OBJECTIVE To study the pharmacokinetic changes in the plasma and cerebrospinal fluid of bronchial asthma model rats after the complication of Ephedra sinica and Prunus armeniaca. METHODS SD male rats were randomly divided into blank group， model group， E. sinica group （12 g/kg， calculated by raw drug， similarly hereinafter）， P. armeniaca group （6 g/kg） and E. sinica-P. armeniaca drug-pair group （12 g/kg of E. sinica+6 g/kg of P. armeniaca）， with 6 rats in each group. Except for the blank group， the bronchial asthma model was induced by spraying rats in each group with an equal volume mixture of 2% acetylcholine chloride and 0.4% histamine phosphate， once a day， for 7 d. One hour before modeling every time， rats in each group were gavaged with the corresponding drug/normal saline， once a day， for 7 d. After the final administration and provocation of asthma， blood and cerebrospinal fluid collection were performed at different time points. The plasma and cerebrospinal fluid samples were pre-treated （with geranylgeranyl as the internal standard）， and the mass concentrations of ephedrine/pseudoephedrine， methyl ephedrine and amygdalin in both samples were determined by liquid chromatography-tandem mass spectrometry. DAS 2.0 pharmacokinetic software was used to determine the main pharmacokinetic parameters through the non-atrial chamber model and to compare the changes of the pharmacokinetic parameters before and after the combination of the two drugs. RESULTS Compared with E. sinica group， cmax and AUC0-21.33 h （or AUC0-10.67 h） of ephedrine/pseudoephedrine and methyl ephedrine in the plasma and cerebrospinal fluid of rats were significantly reduced in E. sinica-P. armeniaca drug-pair group， while CLZ/F and VZ/F were significantly increased （P＜0.05 or P＜0.01）； tmax of methyl ephedrine in the cerebrospinal fluid was significantly shortened （P＜ 0.05）.Compared with P. armeniaca group， the t1/2 of amygdalin in the plasma of rats in E. sinica-P. armeniaca drug-pair group was significantly shortened， and CLZ/F was significantly increased （P＜0.01）； the tmax of bitter amygdalin in the cerebrospinal fluid was significantly shortened， and the AUC0-10.67 h， CLZ/F， and VZ/F were significantly increased （P＜0.01）. CONCLUSIONS The combination of E. sinica and P. armeniaca accelerates the absorption and elimination of ephedra alkaloids， thus reducing the accumulation of ephedra alkaloids in the bronchial asthma model rats.

Objective:To explore the clinical characteristics, treatment and prognosis of primary cardiac tumors in infants and children.Methods:The clinical information for 21 patients with primary cardiac tumor in the Department of Pediatric Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University from May 2010 to August 2018 were analyzed retrospectively.Their median age was 7 months (gestational age 26 weeks-15 years old, and 6 cases were found in fetal phase) and 10 cases of them were male, 11 cases were girl.The clinical features, treatment methods and prognosis were summarized.Results:Among the 21 patients, 8 cases had an atypical heart murmur, 2 cases with chest tightness and chest pain, 2 cases with congestive heart failure, 1 case with dizziness and amaurosis, 1 case with cerebral artery embolism, 1 case with higher inflammatory index, and 9 cases were asymptomatic.Totally, 13 cases underwent surgical resection.All of them were confirmed as benign tumors, including 4 cases of rhabdomyoma, 3 cases of myxoma, 3 cases of fibroma and 2 cases of inflammatory myofibroblastic tumor (IMT) and 1 case of teratomas.There was no death during perioperative period.Follow-ups were performed from 3 months to 7 years, and 3 cases had recu-rrence (2 cases with myxomas and 1 cases with IMT). There were 8 cases without treatment, of which 7 cases were clinically diagnosed as transverse leiomyoma.During the follow-up, 3 cases disappeared, 1 case became small, 2 cases had no obvious change, and 1 case was lost to follow-up.One case was considered to be malignant tumor, and died within half a year.Conclusions:Primary cardiac tumors in children are mostly benign, especially transverse leiomyoma, and their clinical manifestations are diverse.Pathological examination is the golden standard for diagnosis.Surgical treatment is a radical method for most cardiac tumors, some benign tumors can be treated with drug adjuvant therapy, while the prognosis is poor for malignant cardiac tumor patients.

