Objective To evaluate the efficacy and safety of tiotropium bromide in treating stable mild and moderate chronic obstructive pulmonary diseases. Methods A randomized,double-blind,parallel comparison clinical trial was conducted in 40 patients with COPD. Twenty patients in tiotropium bromide group were treated by tiotropium bromide powder,and another twenty patients in controll group were given ipratropium,in contrast. The spirometry of both groups was conducted. 4 weeks after treatment. Results The forced expiratory volume in one second ( FEV1 ) and forced vital capacity(FVC) in two groups were significantly increased after treatment( P<0.01 ). The increase of FEV1 in tiotropium bromide group was higher than that in controll group after 4-week. There was no significant differ-ence in rescue medication consumptions. The incidence of adverse effects has no statistical difference between two groups. Conclusion Tiotropium bromide is an effective and safe bronchodilator in treating patients with COPD.

Objective To explore the causes and managements of peritoneal laceration in the laparoscopic totally extraperitoneal (TEP) hernia repair during learning curve.Methods The retrospective cross-sectional study was conducted.The clinical data of 120 patients with inguinal hernia who underwent laparoscopic TEP hernia repair in the Third Affiliated Hospital of Anhui Medical University (98 patients) and Anhui Provincial Hospital (22 patients) during surgeons' learning curve between February 2012 and January 2017 were collected.Patients underwent laparoscopic TEP hernia repair,meshes were intraoperatively placed and then fixed by medical glue.Observation indicators:(1) intraoperative situations:surgical procedure,operation time,using of mesh,intraoperative peritoneal laceration;(2) postoperative situations:time to anal exsufflation,time for fluid diet intake,occurrence of complications,duration of hospital stay;(3) follow-up:number of patients receiving follow-up,follow-up time,recurrence of hernia during follow-up,pain in inguinal region,intestinal adhesion and obstruction induced abdominal pain,incisional infection.Follow-up using outpatient examination and telephone interview within 10 days postoperatively and using telephone interview at 10 days postoperatively was performed to detect the recurrence of inguinal hernia,pain in inguinal region,intestinal adhesion and obstruction induced abdominal pain and incisional infection up to May 2017.Measurement data with normal distribution were represented as （x）±s.Results (1) Intraoperative situations:of 120 patients,112 underwent laparoscopic TEP hernia repair,5 converted to laparoscopic transabdominal preperitoneal hernia repair and 3 converted to open surgery due to adhesion between hernial sac and surrounding tissues induced bleeding of separation.Total operation time of 120 patients was (71 ± 13) minutes,including (63± 7) minutes in 106 patients with unilateral hernia and (79 ± 11)minutes in 14 patients with bilateral hernia.All the patients used intraoperatively meshes of 10.0 cm×15.0 cm and 16.0 cm× 10.8 cm.Forty-eight patients had intraoperative peritoneal laceration,peritoneal laceration occurred for reconstruction of preperitoneal space in 10 patients,separation of anterolateral preperitoneal space in 11 patients and improperly operating equipment or hernial sac in 27 patients.Of 48 patients with peritoneal laceration,40 continued to finish operation through acupuncturing into the abdominal cavity for exsufflation and then received peritoneal suture and repair,including 5 with recurrence of indirect inguinal hernia (receiving tissue repair) undergoing peritoneal repair through opening hernial sac,and 8 intraoperatively converted to other or open surgery.(2) Postoperative situations:time to anal exsufflation and time for fluid diet intake in 120 patients were (18± 4) hours and (15±6) hours.Of 120 patients,14 had postoperative complications,scrotal emphysema of 6 patients disappeared in 24 hours anti inguinal and scrotal seroma of 8 patients disappeared after puncture treatment.All the patients were discharged from hospital in 2 days postoperatively.(3) Follow-up:112 of 120 patients were followed up for 3-65 months,with a median time of 31 months.During follow-up,there was no occurrence of recurrence of hernia,pain in inguinal region,intestinal adhesion and obstruction induced abdominal pain and incisional infection.Conclusion During surgeons' learning curve,identifying anatomy of the groin clearly,a right way to treat the hernia sac and broken peritoneum in the operation can ensure the smooth completion of the laparoscopic TEP hernia repair.

AIM To investigate the effects of Tea Po lyp henols on induction of apoptosis in human liver cancer cell etc. Telomerase acti vity of BEL-7404 cells was dramatically declined during the cell incuba tion with Tea Polyphenols. METHODS MTT colorimetric assay and trypan b lue exclusion method were used to examine the growth inhibition ofTea Polyphenols on BEL-7404 cells. Telomerase activity in cell was determined by PCR-ELISA method. Cell morphology and DNA gel electrophoresis were used to observe the apoptosis. RESULTS The solution of Tea Polyphenols showed dose-dependent and time-dependent inh ibitory effects on the proliferation on BEL-7404 cell line. After treatment wit h 0 2 and 0 1 g?L -1 tea polyphenols for 48 hours, cells displayed DNA ladder bands and typical morphological change of apoptosis included: ce ll shrinkage, membrane blebbing, chromatin condensation, nuclear fragmentation etc. Telomerase activit y of BEL-7404 cells was dramatically declined during the cell incubation with Tea Polyphenols. CONCLUSION Tea Polyphenols has growth inhibiti ng effect and may induce apoptosis in BEL-7404 in a certain dose range. The ant icancer mechanism of Tea Polyphenols might be related to the inhibition of telom erase activity.

