OBJECTIVE:To observe the clinical effect of tiotropium bromide combined with salmeterol xinafoate and fluticasone propionate in the treatment of medium and severe COPD. METHODS:119 patients with medium and severe COPD were divided into control group(54 cases)and observation group(65 cases)according to admission order. Control group was treated with Salmeterol xi-nafoate and fluticasone propionate powder for inhalation 50 μg,bid;observation group was additionally given Tiotropium bromide powder for inhalation 18μg,qn. Both groups received 1 month of treatment. Lung function indexes as FEV1,FVC and IC,blood gas indexes as SaO2,PaCO2 and PaO2 and inflammatory factors as IL-8 and TNF-α,COPD assessment test(CAT)score were observed in 2 groups,and the occurrence of ADR was also observed. RESULTS:Before treatment,there was no statistical significance in above indexes between 2 groups(P>0.05). After treatment,FEV1,EVC,IC of observation group were increased significantly,SaO2 and PaO2 of observation group were increased significantly,while PaCO2,IL-8 and TNF-αlevels was decreased significantly;those index-es of observation group were significantly better than those of control group,with statistical significance(P<0.05). CAT score of 2 groups were decreased significantly compared to before treatment,and the observation group was significantly lower than control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Tiotropium bromide com-bined with salmeterol xinafoate and fluticasone propionate shows good clinical efficacy and safety in the treatment of medium and se-vere COPD.

Objective To study the oxygenation of the pulmonary surfactant replacement therapy for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in neonates.Methods Ninetyeight eligible neonates with ALI and ARDS were divided into two groups,treatment group (n =30) and control group(n =68).Thirty infants in treatment group were injected with pulmonary surfactant 70 ～ 100 mg/kg via tracheal intubation.The rest of the treatment measures were same in treatment and control group.Results There were no differences between the two groups in gender,gestational age,birth weight and ALI/ARDS.After the pulmonary surfactant replacement therapy for ALl and ARDS,the PaO2/FiO2 and ventilator efficiency index were higher in treatment group than that in control group at 6 h,12 h,24 h,48 h;the oxygenation index and respiratory index were shorter in treatment group than that in control group at the same time.The differences at all time points were statistically significant (P ＜ 0.05).The treatment group also had a significantly shorter duration of assisted ventilation[(66 ± 13) h vs (80 ± 18) h,(82 ±26) h vs (101 ±36) h] and oxygen treatment time [(86±13) h vs (104± 16) h,(103 ±25) h vs (125 ±29) h] (P ＜0.05).Conclusion The application of the pulmonary surfactant replacement treatment in neonates with ALI and ARDS could improve rapidly in dynamic compliance and oxygenation,decrease duration of assisted ventilation and supplemental oxygen administration,thus yield better prognosis.

Objective To study the effect of early pulmonary surfactant (PS) treatment on oxygenation in neonates with acute respiratory distress syndrome (ARDS). Methods Clinical data of neonates with ARDS were retrospectively analyzed. All neonates with ARDS were divided into control group and treatment group. Neonates in treatment group were given PS at a dose of 70-100 mg/kg through the endotracheal tube. Results Among 64 neonates with ARDS, 18 neonates in treatment group were treated with PS, while other interventions were same with 46 neonates in control group. The PaO2/FiO2 and ventilation efifciency index were statistically higher in treatment group than those in control group at 6 h, 12 h, 24 h and 48 h (P<0.05). The oxygenation index and respiratory index were statistically lower in treatment group than those in control group at the same time points (P<0.05). Compared with control group, the treatment group also had a signiifcantly shorter duration of assisted ventilation and oxygen treatment (P<0.05). Conclusions Early treatment with PS in neonates with ARDS could improve the pulmonary compliance and oxygenation, and reduce the duration of assisted ventilation and oxygen treatment, and thus yield better prognosis.

