Objective To investigate the clinical efifcacy of Tiotropium Bromide inhaler on patients with stable chronic obstructive pulmonary disease(COPD). Methods 134 cases with stable COPD were equally randomized into three groups. The conventional treatment group(n=46) were 40 male and 6 femal, aged (63.20±9.3)years old and treated with sustained-release theophylline 0.1 g orally. Observation group with 18μg Tiotropium Bromide(n=45) were 40 male and 5 femal, aged (63.4±85)years old, and given inhaled Tiotropium Bromide 18μg. Observation group with 32μg Tiotropium Bromide(n=43) were 39 male and 4 femal, aged (63.2±9.0)years old, and given inhaled Tiotropium Bromide 32 μg. All patients received same routine therapy, and lasted for 4 weeks. improvement Pre-and post-treatment Lung function and quality of life were compared among those groups. Results In observation group, the results of St George respiratory questionnaire decreased signiifcantly after treatment, which was signiifcantly lower than those of the routine-treatment group (P<0.05). FEV 1/FVC, FEV 1/Pred, FEV 1 were signiifcantly higher than those before treatment (P<0.05). However, the control group showed no signiifcant difference. Conclusion Inhaled Tiotropium Bromide can improve lung function and life quality of paitents with stable COPD, the dose with 32μg per day, which was signiifcantly lower than 18μg per day.

Objective To study the effect and nursing of Mayinglong musk hemorrhoids ointment on anus periderm skin damage of fecal incontinence patients. Methods Thirty-one patients with fecal incontinence-induced anus periderm skin damage from March 2012 to February 2013 in the hospital were set as the control group and another 32 patients with the same disease from March 2013 to January 2014 as the observation group. The anus periderm skin damage of the observation group was treated with Mayinglong musk hemorrhoids ointment 3 to 4 times a day. The anus periderm skin damage of the control group were treated with zinc oxide ointment, 3 to 4 times a day. Both groups used ostomy. The two groups were compared in terms of total effective rate in a month. Result The total effective rate of the observation group was 93.8% and the control group was 71.0%, with significant difference between the groups (P<0.05). Conclusions Mayinglong musk hemorrhoids ointment can be more effective in the treatment of fecal incontinence caused by anus periderm skin damage than zinc oxide ointment. It can improve the effect of treatment and reduce local wound pain. It is convenient to use, cheap and thus worthy of clinical popularization and application.

Objective To evaluate the efficacy of the flexible ureteroscopy and Holmium and FREDDY laser lithotripsy for renal calculi at various locations.Methods From May 2002 to May 2007,338 cases of renal calculi(sized less than 20 mm in diameter)were treated by flexible ureteroscopy and laser lithotripsy in our hospital.The data of the patients were analyzed retrospectively.Among the cases,the calculi were located at the upper or middle calyx or the renal pelvis in 288 patients,at the lower calyx in 37,and in multiple calyxes in 13.All the patients received KUB and IVU before the procedures.With the TerumoTM settled in place,a F8/9.8 Wolf rigid ureteroscope was inserted to observe and dilate the ureteral lumen.Then,an Olympus P3 6.9F flexible ureteroscope was used.When the insertion of the rigid ureteroscope was difficult,a re-ureteroscopy would be tried 2 weeks later with a pig-tail stent in place.The WOM U-100 FREDDY laser and the Lumenis Holmium laser were used to perform the procedure and a pig-tail stent would be set at the end of the procedure.The urethral catheter was removed in the first postoperative day and an intravenous antibiotic prophylaxis was administrated during the first 2 days postoperatively.A follow-up by KUB or non-contrast CT scan was done 4 weeks after the procedure to evaluate the result of the endoscopic nephrolithotripsy.Any residual calculi larger than 4 mm in diameter was taken significant.Results In 28 patients the rigid ureteroscope or the ureteral sheath couldn't be inserted in the first time,and the success rate of the ureteroscopic insertion was 91.7%(310/338).The re-ureteroscopy was successful in the patients after 2 weeks.The calculi were detected in 97.3%(329/338)of the patients,and the procedures succeeded in 306 of them(306/329,93.0%).The success rate of laser nephrolithotomy was 78.0%(32/41)for the lower calyx calculi,which was significantly lower than that for the middle,upper calyxes or renal pelvic calculi 95.1%(274/288),?2=13.601,P=0.000].After 4 weeks,the total evacuation rate of the calculi was 87.6%(296/338).For the calculi in the upper or middle pole or in the renal pelvis,the complete evacuation rate was 90.1%(264/293),which was significantly higher than that for the lower pole 71.1%(32/45),?2=12.929,P=0.000].No patient had ureteric perforation or active bleeding after the surgery.The mean operation time was 35 min(12-55 min).After the operation,11 cases developed nephritic colic.None of them had septicemia or acute renal failure.Gross hematuria disappeared in 1-2 days postperation.Conclusions The flexible ureteroscopy and Holmium and FREDDY laser lithotripsy are safe and effective for renal calculi sized less than 20 mm in diameter,especially for those in the upper,middle poles and renal pelvis.A re-ureteroscopy with the pig-tail stent in place is suggested in two weeks after the failure of the first procedure.

