Objective To evaluate the clinical effect of salmeterol xinafoate and fluticasone propionate powder for inhalation combined ipratropium bromide aerosol in patients with stable chronic obstructive pulmonary disease (COPD).Methods One hundred and twenty patients with stable COPD was randomly divided into control group and observation group with 60 patients each.The control group was received ipratropium bromide aerosol inhalation,and the observation group was given salmeterol xinafoate and fluticasone propionate powder for inhalation and ipratropium bromide aerosol for 6 months.BODE index,SGRQ scores,plasma cortisol and bone mineral density were compared between two groups before and after treatment.Results BODE index scores had no significant difference between two groups before treatment (P＞0.05).After treatment,BODE index scores,dyspnea scale,FEV1％,6MWD and BODE index total scores in observation group were superior to those in control group [ (1.9 ± 0.5) grades vs. (2.3 ± 0.5)grades,(58.5 ± 7.3)％ vs.(50.4 ± 6.2)％,(411.1 ± 56.8) m vs.(347.5 ± 60.4) m,(3.3 ± 1.0) scores vs.(3.8 ± 1.3 ) scores ],there were significant differences (P＜0.05 ).SGRQ scores had no significant difference between two groups before treatment (P＞0.05 ).After treatment and in SGRQ scores,respiration symptom,limitation of activity,disease influence scores in observation group were significantly lower than those in control group [ (20.7 ± 10.3 ) scores vs.(37.9 ± 14.4) scores,(20.7 ± 9.5 ) scores vs.(34.8 ± 13.0) scores,(16.3 ± 6.7) scores vs.(27.2 ± 11.8) scores,(17.5 ± 7.0) scores vs. (34.6 ± 12.3) scores],there were signiticant differences (P＜0.01 ).There were no significant difference of plasma cortisol and bone mineral density between two groups (P＞0.05).Conclusions Salmeterol xinafoate and fluticasone propionate powder for inhalation and ipratropium bromide aerosol in patients with stable COPD can greatly improve the lung function and life quality and with less adverse reaction.

Objective To standardize the modeling and evaluation of type 2 diabetic gastric mucosal injury rat model of spleen deficiency. Methods Male SD rats were randomly divided into normal group and model group, type 2 diabetic rat model with gastric mucosal injury was established by the injection of small-dose streptozotocin (STZ) combined with feeding of high fat and sugar forage and gastric gavage of 30% ethanol solution. After the modeling, we examined the levels of fasting blood glucose ( FBG) , fasting insulin ( FINS) , superoxide dismutase (SOD), malondialdehyde (MDA) and nitric oxide (NO) in the rat serum, and gastric and pancreatic tissue pathology was evaluated after HE staining. Modern medical evaluation method was used for the statistics of information collected by four diagnostic methods of traditional Chinese medicine ( TCM) , and for the identification of properties and evolution of TCM syndromes. Results Type 2 diabetic gastric mucosal injury rat model had been established in 75% of the rats. And 10-16 weeks after the modeling, the model rats had the syndrome of spleen deficiency, showing as persistent emaciation, decreased grasping force, weak activities in open field test, pale tongue nature, decreased r value of the claw and tail, increased defecation frequency, softening of loose stool. Of all the model rats, 78% had the features of diabetes, one indicator of qi deficiency syndrome, and one or more specialized spleen-related indicators. Conclusion These results suggest that type 2 diabetic gastric mucosal injury rat model can be successfully induced by the injection of small -dose streptozotocin ( STZ) combined with feeding of high fat and sugar forage and gastric gavage of 30% ethanol solution, and the time window of spleen deficiency for type 2 diabetic gastric mucosal injury rat model is 10-16 weeks after the modeling.