Objective:To explore the efficacy of nimodipine combined with ganglioside in the treatment of cerebral hemorrhage and its effect on the expression of serum resistin and oxidized low-density lipoprotein (ox-LDL).Methods:According to the random number table method, 100 patients with cerebral hemorrhage admitted in Central Hospital of Zibo from February 2018 to February 2020 were divided into the single treatment group and the combined treatment group, with 50 cases in each group. In addition to conventional treatment, the single treatment group was additionally treated with nimodipine, and the combined group was additionally treated with nimodipine combined with ganglioside. After 2 weeks of intervention, the efficacy of the two groups was evaluated, and the National Institutes of Health Stroke Scale (NIHSS) scores, Ability of Daily Living (ADL) scores, serum inflammatory factors, resistin and ox-LDL levels were evaluated and recorded between the two groups before and after treatment.Results:The total effective rate of treatment in the combined treatment group was higher than that in the single treatment group: 90.0%(45/50) vs. 74.0%(37/50), and the difference was statistically difference ( P<0.05). After 2 weeks′ treatment, the scores of NIHSS was decreased and the scores of ADL was increased in two groups, and the scores of NIHSS in combined treatment group was lower than that in the single treatment group: (9.41 ± 1.27) scores vs. (12.10 ± 1.65) scores; the scores of ADL in the combined treatment group was higher than that in the single treatment group: (67.82 ± 9.04) scores vs. (59.10 ± 8.75) scores, and the differences were statistically differences ( P<0.05). After 2 weeks′ treatment, the levels of serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), resistin and ox-LDL in the two groups were decreased, and the levels of above index in the combined treatment group were lower than those in the single treatment group: (4.81 ± 1.03) mg/L vs. (6.10 ± 1.73) mg/L, (40.96 ± 9.21) μg/L vs. (56.74 ± 8.93) μg/L, (33.20 ± 7.96) μg/L vs. (44.76 ± 8.43) μg/L, (0.29 ± 0.09) μg/L vs. (0.45 ± 0.13) μg/L, (336.25 ± 69.74) mg/L vs. (372.18 ± 68.52) mg/L, and the differences were statistically differences ( P<0.05). There was no significant difference in adverse reactions between the two groups ( P<0.05). Conclusions:Nimodipine combined with ganglioside has a clear efficacy in the treatment of cerebral hemorrhage. It can effectively inhibit inflammation indicators, reduce serum resistin and ox-LDL levels, promote the recovery of nerve defects, and improve their living ability.

Objective:To determine the inflammatory factor levels and inflammatory cell percentages in the patients with cough variant asthma (CVA ), and to clarify their potential role in the pathogenesis of CVA unresponsive to bronchodilator treatment.Methods:60 patients with CVA were randomly selected and divided into CVA unresponsive to bronchodilator treatment group (n=30)and CVA responsive to bronchodilator treatment group (n=30).As the same time 30 cases of healthy persons were used as normal control group.The levels of interluekin-8 (IL-8)and esoinophil cationic protein (ECP)in their induced sputum were detected,the classification of inflammatory cells in their induced sputum were observed, and their scores of cough symptom were recorded. Results:The IL-8 level in the induced sputum of the patients in CVA unresponsive to bronchodilator treatment group was higher than that in CVA responsive to bronchodilator treatment group and normal control group (P<0.05).The ECP level in the induced sputum of the patients in CVA unresponsive to bronchodilator treatment group was lower than that in CVA responsive to bronchodilator treatment group (P<0.05),but it was similar to the level in normal control group (P>0.05).The neutrophil percentages in the induced sputum of the patients in CVA unresponsive to bronchodilator treatment group were higher than those in CVA responsive to bronchodilator treatment group and normal control group (P<0.05).The scores of cough symptom of the patients in CVA unresponsive to bronchodilator treatment group was positively correlated with IL-8 level (r=0.764,P<0.01), and the scores of cough symptom of the patients in CVA unresponsive to bronchodilator treatment group was positively correlated with the neutrophil percentage in induced sputum (r=0.889,P<0.01).Conclusion:IL-8 and neutrophil may be associated with the incidence of CVA unresponsive to bronchodilator treatment. They can aggravate the inflammation and hypersensitivity of airway and cough symptom. The determination of IL-8 and neutrophil can be used as an accessory method in the diagnosis and j udgement of severity degree and curative effect of CVA in clinic.

