Objective To observe and investigate the effect of bronchoalveolar lavage (BAL)joint non -invasive positive pressure ventilation (NIPPV)in treatment of chronic obstructive pulmonary disease(COPD)with type II respiratory failure.Methods 110 patients of COPD combined with type Ⅱrespiratory failure were selected. According to the random number table method,all the patients were divided into observation group and control group. Except routine therapy,the observation group was treated with BAL combined with NIPPV treatment,the control group was treated with NIPPV treatment alone.The heart rate,APACHE Ⅱscore changes,blood gas index,mean arterial pressure and adverse reactions occurrences were compared between the two groups.Results Four hours after treatment,the pH of the observation group was significantly increased to (7.36 ±0.06),and compared with the control group (7.32 ±0.05),the difference was statistically significant (t =3.798,P <0.05 ).Four hours after treatment,PaCO2 level of the observation group was significantly decreased to (59.4 ±12.9)mmHg,which was lower than (69.3 ±11.3)mmHg in the control group,the difference was statistically significant (t =-4.281,P <0.05). 24h after treatment,the PaO2 level of the observation group was significantly increased to (74.8 ±17.2)mmHg, which was significantly higher than (64.7 ±15.1)mmHg of the control group,and the difference was statistically significant (t =3.273,P <0.05 ).There were no statistically significant differences in mean arterial pressure and heart rate at each time point of the two groups (P >0.05).12h after treatment,APACHE II scores of the two groups were significantly decreased,in the observation group,the APACHE II score from (10.8 ±2.5)points decreased to (7.8 ±1.9)points,and in the control group,the APACHE II score from (11.8 ±4.3)points decreased to (9.9 ± 4.5)points,APACHE II score of the observation group decreased more obviously than the control group,and the difference was statistically significant (t =-3.188,P <0.05).The incidence rate of adverse reaction of the observation group (18.18%)was significantly lower than the control group (63.64%).Conclusion BAL combined with NIPPV in the treatment of COPD with type II respiratory failure can effectively improve symptoms in patients with breathing difficulties,improve PaO2 level,reduce PaCO2 level and APACHE II score,and reduce the incidence of adverse reactions,which has good clinical application value.

Adult-onset foveomacular vitelliform dystrophy (AFVD) is characterized by gradually loss of vision,subretinal vitelliform macular lesions and retinal pigment epithelium (RPE) atrophy.The electrooculogram (EOG) is usually normal or reduce slightly.On optical coherence tomography (OCT),there are vitelliform substance which deposited between the photoreceptor layer and the RPE layer,and thinner outer nuclear layer above these deposits.OCT angiography can show the superficial and deep retinal capillaries plexus (DCP) above the yolk-like deposits,the choroidal capillary blood flow is reduced and the DCP blood flow is increased near macular.On indocyanine green angiography (ICG),there is choroidal neovascularization under vitelliform substance at early stage and fluorescence leakage in the corresponding retinal region at late stage.There is no effective treatment for AFVD at present,monogenic gene therapy is the most worth looking forward to.Understanding AFVD clinical manifestations,multi-mode imaging features and new advances in treatment can provide a reference for diagnosis and treatment options

Objective To observe the clinical manifestations and fe at ures of fundus fluorescein angiograms (FFA) of patients with multifocal choroidi tis (MFC). Methods The data of 8 patients who had been diagnos ed by clinic and FFA as with MFC were collected, and their clinical manifestatio ns and results of FFA were analyzed and valued. Results The ag e of the 7 female and 1 male patients ranged from 16 to 32, and all of the 8 pa tients had high myopia (from -6.00 D to -8.00 D) with binocular multiple small yellowish white lesions in posterior pole of the fundus and a few phlogistic ce lls in vitreous body. In addition, macular choroidal neovascularization membrane (CNV) was found in 6 patients, binocular in 2 and monocular in 4. The results o f FFA in 7 patients showed hypofluorescence of the yellowish-white lesions at t he early phase and pigmentation at the late phase; Corresponding manifestations of FFA could be found in the patients attended by CNV surrounded by leakage. Conclusion MFC are mostly diagnosed in young females with myopia. Most of the patients had binocular affection with multiple small yellowish whit e lesions at the posterior pole, whose FFA shows hypofluoresence of the active l esions at the early phase and pigmentation at the late phase. CNV may occur in p atients with MFC.

Purpose To identify and quantitatively evaluate age related changes in the retinal pigment epithelium (RPE) and underlying Bruchs membrane and choroid in donor human eyes. Methods 36unpaired human eyes of varying age (3～93 years) from Caucasian donors were supplied by Manchester Eye Bank (UK) or National Disease Research Interchange (Philadephia,USA).Modified Massons trichrome staining was used to illustrate age related changes in RPE cell, Bruchs membrane thickness, and density of choriocapillaries and thickness of the choroid. Data were assessed using computer aided quantitative morphometric analysis method. Results The thickness of Bruchs membrane increased with age while there is a change in morphology of RPE cells including a decrease in number and RPE cell thickening with age. RPE cells decreased at a rate of 8 cells/mm 2?year, RPE cell height and thickness of Bruchs membrane increased at rates of 0.01(?m/year) and 0.02 (?m/year) respectively. The luminal area of choriocapillaries and the thickness of choroid showed no close relation with age. Conclusion RPE cell loss and thickening of Bruchs membrane and RPE cells may be the earlier and primary alteration with age.

