Objective To investigate effect of tiotropium bromide combined with formoterol on oxidative stress and lipid peroxidation in peripheral blood in elderly patients with chronic obstructive pulmonary disease.Methods 80 elderly patients with chronic obstructive pulmonary disease from our hospital were selected and divided into conventional group and experimental group, conventional group on the basis of conventional therapy was treated with salmeterol xinafoate and fluticasone propionate powder for inhalation with 2 suction per times, 2 -3 times per day for 14d.Experimental group was treated with tiotropium bromide spray combined with formoterol fumarate powder for inhalation with 2 suction per times, 2-3 times per day for 14 d.7 d for a period of treatment, after 2 courses of the treatment, changes of clinical signs, blood gas levels, peripheral blood oxidative stress products and lipid peroxidation and inflammatory factors were compared before and after treatment.Results Compared with conventional group,the recovery time were shorter(P<0.05) ,and blood gas levels, peripheral blood oxidative stress products and lipid peroxidation, inflammatory factors were lower(P<0.05). Conclusion Tiotropium bromide combined with formoterol can significantly reduce airway hyperresponsiveness, inhibit inflammation, relieve clinical symptoms.And the drug resistance is low, the side effect is small, the clinical curative effect is ideal, may be the clinical treatment effective plan, and has the vital significance.

Objective To build the schema of combination between commercially available ultrasound contrast agent SonoVue and self-made liposomes,and determine its efficiency. Methods Microbubbles was labeled by carbocyanines dye DiI. The effect of DSPE-PEG-FITC labelling was determined by flow cytometer to evaluate the insertion efficiency of the amphipathic molecule DSPE-PEG(2000)Amine into lipid monomers shell. Aminated fluorescent liposomes were prepared by rotary evaporation and their size were determined by laser particle size analyzer. Liposomes and microbubbles were combined by two-step glutaraldehyde crosslinking. The impact of liposome concentration and DSPE-PEG (2000)Amine concentration on the construction efficiency of the complex of SonoVue conjugated to liposomes was determined by flow cytometer and multifunctional ELIASA respectively. Results The configuration of SonoVue microbubbles labeled by DiI and DSPE-PEG-FITC showed fine. The combination between liposomes and microbubbles was realized by glutaraldehyde crosslinking. The flow cytometer showed that 200 μl liposomes solution per 200 μl microbubbles suspension was the optimal proportion, with the peak positive rate as (87.80 ± 5.91)%. Multifunctional ELIASA showed that 150 μl DSPE-PEG (2000)Amine (100 μm) solution per 200 μl microbubbles suspension was the optimal proportion, with the peak carry efficiency as (83.41±2.21)%. Conclusions The amination of commercially available SonoVue is realized by the insertion of DSPE-PEG (2000) Amine molecule. Glutaraldehyde crosslinking the liposomes and microbubbles is feasible. Moreover, we can choose other active groups to modify the microbubbles and liposomes, construct more convenient methods with higher efficiency.

Objective To evaluate the safety, feasibility and clinical value of real-time navigation system with CT/MR and sonographic images for percutaneous ablation of hepatic malignancies poorly defined on conventional ultrasonography. Methods Fifteen patients with 22 hepatic malignant lesions underwent percutaneous ablation guided by virtual navigation system with ultrasonography. Treatment response was assessed by the contrast CT/MR followed up one month after procedures. Results Complete tumor necrosis was achieved in 20 lesions, but 2 lesions showed residual tumor in the ablation zone. No treatment associated complications were found. Conclusions The application of virtual navigation system is of clinical value in localization of lesions, guidance of biopsy and assessment of the interventional therapy in patient with hepatic malignancies, particularly for those with poorly identified lesions by conventional ultrasonography.

Objective To analyze the history and present situation of international medical device with visualization softwareto provide references for medical device development in China.Methods CiteSpace visualization software was used to explore international literatures related to medical device from the aspects of yearly quantity,research direction,research organization,quoted literature and etc from 2005 to 2014.Results Medical device drew increasing attention from corresponding researchers,whose development depended on international cooperation.Medical device related closely to engineering and medicine,and had to paid attention to informatization and clinical requirements.Conclusion CiteSpace software is of great value for the study on medical device.

Objective To observe the effect of moxibustion on the learning ability and memory of rat models of Alzheimer’s disease (AD) and the expression of amyloidβ protein (Aβ)-42, interleukin (IL)-1β, and IL-2, for unveiling the function and mechanism of moxibustion in treating AD.Method Forty-eight healthy male Sprague-Dawley rats were randomized into a sham-operation group, a model group, a Western medication group, and a moxibustion group, 12 rats in each group. The AD model rats were established by injection of Streptozotocin (STZ) into bilateral ventricles. From the 10th day after the operation, the moxibustion group started to receive moxibustion at Baihui (GV 20), Mingmen (GV 4), Changqiang (GV 1), and Guanyuan (CV 4); meanwhile, the Western medication group received Donepezil hydrochloride via intragastric administration. After 30-day treatment, the learning and memory ability was tested by using water maze, the hippocampal Aβ-42 was examined by immunohistochemical method, and the expression of hippocampal IL-1β and IL-2 was by double-antibody sandwich ELISA.Result Compared to the model group, moxibustion significantly down-regulated the levels of Aβ-42 (P<0.05) and IL-1β protein (P<0.05), up-regulated the level of IL-2 protein (P<0.05) in hippocampus, and markedly improved the learning and memory of AD rats (P<0.05).Conclusion Moxibustion can enhance the immunity and learning ability, which is plausibly related to the down-regulation of IL-1β, up-regulation of IL-2, and improvement of Aβ-42 in hippocampus.

