Idiopathic pulmonary fibrosis (IPF)is a chronic progressive interstitial lung disease.The prevalence of IPF is increasing year by year,and the diagnostic process is complex,the mortality rate is more than 50％ in children.It has been demonstrated by multicenter,randomized,placebo-controlled trials that most of the clinical assays performed with corticosteroids,immunomodulators and antifibrotic drugs have shown inconclusive results for the treatment of IPF.To date,only pirfenidone has been proved to have significant efficacy in controlled clinical trials in the treatment of IPF.There has been an exponential increase in the number of compounds entering clinical trials for IPF in the last decade.The therapeutic use of new stem cell translantation will have a broad prospect in IPF.

According to the current development of Chinese medicine, frequent international communication in the field of medicine and fewer talents with medical English, the paper emphasizes the urgent need to cultivate talented people in medical English, establishes a new talenta' training pattern through optimization in curricula, reform in training methods and improvement of evaluation system and supporting measures based on modem educational concept.

Objective To evaluate the effects of different durations of severe acute hypervolemic hemodilution (AHH) on acute lung injury in rabbits.Methods Thirty-six healthy adult rabbits of both sexes, weighing 2.7-3.1 kg, were randomly divided into 2 groups (n=18 each) using a random number table: control group (C group) and AHH group.AHH was performed with 6％ hydroxyethyl starch 130/0.4 until the target hematocrit of 20％ was achieved in group AHH.Immediately before AHH (T0) , and at 1,2 and 4 h after AHH (T1-3) , blood samples were taken from the right femoral artery for blood gas analysis.The oxygenation index was calculated.The occurrence of acute lung injury (oxygenation index ≤ 300 mm-Hg) was recorded.After blood samples were collected at T1-3 , 6 rabbits in each group were sacrificed, and lungs were removed for determination of wet/dry lung weight ratio (W/D ratio) and aquaporin-1 (AQP-1) expression (by immuno-histochemistry).Results In group AHH, 1 rabbit developed acute lung injury at 1-2 h after AHH, and 4 rabbits developed acute lung injury at 2-4 h after AHH.Compared with group C,W/D ratio was significantly increased at T1-3, and the expression of AQP-1 was down-regulated at T2,3 in group AHH (P＜0.05 or 0.01).Conclusion Severe AHH performed with 6％ hydroxyethyl starch 130/ 0.4 with the target hematocrit reduced to 20％ and the duration ＞ 1 h induces acute lung injury in rabbits.

Objective To summarize the nursing experience of nursing ocular hypertensive patients having undergone vitrectomy for proliferative diabetic retinopathy.Methods Twenty-one ocular hypertensive patients having undergone vitrectomy for proliferative diabetic retinopathy were assisted to take the correct posture.They were closely observed for timely detection of ocular symptoms and signs and asked to take antihypertensive drugs.At the same time,those with neovascular glaucoma and laser iris neovascular glaucoma plasty were carefully nursed.Results Among the 21 patients(25 eyes),15 patients(18 eyes)had intraocular pressure normalized by way of medicine treatment,the intraocular pressure in another two eyes normalized after laser peripheral iridoplasty;the pressure in another one normalized after laser peripheral iridoplasty combined with peripheral iridectomy and another 4 eyes developed with neovascular glaucoma.Conclusion Combined with the operation,postoperative observation and nursing of postoperative high intraocular pressure can effectively reduce the incidence of ocular hypertension after pars plana vitrectomy for proliferative diabetic retinopathy.

Objective To investigate the effect of different degrees of acute normovolemic hemodilution (ANH) with 6% HES 200/0.5 on mucous membrane of small intestine in rabbits. Methods Thirty-two adult rabbits weighing 2.0-2.5 kg were randomly divided into 4 groups ( n = 8 each): Ⅰ control group underwent no ANH, and Ⅱ, Ⅲ, Ⅳ group underwent ANH with hematocrit (Hct) reduced to 24%, 18% and 12% respectively (group H1-3 ). The animals were anesthetized with 20% urethane 4 ml/kg, thracheostomized and mechanically ventilated (VT = 8 ml/kg, RR = 50 bpm). The body temperature was maintained at 36.5-37.6 ℃. Left carotid artery was cannulated for MAP monitoring and blood sampling. Right jugular vein was cannulated for CVP monitoring. Blood withdrawn from femoral artery was simultaneously replaced by iv infusion of equal volume of HES (200/0.5) until the target Hct was achieved. Blood samples were obtained from superior mesenteric vein (SMV)for determination of plasma concentrations of TNF-α before ANH(T0) and at 8 h after ANH (T1). Small intestinal mucosal tissues were obtained at T1 to observe the pathological changes by electron microscopy. Results Compared with those at T0, plasma concentrations of TNF-a in SMV were significantly increased at T1 in group H2 and H3 ( P ＜ 0.01 ), but no significant change was found in group H1 ( P ＞ 0.05). Compared with group C, plasma concentrations of TNF-α in SMV were significantly increased in group H2 and H3 ( P ＜ 0.01 ), but no significant change was found in group H1 ( P ＞ 0.05). No injury was found in mucous membrane of small intestine in group H1 . The injury to mucous membrane of small intestine was mild in group H2 and severe in group H3 . Conclusion ANH with 6% HES 200/0.5 does not affect mucous membrane of small intestine when Hct is reduced to 24% The injury to mucous membrane of small intestine occurs when Hct is reduced to≤ 18%.

