Objective To evaluate the efficacy and safety of long-term nebulized corticosteroids and inhaled bronchodilators therapy on asthma in long term poor controlled elderly patients.Methods Prospective,randomized control study was conducted.63 elderly asthma patients,who received inhaled corticosteroids or combined with other long-term medication treatment for asthma control for more than 3 months but were still in moderate to severe persistent asthma state,were randomly divided into nebulizer treatment group (n=31) and dry powder inhalation group (n=32),and they were treated correspondingly with Budesonide inhalation suspension 1 mg and Salbutamol 2.5 mg BidorBudesonide/Formoterol powder 320/9 μg inhalation Bid.Patients in the two groups were evaluated for the differences in lung function,acute exacerbations of asthma,asthma control test (ACT) and adverse effects after 12-week treatment.Results The improvement in morning peak expiratory flow (PEF) and ACT score were better in the test group than in the control group [(29.2 ±14.4) ml vs.(15.8±13.5)ml,(4.8±2.2) vs.(3.0±2.7),t=3.715 and 2.897,P=0.000 and 0.005],but there were no statistical differences in average daily use of relievers and severe acute exacerbations between the test and control groups (t=1.512,P=0.136;x2=2.238,P=0.135).The local adverse effects caused by inhaled corticosteroids had no significant difference between the two groups.Conclusions Compared with the powder inhalation,the nebulizer inhalation administration of corticosteroids and bronchodilators could improve the asthma symptoms and lung function better in elderly patients with serious asthma condition and shows a good safety in tbe12 weeks of continuous treatment.

Objective To evaluate the hematologic effects of linezolid in advanced aged patients with hospital onset of infection.Methods The clinical characteristics and complete blood routine examination results of 45 elderly patients aged(92.9±5.2)years treated with linezolid over 600 mg of lowest dose everyday for more than 72 hours were retrospectively analyzed.Results Among the 45patients,20 patients(44.4％)had substantially lower platelet,6 patients(13.3％)lower haemoglobin,1 patient(2.2％)lower absolute neutrophil,and the linezolid treatment in 19 patients were discontinued due to hematological system adverse reactions.The significant drop in platelet occurred at(10.2±3.3)days after treatment.The significant drop in hemoglobin occurred at(9.8±3.0)d after treatment.The lowest count of platelet and hemoglobin took place at(13.1±3.9)d and (10.5±3.5)d after treatment,respectively.The drops in platelet and hemoglobin of some patients took place after cease of treatment.Stepwise logistic regression analysis revealed that treatment duration(OR =1.407,P＜0.05)and creatinine clearance rate(OR=0.732,P＜0.05)were the risk factors for thrombocytopenia.Conclusions The elderly patients using linezolid more likely suffer from adverse reactions of hematological system,particularly thrombocytopeniawhich is significantly more common in patients with renal insufficiency and prolongation of treatment time.The blood routine examination should be monitored closely when elderly patients are treated with linezolid.

