Objective:To investigate the relationship between amylase level in drainage fluid and the risk of salivary fistula(SF)after parotid benign tumor resection.Methods:106 patients underwent benign parotid tumor resection were included and divided into SF occurrence group(SF,n=31)and non-occurrence group(control,n=75).The amylase levels of drainage fluid were com-pared between the 2 groups at 24,48 and 72 h respectively after surgery,and the risk factors related to postoperative salivary fistu-la were evaluated by multivariate Logistic analysis and ROC curve.Results:The content in amylase in drainage fluid at 24,48 and 72 h after operation and partial retention of parotid masseter fascia during operation in the SF group were higher than those in the control group(P＜0.05),and the postoperative compression time was shorter than that in the control group(P＜0.05).Multiva-riate Logistic analysis showed that the amylase content of drainage fluid at 24,48 and 72 h and the complete preservation of parotid masseter fascia during operation were the influencing factors for the occurrence of postoperative SF(P＜0.05).The ROC curve showed that the AUC of amylase level of drainage fluid in predicting the risk of postoperative SF was 0.979(95％CI 0.930-0.997)at 72 h after surgery.Conclusion:The level of amylase in the drainage fluid is associated with the risk of SF after benign parotid tumor resection.The level of amylase in the drainage fluid 72h after benign parotid tumor resection can accurately predict SF after benign parotid tumor resection.

Objective To explore the mechanism of Yishen Jiangtang Decoction(YSJTD)in improving diabetic kidney disease(DKD)based on the apoptotic Bcl-2/Caspase-3 pathway mediated by endoplasmic reticulum stress(ERS).Methods Thirty 8-week-old SPF male db/db mice were used to establish the DKD model and were randomly divided into model,YSJTD,ERS inhibitor(4-phenylbutyric acid[4-PBA]),and control groups(db/m mice),with 10 mice per group.Mice in the YSJTD and 4-PBA groups were gavaged daily with 5.6 mg/(g·d)YSJTD or 0.5 mg/(g·d)4-PBA,respectively,whereas the model and control groups received sodium carboxymethyl cellulose.Each mouse was orally administered 0.01 mL/(g·d)for 8 weeks.The mice were administered 0.01 mL/(g·d)YSJTD or 0.5mg/(g·d)4-PBA via gavage for 8 weeks.The general condition of the mice was observed,and blood glucose and plasma lipid levels were measured.Oral glucose tolerance tests(OGTT)and insulin tolerance tests(ITT)were performed,and the area under the curve(AUC)was calculated.Renal pathological changes(assessed using hematoxylin and eosin,periodic acid-Schiff,and Masson staining)and cell apoptosis,evaluated via TUNEL staining,were examined.Protein expression levels of Caspase-3 and Bcl-2 in kidney tissues were analyzed using Western blotting.A DKD model was established using high-glucose-induced mouse glomerular mesangial cells,SV40 MES 13.The Cell Counting Kit-8 assay was used to screen for high glucose concentrations and to determine the concentration of the YSJTD drug-containing serum.Cells were divided into four groups:control,model(30 mmol/L high glucose),10％YSJTD drug-containing serum(30 mmol/L high glucose+10％drug-containing serum),and 1 mol/L 4-PBA(30 mmol/L high glucose+1 mmol/L 4-PBA).Western blotting was used to detect the protein levels of GRP78,Caspase-3,and Bcl-2 in the cells.Results Compared to the control group,the model,YSJTD,and 4-PBA groups exhibited significantly increased OGTT-AUC,ITT-AUC,triglyceride(TG),and cholesterol(CHOL)levels(P＜0.05).These groups also showed severe renal pathological damage,increased glycogen deposition,and exacerbated fibrosis in kidney tissues.Compared to the model group,both the YSJTD and 4-PBA groups showed significantly reduced OGTT-AUC,TG,and CHOL levels,alleviated renal pathological damage,and decreased glycogen deposition and fibrosis.The YSJTD group also exhibited significantly reduced ITT-AUC(P＜0.05).Compared to the control group,the model group exhibited an increased number of apoptotic cells in renal tissue,reduced Bcl-2 expression,and elevated Caspase-3 expression(P＜0.05).Compared to the model group,both the YSJTD and 4-PBA groups demonstrated a reduced number of apoptotic cells,decreased Caspase-3 expression,and increased Bcl-2 expression,with the YSJTD group showing a more pronounced decrease in apoptotic cells(P＜0.05).In vitro experiments revealed that,compared to the control group,the model group exhibited increased GRP78 and Caspase-3 expression,as well as decreased Bcl-2 expression(P＜0.05).Compared to the model group,the 10％YSJTD drug-containing serum and 1 mol/L 4-PBA groups showed reduced GRP78 and Caspase-3 expression,as well as upregulated Bcl-2 expression(P＜0.05).Conclusion YSJTD improves glucose and lipid metabolism disorders in DKD by inhibiting the ERS-induced apoptotic pathway mediated by Bcl-2/Caspase-3,thereby exerting protective effects on renal function.

