Objective To investigate the effects of noisy pressure support ventilation (Noisy PSV) in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure, and to provide basic support for the new weaning mode for AECOPD. Methods A single-center, prospective, randomized, crossover clinical research was conducted. A total of forty-six AECOPD combined with respiratory failure patients who mechanically ventilated more than 24 hours in intensive care unit (ICU) of Tianjin Haihe Hospital from November 2014 to October 2015 were enrolled in this study. When the respiratory failure improved through conventional treatment, patients were mechanically ventilated with conventional PSV and Noisy PSV for two hours respectively in random sequence during spontaneous breathing recovery phase. The pressure support (PS) level was titrated to reach tidal volumes (Vt) about 8 mL/kg in both modes. The level of positive end-expiratory pressure (PEEP) and fraction of inspired oxygen were kept unchanged in both modes. The coefficient of variation of PS during Noisy PSV was set at 30%. Data of gas exchange, hemodynamics, lung functional parameters, breathing patterns and patient-ventilator synchrony were analyzed. Results All of the patients were well tolerated with the two modes, and no adverse reactions were found. The changes of gas exchange, hemodynamics, respiratory mechanics in PSV and Noisy PSV showed a clinical acceptable range. The variability of Vt was significantly increased in Noisy PSV mode than that in conventional PSV mode. While the number of asynchrony events was decreased in Noisy PSV mode than that in conventional PSV mode. Conclusion The Noisy PSV is safe and feasible for patients of AECOPD with respiratory failure, which may be a new weaning mode for AECOPD.

Intestinal microflora is a general term for microbial communities that reside in the human intestine. In recent years, the research on diseases related to intestinal microbiota has developed rapidly. It is found that intestinal microbiota is closely related to digestive tract diseases, metabolic diseases, immune diseases, mental diseases, and lung diseases. Intestinal dysbacteriosis, mucosal barrier damaging and local immune dysfunction may be involved in a variety of disease processes. In addition, respiratory diseases such as asthma and pneumonia seriously affect human health. The intestinal microbiota is crucial in regulating immune response of lung to pathological mechanism of diseases including asthma, pneumonia and pulmonary tuberculosis. Therefore, it may be a new direction for the treatment of lung diseases by understanding intestinal microbiota in lung diseases, and identifying, describing and manipulating immunity network of pulmonary disease.

Objective To compare total gastrectomy jejunal loop P-type esophagus jejunum Roux-en-Y anastomosis(PRY) and non-type esophageal transection of the jejunum improved Roux-en-Y anastomosis(URY) two different digestion Road reconstruction on the nutritional status of patients and gastrointestinal symptoms. Methods 152patients with total gastrectomy required of gastric cancer patients immediately divided into two groups ,76 patients in each group ,respectively PRY and URY surgical reconstruction of digestive tract, were followed up for 12 months, two groups were compared on nutritional status and gastrointestinal symptoms. Results PRY operation time and postoperative complication rate we re more than URY group(all P ＜0.05) ;two groups 12 months after the mortality and weight changes, hemoglobin, total protein, albumin, and all reflux esophagitis the incidence rate was no significant difference (all P ＞ 0.05); after 3 months and 6 months in both groups food intake ＜ 300ml/second person, eating frequency ＞5 times/d and the difference in the incidence of RSS had statistical significance (all P ＜ 0.05). Conclusion URY surgical reconstruction of digestive tract and maintain the continuity of muscle conduction,and the surgical procedure was simple,a good prognosis and relatively PRY more reasonable in terms of surgical procedures.

[ABSTRACT]OBJECTIVETo explore the efficacy and safety of localization for parathyroid glands with intravenous low dosage of methylene blue in thyroidectomy. METHODSWe retrospectively reviewed the clinical data of 41 patients who suffered from thyroid papillary carcinoma between Aug, 2014 and Jan, 2015 (9 males and 32 females, with a median age of 46 years). Thirty eight patients underwent primary thyroidectomy and 3 patients underwent second operation. A variety of thyroidectomy was performed in all patients, and who also underwent intravenous (3-4) mg/kg methylene blue in operation. RESULTSEighty four parathyroid glands were stained. Among 39 patients who's parathyroid glands were stained, the mean dyeing time was (31.27±9.41) min. Dyeing rates and dyeing time were not significantly different between 3 mg/kg group and 4 mg/kg group (t=0.24 and 0.20, all P>0.05). None of patients had the hypoparathyroidism problem such as peri-oral numbness, tingling, muscle aches and spasms. According to postoperative monitoring of parathyroid hormone, all of patients had no permanent hypofunction of the parathyroid gland. Neurotoxic effects and other serious side effects were not observed in all patients. CONCLUSIONIntravenous low-dose methylene blue in thyroidectomy is a safe, easy, and effective technique that facilitates rapid identification of parathyroid gland.

Objective To discuss the clinical efficacy of video-assisted thoracoscopic surgery(VATS)for bilateral bullous lung disease operation.Methods VATS procedures were performed on 120 patients with bilateral ballous lung disease.56 patients were operated in one-stage with traditional incision surgery.Results 120 patients were cured.The mean duration of chest drainage after surgery was 4.7 days.Postoperative complications occurred in 14 cases,including pulmonary edema,pneumothorax again respiratory failure and so on.The mean postoperative hospital stay was 14.5 days.The patients were followed up 1 to 60 months.Conclusion VATS is an effective and preferred method for bilateral bullous lung disease.compared with conventional open techniques for bilateral bullous lung disease,the advantages of VATS include shorter hospital stays,less postoperative pain and earlier return to work.

