Objective To investigate the reasons for delays in the diagnosis and treatment of lung cancer a-mong 120 female patients. Methods This study was based on 1409 female patients with lung cancer in our hospital. Patients′delay was defined as the time elapsed over 3 months from onset of first symptoms to initial consultation. Re-sults Patients′delay was established in 120 cases. Cough, sputum, hemoptysis and chest tightness were the main symptoms of the initial stage. Few patients′s first symptoms were metastases. 85 patients were diagnosed as metastasis when they consulted with doctor. The frequence was even higher in the group of adenocarcinoma (72. 5%). Concl-usion The major factor influencing patients' delay in female patients is neglecting the symptoms by themselves for the early symptoms of lung cancer.

Objective To conduct a survey and analysis on the cause of delayed diagnosis in female lung cancer and reduce misdiagnosis.Methods The clinical data of female lung cancer with delayed diagnosis over 3 months in our hospital from May 2009 to May 2012 were retrospectively analyzed.Results 164 cases of lung cancer were misdiagnosed as pneumonia,tuberculosis,chronic bronchitis,osteoarthritis or myalgia etc,and 54 cases with lung shadows with delayed diagnosis.The time of delayed diagnosis or misdiagnosis between 3 to 5 months was 89,6 to 8 months was 45,9 to 11 months was 26,and more 12 months was 58.The common symptoms of the patients were cough,expectoration,chest pain and dyspnea.Conclusions The differential diagnosis of lung cancer should be strengthened.It is important to conduct repeatedly intermittent periodic review of X-ray or CT examination for the patients with pneumonia,tuberculosis and lung shadows or nodules.

Objective To enhance the attention of fever of unknown origin(FUO) induced by the human cytomegalovirus(HCMV).Methods Clinical data of 36 patients with HCMV-induced FUO were analyzed.Results Patients were mainly young people,female more than male and the main clinical manifestation was FUO.Serological cytomegalovirus IgG,IgM significantly increased,but these examinations in early onset were ignored by doctors,resulting in delayed diagnosis.Conclusions HCMV-induced FUO is easily overlooked etiology.Anxiety symptoms caused by FUO is greater than the discomfort caused by the disease itself.The related detections of HCMV are the important objective index for diagnosis of the disease.

Objective To investigate the clinical features and diagnostic process of patients with non-small cell lung cancer in in deferent gender and smoking status.Methods Clinical data of 825 patients with non-small lung cancer were retrospectively analyzed.Patients were divided into male and female group,smoking and never smoking group in male patients.Clinic symptom,pathological type,staging,operation and 5-year survival were compared.Results More squamous cell carcinoma,cough and respiration infection were in male patient than those in female with significant differences(45.2%,61.4%,55.2% vs 14.3%,55.2%,11.0% respectively,P 0.05).A higher frenquency of adenocarcinoma was in female than that in male(59.1% vs 37.0%).Malaise and metastasis were more common in female patients than those in male patient with significant differences(32.5%,57.1% vs 4.8%,39.3%,P 0.05).squamous cell carcinoma(53.0%) was mainly in smoking male patients,and adenocarcinoma(50.3%) was mainly in never smoking male patient.After 5-years,only 343 cases were connected,108(31.5%) patient were survival and 235(68.5%) patients died.Conclutions In male smoking patients,the proportion of squamous cell carcinoma is high,and respiratory symptoms were obvious.In neversmoking male and female,adenocarcinoma is common and respiratory symptoms were less obvious.Tumor metastasis is more in female.Five-year survival rate is predominant in patients with early-stage and surgical resection.

OBJECTIVE To analyze the three-drug combination treatment of Helicobacter pylori infections in senile patients of cadres department so as to provide bases for the health education of the outpatient department nurses.METHODS A total of 61 patients who were diagnosed H.pylori infections and enrolled the department of gastroenterology from Jan 2010 to Oct 2011 were randomly selected.All these patients had taken 20 mg Nexium,twice a day for 4 weeks,together with amoxicillin 0.2285g,metronidazole 0.4g twice a day for a 10 day course of treatment;after a course of treatment and drug withdrawal for a month,all these patients were undertaken 13C-urea breath test;the positives should take another three courses;the selected patients,according to the age,were divided into three groups(52-62,63-73,and 74-83 years) to analyze the drug efficacy;the treatment effects on the various age groups of patients were observed.RESULTS The effective rate of the three-drug combination treatment of the H.pylori infection was 88.5%,the cure rates of the three age groups of patients with H.pylori infection were 100.0%,77.8%,and 78.6%,respectively,the difference was not statistically significant.CONCLUSION The three-drug combination treatment has significant effect on the treatment of H.pylori infections,the treatment effect is not related to the age.