Objective:To investigate the diagnostic values of interleukin-22 (IL-22), interferon-γ(IFN-γ)and macrophage migration inhibition factor (MIF) in pleural effusion for tuberculosis pleurisy.Methods:From April 2018 to May 2019, a total of 77 patients including 45 cases of tuberculous pleurisy, 19 cases of malignant pleurisy, 13 cases of parapneumonia and 13 cases of healthy control in Wuxi Fifth People′s Hospital were enrolled. The levels of IL-22, IFN-γ and MIF in plasma and pleural effusion were detected by enzyme linked immunosorbent assay (ELISA). Mann-Whitney U test was used for statistical analysis.The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic values of IL-22, IFN-γ and MIF for tuberculous pleurisy. Results:The median levels of IL-22, IFN-γ, MIF and adenosine deaminase in 45 cases with pleural effusion in tuberculosis pleurisy group were 396.8 ng/L, 2 200.0 ng/L, 241.3 μg/L and 70.8 U/L, respectively, which were all significantly higher than 32 cases with non-tuberculosis pleurisy group, including 19 cases with malignant pleurisy and 13 cases with parapneumonia (52.8 ng/L, 232.3 ng/L, 179.6 μg/L and 17.0 U/L, respectively). The differences were all statistically significant ( U=179.000, 118.500, 287.000, 162.000, respectively, all P<0.05). The median levels of IL-22 and IFN-γ in plasma of tuberculosis pleurisy group were 20.0 ng/L and 45.9 ng/L, respectively, which were both higher than healthy control group (14.3 ng/L and 33.4 ng/L, respectively). The level of MIF was 96.2 μg/L, which was lower than healthy control (159.5 μg/L). The differences were all statistically significant ( U=74.000, 13.000 and 73.000, respectively, all P<0.05). The areas under ROC curve (AUC) of IL-22, IFN-γ and MIF in pleural effusion for the diagnosis of tuberculosis pleurisy were 0.876, 0.917 and 0.682, respectively.The sensitivities were 93.75%, 100.00% and 63.64%, respectively; the specificities were 82.22%, 91.11% and 65.85%, respectively. The median levels of IL-22 and IFN-γ in plasma in tuberculosis pleurisy group at two months of follow-up after anti-tuberculosis therapy were 16.0 ng/L and 33.9 ng/L, respectively, which were both lower than baseline (20.0 ng/L and 44.7 ng/L, respectively). The differences were both statistically significant ( U=2.156 and 2.221, respectively, both P<0.05). Conclusion:IFN-γ and IL-22 in pleural effusion could be used as effective indicators to identify tuberculous pleurisy, and the dynamic monitoring of IL-22 in patients′plasma could be an important biomarker in evaluating the efficacy of anti-tuberculosis treatment.

Objective To explore the methods and means to improve standardized management of regional quality control using quantitative indicators and information technology.Method The Quality Management and Control Indicators for Beijing health and medical institutions were converted into secondary and tertiary entries for quantitative scoring in accordance with the principles of standardization and management in the Integrated Management System of Health Examination under the regional information platform (Beijing Physical Examination Information Platform).APP was downloaded and applied in the on-site quality inspection.The data were obtained in paper forms completed on-site at 185 medical institutions with valid quality inspection scores in Beijing in 2014 and from the 2016 Beijing medical institutions' physical examination quality inspection.The inclusion criteria were as follows:185 institutions were divided into three groups (Level 3,Level 2,Level 1 and below),and each group was further divided into three subgroups with scores of 0-360,361-480,and 481-600;a total of 63 institutions were randomly selected from seven subgroups.Experts used the Integrated Management System of Health Examination Quality Control mobile app for the inspection.The two data groups were compared to check for quality improvement and the consistency of the quality inspection experts.Results The total quality score of medical institutions at Level 1 and below in 2016 (510.02±42.95) was higher than that in 2014 (483.16±79.06),and the difference was statistically significant (t=2.431,P＜0.05).There was no statistically significant difference between Level 2 and Level 3 medical institutions in 2014 and 2016.The scores of institutions at different levels are higher in the laboratory internal quality control and external quality assessment,and the difference was statistically significant (P＜0.05),whereas the score of physical health examination quality management organization only improved in the medical institutions at Level 1 and below,with statistically significant difference (P＜0.05).The changes of scores in the consistency of quality inspection experts was reduced after the application of the system,and the difference in institutions at Level 3 and Level 1 and below was statistically significant (P＜0.05),while not statistically significant in institutions at Level 2 (P=0.840).Conclusion Quantitative indicators and information technology are effective in regional standardized management of physical examination quality,and worthy of further exploration.