Objective To investigate the effects of different degrees of acute normovolemic hemodilution (ANH) with 6% HES 20010.5 on serum S-100B protein concentration and cerebral oxygen metabolism at 37℃ in rabbits.Methods Thirty-two adult rabbits weighing 2.0-2.5 kg were randomly assigned into 4 groups (n = 8each) : Ⅰ control group underwent no ANH and Ⅱ , Ⅲ , Ⅳ ANH group underwent ANH with hematocrit (Hct)reduced to 24%, 18% and 12% respectively. The animals were anesthetized with iv 20% urethane 5 ml/kg,tracheostomized and mechanically ventilated (VT = 15 ml/kg, RR = 30 bpm). The body temperature was maintained at 37℃. Left carotid artery and jugular vein were cannulated for BP monitoring, blood gas analysis and blood sampling. Right jugular vein was cannulated for CVP monitoring. Left femoral artery and vein were cannulated for hemodilution. Blood withdrawn from femoral artery was simultaneously replaced by iv infusion of equal volume of HES (200/0.5) until the target Hct was achieved. Hemodynamics parameters, were recorded and blood gases were analyzed and serum S-100B protein concentration and cerebral O2 metabolic rate (CERO2) were determined before (baseline) and at 2, 4 and 8 h after ANH. Brain water content was measured by wet/dry brain weight ratio. Results There were no significant differences in serum S-100B protein concentration, CERO2 and pH value between group Ⅰ and group Ⅱ (Hct 24%). Serum S-100B protein concentration and CERO2 were significantly increased at 8 h after ANH as compared with the baseline before ANH in group Ⅰ (Her 18%). Serun S-100B protein concentration and CERO2 were significantly increased at 2, 4 and 8 h after ANH as compared with the baseline before ANH in group Ⅳ (Hct 12%). There was no significant difference in brain water content among the 4 groups. Conclusion ANH does not affect cerebral O2 metabolic when Hct is reduced to 24%. CERO2 can not be sustained and ischemic cerebral injury may occur when Hct is reduced to≤18%.

Objective To explore the role of RBC[Ca2+]i levels in pathogenesis of hypoxic-ischemic encephalopathy (HIE) in neonates. Methods Twenty-eight neonates with moderate and severe HIE hospitalizeal from Jun. 2002 to Mar. 2006 were enrolled the study. The neonates with HIE were given routine treatment and Nimodipine for 7～10 days. Blood samples were collected before treatment and at 72 hours,7～10 days after treatment respectively. The levels of RBC [Ca2+]i were measured by Fura-2/AM. Twenty healthy full-term neonates were studied as controls. Results (1) The levels of RBC [Ca2+] i in the neonates with moderate and severe HIE were significantly higher than that in control group at every time points( P＜0. 05 ,P＜0.01). (2) the levels of RBC[Ca2+]i in the neonates with moderate and severe HIE peaked at 72 hours after treatment,and were still significantly higher than that of control group at 7～10 days after treatment(P＜0. 05). (3) In the neonates with HIE,RBC[Ca2+ ]i levels correlated positively with the severity of HIE ( r = 0. 447, P＜ 0. 05 ). Conclusion RBC [Ca2+ ] i levels are closely associated with pathogenesis of HIE, and may play an important role in the pathogenesis of HIE. Evaluating RBC [ Ca2+] i levels in neonate after birth may provide clinical clues for the early diagnosis and prognosis assessment of HIE.

