Objective:To observe the role of Huaiqihuang Granules (HQ) in the long-term management of bronchial asthma in young children, and the effective effect on concomitant rhinitis.Methods:A prospective real-world multicenter study was conducted in children aged 2-5 years with asthma diagnosed in the outpatient department (from April 2016 to March 2019)who received either inhaled corticosteroid (ICS)/leukotriene receptor antagonist (LTRA)(control group); inhaled ICS/LTRA plus HQ(combination group), or HQ alone(HQ group). All patients were followed up at week 4, 8, 12 after treatment. The number of days with asthma symptoms, the frequency of severe asthma attacks, the level of asthma control, and the days with rhinitis symptoms in the last 4 weeks were recorded. Differences before and after treatment, and those among groups after treatment were compared using Kruskal- Wallis H test or Wilcoxon rank-sum test. Results:A total of 2 234 eligible patients were recruited, and 2 147 cases completed followed-up visits, including 477, 1 374 and 296 cases in the control group, combination group, and HQ group, respectively. After the treatment, all 3 groups showed significant declines in the days with asthma symptoms, frequency of severe asthma attack and the days with rhinitis symptoms (all P<0.01), and the rate of well-controlled asthma increased significantly ( P<0.01). It lasted until the end of follow-up. Among groups, patients in the combination group showed significantly less days of asthma symptoms than those of the other 2 group at week 8 and 12[0(0, 0.9) d vs.0(0, 0.3) d, P<0.05; 0(0, 0.1) d vs. 0(0, 1.0) d, P<0.01]. Patients in the combination group and HQ group showed a significantly lower rate of severe asthma attacks than that of the control group at week 12 [0(0, 1), 0(0, 1), 0(0, 2), all P<0.05]. The well-controlled rate of asthma in the combination group was significantly higher than that of the control group and HQ group at week 8 and 12 (89.6% vs. 85.9% vs.82.1%, H=15.28; 90.9% vs. 84.1% vs. 81.8%, χ2=29.32, all P<0.01). Conclusions:HQ can significantly alleviate symptoms of asthma and rhinitis, severe attack of asthma, and increase the control rate of asthma when used as an additional treatment or used alone.

Objective To investigate the clinical efficacy of laparoscopic anatomical left hepatectomy by guided middle hepatic vein approach.Methods The clinical data of 21 patients undergone anatomical left hepatectomy from Oct.2015 to Jul.2018 were retrospectively analyzed.Results Among the 21 cases,the primary hepatocellular carcinoma were found in 4 patients (19.1％),the cholangiocarcinoma in 1 patients (4.8％),the giant hepatic hemangioma in 1 patients (4.8％),the hepatolithiasis in 15 patients (71.3％).All 21 patients were operated under laparoscopy and recovered.The operative time was 160-380 min,the average operative time was(248 ± 56)min,the intraoperative blood loss was 100-700 ml.The average blood loss was (250 ± 40)ml,the average length of hospital stay of the patients was 8-14 (10 ± 2)d.Conclusions Laparoscopic anatomical left hepatectomy guided by middle hepatic vein approach is a safe and effective operation.

Objective To investigate the pathogenic mutations of BRCA1 and BRCA2 in patients with early-onset breast cancer(≤35 years) and explore the relationships between BRCA1/2 mutations and clinical features.Methods Seventy-four patients with early-onset breast cancer were enrolled,who were treated in Hospital 307 between September 2014 and June 2016.High-throughput sequencing was used to test the 49 exon sequences and adjacent sequences of BRCA1 and BRCA2.χ2 test was used to analyze the distribution of BRCA1/2 pathogenic mutations in each group that was set up according to clinical features.Results Fifteen mutations(20.27%) were identified,including 5(6.76%) in BRCA1 and 10(13.51%) in BRCA2.Eleven new pathogenic mutations were discovered,and BRCA1:c.5470_5477delTGCCCAAT was found in one patient.The frequency of BRCA1/2 mutations in the group with a family history of breast cancer or ovarian cancer was higher than in the group without a family history (40.91% vs 11.54%) (χ2=6.534,P=0.011).Conclusion BRCA1/2 pathogenic mutation is significant for early-onset breast cancer,especially for those with a family history of breast or ovarian cancer.The new mutations may be specific to Chinese people.BRCA1:c.5470_5477delTGCCCAAT may be the ancestor mutation among the Chinese.

Objective To develop multi-functional suction tubes used in neuroendoscope assisted pituitary tumor surgery via endonasal transsphenoidal pathway and investigate their application value.Methods The experiments included 145 pituitary tumor patients,recruited in our hospital from March 2014 to March 2015.Self-regulating multi-functional curve and detachable suction tubes were used in neuroendoscope assisted pituitary tumor resection,which could do suction,electrical coagulation and stripping together.The efficacy of them was analyzed.Results There were 101 total tumor resection,26 subtotal resection and 18 partial resection in the 145 pituitary tumor patients.The average operative blood loss was 41.52 mL with application of the multifunctional suction tubes.The shortest time in operation was 28 min,and the average operation time was 76.55 min.Patients were discharged 3-5 days after surgery and the prognosis were good.Conclusion As a safe and effective novel endoscopic neurosurgery instrument,the multifunctional curve and detachable suction and stripping tubes with electrical coagulation could significantly improve surgery effectiveness and reduce operative blood loss when used in pituitary tumor resection through endonasal transsphenoidal pathway.