Objective To compare the detection performance of the modified serum test (TRUST) method and the traditional method in syphilis screening.Methods A series of TRUST high titer syphilis serum was diluted,and the positive rate of each method was calculated by using the improved method and the traditional method.Comparison of two detection methods of C50,C5 ～ C95 interval,as well as the accuracy of the density curve,and the consistency of the two methods were compared,and diagnostic performance were compared.Results The improved method of C50 was less than the traditional method of C50,and the improved method of C5 ～ C95 range was narrower than the traditional method,compared with the traditional method.The improved method of the non precision density curve was steeper than the traditional method,and the two confidence interval of the consistency degree of the 95％ methods was 73.4％ to 95.8％.The diagnostic sensitivity (SEN),diagnostic specificity (SPE),positive predictive value (PPV),negative predictive value (NPV) and diagnostic efficiency(DF) of the improved method were 64.29 ％,99.1％,85.71％,97.05 ％ and 96.39 ％,respectively.The SEN,SPE,PPV,NPV and DF of the traditional methods were 3.75 ％,98.49 ％,75 ％,96.18 ％ and 95 ％,respectively.The improved method was superior to the traditional methods in the two aspects of SEN and PPV (x2 =8.25,10.03,all P＜0.05),with the statistically significant difference.The improved method was slightly higher than the traditional method in SPE,NPV and DF (x2 =2.39,3.45,4.03,all P＞0.05),with the no statistically significant difference.Conclusion The precision,diagnostic sensitivity and diagnostic specificity of the improved method was higher than that of the traditional method,and it can be applied to the detection of large batch samples with the aid of the full automatic enzyme immunoassay instrument.The improved method can be used to replace the traditional method for syphilis screening.

Objective To explore experiences of patients with chronic obstructive pulmonary disease (COPD) to take up the home- based resistance training. Methods Twenty- two patients with COPD who completed the 12 weeks home- based resistance training were interviewed deeply, the phenomenological analysis method was used. Results Though reading, analysis, reflection, separation, theme refining, two themes were drawn: self- perceived benefits; pyhcological, social and healthy status barriers on taking up and persisting in the exercises. Conclusions The study finds that self- perceived benefits, psychological changes and confusion in COPD patients during home- based resistance training.As the medical staff, to seize the COPD patients for the purpose of health to do the health education and strengthen the relevant training, to help the patient perceive benefits on resistance training, to enhance the confidence of participating in the pulmonary rehabilitation, to promote the behavior change. Additionally, we should identify obstacles early and take up the intervention, to stimulate the enthusiasm of home- based resistance training in patients with COPD.

Objective To construct and implement the nursing quality information feedback system based on QUACERS model and control theory, and discuss its application effect and the problems that should be paid attention to and to provide operational cases and practical basis for nursing quality management. Methods Through literature review and expert consultation, the framework and content of nursing quality information feedback system were set up and implemented. The changes of the nursing quality and the repeated occurrence of nursing problems were evaluated before (2013) and after (2015) the implementation of this project. And in December 2015, a self-made questionnaire was conducted among the nurses in the hospital to evaluate the importance of the feedback and it′s effect of improving the nursing quality. And evaluate the timeliness and effectiveness of different feedback forms. Results 1 120 and 1 136 nurses were followed-up in 2013 and 2015 respectively. The scores of human resource management, clinical nursing service and nursing safety management were higher than before, and the repeated occurrence of nursing problems was lower than before. A total of 450 questionnaires were distributed, 438 copies were collected, the effective recovery rate was 97.33%. Ratings for the importance of each item was from 3.37 to 4.57. Ratings for the effect of improving the quality of care was 3.79 to 4.39. The percentage of quality information received by nurses was more than 95%, and the average score of feedback timeliness was 4.29 to 4.53. Conclusions Quality information feedback system based on QUACERS model can cover multiple dimensions of quality management, and it was conducive to obtaining comprehensive information;Combined with multiple feedback forms can improve the effect of information feedback.

OBJECTIVETo investigate the value of diffusion-weighted imaging (DWI) in the diagnosis of T staging for rectal cancer.

METHODSClinicopathologic data and MR images of 46 patients with rectal cancer in our hospital from July 2013 to September 2014 were retrospectively analyzed. The diagnostic sensitivity, specificity and accuracy of T2WI were compared with those of T2WI plus DWI in T staging for rectal cancer. The relationship of mean apparent diffusion coefficient (ADC) value with different T stages of rectal cancer was analyzed.

