Objective To explore the effect of budesonide combined with ipratropium bromide in the treat-ment of acute exacerbations of chronic obstructive pulmonary disease,and observe the adverse reactions during treat-ment.To analyze the treatment of safety and to provide the basis for clinical treatment.Methods 160 cases of acute exacerbations of chronic obstructive pulmonary disease were selected,they were randomly divided into the control group A,B,C and the observation group,with 40 cases in each group.The control group A was treated with prednisone and other conventional,control group B was treated with aminophylline and other conventional treatment,the control group C application included prednisone,aminophylline and other conventional treatment,all the control group were treated with 0.9% sodium chloride solution inhaled as a placebo spray.And the observation group application of budesonide was combined with ipratropium bromide based on the routine treatment.Mainly the effect of treatment was observed,and the blood carbon dioxide partial pressure (PaO2 ),partial pressure of oxygen (PaCO2 ),forced expiratory volume in one second (FEV1 ),forced expiratory volume in one second (FEV1 )and forced expiratory volume in one second to forced vital capacity ratio of FVC (FEV1 /FVC)before and after treatment were detected.And the adverse reactions were observed to evaluate its safety.Results The total effective rate of the observation group was 95.00%(38 /40),which were higher than the control group A,B and C,the differences were statistically significant (χ2 =9.68,9.70,9.91,all P <0.05).The PaO2 level of the observation group after treatment was (76.89 ±0.63)mmHg, which were higher than that of the control group after treatment (73.66 ±0.47)mmHg,and that of two groups after treatment were higher than those before treatment,the differences were statistically significant (t =10.48,13.72,12.83,all P <0.05).The PaCO2 of the observation group after treatment was (50.06 ±0.60)mmHg,which were lower than that of the control group A,B and C after the treatment,each group after treatment was lower than that before treatment,the differences were statistically significant (t =11.72,12.69,10.74,all P <0.05 ).FEV1 and FEV1 /FVC of the observation group after treatment were (2.19 ±0.29)L and (69.27 ±0.59)%,which were higher than those of the control group A,B and C after treatment,and each groupafter treatment was higher than that before treatment,the differences were statistically significant (t =12.68,13.10,12.41,9.89,10.63,11.29,all P <0.05). Comparison of adverse reactions in each group,the difference was not statistically significant (χ2 =1.38,P >0.05). Conclusion It has good clinical curative effect on budesonide combined with ipratropium bromide for the treatment of acute exacerbations of chronic obstructive pulmonary disease patients,which can significantly improve the pulmona-ry function of patients,shorten recovery time,and has high security.It is worthy of clinical application.