ObjectiveTo study the efficacy of immunosuppressant IL-1RA on the rat model of penetrating keratoplasty.MethodsCorneal transplantation were performed orthotopically from Lou rats to F344 rat's recipients.Animals were randomly assigned to the following groups:1.Control.2.CsA(3mg/kg/2d,subconjunctival injection).3.IL-1RA(0.5mg/kg/2d,subconjunctival injection).Treatment began at the 1st day postoperatively and continued until the 14th day postoperatively.Mean survival times and rejection index were determined.ResultsThe mean survival time of the control group was 12.235±1.674 days,but the mean survival time for CsA and IL-1RA were 17.676±1.528 days and 19.250±1.456 days,respectively,which was statistically significant compared with the control group(P<0.01).Vascularization index in IL-RA group was markedly lower when compared with the control and CsA groups(P<0.01).ConclusionIL-1RA can markedly prolong the survival time of corneal allografts by inhibiting graft rejection,and prevent vascular growth of corneal allografts

This study tested the hypothesis that controlled reperfusion with warm blood cardioplegia containing mannitol would result in more effectively improved recovery of myocardial mitochondrial function by preventing or reducing a potentially harmful component of reperfusion. Myocardial mitochondrial function was significantly depressed after 60 min reperfusion, but slightly depressed in the controlled reperfusion group. Significantly increased MDA content and decreased SOD activity were observed after 60 min reperfusion. Hearts in the controlled reperfusion group had low MDA content and might protect the activity of SOD. The- results indicate that controlled reperfusion after ischemia provides benefit in avoiding myocardial mitochondrial reperfusion injury.

Objective To compare the function and influence of magnetic resonance cholangiopancreatography (MRCP) and T tube cholangiography before pulling out T tube after biliary tract surgery. Methods Clinical data from 248 patients with T tube drainage after biliary tract surgery bewteen January 2009 and June 2011 were retrospectively analyzed.Among them, the T tube cholangiography group was 195 cases, and MRCP group was 53 cases.Analyzed the function, the toxic side reaction and effect of prolonged hospitalization time of T tube cholangiography group and MRCP group,and discussed the diagnostic effect of MRCP before pulling out T tube after biliary tract surgery.Results Two groups of patients got distinct and integrated image of the bile ducts all.Compared with T tube cholangiography group, all 53 cases patients of MRCP group got accurate of diagnosis results, no fake positive results and adverse reaction occurred, and no prolonged hospitalization. Conclusion MRCP can replace T tube cholangiography as a means of diagnosis before removal of T tube.

Objective To discuss the management of renal vein trauma in the percutaneous ne-phrostomy (PCN) procedure.Methods Three cases with renal vein trauma by PCN or malposition of nephrostomic catheter were reviewed.Case 1 was a patient with staghorn calculi.There was mas-sive hemorrhage after the puncture and the dilatation during PCN.Then the nephrostomy catheter was clamped.The post-operative CT scan showed the nephrostomy catheter passed the inferior vena cava to the right external jugular vein.Case 2 was a patient with a 3 cm calculus in the inferior calice of the right kidney.A massive haemorrage occurred after the dilatation by the 16 F sheath guided by ultra-sound during PCN.The nephrostomic catheter was found in the renal vein by X-ray film.Case 3 was a patient with bilateral hydronephrosis complicating chronic renal failure,which caused by the meta-static of the gastric carcinoma.After the puncture,the massive hemorrage appeared and a nephros-tomic catheter was placed and then clamped.The catheter was seen in the renal vein confirmed by the X-ray.For all 3 patients,the catheter was withdrawn carefully monitored by the X-ray until the place of the renal vein perforation during the first 24-48h.Then it was withdrawn 3 to 4 cm each time un-til reach the pelvic.Results The hemorrhage was well controlled and nobody needed the surgical in-tervention.There was no renal function aggravation in these 3 patients.Conclusions The renal vein trauma during the echo-guide PCN procedure can be treated by clamping the nephrostomy catheter and withdrawing it gradually.Thus,the surgical intervention can be avoided and this method will not im-pair the renal function.

