Objective To investigate the clinical effect of butylphthalide combined with edaravone in the treatment of progressive cerebral infarction and its impact on neurological deficits and hemorheology .Methods 78 patients with progressive cerebral infarction were divided into the control group and observation group according to the random number table ,39 cases in each group .The two groups were given conventional treatment ,the control group was given edaravone on the basis of the conventional treatment ,while the observation group was given butylphthalide soft capsules and edaravone .All of the patients were given continuous medication for 12d.The degree of neurological deficit score,clinical assessment efficacy and adverse reactions were compared between the two groups .Results The total effective rate of the observation group was 89.74%,which was significantly higher than 66.67% of the control group(χ2 =11.672,P<0.05).After treatment,the NIHSS scores were decreased significantly (t=11.04,12.88,all P<0.05),that in the observation group was declined more significantly ,compared with the control group ,the differ-ence was statistically significant (t=10.93,P<0.05).After treatment,the fibrin level,blood viscosity and platelet aggregation of the observation group were significantly lower than those of the control group ( t=6.69,6.22,7.30,all P<0.05).Conclusion Butylphthalide combined with edaravone in the treatment of progressive cerebral infarction can significantly improve the patients'neurological symptoms ,reduce fibrin level ,blood viscosity and platelet aggrega-tion,and its security is good ,which is worth to be applied in clinical .

Aim To investigate the inhibition of cell proliferation and the expression of PCNA gene of human glioma U251 by elemene.Methods Normal control and treatment group with elemene in human glioma U251 were studied, then the inhibition effect was examined by MTT methods and the density of half death was worked out (IC50). The expression of PCNA protein and gene was examined by immunohistochemical method and RT-PCR in different action time or at different concentrations.Results Elemene had a marked antineoplastic effect on glioma U251 with the dependence of dose and time,IC50 was 0.062 g?L-1. Elemene exhibited the expression of PCNA protein and gene,which could be examined by immunohistochemical method and RT-PCR. The expression of PCNA mRNA was lowered with the increase of drug concentration and action time.Conclusion Elemene inhibited the expression of PCAN gene,induced the inhibition of cell proliferation,and had a marked antiproliferative effect on glioma cells.

Objective:To study the clinical efficacy of levosimendan combined with naoxintong capsule in the treatment of acute heart failure and effects on the serum amino terminal B type natriuretic peptide precursor (NT-proBNP),Galectin-3,endothelin 1 (ET-1),Cystatin C levels.Methods:90 patients with acute heart failure from March 2015 to June 2016 in our hospital were selected and divided into observation group (n=45) and control group (n=45) by lottery method.Patients in the control group were treated by levosimendan alone.Patients in the observation group were treated by Naoxintong capsule combined with levosimendan.The clinical effect,changes of serum NT-proBNP,galectin-3,ET-1,cystatin C levels before and after treatment and the incidence of adverse reactions were compared between two groups.Results:After treatment,the total effective rate was 93.33％ in the observation group,which was higher than that in the control group (77.78％) (P＜0.05);the left ventricular fractional shortening,left ventricular ejection fraction,stroke volume of both groups were higher than those before treatment,the blood pressure,heart rate and serum NT-proBNP,galectin-3,ET-1,cystatin C levels were lower than before treatment,and LVFS,LVEF,SV levels of the patients in the observation group were significantly higer than those of the control group (P＜0.05),the blood pressure,heart rate and serum NT-proBNP,galectin-3,ET-1,cystatin C levels were lower than those of the control group (P＜0.05).Conclusion:Levosimendan combined with Naoxintong Capsule could improve the therapeutic effect of acute heart failure with higher safety and reduce the levels of serum NT-proBNP,Galectin-3,ET-1 and Cystatin C.