Objective To explore the mechanism of Yishen Jiangtang Decoction(YSJTD)in improving diabetic kidney disease(DKD)based on the apoptotic Bcl-2/Caspase-3 pathway mediated by endoplasmic reticulum stress(ERS).Methods Thirty 8-week-old SPF male db/db mice were used to establish the DKD model and were randomly divided into model,YSJTD,ERS inhibitor(4-phenylbutyric acid[4-PBA]),and control groups(db/m mice),with 10 mice per group.Mice in the YSJTD and 4-PBA groups were gavaged daily with 5.6 mg/(g·d)YSJTD or 0.5 mg/(g·d)4-PBA,respectively,whereas the model and control groups received sodium carboxymethyl cellulose.Each mouse was orally administered 0.01 mL/(g·d)for 8 weeks.The mice were administered 0.01 mL/(g·d)YSJTD or 0.5mg/(g·d)4-PBA via gavage for 8 weeks.The general condition of the mice was observed,and blood glucose and plasma lipid levels were measured.Oral glucose tolerance tests(OGTT)and insulin tolerance tests(ITT)were performed,and the area under the curve(AUC)was calculated.Renal pathological changes(assessed using hematoxylin and eosin,periodic acid-Schiff,and Masson staining)and cell apoptosis,evaluated via TUNEL staining,were examined.Protein expression levels of Caspase-3 and Bcl-2 in kidney tissues were analyzed using Western blotting.A DKD model was established using high-glucose-induced mouse glomerular mesangial cells,SV40 MES 13.The Cell Counting Kit-8 assay was used to screen for high glucose concentrations and to determine the concentration of the YSJTD drug-containing serum.Cells were divided into four groups:control,model(30 mmol/L high glucose),10％YSJTD drug-containing serum(30 mmol/L high glucose+10％drug-containing serum),and 1 mol/L 4-PBA(30 mmol/L high glucose+1 mmol/L 4-PBA).Western blotting was used to detect the protein levels of GRP78,Caspase-3,and Bcl-2 in the cells.Results Compared to the control group,the model,YSJTD,and 4-PBA groups exhibited significantly increased OGTT-AUC,ITT-AUC,triglyceride(TG),and cholesterol(CHOL)levels(P＜0.05).These groups also showed severe renal pathological damage,increased glycogen deposition,and exacerbated fibrosis in kidney tissues.Compared to the model group,both the YSJTD and 4-PBA groups showed significantly reduced OGTT-AUC,TG,and CHOL levels,alleviated renal pathological damage,and decreased glycogen deposition and fibrosis.The YSJTD group also exhibited significantly reduced ITT-AUC(P＜0.05).Compared to the control group,the model group exhibited an increased number of apoptotic cells in renal tissue,reduced Bcl-2 expression,and elevated Caspase-3 expression(P＜0.05).Compared to the model group,both the YSJTD and 4-PBA groups demonstrated a reduced number of apoptotic cells,decreased Caspase-3 expression,and increased Bcl-2 expression,with the YSJTD group showing a more pronounced decrease in apoptotic cells(P＜0.05).In vitro experiments revealed that,compared to the control group,the model group exhibited increased GRP78 and Caspase-3 expression,as well as decreased Bcl-2 expression(P＜0.05).Compared to the model group,the 10％YSJTD drug-containing serum and 1 mol/L 4-PBA groups showed reduced GRP78 and Caspase-3 expression,as well as upregulated Bcl-2 expression(P＜0.05).Conclusion YSJTD improves glucose and lipid metabolism disorders in DKD by inhibiting the ERS-induced apoptotic pathway mediated by Bcl-2/Caspase-3,thereby exerting protective effects on renal function.