BACKGROUND: Chitosan and sodium alginate are the good natural materials for microcapsule, and also used widely in tissue engineering. Our research teams have made thorough work at anticoagulant materials, but these materials are inert or simulate the liquid crYstal form of blood vessel wall. While in this experiment, on the base of our previous study, we microencapsulated heparin with biotic anticoagulation activity and other specific performances in order to enable microcapsule to have a long time releasing effect of medicine.OBJECTIVE: To microencapsulate the low molecular heparin so as to ensure the stability of heparin in vivo and analyze the effect of content of chitosan on the performance of heparin microcapsules basing on the natural chitosan and sodium alginate as the enwrapped materials of microcapsules.DESIGN: Open experiment.SETTING: Department of Material Science and Engineering, Jinan University.MATERIALS: The experiment was performed at the laboratory of Department of Material Science and Engineering, Jinan University from October 2004 to June 2005. Heparin, with relative molecular mass＜ 5 000, was provided by Shandong Freda Biochem Co., Ltd.,; Chitosan was provided by Shanghai Bio Life Science & Technology Co., Ltd, DD≥90%, η＜ 100 cps;Sodium alginate was provided by Qingdao Bright Moon Seaweed Industrial Co., Ltd. Emulsions were Span80, and CaCl2, which were both made in China.METHODS: ①Preparation of heparin/chitosan microcapsules (HCM):Some heparin aqueous solution was emulsified in liquid paraffin. The reaction system was stirred fully and presented emulsion. Then the whole reaction system was warmed to be at 50 ℃ and maintained for 20 minutes. Afterwards, 20 g/L chitosan solution was added slowly, subsequently with raising the temperature to be at 60 ℃ and then glutaraldehyde was dropwised keeping the reaction system at 80 ℃ for 1hour. Centrifugation, filtration and washing followed by washing with kerosene fully, remain organic was extracted by dehydrated alcohol with extractor were performed.Drying and xeransis in vacuum were done at last. ② Preparation of heparin-sodium alginate-chitosan microcapsules (HSCM) :Heparin aqueous solution and sodium alginate were emulsified in paraffin, and the reaction system was stirred into emulsion at room temperature for 20 minutes, then 3% CaCl2 solution containing different concentrations of chitosan was added slowly. 30 minutes later, Microcapsules were separated, washed and dried as the treatments as before. ③ Drug content and envelope efficiency were measured, heparin standard curve was determined and in vitro releasing effect of heparin microcapsules was also measured.MAIN OUTCOME MEASURES: ①Effect of chitosan solution concentration on preparation of heparin-chitosan microcapsules; ② Effect of glutaraldehyde dosage on preparation of heparin-chitosan microcapsules; ③Effect of sodium alginate concentration on hepatin-sodium alginate; ④Effect of chitosan concentration on hepatin-sodium alginate-chitosan microcapsules. ⑤ In vitro release of heparin microcapsules enwrapped by different materials. ⑥Measurement of heparin content and envelope efficiency. ⑦ Observation of heparin microcapsule under scanning electron microscope RESULTS: ①With the increasing concentration of chitosan, the color of production changed from yellow to dark, and microcapsules were increscent, but the microcapsules uniformity and property of balling were increased. ②The increasing content of glutaraldehyde led darker production.Increase of glutaraldehyde content made production bond each other severely. The glutaraldehyde, which did not react with chitosan, can solidify itself and presented anomalous microcapsules forming. ③There was not obvious balling property of the production with the change of concentration of sodium alginate. ④The balling property of microsphere was good with increasing concentration of chitosan. However, microcapsules conglutinated with each other. 2% chitosan would be better. ⑤With the increase of chitosan content, the releasing speed ofheparin became slow. ⑥The envelope efficiency was about 58% when microcapsule contained 20%(wt) of chitosan, and used chitosan only the envelope efficiency could approach to 79.9%. ⑦ The surface of microcapsules with chitosan was very compact,and with increasing of content of glutaraldehyde, microcapsules would bond each other.CONCLUSION: Chitosan at certain concentration will affect the uniformity and balling property of microcapsules. Chitosan dosage can alter the envelope efficiency of heparin. Envelope efficiency of heparin is increased and releasing speed of heparin is decreased with the increase of content of chitosan.

Objective:To enhance hospital equipment information management standards for the purpose of measurement instruments.Methods:Using solutions based on Web technology, database technology, database through the establishment of measurement devices, implement life cycle management method.Results: To solve the many hospital only attach importance to the management of medical equipment, ignore the metering device management, lead to measuring instruments record disorder, query the inconvenience problem.Conclusion: Medical device measurement equipment management system improves the ability of the hospital information management, strengthens the efficiency of communication and exchanges of various departments and produces good economic and social benefits.

Objective To discuss the application effect of seamless training model of "demonstration unit" on nursing teaching. Methods 210 nursing students from high professional schools from 2006 to 2009 were set as the experimental group, 210 nursing students of the same education background were selected as the control group. The experimental group adopted seamless training model of "demonstration unit", the control group used traditional segmental teaching mode. Teaching effect was compared between the two groups. Results The theoretic test results, operation and technological testing results and satisfaction degree with the teaching in the experimental group was higher than that of the control group. Conclusions The seamless training model of "demonstration unit" is approved by the patients, teachers and nursing students and improves the quality of clinical teaching. It should be used widely in clinical nursing education.

