Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective:To investigate the imaging characteristics of chest CT angiography in patients with active pulmonary tuberculosis complicated with pulmonary embolism, so as to improve the detection rate of active pulmonary tuberculosis complicated with pulmonary embolism.Methods:The clinical data of 103 patients with active pulmonary tuberculosis treated in Tianjin Haihe Hospital from January 2013 to January 2020 were retrospectively analyzed, including general conditions, symptoms and complications. According to the occurrence of pulmonary embolism, the patients were divided into active pulmonary tuberculosis complicated with pulmonary embolism group (study group, n=43) and active pulmonary tuberculosis without pulmonary embolism group (control group, n=60). The time between the onset of pulmonary embolism and the onset of tuberculosis of the patients in the study group was collected. The chest CT imaging characteristics of the patients of two groups were analyzed. The imaging characteristics, embolism distribution and secondary changes of the patients in the study group were summarized. Results:Time from onset of tuberculosis to pulmonary embolism of the patients in the study group was about 60 days (14 days to 75 days). The incidence of chest tightness and dyspnea of the patients in the study group was significantly higher than that in the control group (all P<0.05). The number of lung lobes involved in lung lesions of the patients in the study group was significantly higher than that in the control group ( P<0.05). The incidence of lesions in the middle lobe of the right lung, the tongue lobe of the left lung and the lower lobes of both lungs of the patients in the study group was higher than that in the control group (all P<0.05). The incidence of peripheral pulmonary embolism was significantly higher than that of central pulmonary embolism ( P<0.05). However, the incidence of atelectasis, pulmonary artery widening, and right heart enlargement in the patients with central pulmonary embolism was significantly higher than that in the patients with central pulmonary embolism (all P<0.05). Conclusions:Multi-slice spiral CT chest angiography can show some important imaging manifestations of patients with active pulmonary tuberculosis and pulmonary embolism, which is helpful for the early detection of the disease and the improvement of its prognosis. Multi slice spiral CT chest angiography can show some important imaging manifestations of patients with active pulmonary tuberculosis complicated with pulmonary embolism, and timely detection is helpful to improve the prognosis of patients with active pulmonary tuberculosis complicated with pulmonary embolism.

Objective:To explore the performance of the commonly used whole blood C-reactive protein (CRP) detection systems and give related recommendation on the performance requirements of detection systems.Methods:A total of 7 540 venous blood samples from 26 maternal, child and children′s hospitals were collected to conduct this multi-center study on the analytical performance of 5 commonly used whole blood CRP detection systems from March to April in 2019. The blank check, carryover, repeatability, intermediate precision, linearity, sample stability, influence of hematocrit/triglyceride/bilirubin, comparison with SIEMENS specific protein analyzer and trueness were evaluated. The 5 systems included BC-5390CRP autohematology analyzer, AstepPLUS specific protein analyzer, Ottoman-1000 Automated Specific Protein POCT Workstation, i-CHROMA Immunofluorometer equipment Reader and Orion QuikRead go detecting instrument. The 5 systems were labeled as a, b, c, d and e randomly.Results:Within the 5 systems, all values of blank check were less than 1.00 mg/L, the carryovers were lower than 1.00%. The repeatability of different ranges of CRP concentrations including 3.00-10.00, 10.00-30.00 and>30.00 mg/L were less than 10.00%, 6.00% and 5.00%, respectively, and the intermediate precision was less than 10.00%. The linearity correlation coefficients of the 5 systems were all above 0.975, while the slope was within 0.950-1.050. Whole blood samples were stable within 72 hours both at room temperature (18-25 ℃) and refrigerated temperature (2-8 ℃). The CRP results were rarely influenced by high triglyceride or bilirubin, except for the immmunoturbidimetric test based on microparticles coated with anti-human CRP F(ab) 2 fragments. When triglyceride was less than 15.46 mmol/L, the deviation of CRP was less than 10.00%. When bilirubin was less than 345.47 μmol/L, the deviation of CRP was less than 10.00%. CRP was more susceptible to Hct on the systems without Hct correction. The deviation of CRP between different Hct dilution concentration and 40% dilution concentration can reach as high as 67.48%. The correlation coefficients ( r) of 5 systems were all more than 0.975 in the range of 0-300.00 mg/L compared with Siemens specific protein analyzer. All systems passed the trueness verification using the samples with specified values of 12.89 and 30.60 mg/L. Conclusion:The performance of 5 systems can basically meet the clinical needs, but it is suggested that the whole blood CRP detection system without automatic Hct correction should be modified manually.

