OBJECTIVE:To observe therapeutic efficacy and safety of glutamine combined with low molecular weight heparin in the treatment of elderly severe pneumonia (SP).METHODS:In retrospective study,88 SP elderly patients were divided into control group (44 cases) and observation group (44 cases).Based on conventional treatment,control group was given Enteral nutritional suspension via nasal feeding.Observation group was additionally given Alanyl glutamine injection 20 g,dissolved in Amino acid solution with ratio of 1:5 at least and maximum concentration belowing 3.5％,i.v.,once a day+Low molecular weight heparin calcium injection 4 KU/kg subcutaneously,once a day,on the basis of control group.Both groups were treated for 7 d.Clinical efficacies and postoperative recovery (ventilator support time,pulmonary rale disappearance time and ICU hospitalization time) were observed in 2 groups.The levels of IgA,IgG,TNF-a,hs-CRP,APACHE Ⅱ score,coagulation function indexes (APTT,D-D,FIB,PT,PLT),blood gas analysis indexes [pa (CO2),SpO2,Oi,pa (O2)] and receptor for advanced glycation end products (RAGE),the occurrence of ADR before and after treatment were also observed in 2 groups.RESULTS:Total response rate of observation group (90.91％) was significantly higher than that of control group (72.73％),while ventilator support time,pulmonary rale disappearance time and ICU hospitalization time were significantly shorter than control group;the incidence of ADR was significantly lower than control group,with statistical significance (P＜ 0.05).After treatment,the levels of IgA,IgG,Oi,SpO2 and pa (O2) in 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group.The levels of TNF-αt,hs-CRP,APACHE Ⅱ score,coagulation function indexes,pa(CO2) and RAGE in 2 groups were significantly lower than before,and the observation group was significantly lower than the control group,with statistical significance (P＜0.05).CONCLUSIONS:Based on conventional treatment,glutamine combined with low molecular weight heparin show significantly effect on elderly SP,effectively improve cellular immune function,coagulation function and blood gas analysis indexes and reduce RAGE level with good safety.

Objective　To investigate the diagnosis and treatment of acute rejection of orthotopic liver transplantation (OLT). Methods　From July 1999 to April 2000, two piggyback liver transplantations were performed on two patients with Wilson's disease. Results　Cyclosporine A, azathioprine and methylprednisolone were the baseline immunosuppression management. Acute rejection occured 5 times in the 2 patients. The correct diagnosis was obtained through clinical inspection, liver function test and biopsy. The rejections were controlled by intensive steriod therapy plus OKT3 or FK506. Conclusions　Clinical inspection and liver function test can suggest the episode of acute rejection in time. Hepatic biopsy is the key point for diagnosis of acute rejecton, Reasonable use of immunosppression is critical for the treatment.

ObjectiveTo explore the damage of blood vessels in carbon monoxide poisoning patients by hyperbaric oxygen, especially for damage of vein, to understand the factors aggravating inflammatory response, thus work out the homologous protective measures.MethodsFrom January 2006 to January 2008, 80 patients of carbon monoxide poisoning were selected as the observation group. Another 80 patients with other diseases were set as the control group. Two groups both accepted hyperbaric oxygen treatment. The time of angioplerosis was compared between the two groups, besides, pain reaction of the observation group was also observed.ResultsThe time of angioplerosis was significantly different between the two groups, pain sensibility intensified in the observation group compared with that before treatment.ConclusionsHyperbaric therapy is closely related with vascular inflammatory reaction of carbon monoxide poisoning patients. Protective measures should be established in order to prevent further damage of vessel, relieve pain of patients and ensure smooth progress of the treatment.

Objective To evaluate the clinical results of proximal humeral internal locking sys-tem(PHILOS)self-locking plates in treatment of proximal humeral fractures. Methods There were 35 patients including 19 males and 16 females(at mean age of 53.5 years,ranging from 29 to 92 years)with proximal humeral fractures treated with PHILOS plate.According to the Neer's classification sys-tem,there were two-part fractures in 19 patients,three-part fractures in 15 and four-part fractures in 1.Surgery was performed with PHILOS serf-locking plate via dehopectoral approach.All patients were fol-lowed up for mean 18.9 months(6-46 months)and evaluated by using Constant score and X-rays. Re-suits X-rays proved that all fractures got good reduction and complete healing during 8-12 weeks.The latest Constant scores was mean 89.5 points(82-94 points).There were no complications including plate loosing.humenral head necrosis or gleno-humeral ioint osteoarthritis. Conclusion PHILOS plate is a good choice for treatment of proximal humeral fractures because of its advantages including easy operation,stable fixation,good clinical results and few complications.