Objective To investigate the feasibility,advantage and clinical effect of video-assisted thoracoscopic in the treatment of sharp injury hemopneumothorax.Methods 53 cases in our hospital of sharp injury hemopneumothorax who need operation treatment were divided into the observation group (VATS group) and the control group(Open group),which were treated by Video-assisted thoracoscopic surgery and the traditional thoracotomy surgery respectively.The clinical effects,such as operative time,intraoperative blood loss,hospital stays,postoperative chest lead flow and so on were compared.Results The operation time,bleeding volume,length of hospital stay,postoperative chest lead flow and pleural drainage days have significant difference (all P ＜ 0.05).Conclusion VATS has shorter operative time,less intraoperative blood loss and quicker recovery after operation,which is a better and safer treatment of sharp injury hemopneumothorax and deserves further clinical application.

Objective To explore the diagnosis, treatment strategies and clinical outcomes of spontaneous subarachnoid hemorrhage in elderly patients. Methods A total of 68 patients aged over 60 years presenting with spontaneous subarachnoid hemorrhage underwent cerebral angiography. And 72 intracranial aneurysms were detected in 60 patients, among whom 47 patients with 59 aneurysms underwent endovascular coil embolization, 6 aneurysms in 6 patients were clipped in microneurosurgery operation, and 7 patients chose conservative treatment. Results A total of 57 aneurysms (96.6%) were embolized successfully, among which 40 aneurysms (70.2%) reached dense occlusion and 17 aneurysms (29.8%) reached incomplete occlusion. Among 47 patients undergoing endovascular treatment, 39 patients (83.0%) were evaluated as good, 7 patients (14.9%) were moderately to seriously disabled according to Glasgow Outcome Scale when they were discharged, and one patient died. Conclusions Active treatment such as endovascular coil embolization can acquire good outcome in elderly patients with spontaneous subarachnoid hemorrhage, especially in elderly patients detected with aneurysms.

Objective To investigate the changes of blood test indexes in patients with severe acute respiratory syndrome (SARS) after 10 years of rehabilitation, and to evaluate the effects of SARS on blood system. Methods Twenty-five cases of SARS confirmed in our hospital (SARS group) and 25 healthy personnel (control group) were included in this study. Values of blood routine test, liver and kidney function, blood lipids, blood glucose, thyroid function, tumor marker and T cell subset index were compared between two groups. Results The serum level of calcium was higher in SARS group than that of control group (mmol/L:2.32 ± 0.08 vs. 2.29 ± 0.08,t=2.072,P<0.05). The level of thyroxine was also higher in SARS group than that of control group (nmol/L: 119.95 ± 29.09 vs. 96.39 ± 14.26, t=3.681,P<0.05), but the results were in the normal range, there was no clinical significance. The level of neuron specific enolase (NSE) was higher in SARS group than that of control group (μg/L, 10.368 ± 3.684 vs. 3.282 ± 1.828, t=9.012, P<0.05), in which only 2 cases were slightly higher than the normal range, but did not exceed more than 1 times of the normal value. The imaging was only part of the old change, and there was no clinical significance. There were no significant differences in other results between two groups. Conclusion Virus of SARS cause no long-term effects on blood system, liver and kidney function, thyroid function and immunity in patients with SARS, and do not increase the probability of cancer.

Objective To study the recogniting patients identity for the safety and reliability of radiotherapy. Methods Through PDCA 4 footwork, namely, plan, do, check, action the technicians in the hospital to improve patients' identity verification.Results After 4 months of PDCA cycle,the patient identity verification qualified rate increase gradually,from 88.17% up to 99.07%,the privacy of patients satisfaction rate rose from 52. 69% to 98. 15%. The patients identification accuracy rate of 100%, technicians working efficiency has been greatly improved. Conclusions The measure of patient identification can improve the working process of radiotherapy for safety and efficiency and can get better privacy protection.

AIM: To investigate the protective effect of five natural anti-oxidants (schisandrin B, Sch B; silibinin, SIB; propyl gallate, PG; sodium ferulate, SF; total flavonoids of hippophase, TFH) on experimental oxidative injuries of lens. METHODS: All fresh transparent lenses of rabbit eyes except control group were bathed in Fenton reaction system in order to produce a model of oxidative damages of lens, meanwhile Sch B, SIB, PG, SF, TFH and pirenoxine sodium (PS) were added in the reaction system in different groups respectively. Lenses were incubated for 24 hours. Then total protein (TP), soluble protein (SP), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione (GSH), vitamin C (Vit C), total activities of anti-oxidation (TAO) and malondiaoldehyde (MDA) in homogenized lenses were measured to observe the effects of five anti-oxidants on above index. RESULTS: Five anti-oxidants increased the anti-oxidative index and decreased MDA in lens of oxidative damages in different levels, the effects are better than that of PS, especially in group SF and Sch B. CONCLUSION: The five natural anti-oxidants protected lens against experimental oxidative injuries very well. There are wide prospects to pursue effective anti-cataract drugs from natural anti-oxidants.