AIM: To analyze neuron-related gene expression before and after mesenchymal stem cells (MSCs) differentiating into neuron-like cells. METHODS: MSCs were induced to neuron-like cells with ?-mercaptoethanol. Before inducement and at 8 h after inducement, the total RNA was extracted, then the expression of microtubule-associated protein-2 (MAP-2), growth-associated protein-43 (GAP-43), NSE, nestin and neurofilament (NF) mRNA were detected with RT-PCR. RESULTS: NSE mRNA expressed before and after inducement, MAP-2, GAP-43, nestin and NF mRNA only expressed after inducement. CONCLUSION: The differentiation of MSCs into neuron-like cells may be related to MAP-2, GAP-43, nestin and NF expression. [

Objective To explore the efficacy of mycophenolate mofetil-based induction or maintenance therapy for children with lupus nephritis combined with Calcineurin inhibitors (cyclosporine A/tacrolimus) for resistant cases.Methods the clinical data were analyzed for 10 patients treated with multi-target therapy (Glucocorticoid + Mycophenolate mofetile+ Cyclosporine A/Tacrolimus) in Department of Nephrology and Rheumatology from January 2005 to December 2011.Calcineurin inhibitor (Cyclosporine A/Tacrolimus) was added when Mycophenolate mofetil-based induction or maintenance protocol was not satisfactory.The data was analyzed by repeated measures data of ANOVA.Results The SLEDAI score (10.9±3.8 vs 7.9±2.6),24 hours urinary protein quantification [(4.0±2.0) vs (2.2±1.8) g] and ESR [(78±10) vs (54±8) mm/l h] were decreased significantly (P＜0.01),while serum albumin [(29±8) vs (34±8) g/L] and complement C3 level [(0.41±0.20) vs (0.70±0.30) g/L] were increased significantly (P＜0.05).The complete remission rate (CR) was 70％ and the response rate was 90％ in the first 6 month,and the CR was 90％ in the last month.Except 1 case withdrawal,the follow-up period for 9 cases was 24 months.Adverse reactions were rare,1 case had lung in-fection,1 case had hyperglycemia and 1 case had transaminase elevation,which disappeared after mana-gement.Conclusion Mycophenolate mofetil combined with Calcineurin inhibitors (cyclosporine A/tacrolimus) is effective for treating lupus nephritis,the dose of induction or maintenance period is low,and adverse reactions are rare.

This paper reviewed the subjective and objective evaluation tools of sleep disorders, and summarized evaluation indicators of sleep disorders, so as to provide a theoretical support and practical reference for the diagnosis of sleep disorders, intervention and related researches.

Objective To evaluate the effectiveness of clinical rotation training in pain department for general practitioner.Methods Totally 31 general practitioners of 3 years program in the First Affiliated Hospital of Chongqing Medical University were involved in clinical rotation training in pain department form August 2008 to December 2011.Training lasted for one month.Clinical rotation training in pain department was conducted for general practitioners by studying rules and regulations,treatment methods,imaging data and clinical practice.Evaluation was made according to the treatment,theoretical knowledge,interpersonal skill and professional competency of general practitioners.Measurement data were expressed as mean ± standard deviation ((-x) ± s) while enumeration data were expressed as rate.Descriptive analysis of the data was used.Results Average total number of patients managed by 31 general practitioners was (15 ± 2),average total number of disease species was (5 ±2),average number of case discussion and small lecture participated was 1 ～2,average number of nerve block participated as assistant was (40 ± 5) and average number of minimally invasive surgery visited and studied was (2 ± 2).Residency duties were skillfully completed and assessment score was (85 ± 4.50).Conclusions Through clinical rotation training,general practitioners can understand common disease diagnosis and treatment category; familiarize clinical evaluation methods and master standards of diagnosis and treatment in pain department.Meanwhile,they would learn doctor-patient communication to establish a good therapeutic relationship with patients.

To study the histogenesis, biological behaviour, classification of pituitary adenoma and the relationship between the symptoms of hormonal hypersecretion and the hormone test in pituitary adenoma. MethodsOne hundred and eighty cases of pituitary adenoma were investigated by clinicopatholgic analysis, and GH, PRL, ACTH, TSH, FSH, LH were examined in 110 cases by ABC immunocytochemical methods. ResultsForty percent of the patients were found to have the identical results between the clinical symptoms and hormonal test. Female patients were more than male ones, and the difference was satistically significant. The results showed that PRL and GH adenoma were often found in the cases by immunocytochemical method,and mixed GH-PRL adenoma were often found in the cases with multihormono-adenoma. ConclusionThe classification is practical and easy to operate, which combines the immunohistochemical examination of pituipary adenoma with the morphology and function.