BACKGROUND: Hypertension is one of the most important risk factors for stroke, and brain focal renin-angiotensin system has been proved to play a vital role in the development of hypertension and stroke.OBJECTIVE: To observe the influence of long-term administration of losartan, an angiotensin-1 receptor antagonist, on the incidence of strokeprone spontaneous hypertension in rats.DESIGN: Randomized controlled experiment.SETTING: Renmin Hospital Affiliated to Wuhan University.MATERIALS: This experiment was carried out in Wuhan University between July 1999 and March 2001. Totally 26 six-week-old male rats with stroke-prone spontaneous hypertension and 8 Kyoto male Wistar rats were recruited in this experiment with the body mass of 144.5-182.1 g.METHODS: Totally 26 six-week-old male rats with spontaneous hypertension were randomized into stroke-Rrone spontaneous hypertension group (n=9) which received gastric perfusion of physiological saline at a dosage of 5 mL/d; losartan 10 mg/(kg·d) group of 9 rats which received gastric perfusion of losartan at a dosage of 10 mg/(kg ·d) and losartan 30 mg/(kg ·d)group of 8 rats which received gastric perfusion of losartan at a dosage of 30 mg/(kg·d). Rats in the three groups were provided with high-protein feed when entering the group, and drank 15 g/L salty water (5 mL/d) from the onset of week 2. At the same time, 8 six-week-old male Wistar rats were taken as normal controls to receive gastric perfusion of physiological saline at a dosage of 5 mL/d once a day; they took ordinary feed and drank running water. All rats lived with 12 hours' day-night alternation at room temperature of 18-20 ℃ and with humidity of 40%-50%. Totally 18weeks later, the incidence of stroke and BP changes were observed. The clinical manifestation of stroke was scored 1 if rats appeared few activities,with movements slightly reduced or excited; 2 score referred to very few activities, with movements obviously reduced or violently stimulated; 3score referred to inability to walk, lying motionless with melancholy symptoms; score 4 referred to paralysis and inability to stand, lateral or bilateral limb paralysis. Transmission electron microscope was used for histological observation of cell apoptosis in the brain.MAIN OUTCOME MEASURES: ① Observation of brain structure at week 18 when rats were decapitated. ② Results of nerve cell apoptosis detected with TUNEL technique. ③ Rat body mass, BP, as well as the incidence and changes of stroke were recorded.RESULTS: Totally 34 rats entered the result analysis. ① The incidence of stroke in the three groups: It was 100%, 22%, and 13%, respectively, in stroke-prone spontaneous hypertension group, losartan 10 mg/(kg·d) group,and losartan 30 mg/(kg·d) group. ② Score for stroke: The score was remarkably higher in stroke-prone spontaneous hypertension group than in losartan 10 mg/(kg·d) group and losartan 30 mg/(kg·d) group [(3.50±0.55,0.67±1.12, 0.38±0.74) minutes]. ③ Electron-microscopic observation: In stroke-prone spontaneous hypertension group, electron density was found increased in necrotic neurons; moreover, some nuclear membrane lost double-layer structure with ridges broken, even reduced or disappeared, displaying vacuolated changes. In losartan 30 mg/(kg·d) group and losartan 10 mg/(kg·d) group, most of neurons displayed basically normal morphology, with neuron chromatin evenly distributed and nuclear envelops regular, but there were still some neurons that had dense chromatin, with ridges broken and reduced. ④ Nerve cell apoptosis in the three groups: It was found obviously lower in normal group than in losartan 30 mg/(kg ·d)group, losartan 10 mg/(kg·d) group, and stroke-prone spontaneous hypertension group [(2.5±0.8, 13.9±4.3, 14.0±4.4, 52.0±16.7)%, P ＜ 0.05]. ⑤ BP changes: At week 18, BP was obviously lower in normal group than in losartan 30 mg/(kg·d) group, losartan 10 mg/(kg·d) group and strokeprone spontaneous hypertension group [(120.1±7.9, 169.4±10.1,216.7±8.3,225.5±6.8) mmHg (1 mm Hg=0.133 kPa), P ＜ 0.05]. ⑥ Changes of body mass: At week 18, body mass was obviously higher in normal group than in losartan 30 mg/(kg·d) group, losartan 10 mg/(kg·d) group, and stroke-prone spontaneous hypertension group [(313.3 ±10.1, 270.8 ± 10.4,258.7±12.7, 231.0±6.5) g, P ＜ 0.05].CONCLUSION: Losartan can obviously reduce the incidence of stroke and nerve cell apoptosis in rats with spontaneous hypertension, suggesting that losartan as an angiotensin-1 receptor antagonist may prevent and delay the onset of stroke through antagonizing angiotensin I receptor, thus exerting brain-protecting function.

Objective To investigate the relationship between UCG changes and syndrome-types of chest stuffiness and pains (CSP). Methods All 305 cases were diagnosed as CSP and received coronary angiography and echocardiography (UCG). The relationship between UCG changes and syndrome-types of TCM was analyzed. Results When coronary arteries were normal and with no abnormal ventricular wall movemoment,the proportions of blood-stasis syndrome (BSS) group and phlegm-turbid syndrome (PTS) group were lower,while higher in the condition of coronary arteries strait and with abnormal ventricular wall movemoment. BSS and PTS were significantly higher in the group with coronary arteries strait and abnormal diastolic function of left ventricle than in the group with no coronary arteries strait. There was no significantlly different symdrome-types distributing between normal and abnormal left ventricle systolic function group. EF was lower in Qi-stagnation syndrome (QSS) group than non-QSS group. FS was lower in Yang-deficiency syndrome (YDS) group than in non-YDS group,the same condition in PTS group and non-PTS group. Conclusion There was no significantly value of dignosing syndrome-types of chest stuffiness and pains in the use of UCG.

