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Objective We make a retrospective analysis , to compare to COPD group and discuss the risk factors and the clinical features in acute exacerbation in patients with ACOS to follow-up the exacerbating frequency after regular treatment in both two groups in one year. Methods There were 56 patients with ACOS and 80 patients with COPD from 2013 to 2015 in our hospital in 30%≤FEV1<80% in the stable phase. The common data of the enrolled patients included the age,sex,smoking, and allergic rhinitis or other allergic diseases in family. We analyzed laboratory index including PaO2,PaCO2,CRP,white blood cells,IgE of serums and compared the proportion of antibiotics,system used of glucocorticoid and noninvasive ventilation in hospitalization of acute exacerbation and followed up exacerbating frequency after using ICS united LABA/LAMA. Results The age and smoking index in the ACOS group were lower than the COPD group (P < 0.05). The allergic rhinitis or other familial allergic diseases,lower age of 60,the high IgE in serum were risk factor, in ACOS. In acute exacerbation, the PaCO2,IgE and WBC in serum were higher than that of the COPD group(P <0.05). The midian length of stay in hosipital was 12 days in the ACOS group and 8 days in the COPD group. The proportion of antibiotics,systemic administration of glucocorticoid and noninvasive ventilation in hospitalization of acute exacerbation in the ACOS group were higher than that of the COPD group (P < 0.05). The exacerbating frequency was decreased after using ICS united LABA/LAMA(1.2±0.6 vs 3.8±1.3,P < 0.05)in both ACOS and COPD groups. Conclusions The allergic diseases may participate in ACOS, in which it has familial tendency. In acute exacerbation, ACOS patients had even more inflammation and faster course than COPD patients. Using ICS united LABA/LAMA can reduce exacerbating frequency in ACOS.

Objective To evaluate the effects of alpha-lipoic acid (α-LA)on autophagy in human skin fibroblasts (HSFs). Methods HSFs at passage 3 - 5 were divided into several groups to be cultured with α-LA at final concentrations of 0, 0.01, 0.05, 0.10, 0.15, 0.20 and 0.50 mmol/L for 4, 12 and 24 hours, respectively. Methyl thiazolyl tetrazolium(MTT)assay was performed to evaluate cellular proliferative activity, monodansylcadaverin(MDC)staining to determine autophagy levels, and Western blot to measure the expression of the microtubule-associated protein 1 light chain-3B(LC3-B). Results After incubation for 24 hours, there was a significant difference in the proliferative activity of HSFs among all the groups (F = 10.41, P < 0.05), while no significant differences were observed after incubation for either 4 or 12 hours (F = 2.85, 1.34, respectively, both P > 0.05). MDC staining also showed a significant difference in the percentage of autophagosome-positive cells among all the groups after 24-hour incubation (F = 8.03, P < 0.05), but no significant difference after either 4- or 12-hour incubation (F = 0.11, 0.10, respectively, both P > 0.05). Western blot revealed that the degree of conversion from LC3-Ⅰ to LC3-Ⅱ(LC3-Ⅱ/LC3-Ⅰratio)was significantly different among all the groups after 24-hour incubation (F = 37.49, P < 0.05), but similar after 4- and 12-hour incubation (F = 3.38, 2.13, respectively, both P > 0.05). Conclusion α-LA may inhibit basal autophagy in HSFs.

