Objective To investigate the effects of noisy pressure support ventilation (Noisy PSV) in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure, and to provide basic support for the new weaning mode for AECOPD. Methods A single-center, prospective, randomized, crossover clinical research was conducted. A total of forty-six AECOPD combined with respiratory failure patients who mechanically ventilated more than 24 hours in intensive care unit (ICU) of Tianjin Haihe Hospital from November 2014 to October 2015 were enrolled in this study. When the respiratory failure improved through conventional treatment, patients were mechanically ventilated with conventional PSV and Noisy PSV for two hours respectively in random sequence during spontaneous breathing recovery phase. The pressure support (PS) level was titrated to reach tidal volumes (Vt) about 8 mL/kg in both modes. The level of positive end-expiratory pressure (PEEP) and fraction of inspired oxygen were kept unchanged in both modes. The coefficient of variation of PS during Noisy PSV was set at 30%. Data of gas exchange, hemodynamics, lung functional parameters, breathing patterns and patient-ventilator synchrony were analyzed. Results All of the patients were well tolerated with the two modes, and no adverse reactions were found. The changes of gas exchange, hemodynamics, respiratory mechanics in PSV and Noisy PSV showed a clinical acceptable range. The variability of Vt was significantly increased in Noisy PSV mode than that in conventional PSV mode. While the number of asynchrony events was decreased in Noisy PSV mode than that in conventional PSV mode. Conclusion The Noisy PSV is safe and feasible for patients of AECOPD with respiratory failure, which may be a new weaning mode for AECOPD.

Intestinal microflora is a general term for microbial communities that reside in the human intestine. In recent years, the research on diseases related to intestinal microbiota has developed rapidly. It is found that intestinal microbiota is closely related to digestive tract diseases, metabolic diseases, immune diseases, mental diseases, and lung diseases. Intestinal dysbacteriosis, mucosal barrier damaging and local immune dysfunction may be involved in a variety of disease processes. In addition, respiratory diseases such as asthma and pneumonia seriously affect human health. The intestinal microbiota is crucial in regulating immune response of lung to pathological mechanism of diseases including asthma, pneumonia and pulmonary tuberculosis. Therefore, it may be a new direction for the treatment of lung diseases by understanding intestinal microbiota in lung diseases, and identifying, describing and manipulating immunity network of pulmonary disease.

As a transmembrane protein, β-amyloid precursor protein(β-APP) distributes extensively in the central nervous system, has the effect of neurotrophic, and neuroprotective, promote neurite growth and synaptogenesis, β-amyloid(Aβ) is the digestion products of its precursor-APP in the pathological conditions, and it is the main component of senile plaques-the main pathological changes of Alzheimer' s disease (AD), its toxic effects can also induce neuronal apoptosis, The expression of the two proteins after brain injuried has a close relationship with the injury, cognitive dysfunction, Alzheimer' s disease and the pathophysiological changes of central nervous system. To explore its expression in the brain after traumatic brain injury can determine the degree of injury, assess the prognosis and open up new avenues for the treatment of traumatic brain injury.

Objective To investigate the safety and efficacy of technical modification for laparoscopic repair of giant hiatal hernias.Methods A total of 49 patients with giant hiatal hernia underwent modified laparoscopic repair by dissecting sac, closing hiatal, mesh placement and fundoplication from June 2010 to May 2014.The operation time, hospitalization time, postoperative complications, upper gastrointestinal imaging and improvement of postoperative symptoms were observed.Results The average operation time was (103.6 ±31.7) min(88-173min).The average length of post operation hospitalization was (4.2 ± 1.8) d (range,3-12d).Postoperative complication occurred in 4 patients,including pleural effusion (1 patient),respiratory failure (1 patient), difficulty in swallowing (2 patients)with complication occurrence rate being 8.2％ (4/49).No conversion or death occurred.The average time of follow-up was (28.3 ± 12.7) months (6-50 months) in 49 cases.During the follow-up, main symptoms were relieved and no recurrence was found by barium swallow.Conclusion Technical modification for laparoscopic repair of giant hiatal hernias is safe and effective.

Objective To establish the reference interval of serum urea nitrogen (BUN) ,creatinine(Cr) ,uric acid(UA) for the healthy adults of Hengshui City .Methods 16 403 cases of healthy adults of different areas in the city were enrolled in the study .By using automatic biochemical analyzer ,3 kidney function indicators(BUN ,Cr ,UA) were determined .According to different sex and age groups ,statistical analysis was performed .Results The reference intervals of 3 kidney function indicators for healthy people in Hengshui City were as follows ,BUN :2 .75-7 .05 mmol/L for male and 2 .24-6 .58 mmol/L for female;Cr:49 .69-87 .96 μmol/L for male and 35 .82-72 .22 μmol/L for female;UA :209 .51 -500 .06 μmol/L for male and 146 .25 -389 .69 μmol/L for female . Conclusion The reference intervals established could basically reflect the concentrations of 3 kidney function indicators for the healthy adults in Hengshui City ,which could provide a reference .