RESULTSThere were no significant differences in the diagnostic sensitivity, specificity and accuracy between T2WI and T2WI plus DWI (all P>0.05). The mean ADC value of DWI performed in pathologic T2, T3a, T3b, T3c and T4 stage was (1.110 ± 0.117) × 10⁻³ mm²/s, (1.035 ± 0.121) × 10⁻³ mm²/s, (0.948 ± 0.109) × 10⁻³ mm²/s, (0.932 ± 0.122) × 10⁻³ mm²/s and (0.843 ± 0.050) × 10⁻³ mm²/s, respectively (F=6.972, P=0.000).

CONCLUSIONDWI can serve as a complement for T2WI in the diagnosis of T stage patients with rectal cancer, and its ADC value presents a downward trend with the advance of T stage.

Objective To investigate the association of the polymorphism of the N-acetyltransferase 2 (NAT2 )gene with isoniazid-induced hepatotoxicity and anti-tuberculous treatment efficacy in Chinese Han patients with tuberculosis(TB).Methods A total of 108 TB patients who received initial anti-TB treatment were followed up prospectively.A polymerase chain reaction direct sequencing approach was used to detect genetic polymorphisms of the NAT2 gene.Associations between NAT2 genotype and isoniazid-induced hepatitis/early treatment were analyzed.Chi-square test was used for statistical analysis. Results Among the 108 TB patients, intermediate-acetylators (IA ) was the most frequent NAT2 genotype with the proportion of 54.63%(59/108).The proportion of rapid-acetylators(RA)was 33.33%(36/108),slow-acetylators (SA)was 10.19%(11/108)and super-rapid acetylators was 1 .85 % (2/108). Among the 20 patients who developed drug-induced hepatitis,2 were RA,5 were SA and 13 were IA. Regarding NAT2 genotype,RA patients had a lower incidence of hepatotoxicity (OR =0.176,95 %CI :0.038-0.809,P =0.014)and SA patients were more likely to developed drug-induced hepatic injury (OR=4.556,95 %CI :1 .231 -16.854,P =0.044 ).Statistical analysis revealed that the frequency of variant diplotypes,NAT2*4/*6A (OR=7.741 ,95 %CI :2.653-22.586,P <0.01 )and NAT2 *6A/*6A (OR=15 .353,95 %CI :1 .506 -156.552,P =0.020)were significantly increased in TB patients with hepatotoxicity.NAT2 *4/*4 was less likely to developed hepatic injury (OR =0.176,95 %CI :0.038-0.809,P =0.014).Among the 58 culture-positive patients,12(31 .03%)were persistent culture positive after 2 months standard therapy.Early treatment failure was observed with significantly higher incidence rate in RA than other genotypes (OR = 7.200, 95 % CI :1 .794-28.900, P = 0.008). Conclusions In Chinese Han TB patients,IA is the most frequent NAT2 genotype.The SA status of NAT2 is a risk factor of isoniazid-induced hepatotoxicity.The diplotype of NAT2 *6A has clearly high risk of isoniazid-induced hepatotoxicity.In contrast,NAT2 * 4/* 4 is protective diplotype.RA is associated with early treatment failure in culture-positive patients.

Objective To investigate the value of diffusion-weighted imaging (DWI) in the diagnosis of T staging for rectal cancer. Methods Clinicopathologic data and MR images of 46 patients with rectal cancer in our hospital from July 2013 to September 2014 were retrospectively analyzed. The diagnostic sensitivity, specificity and accuracy of T2WI were compared with those of T2WI plus DWI in T staging for rectal cancer. The relationship of mean apparent diffusion coefficient (ADC) value with different T stages of rectal cancer was analyzed. Results There were no significant differences in the diagnostic sensitivity, specificity and accuracy between T2WI and T2WI plus DWI (all P>0.05). The mean ADC value of DWI performed in pathologic T2, T3a, T3b, T3c and T4 stage was (1.110±0.117) ×10-3 mm2/s, (1.035±0.121)×10-3 mm2/s, (0.948±0.109)×10-3 mm2/s, (0.932±0.122)×10-3 mm2/s and (0.843±0.050)×10-3 mm2/s, respectively (F=6.972, P=0.000). Conclusion DWI can serve as a complement for T2WI in the diagnosis of T stage patients with rectal cancer , and its ADC value presents a downward trend with the advance of T stage.