Objective To investigate the therapeutical effect and mechanism of tiotropium bromide in patients with stable phase midrange and severe chronic obstructive pulmonary disease (COPD). Methods Seventy-eight patients with stable phase midrange and severe COPD were selected, and they were divided into observation group (40 cases) and control group (38 cases) according to treatment method. All patients were given conventional treatment. The patients in observation group were given tiotropium bromide, and the patients in control group were given terbutaline according to the needs for 12 weeks. The changes of dyspnea, 6 min walking distance, pulmonary function, leukotrienes C4 (LTC4), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-ɑ) before and after treatment, and drug adverse reaction were observed. Results The dyspnea score after treatment in observation group was significantly lower than that in control group:(2.9±0.5) scores vs. (3.5±0.7) scores, 6 min walking distance in observation group was significantly longer than that in control group: (427.67±70.36) m vs. (365.41±61.42) m, forced expired volume in 1 second (FEV1) and FEV1/forced vital capacity in observation group were significantly higher than those in control group:(1.76±0.89) L vs. (1.29±0.53) L and (67.43±9.52)%vs. (56.32±8.51)%, LTC4, IL-8 and TNF-αlevels in observation group were significantly lower than those in control group: (397.41± 198.57)μg/L vs. (1 181.95±207.54)μg/L, (434.81±176.05) ng/L vs. (823.37±165.43) ng/L and (0.15±0.02) ng/L vs. (0.25 ±0.02) ng/L, there were significant differences ( P<0.01). Pearson correlation analysis result showed that serum LTC4 level was negatively related to FEV 1 (r=-0.578, P=0.024);and the serum IL-8 level was negatively related to FEV1 (r=-0.542, P=0.019). There was no obvious drug adverse reaction in the two groups. Conclusions Tiotropium bromide can significantly improve the clinical manifestations in patients with COPD. Tiotropium bromide may take effects by blocking various inflammatory factors release in the stable phase of COPD.

Objective: To investigate the therapeutic effect of acupuncture plus herbal medicine on vascular dementia (VD). Methods: Thirty cases of vascular dementia were treated by acupuncture plus Chinese herbal medicine for 2 months, in comparison with western medication (Nimodipine) in the control group, to observe the evaluation value of Hasegawa Dementia Scale (HDS) before and after the treatments between the two groups, the clinical therapeutic effect and changes of plasma atrial natriuretic peptide (ANP) before and after the treatments between the two groups. Results and Conclusion: There were significant differences in intelligence and therapeutic effect between the two groups (P＜0.01) before and after the treatment, but the therapeutic effect was better in the acupuncture plus medicine group than in the western medication group. Judging from content of atrial natriuretic peptide, there was no significant difference between VD patients and normal adults before the treatment (P＞0.05). Plasma ANP significantly increased in the acupuncture plus medicine group and western medicine group after the treatment (P＜0.01), more remarkably in the acupuncture plus medicine group (P＜0.01).

Objective To investigate the effect of herbal foot-bath plus acupoint application on sleep quality of stomach cancer patients before surgery. Method Eighty eligible patients who were going to receive stomach cancer surgery were randomized into an observation group and a control group, 40 in each group. The control group was given psychological comfort plus switching off lights on time, while the observation group was additionally given herbal foot-bath plus acupoint application before the surgery. The sleep quality on the night before surgery was observed. Result There were significant differences in comparing sleep latency, night wakening, total sleep duration, total sleep quality, daily body function and total score (P<0.05). Conclusion Herbal foot-bath plus acupoint application can enhance the effective sleep duration and sleep quality of patients before stomach cancer surgery.

Objective To compare the EEG complexity between rats under awaking and differ-ent depth of anesthesia via analyzing sample entropy and fractal dimension.Methods Sixteen SD rats were intraperitoneally injected with urethane twice,first with 500 mg/kg and second with 800 mg/kg one hour later.The scalp EEG was collected in stage of awaking (W),light anesthesia (LA)and heavy anesthesia (HA).The sample entropy (SampEn)and fractal dimension (FD)were computed by MATLAB.The characteristic values were denoised by linear dynamic system method during the whole process.Results The value of SampEn and FD gradually dropped from awaking to heavy anes-thesia.The SampEn and FD in W was significantly higher than the value in LA or in HA (P <0.05). The SampEn and FD in HA was significantly lower than that in LA (P < 0.05 ).Conclusion The SampEn and FD of EEG could be used to monitor the depth of anesthesia.

