Based on WANG Xugao's “thirty methods of treating the liver”， it is believed that the occurrence and development of childhood tic disorders follow the dynamic progression from liver qi disease to liver fire disease and then liver wind disease. The basic pathogenesis of three stages are characterized by binding constraint of liver qi， liver fire hyperactivity， and internal stirring of liver wind. Moreover， liver-blood deficiency and stagnation， and malnutrition of liver yin as the main point in terms of the imbalance of liver qi， blood， yin， and yang should be considered， as well as the imbalance relationship of the five zang organs such as the involvement of other organs and the gradually reach of the other organs. Guided by the principles of “thirty methods of treating the liver”， the treatment of tic disorders in liver qi stage should focus on soothing the liver and rectifying qi， soothing the liver and unblocking the collaterals， using Xiaochaihu Decoction （小柴胡汤） and Sini Powder （四逆散）. The treatment of tic disorders in liver fire stage involves clearing， draining and resolving liver heat， using Longdan Xiegan Decoction （龙胆泻肝汤）， Xieqing Pill （泻青丸）， Danggui Longhui Pill （当归龙荟丸）， and Huagan Decoction （化肝煎）. The treatment of tic disorders in liver wind stage involves extinguishing wind and subduing yang， using Lingjiao Gouteng Decoction （羚角钩藤汤） and Liuwei Dihuang Pill （六味地黄丸）. Throughout the treatment process， attention should be paid to harmonizing the liver's qi， blood， yin， and yang， as well as addressing the pathology of other organs.

Objective:To evaluate the performance of the Cepheid Xpert Xpress Flu/RSV assay (Xpert) in the detection of children infected with influenza virus (Flu) or respiratory syncytial virus (RSV).Methods:Nasopharyngeal specimens were collected from children who showed symptoms of respiratory infection and tested FluA, FluB and RSV by Xpert and sequencing assay respectively side by side. Discordant result were tested with a laboratory-developed real-time PCR for resolution.Results:A total of 388 nasopharyngeal swabs (NAPs) from children with acute respiratory tract infection were analyzed and the result showed 91.75-94.85% agreement between two tests. The sensitivity of FluA, FluB and RSV detected by Xpert and sequencing assay were 99.21% (125/126) vs. 92.86% (117/126), 100.00% (109/109) vs. 84.40% (92/109) and 100.00% (52/52) vs. 40.38% (21/52), respectively. The specificity of FluA, FluB and RSV detected by Xpert were all lower than that of the sequencing assay: 95.42% (250/262) vs 99.24% (260/262), 99.28% (277/279) vs 99.64% (278/279) and 99.70% (335/336) vs 100.00% (336/336). The positive predictive values (PPV) of FluA, FluB and RSV detected by Xpert were lower than those of the sequencing assay: 91.30% (126/138) vs. 98.33% (118/120), 98.18% (108/110) vs. 98.92% (92/93) and 98.11% (52/53) vs. 100.00% (21/21), respectively. The negative predictive values (NPV) of FluA, FluB and RSV detected by Xpert were higher than those of the sequencing assay: 99.60% (251/252) vs. 96.67% (261/270), 99.64% (279/280) vs. 94.27% (280/297) and 100.00% (337/337) vs. 91.60% (338/369).Conclusions:The Cepheid Xpert Xpress Flu/RSV assay is a sensitive, reliable and rapid assay for the detection of FluA, FluB and RSV in pediatrics.

