Objective To investigate the clinical effect of heart failure recombinant human brain natriuretic peptide (rhBNP) in treatment of chronic pulmonary heart disease (CPHD).Methods Fifty-six CPHD patients with heart failure were randomly divided into control and research group who were hospitalized from January 2010 to December 2011.Patient in two groups were given oxygen,anti-infection,nutritional support and complications treatment.In addition patients in the treatment group was treated with rhBNP.Clinical symptoms,signs and cardiac,pulmonary function of two groups were recorded.Results The pulmonary artery pressure in treatment group were (39.7 ± 6.2) mm Hg and (26.5 ± 3.8) mm Hg before and after treatment,and the difference was significant(t =14.992,P =0.000).The pulmonary artery pressure in control group were (38.4 ±5.1) mm Hg and (31.5 ±4.5) mm Hg before and after treatment,and significant difference were seen (9.378,P =0.000).In addition,pulmonary artery pressure were different between in treatment and control group(t =-9.742,P =0.000).The level of BNP in treatment group was (873.0 ± 12.9) ng/L and (382.0 ± 11.4) ng/L,there was significant difference(t =353.627,P =0.000) ;While in control group,the level of BNP was (862.0 ± 12.3) ng/L and (568.0 ± 12.6) ng/L before and after treatment,and the difference was significant(t =156.135,P =0.000).And there was sinificant difference between the two groups after treatment (t =-103.490,P =0.000).The left ventricular ejection fraction before and after treatment in treatment group was (38 ±9)％ and (65 ±8)％,and the difference was significant(t =-23.056,P =0.000) ;While in control group,the Left ventricular ejection fraction was (32 ± 7) ％ and (47 ± 5) ％ before and after treatment,and the difference was significant (t =-16.485,P =0.000).And the difference between two groups was significant(t =18.308,P ＜ 0.01).24 h urine volume in treatment group was (0.9 ± 0.4) L and (1.6 ± 0.3) L before and after treatment,and the difference was significant(t =-17.320,P =0.000) ;While in control group,24 h urine volume was(0.9 ± 0.2) L and (1.0 ± 0.6) L before and after treatment,and the difference was significant (t =-5.250,P =0.000).And the difference between two groups was significant (t =6.592,P =0.000).The total effective rate in treatment was 82.2％ (23/28),higher than that in the control group (57.1％ (16/28),and the difference was significant(x2 =4.139,P ＜ 0.05).Conclusion rhBNP can improve heart function of CPHD patients with heart failure.

Objective To explore surgical treatment of ulcerative colitis (UC). Methods Clinical data of 16 patients of UC undergoing surgery were retrospectively analyzed. Results In this series,16 out of 78 UC patients undergoing surgery included failing to control symptom by conservative therapy in 10, bowel obstruction in 3,suspected malignance in 3. Eight cases underwent total proctocolectomy and ileostomy,4 with total proctocolectomy and ileal pouch-anal anastomosis (IPAA),2 with total colectomy and ileorectal anastomosis,2 with partial colectomy. Conclusions The main indications for surgery in UC patients were failure of medical treatment, complicated bowel obstruction and suspected malignance. Total proctocolectomy and ileostomy is a cure for UC, total proctocolectomy and ileal pouch-anal anastomosis benifits defecation control but suffering from high incidence of stomal ulcer.

Objective To evaluate the reliability of transpulmonary thermodilution technique,for the quantification of extravascular lung water.Method Eighteen dogs were randomly divided into 3 groups:normal group(n=6),ALIp(acute lung injury caused by pulmonary monary origin causes)group(n=6)and a ALIexp(acute lung injury caused by extra-pulmonary origin causes)(n=6).ALI_(exp)model was prepared by intravenous injection of injection of oleie acid.ALI_p model was made by inhalation of detergent.Extravascular lung water(EVLW)was measured by PiCCO monitor(PULSION,Germany)before and immediately after the intratracheal introduction of normal saline into the alveoh of lungs of normal and ALI dogs.Results The EVLW of the normal group was(254.5?13.0)mL.The volume of the normal between pre-and postinstillation(?EVLW) was approximate to the volume of normal saline instilled with a good correlation(r=0.986,P

