCT group than in the che-motherapy group (58.8 months vs. 42.1 months, P=0.009). both the PFS (median:30.5 months vs. 11.2 months, P<0.001) and the OS (median:85.5 months vs. 34 months, P=0.015) rates were significantly prolonged in the high-risk subgroup after ASCT. In the interme-diate-risk subgroup, neither PFS nor OS showed any significance after ASCT (P>0.05). In the low-risk subgroup, only PFS was extend-ed (median: 34.8 months vs. 17.6 months, P=0.012) after ASCT, without significant improvements in the OS (P>0.05). Conclusion:The MM patients obtained cytogenetic high-risk benefits mostly from ASCT consolidation after inductions based on novel agents.

Objective To investigate the trend of antimicrobial resistance and the prevalence of resistant genes in Pseudomonas aeruginosa strains isolated from Hangzhou First People's Hospital.Methods Antimicrobial susceptibilities of 1489 Pseudomonas aeruginosa strains isolated from 2003 to 2007 were statistically analyzed using WHONET.MICs of 11 antimicrobisis to 36 multi-drug-resistant Pseudomonas aerugionosa strains were determined by agar dilution method.Genes of β-lactamases(BLA)and aminoglycoside-modifying enzymes(AMEs)were detected by PCR and the PCR products were sequenced.Results The resistant rates to aztreonam,imipenem,ceftazidime,cefepime,piperacillin,piperacillin/tazobactam.cefoperazone/sulbactam,ciprofloxacin,levofloxacin,gentamicin and amikacin were increased from 13.4%,10.6%,8.7%,7.9%,12.7%,12.7%,6.7%, 15.8%,20.5%,24.7% and 10.9%in 2003 to 35.3%,40.9%,18.4%, 32.4%,32.9%,32.0%,21.9%,37.8%,38.6%, 39.4% and 34.8% in 2007.respectively.Hish MICs of 11 antimicrobiMs for multi-drug resistant Pseudomonas aerouginosa were determined with MIC90≥128 μg/mL.In 36 multi-drug resistant Pseudomonas aeruginosa strains,21(58.3%)strains carried β-lactamase genes and 32 strains(88.9%)carried aminoglycosidemodifying enzyme genes,while the deletion rate of oprD2 was 80.6%(29/36).Conclusions The resistant rates to common antibiotics of Pseudomonas aeruginosa have increased.resulting in multi-drug resistance.Genes of β-lactamases and aminoglycoside-medifying enzymes are prevalent in multi-drug resistant Pseudomonas aeruginosa strains,with the common deletion of oprD2.

Objective To explore the antibacterial activity of the baicalin injection in vitro.Methods The broth doubling dilution method has been adopted.And the minimal inhibitory concentration(MIC)and minimum bactericidal concentration(MBC)of baicalin injection on 161 common pathogenic bacteria obtained from clinical practice were determined.Results The MIC range of baicalin against clinically common pathogenic bacteria is 0.1～50mg/ml and the MBC range is 0.2～50mg/ml.The MIC and MBC against staphylococci is remarkably lower than those against other bacteria,with the MIC range of 0.1～6.3mg/ml and MBC range of 0.2～12.5 respectivel.The MIC50,MIC90 are respectively 0.4mg/ml and 0.8mg/ml.Conclusions The baicalin injection possesses various levels of inhibitory effect on manifold pathogenic bacteria,especially the antibacterial effect on the staphylococci.