Objective To investigate the impact of photodynamic therapy (PDT) with verteporfin on the expression of pigment epithelial derivative factor (PEDF) mRNA and vascular endothelial growth factor (VEGF) mRNA in adult retinal pigment epithelial (RPE) cells in vitro. Methods The changes of cellular viability before and after PDT were assessed by methyl thiazolyl tetrazolum (MTT) colorimetric assay. Semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) was conducted to detect the expression of PEDF and VEGF mRNA in RPE cells before and after PDT. Results PDT caused the death of RPE cells. The cellular mortality was positively correlated with the power of photocoagulation and the concentration of verteporfin. Conclusion PDT could down-regulate the expression of PEDF and VEGF mRNA in adult RPE cells in vitro, which may relate to the cure or relapse of subfoveal choroidal neovascular membrane after PDT.

Objective To investigate the treatment method of osteoporotic refracture after vertebroplasty.Methods One hundred and twenty patients (140 vertebraes) with osteoporotic fractures from January 2010 to January 2011 were selected,12 months after operation,15 cases of refracture (20vertebraes) patients as the research object,11 cases were given bone cement to strengthen treatment,postoperative anti-infection,recovery given a positive rehabilitation exercise instruction ;4 cases were given anti-osteoporosis treatment.Follow-up of 10 months,whether leakage of bone cement and the recovery of anti-osteoporosis treatment were observed.Results Eleven patients with refracture in the process of bone cement injection had no prevertebral venous leakage and disc leakage,none of the patients had bone cement leakage after operation;including 3 cases occurred back pain after injection,the main consideration was surgery influenced the local nerve functions and given analgesic treatment,then pain significantly reduced; 4cases with anti-osteoporosis therapy and recoverd better,no pain and other unsuitable symptom occurred.Postoperative 3 d all of the patients could get out of bed,were discharged on 1 week after operation.All patients were not appear the adverse host reaction of fillers,with no occurrence of refracture.Through visual analog pain scale(VAS) score,VAS score in the 3 d after treatment and end-stage follow-up were significantly lower than before treatment [(3.05 ± 0.55),(0.05 ± 0.15) scores vs.(6.95 ± 0.65) scores],and VAS score at the time of end-stage follow-up was lower than 3 d after treatment,there was significant difference (P ＜0.05).Conclusion Bone cement to strengthen with anti-infection and rehabilitation exercise instruction and anti-osteoporosis in the treatment of osteoporotic refracture after vertebroplasty curative effect,safe and reliable effect,worthy of clinical popularization and application.

An abnormal microenvironment which is not fit for the living of normal cells is induced and maintained due to rapid growth, abnormal energy metabolism and self-regulation of specific proteins of the tumor cells. At the same time, the abnormal microenvironment is the guarantee of the neoplastic transformation, proliferation, invasion and metastasis of tumor cells. The microenvironment mainly consists of interstitial cells and their components. There are correlations between the physiological role of body fluid and the physiological functions of microenvironment. Phlegm is the product of abnormal body fluid metabolism. So to discuss the correlations of them may contribute to clarifying the material base of phlegm and will further give new insight for integrated traditional Chinese and Western medicine in cancer research.

Objective　To observe the therapeutic effects and safety of angiotensin-converting enzym e (ACE)-inhibitors in the treatment of the secondary erythromatosis following ren al transplantation.Methods　Twenty-four patients with erythromatosis following renal transplantation recei ved the treatment with ACE-inhibitors. During the administration of ACE-inhibi tors, the hemoglobin, hematocrit and the side effects were observed. Results　All the patients were recovered except one who ha d to be stopped the treatment of ACE-inhibitors because of the depressing of th e blood pressure. The time of producing the effects was 7-20 days. The side effe cts included lower blood pressure accompanied by dizzy in 3 cases, anemia in 2 cases and damage to renal function in 2 cases. Conclusions　ACE-inhibitors were effective in the treatme nt of secondary erythromatosis following renal transplantation. It was important to monitor the hemogram and the renal function of the patients.

medial distal wall. The root canal length of central and lateral incisors were (12.96?6.46) mm and (11.47?6.32) mm respectively. The double root canal was found in 35.9 % of central incisors and in 27.5% of lateral incisors. Most mandibular incisors with long concavity had single root canal. Conclusion: The root canal wall of mandibular incisors was thinner in medial and distal wall than in lingual and labial wall. Mandibular incisors have higher rate in double root canal and the long concavity is not significantly related with number of root canal.

Objective To investigate the information management method for improving the efficiency of rescuing batches of the sick and wounded.Methods A portable palm computer were used to collect the information of the sick and wounded and the collected data were transmitted in real time to the server of the higher rescuing institution in the hospital via wired and wireless networks after being counted up,analyzed and summarized.Results The higher rescuing institution took the real-time information as the decision-making base at any time to give orders and provide assistance that fed back to the rescuing site at any moment.Conclusions The system combines medical rescuing with modern computerized information system,realizing the informatization,digitalization and automation of direction and management models in rescuing batches of the sick and wounded and greatly improving the efficiency for rescuing the sick and wounded.