BACKGROUND:Polylactic acid(PLA)surface is hydrophobic and there are no nataral recognition sites,so its application is limited.Many different strategies have been studied such as composition and chemical Drafting,to produce hydrophilic groups.However,these traditional methods are always involved in complex process and many organic reagents,resulting in decrease of biocompatibility.OBJECTIVE:To conduct the surfacr modification of PL.A and improve its hydrophilicity with low temperature plasma treatment.DESIGN:Controlled observation.SETTING:Department of Materials Science and Engineering in Jinan University.MATERIAIS:The experiment was processed from October 2004 to October 2005 at Guangzhou Research Center of Artificial Organs and Materials Engineering(Ministry of Education).The mainly used materials were:Poly-D,L-lactic acid(Mr 2.9×104,Shandong Medical Instrument Institute),N-vinyl-pyrrolidone(NVP,Acros Company,purified before use).METHODS:The materials were treated in the plasma reactor under different conditions(power=150 W,t=3,2,1 minutes;power=30 W,t=10,8,5,3,1 minutes)to choose the optimal condition,and then PLA were grafted with NVP by gas phase polymerization and liquid polymerization,respectively.MAIN OUTCOME MEASURES:THe surface morphology of the films was observed with scanning electron microscopy and atomic force microscopy.The hydrophilicity of native and treated material surfaces was measured using a water contact angle meter.Surface composition was detected with Fourier transform infrared spectrometer.Mass changesmeasurement was applied to characterize the grafting efficiency.RESULTS:Scanning electron microscopy and atomic force microscopy showed that the plasma medified materials possessed coarse surface with pores and notches.Water contact angles decreased obviously from 78°to 50°after grafting,Fourier transform infrared spectrometer showed a new absorption peak at 1 637.19 cm-1,which corresponded to the carbonyl stretch vibration absorption of amide group in poly-N-vinyl-pyrrolidone.After the plasma treatmerlt at low temperature.the mass change ratio of PLA film material was-0.6.CONCLUSION:The plasma treatment and polymerization can improve the hydrophilicity and cause coarsr surface of PLA material,which will be helpful for the cell attachment.

BACKGROUND: It has been reported that bioactivity is found to be favored by the co-operative behavior of silanol (Si-OH)or Ti-OH etc. groups on the material surface and the involved calcium ions. To confirm the hypothesis that a new family of organic-inorganic hybrid materials, which incorporate gelatin chains covalently into Si-O-Ti network, is synthesized through sol-gel procedure.OBJECTIVE: To synthesize a hybrid of gelatin and CaO-SiO2-TiO2 system which is used for bone repairing, and observe its structure and bioactivity.DESIGN: Randomized control observation.SETTING; the laboratory, School of Material Science and Engineering, Shaanxi University of Science and Technology. MATERIALS: Gelatin (Sinopharm Chemical Reagent Co., Ltd), titanic acid isopropyl ester (Gu'an Hengye Fine Chemicals Co., Ltd), γ-glycidoxy propyl trimethoxy silane (Jingzhou Jianghan Fine Chemicals Co., Ltd), calcium nitrate (Tianjin Bodi Chemicals Co., Ltd)METHODS: The experiment was carried out in the laboratory, School of Materials Sciences and Engineering, Shaanxi University of Science and Technology between April and August in 2006. A new type of bioactive organic-inorganic hybrid was synthesized through sol-gel processing starting from gelatin, γ-(2,3-glycidoxypropyl)trimethoxysilane (GPSM),Tetraisopropyltitanate (TiPT) and calcium nitrate. ①Structure of the hybrid: The structures of the products were investigated with Fourier transformed infrared (FT-IR) diffusive reflection spectroscope, X-ray diffraction (XRD) instrument and scanning electron microscope (SEM) respectively.②Bioactivity: The products Ti15Ca0 and Ti15Ca20 were soaked in a stimulated body fluid (SBF) to evaluate the morphology of the surfaces by SEM and thin-film XRD. MAIN OUTCOME MEASURES: The structure and bioactivity of the hybrid.RESULTS: ①The hybrid was completely amorphous and its surface was almost homogenous, which implied the covalent bonding between the organic component and inorganic component. FT-IR spectra result verified the occurrence of Si-OH group and Si-O-Ti bond, as well as the addition of TiPT supplied Si-O-Ti bond. ②There were lots of apatite crystallines formed on the surface of hybrid Ti15Ca20 after soaked in SBF for 7 days, which confirmed their in vitro bioactivity. These apatite particles were similar to the bioglass and other bioactive materials in the patterns. CONCLUSION: A new type of organic-inorganic hybrid material, which incorporates gelatin chains covalently into Si-O-Ti network, is synthesized through sol-gel procedure. There are lots of apatite and brushite crystals formed on the surface of the product Ti15Ca2O after soaking in SBF for 7 days, which obviously proves the bioactivity of the hybrid.

