Objective To investigate the significance of early blood lactic acid and lactic acid clearance in patients with post-cardiac arrest syndrome(PCAS).Methods 87 cases were divided into the survival group(26 cases) and the death group(61 cases).The clinical data of two groups were analyzed statistically.Results The 6h blood lactate (8.46 ± 2.37) mmoL/L,6h blood lactate clearance rate (34.53 ± 14.75) ％,the residual alkali (-3.08 ± 3.68) mmol/L,6h SevO2 (68.35 ± 6.33) ％,APACHE Ⅲ score (19.64 ± 2.48) points in the survival group were significantly better than those of the death group [blood lactic acid value (12.32 ± 3.56) mmol/L,6h blood lactate clearance rate (27.71 ± 11.38) ％,the residual alkali (-5.61 ± 4.14) mmol/L,6h SevO2 (63.22 ± 5.94) ％,APACHE Ⅲ score (24.32 ± 5.33) points],with significant differences between two groups (t =5.99,2.36,2.73,3.66,5.62,all P ＜ 0.05).The 6h blood lactate clearance rate,6h SevO2 and APACHE Ⅲ score were independent risk factors for the prognosis of PCAS (OR =1.23,1.64,1.28,all P ＜ 0.05).Conclusion The early blood lactate clearance rate can be used as a sensitive indicator for evaluating the prognosis of PCAS.

BACKGROUND:The extracelular matrix with removal of cels and soluble proteins can maintain the normal shape of organs and matrix components. OBJECTIVE:To prepare the acelular matrix of lung tissue using perfusion method. METHODS:Forty Wistar rats were randomly divided into two groups: under routine anesthesia, the chest was open to obtain complete lung tissue for construction of rat lung acelular matrix scaffold using Langendorff perfusion model in experimental group, and there was no treatment in control group. Lung tissue color and shape were observed and recorded dynamicaly. A smal tissue from different sites of the lung was taken from each group and observed histologicaly under electron microscope. The elastic fibers and connective tissues were highlighted by a Weigert or von Gieson staining, respectively. Hematoxylin-eosin staining was also employed. RESULTS AND CONCLUSION:After perfusion with 1% sodium deoxycholate, the lung tissue of the experimental group gradualy appeared with a piecewise and lobulated translucent appearance in white color from the inside to the outside, and the lung structure was clear. Eventualy, the lung tissue became uniform white translucent. The Weigert-Von Gieson staining and hematoxylin-eosin staining showed that there were a large amount of cels in fresh lung tissue sections of the control group, including capilaries, fibroblasts and endothelial cels; the cels were arranged neatly, and had complete alveolar structure; the elastic fiber structure was clear, and the colagen fiber was arranged neatly and compactly. In the experimental group, the lung cels nearly disappeared, and the alveolar structure was stil intact but in a loose state; the elastic fibers were preserved wel and the colagen fibers were loosely arranged. These findings indicate that the perfusion method can be used to effectively construct the lung matrix scaffold in rats.

Objective To investigate the role and regulatory mechanism of micro RNA-9-3 (miR-9-3)in the pathogenesis of chronic lymphocytic leukemia.Methods Using the methylation specific PCR (MSP)technology to detect 8 cases of normal bone marrow tissue and peripheral blood,78 cases of bone marrow tissue came from the chronic lymphocytic leukemia pateints newly diagnosed and the methylation level of 7 kinds of leukemia cell line.Used Western blot to detected the NF-kappa B1 signal transduction pathway activation levels of methylation positive leukemia cell line.Results The miR-9-3 of normal control group were in the negative methylation status.Only I83-E95 and WAC3CD5+ were in positive methylation status in seven kinds of leukemia cell line (the positive of MSP was 28.6%);65 cases occurred miR-9-3 methylated in 78 of chronic lymphocytic leukemia patients (the positive of MSP was 83%).I83-E95 and miR-9-3 cells of WAC3CD5+ were in the methylation state when treatment with 5-nitrogen-2’-deoxidization cytidine (5-Aza2’Dc).Conclusion The abnormal methylation of miR-9-3 were usually seenin chronic lymphocytic leukemia,it could lead to abnormal hyperplasis in cancer cells.The methylation of miR-9-3 could inhibit the activation of NF-kappa B1 signal pathway suggested that it could sup-press the apoptosis of cancer cells through this pathways to trogered the progression of disease.The inhibitor of methylation could be induced the demethylation of leukemia cell lines,so it is possible that miR-9-3 maight be a new gene targets for the treatment of chronic lymphocytic leukemia.