Objective To study the apo-E gene polymorphisms and the lipoprotein level character of different gene expression in patients with cerebrovascular infarction(CI) and intracerebral hemorrhage(ICH).Methord With case-control study method,the apo-E gene expression,its allele frequency and the levels of serum lipids in patients with cerebrovascular infarction or with intracerebral hemorrhage and the control were compared.Result The CI group had a higher apo-E ?4 allele frequency(10%) than controls(4.6%)(P

Objective To study the changes of platelet function in patients with hypertensive disorder complicating pregnancy (HDCP). Methods Forty non-pregnant women, 40 normal late pregnant women and 50 women with HDCP were in cluded in this study. Platelet count were determined by cell-DYN, the platelet alphagranule membrane protein (GMP-140) by radio-immunoassay and thrombosis bla smixgenz (TXB_2) and ?tissue platelet protein (?-tg) by ELISA. Platelet aggregation rate (Pagt) and pletelet adhesion rate (PADT) were also measured. Results The platelet count in non-pregnant, late pregnant and HDCP group were (206?48)?109/L, (204?52)?109/L and (172?51)?109/L, respectively, and that in the HDCP group was significantly lower than the other two. The levels of GMP-140, TXB_2, ?-TG, PAdT and PAgT were (7.9?2.8) ?g/L, (73.6?40.8) ng/L, (16.3?9.5) ?g/L, (18?9)% and (28?10)% in the non-pregnant group, (12.2?3.8) ?g/L, (80.0?39.6) ?g/L, (18.5?9.8) ?g/L, (20?8)% and (29?10)% in the late pregnant group and (25.1?3.8) ?g/L, (107.6?32.8) ng/L, (23.9?9.2) ?g/L, (30?10)% and (40?12)% in the HDCP group. All the above values in the HDCP group were significantly higher than those in the other two groups (P

Objectives To construct prokaryotic expression plasmid of rat surfactant protein C (sp-c) gene under hyperoxia and expression in E.coli. Methods Twenty-one-day-old SD premature rats were exposed to 85%hyperoxia 12 hours after birth. The rats were executed after 7 days and their RNA were extracted from lung and cDNA was synthesized and amplified. And then the cDNA was cloned into pMD18-T vector and confirmed by enzyme digestion and sequencing. After the prokaryotic expression vector pET-28a(+)-sp-c was constructed, the recombinant plasmid was induced by IPTG and expressed in E.coli BL21 strain. The fusion protein was analyzed by SDS-PAGE and Western blotting. Results The pET-28a(+)-sp-c plasmid was constructed and the fusion protein with relative molecule mass of 21000 was highly expressed. Conclusions SP-C is successfully expressed in E. coli, which can be used to study the mechanism of action between SP-C and endoplasmic reticulum, the expression of SP-C in lung epi-thelial cell A549 and the impact of SP-C on proliferation, differentiation and apoptosis of AECIIs in future.

Objectives To investigate the expressions of endoplasmic reticulum stress (ERS)-related factors, glucose regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP), in lungs of rats with bronchopulmonary dysplasia (BPD) and their relationship with pneumonocyte apoptosis, and further to explore the role of ERS-induced apoptosis in the pathogen-esis of BPD. Methods A total of 24 neonatal SD rats were randomly divided into control group and BPD group with 12 rats each. Rats in BPD group were exposed to 85%O2, while rats in the control group were exposed to air. Four rats in each group were sacriifced at 7, 14 and 21 days respectively after exposure. The expression of GRP78 in the lung tissues was examined by immunohistochemistry, the mRNA and protein levels of GRP78 and CHOP were detected respectively by real-time PCR and Western blot, and the apoptosis in lung cells were evaluated by TdT-mediated dUTP nick end labeling (TUNEL) assay. Results The mRNA and protein levels of GRP78 and CHOP, and the cell apoptosis in BPD group were signiifcantly different from those in control group (P<0.01) at different time points and increased over the time of hyperoxic exposure (P<0.01). Conclusions En-doplasmic reticulum stress may be initiated by hyperoxic exposure and apoptosis is induced via CHOP signal pathway, which is involved in the pathogenesis of BPD.

Objective To introduce the methods and experiences of establishing health education management system in a certain tumor hospital and to evaluate the application effect.Methods By building president led,nursing department guided nursing education committee management system,establishing and enhancing the following aspects:health education inspection and assessment criteria,health education clinical pathway,patient satisfaction questionnaire,evaluation system of telephone follow-up of discharge patients; Implementing the following matters:training for nurses on delivering health education,health education clinical pathway,patient and family health education lecture tour,homes for tumor patients and care givers,etc,forming the management network with the core of health education management committee-head nurse-leader of the ward health education group,which was quality control downward,full participation.Results The differences of tumor knowledge awareness,satisfaction of the patient and the ability of delivering health education and giving lecture of the nurses after education were statistically significant compared with those before the education.Conclusions The health education management system can ensure the efficient operation of the care,improve the level of nursing health education for patients and their families,provide certain health guidance,and improve patient satisfaction degree.