Objective:To investigate the relationship between amylase level in drainage fluid and the risk of salivary fistula(SF)after parotid benign tumor resection.Methods:106 patients underwent benign parotid tumor resection were included and divided into SF occurrence group(SF,n=31)and non-occurrence group(control,n=75).The amylase levels of drainage fluid were com-pared between the 2 groups at 24,48 and 72 h respectively after surgery,and the risk factors related to postoperative salivary fistu-la were evaluated by multivariate Logistic analysis and ROC curve.Results:The content in amylase in drainage fluid at 24,48 and 72 h after operation and partial retention of parotid masseter fascia during operation in the SF group were higher than those in the control group(P＜0.05),and the postoperative compression time was shorter than that in the control group(P＜0.05).Multiva-riate Logistic analysis showed that the amylase content of drainage fluid at 24,48 and 72 h and the complete preservation of parotid masseter fascia during operation were the influencing factors for the occurrence of postoperative SF(P＜0.05).The ROC curve showed that the AUC of amylase level of drainage fluid in predicting the risk of postoperative SF was 0.979(95％CI 0.930-0.997)at 72 h after surgery.Conclusion:The level of amylase in the drainage fluid is associated with the risk of SF after benign parotid tumor resection.The level of amylase in the drainage fluid 72h after benign parotid tumor resection can accurately predict SF after benign parotid tumor resection.

One hundred Alzheimer′s disease (AD) patients with behavioral and psychological symptoms of dementia (BPSD) treated with donepezil+risperidone group ( n=50, group 1) or hydrochloride memantine+risperidone group ( n=50, group 2) in geriatric departments of Hangzhou Seventh People′s Hospital were enrolled in the study. Montreal cognitive assessment scale (MoCA), positive and negative syndrome scale (PANSS), treatment emergent symptom scale (TESS) were applied for evaluation; and blood routine examination, blood biochemistry, eletrocardiogram were performed in two groups before and after treatment. After treatment, MoCA score in group 2 (16.10±3.90) was significantly higher than that in group 1 (18.14±3.71)( t=-3.99, P<0.01), and PANSS score in group 2 (86.66±6.62) was significantly lower than that in group 1 (109.50±11.51; t=12.67, P<0.01). The incidence rates of dry mouth (16%,8/50), extrapyramidal side effects (10%,5/50) and the total score of TESS (3.92±2.02) in group 2 were markedly lower than those of group 1 [44%(22/50), 36%(18/50), (12.49±1.45);χ 2=9.33,9.54, t=17.90,all P<0.01]. Meanwhile, group 2 had significantly lower influences on the levels of blood lipids and fasting blood glucose (all P<0.01). The risperidone dose used in group 2 was significantly lower than that in group 1 [(2.06±0.50) vs. (3.85±0.89)mg, t=14.40, P=0.04].The results suggest that hydrochloridememantine combined with risperidone is more effective with less side effects compared to donepezil combined with risperidone for AD patients with BPSD.

Objective To understand the epidemiological characteristics of a healthcare-associated infection(HAI)outbreak due to Norwegian scabies in a hospital,and provide basis for clinical prevention and control of HAI.Methods Through epidemiological investigation,all suspected patients and close contacts were investigated and traced,three dimensional distribution of patients was described,a series of effective comprehensive prevention and control measures were formulated and implemented.Results A total of 16 cases of Norwegian scabies infection occurred in November 3-16,2015,the most frequent cases were in November 11(n=5),the onset time of infection was concentrated in November 9-11(n=10),accounting for 62.50%of total cases.Spatial distribution of 16 cases: 12 cases were in general internal medicine department,2 in nursing department,and 2 were relatives of employees.Population distribution: patients aged 50-59(n=7),female(n=13),and nursing staff(n=9).After taking comprehensive prevention and control measures and medication treatment,16 infected persons were all cured,the cure rate was 100%,there was no new cases occurred in the hospital,epidemic was under control.Conclusion Norwegian scabies is highly contagious,it can cause epidemic in local area.In order to avoid spread of scabies infection in hospital,health care workers should strengthen the diagnosis and precaution level of the disease.

