Objective:To investigate the clinical effects and safety of triple therapy based on ipratropium bromide inhalation in the treatment of acute exacerbation of chronic obstructive pulmonary diseases ( AECOPD) . Methods:Totally 150 patients with acute exac-erbation of AECOPD were randomly divided into control group (75 patients) treated with budesonide combined with salbutamol by in-halation, and treatment group (75 patients) treated with ipratropium bromide inhalation additionally. The clinical effects, dyspnea score, pulmonary function index and blood gas analysis index before and after the treatment and the incidence of adverse reactions of the two groups were compared. Results:The clinical effects of the treatment group was significantly better than that of the control group (P<0. 05). The dyspnea score, pulmonary function index in and blood gas analysis index in the two groups after the treatment were significantly better than those before the treatment(P<0. 05), and the improvement of the treatment group was significantly better than that of control group (P<0. 05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0. 05). Conclusion:Triple therapy including ipratropium bromide inhalation in the treatment of acute exacerbation of AECOPD can ef-fectively alleviate clinical symptoms and signs and improve the lung ventilation function without increased risk of adverse reactions.

Objective: To improve the whole-process management of medical devices in purchase, use and maintenance. Methods: In this paper, we clarify the purchase, use and maintenance requirements of large-scaled medical devices including justification, invitation organization, comprehensive estimation, contract signing protocol, advantage analysis, rational control of availability, efficacy measurement and detection, management at different levels, high-efficacy check-up and scrap procedure to adapt the new challenges during the introduction of more and more advanced, complex and high-tech medical devices. Results:The results being analyzed could be used as important evidence for future purchasing of medical equipment, which was important for scientific and reasonable purchasing and utilizing of medical equipment. Conclusion: Strengthen the management to adapt the new challenges during the introduction of more and more advanced, complex and high-tech medical devices.

Objective: To establish the Perfect Systematization and Informatization for the Management of Medical Equipment Archive, so as to ensure the integrity and traceability of each data. Methods: Analysis on Present Situation and the Problems of Medical Equipment Management, Establish Medical Equipment archive Management System from purchasing of medical equipment, Measurement Controls, the Maintenance to Scrap processing the whole-process of medical devices. Results: In this paper, we discussed all kinds of information and archives network information management in the whole-process of medical devices. To clarify the plan, argument, purchase, installation, acceptance, use, quality control, maintenance, transfers and scrap processing, management at different levels. To establish a complete electronic file system is the main direction of medical equipment information management in the future. Conclusion: Realization of the functions on medical equipment archives network information and dynamic management, that can offer necessary for safe treatment,to can also reduce the operation cost of the equipment.

Objective:This paper makes analysis of problems of emergency equipment existing in clinical application and their causes and puts forward corresponding measure. Methods:Analysis of emergency medical equipment characteristic and the difference between conventional equipment. Find the first aid equipment management problems and reasons existing in the use, and risk assessment. Results:Hospital first aid equipment has the characteristics of more free time, emergency and risks, widely distributed in each department. By the personnel management, periodic inspection, cleaning and disinfection. Risk assessment shall be conducted by experts, the risk value high priority arrangement first aid equipment maintenance, to expect to minimize risk. Conclusion:First aid equipment management is a systematic and important work, to need department, maintenance personnel, equipment manufacturers and so on various aspects to cooperate with each other, to ensure the normal use of equipment.

Objective To evaluate the clinical manifestation and the treatment strategy of the scoliosis associated with Chiari malformation and /or syringomyelia. Methods Fifty-two cases suffered from scoliosis with Chiari malformation and /or syringomyelia were divided into three groups for surgical treatment: 1) Group 1: 18 cases had scoliosis with Chiari Ⅰmalformation and /or syringomyelia without obvious neurologic impairment, their scoliosis was corrected with posterior instrumentation, but their Chiari Ⅰmalformation and syringomyelia were left untreated surgically. 2) Group 2: 12 patients, whose scoliosis was not indicated for surgery but those Chiari malformation associated with syringomyelia, underwent posterior sub-occipital craniectomy to enlarge foramen occipital magnum, C1 posterior arch decompression, duraplasty and syrinx-subarachnoid space shunting no matter whether neurologic deficits were present or not. 3) Group 3: 22 cases in addition of correction of scoliosis, due to neurologic deficits caused by Chiari Ⅰmalformation or syringomyelia, two-stage surgery was indicated: firstly, with posterior suboccipital craniectomy to enlarge foramen occipital magnum, C1 posterior arch decompression, duraplasty and syrinx-subarachnoid space shunting 6 months later, then underwent the scoliosis correction with instrumentation. Results In 34 patients who underwent craniovertebral decompression, only 6 of the 24 cases with preoperatively neurologic deficits achieved mild improvement within 6 months postoperatively. In 40 patients who were treated with posterior correction for scoliosis, the average frontal correction was 63% and the average sagittal correction was 80% for scoliosis less than 90?, the average frontal correction was 49% and the average sagittal correction was 74% for scoliosis more than 90?. At a follow-up of 6 months to 5 years, the average loss of the frontal correction was 6%. Conclusion Scoliosis associated with Chiari malformation and /or syringomyelia can be effectively treated with the similar results, as for adolescent idiopathic scoliosis. The mainstay for diagnosis is MR imaging. Accurate diagnosis and proper treatment for Chiari malformation or syringomyelia before scoliosis surgery will improve the rate of scoliosis correction, decrease the neurological complications.

