Objective To observe and compare the clinical effect of aerosol inhaled and systemic glucocorticoid treatment and its influence on the expression of procalcitonin ( PCT) and hyper-sensitive C reactive protein ( hs-CRP) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods 146 elderly patients with AECOPD were enrolled prospectively.The patients were divided in three groups randomly, including inhalation group (48 cases referred as 2 mg of budesonide nebulization every 8 hours with therapeutic course of 5 days), intravenous group (50 cases referred as 40 mg methylprednisolone intravenous injection once daily with therapeutic course of 5 days), and control group (48 cases with no glucocorticoid ) .All the patients were treated with routine oxygen therapy, anti-inflammation, bronchodilators (β2 receptor agonist and doxofylline) and mucolytics, and so on.The levels of serum PCT and hs-CRP were detected before and after five days treatment, and also the clinical parameters such as symptoms, blood gas analysis, lung function, hospital days, fasting blood glucose and adverse reaction were simultaneously recorded. Results The general clinical data demonstrated no significant difference among the groups.Compared with the control group, the total effective rate, improvement rate of lung function (FEV1%pred and FEV1/FVC) and of blood gas parameters (pH value, PaO2 and PaCO2) in the inhalation group and intravenous group were higher, with shorter hospital days(P<0.05), while with no obvious difference between the two group.The levels of the serum PCT and hs-CRP were decreased in the patients enrolled after treatment, compared with the prior treatment (P<0.05).Compared with the control group, the levels of serum PCT and hs-CRP in the inhalation group and intravenous group decreased significantly, while with no obvious difference between the two groups.The levels of fasting blood glucose in the intravenous group were the highest;compared with the control group, the adverse effect incidence of the inhalation and intravenous groups were higher obviously, with the most obvious in the intravenous group ( P<0.05 ). Conclusion Application of glucocorticoid is benefit to improving the clinical symptom and lung function, and to rectifying hypoxemia and to shortening hospital days.The aerosol inhaled and systemic glucocorticoid application shows equivalent clinical efficiency on anti-airway inflammation.The glucocorticoid inhalation has fewer adverse effects and is recommended to treat the elderly patients with AECOPD .

Objective To study the effects of marrow mesenchymal stem cells on heart functions and ventricular remodeling after myocardial infarction in rats. Methods Myocardial infarction model was established by ligation of the left anterior descending coronary artery (LAD) in adult SD rats. 4 and 8 weeks after MMSCs implantation, he-modynamic evaluations, left ventricular weight/body weight ratio and heart weight/body weight ratio were determined. HE staining was performed for counting microvasculars and Van Gieson staining was used for measurements and calculation of the myocardial fibrillar collagen. Then we investigated the migration and evolution of MSCs in vivo by fluorescent microscope. Results HR was significantly decreased in transplantation MMSCs group. Eight weeks after transplantation, body weight in transplantation MMSCs group reached that of control group. At the same time, SBP, DBP and MBP were significantly increased in transplantation MMSCs group. HR was significantly decreased in transplantation MMSCs group. Secondly, left ventricular weight/body weight ratio and heart weight/body weight ratio were significantly decreased 4 weeks after transplantation MMSCs. Then the ratio was significantly decreased 8 weeks after transplantation MMSCs. Thirdly density of microvasculars was increased at the boundary of infarction site in the animals transplanted MMSCs. Finally, total volume of the myocardial fibrillar collagen was reduced in the MMSCs treated groups after MI. Conclusion Transplanting MMSCs can improve the ventricular remodeling and heart functions in acute MI rat models.