Objective To evaluate the effects of ultraviolet A (UVA) on autophagy in human skin fibroblasts (HSFs).Methods Cultured HSFs were randomly divided into chronic and acute UVA radiation groups.HSFs in the chronic UVA radiation groups were irradiated with UVA at 5,10 and 20 J/cm2 separately once a day for 4 consecutive days,with HSFs receiving no radiation serving as the chronic radiation control group;HSFs in the acute UVA radiation groups received a single session of radiation with 5,10,30 and 60 J/cm2 UVA separately,with HSFs receiving no radiation serving as the acute radiation control group.After additional culture for different durations,methyl thiazolyl tetrazolium (MTT) assay was performed to evaluate the proliferative activity of HSFs,monodansylcadaverin (MDC) staining to determine autophagy levels,and Western blot analysis to track the conversion of the microtubule-associated protein 1 light chain-3 (LC3)-Ⅰ to LC3-Ⅱ.Statistical analysis was carried out by using one-way analysis of variance followed by Students-Newman-Keuls (SNK) test for multiple-group comparisons and by the independent sample t test for two-group comparisons.Results The cellular proliferative activity significantly decreased in the 3 chronic radiation groups at 1 hour after the final UVA radiation compared with the chronic radiation control group (F =155.5,P ＜ 0.05),and in the 4 acute radiation groups at 1,6 and 12 hours after UVA radiation compared with the acute radiation control group (F =1 335,1 649,2 774,all P ＜ 0.05).MDC staining showed that the autophagy levels in HSFs significantly increased in the 3 chronic radiation groups after UVA radiation compared with the chronic radiation control group (F =748.62,P ＞ 0.05),but showed no significant changes in any of the acute radiation groups at 1,6 or 12 hours after UVA radiation compared with the acute radiation control group (F =0.014,0.004,0.002,all P ＞ 0.05).The ratio of LC3-Ⅱ to LC3-Ⅰ was significantly elevated in all the 3 chronic radiation groups at 1 hour after UVA radiation compared with the chronic radiation control group (t =9.002,21.772,18.33,all P ＜ 0.05),but experienced no obvious changes in any of the acute radiation groups at 1,6 or 12 hours after UVA radiation compared with the acute radiation control group (F =0.13,0.27,0.06,all P ＞ 0.05).Conclusion Chronic UVA radiation can upregulate autophagy levels in HSFs,but acute UVA radiation has no evident effects on it.

Objective To compare the difference of entrance dose between CR and amorphous silocon DR system in chest imaging, and to discuss their optimum exposure dose. Methods For CR and DR, different entrance dose was measured by dosimeter in chest phantom. The value of IQFinv was analyzed by CDRAD2. 0 software. Image quality difference between CR and DR was assessed by group t-test. The relationship between image quality and entrance dose was tested by using Pearson correlation analysis. The best IQFinv values in CR and DR system were achieved via ROC curve analysis, and the exposure dose was then calculated. Results There were direct correlation values between entrance dose and the value of IQFinv in CR and DR system, respectively( r =0. 893 ,0. 848 ,P < 0. 01 ) . The linear regression equation for DR was IQFinv =0. 0050 +3. 359, and for CR was IQFinv =0. 005D + I. 651 , where D was entrance dose. The difference of IQFinv value between CR and DR was significant(t = 5. 455 ,P < 0. 05). The best IQFinv value of the two groups from ROC analysis was 3.55. Conclusions With the entrance dose increased, the detection ability of contrast-detail was elevated in the two digital radiography systems. With equal entrance dose, the detection ability of DR in contrast-detail was superior to CR. With equal image quality, DR obviously decreased the radiation dose to the patients.

Objective To investigate the effect of Probucol combined with Enalapril-folic acid tablets on endothelial function in elderly patients with H-type hypertension.Methods A total of 180 elderly patients with H type hypertension were randomly divided into three groups (n =60,each):Group A (conventional treatment),Group B (conventional treatment + a tablet containing 10 mg enalapril and 0.8 mg Folic acid/day) and Group C (conventional treatment + 500 mg Protocol twice daily + a tablet containing 10 mg Enalapril and 0.8 mg folic acid/day).Plasma hemocyanin (Hcy) and asymmetric dimethylarginine (ADMA) levels and serum nitric oxide (NO) and endothelial NO synthase (eNOS) levels were measured before treatment,and 1 and 6 months after treatment.Results In Group A,plasma Hcy and ADMA levels and serum NO and eNOS levels had no significant differences before treatment versus 1 and 6 months after treatment (P＞0.05).Plasma Hcy and ADMA levels decreased and serum NO and eNOS levels increased in Group B 6 months after treatment,compared with those at pretreatment or 1 month after treatment,which were either lower or higher than those in Group A 6 months after treatment (all P＜0.05).Plasma Hcy and ADMA levels decreased and serum NO and eNOS levels increased in Group C 6 months after treatment,compared with those at pretreatment or 1 month after treatment,which were either lower or higher than those in Groups A and B 6 months after treatment (all P＜0.05).After adjustment for other risk factors,partial correlation analysis showed that plasma ADMA was positively correlated with plasma Hcy,while plasma ADMA and Hcy were negatively correlated with serum eNOS and NO (all P＜0.05).Conclusions Probucol in combination with Enalapril-folic acid tablets may be beneficial in improving endothelial function and mitigating the development of atherosclerosis.

