OBJECTIVE:To investigate the safety and effects of different doses of budesonide combined with ipratropium bro-mide on rational symptom,lung function and arterial blood gas indexes of patients with acute exacerbation of chronic obstructive pulmonary diseases (AECOPD). METHODS:186 AECOPD inpatients were selected and randomly divided into low-dose,medi-um-dose and high-dose groups,with 61 cases in each group. All groups received routine treatment as ipratropium bromide 500 μg+0.9%Sodium chloride injection(NS)2 ml,oral inhalation with oxygen drive atomization nebulizer,oxygen flow rate of 4-5 L/min, 15-20 min/time,tid. Low-dose,medium-dose and high-dose group were additionally given Budesonide suspension 0.5,1.0,2.0 mg+NS 2 ml respectively,oral inhalation with oxygen drive atomization nebulizer,oxygen flow rate of 4-5 L/min 20 min/time,bid. Pa-tients in 3 groups were treated for 7 days. Pulmonary function,MRC score,arterial blood gas indexes and ADR were compared among 3 groups before treatment,3 and 7 days after treatment. RESULTS:FEV1% of 3 groups were significantly improved after treatment;3 and 7 days after treatment,FEV1% of high-dose group was higher than that of medium-dose and higher than that of low-dose group,with statistical significance(P<0.05). The MRC scales of 3 groups were significantly decreased after treatment;3 days after treatment,MRC scale of high-dose group was lower than those of medium-dose and lower than that of low-dose group,with statistical significance(P<0.05). 7 days after treatment,MRC scales of medium-dose and low-dose groups were low-er than that of low-dose group,with statistical significance (P<0.05),but there was no statistical significance in MRC scale be-tween high-dose group and medium-dose group after treatment 7 days(P>0.05). After treatment,there was statistical significance in PaCO2 and PaO2 among 3 groups (P<0.05),and the improvement of high-dose group was better than those of medium-dose and better than that of low-dose group,with statistical significance(P<0.05). No severe ADR was found in 3 groups. CONCLU-SIONS:Aerosol inhalation of 2.0 mg budesonide combined with ipratropium bromide can effectively improve pulmonary function, rational symptoms and arterial blood gas indexes with good safety.

B7H1 is a recently described B7 family member.Ligation of PD-1 receptors with B7hl on the surface of activated T cell inhibits T cell proliferation and cytokine production. B7H1 plays a negative regulatory role in peripheral tolerance, autoimmune diseases and chronic infections.B7H1 also has been found to be largely expressed on a broad range of cancers and is thought to contribute to immune evasion by cancers. Blockade of B7H1/PD-1 pathway may contribute to the treatment of autoimmune diseases and maligant tumors.

With the development of modem technology,more and more plastic products are widely used in various fields,while bringing significant convenience to the society,it also leads to more and more environmental estrogen.The influence of plasticizer is increasing,especially on the development of children.Extensive contacting with plasticizer is considered to be closely related with gonadal digenesis,obesity and other problems in children.This review focuses on the latest research results about the basic and clinical experiments of Di (2-ethylhexyl) phthalate (DEHP),which illuminate the effects of DEHP on children's growth and metabolism,and lay foundations for rational clinical intervention and scientific plasticizer's application.

Objective To summarize the methods of multiple digital replantation in different stages and improve the survival rate of replanted digits Methods In the procedure of replantation for fingertip one artery and one vein were anastomosoed, or one atrery was anastomosed accompanied with pulling out the nail and cutting small incision For middle of digit one artery and one vein were anastomosed For the proximal digit the ratio of anastomose for arteries and veins was 1 to 2 or 2 to 2 Superficial vein from arm or artery from the other finger was used if defection of vessel occur Results One hundred and twenty nine digits survived among the 142 replanted digits from 58 cases (survival rate was 90 8%),among which 113 fingers from 46 cases were subjected to following up form 3 months to 3 years, the rate of excellent and good was 85 8% Conclusion It takes more time and higher techniques to replant multiple digits To improve the survival rate, it is important to anastomose vessel excellently, deal with the defection of vessel correctly, and treat postoperative vessel crisis properly In addition, training exercise plays an important role in fnnctional recovery