OBJECTIVE To evaluate the clinical effectiveness,safety,adverse reactions,and the in vitro antibacterial activity of amoxicillin/sulbactam in the treatment of acute bacterial infections so as to provide theoretical basis for the clinical reasonable use of antibiotics.METHODS The minimal inhibitory concentration(MIC) of amoxicillin/sulbactam against clinical isolated strains were determined by using agar dilution method.A randomized multicentre clinical trial on effect and safety of domestic amoxicillin/sulbactan for treatment of acute bacterial infections was conducted.RESULTS The susceptible rate of amoxicillin/sulbactam against the gram-positive strains was 90.0%,significantly higher than that of amoxicillin and cefotaxime.The susceptible rates of amoxicillin/sulbactam against Escherichia coli and Klebsiella pneumoniae were 82.0% and 83.0%,respectively,which were similar to amoxicillin/clavulanic acid,ampicillin/sulbactam and cefotaxime and significantly higher than amoxicillin.The susceptible rate of amoxicillin/sulbactam against Acinetobacter was 83.0%,significantly higher than that of amoxicillin,and slightly higher than that of two agents containing β-lactamases inhibitors and cefotaxime.Of 110 patients who used amoxicillin/sulbactam for the treatment of respiratory system infection,urinary system infections,abdominal infections,and septicemia,84 cases were cured,25 cases were markedly improved,and 1 case was improved.The total effective rate was 99.9%,the bacterial clearance rate was 91.0%,and the incidence rate of adverse reactions was 4.6%.CONCLUSION The adding of enzyme inhibitors has improved the antibacterial activity of amoxicillin against the clinical common pathogens.It suggested that amoxicillin/sulbactam is an effective and safe drug to treat infectious disease.

Objective To analyze the clinical features of male lung cancer patients.Methods The clinic data of 803 cases of male lung cancer were retrospectively analyzed from November 2004 to November 2006 which were divided into elderly group and non-elderly group,smoking group and non-smoking group.Results The squamous cell carcinoma(37.73%)and adenocarcinoma(30.88%)were the most common types.Cough,hemoptysis,dyspnea and pneumonia were the main symptoms.Pneumonia Chinese PLA General Hospital,Beijing 100853,China Chinese PLA General Hospital,Beijing 100853,China and asymptomatic patients in elderly group are more than those in non-elderly group.There are more patients with cough,hemoptysis and metastasis in smoking group than those in non-smoking group(P0.05).Patients with non-small cell carcinoma in non-elderly group were more than elderly group(P0.05).The bronchoscopy was main method of pathology diagnosis.Squamous cell carcinoma were commonly misdiagnosed.Conclution Cough,hemoptysis,dyspnea and pulmonary pneumonia are common clinical featuress of lung cancer.Diagnosis should be careful and some cases need repeat examination.Careful diagnosis and periodic examination are very important.

Objective To investigate the social support and its related factors of elderly patients with chronic obstructive pulmonary disease(COPD).Methods 60 outpatients with COPD over the age of 60 years were recruited in the study.Social support rating scale(SSRS) and demographic information were applied for investigation.Results Scores of objective,subjective support,and availability of support were lower than the norm(P0.05).Social support was significantly different among elderly patients with age,education levels and matital status(P0.05).Patients aged over 70 years,low education level,divorced or widowed were vulnerable groups with low social support.Conclusion Efforts should be made to strengthen the social support system for elderly patients with COPD,especially for those aged over 70 years,low education,divorced or widowed.

