OBJECTIVE:To observe clinical efficacy and safety of Compound xiongshao capsules in the treatment of diabetic peripheral neuropathy (DPN).METHODS:A total of 97 DPN patients selected from our hospital during Jun.2015-Apr.2016 were divided into group A (compound xiongshao treatment group,46 cases) and control group (51 cases) according to random number table.The latter was divided into group B (epalrestat+beraprost sodium group,12 cases),group C (fursultiamine+mecobalamin group,12 cases) and group D (epalrestat group,27 cases) according to clinical symptoms and economic situation of patients.Four groups were given antidiabetic drugs for blood glucose control.Based on it,group A was additionally given Compound xiongshao capsules 0.9 g,tid;group B was additionally given Epalrestat tablets 50 mg,tid+Beraprost sodium tablets 40 μg,tid;group C was additionally given Fursultiamine tablets 50 mg,tid+Mecobalamin tablets 0.5 mg,rid;group D was additionally given Epalrestat tablets 50 mg,tid.All groups were treated for 6 months.Clinical efficacies were observed.TCSS scores,motor nerve conduction velocity (MCV),sensory nerve conduction velocity (SCV),incubation period and amplitude of median nerve and common peroneal nerve,the levels of hemorheology indexes,blood glucose,glycosylated hemoglobin,blood lipid,serum creatinine were compared before and after treatment.The occurrence of ADR was recorded.RESULTS:Total response rates of group A and B (82.61％,83.33％)were significantly higher than those of group C and D (33.33％,66.67％),total response rate of group D was significantly higher than that of group C,with statistical significance (P＜0.05).Before treatment,there was no statistical significance in TCSS scores,MCV,SCV,incubation period and amplitude of median nerve,MCV and amplitude of common peroneal never,SCV,incubation period and amplitude of common peroneal never or whole blood high-shear viscosity among 4 groups (P＞0.05).After treatment,TCSS scores of group A,B and D were decreased significantly compared to before treatment,and those of group A and B were lower than those of group C and D,with statistical significance (P＜0.05).MCV,incubation period and amplitude of median nerve in group A and B,amplitude of median nerve in group C,MCV and amplitude of median nerve in group D were significantly better than before treatment;MCV,incubation period and amplitude of median nerve in group A and B were significantly better than group C and D,with statistical significance (P＜0.05).MCV,incubation period and amplitude of common peroneal never in group A,B,C were significantly better than before treatment,MCV and amplitude of common peroneal never in group A,B were significantly better than group C,D;the improvement of incubation period of common peroneal never in group A,B,D were significantly better than group C,with statistical significance (P＜0.05).SCV,incubation period and amplitude of median nerve,SCV and amplitude of common peroneal nerve in group A,B and D were significantly better than before treatment;SCV,incubation period and amplitude of median nerve,SCV and amplitude of common peroneal nerve in group A,SCV,incubation period and amplitude of median nerve and amplitude of common peroneal nerve in group B were significantly better than group C and D;SCV of median nerve in group D was significantly better than group C,with statistical significance (P＜0.05).Whole blood high-shear viscosity of group A was decreased significantly compared to before treatment,and significantly lower than those of group B,C and D,with statistical significance (P＜0.05).There was no statistical significance in total response rate and TCSS score between group A and B,and in the levels of blood glucose,glycosylated hemoglobin,blood lipid or serum creatinine among 4 groups (P＞0.05).No obvious ADR was found in 4 groups.CONCLUSIONS:Compound xiongshao capsules shows significant therapeutic efficacy for DPN,and improves nerve conduction velocity,incubation period and amplitude of median nerve and common peroneal nerve,whole blood high-shear viscosity.Its effect is similar to that of epalrestat combined with beraprost sodium,and better than those of fursultiamine combined with mecobalamin,epalrestat alone.It does not affect the blood glucose,blood lipid and serum creatinine levels with good safety.

