Objective To evaluate the clinical efficacy of tiotropium combined with salmeterol/fluticasone on the treatment of the patients with asthma COPD overlap syndrome. Methods 122 patients with asthma COPD overlap syndrome were divided into 2 groups by randomized envelope, the experimental group and the control group. The experimental group were given tiotropium bromide combined with salmeterol/fluticasone. The control group were received compound ipratropium bromide combined with salmeterol/fluticasone. The clinical effect was observed. Results Before treatment, there was no significant difference in lung function between the two groups. After treatment, the improvement of pulmonary function indexes in the experimental group was significantly higher than that in the control group (P<0.05). And the number of acute attack and attack time in the experimental group were also better than those in the control group (P<0.05). Conclusion Tiotropium combined with Shah Mette Lo/fluticasone is effective on the treatment of asthma COPD overlap syndrome, and has some clinical advantages in improving lung function and reducing the frequency of attack.

Objective To analyze the effect of salmeterol Lo fluticasone combined with montelukast on the treatment of the elderly patients with severe bronchial asthma. Methods According to the order of admission, 90 elderly patients with moderate or severe bronchial asthma treated in our hospital from October 2015 to October 2016 were divided into two groups: the study group (n=45) and the control group (n=45). The control group were given salmeterol and fluticasone. The study group were received montelukast on the basis of the control group. The therapeutic effects and pulmonary function in the two groups were compared. Results The total effective rate in the study group was significantly higher than that in the control group, the lung function was significantly better than that in the control group, the differences was statistically significant (P<0.05). Conclusion The clinical efficacy is significant which salmeterol fluticasone combined with montelukast was used on the treatment of elderly patients with moderate and severe bronchial asthma , pulmonary function is improved significantly, which is worthy of reference and promotion.

s Objective To explore the value of B mode ultrasound in the detection of amniotic fluid(AF) for fetus of 41～ 46 +6 gestation weeks.Methods B mode ultrasound was performed to monitor AF in 232 fetus of 41～46 +6 gestation weeks compared with that in 296 fetus of 37～40 +6 gestation weeks. Results There were significant differences in amniotic fluid index(AFI), amniotic fluid muddy(AFM) and cavity fetal distress(CFD) between the two groups (P

Objective To evaluate the efficacy and safety of dexmedetomidine aiding spinal -epidural anes-thesia for sedation.Methods Ninety ASAI -II female patients scheduled for elective spinal -epidural anesthesia were randomly divided into 3 groups(30 cases for each group)according to the digital table method.An epidural catheter was inseted at L2 -3 after satisfactory anesthesia,sedative drugs was intravenous.Group A received midazolam 0.05μg/kg initial loading dose for 10min and maintaining with 0.5μg·kg -1 ·h -1 .Group B received midazolam 0.06μg/kg for 5min and maintaining with 0.5mg·kg -1 ·h -1 .Group C received first intravenous injection of propo-fol 0.5 mg/kg,injection time 60s,maintaining with 0.3 -1.2mg·kg -1 ·h -1 .The infusion rate was adjusted to increase or decrease in order to maintain the desired level of sedation(Ramsay score of 3)during operation.The seda-tion efficacy and adverse reactions of three groups were compared.Results The onset time[(11.2 ±2.8)min]in group A was longer than that of group B[(6.4 ±2.4)min],group C[(5.0 ±2.1)min](t =7.12,9.70,all P <0.05).The offset time of group A,B[(12.3 ±2.4)min,(13.8 ±2.5 )min]were longer then those of group C [(7.4 ±2.3)min](t =8.36,7.95,all P <0.05).But 5 and 6 patients in the group B and C occurred hypoxia,and there were 8 and 9 patients developed partial airway obstruction due to relaxation of jaw muscle.At the time 30min, 60min and the end of surgery,the HR of the group A decreased deeply than the other two groups(t =5.02,4.92, 4.90,3.95,5.71,4.09,all P <0.05),10,5,6 patients were given atropine for increasing the HR in the group A,B and C respectively.Conclusion Dexmedetomidine is more safe and effective for the sedation of spinal -epidural an-esthesia,compared with midazolam and propofol,but with lower HR and longer onset time.

Objective:To evaluate the clinical experience and working method of the department of stomatology,otorhinolarynogology and ophthalmology during the peacekeeping period in Liberia.Methods:Five hundred twenty five patients with stomatological,otorhinolaryngological or ophthalmological diseases during the peacekeeping period were reviewed.Results:The patients with stomatogical disease(455),NEN disease(38) and eye disease(32) were treated by a stomatological without mistake during 7 months. Conclusion:Stomatological doctors should be versatile to accomplish their peacekeeping mission.

