ObjectiveTo evaluate the clinical effectiveness and safety of Lianling Formula （连苓方） in the treatment of adolescent atopic dermatitis （AD） exacerbation stage with heart fire and spleen deficiency syndrome. MethodsNinety-two patients were randomly divided into a treatment group and a control group， with 46 cases in each group. Patients in the control group took oral ebastine tablets， and patients in the treatment group took Lianling Formula orally， and both groups used 0.03% topical tacrolimus for 4 weeks. Before and after treatment， the improvement of scoring atopic dermatitis index by 50% （SCORAD50） and 75% （SCORAD75）， scoring atopic dermatitis index （SCORAD）， visual analog scale （VAS）， traditional Chinese medicine （TCM） symptom score， the children's dermatology life quality index （CDLQI）， Athens insomnia scale （AIS） score of both groups were evaluated， and the adverse reactions in both groups were recorded. ResultsFour cases in the treatment group and five cases in the control group were dropped， and intention-to-treat analysis was used. Finally 46 cases in each group were included in the statistics. The SCORAD scores after treatment were lower than those before treatment， and the scores in treatment group were lower than those of the control group （P＜0.01）； the attainment rates of SCORAD50 and SCORAD75 after treatment in the treatment group were 80.43% and 47.83%， which were significantly higher than those in the control group of 63.04% and 26.09%， respectively （P＜0.05）. VAS scores， TCM symptom scores， CDLQI scores， and AIS scores were lower than those before treatment （P＜0.01）， and VAS scores， TCM symptom scores， and CDLQI scores of the treatment group were lower than those of the control group after treatment （P＜0.05 or P＜0.01）， while AIS scores were higher than those of the control group （P＜0.05）. The erythema， papule/edema， oozing/crusting， epidermal peeling， and dryness in the SCORAD scores of the treatment group after treatment were lower than those before treatment （P＜0.05 or P＜0.01）， and the erythema， papule/edema， oozing/crusting， and dryness of children in the control group were lower than those before treatment （P＜0.05 or P＜0.01）. The scores of erythema， oozing/crusting， and epidermal peeling in the treatment group after treatment were all lower than those in the control group （P＜0.05）. The scores of vexation， itching， dry mouth， poor appetite and irregular bowel movements in terms of TCM symptoms in the treatment group after treatment were lower than those before treatment （P＜0.01）， and the scores of itching， vexation， dark urine in the control group were lower than those before treatment （P＜0.05 or P＜0.01）. The scores of itching， dry mouth， poor appetite， irregular bowel movements， and dark urine in the treatment group after treatment were all lower than that in the control group （P＜0.05 or P＜0.01）. No adverse reactions occurred in both groups of children during treatment. ConclusionLianling Formula combined with topical tacrolimus can effectively improve the clinical symptoms of adolescent AD exacerbation with heart fire and spleen deficiency syndrome， and the formula is effective and safe in improving the children's skin lesions， reducing itching， relieving the accompanied TCM symptoms， and improving the quality of life.

Objective:To analyze the impact of Beijing Medical Reform on inpatient costs of medical and surgical patients in a hospital, and to provide reference for the hospital to explore the path of patient cost control.Methods:Based on the data of medical and surgical inpatients′ expenses from June 2016 to December 2019 in a hospital in Beijing, breakpoint regression method was used to analyze the impact of the two reforms(namely the comprehensive reform of separation of medicine and pharmacy and the comprehensive reform of medical consumption linkage)on the level of medical and surgical inpatients′ expenses and the cost structure of drugs and consumables.Results:The two reforms controlled the rapid rise of hospitalization expenses and reduced the proportion of drugs and medical consumption. The effect of the reforms on the total cost control of internal medical patients was better than that of surgical patients.For internal medical patients, the reform of separation of medicine and pharmacy played a greater role in the proportion of medicine; For surgical patients, the two reforms had effectively reduced the proportion of consumables, and the proportion of drugs had gradually decreased.Conclusions:The two reforms have effectively controlled the growth trend of hospitalization expenses, and changed the cost structure of drugs and consumables.

