Cognitive dysfunction is one of the complications of chronic obstructive pulmonary disease(COPD),often affecting the patient's daily life ability and reducing the quality of life.COPD associated cognitive dysfunction includes five areas of primary cognitive domain of awareness,attention,learning and memory ability,execution ability and language skills.The decreased cognitive dysfunction may be correlated with the age,education background,smoking,malnutrition,as well as hypoxemia,hypercapnemia,COPD duration and length of hospitalization stay,inflammatory and other factors.Early screening and assessment of COPD cognitive dysfunction,long-term oxygen therapy and other measures for interfering risk factors and improving the quality of life of patients have a positive significance.

Objective To investigate the clinical value of strain ratio in differential diagnosis of thyroid tumors,compared with the evaluation based on elastography scores.Methods Elastography examinations were performed in 67 patients with 92 thyroid tumors.Ultrasonic elastograms were evaluated according to the four- and five-score system respectively.Strain ratio of the tumor and the surrounding tissue was also calculated.Clinical value of the three evaluations was compared with pathological findings as the reference standard.Results The area under the curve:0.885 for the four-score,0.904 for the five-score,0.961 for the strain ratio.When a cutoff point of 3 was used,four-score and five-score showed a sensitivity of 78.0%,a specificity of 86.3%,an accuracy of 82.6% and a sensitivity of 80.5%,a specificity of 88.2%,an accuracy of 84.8%,respectively.When a cutoff point of 3.57 was introduced,the strain ratio had 92.7% sensitivity,92.2% specificity,92.4% accuracy.Conclusions Strain ratio was more helpful in diagnostic performance of thyroid tumors as a new semi-quantitative method than elastography scores.

OBJECTIVE:To observe clinical efficacy and safety of individual antiviral therapy of tenofovir combined with inter-feron α1b for chronic hepatitis B (CHB). METHODS:96 CHB patients were randomly divided into control group,observation group A and observation group B,with 32 cases in each group. Control group was given entecavir orally,0.5 mg,qd;observation group A was given tenofovir orally,1 piece,qd;observation group B was additionally given interferon α1b,50 μg,3 times a week,on the basis of observation group A. The treatment course lasted for 48 weeks in 3 groups. Clinical efficacy of 3 groups was compared,and the changes of serum liver function indexes,HBV-DNA negative conversion rate and the occurrence of ADR were compared before and after treatment. RESULTS:The total effective rate of observation group B(84.38%)was significantly higher than that of observation group A(62.60%)and control group(37.50%),and that of observation group A was significantly higher than control group,with statistical significance (P<0.05). Compared with before treatment,the serum levels of AST,ALT and TBIL were significantly decreased after treatment in 3 groups;the observation group B were significantly lower than those of obser-vation group A and control group,with statistical significance(P<0.05);there was no statistical significance between observation group A and control group(P>0.05). The negative rate of HBV-DNA in observation group B were significantly higher than those in control group and observation group A after 12 and 24 weeks of treatment,with statistical significance(P<0.05);there was no statistical significance between observation group A and control group (P>0.05). No obvious ADR was found in 3 groups. CON-CLUSIONS:Tenofovir combined with interferon α1b shows significant clinical efficacy for CHB,and is significantly better than that of entecavir and tenofovir alone.

Objective To investigate the afflication of non-humidified low flow nasal oxygen inhalation in the ICU patients. Methods Four hundred patients hospitalized in ICU and needing continuous low-flow oxygen inhalation for more than 24 h were randomly divided into experiment group and control group equally.The experiment group were managed with dried humidification bottle oxygen inhalation and the control group conventional humidified bottle oxygen inhalation.The two groups were compared in terms of 24 h respiratory reactions,bacterial contamination of the humidified bottle,complaints of patients about oxygen inhalation noises and time for nurses to change the humidified bottles.Results The two groups had no significant difference in adverse symptoms(all P>0.05).The rate of bacterial contamination in the experimental group was significantly lower than the control group(P<0.05),the noises were lower and the time for changing the bottle shorter(P<0.05).Conclusion Non-humidified low flow nasal oxygen inhalation in ICU patients is good for reducing the rate of bacterial contamination of humidified bottle and lowering workload and oxygen-inhaling noises.