Objective:To investigate the prognosis of patients with liver metastasis or local recurrence after radical resection of rectal cancer,in order to provide reference for the further screening of high-risk patients for the precise therapeutic methods.Methods:The clinicopathological factor and follow-up data of 485 patients who underwent surgical treatment for rectal cancer from March 2005 to January 2016 were retrospectively analyzed.Including 75 liver metastasis and 32 local recurrence.The prognosis were compared between the patients with liver metastasis and with local recurrence.Results:The difference was statistically significant in CEA level,primary tumor position,surgical methods,tumor cell differentiation,tumor infiltration depth between liver metastasis and local recurrence after radical resection of rectal cancer (P＜0.05).The 1-,3-and 5-year overall survival rates were 76.6％,53.1％ and 18.8％ respectively of patients with liver metastasis,The 1-,3-and 5-year overall survival rates were 81.3％,62.5％ and 37.5％ respectively of patients with local recurrence,the difference was statistically significant(P＜0.05).Conclusion:There were different clinicopathological characteristics of patients between liver metastasis and local recurrence.The prognosis of patients with local recurrence was better than patients with liver metastasis.

Objective To establish the reference intervals of total cholesterol (TC),triglyceride (TG),high density lipoprotein (HDL-C)and low density lipoprotein (LDL-C)in the healthy population in Hengshui region.Methods 16 403 healthy individuals were collected from the various counties and cities in this region and detected the above 4 blood lipid indexes (TC,TG,HDL-C, LDL-C)by adopting the automatic biochemical analyzer.The subjects were grouped according to different genders and ages and the detection results were performed the statistical analysis.Results TC 3.17-7.20 mmol/L;TG 0.08-3.16 mmol/L;HDL-C 0.94-2.30 mmol/L;LDL-C 1 .14 -4.59 mmol/L.Conclusion The differences of blood lipid detection results exist in males and fe-males in Hengshui region,the results are different among different age groups,it is suggested that different genders and different age groups should establish their own normal reference intervals in order to provide the diagnostic basis for clinic.

Objective To observe the effects of dexmedetomidine (DEX) on the expressions of TNF-α, IL-1β and apoptosis-related proteins in rat mesenteric artery.Methods Male SD rats of SPF grade were sacrificed and the mesenteric artery was separated under the stereo-microscope.We established an experimental model of vascular injury induced by lipopolysaccharide (LPS) and randomly divided the injured vessels into dexmedetomidine treatment group and control group.DEX treatment group was divided into 10-8, 10-7, and 10-6 mol/L subgroups according to the different concentrations of DEX.RNA and total protein was extracted in each group.The mRNA expressions of TNF-α, IL-1β and CaSR were detected by RT-PCR and the protein expression of TNF-α, Caspase-3 and AMPK were tested by Western blot.Results DEX (10-8, 10-7, and 10-6mol/L) obviously reduced vascular inflammatory reaction induced by lipopolysaccharide, reduced the mRNA and protein expressions of TNF-α as well as mRNA expression of IL-1β.Caspase 3 protein expression significantly lowered in blood vessels in DEX group compared with LPS group.DEX had no obvious effect on lipopolysaccharide-induced vascular AMPK and CaSR mRNA or protein expressions.Conclusion DEX obviously deceased the expressions of inflammation-related proteins, suggesting that DEX has anti-inflammatory effects.

Objective:To evaluate the efficacy of computed tomography (CT)-guided implantation of radioactive ~(125)I seeds in the treatment of residual foci of nasopharyngeal carcinoma after radiotherapy.Methods:Twenty-five nasopharyngeal carcinoma patients who had residual foci after radiotherapy were implanted radioactive ~(125)I seeds from January 2007 to January 2008 in our hospital. Three-dimensional treatment planning system (TPS) was used to calculate the quantity and total dosage of ~(125)I seeds. The radioactive ~(125)I seeds were implanted into residual foci under CT guidance. The dosage distribution of radioactive ~(125)I seeds were verified after surgery. The nasopharyngeal endoscopy CT scans were performed at 3, 6, and 12 months after surgery and the short-term efficacy and adverse reaction were evaluated. Results:Out of the 25 patients, 20 patients had complete response (CR), 2 patients had partial response (PR), 2 patients had no change (NC), and 1 patient had progressive diseases (PD). The overall effective rate (CR+PR) was 88.0%. All patients had no serious postoperative complications. Conclusion:CT-guided implantation of radioactive ~(125)I seed was an effective and safe method in the treatment of the residual foci of nasopharyngeal carcinoma after radiotherapy.

We report the treatment process of a patient with acute vertebral artery occlusion complicated by top of the basilar artery syndrome after arterial thrombolysis.The top branches of vertebral artery and basilar artery were patent after the mechanical and drug thrombolysis again. The prognosis of the patient was good. The modified Rankin scale score was 1. It suggested that in addition to the arterial local thrombolysis was effective to the lesions themselves, it also had good efficacy for the newly developed embolic complications during the process of thrombolysis.