Objective： This study was designed to evaluate the clinical experience of esophageal replacement with colon (ERC). Methods： Among 51 patients, 6 with benign stricture and 45 with esophageal carcinoma, all of them were performed cervical esophagocologastrostomy. Among 51 patients, 48 patients received ERC by the transverse colon, including isoperistaltic anastomosis (27/48) and antiperistaltic anastomosis (21/48); three patients received ERC along the peristaltic direction by the right-side colon. In these patients, 24 cases were supplied blood by the arteria colica media and 27 cases by the arteria colica sinistra. Results： There was no operative death in the whole group. The postoperative complications consisted of leakage of cervical anastomosis(2 cases), cervical wound inflammation(3 cases), laryngeal recurrent nerve injury (1 cases), lung inflammation (3 cases). Conclusion： The authors conclude that colon was rich in blood and enough in length so that it can be grafted into neck and anastomosed with the esophagus and the result is satisfactory. Improved surgical technique can reduce the incidence of complications of ERC.

Objective To observe the early outcome and crisis onset after surgical treatment on myasthenia gravis with thymoma and analyze the relevant factors.Methods 436 patients with myasthenia gravis were treated surgically between January 1999 and Jan- uary 2005,58 patients with thymoma.The severity of MG disease was classified according to modified Osserman classification:type Ⅰ(n=17),type Ⅱ a(n=23),type Ⅱ b(n=12)and type Ⅲ(n=6).The distribution of thymomas by the Masaoka clinical stage showed 30 in stage Ⅰ,18 in stage Ⅱ,7 in stage Ⅲ and 3 in stage Ⅳ.The early outcome and crisis onset after surgical treat- ment were analyzed by statistical methods.Results After operation,symptoms improved in 16 eases(27.59%),no change in 18 eases(31.03%),deterioration in 11 cases(18.97%)and crisis onset or death in 13 cases.Logistic test showed that the possibility of crisis onset in patients with thymoma is 1.286 times higher than patients without thymoma.Patients with thymoma,type Ⅱ or above are in high risk group of crisis.The incidence rate of crsis in type Ⅱ group or above was significantly higher than type Ⅰ(P=0.048 0.05).Conclusion The risk of crsis onset after operation significantly raises in myasthenia gravis patients with thymoma.The staging of the disease are associated to development of crisis and crisis onset is independents to patho-staging of thymoma.

OBJECTIVESTo understand the hepatic pathology, hepatitis B reactivation rates and serological changes in chronic HBV carriers.

METHODSA 5 year dynamic observation and survey of 220 chronic HBV carriers in Wuxi district was taken, analyzing their clinical symptoms, liver histopathology, virology and HBV immunological markers.

RESULTSThirty-five of the 220 (15.9%) patients, showed hepatitis B reactivation. The hepatitis B reactivation rate of patients with obvious hepatic tissue inflammation (> or = G2) was 27.0% (33/122) and the rate of the patients with mild hepatic tissue inflammation (G0-G1) was 2.0% (2/98), showing significant differences (x2=25.41, P less than 0.01). The reactivation rate of patients with high inflammation was clearly higher than those with mild inflammation. Twenty-seven of the 35 hepatitis B reactivation cases were older than 40 years, showing a significant association between the ages of the patients and hepatitis B reactivation rates (x2=6.72, P less than 0.01), moreover there was no relationship between sex and the hepatitis B reactivation rate. There were differences in the inflammation grades and fibrosis stages between HBeAg positive and anti-HBe positive group cases (Kruskal-Wallis Test, x2=8.68, P less than 0.01, x2=6.84, P less than 0.01), showing inflammation grades and fibrosis stages of the anti-HBe positive group were higher than those of the HBeAg positive group. There were no obvious differences about the inflammation grade between age less than 40 years old and > or = 40 years old group cases (x2=0.62, P more than 0.05), but there were significant statistical differences about the fibrosis stage (x2=7.37, P less than 0.01), showing fibrosis stage of more than 40 years old group cases was clearly higher than the less than 40 years old group cases. Fifty-six cases received a liver biopsy for a second time and 23 for a third time. We found those whose hepatic tissues were normal in their first liver biopsies, then their liver histology continued remaining stable for several years while those with abnormal ones hardly or only recovered slightly. The rate of HBsAg turning to negativity per year was 1.55% and for HBeAg was 5.4%.

CONCLUSIONThe hepatic tissue pathology for most chronic HBV carriers (55%) had significant abnormalities (inflammation grade > or = G2), and the rates of hepatitis B reactivation were highly relevant to the liver inflammation grades and the ages of the patients.