OBJECTIVE To investigate the resistance and the distribution of the main ?-lactamases encoding gene in Acinetobacter baumannii isolated from four hospitals in Hangzhou city to provide the basic data for the optional treatment of A.baumannii infection.METHODS The identification of A.baumannii was performed using VITEK-AMS60.The minimum inhibitory concentrations(MIC) was examined by agar dilution and E-test.The homology of the resistant isolates was finished by pulsed field gel electrophoresis(PFGE).PCR and sequencing were used to analyze the ?-lactamases encoding gene of the 36 strains of imipenem-resistant A.baumannii.RESULTS All of the imipenem-resistant isolates produced carbapenemase OXA-23,and 5 isolates produced PER-1,2 isolates produced TEM-1 except OXA-23.No metallo-?-lactamases were detected.No plasmid was extracted.Clone transmission of the imipenem-resistant strains existed in the 4 hospitals.Most strains were isolated from intensive care unit(ICU). CONCLUSIONS The clone transmission of imipenem-resistant A.baumannii strains is occurred in 4 hospitals.All strains produce carbapenemase OXA-23.Five strains also produce PER-1 type extended-spectrum ?-lactamases.Two strains also produce TEM-1 type extended-spectrum ?-lactamases.

OBJECTIVE To investigate the rate of the clinical isolation of ESBLs positive Escherichia coli and the resistance in intensive care units(ICU).METHODS We isolated E.coli from 2003 to 2004 in our hospital ICU,phenotypic confirmatory test was applied to detect ESBLs.Bacterial drug susceptibility test was performed by standard Kirby-Bauer method.RESULTS The isolation rate of ESBLs positive E.coli was 74.36% in 2003 and 81.58% in 2004.ESBLs positive bacteria had high resistance to antibacterial drugs,but the resistance rate did not rise.ESBLs negative bacteria were more susceptible to antibacterial drugs(P=0.001);but ESBLs negative bacteria in 2004 had higher resistance than in 2003(?2=84.511,P=0.001).CONCLUSIONS It is very important for ICU to use ESBLs detection test in time,and antibacterial drugs in reason.

OBJECTIVE To investigate the distribution and the antimicrobial resistance of Alcaligenes xylosoxidans and to provide the guidance of rational use of antibiotics.METHODS A.xylosoxidans was isolated and identified through VITEK-AMS all-automatic microbiology analysis system and its G~-bacilli identification cards(GNI) and drug sensitivity cards(GNS-KI/121) were also analyzed.Drug-resistance was tested by Kirby-Bauer disk(sensitivity) method((Bio-Merieux) and Oxoid products).RESULTS The drug-resistance rates to the 1st to 4th((except) CAZ) generation cephalosporins were more than 77%.The drug-resistance rate to the aminoglycosides was more than 76%,and to(ampicillin,) amoxicillin/CA,ampicillin/sulbactam,cefoxitin and cefuroxime were all 100%;but to(aztreonam) was 92.86%;66.67% and 44.44% strains were resistant to ciprofloxacin and(levofloxacin).(CONCLUSIONS) The detection rates of the multidrug resistant A.xylosoxidans have the tendency to increase yearly.The antibiotics should be used reasonably according to the results of drug sensitivity test in clinic.

OBJECTIVE To investigate the distribution of pathogens and their antibiotic resistance in lower respiratory tract infection(LRTI) from intensive care unit(ICU) in our hospital,and provide basis for rational selection of clinical drugs.METHODS Pathogens were detected from qualified sputum specimens in LRTI from ICU and identified by VITEK-AMS60 automatic microbial analyzing system.Drug susceptibility was determined by KB test.RESULTS From 320 sputum specimens 367 pathogens were detected between from Jan 2007 to Mar 2008,including 261 strains(71.1%) of Gram-negative bacilli,70 strains(19.1%) of fungi,and 36 strains(9.8%) of Gram-positive cocci.21.8% Of the isolated pathogens were Acinetobacter baumannii,with 16.7% of drug-resistant rate to cefoperazone/sulbactam and over 71% to other 13 antibiotic agents.The rate of extended spectrum ?-lactamases(ESBLs) producing Escherichia coli isolates and Klebsiella pneumoniae ones were 65.2% and 72.0%,respectively,comparing to 84.6% for meticillin-resistant Staphylococcus aureus(MRSA).CONCLUSIONS Gram-negative bacilli are the major pathogens of LRTI in ICU,in which A.baumannii shows with a high rate of drug-resistance,followed by fungi,which should attract the clinician′s more attention.