Objective To assess the cerebrovascular reserve (CVR)and the relationship of CVR with the short-term prognosis in patients with acute atherosclerotic cerebral infarction.Methods A total of 106 patients with unilateral acute (within 72 h) atherosclerotic cerebral infarction (trial group) were selected from December 2016 to December 2017 in the Department of Neurology of the First People's Hospital of Hefei,which were divided into two groups including the lesion group (106 cases) and the nonlesion group (106 cases).The median score of NIHSS in patients was 4(2,5).The control group included 40 healthy controls.The cerebral blood flow reserve and pulsatility index were measured by transcranial Doppler combined with CO2 inhalation test in both the trial group and the control group.According to the rate of change of cerebral blood flow velocity (CBFV),all subjects were divided into two groups including the normal group and the impaired cerebral blood flow reserve group.The changes of CBFV were compared in the control group and the trial group,which was divided into two groups including the group with lesion side and the group with non-lesion side.To evaluate the brain structure reserve the circle of Willis in the trial group was assessed by MRA.According to the integrity of the circle of Willis anterior and posterior circulation all subjects were divided into four groups (type Ⅰ,type Ⅱ,type Ⅲ and type Ⅳ).The effect of the factors,such as diabetes,hypertension,low density lipoprotein (LDL),high density lipoprotein (HDL),smoking,and drinking history,on cerebral blood flow reserve was measured by single-factor analysis.The correlation of NIHSS scores,infarct size and volume with CVR was also measured.All patients in the trial group were treated with drugs and were followed-up for three months.The modified Rankin Scale (Mrs) was used to evaluate the prognosis of the patients.It means poor prognosis if the value of Mrs was more than three.The effects of factors,such as sex,HDL,LDL,diabetes,hypertension,smoking history,drinking history,cerebral blood flow reserve,NIHSS scores,brain structure reserve,infarct location,age,on the prognosis were measured by multivariate Logistic regression.Results The increase rate of CBFV in the lesion-side of patients with atherosclerotic cerebral infarction was 5.94％ (2.18％,10.49％),and the increase rate of pulsatility index was 10.77％ (2.21％,22.62％),which were both lower than the control group (CBFV:11.54％ (5.01％,17.96％),Z =2.547,P＜0.05);pulsatility index:48.36％ (33.93％,64.51％),Z =6.604,P ＜ 0.01).There was significant difference (x2 =4.328,P ＜ 0.05) in the distribution of diabetes,which was 2/14 in the normal group and 43.48％ (40/92) in the impaired cerebral blood flow reserve group.And in the trial group the brain structural reserve was positively correlated to the infarct volume and the NIHSS score,and the rank correlation coefficient was 0.219 and 0.238 respectively (P ＜ 0.05).The prognosis of cerebral blood flow reserve in the normal group was better than the impaired group (x2 =4.155,P ＜ 0.05),for example,the proportion of patients with good prognosis and normal CBFV was 18.84％ (13/69),the proportion of patients with good prognosis but decreased CBFV was 81.16％ (56/69),the proportion of patients with poor prognosis but normal CBFV was 2.70％ (1/37),the proportion of patients with poor prognosis and decreased CBFV was 97.30％ (36/37).The proportion of patients with type Ⅰ and type Ⅲ of the brain structure reserve was 37.68％ (26/69) and 5.80％ (4/69) respectively,whose prognosis was better (x2 =8.456,P ＜ 0.05) than patients with type Ⅱ and type Ⅳ,whose proportion was 43.48％ (30/69) and 13.04％ (9/69).Multivariate Logistic regression analysis showed that NIHSS score,age,and brain structural reserve were risk factors for poor prognosis in the trial group.Normal cerebral blood flow reserve was a protective factor for good prognosis.Conclusions CVR in patients with acute atherosclerotic cerebral infarction is significantly reduced.CVR can be used as an index to evaluate the prognosis of patients who were followed-up for three months.

Yishen Juanbi Method for Treating Rheumatism began from Mr. ZHANG Ci-gong to the formation and development of Mr. ZHU Liang-chun, and by the evidence-based source, innovation and perfection of the third and fourth generations of successors, has formed the unity of the principle, rule, method, medicine, and the unique diagnosis and treatment of rheumatism of integration of the internal treatment and external treatment. All of these provide original insights for rheumatology of TCM theory and the application of insect medicine, and provide valuable treatment technology for China's young rheumatology disciplines.