Objective To analyze the correlation between the expression of Ki-67 and Her-2 and clinical features in breast invasive ductal carcinoma .Methods Clinical and pathological data of 202 female breast invasive ductal carcinoma patients were collected between January 2012 and September 2014 .The correlation between the expression of Ki-67 and Her-2 and clinical features was analyzed .Results The positive rate of Ki-67 was 73.3%(148/202) and that of Her-2 was 19.3(39/202).The expression of Ki-67 was related to histological grading , ER and PR status(P<0.05),but not to age, tumor size or lymph node status(P>0.05).The expression of Her-2 was related to ER and PR status (P<0.05), but not to age, tumor size, histological grading, or lymph node status(P>0.05).Moreover, the low expression Ki-67 and negative expression of Her-2 were positvely corelated with the positive expression of hormone receptor [estrogen receptor(ER),pro-gestin receptor(PR)](P<0.05).Conclusion High expression of Ki-67 suggested that the differential grade of tumor was lower , malignant grade was higher , infiltration was stronger and metastasis was easier .High expression of Ki-67 and positive Her-2 suggests lower sensitivity to endocrine therapy and treatment .Detection of Ki-67 and Her-2 expression in breast inva-sive ductal carcinoma is of guiding significance for understanding the degree of malignancy and for evaluating prognosis .

Objective To sum up the clinical characteristics and the diagnostic and therapeutic principle of severe hypertensive intracerebral hemorrhage complicated with gastroparesis.Methods The clinical data of 51 patients with severe hypertensive intracerebral hemorrhage complicated with gastroparesis were retrospectively analyzed.Results Of the patients who died,3 died of over-severe hemorrhage,and 1 died of acute respiratory distress syndrome caused by aspiration,as well as one died of respiratory failure resulting from pulmonary infection after aspiration.None died of digestive tract complication.Twenty-one patients(41.18％) needed feeding via naso-intestinal tube.Thirty patients (58.82％) were recovered within two weeks and 14 patients (27.45％) were recovered within the third week,and those who recovered beyond three weeks accounted for 3.92％ (n =2).Conclusion The gastroparesis complicating severe hypertensive intracerebral hemorrhage is considered as a functional disorder rather than mechanical obstruction.It is mainly on the basis of symptoms and signs in combination with gastroscopy or radiography that the diagnosis can be made.The conservative treatment (including nasal feeding in some patients) should be applied to the disorder.

BACKGROUND:Abnormal immunological function is possibly observed after cardiac valve replacement. However, effect of continuous venovenous hemofiltration on immunological function after cardiac valve replacement is rarely reported.
OBJECTIVE:To observe the effect of continuous venovenous hemofiltration on the cellular immune function in patients with multiple organ dysfunction syndrome after cardiac valve replacement.
METHODS:Thirty-one patients with multiple organ dysfunction syndrome after cardiac valve replacement in Xijing Hospital, the Fourth Military Medical University of Chinese PLA, from August 2008 to July 2009, were included in this study. They were treated with continuous venovenous hemofiltration using AV600 hemofilter and were divided into two groups:survival group (17 survivors) and death group (14 deaths). In addition, 16 healthy blood donors served as the control group.
RESULTS AND CONCLUSION:The duration of acute renal failure before continuous venovenous hemofiltration of survival group was significantly lower than that of death group (P<0.05). Before continuous venovenous hemofiltration, the CD4+/CD8+ratio and Th1/Th2 ratio of survival group and death group were lower than that of control group (P<0.05), and lymphocyte apoptosis rate and Fas/FasL antigen expression were higher than that of control group (P<0.05). This evidence suggested the presence of immunosuppression state and Th1/Th2 disbalance. During continuous venovenous hemofiltration, the CD4+/CD8+ratio and Th1/Th2 ratio of survival group were gradual y increased (P<0.05), while lymphocyte apoptosis rate and Fas/FasL antigen expression were gradual y decreased (P<0.05) at 24 hours. The above changes were observed in both survival group and death group, but emerged latter in death group. Continuous venovenous hemofiltration can improve cellular immune function, maintain the balance of T lymphocyte subsets and Th1/Th2, down-regulate Fas/FasL expression on the surface of lymphocyte membrane, and decrease lymphocyte apoptosis rate in patients with multiple organ dysfunction syndrome after cardiac valve replacement. Early continuous venovenous hemofiltration can improve patients’ prognosis.

