Objective To evaluate the clinical effect of clopidogrel combined with low molecular weight heparin (LMWH) on chronic pulmonary heart disease in patients with acute exacerbation.Methods Eighty cases of patients with chronic pulmonary heart disease with exacerbation were randomly divided into treatment group (40 cases) and control group (40 cases).Patients in control group were administrated with conventional treatment including infection control,cough,phlegm,relieving spasm and asthma,persistent low flow oxygen,maintain airway patency,strong heart,diuresis,anti arrhythmia.Patients in treatment group were treated with subcutaneous injection of low molecular weight heparin and oral clopidogrel therapy beside routine treatment.Plasma prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time (TT),fibrinogen(Fb) and pulmonary function(FEVI) were measured.Results (1) After treatment,Fb in treatment group and control group were (3.92 ± 1.11) g/L,(4.54 ± 1.41) g/L respectively.While PT,APTT,TT and FEVI in treatment group were (13.02 ± 1.52) s,(33.21 ± 4.03) s,(14.03 ± 2.52) s,(45.73 ± 7.38) ％ respectively,significantly higher than the control group ((11.31 ± 2.01) s,(30.13 ± 3.59) s,(12.88 ± 2.11) s and (40.12 ± 6.99) ％,P ＜0.05).(2) In control group,FEVI after treatment significantly improved than that of before treatment (t =4.821 ; P ＜ 0.05),while PT,APTT,TT were no significant changes (P ＞ 0.05).PT,APTT,TT,FEVI in treatment group were significantly improved after treatment than that of before treatment(P ＜ 0.05).(3) The clinical effective rate in treatment group was 80.0％ (32/40),higher than that in control group (65.0％(26/40) x2 =4.815; P ＜0.05).Conclusion The therapy scheme of clopidogrel combined with low molecular heparin calcium is proved to be an efficacy method for reducing sputum viscosity,antiinflammatory,anti allergic effect,platelet aggregation,increasing pulmonary blood flow,improving the condition of patients with pulmonary heart diseasethe.And its clinical effect is significant,worthy to promote and apply.

BACKGROUND: Soft tissue filling is a problem in clinic. It has been proved that ultrasonic wave-treated mature adipocytes cannot be used for cell transplantation.It is hopeful to solve the problem with adipose tissue engineering. OBJECTIVE: To observe the effect of ultrasonic wave on the in vitro culture and proliferation of preadipocytes, and validate the possibility of preadipocyte as seed cell in adipose tissue engineering following ultrasound-assisted liposuction. DESIGN: Controlled observation experiment. SETTING: Department of Plastic Surgery, Rennin Hospital, Wuhan University. MATERIALS: This experiment was carried out in the Medical College of Wuhan University from July 2003 to September 2004. One local 3-month-old hybridized pig was provided by the Experimental Animal Center of Medical College of Wuhan University. After the pig was anesthetized with ketamine, an area of 10 cm×20 cm was labeled on both sides of back respectively, and the tissue in the labeled area was harvested. The tissue on the right side served as experimental group and that on the left side served as control group. METHODS: The tissue of the expedmental group was pretreated for 8 minutes by ultrasonic wave with the energy of 3W/cm2. Under aseptic condition, the skin layer was open, and 100 g subcutaneous adipose tissue was resected from each side and then placed in prepared container containing cold D-hanks solution for later use. The ultrasonic wave-treated porcine preadipocytes of adipose tissue of experimental group were isolated and cultured in vitro, and the number and lipid content of preadipocytes were measured every other 2 days. Results were presented as the mean val ue of the number of cells of three wells. In the control group, pretreatment of ultrasonic wave was omitted. The growth curves of two groups were drawn. Intracellular adipose content was measured by oil red O staining. Absorbance (A) was measured with spectrophotometer (HITACHI G2000), which was regulated at the wavelength of 510 nm. MAIN OUTCOME MEASURES: ① Morphological observation of culture of porcine preadipocytes. ②The growth curves of experimental and control groups. ③3 Change in the lipid content of experimental and control groups.RESULTS: ① Cells in the control group adhered to the wall within 6 to 24 hours, and those in the experimental group basically adhered to the wall after 1 to 2 days, and there were many non-adhesive cells in the exoerimental group. Accumulation of adipose granules in the cells was found in the control group after 4 days and that was found in the experimental group after 6 days. On day 12, the cells in the control group basically differentiated into the cells with single lipid drop or multiple lipid drops, and a small amount of natant mature adipocytes were found, while few cells with lipid drop were found in the experimental group. ②Under the condition of the same amount of cells, the cell doubling time of experimental group was about 72 hours and that of control group was 36 hours. After 9-day culture, the number of cells in the experimental group and control group was 13×104 cells/well and 18×104 cells/well, respectively. The rate of cell proliferation of experimental group was very slow. ③Lipid of the experimental group appeared on the 6th day after culture, and that of the control group appeared on the 4th day after culture. The peak value of A was 0.32 and 0.68 in e penmental group and control group respectively.CONCLUSION: Ultrasonic wave has obviously inhibitory effect on the proliferation and differentiation of preadipocytes.The preadipocytes treated by ultrasonic wave are not suitable as seed cells.