Objective:To develop a new preparation process of PLGA microparticles for protein drugs by SPG membrane emulsifi-cation combined with W/O/W double emulsion-solvent technique. Methods:Lysozyme was used as the model drug to prepare the mi-croparticles. The influence of formula factors on the properties of the microparticles was studied, and the physicochemical properties, in vivo compatibility and degradation of the microparticles were investigated as well. Results:The drug loading of lysozyme-loaded mi-croparticles was 35%, the entrapment efficiency was 72. 43% and the average size was 63. 89 μm with PDI of 0. 675. DSC and FTIR showed that lysozyme was entrapped in the microparticles. The microspheres had promising biocompatibility and sustained degradation in vivo. Conclusion:The paper describes a new satisfactory preparation process of PLGA microparticles for protein drugs with good in vitro and in vivo properties.

Objective To investigate the antimicrobial resistance in the A cinetobacter baumannii strains in different parts of China during 2012 .Methods A total of 8 739 clinical isolates of Acinetobacter were collected from 13 general hospitals and two children’s hospitals ,of which most were A . baumannii (89 .6% , 7 827/8 739 ) . Antimicrobial susceptibility testing was carried out by means of Kirby-Bauer method according to the unified protocol . The susceptibility testing data were analyzed by WHONET 5 .6 software according to CLSI 2013 breakpoints .Results Majority (85 .4% ) of the Acinetobacter strains were isolated from inpatients .The remaining 14 .6% were from outpatients and emergency room patients .Of the 7 827 strains of A .baumannii , 10 .9% ,35 .2% ,35 .7% and 43 .4% were resistant to tigecycline ,minocycline ,cefoperazone-sulbactam and amikacin , respectively .The percentage of A .baumannii resistant to imipenem and meropenem was 63 .5% and 68 .2% ,respectively . The antimicrobial resistant pattern varied in different hospitals . The resistance of A . baumannii varied between different clinical departments .A number of pandrug resistant (PDR) (20 .0% ,1 567/7 827) and multidrug-resistant (MDR) (45 .0% , 3 521/7 827 ) A . baumannii were identified . Conclusions A . baumannii is the most popular pathogenic bacteria among Acinetobacter .The antibiotic resistance of A .baumannii is still increasing .Cefoperazone-sulbactam and minocycline has good in vitro antibacterial activity against A .baumannii .The antibiotic resistance of A .baumannii varies greatly with hospital and department .

Objective To explore the clinical head nurses'effective competence through interviewing nursing supervisors by in depth interview method and to provide reference for constructing training content for clinical head nurses in Macau and Guangzhou.Methods In depth interview was carried out among 8 nursing supervisors from 2 hospitals in Macau and 9 nursing supervisors from 2 tertiary hospitals in Guangzhou.Content analysis was utilized through organizing records and then forming written documentations.Results The themes were drawn after the interview,which were good moral character accomplishment,good communication skill,prospective and creative thinking,favorable executive ability.Forwardlooking and innovative were significantly different in Macau and Guangzhou.Conclusions The effective clinical head nurses' competence is multi-faceted,the results can provide reference for selection,evaluation and training for head nurses.

Objective To develop a method for rapid detection of Mycoplasma pneumoniae and its macrolide resistance mutation. Methods The primers and cycling probe sets were designed to detect two single nucleotide mutation, A2063G and A2064G, in the 23s rRNA gene of Mycoplasma pneumoniae. By using recombinant plasmids containing 23s rRNA gene fragments, 102 Mycoplasma pneumoniae clinical isolates from 2005 to 2008, and 136 nasopharyngeal suction specimens from pediatric patients with low respiratory tract infections in Shanghai Children's Hospital from November to December in 2009 were investigated to determine the specificity and the sensitivity of the CycleavePCR method. PCR amplification and sequence analysis of 23S rRNA genes were performed for all Mycoplasma pneumoniae strains and Mycoplasma pneumoniae positive specimens to confirm the results of the CycleavePCR method. Results Of 102 clinical isolates, 83 was resistant to erythromycin and sequence results show that all macrolide-resistant Mycoplasma pneumoniae strains harbored an A2063G ( 82/83 ) or A2064G ( 1/83 ) transition mutation in 23S rRNA genes. Twelve was Mycoplasma pneumoniae detected positive by CycleavePCR in 136nasopharyngeal suction specimens. The CycleavePCR results were consistent with those of routine PCR and sequencing. There was no signal production from other bacterial species. Sensitivity and specificity were 100%. The detection limit of the CycleavePCR was 10 plasmid copies per reaction. Experiment can be done within 1.5 h. Conclusion A novel method is developed to detect erythromycin-resistant strains harboring A2063G and A2064G transition mutation in the 23s rRNA gene using CycleavePCR.