Objective:To investigate the expression of programmed death ligand 1 (PD-L1) in rectal cancer tissues and the correlation of PD-L1 expression with clinicopathological characteristics and overall survival of patients.Methods:The clinical data of 200 newly treated rectal cancer patients in Shanxi Provincial Cancer Hospital from January 2014 to December 2015 were retrospectively analyzed. The expression of PD-L1 in rectal cancer tissues was detected by immunohistochemistry. The correlations of PD-L1 expression with gender, age, tumor T stage, lymph node metastasis, tumor differentiation, histological type, tumor TNM stage, neutrophil-to-lymphocyte ratio (NLR) and overall survival of patients were analyzed.Results:The positive expression rate of PD-L1 was 24% (48/200). The positive expression rate of PD-L1 was high in patients with lymph node metastasis and high NLR (≥ 3.5) (both P < 0.05). The 5-year overall survival rate in PD-L1-positive group was 42%, and the PD-L1-negative group was 59%, and the difference between the two groups was statistically significant ( P < 0.05). The results of multivariate analysis showed that lymph node metastasis ( HR = 3.456, 95% CI 2.148-5.556, P < 0.01), NLR ≥ 3.5 ( HR = 1.871, 95% CI 1.169-2.996, P = 0.009), and PD-L1-positive expression ( HR = 2.187, 95% CI 1.373-3.484, P = 0.001) were independent adverse influencing factors for the overall survival of rectal cancer patients. Conclusion:PD-L1 is highly expressed in rectal cancer tissues, and the positive expression of PD-L1 is associated with poor overall survival of patients.

Objective To assess the feasibility of semi-quantitative scoring system for contrast-enhanced ultrasound (CEUS)quantitative analysis's color images in the differential diagnosis of breast nodules.Methods Totally 244 BI-RADS 4 breast solid lesions received CEUS before core needle biopsy or surgical resection were included.A semi-quantitative scoring system for color images of CEUS quantitative analysis were built.The scores were given as follows:1 )Color type and its distribution (0 to 4);2)Color scope (0 to 1 );3)Color margin (0 to 1 );4)Color shape (0 to1 ).The total score for each lesion would be from 0 to 7.And the differenital value between benign and malignant lesions were assessed.Results The total semi-quantitative scores of 102 malignant tumors (5.1 ±1 .7)was significant higher than that of benign lesions (3.34±0.7)(P < 0.05 ).In 102 malignant lesions,the total scores of 81 lesions (79.41 %)were more than 4 points,and in 142 benign lesions,the total scores of 89 lesions (62.67%)were less than 4 points.Depending on the Wilcox rank sum test (Mann-Whitney)analysis,the distribution of total scores between benign and malignant lesions was significant different (P <0.000 1).Total score 4 was selected as the best cutoff,the area under ROC curve was 0.749,on which the sensitivity,specificity and accuracy were 79.4%,62.7% and 69.67%,respectively.Conclusions The semi-quantitative scoring system of CEUS quantitative analysis color images showed good sensitivity but not satisfied specificity and accuracy in differential diagnosis between malignant and benign breast lesions.

Objective To determine the pathogenic bacteria distribution and drug resistance in children with sepsis. Methods From 2002 to 2011, a ten consecutive years of monitoring of pathogenic bacteria distribution, drug resistance in pediatric patients with sepsis were conducted. Results From 2002 to 2011, 2 493 strains of pathogenic bacteria were detected in 68 419 specimens of blood culture. The positive rate was 3.64%. Among them, 1 913 strains (76.73%) were the gram-positive bacteria (G+bacteria), 562 strains (22.54%) were gram-negative bacteria (G-bacteria) and 18 strains (0.72%) were fungi. From 2002 to 2006, 959 strains (4.73%) of pathogenic bacteria were detected in 20 287 specimens of blood culture. Among them, the G+bacteria was 731 strains (76.23%), G-bacteria was 228 strains (23.77%). From 2007 to 2011, 1 534 strains (4.73%) of pathogenic bacteria were detected in 48 132 specimens of blood culture, G+ bacteria was 1 182 strains (77.05%), G-bacteria was 334 strains (21.77%), fungi was 18 strains (1.17%). The positive rate of blood culture, the pathogenic bacteria distributions of G+, G-, and fungi were signiifcantly different between the ifrst and the second 5 years (P<0.01). The positive rate of G+bacteria tended to increase and the positive rate of G-bacteria tended to decrease. Com-paring between the ifrst and second 5 years, the positive rate of coagulase-negative staphylococci, Klebsiella, Alcaligenes, fungi tended to increas, and the positive rate of Staphylococcus aureus, Enterococcus, Pseudomonas, Salmonella tended to decrease. The distribution of pathogens in different age groups of children with sepsis also were signiifcantly difference (P<0.001). Over the 10 years, G+positive bacteria were highly resistant to penicillin and erythromycin, but not resistant to Vancomycin. ESBLs positive E. coli strains and Klebsiella Trevisan became highly resistant to antibiotics. Salmonella was sensitive to commonly used antibiotics. Conclusions Coagulase negative staphylococcus was the most common pathogenic bacteria in children with sepsis in the last 10 years, multiple pathogenic bacteria also show a growing trend in drug resis-tance.