Objective To study the effect of nursing intervention based on quantitative evaluation strategy on treatment effect of elder patients with pulmonary respiratory distress syndrome when received pressure control treatment.Methods 80 cases elder patients with pulmonary respiratory distress syndrome in our hospital were enrolled and randomly divided into the observation group and the control group,there were 40 cases in each group.The observation group received nursing intervention based on quantitative evaluation strategy,while the control group received routine nursing intervention.Then alveolar oxygen function,hemodynamic index,serum inflammatory factor levels and adverse reactions were compared between the two groups.Results ① Alveolar oxygenation function:arterial blood oxygen partial pressure,oxygenation index ratio and arterial blood carbon dioxide partial pressure level in the observation group was (91.61±12.09),(367.34±43.39) and (34.46±5.75) mmHg (1 mmHg=0.133 kPa) respectively,which was significant different than those in the control group respectively,they were (83.33±11.21),(318.34±21.43) and (44.52±5.33) mmHg,P＜0.05.②Hemodynamic index:heart rate central venous pressure in the observation group after the treatment was (95.15±9.02) beats/min and (10.21±2.12) cmH2O (1 cmH2O=0.098 kPa) respectively,which was significant different than those in the control group respectively,they were (99.85±9.15) beats/min and (12.45±2.21) cmH2O,P ＜ 0.05.③Serum inflammatory cytokines:serum interleukin-6,monocyte chemotactic factor protein-1,tumor necrosis factor-α levels in the observation group were lower than those in the control group (118.08±15.32 vs 194.58±22.48) mg/L,(21.54±3.54 vs 39.33±5.43,0.61±0.02 vs 1.41±0.04) μg/L,P＜0.05.④Quantitative evaluation comparison:after treatment,observation group patients with mild was obviously higher than that of before treatment (47.50％ vs.20.00％),severe patients was lower than that before treatment (15.00％ vs 45.00％),x2=10.516,P＜ 0.01.⑤Adverse reactions:observation group adverse reactions was obviously lower than that of control group [7.5％(3/40) vs 25.0％(10/40)],x2=4.501,P ＜ 0.05.Conclusion Nursing intervention based on quantitative evaluation strategy is helpful to improve alveolar oxygenation function,stable hemodynamic indexes,relieve inflammation,reduce adverse reactions.

BACKGROUND:Aerobic exercise has an anti-atherosclerosis effect and some Chinese herbal components have some interventional effects on the atherosclerosis vulnerable plaque. OBJECTIVE:To observe the effects on lipid metabolism and adhesion molecules of atherosclerotic elderly rats after the interventions of Poria compound and aerobics exercise, and explore the mechanism and prevention of hyperlipidemia-induced atherosclerosis. METHODS:Forty Spraque-Dawley elderly rats, of specific pathogen free level, were randomly divided into four groups: control group, model group, medication group, and intervention group, with 10 rats in each group. Rats in the control group were normaly fed, while rats in the other groups were intraperitonealy injected with vitamin D3 and high-fat forage for 16 weeks, to establish atherosclerosis model. During the model establishment, rats in the medication and intervention groups were given 20 g/kg Poria compound and Poria compound + 1-hour swimming, respectively. RESULTS AND CONCLUSION:Compared with the control group, total cholesterol, serum triglyceride, low-density lipoprotein expression, intercelular cel adhesion molecule-1 and lymphocyte function association antigen-1 concentrations were increased in the model group. Compared with the model group, these indexes were obviously increased in the medication and intervention groups. The serum triglyceride and low-density lipoprotein expression in the intervention group were lower than those in the medication group, while the serum high-density lipoprotein expression was higher than the medication group. Experimental findings indicate that, the combined interventions of Poria compound and aerobics exercise is better than Poria compound alone, and multi-factor treatment of atherosclerosis should be taken to enhance the efficacy of colaborative approach.

BACKGROUND:Calcaneal fractures with subtalar arthritis were treated with bone graft fusion in the clinic, but previous big “L” approach could cause great trauma to patients, and was not conducive to the patient’s recovery. OBJECTIVE:To explore the repair effect of modified smal “L” approach in bone fusion Kirschner wire on calcaneal fractures with subtalar arthritis. METHODS: Clinical data of 23 patients with calcaneal fracture with subtalar arthritis in the First Hospital-Fengtai Hospital, Peking University from November 2012 to November 2013 were retrospectively analyzed. Al patients received modified bone graft fusionvia smal “L” approach. Repair effect was observed. American Orthopaedic Foot and Ankle Society scores and hind foot scores were evaluated before and after treatment. RESULTS AND CONCLUSION:Bone graft fusion was successfuly conducted in 23 patients. The operation time was 55-90 minutes, averagely (70±2.5) minutes. Al incision was healed wel after operation. Wound infection or flap necrosis did not occur. During folow-up, patients reached bone healing, and no talus osteonecrosis or bone absorption appeared. By the time of the last folow-up, AOFAS score of 23 patients was (85.6±3.7), which was significantly higher than (50.3±6.2) points before treatment (P < 0.05). These results suggest that modified bone graft fusion with smal “L” approach for calcaneal fracture with subtalar arthritis obtained good clinical effects.Moreover, the operation was simple and the complications were less. This method can effectively solve the insufficient exposure of inside of the subtalar joint via previous approaches and big processing difficulty.