Objective:To explore influence of position of myocardial infarction and coronary artery lesions in patients with acute ST elevation myocardial infarction (STEMI) ,and the relationship among heart failure ,arrhythmia and severity of coronary artery lesion .Methods :Clinical data of 224 patients ,who hospitalized in our hospital because of STEMI and received coronary angiography from Jan 2009 to Jun 2011 ,were retrospectively analyzed .General data of patients were collected ,and SYNTAX score was used to reflect severity of coronary artery lesion ,and the rela‐tionship among heart failure ,arrhythmia and SYNTAX scores were analyzed .Results:Incidence rate of heart fail‐ure in patients with infarction relate artery left anterior descending artery (LAD) AND/or left main coronary artery (LM) was significantly higher than that of patients with right coronary artery (RCA) (57.0% vs .39.7% , P=0.017) ,incidence rate of arrhythmia in patients with RCA was significantly higher than that of patients with left circumflex artery (LCX) (37.0% vs .6.3% , P=0.016);incidence rates of arrhythmia (48.4% ) ,shock (54.8% ) were highest in patients with inferior wall/right ventricle than those of other position , P<0.05 or <0.01.SYNTAX scores in patients with heart failure and arrhythmia were significantly higher than those of patients without heart failure and arrhythmia respectively [ (18.7 ± 9.1) scores vs .(15.4 ± 8.6) scores ,(19.7 ± 9.0) scores vs .(16.1 ± 8.8) scores , P<0.01 both] .Conclusion:Incidence rates of heart failure ,cardiogenic shock and arrhythmia are related to coronary artery lesions position and degree and myocardial infarction position in STEMI patients .

Objective: To investigate the mechanism of vascular endothelial growth factor ( VEGF)165 and hepatocyte growth factor (HGF) improving cardiomyocyte proliferation in experimental porcine after myocardial infarction (MI).
Methods: The MI model was established by left anterior descending artery ligation in 15 male pigs and the animals were divided into 3 groups, n=5 in each group. Control group, the pigs received normal saline injection at the infarct and peri-infarct zones. VEGF group, the pigs received (1×1010 ) pfu of viral titers of Ad-VEGF injection. HGF group, the pigs received (1×1010 ) pfu of viral titers of Ad-HGF injection. The myocardial perfusion and cardiac function were examined by SPECT, the protein expressions of VEGF165 and HGF were measured by Western blot analysis, cardiomyocyte proliferation was analyzed by immunolfuorescence and immunoprecipitation method.
Results: ① Compared with Control group, the expressions of VEGF165 and HGF were higher at the infarct and peri-infarct zones in both treatment groups; ② Both treatment groups had better cardiac function and myocardial perfusion; ③ Both treatment groups had improved cardiomyocyte proliferation at the infarct and peri-infarct zones.④VEGF165 promoted cardiomyocyte proliferation via p27 pathway;⑤HGF promoted cardiomyocyte proliferation via p21 and p27 pathways.
Conclusion: VEGF165 and HGF could improve myocardial perfusion and function in experimental porcine after MI, VEGF165 and HGF promote cardiomyocyte proliferation via different pathways.

OBJECTIVE: To evaluate the difference and correlation between continuous non-invasive arterial pressure (CNAP) monitor and pulse indicated continuous cardiac output (PiCCO) monitor on determination of hemodynamic parameters in mechanically ventilated critically ill patients, and to assess the feasibility of non-invasive monitoring of hemodynamics with CNAP. METHODS: A prospective observation self-control study was conducted.The critically ill patients with mechanical ventilation who needed hemodynamics monitoring, and admitted to the fourth department of intensive care unit (ICU) of Fujian Provincial Hospital from June 2018 to March 2019 were enrolled. PiCCO catheter were inserted immediately after admission, the hemodynamic indexes were measured by thermodilution method, and mean arterial pressure (MAP_PiCCO), cardiac index (CI_PiCCO), pulse pressure variation rate (PPV_PiCCO) and systemic vascular resistance index (SVRI_PiCCO) were obtained at 0 hour and 24 hours respectively. Meanwhile, the above indexes (MAP_CNAP, CI_CNAP, PPV_CNAP and SVRI_CNAP) were measured with CNAP. All measurements were repeated thrice and average values were reported. The differences in above parameters between the two methods were evaluated. Pearson test was used for the correlation analysis and Bland-Altman analysis method was used for consistency test. RESULTS: Thirty-eight patients were enrolled into this study. One patient died within 24 hours was excluded, 2 patients were excluded due to withdrawing treatment within 24 hours, 2 patients were excluded because of atrial fibrillation, and 1 patient's data was lost due to technical problems. Thus, data from 32 patients were available for final analysis. There were 12 females and 20 males, aging 26-84 years old with the mean of (66.8±19.1) years old, body mass index (BMI) of (23.7±3.9) kg/m², acute physiology and chronic health evaluation II (APACHE II) score of 19.5±5.3, sepsis-related organ failure assessment (SOFA) score of 9.7±4.1. There were no significant differences in CI or PPV between CNAP and PiCCO groups [CI (mL×s^-1×m^-2): 59.8±12.6 vs. 58.5±14.2, PPV: (14.7±6.8)% vs. (14.0±6.8)%, both P > 0.05]. MAP and SVRI measured by CNAP were significantly higher than those measured by PiCCO [MAP (mmHg, 1 mmHg = 0.133 kPa): 65.6±9.4 vs. 60.1±9.2, SVRI (kPa×s×L^-1×m^-2): 206.2±53.9 vs. 179.5±57.8, both P < 0.01]. The correlation analysis showed that MAP, CI, PPV and SVRI measured by the two methods were significantly positively correlated (r value was 0.624, 0.864, 0.835 and 0.655 respectively, all P < 0.05). Bland-Altman analysis showed that CNAP and PiCCO had a good consistency for the measurement of CI and PPV, the average differences were 1.2 mL×s^-1×m^-2 and 0.5% respectively, while the 95% confidence interval (95%CI) were -12.8-15.3 mL×s^-1×m^-2 and -7.1%-8.2% respectively. However, the consistency of MAP and SVRI measured by those two methods was poor, the average differences were 5.5 mmHg and 26.8 kPa×s×L^-1×m^-2 respectively, while the 95%CI was -10.4-21.3 mmHg and -64.5-118.0 kPa×s×L^-1×m^-2 respectively. CONCLUSIONS CNAP was comparable with PiCCO when monitoring CI and PPV in mechanically ventilated critically ill patients; while the results of MAP and SVRI might be inaccurate, which should be interpreted correctly and carefully.
Adult ; Aged ; Aged, 80 and over ; Arterial Pressure ; Cardiac Output ; Critical Illness ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Prospective Studies ; Respiration, Artificial