Objective To investigate the significance and expression of PTEN, MLL in T lymphoblastic lymphoma/leukaemia(T-LBL/ALL). Methods Seventy-six cases of T-LBL/ALL were studied by using immunohistochemical EnVision method for PTEN. Fluorescence in-situ hybridization (FISH) for MLL gene (located on chromosome 11q23) was performed to detect its breakage and amplification. Results Among the 76 cases ofT- LBL/ALL, the positive rate of PTEN was 64.47 % (49/76), lower than that in reactivated lymphoid tissue (100 %, 20/20) (λ2= 19.220, P ＜0.05). PTEN expression was reversely correlated to theclinical stage, Ki-67 index and LDH level (P ＜0.05). Among the 76 cases, MLL gene with breakage of 11q23 was detected in 13 cases (17.11%), and amplification in 18 cases (23.68 %). Survival rate ot MLL gene breakage group was lower than that of non-breakage group (25.0 %, 43.6 %). Survival rate of MLL gene amplification group was lower than that of non-amplification group too (17.1%, 42.7 %). Both of breakage and amplification were related to prognosis ( λ 2 = 11.357, λ 2 = 4.533; P ＜0.05). Conclusion Anti-oncogene PTEN down-regulation may play an important role on the development and proceeding of T-LBL/ALL. MLL gene with breakage and amplification of 11q23 are helpful to predict prognosis of T-LBL/ALL. The case with MLL gene breakage and amplification of T-LBL/ALL may have a poor prognosis. It hints this group maybe a subtype of T-LBL/ALL.

Objective To investigate the epidemiological characteristics of children infected by mycoplasma pneumoniae(MP)over the last five years in Kunming region.Methods Indirect immunofluorescence assay was used to detect blood MP-IgM of hospitalized patients from January 2003 to December 2007 in order to determine the age and gender distribution characteristics of MP infection and to investigate the epidemiological features of the five years' results.Results Infection incidences by MP in Kunming region over the last five years were 20.9%,14.3%,17.5%,15.7%and 19.5%,respectively.Statistical significance was found among the groups mentioned above(P＜0.01).The MP infection incidences in different age groups were 10.7%(～1 year old),20.5%(～3 years' old),21.5%(～6 years' old)and 21.7%(～14 years' old).MP infection incidences showed age and gender characteristics(P＜0.01).Infants showed lower NIP infection incidence and infection incidence was higher in female.The epidemiological investigation indicated that MP infection incidences varied from year to year(P＜0.01).The infection incidences of 2003 and 2007 by MP were higher than those of the other years.There were epidemiological differences in infection incidences by NIP over last five years(summer,autumn and winter).The MP infection incidences showed seasonal differences(P＜0.01).Conclusion Mycoplasma pneumoniae was the main local causative agent responsible for respiratory tract infection in children aged under one years' old in Kunming region.Over the last five years,there were two outbreaks in the local area,but with no seasonal regularity of epidemiology.

With regard to required quantization medical quality,precise medical measurement is to influence profoundly. From the five aspects to explain the relationship of medical measurement and medical quality, and to discuss management of medical measurement on installing inside measurement administration, take specific task and complete measurement work effectively in various Grade hospitals.

Exposure of gerbils 120 min to a high concentration oxygen (HCO)atmosphere after 60 min cerebral ischemia resulted in a marked increase in cerebral malondialdehyde (MDA, 4.39?0.26 nmol/mg protein). Much less cerebral MDA was among the other groups (2.63?0.50 nmol/mg protein in sham-operated controls; 3.07?0.52 nmol/mg protein in gerbils exposed to HCO without ischemia; 2.96?0.41nmol/mg protein in ger. bils subjected to 60 min ischemia; 2.79?0.59nmol/mg protein in gerbils subjected to 60 min ischemia and 120 min reperfusion). The contents of cerebral water, sodium, increassd after 60 mln cerebral ischemia. The contents of TXB_2 increased, 6-Keto-PGF_(1?) decreased, the elevation of cerebral water and sodium were more obvious after 120 min repefusion following ischemia. There was no difference in these items except for MDA between the reperfusion groups within air and within HCO.The authors proposed the mechanism that HCO elevates the contents of cerebral MDH might be due to abnormal function of election transport chain of mitochondria.

DND in the gerbil hippocampus was performed by bilateral occlusion of carotid arteries for 20 min followed by reperfusion 2 or 7 days. The contents of Ca~(2+) and MDA in drosal hippocampus were measured after two days reperfusion. Neuronal density in CA1 sector of hippocampus was used as an parameter. Effects of nimodipine and Superoxide dismutase (SOD) on DND in hippocampus were observed after 7 days reperfusion.The results indicated that the levels of Ca~(2+) and MDA were increased significantly. DND in hippocampal CA1 sector was ameliorated by both nimodipine and SOD significantly. It was suggested that Ca~(2+) and Iipid peroxidation play an important role in the development of DND hippocampus after transient forebrain ischemia in gerbils. Calcium Antagonist and free radical scavenger have obvious protective effects on DND in hippocampus.