Objective To investigate the feasibility of using problem-based learning in nursing clinical teaching in the obstetrics and gynecology department.Methods Sixty-six nursing students were randomly divided into PBL group and lecture-based learning(LBL)group .At the end of their internship,the two groups were compared in terms of examination performance,learning attitude and aptitude,and their feedback on the two learning modes.Results The students in the PBL group were significantly better than those in the control group in terms of examination performance,learning attitude and aptitude,and their feedback on the learning mode(P<0.001).Conclusions PBL may be effective in the improvement of their attitude to learning and aptitude,the comprehensive ability.It can provide an environment to promote internal learning motivation for students.

In order to promote the integration between disciplines, the convergence between basic course and clinical teaching, increasing students ability including the active learning and life-long learning ability, finding problem and solving problem ability, teamwork spirit and so on. After nearly 3 years preparation, Hebei Medical University successfully carried out the PBL teaching in Seven-year Clinical Medicine Science. Combining with the teaching activities, formative assessment was carried out, and PBL teaching website was established. The reform has already achieved initial results, got good responds from teachers and students. Through the study, it has been confirmed that the PBL teaching method in Hebei Medical University is effective and worthy to reference.

Objective: To observe the clinical effect and safety of 125I seed implantation combined with chemotherapy in treatment of advanced colorectal cancer with liver metastasis. Methods: Totally 27 cases of advanced colorectal cancer with 60 liver metastasis were enrolled. 125I seed implantation was performed, followed by second-line chemotherapy. The clinical effect, safety and prognosis of the above treatments were observed. Results: Totally 1 995 125I seeds were successfully implanted into 60 liver metastasis([33.41±24.79]seeds in each lesion), and the dose distribution was uniform. Postoperative adverse reactions were mild and recovered after symptomatic treatment. There was no significant difference of liver function before and 1 week after 125I seed implantation. Six patients were treated with oxaliplatin combined regimen and 21 with irinotecan combined regimen 1 week after 125I seed implantation. At the end of 3 and 6 cycles of chemotherapy, the lesion diameter and carcinoembryonic antigen (CEA) level significantly reduced compared with those before implantation (both P< 0.001). The median progression-free survival (PFS) and median overall lifetime (OS) was 8.1 months and 14.6 months, respectively. Conclusion: 125I seed implantation combined with second-line chemotherapy is safe and effective in near future for treating advanced colorectal cancer patients with liver metastasis.

Severe liver disease during pregnancy is uncommon in clinical practice. The most common cause of liver disease during pregnancy is liver dysfunction, with an overall prevalence rate of approximately 3%. Liver disease during pregnancy is classified into the liver diseases directly caused by pregnancy and those co-existing with pregnancy, i.e., pre-existing liver disease or occasional liver disease during pregnancy. A differential diagnosis of pre-existing and co-existing liver diseases may help to improve maternal and fetal outcome. During clinical diagnosis and selection of treatment and intervention measures, priority should be given to the potential impact on mother and fetus. This article introduces the latest research advances in the general information, pathogenesis, treatment, and pregnancy outcome of major liver diseases during pregnancy and elaborates on the risk of pregnancy and related coping measures for patients with pre-existing liver disease, so as to guide clinical diagnosis and treatment and patient management.

Objective To explore the effect of intermittent fasting on blood glucose control in patients with type 2 diabetes mellitus(T2DM)complicated by overweight and obesity.Methods 46 T2DM patients with overweight and obesity were divided into control group(Con,n=22)and intermittent fasting group(IF,n=24)according to their wishes.Con group was given routine diet and drug treatment by specialists in endocrinology.IF group completed the intermittent fasting by using a combination of meal replacement and natural diet,and hypoglycemic drugs were reduced on fasting days.Results Compared with Con group,IF group showed a significant decrease in body weight,BMI,hypoglycemic drug efficacy score,WC,fat index,hip circumference and visceral fat(VF)(P＜0.05).After intervention,the proportion of diabetes in remission or near remission in IF group was higher than that in Con group(P＜0.05).Conclusion Intermittent fasting can reduce the application of hypoglycemic drugs in T2DM patients with overweight and obesity,and can also reduce weight and VF.