Objective To compare the therapeutic efficacy of reteplase(r-PA) and alteplase(t-PA) in the high risk patients with pulmonary embolism during a pulmonary artery catheter broken bolt in the interventional treatment,and to evaluate the clinical safety.Methods 54 high risk patients were selected as the research subjects,and they were randomly divided into treatment group(24 patients) and control group(30 patients).Patients in both two groups were given general treatment,low molecular heparin sodium anticoagulation therapy.Besides,the control group was given local perfusion thrombolysis enzyme treatment.While the treatment group was given local perfusion at enzyme thrombolysis treatment.Results Two-way Chi-square test results showed that before treatment,there were no significant differences in HR,RF,PaO2,PaCO2 and SaO2 between the two groups(all P>0.05).After 3-day treatment,in the treatment group,HR[(83.39±14.25)times/min],RF[(17.80±1.65)times/min],PaO2[(87.59±7.34)mmHg],PaCO2[(37.60±7.62)mmHg],SaO2[(97.29±6.72)%] in the treatment group group,which in the control group were (97.7±15.51)times/min,(20.49±1.68)times/min,(81.53±6.42)mmHg,(35.69±4.57)mmHg,(93.91±3.27)%,the differences between the two groups were statistically significant(t=8.01,7.33,6.32,all P<0.05).After three days therapy,the total effective rate was 86.67% in the treatment group,which was significantly higher than 75.00% in the control group (x2=1.21,P=0.55).After thrombolysis treatment,there was no significant difference between the treatment group and control group in hemorrhage rate(x2=2.24,P=0.53),which were 13.33% and 12.50%,respectively.Besides,the hemorrhage patients were all got effectively treated and their condition was significantly improved,and none of them occurred severe bleeding during the observation periods in the two groups.Conclusion Local perfusion reteplase therapy in high-risk patients with PE through the pulmonary artery catheter broken bolt in the interventional treatment is safe and is worthy of clinical promotion.

Objective To explore effects and possible mechanisms of combination therapy with methotrexate (MTX) and low dose cyclophosphamide (CTX) intermittently on the cyclin D 1 expression in the synovium of collagen induced arthritis rats.The outcome is analyzed.Methods After CIA experimental models were successfully established in female Wistar rats,they were randomly divided into CIA model group,low-dose MTX treatment group (0.9 mg·kg-1·W-1),high-dose MTX treatment group (2.7 mg·kg-1·W-1),Jowdose CTX treatment group [24 mg·kg-1·(3W)-1],and" low-dose MTX + low-dose CTX treatment group (MTX 0.9 mg·kg-1·W-1,CTX [24 mg·kg-1·(3W)-1].All of the rats were sacrificed 24 weeks after the first immunization,the specimens of ankle joints were exposed,fixed,decalcified,wrapped and cut into slices.The Cyclin D1 mRNA levels were examined by situ hybridization.Results The mRNA level of cyelin D1 in CIA synovial lining layer was significantly higher than that of normal controls,which suggested that in situ proliferation of synoviocytes might contribute to the thickening of rheumatoid synovial lining layer.The synovial expression intensity of the mRNA level of cyclin D1 in the treatment groups was decreased evidently.The mRNA level of cyclin D1 of the combination treatment group was higher than other groups,which was statistically significant (P＜0.05).Conclusion This is the first research on the effects of MTX combined with CTX intermittently based on cell cycles in CIA animal model.Combination therapy seems to be more effective than single-agent therapy.The results suggest that combining cell cycle stage specific agent MTX with cell cycle stage nonspecific agent CTX may be synergistic in the treatment of RA.Inhibition of the increased expression of the synovial cyclin D1 mRNA maybe an important mechanism of the MTX and CTX combination treatment for RA.

Objective To investigate the effect of combination low-dose of methotrexate (MTX) and cy-clophosphamide (CTX) intermittent therapy on the synovial cell p53 expression of collagen-indued arthritis Rats. The possible synergistic effect is examined and the possible meehaniams are evaluated. Methods Models of CIA were successfully established in 75 female Wistar rats. The CIA rats were then randomized into controls. At the end of this 24-week study the synovium of ankle joints were obtained, fixed, decalcified, wrapped and cut into slices. The intensity of p53 mutations expressions was examined by immunohistochemi-stry method. Results The intensity of p53 mutations expression of synoviocytes in CIA model group was significantly higher than that in the controls. In addition, the p53 mutations expressions in the synoviocytes of the treatment groups were decreased markedly, which did not return to the baseline level. The improvement of p53 mutations in the combination treatment group was higher than the single treatment groups and the difference was statistically significant (P<0.05). However, the difference between the combination treatment group and high-dose MTX treatment group was not significant. Conclusion Low-dose of MTX combined with CTX has the same efficacy comparing to high-dose of MTX in inhibiting p53 expression of CIA rats synoviocytes, but it is superior to low-dose single drug group. The results suggest that the combination of MTX and CTX may be synergistic in the treatment of RA.