Objective To investigate the effects of aspirin(aspi) on rat cardiac fibroblasts (CFs) proliferation induced by aldosterone(ald) and the underlying molecular mechanisms .Methods Primary CFs from 1-3 day neonatal rats were digested by 0.08%trypsin and then purified by differential adhesion .The rats were divided into four groups:control group, DMEM medium ( free calf serum ) , ald group [ DMEM medium ( free calf serum ) +ald 1 ×10 -8 mol/L ] , aspi group [DMEM medium (free calf serum)+ald 1 ×10 -8 mol/L+aspi 1.11 ×10 -6 mol/L] and spiro group [DMEM medium (free calf serum)+ald 1 ×10 -8 mol/L +spiro 1 ×10 -6 mol/L].The morphology of CFs was assayed by HE staining methods .MTT Methods were used to measure cell proliferation .Western blotting was used to determine protein expression of TGF-β-Smad 2,3,4.Results HE Staining results showed that compared with the control group , ald activated cell proliferation and increased the cell division phase significantly (P<0.01).Compared with ald group, aspi+ald as well as spiro+ald could reduce cell division significantly ( P<0 .05 ) .MTT assay showed that compared with control group , ald could significantly improve the metabolism of MTT in CF (P <0.01).Compared with ald group, aspi +ald as well as spiro+ald could reduce the metabolism of MTT (P<0.01).Western blotting revealed that the expression levels of TGF-β-Smad 2, 3, 4 in CF were significantly increased by the stimulation of ald but were significantly reduced in aspi +ald and spiro+ald groups compared with ald group (P<0.01).Conclusion Aspi can inhibit the proliferation of CFs induced by ald,possibly by down-regulating the expression of Smad 2, Smad3 and Smad4.

Objective:To study the correlation of leucocyte level of peripheral blood with degree of pyretic pulmonary syndrome in different bacterial pneumonia patients and to provide evidence in clinical practice.Methods:To observe pneumonia patients that had been healed in our respiration department of The Jiangxi Province Chinese Medicine Hospital from January,2006 to December,2007 years,incorporating the non-foundation disease or the chronic obstuctive pulmonary disease or chronic cor corpulmonale,We were to summarize relation degree of pyretic pulnonary syndrome to the white blood cell countingthe neutral granular cell percentage relevance.Results:From the non-foundation disease's pneumonia patients group,degree of pyretic pulnonary syndrome and the peripheral blood white blood cell counting and the neutral granular cell level had obvious relevance(P

Objective To study the effects of marrow mesenchymal stem cells on heart functions and ventricular remodeling after myocardial infarction in rats. Methods Myocardial infarction model was established by ligation of the left anterior descending coronary artery (LAD) in adult SD rats. 4 and 8 weeks after MMSCs implantation,hemodynamic evaluations,left ventricular weight/body weight ratio and heart weight/body weight ratio were determined. HE staining was performed for counting microvasculars and Van Gieson staining was used for measurements and calculation of the myocardial fibrillar collagen. Then we investigated the migration and evolution of MSCs in vivo by fluorescent microscope. Results HR was significantly decreased in transplantation MMSCs group. Eight weeks after transplantation,body weight in transplantation MMSCs group reached that of control group. At the same time,SBP,DBP and MBP were significantly increased in transplantation MMSCs group. HR was significantly decreased in transplantation MMSCs group. Secondly,left ventricular weight/body weight ratio and heart weight/bodyweight ratio were significantly decreased 4 weeks after transplantation MMSCs. Then the ratio was significantly decreased 8 weeks after transplantation MMSCs. Thirdly density of microvasculars was increased at the boundary of infarction site in the animals transplanted MMSCs. Finally,total volume of the myocardial fibrillar collagen was reduced in the MMSCs treated groups after MI. Conclusion Transplanting MMSCs can improve the ventricular remodeling and heart functions in acute MI rat models.

