Objective To explore the effects of early glucocorticoids (GC) therapy on the outcome of patients with acute respiratory distress syndrome (ARDS). Methods The clinical data of all ARDS patients admitted from January 2008 to December 2011 in Chengdu Military General Hospital of Chinese PLA were retrospectively analyzed. The adult patients whose diagnosis was in accord to the Berlin ARDS diagnostic criteria published in 2012 were enrolled, and based on whether using glucocorticoid or not, they were divided into GC group and non-GC group. All the patients in GC group received low dosage of intravenous GC within 48 hours after the onset of ARDS, including different kinds of GC, methylprednisolone, dexamethasone and hydrocortisone (hydrocortisone dosage < 5 mg·kg-1·d-1, the dosage of former two kinds of GC being converted to that of hydrocortisone), and the therapeutic course of the two groups was 7 to 21 days. The patients in non-GC group received no GC therapy after the occurrence of ARDS. The duration of mechanical ventilation, the length of intensive care unit (ICU) stay and totally in hospital, medical cost and 28-day survival rate were compared between the two groups. Results One hundred and seventeen patients with ARDS were collected, including 56 cases (47.86%) in GC group and 61 cases (52.14%) in non-GC group. The duration of mechanical ventilation in GC group was significantly shorter than that in non-GC group [days:0 (0, 2.50) vs. 2.00 (0, 2.50), Z=2.015, P=0.044]. The 28-day survival rate in GC group was significantly higher than that in non-GC group [71.43%(40/56) vs. 50.82%(31/61),χ2=5.198, P=0.023]. There were no significant differences in the length of ICU stay [days:7.50 (2.00, 11.00) vs. 4.00 (1.00, 9.00), Z=1.879, P=0.060] and stay totally in hospital [days:16.00 (10.00, 27.75) vs. 15.00 (7.00, 28.00), Z=0.592, P=0.552] between GC group and non-GC group. However, the medical cost in non-GC group was significant lower than that in GC group [10 thousand Chinese yuan:3.15 (1.51, 5.78) vs. 4.39 (1.66, 10.88), Z=2.204, P=0.028]. Conclusion The early GC therapy may improve the outcome of patients with ARDS, especially beneficial to the 28-day survival rate.

Objective To study the efficacy of movement imagination combined with biofeedback for stroke patients with upper extremity dysfunction. MethodsEighty stroke survivors were recruited and randomly divided into a movement imagination group ( n =40) and a movement imagination combined with biofeedback group ( n =40).Their EMG mean values during wrist dorsiflexion were amplified and calculated.Fugl-Meyer upper extremity function scores (FMAs) and the modified Barthl index (MBI) were recorded before and after 6 weeks of treatment.ResultsAfter 6 weeks of treatment the two groups had significantly higher mean EMG values,FMA scores and MBI scores,but the effects in the combination group were significantly better than those in the simple movement imagination group. ConclusionMovement imagination can be made more effective by combining it with biofeedback for promoting the recovery of stroke patients with upper extremity dysfunction.

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Objective To investigate the merit and feasibility of vasoactive drugs by the double atrial infusion in children with congenital heart disease combined with pulmonary hypertension.Methods Ninety cases of congenital heart disease combined with pulmonary hypertension were randomly selected.One group(45 cases) was infused by double atrialadministration,which left atrium for catecholamines,and right atrial infusion for highly targeted expansion of pulmonary vascular drugs,such as prostaglandin E1.Another group(45 cases) was infused through the right atrium by a central venous to catecholamines and pulmonary vascular dilatation drugs.Cardiac output(CO) and cardiac index were measured by thermal dilution method and systemic vascular resistance and pulmonary vascular resistance(PVR) were calculated.Results Three cases were dead in early postoperative period(1 week),which were central intravenous group.2 cases with total anomalous pulmonary venous drainage had low co after operation,include 1 case through the left atrium,and the other case through central venous administration,and were recovered.There was no long-term mortality.There was no significant difference in CPB time,blocking time,the amount and timing of vasoactive drugs in two groups (P ＞ 0.05).Conclusion Double atrial infusion of vasoactive drugs can significantly reduce the mean pulmonary artery pressure and pulmonary vascular resistance,and increase CO,which is better than the traditional central intravenous methods.The treatment method is of very important significance.Thus double atrial infusion is safe and feasible.