Objective To provide a reference for clinicians in the diagnosis of the cause of chronic cough.Methods Retrospective clinical analysis of clear,effective treatment of 78 cases of patients with chronic cough was performed.Results The causes of 78 cases of chronic cough chronic pharyngitis,postnasal drip syndrome,allergic airway cough,cough variant asthma,gastro-esophageal reflux,drug factors and eosinophilic bronchitis account for 23%,20.5%,19.2%,16.7%,10.3%,7.7%,2.6%.After the specific treatments aiming at different causes,the coughing symptom of all patients was either significantly alleviated or even disappeared.Conclusion To standardize diagnosis flow of chronic cough,it is helpful to improve the rate of correct etiologic diagnosis of chronic cough.

ObjectiveIn order to find effective and economical method of treating the cough induced by angiotensin converting enzyme inhibitor.(ACEI).MethodsWe observed the treatment effect on cough induced by ACEI in 70 cases of patients after taking ketotifen and ambroxol Hydrochloride.ResultsThe effective treatment rate of ACEI-induced coughing patients taking ketotifen and ambroxol hydrochloride was 88.6%.ConclusionEarlier in the ACEI-induced cough there is no effective clinical treatment,the study showed that ketotifen and ambroxol hydrochloride combined is the economic and effective way in treatment ACEI-induced cough.

[病例]男,59岁.因打排球后出现阵发性双侧胸痛、间断轻度憋气就诊.有结核性胸膜炎病史.

OBJECTIVE To investigate the changes of serum cytokines (IL-2,IL-4,IL-6,IL-8) and T-lymphocyte subsets(CD3,CD4,CD8) before and after taking A-cetylcystein( NAC) in the patients with COPD and evaluate the influence of NAC on the airway inflammation and clinical effects.METHODS 30 elderly patients in stable stage(gradeⅡ-Ⅲ) of COPD were involved.Taking NAC 600mg bid for 4 weeks.Before NAC and after taking NAC 4 weeks,the serum level of cytokines (IL-4,IL-6,IL-8; VEGF; IFN-γ; TNF-α; MCP-1; EGF) and T-lymphocyte subsets(CD3,CD4,CD8) were measured by bio-chip and flow cytometry respectively.Before and after treatment 4 weeks with NAC frequent of cough in average weeks were record.RESULTS After 4 weeks treatment with NAC the serum concentrations of IL-6,IL-8 were significantly lower (P0.05) and IL-2,MCP were significantly higher (P0.05) than those before treatment.CD8 ratio was increased than before treatment (P0.05). IL-4、VEGF,IFN-γ、TNF-α and EGF concentrations and CD3,CD4 ratio were no significantly changes before and after treatment.Frequent of cough were reduced during NAC was taken 4 weeks.CONCLUSION NAC inhibits inflammatory action by decreasing IL-6 and IL-8.It might play an impotent role to inhabit disease progression in stable COPD.

Objective To analyze the distribution and evolution of the risk factors for coronary heart disease (CHD) in middle-aging males, and provide the evidence for the prevention and treatment of male patients with CHD. Methods 1639 male people over 45 years old were enrolled in the study. They were divided into non- senile group (45-59 years old) and senile group (60-93 years old).The subjects over 60 years old were further divided into three groups:60-69 years old group, 70-79 years old group, 80-93 years old group. The interrelation between the risk factors of CHD and aging was analyzed. Results The prevalence rates of drinking, smoking, diastolic hypertension and low HDL-C in non-senile group were much higher than those in senile group (x2=28.80,18.35,15.72,17.84,P<0.01). In contrast, the prevalence rates of overweight, systolic hypertension, fasting hyperglycemia,postprandial hyperglycemia in senile group were significantly higher than those in non senile group. The prevalence rates of high triglyceride in non- senile group and senile group were 18.0% and 16.2% respectively(P>0.05). The prevalence rates of high cholesterol in non- senile group and senile group were 36.9% and 31.5% respectively(P>0.05). There was a significant decrease in the prevalence rates of overweight, postprandial hyperglycemia (P<0.05) and drinking,smoking, diastolic hypertension, high triglyeeride (P<0.01) in over 70-year+old males. And the prevalence rates of overweight, postprandial hyperglycemia, high triglyceride of over 80-year-old males were higher than those of over 70-year-old males (x2=10.05,4.16,5.97,P＜0.01). However,the prevalence rates of systolic hypertension of over 80-year-old males were lower than those of over 70-year-old males (X2=21.25,P＜0.01). There was no significant change in other risk factors of CHD at different ages of senile group. Conclusions For non-senile males, the important measures to treat the risk factors of CHD should include stopping smoking, restricting alcohol, eating low fat diet, changing bad life habits, controlling diastolic hypertension and modifying lipid. In contrast, for senile males, more attention should he paid to limiting total energy intake, increasing sports, losing weight, controlling systolic hypertension, hyperglycemia and modifying lipid.