Objective To explore the effect of clinical nursing pathway (CNP) in perioperative nursing for breast cancer,especially the instructive important role in the rehabilitative excises postoperation and after discharge.Methods In accordance with the standard for the entry and exit of the CNP,102 patients with breast cancer were randomly divided into the experimental group (50 patients) and the control group (52 patients),the experimental group received the care of clinical nursing pathway and the control group received the traditional care.The effect of clinical nursing pathway on the following aspects such as the level of mastering knowledge about hospitalization,self-care ability after discharge,the degree of satisfaction about nursing were compared between the two groups.Results Compared with the control group,the level of mastering knowledge about hospitalization and self-care ability after discharge in the experimental group were significantly better,the degree of satisfaction about nursing reached 98.92%,which was higher than that of the experimental group.Conclusions Application of the full care model with CNP demonstrated good effect on the perioperative nursing for breast cancer,it encourages patients to do the limb functional training,promotes the recovery of disease,and then shortens hospital stay and saves hospital costs.

Objective To observe whether hydrogen sulfide modulates adipocytes to secrete adiponectin.Methods Thirty-two male SD rats were randomly divided into normal diet group (n =8),high-fat diet group (n =8),high-fat + cysteine group (n =8),and high-fat + propargylglycine (cystathionine-γ-lyase inhibitor) group (n =8).The fatty liver animal model was established using the high fat diet; meanwhile,L-cysteine was applied to the animals to produce endogenous hydrogen sulfide and propargylglycine to inhibit the production of endogenous hydrogen sulfide.Fatty degeneration of the hver of animals and plasma within the adiponectin concentration was observed after 8 weeks.The omental adipose tissues were excluded and digested using collagenase Ⅰ to isolate fat cells.Sodium hydrosulfide and propargylglycine was applied to stimulate the cells in vitro for 7 days before the detection of the cell supernatant adiponectin content.Results Liver steatosis was established after highfat diet for eight weeks.Steatosis was significantly extenuated after the application of L-cysteine and aggravated by propargylglycine.Plasma hydrogen sulfide and adiponectin levels in fat diet group animals were (21.13 ± 7.06) mmol/L and (3.16 ± 1.15) mg/L respectively,which significantly decreased when compared with the normal diet group with the levels of hydrogen sulfide (29.13 ± 13.06) mmol/L and adiponectin (8.98 ± 2.84) mg/L (P=0.0229,P=0.0062).Hydrogen sulfide [(35.47 ±9.04) mmol/L] and adiponectin [(6.54 ± 1.38) mg/L] levels in the high fat + cysteine group significantly increased (P =0.0032,P =0.0131).However,hydrogen sulfide [(16.65 ±8.79) mmol/L] and adiponectin [(2.50±0.91) mg/L] in high fat + propargylglycine group were significantly decreased (P =0.0191,P =0.0021).Hydrogen sulfide was not significantly differem in the supematam of adipocyte isolated from normal diet group [(26.77 ± 12.65) mmol/L] and from high-fat diet group [(28.76 ±9.09) mmol/L] (P =0.0927),but that in the sodium hydrosulfide and propargylglycine ceils supematants significandy either increased or decreased (P =0.0000,P =0.0000).Adiponectin in the supematants of high-fat diet group and normal diet group adipocyte showed no significant difference [(4.21 ± 1.61) mg/L vs (4.49 ± 1.09) mg/L,P =0.1076)].The levels of adiponectin in sodium hydrosulfide and propargylglycine cell supernatants increased and decreased respectively than that in higher fat diet group cells [(5.77 ±0.86) mg/L vs (4.21 ±1.61) mg/L,P =0.0094; (3.01 ±1.26) mg/L vs (4.21 ± 1.61) mg/L,P =0.0108].Conclusion Hydrogen sulfide promotes adipocytes to secrete adiponectin.