Objective To investigate the causes and preventive measures of upper gastrointestinal bleeding in hyperbaric oxygen therapy for patients with severe closed head injury.MethodsThe clinical data of 24 cases of patients with upper gastrointestinal hemorrhage treated by hyperbaric oxygen therapy in the first people's Hospital of Fuyang District Hangzhou from May 2011 to May 2016 were analyzed, the occurrence time and clinical effect of upper gastrointestinal bleeding were analyzed.ResultsAmong the 24 cases of patients, 14 cases were treated for the first time that overt bleeding, including bleeding from the stomach liquid outflow of blood from 2 cases, gastric outflow 2 cases, hemorrhage after cure again received hyperbaric oxygen therapy 3 times again dominant bleeding 2 cases;6 cases hyperbaric oxygen treatment for third, 7, 10 times brown liquid or bloody fluid from the stomach outflow;4 cases hyperbaric oxygen treatment in patients with second and 3 courses of coffee liquid from the outflow tube, which accounted for 58.3%, 25.0%, 16.7% of the total, retrospectively;8 cases were with good recovery, 10 cases moderate disability, 4 cases severe disability, 2 cases vegetative state, 0 case died, the good recovery rate was 33.3%.ConclusionNot correctly grasp the time of hyperbaric oxygen therapy in the treatment of patients with severe closed craniocerebral injury will cause upper gastrointestinal hemorrhage, correct application of H2 receptor binding agent, developing targeted therapy programme can effectively prevent and treat upper gastrointestinal bleeding, so is worthy of the clinical's full attention.

Objective To investigate the brain protective effects of isoflurane preconditioning for local cerebral is-chemia adult rat model by detecting HIF-1α, HO-1 and Bcl-2 expression level. Methods 84 two-month old Spra-gue-Dawley male rats were randomly divided into sham group, ischemia-reperfusion group ( MCAO group) and isoflurance preconditioning group (ISO group). ISO group was exposed to isoflurane for 30 min and then underwent a 90 min middle cerebral arterial occlusion (MCAO), while MCAO group underwent MCAO only. At 24 h after reperfusion all the groups were investigated by modified neurological severity score for neurological deficits, TTC staining for infarct percentage. Cerebral cortices were harvested for HIF-1α, HO-1 and Bcl-2 protein expression level detection at 6 h, 24 h and 72 h after reperfusion using RT-PCR and western blot. Results The mNSS score and infarct percentage in ISO group decreased significantly compared with those of MCAO group at 24 h after reper-fusion(P < 0. 05). Compared with the MCAO group, ISO group had significantly up-regulated protein levels of HIF-1α, HO-1 and Bcl-2 at 6 h and 24 h after reperfusion(P < 0. 05). There was no difference between ISO group and MCAO group for 3 gene expression at 72 h(P > 0. 05). Conclusion Isoflurane preconditioning plays short-term cerebral protective effect through the up regulation of HIF-1α, HO-1 and Bcl-2 gene expression.

Objective To evaluate transsphincteric operation (Mason operation) for rectal tumors.Methods Retrospective study was used to analyze the experience of Mason operation for 150 patients with mid and lower rectal tumors between Aug 1990 to Dee 2008. Results There were villous adenoma in 75 cases,early rectal cancer in 48 and advanced rectal cancer in 9,submucosal carcinoid nodule in 23.Of the 126 rectal tumor patients,120 underwent partial rectectomy,6 underwent segmental rectectomy.Seventeen out of the 21 rectovaginal fistula or rectourethral fistula cases underwent successful one-stage repair.Six patients(4%)developed wound infection.Five patients(3.3%)were complicated with recto-cutaneous fistula.Two patients(4.3%) suffered from local recurrence in 46 followed up early staged rectal carcinoma with a five-year survival rate of 84.5%(39/46).On discharge from hospital no patient suffered from incontinence.Conclusion Mason operation is satisfactory with good exposure and simple access to the rectum,which Was suitable for those lesions that could be locally resected on mid and lower rectum.

The part-time graduate student education is the important part of the graduate student system in Chinese medicine education.Developing and regulating the part-time graduate student education in Chinese medicine is helpful to the consummation of Chinese medicine graduate student system,the cultivation of the high lever talents in Chinese medicine,and keeping up with international graduate student educational system.

Objective To evaluate the biomechanical basis and long term clinical outcome of the offset hook-screw combined instrumentation in preventing against correction loss after it is used to treat the unstable thoracolumbar fractures. Methods Of 98 cases treated with the offset hook-screw combined instrumentation from July 1997 to December 2002, 64 with follow-up over two years were reviewed. All 64 cases received operation within average 3.2 days after injury, of which 41 were fixated with CD or CD-Horizon instrumentation and 23 with TSRH instrumentation. The long term clinical outcome evaluation included the maintenance of the vertebral height restoration, the sagittal kyphotic Cobb angle loss and the coronal Cobb angle correction loss. Results No death occurred. But after operation, there was one case with worsened neurological deficits (recovered one week after surgery) and two with deep infection. The average post-operative vertebral height and the coronal Cobb angle were restored by 89.0% and 100.0% respectively and the sagittal kyphotic Cobb angle corrected from preoperative 31?to postoperative -1? . During the follow-up for 24-62 months, no instrumentation breakage occurred. The pseudoarthrosis was affirmed in one case and suspected in two with the vertebral height loss of 8.6% and the kyphotic Cobb angle correction loss of 4?respectively. Conclusions The offset hook-screw combined instrumentation can satisfactorily restore the normal sagittal profile, effectively prevent the fixation loosening or breakage, minimize the mechanical failure of instrumentation, and particularly reduce the loss of long-term correction.