Objective To investigate the correlation of HBV DNA level with clinicopathological characteristics and prognosis of HBV-associated glomerulonephritis ( HBV-GN ) .Methods One hundred and two patients with HBV-GN admitted in Affiliated Hospital of Qingdao University during January 2009 and October 2012 were successively enrolled.Fluorescence quantitative polymerase chain reaction was used to determine the serum titer of HBV DNA.According to HBV DNA levels the patients were divided into three groups:low-replication group (HBV DNA <103 copies/mL), moderate-replication group (103 copies/mL ≤HBV DNA≤105 copies/mL) and high-replication group ( HBV DNA >105 copies/mL) .Renal biopsy was performed to determine the pathological type, and immunofluorescence assay was used for quantitative detection of HBV related antigens ( HBsAg, HBcAg and HBeAg ) in kidney. All patients received lamivudine (100 mg/d) plus adefovir dipivoxil (10 mg/d) combination therapy and followed up for 18 months.The renal function, biochemical and immunological indexes before and after the treatment were measured.One-way ANOVA was used to analyze the differences of above parameters among patients in three groups.Spearman correlation coefficient was used for correlation analysis between HBV DNA level and pathological stages in kidney.Results There were 20 patients in low-replication group, 51 in moderate-replication group and 31 in high-replication group.With the increase of serum level of HBV DNA, 24-h urine protein excretion, plasma cholesterol, and triglycerides increased (F=34.64, 40.10 and 31.72, P<0.01), plasma level of albumin decreased (F=24.04, P<0.01), and the immune complexes of HBV related antigens ( HBsAg, HBcAg and HBeAg) in kidney increased ( F=41.49, 15.64 and 10.41, P<0.01).For 78 patients with HBV-membranous nephropathy ( HBV-MN), the pathological injury was aggravated with the increase of serum level of HBV DNA (r=0.38, P<0.01).The level of 24-h urine protein excretion declined after treatment in three groups ( t =7.86, 19.28 and 16.74, P <0.01 );complement C3 increased, but no statistical significance was observed ( t =1.05, 1.04 and 1.94, P >0.05);no change in creatinine was found (t =0.14, 0.52 and 0.57, P >0.05).After 18-month treatment, clinical remission rates in three groups were 95.0% ( 19/20 ) , 70.6% ( 36/51 ) and 54.8%(17/31), respectively.The clinical remission rate was significantly lower in the high-replication group as compared with that in low-replication group (χ2 =9.44, P<0.01).Conclusion Serum level of HBV DNA is closely correlated with renal function, renal pathology and clinical remission rate in HBV-GN patients, which may be used for the evaluation of kidney biopsy, treatment and prognosis in patients with HBV-GN.

ObjectiveTo determine the features of antrum gastritis by magnified narrow band imaging (M-NBI) and to evaluate the feasibility of target biopsy with M-NBI.MethodsA total of 69 consecutive patients who underwent M-NBI were recruited in the study.The gastric mucosa of antrum was observed under M-NBI and the gastric microstructure patterns were classified into 5 type.M-NBI findings were compared with the conventional histological findings.In addition,the interobserver agreement was assessed.ResultsA total of 173 gastric antral sites from 69 patients were examined by M-NBI.Type A was mainly normal sites (89.8％,44/49),while type B and C were chronic inflammation (53.3％,24/45 )and active inflammation (74.3％,26/35).Compared with the type A group,the inflammatory degree in type B (P＜0.001 ) group and type C group (P＜0.001) was significantly higher.The sensitivity,specificity,accuracy of the type B and type C pattern for predicting antrum gastritis were 87.5％,78.0％ and 81.5％.The sensitivity,specificity,accuracy of the type D and type E pattern for predicting intestinal metaplasia of antrum were 83.8％,90.4％ and 77.5％,respectively.The kappa value for the interobserver agreement was 0.734 [ 95％ CI(0.591-0.977 ) ].ConclusionMicrostructure features of antrum gastritis determined by M-NBI are highly correlated with histopathology,and can evidently help diagnosis.

Objective:To investigate the correlation between the expression of angiogenic factors (MVD, IGF-1, and STAT3) in colorectal carcinoma and adenoma and the microvascular characteristics under narrow band imaging (NBI), in order to evaluate the fea-sibility of NBI in real-time observation of angiogenesis. Methods:Patients with pathologically confirmed colorectal polyps were re-cruited and examined by NBI. Vascular patterns were classified into typeⅠ(invisible or faintly visible), typeⅡ(clearly visible and regularly arranged in a round, oval honeycomb-like pattern), and typeⅢ(clearly visible and irregularly arranged in terms of size and caliber or irregularly winded). Immunohistochemical staining was performed to determine the expression of CD34, IGF-1, and STAT3. Histological results were compared with the vascular patterns under NBI. Results:The NBI endoscopy results of 64 sites (15 adenocar-cinomas, 29 adenomas, and 20 normal tissues) from 58 patients were introduced and examined in this study. Adenomas ranked the first (82.1%, 23/28) among the vascular patternⅡcases, whereas early adenocarcinomas dominated the vascular patternⅢcases (66.7%, 10/15). The expression levels of MVD-CD34 and IGF-1 in normal mucosa, adenomas, and adenocarcinomas were significantly differ-ent (P<0.0001 and P=0.0062, respectively). All the expression levels of MVD-CD34, IGF-1, and STAT3 in sites displaying vascular pat-ternsⅠ,Ⅱ, andⅢwere significantly different (P<0.0001, P=0.0010, and P=0.0055, respectively). Spearman correlation coefficients between the NBI vascular patterns and the MVD-CD34, IGF-1, and STAT3 expression levels were 0.67, 0.41, and 0.40, respectively. Conclusion:Vascular pattern analysis through an NBI system can be a promising tool to evaluate angiogenesis of colorectal lesions in real-time endoscopic observation.

