Objective To observe the effect of penehyclidine hydrochloride (PHCD) combined with mechanical ventilation on inflammatory response in rats with acute respiratory distress syndrome(ARDS)induced by hydrochloric acid(HCl)inhalation. Methods 32 adult healthy male Sprague-Dawley(SD)rats were randomly divided into four groups:sham operation group,ARDS model group,PHCD group(intraperitoneal injection of 0.5 mg/kg PHCD at 30 minutes before HCl instillation)and mechanical ventilation group〔mechanical ventilation was given after PHCD treatment,ventilator settings were as follows:tidal volume(VT)=4 mL/kg,respiratory rate(RR)= 70 beats/min,the time ratio of inspiration to expiration(I:E)=1:2,fraction of inspired oxygen concentration(FiO2)=0.21〕,8 rats in each group. The rat ARDS model was created by HCl(0.1 mol/L,1.2 mL/kg) intratracheal instillation. After mechanical ventilation for 4 hours,the experiment was stopped. Arterial partial pressure of oxygen(PaO2)was measured,and the oxygenation index as well as lung wet/dry weight ratio(W/D)were calculated respectively. The pathological changes in lung tissues were observed under light microscope,and the pathological score was evaluated. The levels of myeloperoxidase(MPO),interlukin-8(IL-8)and nuclear factor-κB (NF-κB)in homogenate of lung tissues were all measured respectively by enzyme linked immunosorbent assay (ELISA). Results In rats of ARDS model group, there were significant infiltration of inflammatory cells, collapse of extensive pulmonary alveoli and hyaline membrane formation in lung tissues,but the edema in pulmonary mesenchymal tissue and congestion of micro vessels were not obvious. Compared with sham operation group,the lung tissue pathological score(9.88±2.03 vs. 1.38±0.92),lung W/D ratio(7.67±0.96 vs. 4.08±0.65)were significantly increased(both P<0.01),while oxygenation index〔mmHg(1 mmHg=0.133 kPa):213±29 vs. 428±28〕was markedly decreased in model group(P<0.01);and the concentrations of MPO(μg/L:34.18±3.99 vs. 20.92±1.40), IL-8(ng/L:864±53 vs. 583±91)and NF-κB(ng/L:1 229±133 vs. 803±130)in homogenate of lung tissues were significantly higher in model group(all P<0.01). The pathological changes in lung tissues including inflammatory cell infiltration,collapse of alveoli and pulmonary edema,etc. were obviously improved when treated by PHCD or mechanical ventilation and the lung pathological score and W/D ratio were significantly decreased compared with those of model group,oxygenation index in these two groups were both significantly increased,meanwhile, the concentrations of MPO,IL-8 and NF-κB were sharply decreased when compared with those of model group (all P<0.05). The degree of improvement in all above indexes were greater in mechanical ventilation group than those in PHCD group(lung injury score:5.63±1.85 vs. 7.63±1.67,lung W/D ratio:5.35±1.05 vs. 6.46±1.17, oxygenation index:325±57 vs. 272±44,MPO:25.80±3.36 vs. 29.88±3.93,IL-8:736±53 vs. 802±53, NF-κB:984±75 vs. 1 109±118,all P<0.05),however they did not reach the levels of the sham operation group (P<0.05 or P<0.01). Conclusion PHCD can inhibit the inflammatory response in ARDS rats induced by HCl inhalation,thus it may protect the lung tissue from injury induced by HCl,and the protective role of PHCD plus menchanical ventilation is superior to that of PHCD only.

Objective To explore the issues of everyday expenses list used in the cadre wards and find out countermeasures for the purpose of reducing medical disputes and improving the patients’satisfaction.Method Seventy-four patients admitted in our department from July to September 2012 were set as control group,where an investigation was conducted to find out the issues in the practical use of every expenses list and corresponding measures were worked out and used in observation group,which included 78 patients admitted in the department from October to December 2012.The two groups were compared in terms of self-paid articles, re-recording of missed expenses,failure to timely refunding,charging by other means,disagreement on curative nursing items and unclear items for charging.Result The observation group was significantly better than the control in self-paid articles,re-recording of missed expenses and failure to timely refunding(all P<0.05).Conclusions There are some issues in the use of everyday expenses list in the cadre wards.We should take corresponding countermeasures to ensure the interests of the hospital and the patients and the enhanced degree of patients’comfort.

[Objective]To summarize Pro.YangJiguo’s experience in using PingchuanⅠ for treating three periods of asthma in children .[Method] Accord-ing to the analysis of three clinical features and diagnosis and treatment of pediatric asthma, namely attack period(not the control period), duration peri-od(part of the control period) and remission period(control period), it concluded Professor Yang Jiguo's how to use PingchuanⅠto treat pediatric asthma. [Result] For pediatric asthma episodes in smooth wheezing, we join the medicine of freeing lung to relieve exterior syndrome on the basis of Pingchuan I;in duration, join yupinfeng for nourishing Qi and supporting essence; in remission, join the dragon negundo ginseng and astragalus mixture to improve children's physique, and improve the body's immune function. [Conclusion] Pingchuan I for treating three periods of asthma in children has a significant effect, unique advantages and is worth promotion.