Objective: To investigate the value of pulse indicator continuous cardiac output (PiCCO) monitoring in the treatment management of patients with severe heart failure. Methods: Sixty patients of severe heart failure admitted to intensive care unit (ICU) of Fujian Provincial Hospital from August 2017 to February 2019 were enrolled, and they were divided into control group and treatment group according to random number table method, with 30 in each group. The treatment group used bedside PiCCO to carry out minimally invasive hemodynamics monitoring, according to the monitoring data target guidance for vasoactive drugs and liquid management. The control group was based only on traditional electrocardiogram (ECG) monitoring and lung sound, urine volume of vasoactive drugs and liquid management. The changes of cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), invasive mean arterial pressure (MAP) and central venous pressure (CVP) were observed before and 72 hours after treatment in the treatment group. The 7-day total effective rate, the length of ICU stay and 28-day mortality were compared between the two groups. Results: Compared with before treatment, CI and MAP in the treatment group were significantly increased after treatment [CI (mL·s^-1·m^-2): 53.34±16.67 vs. 35.01±13.34, MAP (mmHg, 1 mmHg = 0.133 kPa): 72.6±10.6 vs. 62.5±10.3, both P < 0.05], GEDVI, EVLWI, SVRI, CVP were significantly decreased [GEDVI (mL/m²): 760.3±90.2 vs. 960.2±110.3, EVLWI (mL/kg): 6.5±1.3 vs. 12.5±6.2, SVRI (kPa·s·L^-1·m^-2): 297.3±35.1 vs. 434.1±58.8, CVP (mmHg): 10.1±2.6 vs. 12.2±3.4, all P < 0.05]. Compared with the control group, the 7-day total effective rate of the treatment group was significantly higher (90.0% vs. 80.0%), the length of ICU stay was significantly shorter (days: 8.2±4.5 vs. 10.3±2.5), and the 28-day mortality was significantly lower, with statistically significant difference (all P < 0.05). Conclusion PiCCO monitoring is a goal-oriented treatment management for patients with severe heart failure, which is helpful to individualized accurate treatment, shorten the length of ICU stay and improve short-term prognosis.

