OBJECTIVE To evaluate the clinical efficacy of piperacillin/tazobactam for acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with pulmonary encephalopathy.METHODS Seventy three cases of AECOPD with pulmonary encephalopathy were randomized into piperacillin/tazobactam group and ceftazidime group,and sputum culture was underwent for each case before and after treatment.RESULTS The total efficacy rates and bacterial clean rates in piperacillin/tazobactam group and ceftazidime group were 91.67% and 88.89%,75.68% and 57.89%,respectively,and the differences between the two groups were statistically significant.CONCLUSIONS It suggested that piperacillin/tazobactam be a more effective drug for AECOPD with pulmonary encephalopathy.

Objective To study the effect of implanted stent or selected operation in patients with acute occlusion of right coronary artery during the emergency coronary arteriongraphy. Methods Forty-three patients with acute occlusion of right coronary artery who underwent the emergency coronary arteriongraphy were divided into two groups: the implanted stent group ( n = 23) during the emergency coronary arteriongraphy and the selected operation group (n =20) during the emergency coronary arteriongraphy . Then we observed the general data, the coronary artery pathological changes, preoperative and postoperative thrombus, the blood flow, remained stenosis and the prognosis. Results The implanted stent group was similar to the control group in general condition, but implanted stent group was significantly different from the control group in the near, intermediate and distal coronary artery pathological changes ( <0.05) . The control group was significantly different from the implanted stent group in the thrombus and slowly blood flow ( <0.05) . After three months, we reviewed coronary arteriongraphy and selected operation, The implanted stent group was significantly different from the control in the remained stenosis and slowly blood flow (<0.05) . But the implanted stent group was similar to the control groug in the thrombus and new proceeding cardiovascular events. Conclusion When thrombus appears in acute occlusion of right coronary artery, we can implant stent during the emergency coronary arteriongraphy if the thrombus is little, or we can select operation after PTCA on the contrary.

ObjectiveTo evaluate the clinical value of the pumping and popliteal vein thrombosis contact thrombolytic treatment of lower extremity deep venous thrombosis(LEDVT).MethodsFor thirty deep venous thrombosis patients with ipsilateral popliteal vein approach through a comprehensive intervention,the line of the inferior vena cava filter was implanted under the premise of first balloon mechanical thrombus fragmentation and thrombus aspiration by 10 F improved the inferior vena cava stents conveying sheath,followed by the line of contact thrombolytic therapy.Four patients underwent iliac vein in the thrombolytic treatment of stent implantation.Vein patency and venous patency score and health and poor limb circumference difference were used to assess efficacy of treatment.Patients were followed up for at least 1 year.ResultsThe technical success rate was 100％.At six months after sugery,the mean lower limb circumference difference of the 30 patients was＜ 1.5 cm.Lower limb venous angiography showed significantly improved vein patency score [ (9.5 ± 2.6) vs.(3.6 ± 2.1 ),Z =1.65,P ＜ 0.01 ].Venous patency rate was ( 69.5 ± 13.2) ％.No serious complications during treatment and the period of follow-up.Conclusion Transpopliteal vein interventional treatment of lower extremity deep venous thrombosis is simple,safe and effective.