Objective To investigate the clinical features of small bowel Crohn's disease(CD).Methods From January 2009 to September 2012,a total of 138 patients diagnosed as CD who underwent examinations of colonoscopy,digestive tract radiography,capsule endoscopy,double-balloon enteroscopy and computed tomography (CT) enterography were enrolled.According to the Montreal Classification criteria,the disease was typed by the age at diagnosis,location of the lesions and behavior of the disease.The clinical symptoms,laboratory examinations,diagnostic methods and recurrence condition were also evaluated.Through the comparison of the clinical features of ileocolonic and colonic CD,the clinical features of small bowel CD were analyzed.Measurement data were analyzed with t-test,analysis of variance or non parametric test.Chi square test was performed for count data.Spearman's correlation analysis was used for correlation analysis and multivariate Logistic regression analysis was used for risk factors screening.Results A total of 62 (44.9％) cases were simple small bowel CD.Fifty-three patients (85.5％) were male,and the mean age at diagnosis was 35.3 years old.The age of 67.7％(42/62) of small bowel CD patients were less than 40 years old when diagnosed.The ratio of stricture in small bowel CD group (35.5％,22/62) was significantly higher than that of ileocolonic (18.8％,6/32) and colonic CD group (13.9％,5/36) (x2=6.594,P=0.037).Jejunal involvement was an independent risk factor for structure in CD (OR=3.481,95％ CI:1.250 to 9.693).The patients with obstructive symptoms as primary symptom in small bowel CD (38.7％,24/62) were more than those with colonic CD (16.7％,6/36) (x2 =5.210,P=0.022).However,patients with diarrhea as primary symptom in small bowel CD (21.0％,13/62) were less than those with ileocolonic (37.5％,12/32) and colonic CD (44.4％,16/36) (x2=6.512,P=0.039).Patients with two or more extraintestinal manifestations in small bowel CD (3.2％,2/62) were also significantly less than those with ileocolonic (15.6％,5/32) and colonic CD (19.4％,7/36) (x2=7.957,P=0.019).The score of CD activity index was generally low,and with no statistical correlation to serum inflammation markers such as C reaction protein.The average time duration between induction of remission and clinical recurrence of small bowel CD ((23.64 ± 17.08) months) was shorter than that of ileocolonic type ((35.07±29.84) months,t=-4.285,P=0.002) and colonic CD ((32.35 ± 28.46) months,t =-3.700,P =0.004).However,there was no significant difference in the rate of clinical recurrence between small bowel CD and ileocolonic,colonic CD.Conclusions Patients with small bowel CD account for a large proportion in patients with CD,especially in males.Stricture is more common in jejunum CD.The time duration between induction of remission and clinical recurrence of small bowel CD is short.

Hijack terror is one of the most common terror attacks. In this paper, the definition, the present condition and future development of hijack terror are elucidated. Hijack terrorism may seriously endanger human lives, result in great economic loss, create social panic and political tumult. The medical succor for hijack terror includes treatment and transportation of the wounded, sanitation for epidemic prevention, protection from harmful agents, and medical health care. The challenges confronting medical support for hijach terror are its unexpectedness and abruptness, complexity, and arduousness in its implementation. In order to negotiate these challenges, it is imperative that a flawless counterplan should be worked out, a highly efficient counterterrorism medical organization should be established, intense emphasis should be paid in the studies of anti-neuclear, antimbiological and anti-chemical warfores, and education for psychological prepuredness should be stressed.