Objective To investigate the impact of chronic obstructive pulmonary disease(COPD) on quality of life and other relationship factors in the elderly. Methods Eighty-six elderly patients with the stable stage of COPD were involved. Respiratory questionnaire for quality of life was inquired. Body mass index,6-minutes walk distance(6MWD),T lymphocyte subpopulation and pulmonary function were measured. Pearson’s linear correlation was used to examine the relationship between the score of quality of life and age,body mass index,6MWD and pulmonary function. A statistic analysis of Pearson’s linear correlation was also performed in pulmonary function with body mass index and smoking index with T lymphocyte subpopulation. Results A positive correlation was found between the total score of quality of life and age(P0.05). There was a negative correlation between the total score of quality of life and body mass index(P0.01). The total score of quality of life had a negative correlation with 6MWD and FEV1(P0.01)). A positive relationship was shown in FEV1 and body mass index(P0.01). Smoking index was significantly related with CD8+ T cell(P0.05). Conclusions The evaluation of health status by the score of quality of life is easy and advisable in the elderly patients with stable COPD. CD8+ T cell in COPD patients may be increased and influenced by smoking index.

Objective To determine the distribution of vitamin D receptor (VDR) gene polymorphism in women of Han and Mongoloid nationality in China.Methods VDR genotypes of healthy postmenopausal women of 179 Han and 112 Mongoloid nationality were classified by polymerase chain reaction-restriction fragment length polymorphism to calculate genotype frequencies and distribution.Results For women of Han and Mongoloid nationality, the BB genotypes accounted for 0% and 4.46%, the bb genotypes accounted for 90.5% and 50% respectively (P<0.001). Conclusions There was a significant difference in VDR genotype between women of Han and Mongoloid nationality, which need further evidence on the different pathogeny of osteoporosis in various ethnic groups.

To investigate the level of T-lymphocyte subsets(CD3~ +,CD4~ +,CD8~ +)and serum IL-4,IL-8 and TNF-α in senile patients with stable chronic obstructive pulmonary disease(COPD) and provide basis in observing the inflammatory process of COPD, 50 senile patients with stable COPD and 40 senile healthy persons as control group were selected, and levels of IL-4, IL-8 and TNF-α in serum were detected by RIA method, the T-lymphocyte subset (CD3~ +, CD4~ +, CD8~ +)of peripheral blood was measured by flow cytometry. The levels of CD3~ +,CD4~ + in COPD group were lower than in control group(P<0.05) and IL-4, TNF-α were higher in COPD group than in control group(P<0.05). And CD8~ +, IL-8 were also slightly higher in COPD group compared with that in control group, but the difference between them is not significant. CD3~ +,CD4~ + were lower and IL-4, TNF-α were higher in COPD group than those in control group, which means that abnormal cellular immunity function and inflammatory process still existed in the stable period of COPD.