Objective To determine the treatment effect of cesarean scar pregnancy (CSP) and provide theoretical guidance in selecting proper treatment for this disease. Methods Sixty-two patients were randomly divided into 2 groups taken uterine artery embolization combines uterine curettage (combination group,n = 32) and gynaecologic surgery (surgery group, n = 30) respectively. The operation time, blood loss, intraoperative fluid volume, uterine retention rate, hospitalization days and medical expense of two groups were recorded and compared.The complication occurrence of both short-term and long-term was observed, and the results in two groups were compared. Long term and short term occurrence of complications were also observed. Results No significant difference in preoperative indicators was found between two groups, includes average age, menopause time, blood β-HCG value,gestational sac diameter,the amount of vaginal bleeding (P ＞ 0. 05 ). But after the operation,we found significant difference between the combination group and surgical group in uterine retention rates (96.9% (31/32)and 20.0% (6/30) respectively, P ＜ 0. 01 ). The significant differences were also observed in operative time (42. 0 ±13.2) min and ( 120.0 ± 34.5 ) min respectively, P ＜ 0. 001 ); average hospitalization days ( (7.0 ± 1.0)days and ( 15.0 ± 2.0) days respectively, P ＜ 0. 001 ); medical expense ( $ 9143.5 ± 864.3 and $ 11 371.7 ±1621.0 respectively, P ＜ 0. 001 ) between the combination group and surgical group. During hospitalization,complication occurred in 1 case in combination group and in 7 cases in surgery group, of which mild complications were seen in 6 and serious complication in 1 patient. No treatment-related complications occurred in long-term observation in neither of the groups. The complication occurrence in combination group and surgery group were 3.1%(1/32) and 23.3% (7/30) respectively ,with a significant difference between two groups (P ＜ 0.01 ). Conclusions In the treatment of cesarean scar pregnancy, the uterine artery embolization combines uterine curettage therapy is superior to gynaecologic surgery for its shorter operative time, less infusion quantity, higher uterine retention rate,fewer complications, shorter time of hospitalization, less medical expense and better security.

Objective To evaluate the effect of autologous bone marrow-derived stem cell (MSCs)transplantation in the treatment of decompensated hepatic cirrhosis.Methods Bone marrow was harvested (150-200 ml) from 25 patients with decompensated cirrhosis and hepatic failure.The MSCs were isolated according to the method reported by Wollert and infused into liver via hepatic artery catheter.At different time points after the transplantation,the patients' liver function and prothrombin time(PT) were evaluated,and the survival rate and symptoms of the patients were recorded.Results All the serum biochemical indexes remained stable 2 weeks after the transplantation,and at 4 weeks after transplantation,levels of albumin was increased significantly in comparison with the preoperative level((30.91 ±4.00) g/L vs (26.65 ±5.30) g/L,t =3.07,P ＜0.05).At 12 weeks,the levels of albumin further increased((32.00 ±6.18) g/L vs (26.65 ±5.30) g/L,t =3.02 P ＜ 0.01).While at 12 weeks after operation,there was significant difference on the total bilirubin ((39.94 ± 21.15) mmol/L vs (125.01 ± 150.05) mmol/L; t =2.63,P ＜ 0.05),tolal bile acid ((41.63 ±33.91) μmol/L vs (78.00 ± 59.80) pmol/L;t =2.53,P ＜ 0.05) when compared with the preoperative level.4weeks after operation,the liver enzyme indicators changed significantly when compared with the preoperative level (P ＜0.05).At 12 weeks after operation,there was significant difference on the PT((14.71 ± 1.59) s vs (21.40 ± 6.07) s,t =5.01,P ＜ 0.01) and the level of fibrinogen ((2.64 ± 0.61) g/L vs (1.66 ± 0.94) g/L,t =4.17,P ＜0.01).1 week after the transplantation,90.67％ patients exhibited improved appetite and 88.5％patients showed better physical strength; at 2 weeks,hepatic face improved in 16 cases (63.5％),and spider telangiectasia was significantly reduced in 1 case;at 12 weeks,the survival rate of the patients was 77.44％,and 3 died or gave up treatment due to chronic liver failure complicated by spontaneous bacterial peritonitis,hepatorenal syndrome,or DIC.No complications associated with the transplantation occurred in these patients.Conclusion MSCs transplantation can significantly improve the liver function of patients with decompensated hepatic cirrhosis with good safety and effectiveness,but the indications should be strictly controlled.