OBJECTIVE:To observe the efficacy and safety of olanzapine combined with ziprasidone in the treatment of refrac-tory schizophrenia in elderly patients. METHODS:120 elderly patients with schizophrenia were randomly divided into control group and study group. Control group was orally treated with Olanzapine tablet 10-20 mg,once a day;study group was orally treat-ed with Ziprasidone hydrochloride capsule 80-120 mg,twice a day+Olanzapine tablet(the usage was the same as control group). The clinical efficacy in 2 groups was evaluated after 2 weeks,PANSS score,FPG,2 h PG,TC,TG,HDL-C,LDL-C,body weight, BMI before and after treatment and incidence of adverse reactions were observed. RESULTS:There were no significant difference in the total efficacy and incidence of adverse reactions between 2 groups(P>0.05). After treatment,the PANSS scores at different time point in 2 groups were significantly lower than before,and 12 weeks<8 weeks<4 weeks<2 weeks,the differences were sta-tistically significant(P<0.05),however,there was no significant difference between 2 groups(P>0.05). There were not signifi-cant differences in the indexes of blood glucose and lipid,body mass and BMI in study group before and after treatment (P>0.05);after treatment,the blood glucose after 8 and 12 weeks and LDL-C,TG,TC,body mass and BMI after 4,8 and 12 weeks in control group were significantly higher than before and study group same time,the HDL-C was significantly lower than before and research group,the differences were statistically significant(P<0.05). CONCLUSIONS:The efficacy and safety of both olan-zapine combined with ziprasidone and olanzapine alone in the treatment of refractory schizophrenia in elderly patients is similar, however,it is better than olanzapine alone in terms of controlling blood glucose and lipid.

Objective To summarize the experience of emergency treatment of primary liver cancer rupture bleeding and improve the level of diagnosis and treatment of the disease.Methods From October 2008 to December 2012.The clinical data of 11 patients with spontaneous rupture of primary liver cancer were analyzed retrospectively.Results Three cases were given conservative treatment.Among them,1 case died,2 bleeding cases were hemostasis,8 cases were operated.Surgical operation is the main method of emergency treatment.The effect after operation was satisfactory.1 case with liver tumor resection died in the first days after the operation,1 case was transferred to higher level hospitals for further treatment because massive ascities in third days after operation,6 cases were successfully discharged,survival rate was over 3 months.Conclusions In the process of emergency treatment we should pay attention to reduce the rate of misdiagnosis and missed diagnosis.When the diagnosis was confirmed,we must treat the shock and plan an active operation scheme.Operation mode can be selected of tumor resection or simple hemostatic gauze tamponade suture hemostasis,saving lives of patients in the shortest time is the goal of emergency treatment.

Objective To investigate the relationship between C734A and G-2964A polymorphism of cytochrome P450 1A2 gene and clinical efficacy of duloxetine.Methods 223 patients with depression were treated with duloxetine for six weeks.The clinical efficacy was evaluated with the Hamilton rating scale for depression (HAMD) ;single nucleotide polymorphism (SNP) at position C734A and G-2964A of CYP1A2 gene were identified with restriction fragment length polymorphism(RFLPs) ;then one-way ANOVA was adopted to analyze the relationship between SNP and clinical efficacy.Results (1) In 223 patients,the frequency of allele A at locus 734 was 63.64％,while that of allele A at locus-2964 was 26.82％.(2) 220 patient underwent the whole treating course.The conjoint analysis of two locuses indicated that the decreasing ratio of HAMD score of high-activity group,middle-activity group and low-activity after treatment was (56.05± 10.13) ％,(66.36± 8.66) ％ and (73.82± 7.10) ％ respectively,the differences obtained by pairwise comparison of the three groups were of statistical significance(P＜0.01).Conclusion There is close relationship between C734A and G-2964A polymorphism of CYP1A2 gene and clinical efficacy of duloxetine in the treatment for depression.

Objective To study the clinical significance of nursing intervention in the treatment of diabetes patients with Alzheimer disease .Methods We screened 138 patients, who were randomly divided into intervention group and control group .Therapeutic counseling , diet control , psychological counseling and basic lifestyle guidance and other nursing interventions were applied in treatment of intervention group patients . Results After half and one month of intervention , the two hours postprandial blood glucose and fasting blood glucose in the intervention group were significantly decreased , compared with the control group ( t=-2.890,-2.971, -2.822, -2.819, respectively;P<0.05).Meanwhile, the nursing satisfaction in the intervention group was significantly higher than that in the control group (69.57% vs 46.38%;Z=-2.966,P<0.05). Conclusions Nursing intervention for diabetes patients with Alzheimer disease can promote patients ’ condition and increase their compliance .