Objective To investigate the preventive effects of AT1 receptor antagonist Lorsartan on blood pressure and stroke in spentaneously hypertensive stroske prone rat (SHRsp). Methods Twenty six 6 week aged SHRsp were divided into Losartan 30 mg/kg/d group (n=8), Losartan 10 mg/kg/d group (n=9) and normal saline group (n=9), and 8 sex and age matched Wistar Kyoto(WKY ) as control group (n=8). SHRsp were subjected to 1 5% saline solution as intake and administered 30 mg/kg/d Losartan or 10 mg/kg/d Losartan or equal volume of 0 9% saline solution for 18 weeks by gavage, respectively. The systolic blood pressure was measured by tail cuff sphygmomanometry and clinical score of stroke and survival time of SHRsp were recorded. The coronal brain sections was examined by microscope and electron microscope after decapitation. Apoptosis was analyzed by TdT mediated dUTP biotin nick end labeling and image analysis system. Results Losartan 10mg/kg/d showed no affect on systolic blood pressure but it prevented the occurrence of stroke. The clinical scores of stroke in Losartan 30 mg/kg/d group (0 4?0 7) and Losartan 10 mg/kg/d group (0 7?1 1) were both more decreased than in normal saline group(3 5?0 6) ( P

To study the value of high-fluorescent cell for the screening of malignant hydrothorax or ascites. The clinical diagnosis results and hydrothorax or ascites specimens of 400 outpatients registered from January to December in 2014 were collected, and high-fluorescent cells were counted with Sysmex XE-5000 blood cell analyzer, and then stained for microscopy. Receiver operating characteristic (ROC) curve was used to explore the sensitivity, speci-ficity, positive likelihood ratio and negative likelihood ratio of high-fluorescent cell for screening malignant hydrothorax or ascites. The numbers of high-fluorescent cells of the cancer patients were significantly higher than those of the non-cancer patients, with Z equal to -7.372 and P less than 0.05. The values of the area under curve (AUC), sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 0.801, 70.67%, 84.31%, 4.50 and 0.35 respective-ly. Detection of high-fluorescent may be used to screen malignant hydrothorax or ascites, and further exami-nation and follow-up have to be performed in case the number of high-fluorescent cells in the hydrothorax or ascites is not less than 68.

Objective To evaluate the effect of single CVVH and HDF on endothelial system. Methods Group CVVH:20 patients with multiple organ dysfunction syndrome ( MODS) underwent CVVH for 12h.Vascular access was through two-lumen catheter in femoral vein;Group HDF:Twenty patients with end stage renal disease (ESRD) on maintenance hemodialysis underwent HDF for 4h.Vascular access was through internal arteriovenous fistula.Group control:Healthy people were examined at our hospital.The se-rum levels of sVCAM-1, sICAM-1, vWF and MMP-9 were measured by enzyme-linked immunosorbent assay ( ELISA) after centrifugation in treatment group before and after treatment.Four cytokines were also meas-ured in fasting healthy subjects in the morning.Results The levels of serum sVCAM-1, sICAM-1, vWF, MMP-9 were significantly higher in Group CVVH and HDF than control group before and after treatment( P<0.05).Group CVVH:The serum levels of sICAM-1 and sVCAM-1 were significantly lower in post-treat-ment than pre-treatment, But the serum levels of vWF and MMP-9 showed no obvious changes after CVVH;Group HDF:the levels of four cytokines showed no obvious changes after single HDF.Conclusions Endo-thelium becomes impaired in MODS and ESRD patients, Endothelium may be protected by CVVH through the partial removal of cytokines harmful to endothelium in MODS patients.Single HDF therapy does not pro-tect endothelial function obviously in MHD patients.

Objective To analysis of incidence and mortality of prostate cancer in urban Guangzhou during 2000-2011 and discuss the trends.Methods The incidence and mortality rates were calculated by analyzing data obtained from Guangzhou Cancer Registration Center.Standardized rates were calculated using the Segi's World Standard Population.According to the characters of morbidity and mortality,ages were divided into three groups of 0-64,65-74 and ≥ 75 years.The average annual percentage change (AAPC) were calculated by Jointpoint Regression Program 4.0.4.Results Altogether 3 029 new cases of prostate cancer and 964 related deaths were registered between 2000 and 2011.The AAPC was 10.01％ (95％ CI:6.00％-14.20％) in crude incidence rate and 8.04％ (95％ CI:6.20％-9.90％) in crude mortality rate,resulting in a total increase of 287.76％ (from 4.82 to 18.69 per 100 000 population) in incidence and 142.90％ (from 2.41 to 5.86 per 100000 population) over the 12 years.There was no significant difference in both standardized incidence and mortality change.The AAPC was 11.51％ (95％ CI:6.00％-17.30％) in 0-64 age incidence rate (resulting in increase of 315.87％ and 1.99 per 100,000 population),4.19％ (95％ CI:0.30％-8.20％) in 65-74 age incidence rate (resulting in increase of 92.72％ and 45.82 per 100 000 population) and 2.77％ (95％CI:-1.00％-6.70％) in ≥75 age incidence rate (resulting in increase of 42.84％ and 63.13 per 100 000 population).The age incidence rate increase was the largest in the ≥ 75 age group,but fastest in the younger group.The age mortality trend was only statistically significant in 0-64 age group,AAPC was 6.25％ (95％ CI:0.30％-12.60％).Conclusions The incidence and mortality rates of Guangzhou increased in a fast rate.The prevention and control of prostate cancer should be strengthened.