Objective To study the effect of mechanical ventilation guided by esophageal pressure on hemodynamics and oxygen metabolism of severe acute pancreatitis (SAP) swine model with intra-abdominal hypertension (IAH) Methods By self-controlled study,SAP model was made by infusing sodium taurocholate (5％) into the pancreatic duct in 6 domestic swine.Mechanical ventilator mode was volumeassist control with tidal volume 10 ml/kg ; FiO2 40％ and PEEP 5 cm H2O (routine ventilation) given to SAP model swine.After 3 h ventilation,pneumo-peritoneum was made with N2 gas to increase the intraabdominal pressure (IAP) to 25 mm Hg in SAP swine.Three more hours later,PEEP was adjusted as the measurement of esophageal pressure (Pes guided ventilation) to such a level that trans-pulmonary pressure stayed above 0 cm H2O during end-expiratory occlusion.During the investigation period,heart rate (HR),cardiac output index (CI),central venous pressure (CVP),mean arterial pressure (MAP) and pulmonary arterial wedge pressure (PAWP) were continuously recorded with the aid of Swan-Ganz catheter and ECG monitor,and oxygen partial pressure of artery (PaO2) and carbon dioxide partial pressure of artery (PaCO2) were measured by blood-gas analysis.In addition,systemic oxygen delivery (DO2) and systemic oxygen consumption (VO2) were calculated by using the data of blood-gas analysis of arterial and central venous blood.Results No swine model was subjected to barotrauma.After routine mechanical ventilation,there were significant differences in HR,CI,MAP,CVP,PAWP,Ppeak,Pplat,Pes,pulmonary compliance (Cstat),PaO2,and DO2 between SAP and IAH in swine (all P ＜ 0.05).Compared with routine ventilation,however,PaO2 and Cstat improved significantly with lower CI and increased Pplat after PEEP adjusted according to measurements of esophageal pressure (all P ＜ 0.05).The lactate decreased significantly after esophageal pressure guided ventilation (all P ＜ 0.05).There were no significant changes in PaCO2,HR,MAP,CVP and PAWP in IAH swine after mechanical ventilation with routine parameters (all P ＞ 0.05).Conclusions There were remarkable effects on oxygen metabolism in response to mechanical ventilation guided by esophageal pressure.In case of clinical application of mechanical ventilation,the results of this study are in favor of setting transpulmonary pressure according to measurements of esophageal pressure in SAP patients with IAH in an early stage.

OBJECTIVE: To explore the influence of psychological factor on asthma, the protective and therapeutic effects of Shugan Lifei Recipe on rats with asthma under stress and the mechanisms. METHODS: Allergy and stress-induced asthma models were established in rats by giving ovalbumin and restraining stress. Radioimmunoassay, enzyme linked immunosorbent assay, in situ hybridization and immunohistochemical method were used to detect plasma corticosterone, IL-4, IFN-gamma, expression of glucocorticoid receptor (GR) mRNA in hippocampus and adrenocorticotropic hormone corticoliberin (CRH) positive neuron in hypothalamus. Optical and electron microscopes were used to observe the morphological changes of pulmonary hilar and hippocampal tissues. RESULTS: Shugan Lifei Recipe (SGLFR) could reduce plasma corticosterone, decrease CRH positive neurons in paraventricular nucleus of hypothalamus, up-regulate the expression of GR mRNA in hippocampus and reduce the injury of hippocampal neuron. SGLFR had certain inhibitive effect on hyperfunction of hypothalamo-pituitary-adrenal cortex (HPA) axis in rats with asthma under stress and could also relieve the pathological changes of the pulmonary hilar tissue. The level of plasma IFN-gamma was increased while the level of plasma IL-4 was decreased in SGLFR-treated group. CONCLUSION: The mechanism of SGLFR in treating the rats with asthma under stress is probably to regulate the hyperfunction of HPA axis and the disorder of immuo-system.

Objective:To construct a recombination plasmid containing a kanamycin resistance gene,the upstream and downstream fragment of luxS of Streptococcus mutans so that luxS can be knock out by transforming the plasmid into S.mutans later.Methods:Kanamycin resistance gene,the upstream and downstream of luxS were cloned respectively by using plasmid pEGFP-N1 and DNA of Streptococcus mutans as template.Then the genes were ligated into Multiple Cloning Site(MCS) of vector pMD19-T in certain order and transformed into E.coli Competent Cells.Finally transformants were selected for resistance to kanamycin and ampicillin.Results:Kanamycin resistance gene and the upstream and downstream of luxS were successfully ligated into accurate enzyme digestion site of vector pMD19-T,and restriction digests analysis and sequencing result was correct.Conclusion:LuxS gene knock-out of Streptococcus Mutans recombinant plasmid is constructed and built a base of constructing Streptococcus Mutans luxS mutans in the future.

Objective: The influence on the blood glucose,ALB,LYM,K+,Na+,Cl-,TG,TC and so on after the use of different nutrition formula was observed in patients with cerebrovascular disease and type 2 diabetes.Methods: 40 patients who suffered from cerebrovascular diseases and type 2 diabetes were divided into two groups: one group using the ordinary formula and the others using special-purpose formula of diabetes.The levels of blood glucose,ALB,LYM,K+,Na+,Cl-,TG,TC were monitored.Results: The patient's blood glucose after use of ordinary formula rised obviously and insulin or the oral drug for decreasing blood glucose was used.The blood glucose in special-purpose diabetes formula group didn' t increase obviously,and there was not the need of using insulin(P

Objective • To investigate the current status of self-perceived burden of the patients with non-Hodgkin's lymphoma (NHL) and analyze the related factors. Methods • A total of 169 NHL patients who were hospitalized in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from Jan. to Oct., 2019, and their caregivers were enrolled by convenience sampling method. The general information questionnaire, Social Support Rating Scale (SSRS), Self-rating Depression Scale (SDS), Zarit Caregiver Burden Interview (ZBI) and Self-perceived Burden Scale (SPBS) were used to investigate, and the factors related to the score of SPBS were analyzed. Results • The average score of SPBS was 28.95±11.27, while the score of economic burden was the highest (3.13±1.37). Multiple regression analysis suggested that the family income per month per person (P=0.001), Karnofsky performance status (KPS) (P=0.027), SDS score (P=0.006) and ZBI score (P=0.000) were associated with the SPBS score in the NHL patients. Conclusion • The overall selfperceived burden in the patients with NHL is mild-to-moderate, but the economic burden is not neglectable. Low monthly income, poor ability of self-care, depressive symptoms and heavy burden of caregivers can aggravate the self-perceived burden of the patients with NHL.