Objective To investigate the effect of berberine anti macrophages apoptosis, initially to determine the concentration of anti-apoptosis and to explore its mechanisms of treatment in atherosclerosis (AS). Methods Apoptosis of RAW264.7 macrophages is induced by 0.5 μmol/L Tg and 50 μg/ml Fuc. The cell survival rate and apoptosis rate was detected by MIT and flow cytometry, respectively. Results There was statistical significance between the berberine group of 800 μg/ml and normal group in the cell sur-vival rate(P<0.01). With the decline in concentration of berberine, the cell apoptosis rate showed a down-ward trend, berberine (0.02-0.63 μg/ml) effectively inhibited the cell apoptosis induced by Tg and Fuc. Conclusion Berberine group has little impact on the cell proliferation. Berberine can effectively inhibit the cell apoptosis induced by Tg and Fuc.

Objective To compare the efficacies between interventional embolization and surgical clipping in treatment of ruptured intracranial aneurysms to provide an evidence‐based basis for selecting the clinical treatment scheme .Methods The related randomized controlled trail(RCT) literatures on the effects of interventional embolization and surgical clipping were retrieved from the databases of Pubmed ,Cochrane ,Medline and Embase .The screening was independently performed by two researchers according to the including and excluding criterion .The occurrence rate of adverse reactions ,postoperative 1‐year mortality rate ,re‐bleeding rate ,occurrence rate of vasospasm and ischemic cerebral infarction served as the measurement indicators .The data were extracted and performed the meta analysis by the RevMan5 .3 software .Results Sixteen RCT literatures were included for conducting analy‐sis ,involving 7 373 patients ,in which 3 092 cases adopted interventional embolization and 4 281 cases adopted surgical clipping .The occurrence rate of adverse events(OR=1 .25 ,95% CI ,1 .12-1 .40 ;P<0 .000 1) and re‐bleeding rate(OR=0 .43 ,95% CI ,0 .28 -0 .66 ;P=0 .000 1) in the interventional embolization group were lower than those in the surgical clipping group ;however ,there were no statistical differences between the interventional embolization group and surgical clipping group in the postoperative 1‐year mortality rate(OR=1 .13 ,95% CI ,0 .92-1 .39 ;P=0 .23) ,incidence rate of vasospasm (OR=1 .41 ,95% CI ,0 .99-2 .02 ;P=0 .06) and incidence rate of ischemic cerebral infarction(OR=0 .66 ,95% CI ,0 .42 -1 .05 ;P=0 .08) .Conclusion The current clinical re‐search evidences indicate that using the interventional embolization in treating ruptured intracranial aneurysms can obviously reduce the occurrence rate of adverse events than the surgical clipping ,but increases the re‐bleeding rate .The postoperative 1‐year mortali‐ty rate ,incidence rate of vasospasm and incidence rate of ischemic cerebral infarction have no obvious difference between these two kinds of operation .

Objective:To investigate the clinic effect of r-MHT and hematoma aspiration on the traumatic intracerebral hematoma.Methods:89 cases with traumatic intracerebral hematoma were given hematoma aspiration,47 of them were given r-MHT and hematoma aspiration,the clinic effect on the 1st,7th,14th day after treatment were evaluated by NIHSS,the hematoma volume before treatment on the 1st,7th,14th day after treatment were counted by Dotian formula.Results:The effective rate of treatment group was 93.6％,which was significantly higher than that of the control group (P＜0.05).The NIHSS score of treatment group was significantly higher than that of the control group(P＜0.05) on the 1 st day,1st,2nd week after treatment (P＜0.05).Conclusion:r-MHT and hematoma aspiration couldn effectively reduce the brain damage,improve the patient's neurological fumction in treating traumatic intracerebral hematoma.