OBJECTIVE:To evaluate the effect of special rectification on the rational use of antibiotics and relieving bacterial resistance. METHODS:It was divided into groups based on the before and after 3 years of special rectification. The data of related index and bacterial resistance of antibiotics in the clinical use in 2 groups were compared. RESULTS:After special rectification, the use rate of antibiotics in inpatients was decreased from 77%to 55%,use intensity was decreased from 86 DDDs/(100 person· d) to 39 DDDs/(100 person·d),the prophylactic use rate of antibiotics for typeⅠincision surgery was decreased from 98% to 27%,the antibiotics prescriptions of patients in outpatient and emergency departments were respectively decreased from 36% to 12% and 49% to 23%. The submission rate of microbiological testing specimens was increased from 20.2% to 38.8%,submission rate of sterile site specimens was increased from 29.8% to 37.6%. The detection rate of fungus was decreased from 14.4% to 11.2%. The detection rates of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β- lactamases (ESBLs) strains were respectively decreased from 57.3% to 51.3% and 43.2% to 36.1%. The total detection rate of top 5 multi-drug resis-tant bacteria was decreased from 48.4% to 29.3%,however,the detection rate of Acinetobacter baumannii was increased to 80.7%,and the resistance rates of Acinetobacter baumannii to imipenem and meropenem were respectively 66.9% and 69.1%. There was an increasing trend for Klebsiella pneumoniae to 1,2 and 3-generation cephalosporins,piperacillin amoxicillin/tazobac-tam,imipenem,meropenem. CONCLUSIONS:Special rectification of antibiotics has obvious effect on the rational use of antibiot-ics and relieving bacterial resistance in the clinic,and it improves the management of clinical use of antibiotics in hospital. Howev-er,bacterial resistance situation is still grim,it needs to establish a long-term management mechanism of clinical use of antibiotics, strengthen the monitoring pathologic examination and monitoring of bacterial resistance,and strictly perform hand hygiene and dis-infection and isolation system.

Objective To explore the experience of emergency operation for patent ductus arteriosus (PDA) in neonates and to assess the therapeutic effect.Methods The clinical data of 31 PDA neonates(15 male,16 female) treated in our department from July 2012 to February 2015 were reviewed retrospectively.Of these cases,28 were preterm infants and 3 were full term infants.Mean gestational age was 30+4 weeks ranging from 26+2 to 39 +3 weeks.Mean birth weight and weight at operation was(1 159.0 ± 729.2) g and (1 522.0 ± 644.5) g,respectively.We operated with left transaxillary straight incision in 6 cases and posterolateral minimal incision in 25 cases,and the pleural cavity was entered via the 4th intercostal space.All the neonates were divided into ＜ 1 500 g group(n =24) and ＞ 1 500 g group(n =7) by weight,the clinical prognosis were analysized.Results All 31 operations were finished successfully.No deaths occurred as a result of surgery.Average time of operation was (62.7 ± 29.9) min.Mean time of mchanical ventilation after the operation among survivors was (5.5 ± 4.7) d.The time of mechanical ventilation between ＜ 1 500 g group and ＞ 1 500 g group were (7.2 ± 2.3) d and (4.9 ± 2.4) d respectively,and there was significant difference between two groups(P ＜ 0.001).The time of hospital stay were (45.3 ± 11.0) d and (20.4 ± 14.5) d respectively between two groups (P ＞ 0.05).Twenty-eight cases recovered and released from the hospital successfully.Two cases quited the treatment themselves and 1 succumbed to death because of heart failure,hyperkalemia and arrhythmia.ConclusionEmergency surgical closure is a safe and effective method for the treatment of neonatal large PDA,especially with congestive heart failure,a variety of complications,long time ventilator dependence,medical treatment failure,which should be ligatured timely as it can have severe influence on the cardiopulmonary function.After ligation the abnormal shunt will disappear and the cardiopulmonary function will be better.It is helpful to extubate ventilators and improve the survival rates.