OBJECTIVE:To investigate the effects and safety of 2 kinds of glucocorticoid administration regimens including 5 d and 15 d on clinical efficacy,pulmonary function,quality of life in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). METHODS:A total of 160 elderly patients with AECOPD selected from Haikou Forth People's Hos-pital during May 2013-Dec. 2015 were divided into group A and B according to lottery method,with 80 cases in each group. Both groups received symptomatic treatment as eliminating phlegm and relieving asthma,controlling infection,etc. Based on it,group A was given Methylprednisolone sodium succinate for injection,40 mg/d for 15 d;group B was given Methylprednisolone sodium succinate for injection,40 mg/d for 5 d. Clinical efficacies were compared between 2 groups as well as the levels of pulmonary ven-tilation function indexes,blood gas analysis indexes,Spitzer life quality index scale (QLI) scores before and after treatment. The occurrence of ADR was also compared between 2 groups. RESULTS:Total response rate of group A was 92.50%,and that of group B was 90.00%,without statistical significance(P>0.05). Before treatment,there was no statistical significance in the levels of pulmonary ventilation function indexes,blood gas analysis indexes,QLI scores between 2 groups (P>0.05). After treatment, FVC,FEV1,FEV1% and PaO2 of 2 groups were significantly higher than before treatment,while PaCO2 was significantly lower than before treatment,with statistical significance (P<0.05);there was no statistical significance between 2 groups (P>0.05). QLI scores of 2 groups were significantly higher than before treatment,and the group B was significantly higher than the group A, with statistical significance (P<0.05). The incidence of ADR in group B (6.25%) was significantly lower than group A (22.50%),with statistical significance(P<0.05). CONCLUSIONS:Glucocorticoid administration regimen including 5 d and 15 d in the treatment of elderly patients with AECOPD possess the same effects in improving lung function;glucocorticoid administra-tion regimen for 5 d application is superior in effectively improving the quality of life of patients,reducing the risk of ADR,and has clinical value.

Objective To determine the dose-effect curve of fentanyl with respect to the suppression of somatic or hemodynamic responses to skin incision when plasma propofol concentration was maintained at 3 ?g?ml-1 by target-controlled infusion (TCI) .Methods Twenty-four ASA Ⅰ-Ⅱ patients aged 31-65 yrs undergoing elective surgery under general anesthesia were enrolled in this study. Anesthesia was induced with TCIs of fentanyl and propofol. The patients were randomized to receive fentanyl by TCI at a target plasma concentration of 1.0, 1.5, 2.25 or3.38 ng?ml-1 . The target plasma propofol concentration was set at 3 ?g?ml-1 in all patients. The patients were intubated when the patients failed to respond to verbal command and eyelash reflex was lost. Tracheal intubation was facilitated with succinylcholine 1 mg?kg-1. MAP, HR, ECG and SpO2 were monitored before and during anesthesia. The duration between the start of TCIs and skin incision was longer than 30 min for fentanyl and 15 min for propofol to ensure that the effect-site drug concentrations reached the steady-state. The changes in BP and HR and body / limb movement and other signs of inadequate depth of anesthesia like lacrimation, flushing and sweating during and immediately after skin incision were recorded. The fentanyl plasma concentrations (predicted target concentration) at which 50% of the patients did not respond to skin incision (Cp50) were calculated. Results The Cp50 of fentanyl based on somatic response was 1.84 ng?ml-1 . Its 95% confidince interval ranged from 1.46 ng?ml-1 to 2.33 ng?ml-1 . The Cp50 of fentanyl based on hemodynamic response was 2.67 ng?ml-1 with a 95% confidence interval from 1.96 ng?ml-1 to3.62 ng?ml-1. Conclusion When anesthesia is induced with TCIs of propofol and fentanyl, if target plasma propofol is set at 3 ?g?ml-1 , target fentanyl plasma concentration should be set at least at 5.12 ng?ml-1 to ensure adequate depth of anesthesia for skin incision.

Objective To study the feasibility and morphological characteristics of wide caliber of local biliary tract constructed by increasing pressure of local bile duct in a short period of time.Methods Twelve mongrel dogs were randomized into 2 groups.In group A,only inlaid bile duct dilator(IBDD)was placed for biliary drainage in common bile duct.In group B,IBDD was placed in tommort bile duct for biliary drainage and dilated it through affusing 0.1 ml,0.1 5 ml,0.2 ml and 0.25 ml water on postoperative day 1,8,15 and 22,respectively.The expandable ballbladders were kept on being dilated with increasing pressure for a month.Total bilirubin(TB),alanine aminotransferase (ALT),aspartate aminotransferase;aspartate transaminase(AST)of serum,bile duct diameter (BDD),histologic changes of biliary duct wall and hepatic tissue,and postoperative biliary tract contrast were determined before and after operation in both groups.Results There was no significant difference in TB,ALT,AST and histologic changes of hepatic tissue in bilary predilation and postdilation of each group and between group A and group B.There was great difference in BDD in bilary predilation and postdilation of each group and between group A and group B.In group B,the biliary wall was thickened and the lumina of bile duct widened,favorable tenacity of broaden biliary tract was shown.The specific staining of the broadened biliary wall showed that collagen and elastic fibers compacted fine and close and there was no breakage.Conclusion Dilated local bile duct constructed by increasing internal pressure of local bile duct has thick wall,wide caliber and its collagen and elastic fibers compact fine and close.This provides condition to supply early-stage cholangio-jejunostomotic reconstruction of bile duct iniury and create wide stoma for cholangio-jejunostomy in dogs.