ObjectiveTo evaluate the effect of Rhubarb associated preparations (rhubarb or prescriptions of traditional Chinese medicine including rhubarb) on sepsis patients with acute gastrointestinal dysfunction (AGI).Methods The retrieval of databases from libraries including PubMed, Medline, Cochrane Central Register of Controlled Trials, CNKI, CBMdisc, Wan Fang Database, VIP database were searched to identify randomized controlled trials (RCTs) about Rhubarb associated preparations for treatment of sepsis patients with AGI from the foundation of the various databases to March 2016. And in the mean time, the references of the studies accepted were also retrieved. The retrieving and screening of literatures were performed independently by two researchers, the methodological quality and data extraction of the enrolled literatures were assessed by Jadad scale, and Cochrane Collaboration 5.3 software was used to perform Meta analyses to observe the effects of rhubarb associated preparations on gastrointestinal function score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and 28-day mortality in sepsis patients with AGI; the bias of published literatures was evaluated by funnel plot.Results ① Finally, 16 studies involving 1 171 patients (610 in rhubarb preparation group and 561 in the control group) were identified and enrolled. 12 studies had a Jadad score ≥ 3 and 4 studies < 3. The random method was used in classification of groups in all the studies in which the intergroup baseline data being comparable was clearly indicated. The blind method was applied in 5 contained RCTs.② The results of Meta-analyses showed that rhubarb associated preparation could improve gastrointestinal function score [mean difference (MD) = -0.52, 95% confidence interval (95%CI) = -0.55 to -0.48, P < 0.000 01], reduce the APACHEⅡ score (MD = -3.66, 95%CI = -5.00 to -2.33,P < 0.000 01) and 28-day mortality [odds ratio (OR) = 0.46, 95%CI = 0.30 to 0.71,P < 0.000 01] compared with those in the control group, the differences being statistically significant. No publication bias was seen in 16 literatures containing RCTs from the funnel plot.Conclusions Compared with the control group, the rhubarb associated preparations combined with conventional theraph can significantly improve the gastrointestinal function score, reduce APACHE Ⅱ score and 28-day mortality of sepsis patients with AGI, which suggests the rhubarb associated preparations have better efficacy. In addition, the result of sensitivity analysis has not substantially changed the results of Meta-analysis.

Objective To investigate the incidence,diagnosis,treatment and prognosis of abnormal lymphatic vessels in intestinal lymphangiectasia (IL) patients complicated by portal vein hypertension.Methods General information,clinical manifestations,laboratory tests,endoscopy and pathological examination,the results of direct and nuclide lymphangiography,treatment and prognosis of seven IL patients complicated by portal vein hypertension were retrospective analyzed.Results Among seven IL patients complicated by portal vein hypertension,there were five cases with abnormal lymphatic vessels and two cases were merely secondary to portal vein hypertension.The main symptoms were edema,abdominal distension and diarrhea.The results of laboratory tests mainly were lymphocytopenia (0.3× 109 to 1.7 × 109/L),hypoalbuminemia (16.0 to 27.8g/L) and hypoglobulinemia (13.2 to 17.7 g/L).Under endoscope,mucosal edema,chronic inflammatory reaction,intestinal villi spot and patched white nodular changes and polyp-like changes appeared.For treatment,the low-fat with medium-chain triglyceride diet and symptomatic support was the basic treatment.The condition could be relieved by surgical remission of abnormal lymphatic vessels or partial small-bowel resection.If the etiological factors could not be removed,the therapeutic effect was poor in the patients merely secondary to portal vein hypertension.Conclusion The suspicious IL patients complicated by portal vein hypertension need further examination to explore whether abnormal lymphatic vessels existed,and to provide evidence for surgical intervention.