Objective To learn the current in vitro antimicrobial susceptibility of Mycoplasma pneu-moniae in Shanghai and to understand the mechanisms of resistance to macrolides. Methods M. pneumoniae was isolated from pediatric patients with low respiratory tract infections(RTI) using broth and PPLO agar medi-um. PCR amplification and sequence analysis of P1 adhesion gene were performed to identify all M. pneumoniae strains. Susceptibility testing was carried out for macrolides, tetracyclines and fluoroquinolones using broth mi-crodilution method with SP4 broth. PCR amplification and sequence analysis of 23S rRNA genes were performed for all M. pneumoniae strains. P1 gene PCR-RFLP typing was performed to subtype the M. pneumoniae strains. Results One hundred and two M. pneumoniae strains were isolated in Shanghai from Oct 2005 to Dec 2008. All M. pneumoniae isolates were susceptible to the tetracyclines and fluoroquinolones tested. Of 102 clinical isolates, 83(81.4%) was resistant to erytbromycin and all 83 erythromycin-resistant strains had MIC>128 mg/L. An increasing trend of resistance rates were showed: 16.7% (1/6) in 2005, 76.5% (13/17) in 2006, 100.0% (24/24) in 2007 and 81.8% (45/55) in 2008. All macrolide-resistant M. pneumoniae strains harbored an A2063G transition mutation in domain V of 23S rRNA genes. The P1 gene RFLP type 1 is predominant (85.3%, 87/102) in M. pneumoniae clinical isolates. Conclusion The macrolide resistance rate of M. pneu-moniae is very high in Shanghai. The mechanism of macrolide resistance is associated with transition mutation on the 23S rRNA gene.

OBJECTIVE: To analyze the indications of the therapies for rheumatoid arthritis (RA) with neural network model analysis. METHODS: Three hundred and ninety-seven patients were included in the clinical trial from 9 clinical centers. They were randomly divided into Western medicine (WM) treated group, 194 cases; and traditional Chinese herbal medicine (CM) treated group, 203 cases. A complete physical examination and 18 common clinical manifestations were prepared before the randomization and after the treatment. The WM therapy included voltaren extended action tablet, methotrexate and sulfasalazine. The CM therapy included Glucosidorum Tripterygii Totorum Tablet and syndrome differentiation treatment. The American College of Rheumatology 20 (ACR20) was taken as efficacy evaluation. All data were analyzed on SAS 8.2 statistical package. The relationships between each variable and efficacy were analyzed, and the variables with P<0.2 were included for the data mining analysis with neural network model. All data were classified into training set (75%) and verification set (25%) for further verification on the data-mining model. RESULTS: Eighteen variables in CM and 24 variables in WM were included in the data-mining model. In CM, morning stiffness, swollen joint number, peripheral immunoglobulin M (IgM) level, tenderness joint number, tenderness, rheumatoid factor (RF), C-reactive protein (CRP) and joint pain were positively related to the efficacy, and disease duration and more urination at night negatively related to the efficacy. In WM, erythrocyte sedimentation rate (ESR), weak waist, white fur in tongue, joint pain, joint stiffness and swollen joint were positively related to the efficacy, and yellow fur in tongue, red tongue, white blood negatively related to the efficacy. In the analysis with the neural network model in the patients of verification set, the predictive response rates of 20% patients would be 100% and 90% in the treatment with CM and WM, respectively. CONCLUSION: Neural network model analysis, based on the full clinical trial data with collection of both traditional Chinese medicine and modern medicine diagnostic information, shows a good predictive role for the information in the efficacy in rheumatoid arthritis.