OBJECTIVE The head of malleus (HOM) was regarded as the landmark for the middle cranial fossa approach,and its relationship with internal auditory meatus(IAM) was measured. The purpose of this study was to find a safe method to locate IAM. METHODS Twelve heads of adult cadaver fixed with 10 % formaldehyde (23 sides) were microsurgically dissected from the middle cranial fossa approach. The foramen spinosum,Ferrein's foramen,greater petrosal nerve,lesser petrosal nerve,facial nerve,HOM,arcuate eminence,superior petrosal sinus,semicircular canal,and IAM were exposed. First,blue lines method was used to locate IAM. Second,HOM as the landmark was used to locate IAM. RESULTS The angles between the SSC and the longitude axis of IAM are 58.52??4.84?。 A perpendicular line (AB) was drew from the center of HOM to the longitude axis of the temporal bone (the longitude axis of the superior petrosal sinus),line BC was drew from the anterior 30?(28.93?? 6.07?) to the line AB. On the line BC,fundus of IAM can be located (6.69?1.10) mm medial to HOM,the center of the internal acoustic pore can be located (20.1?1.48)mm medial to HOM. CONCLUSION In the middle cranial fossa surgery,HOM can be used to locate IAM and its surroundings structures when traditional landmarks are unrecognized.

Intestinal microecology is an important and complex biological system necessary for human health.Its disorder is involved in the development of various diseases of human body.The technology of intestinal microbiota transplantation can effectively regulate the intestinal flora,repair the imbalance of the intestinal microecology,and bring a new breakthrough for the treatment of many diseases of gastrointestinal tract and outside gastrointestinal tract.However,there is still no systematic and complete management standard for intestinal microbiota transplantation technology.This paper discussed related content involved in standardized management of intestinal microbiota transplantation technology and reflected the ethical problems involved in standardized management from the perspective of medical ethics,in order to promote the clinical application of intestinal microbiota transplantation technology.

ObjectiveDiabetes is an independent risk factor for coronary artery bypasss grafting(CABG). Off pump coronary artery bypasss (OPCAB) experience in 251 cases was reviewed to determine whether diabetes wou ld be applicable in OPCAB procedures.MethodsConsecutive 251 patients underwent OPCAB over 12 month period. This study included 71 diebetic patients (DM group) and 180 nondiabetic patients (NDM group). Preoperative v ariables were compared between the two groups by univariate analysis.R esultsNo differences were found regarding the length of stay in cardio intensive care unit [DM group(2.4?0.3)d; NDM group (2.4?0.3) d;P=0. 386], and sternal complication (DM group: 5.7%;NDM group: 3.9%;P=0.511) . In hospital complications were as follows: death rate(DM group: 2.8%; NDM gr oup: 1.1%; P=0.680); stroke (DM group: 2 8%; NDM group: 1 7%; P=0 623 ); hemofiltratioin renal failure (DM group: 2.8%; NDM group: 0.5%; P=0.194); myocardial infarction(DM group: 0%; NDM group: 0.5%;P=1.000); blood using were more frequent in DM group comparied with NDM group (P=0.111). ConclusionOPCAB in diabetic patients is as safe as in non diabetic patients.

Objective To discuss anatomical characteristics and clinical results of the lateral superior genicular artery perforator iliotibial band flap. Methods From September 1999 to July 2009, the origin,course, branches and distribution of the lateral superior genicular artery and blood supply of iliotibial band were observed on 40 sides adult lower limbs perfused with red latax. Five perforator iliotibial band and 4 perforator iliotibial band flaps of 9 cases were treated with anastomosis of lateral superior genicular artery perforating rami. Results The lateral superior genicular artery of 35 cases (80%) originates from the popliteal artery. Its originated external diameter was (1.8 ± 0.4) mm. It divides into ascending branch and descending branch, and they gives off septofascio-cutaneous perforator, or anatomoses the lateral uppermost genicular artery in the vastus lateralis muscle, and then formes the musculocutaneous perforator of iliotibial band. The originated external diameter of the larger perforator of iliotibial bands was ( 1.0 ± 0.2) mm and they provides for the skin and iliotibial band of lateral superior genicular area. Nine cases, including 5 cases of simple Achilles tendon defects, two cases of achilles tendon defects with skin defects, and 2 cases of lower extremity and foot soft tissue defects were treated with transplantation of the vascularized iliotibial band (flap) with perforator vascular anastomoses. All cases were followed up 6 - 92 months. The results showed significant improvement in "heel test" and Thompson sign in the rerupture of the Achilles tendon occurred. Four perforator iliotibial band flaps survived well. Conclusion The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and new donor in the reconstruction of soft tissue and composite defects.