Objective To study the MRI of cervical spinal cord injury without fracture and dislocation and explore of the apparent diffusion coefficient (ADC) of injured site related to the severity of injury. Methods 46 patients with cervical spinal cord injury without fracture and dislocation and 20 healthy controls were scaned with routine MRI and diffusion weighted imaging. The ADC value of site of injury and grades of Frankel's classification were analyze with the correlation. Results There were 22 cases with spinal cord edema, 8 cases with intramedullary hemorrhage, 14 cases with edema and hemorrhage, 2 cases without abnormal finding. The ADC of controls and patients were (1.05±0.12)×10-3 mm2/s, (1.21±0.23)×10-3 mm2/s (t=0.704, P<0.05). The ADC values positively correlated with the grades of Frankel's classification (r=0.407, P<0.05). Conclusion MRI may help to find the cervical cord injury in those without fracture and dislocation, and the ADC may be resposible to the severity of injury.

Objective To explore the symptoms of anxiety,family structure,and the distribution features of family about in-patients.And to find out the influence of the family structure on in-patients' symptoms of anxiety.The results would provide evidentiary support and suggestions for in-patients to improve quality of life and for prevention and intervention of anxiety.Methods Family table was used to register the family structure which was classified as the nuclear family,stem/expended family and other classification.The anxiety of in-patients was measured by self-rating anxiety scale.Results A total of 512 cases of in-patients completed the survey,there were 483 valid questionnaires.The rate of effective questionnaire was 94.34％.In family structure of in-patients,core family accounted for 48.65％,stem/expended family was 36.85％.The sex of family structure showed significant difference,the female proportion of the nuclear family was significantly higher than male.Among all in-patients,78.05％ did not have anxiety,low-level,medium-level,and severe anxiety showed no significant differences.The effects of anxiety on family structure had significant differences.The anxiety level of stem family was relatively higher.Conclusions Economic development and the population flow due to industrialization and globalization changed family structure of our country,especially in coastal de-velopment cities with fast economic development,fast-paced and stressful work,and it may affect the influ-ence of Chinese traditional family structure on anxiety of the in-patients.

Objective To investigate the image quality and radiation dose of 640-slice CT coronary arteriography(CTCA) with adaptive iterative dose reduction three-dimensional (AIDR3D)reconstrucction algoritym.Methods 640-slice CTCA with auto-matic exposure was performed on 84 consecutive patients.The original image data were reconstructed with AIDR3D and the filtered back-projection (FBP)algorithms at the image postprocessing workstation.Two experienced radiologists without knowing clinical information and reconstruction algorithms independently measured and calculated the image noise,signal-to-noise ratio and contrast-to-noise ratio with AIDR3D and FBP reconstruction algorithms.The qualitative image quality was assessed by using the 4-point scale.The radiation dose was calculated based on dose-length product exported on CT scanner.The quantitative and qualitative im-age quality with two kinds of reconstruction algorithm was analyzed statistically.Results The CTCA image noise was (27.20± 4.40)HU with AIDR3D and (60.00±12.40)HU with FBP,which with AIDR3D was decreased by 46.10% than that with FBP;the signal-to-noise ratio was 21.10 ± 5.10 with AIDR3D and 11.40 ± 2.80 with FBP,which with AIDR3D was increased by 84.70% than that with FBP;the contrast-to-noise ratio was 24.70±5.10 with AIDR3D and 13.50±3.20 with FBP,which with AIDR3D was raised by 82.20% than that with FBP,the differences in 3 indexes between the two kinds of reconstruction algorithm were statistically significant(P < 0.05 ).The CTCA qualitative image quality scores of proximal,middle and distal parts with AIDR3D were (3.90±0.30),(3.70±0.50)and (3.60±0.60)respectively,which all were higher than (2.60±0.60),(2.30± 0.60)and (2.10±0.70)with FBP respectively,the differences in 3 items between 2 kinds of algorithm had statistical significance (P <0.05).The total segments which could be used to diagnose the CTCA images with AIDR3D and FBP algorithms were 1 216 segments (96.50%)and 504 segments (40.00%),respectively,the difference had statistical significance(P <0.05).The mean ef-fective radiation dose was (2.10±1.00)mSv.Conclusion 640-slice CTCA with AIDR3D reconstruction algorithm not only signifi-cantly reduces the image noise than the conventional FBP algorithm,improves the quantitative and qualitative image quality,but also decreases the effective radiation dose.