BACKGROUND: Total glucosides of paeony, effective component extracted from peony, has good inflammatory and analgesic effect. OBJECTIVE: To investigate the curative effect and side effect of total glucosides of paeony combined with methotrexate and sulfasalazine in the treatment of ankylosing spondylitis. DESIGN: Randomized and controlled observation SETTING: Department of Rheumatology , Guangdong Hospital of Traditional Chinese Medicine PARTICIPANTS: Totally 80 inpatients with ankylosing spondylitis hospitalized in the Clinic of Department of Rheumatology, Guangdong Hospital of Traditional Chinese Medicine from June 2003 to April 2004 were involved. The patients were randomly divided into 2 groups with 40 patients in each group. Informed consent was obtained. METHODS: Experimental group: 2 capsules of total glucosides of peony was taken orally, three times per day; methotrexate 10 mg/time, once per week; sulfasalazine 0.5 g/time, three times per day. Control group:methotrexate and sulfasalazine were taken orally and the dosage and method were the same as those in the experimental group. Two groups all used the same NSAID (Nimesulide) , 0.1 g/time, twice per day. The period of the treatment was 3 months. Evaluation of spinal column function and laboratory examination was performed before treatment and 4, 8 and 12 weeks after treatment. MAIN OUTCOME MEASURES: Primary outcomes: Bath ankylosing spondylitis activity index, Bath ankylosing spondylitis function index [1-2],duration of morning stiffness, systemic pain and spinal pain on a four point Likert scale, overall assessment of patient and physician on a four point scale. Secondary outcomes: ①erythrocyte sedimentation, C-reaction protein,Schober test, chest expansion, Occiput to wall distance and finger to floor distance.② Adverse events and side effects. RESULTS: The observation of 38 patients in the experiemtnal group and 37 patients in the control group was completed. ①Result of Bath ankylosing spondylitis activity index, Bath ankylosing spondylitis function index,duration of morning stiffness, pain and spinal pain on a four point Likert scale, overall assessment of patient and physician on a four point scale:The indices at week 4, 8 and 12 werevmore significantly decreased than those before treatment in each group (P ＜ 0.05); the Bath ankylosing spondylitis activity index, pain and spinal pain on a four point Likert scale,overall assessment of patient and physician on a four point scale at week 4and all the indices at week 8 and 12 were more significantly decreased than those in the control group (P ＜ 0.05). ② Evaluation result of Erythrocyte sedimentation rate (ESR) and C reaction protein, Schober test, chest expansion , occiput to wall distance and finger to floor distance: Each index at week 4, 8 and 12 in the experimental group were significantly decreased than those before treatment (P ＜ 0.05), those at week 8 and 12 in the control group were more significantly decreased than those before treatment (P ＜ 0.05). ESR , C reactive protein (CRP) , chest expansion and finger to floor distance at week 12 in the control group were more significantly decreased . ③ Adverse events and side effects: All adverse reactions occurred transiently during the course of disease in the two groups. Undisposed or after having taken live-protective medicine, all patients recovered.Drug was not withdrawn in any case.The incidence of adverse reaction in the experimental group was lower than that in the control group [10％ (3/30),57％(17/30) ,P ＜ 0.05]. CONCLUSION: Combination of total glucosides of paeony, methotrexate and sulfasalazine has an enhanced effect and better safety without special adverse reaction in the treatment of ankylosing spondylitis.

OBJECTIVE To investigate the transgenerational effect of neuroendocrine metabolic programmed alteration in adult intrauterine growth retardation (lUGR) offspring rats with prenatal nicotine exposure. METHODS Pregnant Wistar rats were administered daily with nicotine (2 mg.kg-1 ) by sc from gestational day 11 until delivery. F1 offspring was fed with a standard diet before four groups in F2 were set up according to the cross-mating between F1 normal adult rats and nicotine-induced lUGR adult rats. CC group was mated by F1 normal adult rats, CN group by F1 normal adult male rats and lUGR adult female rats, NC group by F1 lUGR adult male rats and normal adult female rats, while NN group was mated by F1 lUGR adult rats. F2 adult rats were subjected to a fortnight ice water swimming stimulus. Blood samples were collected before and after stress and then detected for the levels of adrenocortico-tropic hormone ( ACTH), corticosterone ( CORT), glucose, triglycerides ( TG) and total cholesterol (TCH). RESULTS Before stress, the level of serum CORT in F2 male rats of NN group was decreased to 73.9% of that of the CC group (P<0.05),while the level of serum TG in F2 male rats of CN and NC groups was increased to 1.43 and 1.52 times that of the CC group, respectively ( P<0.05). Meanwhile, the level of serum TG in F2 female rats of CN, NC and NN groups was increased to 1.71, 1.80 and 1.81 times that of the CC group, respectively (P<0.05). After stress, the serum CORT gain rate in F2 male rats of CC group was -1.67%, but was 36.0% in NN group. The serum glucose level in male NC group and in female CN group was increased to 1.61 and 1.62 times that of the corresponded CC groups, respectively (P<0.01). Furthermore, the serum TG gain rate in F2 rats of each nicotine group was decreased markedly in comparison with their corresponding controls (P<0.05), ie, the serum TG gain rates in F2 male rats of CN, NC and NN groups were decreased to 46.4%, 16.7% and 7.7% of the CC group, while the serum TG gain rates in F2 female rats of these groups were decreased to 20.6%, 4.0% and 8.4% of the CC group, respectively. Compared with CC group, TCH level of females and males in NN group was decreased by 40.5% and 21.9%(P<0.01) before stress, respectively, and the TCH gain rate of females in NN group was increased by 49.7%(P<0.05) after stress. CONCLUSION The reproductive and developmental toxicities and the neuroendocrine metabolic programming alterations induced by prenatal nicotine exposure are transgenerated to F2 offspring and these effects exhibit gender and parental differences.

