Objective To study and compare the effect of different ventilation modes in chronic obstructive pulmonary diseases (COPD) combined with respiratory failure. Methods Fifty patients with COPD combined with respiratory failure were divided into group A and group B with 25 cases each by random digits table,and they were treated with invasive positive pressure ventilation. Then the two groups were respectively treated with synchronized intermittent mandutory ventilation (SIMV) + pressure suppert ventilation (PSV) and PSV + positive end-expiratory pressure (PEEP) after appearing the pulmonaryinfection-control- window. And the time of mechanical ventilation, length of hospital stay, reintubation rate, complication rate and serum interleukin (IL)-8,high Sensitiveity c-reactive protein (hs-CRP), IL-4 and interferon (IFN)- γ of the two groups before and after the treatment was analyzed and compared. Results The time of mechanical ventilation and length of hospital stay in group B was shorter than that in group A [(11.8 ± 2.3), (16.8 ± 3.2) d vs. (20.3 ± 2.0), (28.8 ± 4.1) d], and the reintubation rate and complication rate was lower than that in group A [8%(2/25), 8%(2/25) vs. 24%(6/25), 24%(6/25)]. The levels of serum IL-8, hs-CRP, IL-4 and IFN- 7 were lower in group B than those in group A (P ＜ 0.05). Conclusion The effect of nasal mask inhaled oxygen early given to COPD combined with respiratory failure is better, and it should be paid attention to.

Objective To investigate the diagnostic value of 16 ku-38 ku-ESAT-6 protein in tuberculosis (TB). Methods ELISA was used for measuring the level of recombinant 16 ku-38 ku-ESAT-6 protein in 105 TB patients (TB group,26 patients with smear-positive, 79 patients with smear-negative) and 45 controls (control group, 20 healthy volunteers and 25 subjects with pulmonary diseases other than TB). The value of the antigen for diagnosis of TB in serodiagnosis was assessed, and ROC curve evaluation system was established. Results In control group, the positive rate of anti-recombinant 16 ku-38 ku-ESAT-6 protein and commercialization of TB antibody test kit had significant difference [6.67% (3/45) vs. 51.11% (23/45)](P＜0.01);but in TB group, there was no significant difference [59.05%(62/105) vs. 64.76% (68/105)](P＞0.05). The optical density value in TB group and control group was 2.22 ± 0.58 and 1.35 ± 0.24,and there was significant difference(t = 6.06,P＜ 0.01). The sensitivity, specificity, positive predictive value and negative predictive value of the test was 59.05%,93.33%,95.38%,49.41% respectively. Analyzed by ROC curve, the area under the curve was 0.751, the- value of cutoff was 2.52, and sensitivity and specificity was 65.4% and 84.8%. Conclusions Recombinant 16 ku -38 ku -ESAT-6 protein of mycobacterium tuberculosis has higher specificity, and it can significantly distinguish TB and non-TB. So it might be selected as one of diagnosis antigens of TB.

Objective To investigate the effects of short term insulin pump intensive therapy on flow-mediated dilation (FMD) in type 2 diabetes mellitus (T2DM) patients with and without vascular complications. Methods Seventy-six patients with T2DM (T2DM group) were divided into 2 subgroups: T2DM1 subgroup (28 patients with vascular complications) and T2DM2 subgroup (48 patients without vascular complications). Meanwhile, 30 healthy cases were selected as NC group. All research subjects accepted high-frequency ultrasound detection on brachial artery for FMD. After insulin pump intensive therapy,FMD in T2DM group was reexamined, fasting insulin was detected and HOMA-IR was calculated. Results Compared with that in NC group, FMD in T2DM group was significantly lower(P＜ 0.01). However, glycosylated hemoglobin (HbA1c ), fasting plasma glucose (FPG ),H0MA-IR and blood fat were significantly higher (P＜0.01 or ＜0.05). Correlation analysis showed that FMD had negative correlation with HbA1c, FPG, HOMA-IR, triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C)(P＜0.01),and had positive correlation with high-density lipoprotein cholesterol (HDL-C). After 2 weeks of insulin pump therapy, the improvement of FMD between the two groups was different. FMD in T2DM1 subgroup increased from (4.25 ± 1.96)% to (4.96 ± 1.36)%(P＞0.05), and FMD in T2DM2 subgroup increased from (4.02 ± 2.35)% to (7.56 ± 2.34)%(P＜ 0.01). Conclusion Insulin pump intensive therapy can evidently improve FMD in T2DM patients without vascular complications.