It is the hotspot that studying the interplay and mechanism between intestinal flora metabolites and diseases.Deoxycholic acid, one of the intestinal flora metabolites, is one of the most abundant secondary bile acids in human intestinal tract, which is corelated with many diseases, while the mechanisms remain unclear.The imbalance of deoxycholic acid is connected with the intestinal flora disorder and high fat diet, which could result in several immunoreaction and inflammatory reaction.In this review, the interaction between deoxycholic acid and digestive diseases in children, such as non-alcoholic fatty liver disease, inflammatory bowel disease and irritable bowel syndrome, is discussed to explore their related mechanism, so as to clarify the direction of further study on the influence of intestinal microbiota metabolites deoxycholic acid on the human body.

Objective To investigate the correlation between ipsilateral prominent posterior cerebral artery laterality (PCAL) and white matter hyperintensities (WMHs) in patients with severe internal carotid artery (ICA) stenosis. Methods From April 2016 to December 2017, patients with unilateral ICA stenosis≥70% (including occlusion) and contralateral ICA stenosis <50% or no stenosis admitted to the Department of Neurology, Liaoning Provincial People's Hospital were enrolled. According to the presence or absence of PCAL on the ipsilateral side of ICA stenosis, they were divided into positive group and negative group, and the severity of WMHs was compared between the 2 groups. The patients were grouped according to the severity of overall WMHs and deep WMHs (DWMHs) and periventricular WMHs (PWMHs) on the ipsilateral side of ICA stenosis. Multivariate logistic regression analysis was used to determine the independently relevant factors of WMHs. Results A total of 131 patients were enrolled, 65 of them (49.62% ) had ipsilateral PCAL positive. The proportion of severe DWMHs in this group was significantly lower than that in the ipsilateral PCAL negative group (38.46% vs. 59.09% ; χ2 =5.578, P=0.018 ). Multivariate logistic regression analysis showed that advanced age (odds ratio [ OR] 2.196, 95% confidence interval [ CI] 1.278-3.773; P=0.004), hypertension (OR 3.279, 95% CI 1.107-9.709; P=0.032), and high systolic blood pressure (OR 1.027, 95% CI 1.002-1.053; P=0.031) were independently associated with severe overall WMHs; advanced age (OR 1.957, 95% CI 1.141-3.358; P=0.015) and hypertension (OR 4.739, 95% CI 1.570-14.286; P=0.006) were independently correlated with ipsilateral severe DWMHs, ipsilateral PCAL (OR 0.340, 95% CI 0.135-0.856; P=0.022 ) was independently correlated with ipsilateral mild DWMHs; advanced age (OR 1.805, 95% CI 1.175-2.775; P=0.007) and high systolic blood pressure (OR 1.030, 95% CI 1.007-1.053; P=0.010) were independently correlated with ipsilateral severe PWMHs. Conclusion Ipsilateral PCAL is an independent protective factor for ipsilateral DWMHs in patients with severe ICA stenosis.

Objective To explore the therapeutic effect of drinking water test combined with swallowing training on cerebral infarction patients with dysphagia.Methods A total of 68 cerebral infarction patients with dysphagia in our department were randomly divided into observation group and control group.The control group was given routine nursing,while the observation group was given drinking water test to guide diet,and systemic swallowing function training on the basis of the control group.The therapeutic effects,feeding conditions and VSD scale scores were compared after 1 month of intervention between the two groups.Results The drinking water test score in the observation group was lower than that in the control group,and the total effective rate of the swallowing function improvement was higher than that in the control group,the differences were statistically significant (P ＜ 0.05).The FOIS score in the observation group was higher,and the score of VSD scale was lower than that in the control group,the differences were statistically significant (P ＜ 0.05).Conclusion Drinking water test combined with swallowing training can effectively improve the swallowing function of patients with dysphagia after cerebral infarction,and is beneficial to the normal diet of the patients.

Objective To study the effect of comprehensive nursing intervention on improving postoperative pain in middle-aged and elderly patients with proximal humerus fractures.Methods A total of 94 elderly patients underwent surgical treatment of proximal humerus fractures were divided into control group and experimental group according to the random number table method,with 47 cases per group.The control group was given routine fracture nursing intervention during perioperation,and the experimental group was given comprehensive nursing intervention on the basis of conventional nursing,all the patients were followed up for 6 months.The complications,the degree of pain and the recovery of shoulder function were observed and compared between the two groups.Results The total incidences of complication in postoperative bedsores,respiratory infections,fluctuations in blood pressure,inflamed fractures were lower than that in the control group (P ＜ 0.05);The VAS score of the experimental group was lower than that of the control group at 1 d,1 week and 1 month after nursing intervention (P ＜ 0.05).The Constant-Murley score of the experimental group was significantly higher than that of the control group at 3 months and 6 months after the intervention (P ＜ 0.05).Conclusion Comprehensive care intervention is effective for elderly patients with proximal humerus fractures in the perioperative period,and it can effectively reduce postoperative complications and degree of postoperative pain,promote patients'shoulder function recovery,so it is worthy of application and promotion.