Objective To compare the efficacy and safety of intravenous thrombolysis on cardiogenic cerebral infarction and noncardiac infarction by recombinant tissue plasminogen activator (rt-PA). Methods Comparations of NIHSS, mRS and adverse events before and after treatment were made between the cardiogenic group and the noncardiac group. Results No significant differences in the NIHSS and mRS were found between the two groups. The incidence of brain hernia and dermatorrhagia in the cardiogenic group was higher than that in the noncardiac group. Conclusion Rt-PA therapy in cardiogenic cerebral infarction was effective and safe in spite of higher incidence of hemorrhage and brain hernia.

Objective:To explore therapeutic effect and safety of endovascular stenting on transient ischemic attack (TIA) caused by atherosclerotic vascular stenosis .Methods:A total of 100 patients with TIA caused by vascular ste-nosis in our hospital from Jan 2011 to Feb 2013 were enrolled ,and equally divided into combined treatment group (received endovascular stenting combined medication ) and routine treatment group (received medication treat-ment) .After 12-month treatment ,recurrence rate of TIA ,incidence rate of stroke and vascular stenosis rate before and after treatment were compared between two groups .Results:Compared with before treatment ,there was no significant change in all above-stated indexes after treatment in routine treatment group;were significant reduction in vascular restenosis rate [ (73.31 ± 12.76)% vs .(25.01 ± 5.73)% ] in combined treatment group ,and it signifi-cantly reduced than that of routine treatment group (74.33 ± 12.96)% ,P<0.01 both ;during the 12-month follow-up ,compared with routine treatment group , there were significant reductions in percentages of recurrent TIA (16.0% vs .2.0% ) and cerebral stroke (12.0% vs .0) in combined treatment group ,P<0.05 both Conclusion:En-dovascular stenting can significantly improve clinical therapeutic effect and prognosis in patients with atherosclerotic vascular stenosis ,and is worth clinical extension in some condition .

Objective To inVestigate the effect of emodin on hyPertroPhic scar fibroblasts ( HSFs ) and exPlore the underlying mechanism. Methods HSFs were treated by emodin at final concentrations of 0,20,40,and 80 μmol·L-1, resPectiVely,in the cultural media. Forty_eight hours later,the cells were subjected to MTS assay and flow cytometry assay with annexin V and ProPidium iodide as dyeing indicators. Whole cell lysates from the cells of eVery grouP were subjected to Western blotting to measure the Protein exPression leVels of ERK1∕2,Bcl_2,Mcl_1 and RIP1. Results The cell Viability of HSFs was inhibited by emodin in a dose dePendent manner. The mortality rate of HSFs treated with emodin for 48 h at the concentrations of 40 and 80 μmol·L-1 were 28. 6%and 68. 0%,resPectiVely,which was significantly higher than that of the control grouP ( P<0.01).Pretreatmentwith Z_VAD_FMK could Partially reduce the mortality caused by emodin (P<0.05).PhosPhorylation of ERK1∕2 and the exPression of RIP1 and Mcl_1 were inhibited by emodin. Conclusion Down regulation of ERK1∕2,RIP1 and Mcl_1 by emodin may account for the inhibited Proliferation and increased cell death of HSFs.