Objective:To observe the effect of low-dose mifepristone combined with dydrogesterone tablets on uterine volume and dysmenorrhea in patients with adenomyosis.Methods:From January 2019 to January 2020, 82 patients with adenomyosis who were diagnosed and treated in the department of obstetrics and gynecology of the People's Hospital of Changxing County were selected and divided into two groups according to the random number table method, with 41 cases in each group.The observation group was treated with low-dose mifepristone combined with dydrogesterone tablets, and the control group was treated with levonorgestrel intrauterine system.The clinical efficacy of the two groups after treatment was observed, and the uterine volume, dyenorrhea, estradiol(E 2), luteinosin(LH), serum follicle-stimulating hormone(FSH) and carbohydrate antigen 125(CA125) before and after treatment were counted. Results:After treatment, the total effective rate of the observation group was higher than that of the control group(80.49% vs.97.56%, χ 2=6.116, P<0.05). Before treatment, the uterine volume between the two groups had no statistically significant difference ( t=0.165, P>0.05). After treatment, the uterine volume of both two groups was reduced compared with before treatment ( t=17.541, 36.940, all P<0.001). And the uterine volume of the observation group was significantly smaller than that of the control group ( t=-39.506, P<0.001). Before treatment, the degree of dysmenorrhea between the two groups had no statistically significant difference ( t=0.603, P>0.05). After treatment, the degree of dysmenorrhea in both two groups was reduced compared with before treatment ( t=26.100, 46.610, all P<0.001). The score of dysmenorrhea in the observation group was significantly lower than that in the control group( t=20.327, P<0.001). Before treatment, the levels of E 2, LH, FSH and CA125 between the two groups had no statistically significant differences( t=0.124, 0.502, 0.222, 0.084, all P>0.05). After treatment, the levels of E 2, LH, FSH and CA125 in the two groups were improved.And the E 2 and CA125 levels of the observation group were better than those of the control group ( t=-3.392, 6.171, 2.619, 18.728, -9.889, 4.582, 2.572, 23.629, all P<0.05), while the LH and FSH levels of the two groups had no statistically significant differences ( t=6.064, 1.108, 1.166, -7.392, all P>0.05). Conclusion:The treatment of adenomyosis with mifepristone combined with dydrogesterone tablets is effective, it can effectively reduce the uterine volume, reduce dysmenorrhea, improve the sex hormone levels of patients, which is worthy of clinical promotion.

Objective: Apolipoprotein E (ApoE) is mainly synthesized in the liver. So far, it is unknown the relationship among APOE gene polymorphisms and WML, brain atrophy. Therefore, the aim of the study was to assess the associations of APOE gene polymorphisms in patients with WML and brain atrophy. Methods: A total of 58 patients with WML, 128 patients with brain atrophy, 112 patients with co-occurrence of WML and brain atrophy and 95 healthy elderly volunteers were recruited from Renmin Hospital of WuHan University. Results: Allele E3 was the most common allele. The alleles E2 had significantly higher levels of ApoB and lower age in WML group. The alleles E2 was associated with the lower level of ApoB, LDL-Ch, TCh, and sdLDL in co-occurrence group. The E3/E3 genotype has higher level of sdLDL, but lower age and female frequency in WML. The E3/E4 genotype had higher level of TG, but lower age in WML. Gender, Age, E2, Hyperhomocysteinemia and UA were also significantly associated with disease progression. Conclusion This study found that clinical data, lipids and metabolic complications were closely related to ApoE genotypes and alleles, and also disease progression and type.

Trauma is the leading cause of death for people under 40 years old in the world. At present, the rescue and treatment system of trauma patients in China is not yet well established, and the mortality of trauma patients is higher than those in the developed countries. Improving the treatment system is the key to reducing the trauma mortality. In order to innovate the service mode of trauma first aid, further promote the establishment of regional trauma first aid system, improve the ability of trauma treatment, reduce the mortality and disability rate of trauma patients in Jiangxi Province, recently Health Commission of Jiangxi Province and the First Affiliated Hospital of Nanchang University have reached a consensus on the establishment of Jiangxi trauma first aid center. In order to provide reference for the construction of trauma treatment system, the author analyzes the following aspects including functional positioning, basic requirements, organization management, and evaluation of core indicators.

Objective To establish a HPLC method for simultaneously determining the content of dexamethasone ace-tate ,camphor and phenol in compound cream .Methods The separation was performed on a SHIADZU-GL Inertsil? ODS-3 RP C18 analytical column with the mobile phase consisting of methanol-water (60:40) .The flow rate was 1 .0 ml/min .The detection wave length was 285 nm and the column temperature was 40 ℃ .Results Dexamethasone acetate ,camphor and phe-nol showed good linearity (r> 0 .9995 , n= 7) within the concentration range of 4 .024-40 .24 ,101 .7-2033 and 10 .38-425 .2 μg/ml ,respectively . The average recovery of dexamethasone acetate ,camphor and phenol was 101 .2％ (RSD was 0.56％ ) ,99 .89％ (RSD was 0 .72％ ) ,100 .2％ (RSD was 0 .97％ ) ,respectively .Moreover ,the RSDs were less than 1 .5％ in the repeated tests .Conclusion The method was simple ,quick and accurate .It is suitable for the quality control of dexametha-sone acetate camphor and phenol cream .