Objective To investigate the application value of methylene blue excretion test in early reasonable nutritional support for severe traumatic brain injury.Methods One hundred and thirty-three cases of severe traumatic brain injury admitted to hospital from January 2010 to June 2012 were chosen as treatment group,while the 127 cases of similar patients admitted to hospital from January 2007 to December 2009 were chosen as control group.Patients in treatment group underwent methylene blue excretion test in 3 days,8 days,15 days after injury,and the nutritional support ways were determined according to the elimination time of methylene blue in patients' urine.The control group conventionally receive enteral nutrition support therapy firstly,after 15 days if they still cannot be tolerant of the enteral nutrition,then parenteral nutrition therapy were adopted.The weight,serum albumin and hemoglobin circumstances of the two groups were determined and the complications were recorded.Glasgow coma score (GCS) of 3 months after injury were followed up.Results There was no significant difference on the average body weigh between these two groups before treatment.The average body weight of the treatment group was significantly higher than that of control group after 3 months treatment((56.3 ± 5.5) kg vs.(52.6 ± 5.3) kg,t =5.93,P ＜ 0.01).The serum albumin and hemoglobin of 14 d,21 d after injury were significantly higher than those of the control group (serum albumin of 14 d:(32.7 ±3.4) g/L vs.(28.8 ±3.1) g/L; serum albumin of 21 d:(34.3 ±3.8) g/L vs.(30.7 ±3.3) g/L;hemoglobin of 14 d:(113.4±12.5) g/L vs.(102.2 ±11.6) g/L;hemoglobin of 21 d:(118.5 ±13.3) g/L vs.(106.7 ± 12.4) g/L.Nutritional status of treatment group was significantly better than that of the control groupall P ＜ 0.05).After three months,the effective rate of treatment group (93.23％ (124/133)) was significantly higher than that of the control group (84.25％ (107/127)),the difference was statistically significant (x2 =5.29,P ＜ 0.05).Conclusion Determining the early reasonable nutrition support ways for patients with severe traumatic brain injury according to the elimination time of methylene blue in the urine,can provide comprehensive nutrition to patients,enhance their body resistance,reduce the incidence of complications,and create an important clinical value for improving prognosis.

Objective To investigate the clinical effect of early application of nimodipine on a large area cerebral infarction after severe traumatic brain injury operation.Methods Fifty-one patients with severe head injury after large area cerebral infarction were as treatment group who hospitalized from January 2009 to January 2012,and 48 hospitalized cases as the control group from January 2005 to January 2008.The patients in control group were received drugs to decrease intracranial pressure,and enhance nerve nutrition therapy,while in the treatment group,beside the therapy method of control group,were received nimodipine intravenously by micro-pump for 10 days,and then oral administration for 10 days.Plasma endothelin-1 was detected at 0,5th,7th,14th day days after hospitalization.Dopple was pplied to record the middle cerebral artery (MCA) peak systolic velocity(Vp) of the injured side for 7 d.Glasgow outcome score(GOS) was recorded in the 3 months follow-up.The awakening time was recorded consciousness.Results At 21 st day after treatment,22 cases were died in the treatment group and survival patients with cerebral vasospasm were 14 cases (48.28％,14/29).However,30 cases were died in control group and cerebral vasospasm(CVS) of survival patients was 15 cases (83.33％,15/18),significantly higher than that in treatment group (x2 =5.78,P ＜ 0.05).The variable tendencies of Vp,plasma endothelin-1 and the intracranial pressure were significantly different between the treatment group and the control group (Vp:F group =276.27,Ftime =603.54,F interactive =85.68 ; plasma endothelin-1:F grouP =281.16,F time =608.32,F interactive =87.45 ; intracranial pressure:F grouP =326.58,F time =78.63,F interactive =27.39 ; P ＜ 0.05).Mter 3 months of treatment,the value of GOS was significandy higher in treatment group than that of control group (x2 =4.76,P ＜ 0.05).Furthermore through three months treatment,the effective rate in treatment group was higher than that in the control group (52.94％ (27/51) vs.(31.25％ (15/48)),the awakening periods was shorter than that in control group((20.7 ±6.5) d vs.(27.8 ± 7.6) d,t =3.19,P ＜ 0.05)).Conclusion Early applications of nimodipine treatment after severe traumatic brain injury patients with massive cerebral infarction can significantly improve the clinical efficacy and shorten the duration of coma.

Objective To estimate the relationships between lipoprotein-associated phospholipase A2 (Lp-PLA2) activity and cerebral feeding artery athemsclemsis.Methods The blood samples were obtained from 148 atheroselerosis patients (atheroselerosis group) and 40 normal controls (control group).Activity of plasma Lp-PLA2 and traditional factors were determined.Logistic and regression model was adopted to analyze the roles of Lp-PLA2 and generally inflammatory risk factors in athemselemsis.Results Lp-PLA2 activity was significantly higher in atheroselerosis group than that in control group [(29.84±3.50)lesion number showed positive correlation with Lp-PLA2 (r=0.491,P＜0.01 and r=0.249,P=0.026).Adjusted other risk factors,Lp-PLA2 was an independent risk factor in cerebral feeding artery atherosclerosis.Conclusion Lp-PLA2,a novel inflammatory marker,is an independent risk factor of cerebral feeding artery atherosclerosis.