BACKGROUND:Previous studies have found that combined use of Buyang Huanwu decoction and bone marrow mesenchymal stem cel (BMSC) transplantation can play a synergic role against cerebral ischemia injury. OBJECTIVE:To analyze the effect of Buyang Huanwu decoction combined with BMSC transplantation to promote angiogenesis after cerebral ischemia. METHODS:Ninety-six Sprague-Dawley rats were randomly divided into four groups, and used to make middle cerebral artery occlusion models. In combined group, rats were given intragastrical administration of Buyang Huanwu decoction 10 mL/kg once a day, beginning at 3 days prior to modeling, and then given intragastrical administration of Buyang Huanwu decoction once at 2 hours after modeling, fol owed by its intragastrical administration every 12 hours. In BMSC and combined groups, BMSC suspension was injected into the rat ventricle after 2-hour cerebral ischemia/2-hour reperfusion, and then 30 minutes later, CD34 and CD45 antibodies were injected. In antibody group, CD34 and CD45 antibodies were injected. In model group, only normal saline was given. SerumαVβ3 level detection, immunohistochemical observation, Q-PCR and western blot tests were performed in the combined group at 12, 24, 36, 48 hours after reperfusion, while these indices were detected in the other three groups at 36 hours after reperfusion. RESULTS AND CONCLUSION:(1) The level of serumαVβ3 was lower in the antibody group than the model group (P<0.05), higher in the BMSC and combined groups than the antibody group (P<0.05), and higher in the combined group than the BMSC group (P<0.05). (2) Immunohistochemical findings showed that compared with the antibody group, the number of CD34 positive cel s was higher in the model, BMSC and combined groups (P<0.05). (3) Results from the Q-PCR and western blot assay showed that compared with the model group, the pFAK protein expression level was lower in the antibody and BMSC group, but FAK gene expression level had no overt changes;while the protein levels of FAK (24 hours after reperfusion) and pFAK (12 hours after reperfusion) were significantly increased in the combined group than the antibody and BMSC groups (P<0.05, P<0.01). Moreover, this increase exhibited a gradual y rising trend with the extension of reperfusion time. To conclude, the combined use of BMSC transplantation and Buyang Huanwu decoction can reverse the effect of CD34+CD45 antibodies that lead to the decrease in the number of vascular endothelial cel s and levels of integrinαVβ3 and downstream signaling molecules, thereby to promote angiogenesis in the MCAO model.

Objective To identify risk factors of systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL).Methods We retrospectively reviewed 438 renal calculi patients after PCNL from August 2015 to July 2016.Among them,there were 251 men and 187 women,the mean age was (49.4 ± 11.1) years.The positive preoperative urine WBC,culture and nitrite rates were 29.7％ (130),12.1％ (53) and 15.1％ (66),respectively.The stone size was (851.2 ± 663.6) mm2,the stone CT value was (960.4 ± 303.4) HU,the operative time was (63.5 ± 33.4) min,124 (28.3 ％) were infection stones and multiple-tracts PCNL was performed in 69 (15.8％) patients.Univariate and multivariate logistic regression analysis were used to analyze perioperative predictors after PCNL.Results Thirty-nine patients developed SIRS (8.9％) after PCNL.The univariate analysis showed that positive preoperative urine WBC,nitrite,culture,operation time,stone size and transfusion had significantly impacts on the outcome of postoperative SIRS after PCNL (P ＜ 0.05).Multivariable logistic analysis showed that positive preoperative urine nitrite (OR =5.990,P ＜ 0.001),stone size (OR =2.251,P =0.027) and transfusion (OR =7.501,P =0.007) were independently related to the postoperative SIRS.Conclusion The positive preoperative urine nitrite,stone size and transfusion are independent risk factors for postoperative SIRS after PCNL.

Objective To investigate the levels of serum AFP and CEA in healthy physical examination people and their sexual difference.Methods (1 )Healthy physical examination people were divided into the group A(510 males)and group B(477 fe-males);(2)these two groups were subdivided into the group A1 (<40 years old),A2 (40 - <50 years old),A3 (50 - <60 years old),A4(60-<70 years old)and A5 (70 -87 years old),and group B1 (<40 years old),B2(40 -<50 years old),B3 (50 -<60 years old),B4(60-<70 years old)and B5(70-87 years old).The serum AFP and CEA in 987 healthy physical examination peo-ple were measured by the electrochemiluminesence immunoassay,and then the detection results were compared among various groups.Results (1)The detection results of serum AFP and CEA had statistically significant differences between the group A and B (P <0.01);(2)there was no statistical differences among the group A and among the group B.Conclusion The serum AFP and CEA levels in healthy physical examination people in the local area have difference between males and females,which in males are significantly higher than those in females,indicating that the reference range of AFP and CEA should be repectively established ac-cording to different sexes;while the serum AFP and CEA levels have no differences among various age groups in males and fe-males.