Objective To observe the change of oxidalive stress indexes in the patients with diabetic perineuropathy (DPN), and investigate the protection role of glutathione (GSH) on neuroprotective effect. Methods The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) and sensory nerve conduction velocity (SCV) were detected in 54 cases with DPN (DPN group) and 30 cases of health examination (control group). Fifty-four cases with DPN were divided into GSH group (given basic treatment and GSH 1.8 g/d) and CON group(given basic treatment and B vitamin) with 27 cases each by random-digits table. After treatment of 2 weeks, the levels of SOD, MDA and SCV were compared. Results The levels of MDA in DPN group were significantly higher than those in control group, while the activity of SOD was significantly lower than that in control group [(7.23 ±2.31) μmol/L vs. (4.87 ± 1.17) μmol/L, (59.72 ± 13.58) kU/L vs. (76.19 ± 7.55 ) kU/L](P＜ 0.01). After treatment, the level of MDA was decreased and the activity of SOD was increased in GSH group and CON group (P ＜0.05),but there was no significant difference between the two groups(P＞ 0.05). After treatment, the level of SCV was significantly increased in GSH group,while there was no significant difference in CON group (P ＞0.05). Conclusions Oxidative stress exists in DPN patients. The antioxidant treatment with GSH can improve impaired nerve and has a better effect of nerve protection than classical nerve nutrition therapy.

Objective To investigate the clinical significance of the expression of microvessel density and adhesion molecules in the tissue of chronic gastritis and gastric cancer. Methods Fifty-six patients with chronic superficial gastritis (chronic superficial gastritis group), 55 cases of gastric cancer without lymph node metastasis (gastric cancer without lymph node metastasis group) and 57 patients with gastric cancer and lymph node metastasis (gastric cancer with lymph node metastasis group) were included in this study. Gastric pathology paraffin blocks was studied using immunohistochemical Envision method. Microvessel density CD34 and cell adhesion molecule Syndecan-1 expression was examined. In 112 gastric cancer patients, 47 patients were highly differentiated, and 65 patients were poorly differentiated. Results Microvessel density CD34 results:in chronic superficial gastritis group was (13 ± 10)/HP,in gastric cancer without lymph node metastasis group was (27 ± 11 VHP, in gastric cancer with lymph node metastasis group was (28 ± 10)/HP. There were significant differences between chronic superficial gastritis group and gastric cancer without lymph node metastasis group,and between chronic superficial gastritis group and gastric cancer with lymph node metastasis group (t = 7.044,7.908, P ＜0.05), but there was no significant difference between gastric cancer without lymph node metastasis group and gastric cancer with lymph node metastasis group (t = 0.506,P ＞ 0.05). In chronic superficial gastritis group, gastric cancer without lymph node metastasis group and gastric cancer with lymph node metastasis group, Syndecan-1 positive expression ratewas 96.43%(54/56),45.45%(25/55),24.56%(14/57),and there was significant difference between chronic superficial gastritis group and gastric cancer without lymph node metastasis group,and between chronic superficial gastritis group and gastric cancer with lymph node metastasis group (x2 = 163.560,17.197,P＜ 0.01). There was significant difference between gastric cancer without lymph node metastasis group and gastric cancer with lymph node metastasis group (x2 = 5.340, P ＜ 0.05). Conclusions Microvessel density is related with the occurrence of gastric cancer;adhesion molecule Syndecan-1 expression reduces the incidence of gastric cancer development, and might further promote the metastasis of gastric cancer. Detecting the expression changes of microvessel density CD34 and cell adhesion molecule Syndecan-1 facilitates the diagnosis and prognosis of gastric cancer.

Objective To investigate clinical characteristics of patients with ST-elevation myocardial infarction (STEMI) and hypokalemia and the effects of hypokalemia on prognosis. Methods Consecutive 216 cases with STEMI who underwent emergency PCI were divided into group A (serum potassium ＜ 3.5 mmol/L) and group B (serum potassium＞3.5 mmol/L). Infarct site, infarct interrelated artery, peak level of CK-MB and cTnT were compared between two groups. Post-infarctional angina pectoris, arrhythmia, heart failure and cardiac death were compared. Results (1 )The percentage of anterior wall myocardial infarction , left anterior descending artery (LAD) lesions in group A were significantly higher than those in group B [61.2%(41/67) vs. 44.3%(66/149),55.2%(37/67)vs. 38.9%(58/149),P = 0.022,0.026]. The peak levels of CK-MB and cTnT in group A were significantly higher than those in group B [(194.39 ± 101.27) μg/L vs. (115.35 ±78.62)μg/L,(19.16 ±11.48)μg/L vs. (9.07 ±7.65) μg/L,P = 0.004,0.002].(2)Left ventricular ejection fraction in group A was significant lower than that in group B (P - 0.003). The incidence rates of post-infarctional angina pectoris, ventricular tachycardia, ventricular fibrillation and heart failure were significantly higher in group A [43.3%(29/67),32.8%(22/67), 11.9%(8/67),37.3%(25/67)] than those in group B [24.8%(37/149),18.1%(27/149),4.0%(6/149),20.8%(31/149)](P = 0.006, 0.017, 0.029, 0.010). Conclusions Hypokalemia is associated with infarct site and infarct interrelated artery. Hypokalemia has bad effect on prognosis of STEMI.