OBJECTIVE: To evaluate the cost-effectiveness of 3 therapeutic schemes in the treatment of chronic Hepatitis B with YMDD mutation.METHODS: 90 patients were randomly assigned into three groups: the patients in Group A were assigned to receive Adefovir Dipivoxil in combination with Lamivudine for 12 weeks followed by administration of Adefovir alone for 36 weeks;Group B received Adefovir in combination with Lamivudine for 48 weeks,while Group C received Entecavir alone for 48 weeks.The cost-effectiveness of the 3 groups were analyzed.RESULTS: In the three groups(A,B,and C),the cost-effectiveness ratios for HBV DNA negative-conversion ratewere 12 685.6,15 481.3,and 31 462.2,respectively and the incremental cost-effectiveness ratios of Group B and Group C were 29 501.5 and 106 907.8 respectively as against Group A.The cost-effectiveness ratios of the three Groups(A,B,and C) for serum alanine aminotransferase normalization rate were 12 685.6,14 284.9,31 462.2 respectively,and the incremental cost-effectiveness ratios of Group B and Group C were 19 618.5 and 106 907.8 respectively as against Group A.The cost-effectiveness ratios of the three Groups(A,B,and C) for HBeAg/HBeAb seroconversion rate were 76 227.9,93 120.3,and 209 664.0 respectively,and the incremental cost-effectiveness ratios of Group B and Group C were 178 350.0 and 1 267 621.4 respectively as against Group A.In Group A,1 case showed rtA181V mutation and another one showed rtN236T mutation after 48-week treatment.CONCLUSION: Group B(ADV in combination with LAM) is more cost-effective in the treatment of chronic hepatitis B with YMDD mutation.

Objective To investigate the diagnostic value of MSCT with multi-planar reconstruction(MPR)and maximum intensity projection(MIP)in diagnosis of spinal burst fracture.Methods 45 patients(53 vertebras)with vertebral burst fracture were examined by MSCT and processed with MPR and MIP.The imaging features were analyzed comparatively.Results The axial images clearly demonstrated the vertebral body vertically or transversely burst crack in 49 vertebras(92.5%),bony fragment inserted into the spinal canal and stenosis of spinal canal in 34 vertebras(64.2%).The sagittal images showed kyphosis in 28 vertebras(62.2%).The sagittal and coronal images showed decreased height of the vertebral body in 37 vertebras(69.8%)and depressed fracture of vertebral end plate in 19 vertebras(35.8%).Total 44 fractures were located at spinal appendix,39 were showed by axial images,35 by sagittal images and 33 by coronal images.MIP displayed the space changes of bone structures in all cases and rotary dislocation fracture in 6 cases(11.3%).Conclusion MPR and MIP are of significant values in diagnosis and clinical treatment of spinal burst fracture.