Objective:To investigate the relationship of CYP2C19 gene polymorphisms and clopidogrel resistance in the patients with coronary atherosclerotic heart disease ( CAHD) accepted percutaneous coronary intervention ( PCI) in Chinese Han population from north Sichuan. Methods:The patients with CAHD undergoing PCI were recruited. The fluorescence in situ hybridization ( FISH) technology was used to detect the CYP2C19 gene polymorphisms in all the patients. According to the different genotypes, the patients were divided into different groups. The platelet maximum aggregation rate ( MAP) induced by ADP was detected before and after the administration of clopidogrel. Results:The 110 patients were divided into three groups:52(47. 3%) patients were divided into the fast metabolism group, 42(38. 1%) patients were in the moderate metabolism group and 16(14. 6%) patients were in the slow metab-olism group. Before the administration, there was no significant difference in the basic values of the platelet aggregation rate among the groups with various metabolism type (P=0. 873). In 24 hours after the administration of 300mg clopidogrel, there was notable differ-ence in the platelet aggregation rate (17. 74% ± 5. 87% vs 21. 44% ± 8. 71% vs 27. 05% ± 8. 83%, P=0. 044) and the decrease de-gree (20. 08% ± 5. 94% vs 18. 87% ± 4. 72% vs 11. 54% ± 2. 94%, P=0. 01) among the three groups. The moderate metabolism group and slow metabolism group had higher MAP with lower decrease degree than the fast metabolism group. Totally 21 patients (19. 1%)were with CR, and among them, 2 patients (3. 8%) were in the fast metabolism group,12 patients (28. 6%) in the moder-ate metabolism group and 7 ones (43. 8%) in the slow metabolism group, and the difference of CR distribution among the three groups was significant (P<0. 001). The moderate metabolism group and slow metabolism group were more likely to have clopidogrel resist-ance, especially the slow metabolism group. Conclusion: There is a certain relationship of CYP2C19 gene polymorphisms and clopi-dogrel resistance in the patients with CAHD accepted PCI in Chinese Han population from north Sichuan, and those with slow metabo-lism genotype are more likely to have clopidogrel resistance with reduced efficacy.

Objective:To find the best synthesis method of 6-benzyl-1-[ ( benzyloxy ) methyl ]-3-hydro-xy-5-(hydroxymethyl)pyrimidine-2,4(1H,3H)-dione e for observing the change of its biological activity after N-3 hydroxylation .Methods:After trying some N-hydroxylation methods , the target compound was successfully synthesized via one-pot oxidizing process by sodium hydride ( NaH) and 3-chloroperbenzoic acid( m-CPBA);the anti-HIV reverse transcriptase ( RT) activity and integrase ( IN) activity of the tar-get compound was assayed via enzyme-linked immunesorbent assay ( ELISA) and phosphorylation of DNA package method .Results:The target compound could be obtained through the improved m-CPBA oxida-tive method by only one step , and the yield of the reaction could reach 60%-70%.And the structure of this compound was identified by 1 H NMR, 13 C NMR and MS;The activity result showed it added the an-ti-HIV IN activity after N-3 hydroxylation as well as retained the anti-HIV RT activity.Conclusion:The improved m-CPBA oxidative method is a convenient and efficient way to prepare the compound 6-benzyl-1-[(benzyloxy)methyl]-3-hydroxy-5-(hydroxymethyl)pyrimidine-2,4(1H,3H)-dione e which has both anti-HIV RT and IN activity .

Objective To evaluate the correlation between serum uric acid with cognitive disorder after acute cere?bral infarction by prospective study. Methods Four hundred consecutively enrolled patients of acute cerebral infarction were divided into no cognitive impairment group and cognitive impairment group according to the assess of Montreal Cog?nitive Assessment (MoCA). Univariate analysises were conducted in the potential risk factors of cognitive impairment in?cluding age, sex, smoking, alcohol, hypertension, diabetes, dyslipidemia, level of education, infarction in key parts, atrial fibrillation, serum uric acid, blood homocysteine between two groups. The statistically significant indicators in univariate analysises were used as independent variables and the scores of MoCA were used as the dependent variable to conduct multiple linear regression analysis. The assessment on the risk of cognitive impairment after cerebral infarction were con?ducted according to serum uric acid, sex, age and TOAST classification further. Results Serum uric acid was indepen?dent risk factors of cognitive disorder after acute cerebral infarction. The risk of cognitive disorder after acute cerebral in?farction was significantly increased in patients with high level of serum uric acid than with normal level and the relative risk was 1.35,95%CI(1.098,1.660). Especially for the young, male or patients with cerebral infarction in classification of small artery occlusion, the risk increased further, and the relative risk was 1.513, 95%CI(1.092, 2.096)1.412, 95%CI (1.125, 1.771)and 1.464, 95%CI(1.128, 1.900)respectively. Conclusion Exaltation of Serum uric acid was indepen?dent risk factor of cognitive disorder after acute cerebral infarction. The risk of cognitive disorder after acute cerebral in?farction was significantly increased in patients with high level of serum uric acid than with normal level, and especially for the young, male and patients with cerebral infarction in classification of small artery occlusion, the risk increased fur?ther.