Objective To explore the efficacy and safety of the bronchoscopic high frequency electrocoagulation combined with balloon dilatation in treating tuberculosis inflammatory airway constriction. Methods According to the different methods of treatment, 55 patients with tuberculosis airway constriction were randomly divided into two groups, the balloon dilatation group (26 cases) and combination group (29 cases). The patients in balloon dilatation group underwent bronchoscopic balloon dilatation and the patients in combination group underwent bronchoscopic balloon dilatation combined with high frequency electrocoagulation. The patients of the two groups accepted endoscopic therapy once a week. Effective rate of recanalization for the narrow airway, frequency of effective treatment and the time of tuberculosis bacterium vanishing was recorded. Intraoperative and postoperative complications were also observed. Three months after the treatment, all patients accepted bronchoscopic to observe and assess the airway restenosis rate. Results After treatment, the effective rate in balloon dilatation group and combination group had no significant difference[69.2%(18/26) vs. 89.7% (26/29 )](P＞ 0.05 ),but frequency of effective treatment and time of tuberculosis bacterium vanishing had significant difference[(3.5 ±1.3) times vs. (1.5 ± 1.1) times, (23.3 ±3.6) d vs.(13.2 ±2.3) d](P<0.01). There was no significant difference on the intraoperative and postoperative complications between two groups (P＞0.05). The airway restenosis rate was 33.3%(6/18) in balloon dilatation group and 7.7%(2/26) in combination group after treatment for 3 months (P ＜0.05). Conclusions Combination of bronchoscopic balloon dilatation and high frequency electrocoagulation is an efficacy and safety way for the tuberculosis inflammatory airway stenosis. It can reduce the frequency of interventional therapy, shorten the time of tuberculosis bacterium vanishing, and may also decrease the airway restenosis rate.

Objective To evaluate the clinical significance of quantitative sensory testing (QST) in screening diabetic peripheral neuropathy of the early stage. Methods One hundred patients with type 2 diabetes mellitus were examined by nerve conduction velocity (NCV) and QST examination. With the NCV positive as the gold criterion for screening diabetic peripheral neuropathy of the early stage, the sensitivity and specificity of QST was further analyzed for diagnosis of the early stage diabetic peripheral neuropathy. Results Among the 100 patients with type 2 diabetes mellitus,there were 41 cases positive and 59 cases negative in NCV examination. On the other hand,there were 74 cases positive,and 26 cases negative in QST. The sensitivity and specificity of QST for the diagnosis of early stage diabetic peripheral neuropathy was 97.56% (40/41) and 42.37% (25/59). Conclusions In the screening of early stage diabetic peripheral neuropathy,QST shows higher detection sensitivity,but lower specificity than NCV examination. Therefore, QST may be an examination for the supplement of the routine electromyography.

Objective To investigate the risk factors of short-term prognosis in patients with viral encephalitis. Methods Clinical data of 124 patients with viral encephalitis were analyzed retrospectively. All patients were divided into good prognosis group and poor prognosis group according to the Glasgow outcome scale. Fourteen related risk factors were chosen and multifactor Logistic regression analysis was made. Results Univariate analysis showed, the duration of seizure, consciousness disorder, deficiency of cranial nerves, severe abnormal electroencephalogram and abnormal cranial MRI had significant correlation with short-term prognosis (P＜0.05), but age, sex,behavior disorder, meningeal irritation sign, pressure of cerebrospinal fluid (CSF), leukocyte number of CSF, protein level of CSF, peripheral white blood cell, and abnormal cranial CT had no correlation with short-term prognosis (P ＞0.05). Multivariate analysis showed that the abnormal of cranial MRI and the duration of seizure were the independent risk factors of short-term prognosis. Conclusions The short-term prognosis of viral encephalitis relates with many factors. The abnormal cranial MRI and the duration of seizure are the important related risk factors.

Objective To investigate the hospital mortality of rheumatic heart disease (RHD)and major cause of death. Methods One hundred and thirty patients with RHD prepared to take valve replacement from January 2006 to November 2009 were involved in this study. They were divided into two groups according to all clinical data: death group (10 cases ) and survival group (120 cases ). The clinical data and complications were collected, and the hospital mortality and their causes were analyzed with Logistic regression analysis. Results Univariate analysis: total bilirubin and indirect bilirubin levels in death group [(30.31 ± 19.10), (22.38 ± 17.34) μmol/L] were significantly higher than those in survival group [(19.47 ± 8.61),(12.92 ± 7.30) μmol/L] (P ＜ 0.01). The incidence of postoperative complications,history of cerebral infarction and cardiovascular complications in death group were significantly higher than those in survival group (P ＜0.01). The Logistic regression analysis showed that the postoperative complications was an independent risk factor for hospital mortality (P =0.002). Conclusions RHD with postoperative complications is identified as an independent predictor of hospital mortality. It is very important to enhance the treatment and care during hospitalization.