BACKGROUND: Vitamin D receptor (VDR) gene shows restriction fragment length polymorphism with incision enzyme Bsm Ⅰ ,Apa Ⅰ ,Taq Ⅰ ,which is related to bone mineral density (BMD).However, it is unclear that the relationship between VDR gene (Bsm Ⅰ ) polymorphisms and BMD,osteoporosis.OBJECTIVE: To analyze the distribution regularity of vitamin D receptor gene polymorphism related to BMD in postmenopausal women of Han,Uygur, Kazak and Mongoloid nationality in China. DESIGN: controlled observation.SETTING: Institute of Gerontology,General Hospital of Chinese PLA.PARTICIPANTS: Totally 179 women of Han,who were taking physical examination in General Hospital of Chinese PLA from January 2002 to December 2003, at the average age of (59±3) years,were selected. A total number of 122 women of Uygur with average age of 56.49 years; 63 women of Kazak with average age of (55±3) years; and 112 women of Mongoloid with average age of (57±3) years,who were all taking physical examination in department of geriatrics, Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA from January 2001 to December 2003.All of them were informed consent.METHODS: VDR genotypes(Bsm Ⅰ ) were defined with polymerase chain reaction-restriction fragment length polymorphism,so as to analyze distribution of Vitamin-D receptor gene (Bsm Ⅰ )polymorphisms of postmenopausal women in Han,Uygur, Kazak,Mongoloid nationality,and compared with the data of USA,Australia,France,Japan,Korea. Enumeration data were compared with Chi-square test.MAIN OUTCOME MEASURES: VDR (Bsm Ⅰ ) polymorphisms in healthy postmenopausal women from Han, Uygur, Kazak, Mongoloid populations in China, which were compared with the data of USA, Australia,France, Japan, Korea.RESULTS: For women of Han, Uygur, Kazak and Mongoloid nationality,the BB genotypes accounted for 0, 4.1%, 6.35% and 4.46%, the bb genotypes accounted for 90.5%, 69.67%, 38.1% and 50% respectively. There was a significant difference between women of Han, Uygur, Kazak, and Mongoloid nationality(P ＜ 0.01). There was insignificant difference in comparation of distribtuion of VDR genotype between Kazak nationality and the west races, but it was significantly different to that in Japan,Korea races.CONCLUSION:VDR genotype polymorphisms is characterized by obvious racial diversify in postmenopausal women of Han,Uygur, Kazak,Mongoloid populations in China;Distribution of VDR gene frequency of Kazak population is similar with the west race ,but is different to Japanese and Korea's race.

?Objective To determine the distribution of vitamin D receptor gene polymorphism in women of Han,Uygur,Kazak and Mongoloid nationality in China.Methods Polymorphism defined by the Bsm1 restriction enzyme using polymerase chain reaction-restriction fragment length polymorphism in healthy postmenopausal women of 179 Han nationality,122 Uygur nationality,63 Kazak nationality and 112 Mongoloid nationality.The genotype frequencies of the VDR were calculated later using the Hardy-Weinberg equilibrium formula.Results For women of Han,Uygur,Kazak and Mongoloid national,the BB genotypes accounted for 0%,4.1%,6.35% and 4.46%,the bb genotypes accounted for 90.5%,69.67%,38.1% and 50% respectively.We found that was a significant difference between women of Han,Uygur,Kazak,and Mongoloid nationality.Compared to Caucasian population,there was no significant in VDR gene in Kazak nationality.Conclusions There was a significant difference between women of Han and Uygur,Kazak,and Mongoloid nationality in VDR genotype.The present study provide further evidence on the different pathogeny of osteoporosis in various ethnic groups.

OBJECTIVE To investigate nosocomial pulmonary infection in elderly patients receiving long-term(at least 30 day) mechanical ventilation. METHODS Retrospective survey was carried out in the aged patients with long-term mechanical ventilation,who admitted from Jan 2002 to Jun 2005.The risk factors of common pneumonia were studied by means of Logistic regression analysis. RESULTS In 69 cases with long-term mechanical ventilation,53 patients were caught common pneumonia(76.81%).Pulmonary tuberculosis and plural tuberculosis were(7(10.14%)) and(1(1.14%)),respectively.Nontuberculous mycobacterial infection was identified in 3 cases(4.35%).There were 8 cases suffered from Pneumocystis carinii pneumonia(11.59%).The length of mechanical ventilation and aspiration seemed to be the important risk factors for the development of common bacterial pneumonia. CONCLUSIONS The most significant preventive measures of common pneumonia include short mechanical ventilation and prevention of aspiration of gastric contents.Mycobacterium tuberculosis,nontuberculous mycobacteria and P.carinii induced pneumonia also should be considered in the elderly with(long-term) mechanical ventilation.