Objective:To explore the efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome (ACS) Chinese patients using glycoprotein Ⅱb/Ⅲa inhibitor (GPI).Methods:The data from CCC-ACS (Improving Care for Cardiovascular Disease in China-ACS) project were systematically reviewed in ACS patients with GPI. The patients were divided into ticagrelor and clopidogrel groups. A logistic analysis and propensity score matching (PSM) were performed to compare occurrences of major cardiovascular events (MACE) and bleeding events between the two groups during hospitalization.Results:A total of 63 641 ACS patients were collected from 150 hospitals. Logistic regression analyses showed that there was no statistically significant difference in the reduction of MACE between ticagrelor and clopidogrel when using GPI ( OR=0.881, 95% CI 0.599-1.296; P=0.521). However, major bleeding rate was higher in the ticagrelor group than that in the clopidogrel group ( OR=1.401, 95% CI 1.075-1.852; P=0.013). Similar results were observed after PSM. No statistic difference in MACE between the ticagrelor and clopidogrel group ( OR=0.919, 95% CI 0.613-1.376; P=0.681). Major bleeding rate was higher in the ticagrelor group ( OR=1.559, 95% CI 1.130-2.150; P=0.007). Conclusion:In ACS patients with GPI, ticagrelor did not reduce MACE, but increased the major bleeding risk compared with clopidogrel.

Objective To explore the effect of short-term intensive rehabilitation training on respiratory function, motor function and the life quality of patients with obstructive sleep apnea combined with chronic obstruc-tive pulmonary disease ( OSA-COPD) . Methods Fifty-seven patients with OSA-COPD were randomly divided in-to an observation group and a control group. Both groups were treated with non-invasive positive pressure ventilation ( NPPV) , oxygen therapy and a bronchodilator, while the observation group was additionally provided with 8 weeks of intensive lung rehabilitation training, including respiratory function training and limb exercise training. Polysom-nography was used to monitor the apnea hyponea index ( AHI) , the lowest oxygen saturation level during the night ( LowSpO2 ) and the nocturnal oxygen saturation ratio for ＜ 90% of total sleep time ( tst90) . Arterial blood gases, forced vital capacity ( FVC) and forced expiratory volume in one second ( FEV1 ) were measured. The 6-minute walk test (6MWT) and St. George's respiratory questionnaire ( SGRQ) were used to evaluate all the patients before and after the intervention. Results After 8 weeks of treatment, the average AHI, LowSpO2 , TST90 and PaO2 had improved significantly in both groups. There was no significant difference between them. After the treatment the average FVC, FEV1 and 6MWT time of the observation group were significantly better than before the treatment and the significantly better than the control group's averages. After treatment, the average SGRQ score and activity abili-ty score of the observation group were also significantly improved and significantly better than the control group's av-erages. Conclusions NPPV can effectively improve OSA-COPD patients'tolerance of short-term intensive pulmo-nary rehabilitation training. With that assistance, short-term intensive rehabilitation training can promote the recov-ery of respiratory function and motor function, and improve the life quality of patients. Therefore, such therapy is worthy of clinical promotion and application.

Objective To explore the effect of pulmonary rehabilitation training on the respiratory function,motor function,life quality,survival and complications of patients with non-operative lung cancer.Methods A group of 88 patients with non-operative lung cancer was randomly divided into a training group (n=45) and a control group (n=43).Both groups were given anti-tumor therapy,while the training group was additionally provided with systematic respiratory training,including breathing pattern training,cough and expectoration training,respiratory gymnastics and walking training.Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) were measured at the outset and after 8,16 and 24 weeks of the training.The 6-minute walk test (6MWT) was administered along with the QLQ-C30 assessment of the European Organization for Research and Treatment of Cancer.Complications in both groups were also recorded and analyzed.The progression-free survival (PFS) and overall survival (OS) were followed up after the treatment.Results After 8,16 and 24 weeks of the treatment,the average FVC and FEV1 volumes and the 6MWT times of the training group were significantly better than those before treatment and significantly better than the control group averages.Indeed,no significant improvement was observed in the control group's average FVC,FEV1 or 6MWT results.After 24 weeks the treatment group's average scores on the physical function,social function,emotional function,fatigue,nausea and vomiting,pain,dyspnea,insomnia,appetite,constipation,and overall quality of life sub-scales of the QLQ-C30 had all improved significantly more than in the control group.The incidence of pulmonary complications in the control group (26％) was significantly higher than that in the training group.(11％).The median PFS and OS of the training group (14.3 and 27.3 months) were not significantly better than those of the control group,however.Conclusion Respiratory exercise training and aerobic exercise training combined with the anti-tumor therapy,while not prolonging survival,can effectively improve the life quality of patients with non-operative lung cancer,reducing the incidence of complications and promoting the recovery of respiratory function.The combination is worthy of popularization in clinical practice.