Objective To investigate the influence of gestational vitamin A(VA) deficiency on lipid synthesis in offspring liver tissue by using the rat model of gestational vitamin A deficiency.Methods The rat model of gestational VA deficiency was established and divided into the normal AV,VA deficiency and VA deficiency and supplement (VAD) groups.The offspring blood lipid levels were detected.The mRNA expression changes of lipid synthesis molecule ACC1,FAS and SREBP1 in liver were detected;the lipid droplet deposition situation after HE staining in offspring liver tissue section was observed.Results The HDL-C level of the VAD group was significantly lower than that of the VA normal group(VAN group and VAS group,P＜0.05),and the difference between the VAN group and VAS group had no statistical difference(P＞0.05).The TG level had statistically significant difference among the three groups(P＜0.05).The ACC1,FAS and SREBP1 mRNA expression levels in the VAD group were significantly increased.The liver in the VAD group appeared more lipid droplet deposit with partial lipid droplet vacuoles in cytoplasm;while the liver cells in the VAS and VAN groups showed the regular arrangement without obvious lipid droplet deposit.Conclusion Gestational VA deficiency may induce the abnormal activation of liver lipid synthesis pathway in rat offspring and causes lipid metabolic disturbance.

Objective To study the clinical,imaging and pathological characteristics and diagnostic methods of pulmonary mucosa-associated lymphoid tissue-derived lymphoma (MALToma),and differentiate from three kinds of pulmonary lymphatic hyperplasia.Methods Medical history,imaging and pathological examination of three cases of pulmonary MALToma were introduced in detail.And differentiated from lymphocytic pseudolymphoma (nodular lymphoid hyperplasia),follicular bronchiolitis and lymphocytic interstitial pneumonia.Results The clinical manifestations and imaging examination of pulmonary MALToma had no special and were not easy to differentiate from cancer.Histopathologically,widened marginal zones encircled one or more germinal centers.The neoplastic lymphocytes invaded germinal center and bronchiole resulting in follicle colonization and lymphoepithelial lesions.Conclusion Pulmonary MALToma is a rare low grade malignant tumor.Histopathology is the key method to diagnosis,while clinical manifestations and imaging examination have no special symptoms at diagnosis.MALToma is differed from pulmonary lymphatic hyperplasia in widened marginal zone encircled one or more germinal centers,follicular colonization,lymphoepithelial lesions,cell types between follicular.

Objective To evaluate the role of the diffusion kurtosis imaging(DKI)in the differential diagnosis of breast lesions. Methods Seventy five breast lesions(32 benign and 43 malignant)in 72 patients confirmed by histopathology were studied. All patients underwent 3.0 T MR examinations, including T1WI, T2WI, T2WI-spectral adiabatic inversion recovery, 4b diffusion-weighted imaging, and dynamic contrast-enhanced MR imaging(DCE-MRI). Data were post-processed by mono-exponential and diffusion kurtosis models for quantitation of ADC, apparent diffusion for non-Gaussian distribution(D), and apparent kurtosis coefficient(K). All breast lesions were described with the classification by breast imaging report and data system(BI-RADS). Lesions with BI-RADS class 4B or above were rated as malignancy. Independent sample t test was used to compare the ADC, D, and K value differences between benign and malignant lesions . ROC analysis was performed to assess the role of ADC, D, K value, and BI-RADS in the differential diagnosis of breast lesions. The morphological characteristics, time-signal curve(TIC)type, and other differences between benign and malignant lesions were analyzed with Chi-square test. Results ADC and D values were significantly lower in malignant than in benign lesions(P<0.01). Conversely, K value was significantly higher in malignant lesions than in benign ones(P<0.01). The shape of the benign and malignant breast lesions, edge, enhancement mode, TIC, and BI-RADS classification difference had statistical significance(P<0.05, respectively). The areas under the ROC curve of ADC, D, K, DCE-MRI, and DCE-MRI combined with K value were 0.857, 0.884, 0.949, 0.806, and 0.958, respectively. DCE-MRI combined with K value had the highest diagnosis efficiency. At a cutoff value of K= 0.856, the sensitivity and specificity were 83.7% and 93.8%, respectively. Conclusions DKI model showed higher diagnostic efficiency than that of traditional DWI model. DCE-MRI combined with K value can increase the diagnostic efficiency in breast lesions.