Gray zone lymphoma (GZL) is a special type of B-cell lymphoma,it is rare in clinical and reported fewly.In order to strengthen the understanding of GZL and make it be more recognized by clinicians.This article reviewed the status and progress of GZL by cell morphology,immunohistochemistry,cytogenetics and molecular biology,and discuss the current diagnostic criteria and treatment strategies.

Objective] To sum up director doctor Sheng Yuanliang ’s experience in treating severe hepatitis. [Method] Through analyzing the treating rules,causa morbi and mechanism of severe hepatitis,it sums up the key points of data of severe hepatitis,with 1 case for detailed explanation. [Result] The reason of the disease is mainly“damp,heat and toxin evils”,with corresponding therapies of removing heat to promote dieresis ,removing toxin and stasis. [Conclusion] The famous TCM doctor Shen Yuangliang’s applying clearing heat to promote dieresis,removing stasis and toxin to treat severe hepatitis,gets good clinical effect,having enlightenment meaning to clinical practice,with promotion value.

Objective To analyze the effect of tiotropium bromide on pulmonary function and airway remodeling in elder chronic obstructive pulmonary disease (COPD) stabilization patients.Methods Ninety-two elder patients diagnosed as COPD stabilization were divided into treatment group (50 patients) and control group (42 patients) by random digits table method.The patients in two groups were given basic treatment such as antimicrobial therapy,spasmolysis,antiasthma,expelling phlegm,and the patients in treatment group were given tiotropium bromide every day for 12 months besides the basic treatment.Meanwhile,40 healthy persons whose ages matched with those of COPD stabilization patients were as healthy control group.High resolution computerized tomography (HRCT) was employed to measure the parameters such as the airway wall thickness,the outer and inner diameter of the airway,airway wall area to assessed the airway remodeling before and after treatment in order to evaluate the drug etficacy.Meanwhile,the lung function,the inflammatory cytokines [interleukin (IL)-8,tumor necrosis factor (TNF)-α] in blood plasma and T lymphocyte subsets were also determined.Results The index of lung function in treatment group was significantly better than that before treatment and control group,and there was significant difference (P ＜ 0.05).The airway wall thickness in treatment group had no significant difference before and after treatment (P ＞0.05),and other index of airway remodeling was significantly improved compared with that before treatment (P ＜ 0.05).After treatment,the distance of 6 min walk test in treatment group was significantly longer than that in control group,and there was significant difference (P ＜ 0.05).The level of serum IL-8 and TNF-αt before treatment had no significant difference between two groups (P ＞0.05),and decreased significantly after treatment and the improvement was more pronounced in treatment group compared with that in control group (P ＜ 0.05).Compared with that in healthy control group,the level of CD3+,CD4+,CD4+/CD8+ was significantly lower and the level of CD8+ was significantly higher before treatment in treatment group and control group (P ＜ 0.05).After treatment,the level of CD3+,CD4+,CD4+/CD8+ was significantly increased and the level of CD8+ was significantly decreased (P ＜ 0.05),and the improvement was more pronounced in treatment group compared with that in control group (P ＜ 0.05).Conclusion Tiotropium bromide can improve airway remodeling and lung function in elder COPD stabilization patients.

OBJECTIVE To analyze and summarize the clinical features and distribution of antibiotic susceptibility of Stenotrophomonas maltophilia pneumonia.METHODS We statistically analyzed the clinical data of thirty-one cases of S.maltophilia pneumonia,and determined drug susceptibility of this bacteriaum,using K-B methods.RESULTS Twenty-six out of 31(83.87%) cases were old age patients.All Patients were with underlying diseases,while 17(54.84%)cases had chronic obstructive pulmonary disease history and 15(43.39%) cases were with immunodeficiency.Out-of hospital infection and nosocomial infection were 10(32.26%) cases and 21(67.74%),respectively.The clinical symptoms were mainly cough and expectoration(100.00%),17(54.84%) cases had fever,and 24 cases(77.42%) had dyspnea.Chest X-ray showed different-degree shadow on lungs.Besides compound sulfamethoxazole,ciprofloxacin,minocycline and amikacin were susceptive(71.41-45.00%),the drug susceptibility test showed,that the microbe was resistant to lots of antibiotics(28.57-100.00%).CONCLUSIONS The risk factors of S.maltophilia pneumonia are ageing,underlying diseases and immunodeficiency.Early choosing susceptive antibiotics and drug sensitivity test would improve the prognosis.