Objective To summarize the characters of the elastograms of different pathological nodules, and to observe the value of elastography in differentiating benign from malignant thyroid solid nodules. Methods One hundred and sixteen patients with thyroid nodules were enrolled in the study and 122 nodules were detected in total. All of them were examined by elastography and conventional ultrasound. Five sonographers were invited to evaluate the nodules double blinded basing on the images and the four-point system proposed by Fukunari. The interobserver agreement was evaluated by Kappa coefficient. Diagnostic performances of the five readers were compared by the ROC curves. Distributions of elastography scores of different pathological nodules were compared by one-way ANOVA. Results Interobserver agreements on scoring the nodules were moderate. Mean value of benign nodules was obvious lower than that of the malignant ones. The mean score of nodular goiters was 2.67 ± 0.89, range from 1 to 3. Most of the adenomas got score of 2, but the score of thyroiditis was quite high. No significant differences were found between the comparison of thyroiditis and thyroid cancers. Areas under the ROC curve (AUC) of the five readers were 0.82,0.81,0.79,0.73 and 0.83 respectively. When 3.5 was choosen as the cut-off point, the sensitivity of elastography was 82.4%, and specificity was 71.6%. Conclusions Elastography was really a useful technique for it can provide a new index for the differential diagnosis of thyroid nodules. However, the 4-point score system is not comprehensive enough.

Objective To explore the mechanism and inhibition of botulinum toxin type A (BTXA) on hypertrohic scar fibroblasts.Methods The cells were treated by 0 (control),0.2,0.4,0.8 U/ml BTXA for 48 h.Cell viability was detected by MTT assay.Cell apoptosis was detected by Hoechst staining.Cell cycle was detected by flow cytometry.The level of cell cycle related protein D1 (Cyclin D1),proliferation nuclear antigen (PCNA) and activation of phosphatidylinositol 3 kinase (PI3K) / protein kinase B (AKT) signaling pathway were assayed by western blot.Results Compared with control group(0.75±0.07),0.2,0.4,0.8 U/mL BTXA(0.59 ± 0.06,0.43 ± 0.04,0.34± 0.03) inhibited hypertrohic scar fibroblasts cell viability,increased cell apoptotic rate[control group(2.38±0.24)％;BTXA(15.79±1.54)％,(27.32±2.69)％,(38.46±3.90)％],down-regulated the expression of Cyclin D1(control group 1.57±0.18;BTXA 0.93±0.07,0.42±0.04,0.35±0.03) and PCNA(control group 1.46±0.16;BTXA 0.50±0.05,0.59±0.05,0.37±0.03),inhibited the expression of PI3K(control group 0.98±0.06;BTXA 0.49±0.04,0.50±0.04,0.39±0.03) and the phosphorylation of AKT(control group 1.38±0.08;BTXA 0.97±0.06,0.60±0.04,0.29± 0.02),made cell cycle arrested in G1 phase,The difference was statistically significant (P＜0.05).Conclusion These results suggested BTXA inhibit proliferation via blocking the activation of PI3K/AKT signal pathway and down-stream related cell cycle related protein.

Objective To study the feasibility and characteristic findings of contrast-enhancedultrasound(CEUS)on peripheral pulmonary tumors.Methods Twenty patients with peripheral pulmonarytumors proven by pathology were studied.They were divided into two groups:primary pulmonary tumors (n=15),and metastatic pulmonary tumors(n=5). The dynamic enhancement images were stored and Strip enhancement was dominant in the primary pulmonary tumors,while dot enhancement was dominant in ascended quickly and descended slowly,while ascended slowly and descended slowly in majority of metastaticThe modes of enhancement and time-intensity curves were all different in primary and metastatic pulmonary tumors.Contrast-enhanced uhrasound is promising in the diagnosis of peripheral pulmonary tumors.