Objective To evaluate the effect of sevoflurane on the expression of calcium-sensing receptor (CaSR) in the myocardium of rats with high-level spinal cord injury (SCI).Methods Thirty healthy male Wistar rats, weighing 250-300 g, were randomly divided into 3 groups using a random number table: sham operation group (group S, n = 6) , SCI group (n =12) and sevoflurane group (group Sev).SCI was induced in anesthetized rats by dropping a l0-g weight onto C7 spinal cord from 5.0 cm height falling freely inside a vertical hollow glass tube.Group SCI inhaled 2 L/min pure oxygen for 30 min, and group Sev inhaled 2％ sevoflurane for 30 min starting from 30 min after SCI.At 12 and 24 h after SCI (T1,2) , 6 rats were selected randomly, and blood samples from the abdominal aorta were drawn for determination of serum cardiac troponin I (cTnI) concentrations.The rats were then sacrificed, and myocardial specimens were obtained for determination of CaSR protein and mRNA expression (using fluorescent quantitative real-time reverse transcriptase-polymerase chain reaction or Western blot) and for examination of myocardial ultrastructure (with transmission electron microscope).Results Compared with group S, the serum cTnI concentrations and CaSR protein and mRNA expression were significantly increased at T1,2 in SCI and Sev groups.Compared with group SCI, the serum cTnI concentrations and CaSR protein and mRNA expression were significantly decreased at T1,2 in Sev group.The damage to myocardial cells was significantly reduced in group SCI compared with group Sev.Conclusion Sevoflurane reduces myocardial damage through inhibiting CaSR expression in the myocardium of rats with high-level SCI.

Objective To evaluate the effects of mechanical ventilation with heliox-oxygen on acute lung injury (ALI) in rabbits.Methods Thirty healthy New Zealand male rabbits, weighing 2.2-2.4 kg, were randomly divided into 3 groups (n =10 each) using a random number table: control group (C group), ALI group and mechanical ventilation with helium-oxygen group (HO group).The right common carotid artery was cannulated for fluid administration and blood sampling in the rabbits anesthetized with urethane.In ALI and HO groups, 1.2 ml/kg hydrochloric acid (HC1) of pH value 1.0 was injected into the right bronchus, followed by 2 ml air injection, and 5 min later 0.8 ml/kg HCI of pH value 1.0 was injected into the left bronchus, followed by 2 ml air injection.In C group, the equal volume of normal saline was given as previously described.After ALI, the rabbits were mechanically ventilated with airoxygen (air 50％-oxygen 50％) in C and ALI groups, or with helium-oxygen (helium 50％-oxygen 50％)in HO group.Mechanical ventilation (tidal volume 8 ml/kg, respiratory rate 30 breaths/min, inspiratory/ expiratory ratio 1 : 1) lasted for 4 h in the three groups.At 30 min before and after HC1 injection (T0,1) and 1, 2, 3 and 4 h of ventilation (T2-T5) , arterial blood samples were collected to detect the levels of surfactant-protein (SP-A) in serum by enzyme-linked immunosorbent assay.The animals were sacrificed at T5, and lungs were removed for examination of the pathologic changes with light microscope.The wet to dry lung weight ratio (W/D ratio) was calculated.Results Compared with group C, the levels of SP-A in serum were significantly increased at T1-T5, and W/D ratio was increased in ALI and HO groups.Compared with group ALI, the levels of SP-A in serum were significantly decreased at T5, and W/D ratio was decreased in HO group.Conclusion Mechanical ventilation with heliox-oxygen can reduce ALI in rabbits.

Objective To investigate the CT findings of orbital inflammatory pseudotumor in different types and to improve the diagnosis and differential diagnosis of this disease.Methods CT findings of orbital inflammatory pseudotumor in 58 cases confirmed by clinic or pathology were analysed retrospectively.Results This disease could be categorized five types according to CT findings: ①mass type in 5 cases (8.6%), the characteristic CT findings were soft-tissue masses in intraorbit; ②diffusion type in 5 cases (8.6%) showed retrobulbar fat interspace of high-density without masses; ③myositis type in 22 cases(37.9%) showed the enlargement of entire muscles including the tendinous insertion;④lacrimal galnd type in 6 cases(10.3%) showed enlargement of lacrimal gland on CT; ⑤the mixed type in 20 cases (34.5%) showed hypertrophy of the extra-ocular muscles adjacent to mass and high-density of surrounding fat ,or hypertrophy of the extra-ocular muscles adjacent to enlarged lacrimal gland.There were in different degree of paranasal sinusitis such as maxillary sinusitis and/or ethmoid sinusitis in 22 cases(37.9%).Conclusion CT scan is of important role in diagnosing and differential diagnosing orbital inflammatory pseudotumor.