Objective To investigate the expression of connexin (Cx) 43, Cx26 gene in the thyroid tissue in patients with autoimmune thyroid diseases (AITD).Methods The thyroid tissue specimens of 76 cases were selected, including 30 cases of Graves disease (GD group), 30 cases of Hashimoto thyroiditis( HT group ), and 16 cases of normal tissues from thyroid adenoma (control group), which were all confirmed by pathologic diagnosis.The expression of Cx43 and Cx26 mRNA among three groups was determined by reverse transcriptase polymerase chain reaction (RT-PCR), and GAPDH,which was used as the internal control.Results The staining of Cx43 and Cx26 mRNA in all the cases from human thyroid tissue were strongly positive.The expression levels of Cx43,Cx26 mRNA in GD group were significantly higher than those in control group (0.9307 ± 0.0716 vs.0.5938 ± 0.0484 and 0.7371 ± 0.0463 vs.0.3431 ± 0.0399 ) (P ＜ 0.01 ).And the expression levels of Cx43,Cx26 mRNA in HT group were significantly lower than those in control group (0.3581 ±0.0458 vs.0.5938 ±0.0484 and 0.3150 ±0.0218 vs.0.3431 ±0.0399)(P＜0.01 or ＜0.05).Conclusion The Cx43 and Cx26 mRNA expression in the human thyroid tissue and a remarkable deferral expressions of Cx43 and Cx26 mRNA in three groups of AITD suggests that gap junction is associated with AITD.

Objective To investigate the application of percutaneous transluminal balloon dilatation (PTA) in catheter replacement within patients with catheter-related central vein disease (CVD). Methods Thirteen cases of CVD patients from Jan 2015 to Mar 2018 admitted into the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. All of them underwent digital subtraction angiography (DSA) to clarify problem origin. Suitable balloons were chosen to dilate the original catheters or the occlusive veins, and then the original catheters were replaced. PTA was used to help catheter replacement and all patients were followed up for 6 months. Results Four of the 13 patients were found stuck when replacing catheters. All of them successfully had catheters removed with PTA (Hong's techniques). All patients had successfully catheter replacement with blood flow volume>250 ml/min. Among 4 patients with edema, 3 patients showed better within 6 months. Only 3 patients needed warfarin to keep blood flow volume>250 ml/min within 6 months. Conclusions PTA shows advantages of lesser trauma, better tolerance and higher success rate in patients with catheter-related CVD. It can also relieve symptoms resulting from occlusive central vein.

Objective    To evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB). Methods    The clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee (PCV-VG) group (n=201), a pressure-controlled ventilation (PCV) group (n=200) and a volume-controlled ventilation (VCV) group (n=203). The association between intraoperative ventilation modes and PPCs (defined as composite of pneumonia, respiratory failure, atelectasis, pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. Results    The PPCs were found in a total of 246 (40.7%) patients, including 86 (42.8%) in the PCV-VG group, 75 (37.5%) in the PCV group and 85 (41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode (aRR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode (aRR= 0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. Conclusion    Among adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.

Objective    To evaluate the effect of driving pressure-guided lung protective ventilation strategy on lung function in adult patients under elective cardiac surgery with cardiopulmonary bypass. Methods    In this randomized controlled trial, 106 patients scheduled for elective valve surgery via median sternal incision under cardiopulmonary bypass from July to October 2020 at West China Hospital of Sichuan University were included in final analysis. Patients were divided into two groups randomly. Both groups received volume-controlled ventilation. A protective ventilation group (a control group, n=53) underwent traditional lung protective ventilation strategy with positive end-expiratory pressure (PEEP) of 5 cm H2O and received conventional protective ventilation with tidal volume of 7 mL/kg of predicted body weight and PEEP of 5 cm H2O, and recruitment maneuver. An individualized PEEP group (a driving pressure group, n=53) received the same tidal volume and recruitment, but with individualized PEEP which produced the lowest driving pressure. The primary outcome was oxygen index (OI) after ICU admission in 30 minutes, and the secondary outcomes were the incidence of OI below 300 mm Hg, the severity of OI descending scale (the Berlin definition), the incidence of pulmonary complications at 7 days after surgery and surgeons’ satisfaction on ventilation. Results    There was a statistical difference in OI after ICU admission in 30 minutes between the two groups (273.5±75.5 mm Hg vs. 358.0±65.3 mm Hg, P=0.00). The driving pressure group had lower incidence of postoperative OI<300 mm Hg (16.9% vs. 49.0%, OR=0.21, 95%CI 0.08-0.52, P=0.00) and less severity of OI classification than the control group (P=0.00). The incidence of pulmonary complications at 7 days after surgery was comparable between the driving pressure group and the control group (28.3% vs. 33.9%, OR=0.76, 95%CI 0.33-1.75, P=0.48). The atelectasis rate was lower in the driving pressure group (1.0% vs. 15.0%, OR=0.10, 95%CI 0.01-0.89, P=0.01). Conclusion    Application of driving pressure-guided ventilation is associated with a higher OI and less lung injury after ICU admission compared with the conventional protective ventilation in patients having valve surgery.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.