0.05);the difference on d3 with that on d9 was significant(P0.05);the difference on d3 with that on d7 and d9 was significant(P

Objective To study the variation of the level of NOS,NO and Ang (1-7) in spontaneously hypertensive rat(SHR).Methods SHR were divided randomly into 3 groups:Bushenyixin group(n=8),valsartan group (n=8),and model group (n=7).Each group was given Bushenyixin tablet,valsartan,and saline by gavage respectively.After 4 weeks,the concentration of NOS,NO,Ang (1-7) in plasma and the concentration of NOS,NO in aorta were be observed.Results The concentration of NO in plasma was significantly lower in the Bushen-Yxin group than for model group(15.500±4.375)μmol/L vs.(26.000±2.828)gmol/L,P＜0.05.The concentration of NO in aorta and Ang1-7 in plasma were significantly higher in the Bushen-Yixin group than in the model group [(35.604±7.505)μmol/L vs.(17.437± 11.649) μ mol/L,(45.542 ± 12.726)ng/L vs.(25.521 ± 2.727) ng/L,P＜0.05].The concentration of NO in aorta was significantly higher in Bushen-Yixin group than in the valsartan group [(21.537± 13.484) μmol/L,P＜0.05].Conclusion Bushen-Yixin tablet had effects of increasing of NO level in aorta and Ang (1-7) level in plasma in spontaneously hypertensive rat.

Objective To explore the effects of mulitinational united medical transport of emergency and critical patients in Indonesia after earthquake tsunami disaster.Method Various factors,which affected mulitinational united medical transport in Indonesia after earthquake tsunami disaster were analyzed.Results All of the 217 emergency and critical patients were successfully transported to the destination.Conclusion Mulitinational united medical rescue had advantages on integrating medical resources and improving efficiency.During mulitinational united medical transport,the tasks should be distributed rationally,and self-protection of medical workers was the basis of accomplishing medical rescue.

Objective To introduce the methods of performance excellence management model in clinical nursing teaching. Methods A total of 110 clinical nursing interns were selected before and after implementation of performance excellence model, traditional teaching method was used prior to the implementation of performance excellence model. The teaching quality evaluation, teachers teaching level feedback, examination of interns, teachers′ satisfaction degree with nursing work were investigated and compared before and after the implementation of performance excellence model. Results After the implementation of excellent performance management model, the assessment of interns with teaching quality scored from 3.75±0.51 (before the implementation) to 3.98±0.14, t=-6.738, P<0.01. Examination of interns by teachers scored from 92.44 ± 1.44 to 95.01 ± 2.20, t=-7.24, P<0.01. Teachers′satisfaction degree with nursing work scored from 3.91 ± 0.44 to 4.26 ± 0.46, t=-3.006, P<0.01. Conclusions The application of excellent performance management model in the hospital clinical nursing teaching can effectively improve the quality of teaching as well as satisfaction degree of nursing interns, teachers and departments.

Objective To observe the efficacy of mesalazine combined with probiotics in the treatment of ulcerative colitis. Methods 60 patients with ulcerative colitis who were admitted to our hospital from May 2015 to May 2017 were selected randomly. These patients were divided into two groups according to the treatment method: mesalamine com bined with probiotic group(combination therapy group, n=30) and mesalamine alone treatment group (n=30). The clinical symptom score, endoscopic score, serum CRPlevel, clinical efficacy, incidence of adverse reactions and recurrence in both groups were statistically analyzed. Results Compared with those before treatment, the clinical symptom score, en doscopic score and serum CRPlevel were significantly lower in both groups after treatment(P＜0. 05); After treatment, clinical symptom score, endoscopic score and serum CRPlevel were significantly lower in the combination therapy group than those in the treatment alone group(P＜0. 05). The total effective rate in the combination therapy group was 93. 3％(28/30), significantly higher than 63. 3％(19/30) in the treatment alone group(P＜0. 05). The recurrence rate was 13. 3％ (4/30), significantly lower than that of 33. 3％(10/30) in the treatment alone group(P＜0. 05). However, the incidence rates of adverse reactions in the two groups was 6. 7％(2/30) and 10. 0％(3/30) respectively, which were not significantly different(P＞0. 05). Conclusion The efficacy of mesalazine combined with probiotics in the treatment of ulcerative colitis is more significant than that of mesalazine alone. At the same time, it is also more effective in improving the clinical symptoms, reducing the serum CRPlevel and recurrence rate in the patients, and will not increase the patients' adverse reactions to a great extent, so it is worthy of promotion and application in clinical settings.

Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.