Objective To investigate the application value of the Mini-Nutritional Assessment (MNA) in assessing the nutritional status in middle-aged women with diabetes.Methods Using the normal range of traditional nutritional index as the reference standard,two hundred and forty middle-aged women with diabetes were recruited and their nutritional status were assessed by MNA and laboratory test (including PAB,Fib,TLC,CHOL),respectively.Finally,the results were analyzed and compared.Results The correlation coefficient of MNA value and BMI、PAB,Hb,TLC,CHOL were 0.571,0.614,0.781,0.568,0.218.MNA had good correlations with several traditional laboratory indicators regarding with nutritional status,with signifi-cant difference.In this study,the results of investigation by MNA showed that:the rates of malnutrition,potential malnutrition,and normal nutritional were 30％(72 cases),65％(156 cases),and 5％(12 cases),respectively.The sensitivity and specificity of MNA were 96.1％ and 98.2％ respectively.Laboratory testing resuits:malnutrition and normal nutrition were 31％ (74 cases) and 4％ (10 cases).Kappa test(Kappa=0.922):the results of MNA and laboratory testing had strong consistency.Conclusions MNA is feasible in assessing nutritional status in the domestic middle-aged women with diabetes.

Objective To investigate the efficacy of externally applied diclofenac diethylamine emulgel on the prevention of PICC-induced mechanic phlebitis. Methods One hundred cancer patients with PICC were divided into two groups. diclofenac diethylamine emulgel and mucopolysaccharide polysulfate cream were applied three times a day for 7 days after catheterization in the two groups,respectively. Results There was no significant difference on the incidence of mechanic phlebitis between the two groups (4% vs. 8%,P>0.05). Conclusion The efficacy of externally applied diclofenac diethylamine emulgel on the prevention of PICC-induced mechanic phlebitis is the same as mucopolysaccharide polysulfate cream. Except their common virtue of convenient and simple operation,the price of diclofenac diethylamine emulgel is lower than mucopolysaccharide polysulfate cream and worthy to be spread in clinical practice.

The treatment of malignant tumor is one of the world's worst medical problem and is thus a research hotspot. The occur-rence of tumor development follows the molecule→cell→tissue→organ process. In theory, treatment can be achieved at any stage of tumor-growth by inhibition. Minimally invasive technology for treating tumor embodies the following direction of tumor treat-ment:minimally invasive, precise, and efficient. With endoscopy or imaging as a guide, the purpose of minimally invasive therapy is to have a small wound and to control tumor maximally at the tissue and organ level;thus, this therapy mode is the best and most pre-cise. This kind of technology has a good application prospect, even in the case of distant metastasis, and can be used to relieve the symptoms and improving the quality of survival by treating lesions affecting important organ functions. Minimally invasive therapy is a great challenge following the direction of modern medicine. With the development of medical science and technology, the important role of minimally invasive therapy in future tumor therapy is foreseen.

Objective To investigate the effect and mechanisms of lincRNA-p21 knockdown on radiosensitivity of hypoxic tumor cells.Methods The expression of lincRNA-p21 in SMMC7721 and U251 MG cells after hypoxia treatment were detected by QRT-PCR.Lentivirus vector carrying lincRNA-p21 siRNA or scrambled oligos were constructed.SMMC7721 and U251MG cells with stable integration of lincRNA-p21 siRNA or scrambled sequence were generated through lentiviral-mediated gene transfer.Cell cycle and apoptosis of hypoxic tumor cells were analyzed by flow cytometry.Radiosensitivity of hypoxic tumor cells were measured by cloning formation assay.The expressions of HIF-1α and GLUT1 protein were detected by Western blot.Results Under hypoxia condition (1％ O2) for 24 and 48 h, lincRNA-p21 strongly increased (t =5.13, 7.49, 8.90, 10.11, P ＜ 0.05) in SMMC7721 and U251MG cells in a timedependent manner, but this increase was suppressed in the SMMC7721 and U251MG cells with stable integration of lincRNA-p21 siRNA (t =144.81, 334.32, P ＜ 0.05).When SMMC7721 and U251MG cells were cultured under hypoxia condition (1％ O2) for 48 h, knockdown of lincRNA-p21 induced G2/M phase arrest (t =7.05, 10.18, P ＜ 0.05) and apoptosis (t =42.27, 24.79, P ＜ 0.05), reduced the expressions of HIF-1α and GLUT1 protein, and enhanced radiosensitivity with a radiosensitization ratio of 1.23 and 1.31, respectively.Conclusions Hypoxia treatment elevate the expression of lincRNA-p21.Knockdown of lincRNA-p21 enhance radiosensitivity of hypoxic tumor cells accompanied with G2/M phase arrest, apoptosis induction and the decrease of HIF-1α protein expression.

Diabetes could damage the peripheral and central nervous system,and was the risk factor of cognitive impairment in the elderly.The pathogenesis of cognitive dysfunction caused by diabetes was complex.At present,hyperinsulinemia and/or insulin deficiency,glycemic control,glycation end-products,inflammatorv mediators,hypothalamic-pituitary-adrenal axis dysfunction,blood-brain barrier dysfunction and other factors were considered to be the major causes of cognitive impairment in elderly patients with diabetes.Good metabolic control may help prevent its occurrence and/or progression.

Coincidence exists in the value selection,main form of human communication and imbalance between teacher-student relationship and doctor-patient relationship.Therefore,teacher-student relationship today will directhy have an impact on the future of doctor-patient relationship.Teachers should cultivate medical students'equality consciousness and communicating ability between doctors and patients by establishing equal relationship and good communication between teachers and stdents.

Objective To explore the feelings of the caregivers of dementia patients,and find the resource of the caregiver's abuse tendency to dementia patients in community.Methods The data of 10 caregivers were collected through deep interviews,and the Colaizzi analysis method was used to analyze the data.Results Through repeatedly reading,arranging,analysis,separation,and theme refining,five themes were drawn:lack of related knowledge and care skills,care tasks making caregivers tired,the economic burden,lack of social support,low sense of worth.Conclusions When concerning the problems caused by dementia patients,it's necessary to appeal the society and government to provide feasible service and assistance on the issue of abuse tendency,which is produced by the caregivers during the process of taking care of them.