Adolescent ; Adult ; Carrier State ; virology ; Child ; Female ; Follow-Up Studies ; Hepatitis B virus ; physiology ; Hepatitis B, Chronic ; pathology ; virology ; Humans ; Inflammation ; Liver ; pathology ; virology ; Male ; Middle Aged ; Virus Activation ; Virus Replication ; Young Adult

Objective To explore the value of minute ventilation recovery time (VERT) as a weaning predictor in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD).Methods A prospective study was performed from March 2008 to July 2012.Fifty-two COPD patients under mechanical ventilation for more than 48 hours in our RICU tolerated a spontaneous breathing trial (SBT) and were ready for planned extubation.After SBT,these patients were placed back on their pre-SBT ventilator settings for up to 25 minutes,during which VERT was obtained.VERT was defined as the time for minute ventilation to return to baseline measured before SBT.Respiratory rate,tidal volume,minute ventilation and respiratory rate/tidal volume ratio were also obtained before SBT and just after SBT.Arterial blood gas data were measured and recorded before weaning.According to the weaning outcome,the patients were classified as successful group (40 cases) or failed group (12 cases).VERT and other quantitative variables were compared using t test.A multiple logistic regression was performed to explore possible factors associated with the weaning outcome.The sensitivity and specificity of VERT for predictive capacity in weaning were assessed using ROC cure.Results VERT and respiratory rate after SBT were significantly different between two groups.Multiple logistic regression revealed that VERT was the only predictor associated with weaning outcome (b =0.282,P ＜0.001).The area under ROC curve for VERT was 0.957 (95％ CI:O.907-1.008).With a cut-off value of 10.5 minutes,the sensitivity and specificity of VERT for predicting weaning failure were 1.0 and 0.85,respectively.Conclusions VERT may be a new predictor for extubation and determination of mechanical ventilation weaning in patients with COPD.VERT is a variable to be easily measured thereby being conveniently used in clinical practice.

Objective To explore the surgical treatment of Crohn's disease(CD).Methods Clinical data of 11 patients with Crohn's disease undergoing surgery were retrospectively analyzed.Results 9 cases were diagnosed before operation,with symptoms including abdomen pain,diarrhea or constipation,weight loss,and segmental lesions.Abdominal mass was the most common cause,accounting for 54.5%(6/11)in surgery,and intestinal obstruction was secondary.accounting for 36.4%(4/11),and perianal abscess,9.1%(1/11).Partial enterectomy and anastomosis was the main procedure.3 cases were suspected malignance and underging radical cure.The pathology results showed there was moderate atypical hyperplasia in 2 of 3.Most of the patients had a good recovery and their nutritional conditions were improved obviously(P＜0.05).Conclusion Abdominal mass and intestinal obstruction are the main causes of surgical management in patients with Crohn's disease.The possibility of cancerization is higher in patients with longer medical history.The length of intestine reseeted would be enough with visitable lesions resected,and the operative effects are as good as those underwent radical cure.

Objective: To understand the effect of dobutamine on the integrated backscatter of myocardium. Methods: Nineteen open-chest dogs were detected by HP Sonos 5500 with S8 transducer, and the WT, AIBS and CVIB were measured before and after the dobutamine stress. Results: During the dobutamine stress, following the increase of WT, the transmural, subepicardial and subendocardial CVIB all increased. And the increase of subepicardial CVIB was greater than that of subendocardial CVIB, leading to the decrease of TGI. But the AIBS didn't change significantly in the whole process. Conclusion: Dobutamine can enhance myocardium CVIB but has no obvious infleunce on AIBS.

Objective To explore the activition and polarization of microglia in the epileptic rats induced by lithium chloride-pilocarpine. Methods One hundred male SD rats were randomly divided into five groups: control group and different time points model groups including 1d,3d,7d and 14d. Epilepsy models were established by lithium chloride-pilocarpine intraperitoneal injection. The control group was given the same dosage of normal saline. The morphology change was detected by immunofluorescence,and the expressions of iNOS and Arg-1 were determined by IHC at respective time points. Results Compared the model groups with control group,microglia was activated,synapsis was shorten,volume got bigger,most of them seemed as amoebocyte,the expression of iNOS increased and Arg-1 decreased,especially at 3d.ConclusionThe results from this study indicated that microglia was activated and polarized in epileptic rats induced by pilocarpine.