Objective To explore the clinical risk factors of ventilator-associated fungal pneumonia (VAFP) in emergency intensive care unit.Methods One hundred and ninety-seven consecutive patients with 121 males and 76 females,aged from 17 to 98 years met the criteria of ventilator-associated pneumonia in emergency intensive care unit admitted from July 2009 to June 2014,were retrospectively evaluated.Those with mechanical ventilation less than 48 hours or treatment discontinued were excluded.Patients were divided into VAFP group and ventilator-associated non-fungal pneumonia group according to the results of fungal culture and microscopy.Univariate analysis was used to find out preliminary risk factors for VAFP,and then the ultimate independent risk factors were determined with multivariate stepwise logistic regression analysis.Results The occurrence of VAFP was 32.0 ％ (63 cases) out of 197 patients with ventilatorassociated pneumonia.In those 63 patients,there were 71 species found from fungus culture.Candida albicans counted for 33 (46.5％),Candida glabrata for 11 (15.5％),other Candida Albicans for 26 (36.6％).The preliminary univariate analysis showed that 19 factors were statistically significant,while multivariate stepwise logistic regression analysis revealed that acute physiology and chronic health evaluation Ⅱ score≥ 22,radiotherapy or chemotherapy,mechanical ventilation ≥14.11 days,use of antibiotics ≥14 days,use of glucocorticoid and other immuno-suppressants were independent predictors of VAFP,and the adjusted odds ratios with 95％ confidential intervals were 4.133 (2.831-6.033),2.977 (1.942-4.564),2.305 (1.439-3.736),1.988 (1.441-2.741),1.528 (1.337-1.746),respectively.Conclusion Higher APACHE Ⅱ score,radiotherapy or chemotherapy,prolonged use of mechanical ventilation,prolonged use of antibiotics,use of glucocorticoid and immunosuppressants are independent risk factors of VAFP.The incidence rate of VAFP may be reduced by improving patients' overall clinical setting,shortening the duration of mechanical ventilation and employment of antibiotics,and more strict guidelines to the application of glucocorticoid and immunosuppressants.

Objective To study etiology screening role of transrectal ultrasonography in male obstructive azoospermia infertility.Methods The clinical data of 328 cases who suspected of being obstructed sperm disease were retrospectively analyzed.TRUS detection was conducted,at the same time,the sperm amount,sperm and semen pH,pure berries quantitative,neutral sugar alpha glycosidase enzymes quantitative,elastic hard protease were tested.Results In 328 cases with male obstructed no sperm,by TRUS detection results,216 cases (65.8％) could find the causes,ejaculatory duct expansion,seminal vesicle gland lesions,prostate midline cyst were the top three causes respectively;112 patients(34.2％) had no obvious abnormal ultrasonic testing.Sperm was not seen in semen of obstructive azoospermia patients and semen pH ＜ 7,pure berries sugar quantitative and quantitative value neutral alpha glycosidase enzymes were very low,hard elastic protease was low.Conclusion The main causes of obstructive azoospermia were ejaculatory duct expansion,seminal vesicle gland lesions,prostate midline cyst,sperm TRUS detection used for diagnosis of high sensitivity,and easy to operate,noninvasive,and combined with seminal plasma biochemical examination,the diagnostic effect is much better.

Ribavirin is a broad-spectrum antiviral agent and glycyrrhizin has activities of anti-inflammation, immunoregulation and anti-viral infections. To enhance antiviral efficacy and weaken side-effects of ribavirin, antiviral effects of the combination of glycyrrhizin and ribavirin were studied in the present study. Firstly, a mouse model of viral pneumonia was established by inoculation of influenza H1N1 virus. Protective effects of glycyrrhizin and ribavirin used alone or in combination against H1N1 virus infection in mice were evaluated based on the survival rate, lung index and virus titer in lungs of mice. Results showed that the combination of glycyrrhizin and ribavirin significantly inhibited the lung consolidation with a 36% inhibition ratio on the lung swell of infected mice. The combination of the two drugs exhibited synergetic effects on survival of infected mice. The combination of 50 mg · kg(-1) · d(-1) glycyrrhizin and 40 mg · kg(-1) · d(-1) ribavirin resulted a 100% protection for infected mice with a synergetic value of 36, which was significantly higher than the control group and each drug alone. This combination also resulted a significant drop of lung virus titer (P < 0.01), as well as inhibition on the production of proinflammatory cytokines IL-6 (P < 0.01), TNF-α (P < 0.01) and IL-1β (P < 0.05) induced by virus infection compared to the control. The treatment of ribavirin plus glycyrrhizin was more effective in influenza A infection in mice than either compound used alone, which suggested a potential clinical value of the combination of the two agents.