Objective To assess the diagnostic value of chronotropic index in identifying coronary artery disease (CAD). Methods One hundred and sixty two patients with suspected CAD were referred for a routine treadmill exercise electrocardiogram and subsequently underwent selective coronary angiography within 3 weeks. The magnitude of ST segment depression and chronotropic index were measured by a computerized ECG system. CAD was defined by coronary angiography. Results In detecting CAD, the sensitivity was 70. 1% versus 60.9% (P< 0.05) ,the specificity was 84.0% versus 73.3% (P<0.05), and the accuracy was 76.5% versus 66.7% (P< 0.05) by chronotropic index and standard electrocardiographic test criteria. The value of Kappa statistic for chrono-tropic index consistency in our experiment was 0.534(>0.4). The number of diseased vessels was correlated with the mean value of chronotropic index. The chronotropic index decreased from 0.88±0.09 in patients without coro-nary disease to 0.68±0.06 in those with 3 vessels involved (P<0.01). A more closed relationship was found be-tween chronotropic index and lesion in the fight coronary artery. Conclusions Chronotropic index is possibly a valu-able positive index for the diagnosis of CAD. The sensitivity,specificity and accuracy of chronotropic index are signif-icandy higher than those of standard electrocardiographic test criteria in identifying CAD.

AIM: To study the role of peroxisome proliferator-activated receptor-α (PPAR-α) signal transduction pathway in cardiac hypertrophy induced by high glucose and insulin (HGI). METHODS: The cultured neonatal rat cardiomyocytes were used to observe the effect of fenofibrate (FF), a selective PPAR-α agonist, on cardiomyocyte hypertrophy induced by HGI (glucose at concentration of 25.5 mmol/L and insulin at 0.1 μmol/L). The cardiomyocyte hypertrophic responses were assayed by measuring the cell surface area, protein content, and mRNA expression of atrial natriuretic factor (ANF). The expressions of mRNA and protein were assayed by real -time PCR and Western blotting. RESULTS: In cultured cardiomyocytes, HGI induced profound change of hypertrophic morphology, the significant increase in cell surface area, protein content and ANF mRNA expression compared to those in vehicle control (P<0.01), but the expressions of PPAR-α mRNA and protein decreased significantly (P<0.05). At the same time, the expression of cyclooxygenase 2 (COX-2), one of the PPAR-α downstream effectors was obviously elevated (P<0.05). However, FF (0.1, 0.3 and 1 μmol/L) inhibited the cardiomyocyte hypertrophy induced by HGI in a concentration-dependent manner (P<0.01). FF at concentration of 0.3 μmol/L increased the expressions of PPAR-α in both mRNA and protein levels (P<0.05) and inhibited the expressions of COX-2 (P<0.05), which were abolished by MK 886 (0.3 μmol/L), a selective PPAR-α antagonist (P<0.05). CONCLUSION: PPAR-α signal transduction pathway and its downstream effector COX-2 might involve in the cardiomyocyte hypertrophy induced by HGI.

AIM:To study the role of peroxisome proliferator-activated receptor-? (PPAR-?) signal transduction pathway in cardiac hypertrophy induced by high glucose and insulin (HGI). METHODS:The cultured neonatal rat cardiomyocytes were used to observe the effect of fenofibrate (FF),a selective PPAR-? agonist,on cardiomyocyte hypertrophy induced by HGI (glucose at concentration of 25.5 mmol/L and insulin at 0.1 ?mol/L). The cardiomyocyte hypertrophic responses were assayed by measuring the cell surface area,protein content,and mRNA expression of atrial natriuretic factor (ANF). The expressions of mRNA and protein were assayed by real -time PCR and Western blotting. RESULTS:In cultured cardiomyocytes,HGI induced profound change of hypertrophic morphology,the significant increase in cell surface area,protein content and ANF mRNA expression compared to those in vehicle control (P