Objective To investigate the level of plasma GDF-15 in patients with COPD and its clinical value in the diagnosis of COPD in the stable stage and in acute exacerbation stage. Methods From 2015 to 2016, 58 cases of patients with COPD were enrolled ,including COPD patients in the stable stage and in acute exacerba-tion stage. 29 cases of COPD patients diagnosed in our hospital were enrolled in the experimental group ,and 29 cases of age-,gender and body mass index-matched healthy people were enrolled in the control group. Compared and analyzed the blood cell count ,determination of plasma GDF-15 and C-reactive protein were performed and ana-lyzed. Spearman correlation analysis was conducted to compare levels of GDF-15 and C-reactive protein between pa-tients with the stable stage of COPD and those with acute exacerbation stage of COPD. The diagnostic efficacy was compared between GDF-15 and C-reactive protein in differentiatingthe COPD in acute exacerbation period and in the stable period. Results Level of GDF-15 in the stable COPD patients was significantly increased compared with that in the control group. The plasma GDF-15 level was significantly increased in acute exacerbation COPD patients compared to patient with the stable COPD(P<0.001). For the stable COPD patients,GDF-15 level and C-reactive protein level was positively correlated(r = 0.776,P < 0.001). In acute exacerbation COPD patients, GDF-15 level and C-reactive protein level was positively correlated (r = 0.877,P < 0.001). The ROC curves showed that the GDF-15 level on the diagnosis of acute exacerbation COPD patients with an AUC was 0.783(95%CI,0.666~0.900,P<0.001)and with the diagnostic accuracy was 69%. C-reactive protein in the acute exacer-bation of AUC diagnosis of COPD was 0.686(95%CI:0.549~0.823,P<0.01)and the diagnostic accuracy rate was 59%. Conclusion The plasma level of GDF-15 was significantly increased in COPD patients compared with people in the healthy control group. Plasma GDF-15 and C- reactive protein were highly correlated in the stable stage of COPD patients and in acute exacerbation stage of COPD patients. The diagnostic accuracy of GDF in patients with the stable stage of COPD and with acute exacerbation stage of COPD was higher than C-reactive pro tein.

Objective To explore and evaluate the micro-anatomic structure of posterior-middle cra nial fossa in the retrosigmoid keyhole approach for clinical application. Methods Ten formalin-fixed adult cadaver heads of 20 sides were used to apply the retrosigmoid keyhole approach to reach and observe the structure of posterior-middle cranial fossa.Results The retrosigmoid keyhole approach can reach petroclival region from post-lateral aspect and through this approach the lateral potion of cerebellar hemisphere、petrosal bone,CN Ⅴ,Ⅶ,Ⅷ,part of CN Ⅸ-Ⅻ,lateral potion of pons、vertebral artery and anterior inferior cerebellavar artery can be exposed cleady.Resecting part of supra-tubercle of IAM can enlarge the exposure of IAM and CN V.After cutting off the edge of tentorial part of CN Ⅳ and middle cranial fossa can be exposed.Conclusion Through retrosigmoid keyhole approach we can use the small but compatible bone hole to diminish the ineffective exposure of the cerebellum.Meanwhile the wound because of the approach and complication can be cut down.It's an effective,safe and convenience approach in clinical application to resect the tumor mainly located in posterior cranial fossa.

Objective To investigate the effect of simvastatin on oxidative stress and inflammatory reac-tion in patients with stable moderate to severe chronic obstructive pulmonary disease and its mechanism. Meth-ods Sixty patients diagnosed with chronic obstructive pulmonary disease were randomly divided into the simvas-tatin group and the placebo group.The simvastatin group was treated with simvastatin in 40 mg/d for 12 weeks,and the placebo group with placebo.The general clinical features,the concentration of inflammatory factors,pulmonary function,6-minute walk test and MRC score were compared between the two groups.Results There was no signif-icant difference between these two groups in basic features. There was a decrease of IL-6,TNF-a and Hs-CRP in concentration in the simvastatin group after treatment. which was significantly lower than that of the placebo group after treatment.The 6-minute walk test in the simvastatin group was much better than that in the placebo group(P=0.00).MRC score was improved compared with therapy before(P=0.02).There was no significantly difference in 6-minute walk test and MRC score before and after treatment in the placebo group(P=0.81). The PaO2 was im-proved after treatment in the simvastatin group compared with therapy before and that in the placebo group after therapy(P<0.05)respectively.There was no significantly difference in FEV1and FVC between these two groups. Conclusion Simvastatin can decrease the concentration of inflammatory factors in stable moderate to severe chron-ic obstructive pulmonary disease,and improve the pulmonary function.