Objective To evaluate left atrial(LA) function in patients with prophase type 2 diabetes mellitus(T2DM) combinated with or without hypertension using left atrial volume tracking method(LAVT). Methods Thirty-one simple T2DM(T2DMI group) ,21 T2DM accompany with hypertension(T2DM2 group) and forty-five healthy subjects (control group) were enrolled in this study. Ultrasound LAVT(EUB-6500, Hitachi Medical Corporation) was applied to display and analyzed the LA volume loop imaging on the standard LV apical two and four chamber views. The maximal and the minimal LA volume (LAVmax, LAVmin) and the volume before LA contraction (LAVp) were recorded from the LA volume loop. The body surface area was used to correct these volume indexs. The LA reservoir function was assessed by calculating the total of LA filling volume (LAVItotal) and the expansion index(iLAVIe). The passive and active emptying percentage of the total emptying volume(LAVIpass, LAVIact) and the emptying index(iLAVIpass,iLAVIact) were caculated as the parameters of the LA conduit and booster pump function. Results Compared with the values in the control group, the LAVhotal,LAVIact were significantly higher and the LAVlpass,iLAVlpass were lower in the T2DM group (all P<0.05) ,while the iLAVIact was higher only seen in the T2DM2 group(P<0. 05). The LAVlact, iLAVIact were higher and the LAVIpass was lower in T2DM2 group than those in the T2DM1 group (all P<0.05). Conclusions The LA conduit hypofunction in primary in the prophase T2DM,when combinated with hypertension the LA constriction function compensatorily increased, LAVT can evaluate the function of LA in patients with T2DM accurately and rapidly.

Objective To investigate the elasticity of the radial artery wall in type 2 diabetes mellitus (T2DM) patients with elastosonography. Methods A total of 37 patients with T2DM and 42 normal subjects were studied with elastosonography. The systolic diameter (Ds) and diastolic diameter (Dd) of the radial artery were measured, and the strain ratio of the blood in the radial artery to the wall of the radial artery was calculated. Results The strain ratio of the radial artery in T2DM group was significantly higher than that in normal group (P＜0.05). There was no significant difference in Ds and Dd of the radial artery between T2DM group and the control group (P＞0.05). Conclusion The early change of the radial artery wall elasticity in patients with T2DM can be assessed with elastosonography.

Objective To observe hemodynamic changes in patients with primary hypertension with wave intensity (WI). Methods Carotid arteries of 36 patients with primary hypertension and 30 age-matched normal controls were examined with imaging technique of WI. The following parameters were measured: the first wave peak in early ejection (W1), the second wave peak in late ejection (W2), the negative area during the mid-ejection (NA), the interval between the R wave of the ECG and the first peak of W1 (R-1st), the interval between the first peak and the second peak (1~(st)-2~(nd)), the ratio of R-1st and a cardiac cycle time R-1_(HR)~(st)) and the ratio of 1~(st)-2~(nd) , as well as one cardiac cycle time (1~(st)-2(_(HR)~(nd)). Results ①W1 in primary hypertension group increased compared with those of normal controls (P＜0.01), while no significant difference of W2, NA, R-1st, 1~(st)-2~(nd), R-1_(HR)~(st), 1~(st)-2_(nd)~(HR) was detected (P＞0.05). ②Both W1 and W2 correlated positively with pulse pressure (PP) and systolic blood pressure (SBP) (r=0.66, 0.55, P＜0.01;r=0.62, 0.44, P＜0.01). W1, W2 and age, DBP were not related significantly (P＞0.05). Conclusion The hemodynamic parameters of WI technology provide a new way to evaluate the dynamics of the heart and vascular system and their interaction.