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 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.

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 evaluate the risk factors for intracranial hemorrhage in premature infants. Methods Cochrane Library, PubMed, ScienceDirect, Chinese Academic Literature Main Database, Chinese Science and Technology Periodi-cal Database, Wanfang Periodicals and Dissertation Database were searched for articles published from January 2000 to December 2012 on the risk factors of intracranial hemorrhage in premature infants, with retrospective retrieval and manual retrieval as supplement. RavMan5.2 provided by Cochrane was used for meta-analysis. Fixed-or random-effects models were selected according to the results of heterogeneity test. Results Nine studies were conifrmed to be eligible. Odds ratio (OR) and 95%conifdence interval (CI) of the risk factors were as follows:gestation age≤32 weeks (OR=3.29, 95%CI=2.76-3.91), birth weight≤1 500g (OR=2.68, 95% CI=2.24-3.20), maternal complications (OR=1.59, 95% CI=1.23-2.06), intrauterine distress or birth asphyxia (OR=2.42, 95% CI=2.06-2.84), mechanical ventilation (OR=3.23, 95% CI=2.55-4.09), metabolic acidosis (OR=2.88, 95%CI=2.04-4.05), use of high concentration of oxygen (OR=2.98, 95%CI=1.63-5.44), prenatal use of dexametha-sone (OR=0.69, 95%CI=0.55-0.86), respiratory distress syndrome (OR=1.57, 95%CI=1.04-2.39). Those differences were all statistically signiifcant. There was no difference in caesarean section (OR=0.99, 95%CI=0.84-1.17), multiparity (OR=1.05, 95%CI=0.79-1.40) and gender (OR=1.25, 95%CI=0.97-1.59). Conclusions The risk factors for intracranial hemorrhage in premature infants are gestation age≤32 weeks, birth weight≤1 500 g, maternal complications, intrauterine distress or birth asphyxia, mechanical ventilation, metabolic acidosis, use of high concentration of oxygen, respiratory distress syndrome, but prenatal use of dexamethasone can reduce the incidence of intracranial hemorrhage in premature infants.

Objective To study the protective role of continuous veno-venous hemofiltration (CVVH) in cardiac insufficiency refractory to diuretic therapy after acute myocardial infarction.Methods A total of 104 acute myocardial infarction patients admitted from march 2012 to march 2016 were recruited.According to their wishes,the patients were divided into two groups,continuous veno-venous hemofiltration combined with routine therapy as experimental group (n =52) and conventional treatment as control group (n =52).Mortality rate within one month,the mean length of ICU stay,the mean length of hospital stay,ventilator usage and urine output volume were documented.Then the difference in BW between pre-and post-treatment was determined for evaluation of fluid retention,and blood plasma C-reactive protein (ΔCRP),interleukin 6 (ΔIL-6),interleukin 8 (ΔIL-8),tumor necrosis factor-α (ΔTNF-α) and left ventricular ejection fraction (ΔLVEF) were measured and calculated.A multiple linear regression model to predict ΔLVEF was established.Data recorded at different intervals in the same group were analyzed by ANOVA.Data of the monitoring biomarkers,the mean length of ICU stay,the mean length of hospital stay of two groups were recorded at the same given intervals were analyzed by t test.Data of mortality rate within one month,drugs and ventilator usage in two groups were analyzed by x2 test.P value less than 0.05 was considered statistically significant.Results There were significant differences in mortality rate within one month,the mean length of ICU stay,the mean length of hospital stay,and the duration of ventilator usage between the two groups (P ＜ 0.05).Total volume of fluid output (urine and ultrafiltration volume) was higher in experiment group than that in control group in 48 hours after the treatment (P ＜ 0.01).The levels of CRP,IL-6,IL-8 and TNF-α decreased significantly (P ＜ 0.05) in experiment group after treatment but not in control group (P ＞ 0.05) as compared with those before the treatment.BW was decreased and LVEF was increased in both groups after treatment (P ＜ 0.05) compared with those before the treatment.Levels of CRP,IL-6,IL-8 and TNF-α were lower in experiment group than those in control group after treatment (P ＜ 0.05).BW was meagerly lower and LVEF was meagerly higher in experiment group than those in control group without statistical significance (P ＞ 0.05).However,the degrees of ΔLVEF andΔBW were greater in experiment group than those in control group (P ＜ 0.01).In experiment group,significantly positive correlations were found among ΔBW,ΔCRP,ΔIL-6,ΔIL-8,ΔTNF-α and ΔLVEF (P ＜0.05).Multiple linear regression analyses showed that ΔBW and ΔTNF-α were the independent factors forΔLVEF and ΔBW was the main independent factor for ΔLVEF in control group.ΔLVEF was positively correlated with ΔBW (P＜0.01) but had no correlation with ΔCRP,ΔIL-6,ΔIL-8 and ΔTNF-α (P ＞0.05).Multiple 1inear regression analyses showed that only ΔBW was the independent factor for ΔLVEF.Conclusion CVVH plays protective role in acute myocardial infarction patients with consequent cardiac insufficiency refractory to diuretic therapy by clearance of inflammatory cytokines and removal of retained fluid,and the removal of retained fluid is the most import mechanism to protect heart function.