BACKGROUND:Inflammatory cellactivation and the generation of oxygen free radicals are important factors of lung ischemia-reperfusion injury. Adding the drugs with anti-inflammation and antioxidant effects into the lung preservation solution used, can improve the protection fluid, and play a crucial role in the study of lung ischemia-reperfusion injury and protection of the function of transplanted lung. OBJECTIVE:To discussion the effect of harmine in canine model of pulmonary ischemia-reperfusion injury. METHODS:Twelve healthy hybrid dogs were randomly divided into two groups, with six rats in each group. A canine model of lung ischemia-reperfusion injury was established, and the protecting liquid was perfused with the clockwise irrigation method. Control group:low potassium dextran protective fluid;experimental group:low potassium dextran+harmine protective fluid. After 2 hours of ischemia, the left lung circulation was recovered. The left lung tissue and blood samples were col ected from two groups of animal models after reperfusion, and their cytokines levels and the lung wet/dry weight ratio were detected and calculated. Bronchoalveolar lavage fluid was col ected to observe the pathological indicators. The main pulmonary artery pressure, left and right pulmonary artery pressure were recorded by continuous monitoring. RESULTS AND CONCLUSION:There were no statistical y significant differences in the interleukin-17, tumor necrosis factorαand endothelin 1 content in the left lung tissue and the blood between the two groups at 2 and 4 hours after reperfusion (P>0.05). After 4 hours of reperfusion in both groups, the neutrophil number, the number of lymphocytes, alveolar edema index, and vascular wal damage in bronchoalveolar lavage fluid showed no statistical y significant differences (P>0.05). Through the analysis of variance, the main pulmonary artery pressure, left pulmonary artery pressure and right pulmonary artery pressure also had no statistical significance between the two groups (P>0.05). By the analysis of cytokines, pathological indicators, lung wet/dry weight ratio, and pulmonary arterial pressure, harmine has no significant lung protection effect in canine model of lung ischemia-reperfusion injury.

Objective To explore the dose-effect relationship and optimal concentration of sodium taurocholate (NaTc) to establish acute necrosis pancreatitis (ANP) complicating MODS in a rat. Methods 280 SD rats were randomly divided into control group (n =40) and 3.5%, 4%, 4.5%, 5% ANP group (n = 60, respectively). ANP groups were induced by retrograde injection of NaTc solution into the pancreatic duct of rats. Rats in each model group were sacrificed at 1, 3, 6, 12 and 24 h after the model induction. Serum amylase, serum total bilirubin, creatinine, blood gas analysis, and pathological changes of pancreas were determined. Survival rate at 24 h after the model induction was observed in other 20 ANP rats in each group. Results In each groups, the serum amylase level, creatinine, blood gas analysis and pathological changes all increased corresponding to the increase of NaTc, and there was significant dose-effect relationship and time-effect. In 4.5% group, the dysfunction of liver and kidney reached the peak at 6 h,while the respiratory dysfunction reached its peak at 12 h. Its incidence of MODS was 52.5%, which was significantly higher than those in 3.5%, 4.0% group (15.0% and 37.5%) ;and 24 h survival rate of 4.5% group was 65%, which was significantly higher than that in 5% group (30%). Conclusions 4.5% NaTc solution may be the optimal concentration to establish the ANP model, which had higher incidence of MODS and 24 h survival rate.

Objective To investigate the time-course change of intra-abdominal pressure (IAP), TNF-α in rat with acute necrotizing pancreatitis (ANP) and its mechanism. Methods 80 SD rats were randomly divided into ANP group and control group. ANP group was induced by retrograde injection of 4.5% sodium taurocholate into the pancreatic duct in SD rats, while control group was induced by injection of saline at the same dosage. Eight rats in each group were killed at 1 h, 3 h, 6 h, 12 h and 24 h, respectively. The serum levels of amylase, TNF-α were determined;IAP, amount of abdominal ascites, pancreatic pathologic changes were evaluated. Results The levels of amylase in ANP group increased progressively with time, which were 32-folds higher than those in control group at 24 h. The serum levels of TNF-α in ANP group reached the peak at 6 h, and were significantly higher than those in the control group. The amount of abdominal ascites increased post-ANP induction and reached the peak at 24 h, which was 4.7-folds higher than that in the control group. The IAP significantly increased 1 h after induction, which was 3 times as high as the control group in 3 h group and 9 times in 12 h group. Pathologic injuries deteriorated progressively and reached the peak at 24 h. Conclusions Significant IAP occurred in ANP rats and reached the peak at 12 h, TNF-α reached the peak at 6 h, therefore IAP may be the secondary response to inflammatory reaction.