AIM: To determine if aquaporin-1 (AQP-1) expression and function is influenced after lipopolysaccharide (LPS) stimulation in rat lung microvessel endothelial cells and to investigate the mechanisms of lung fluid abnormal metabolism in acute lung injury. METHODS: LPS at different concentrations (100 ?g/L, 1 mg/L or 10 mg/L) was used to stimulate cultivated rat lung microvessel endothelial cells in vitro at different stimulatory times (4 h, 12 h or 24 h), respectively. Tritium water permeation was conducted for determining the intracellular signal intensity in rat lung microvessel endothelial cells. The RT-PCR technique was applied for the assay of the expression of AQP-1 mRNA. RESULTS: The signal intensity of intracellular tritium water in the LPS stimulation group was less than that in normal control significantly. Compared with the normal control group (P

Objective To compare the efficacy of arterial stenting with that of traditional B -T shunt for neo-natal pulmonary atresia with intact ventricular septum.Methods Twenty -six cases of neonatal pulmonary atresia with intact ventricular septum were treated at Children′s Hospital of Zhengzhou from December 2005 to December 201 5,aged 3 to 23 days[(8.20 ±4.80)days],and weighted 2.80 -3.88 (3.41 ±0.27)kg.Accompanied with pulmonary hypo-plasia,all these patients were combined with PDA and ASD or PFO.Before operation,the peripheral oxygen saturation was kept in 61 % -75%,averaged at 67%.Among them,1 2 cases underwent arterial catheter stenting,and 1 4 cases re-ceived B -T shunt (including modified B -T shunt and central shunt)ductus ligation.After operation,the oxygen satu-ration in these children was observed,and they were examined by echocardiography and true lateral chest X -ray,blood flow situations in stents and shunts were assessed,and follow -up examinations were conducted in 1 ,3,6 and 1 2 months postoperatively.Results Stents were successfully inserted into these 1 2 cases.After traditional pulmonary shunt,pa-tients′peripheral oxygen saturation was (82.73 ±5.59)%,compared with that of patients after arterial catheter sten-ting (86.1 8 ±3.1 9)%,there was significant difference(t =1 0.71 ,P <0.05).In pulmonary shunt group,2 cases died,1 case died of postoperative heart failure,and the other case was complicated with pulmonary infection and died of respiratory failure;in catheter stent group,1 case was complicated with postoperative supraventricular tachycardia and recovered after drug intervention.For the follow -up examinations 1 ,3,6 and 1 2 months after the operation,1 case of B -T shunt in pulmonary shunt group was improved by central shunt due to slow blood flow,less shunt volume,and ox-ygen saturation decreased to 69%.For the catheter stent group,1 case was improved by stent balloon dilatation due to declined peripheral oxygen saturation 2 months postoperatively,and after the operation,transcutaneous oxygen saturation was improved.No patients died in the catheter stent group.Conclusions In traditional B -T shunts,the operation is extensive,and complications are common,and the recovery turns slowly.Arterial catheter stenting can be used as the preferred method of treatment for one -stage surgical pulmonary atresia with intact ventricular septum to reduce the weakness feasibly and effectively.

Objective: To investigate the clinical research of Guo's Liulian therapy in treating acute pancreatitis intestinal mucosal barrier dysfunction and provide reference for the patients with acute pancreatitis. Methods: The 68 patients with acute pancreatitis who were admitted to our hospital from September 2016 to May 2018 were selected as study subjects. According to the random number table method, the patients were divided into the observation group and the control group, with 34 cases in each group. The patients in the control group were treated with conventional western medicine. The patients in the observation group were treated with Guo's Liulian therapy on the basis of the above treatment. The time of intestinal paralysis was compared between the two groups. The changes of intestinal mucosal barrier function and serum inflammatory factor related indexes before and after treatment were analyzed in the two groups. The difference of therapeutic effects between the two groups was observed. Results: In the observation group, the abdominal pain relief time, abdominal distention relief time, bowel sound recovery time, and first bowel anus defecation time were significantly lower than those in the control group (t=7.621, 5.332 6.625, 8.762, all Ps<0.01). After treatment, serum LPS, DAO, ET, D-lactic acid, TNF-α, IL-1, IL-6, IL-8, and IL-10 and urine L/M were significantly lower in the observation group, while the serum ITF and MFG-E8 were significantly higher in the observation group (t=9.856, 6.974, 9.784, 16.068, 9.550, 12.506, 22.343, 16.625, 6.774, 23.469, 20.118, 23.031, all Ps<0.01). Conclusions The Guo's Liulian therapy treatment of acute pancreatitis in patients with intestinal mucosal barrier dysfunction can reduce the palsy remission time, reduce inflammation, increase serum ITF, MFG-E8 levels, repair of intestinal permeability, and improve the intestinal barrier function.