In the middle of the 20th century, the United States first proposed the medical humanities theory to campus and offered a variety of medical humanities curriculum, hoping that medical students would have a better understanding of diseases, pain, show themselves more compassion, and foster their communication skills. In recent years, the medical humanities education played a positive role in developing and improving medical students’ comprehensive ability as well as their diagnosis and treatment technology. Currently, American pays more attention to establish a unified and objective standard to evaluate the effect of medical humanities curriculum. Meanwhile, many experts give some suggestions to the medical humanities education.

A method was developed for simultaneous determination of Clozapine, Quetiapine and Risperidone in human serum by fully automated online solid phase extraction ( SPE )-high performance liquid chromatography. With Capcell MF Ph-1 column as SPE cartridge and Acclaim C18 as analytical column, high
selectivity could be achieved by this method according to the selective complementarity of the two columns. In the experiment, ACN-H2 O was used as the SPE mobile phase with a flow rate of 1 mL/min and ACN-10 mmol/L NH4 Ac was used as the analytical mobile phase with a flow rate of 1 mL/min. Serum samples were injected directly into the SPE column and the biological matrix was washed out with the loading solvent. By rotation of the switching valve, Clozapine, Quetiapine and Risperidone were eluted from the SPE cartridge in the back-flush mode and transferred to the analytical column by the chromatographic mobile phase. The whole time of the online SPE purification and chromatographic separation of the analytes was 18 min. Calibration curve of Clozapine with good linearity ( r=0 . 9996 ) was obtained in the range of 10-1800 μg/L in human serum, and the recoveries at low, medium and high concentration levels were 118. 4%, 105. 0% and 105 . 4%. Calibration curve of Quetiapine with good linearity ( r=0 . 9997 ) was obtained in the range of 3 . 6-640 μg/L in human serum, and the recoveries at low, medium and high concentration levels were 112. 8%, 101 . 1% and 101 . 5%. Calibration curve of Risperidone with good linearity ( r=0 . 9995 ) was obtained in the range of 0. 71-128 μg/L in human serum, and the recoveries at low, medium and high concentration levels were 100. 7%, 97. 2% and 98. 8%. In conclusion, the established automated online SPE-HPLC-UV method demonstrated good performance in terms of linearity, specificity, limits of quantification, and was successfully utilized to quantify Clozapine, Quetiapine and Risperidone in human serum.

Type Ⅰ congenital biliary dilatation is a congenital biliary duct defect disease.It is also called congenital choledochocele cyst (CCC).Endoscopic ultrasonography (EUS),magnetic resonance cholangiopacreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are very important for the diagnosis.Operation is generally regaded as the best choose.It is recommended that cholecystectomy + choledochal cyst excision + hepatic duct jejunum Roux-Y anastomosis is the chief therapeutic method.This article reviews the pathogenesis,classifications,diagnosis and treatment of the disease.

Objective To investigate the related factors affecting prognosis of patients with colorectal cancer undergoing palliative resection.Methods The clinical data of 345 patients with colorectal cancer who underwent palliative resection at the First Affiliated Hospital of Guangxi Medical University between January 2007 and December 2011 were retrospectively analyzed.Patients selected the emergent operations or restrictive operation based on the conditions of patients,and then received chemotherapy,radiotherapy and biotherapy.Chemotherapy regimens included FOLFOX4 (5-FU/CF + oxaliplatin) regimen,XELOX (capecitabine + oxaliplatin) regimen and FOLFIRI (5-FU + CF + irinotecan) regimen.Biotherapy regimens included molecular targeted therapies using bevacizumab and cetuximab.The follow-up was applied to patients by outpatient examination,telephone interview and correspondence once every 3 months up to March 1,2014.The survival curve was drawn by the Kaplan-Meier method.The survival rate was analyzed using the Log rank test.The multivariate analysis was done using the COX regression model.Results Of the 1 930 patients,345 patients received palliative resection with a percentage rate of 17.876％.Among the 345 patients,104 patients received emergent operations and others received restrictive operations.After operation,178 patients received adjuvant treatment,FOLFOX4 regimens were done on 85 patients,XELOX regimens on 32 patients,FOLFIRI regimens on 20 patients,radiotherapy on 17 patients and molecular targeted therapies on 24 patients.Seven patients died in the perioperative period and other patients were followed up for 3.0-82.0 months with a median time of 14.0 months.The 1-,3-and 5-year survival rates and the mean survival time were 49.57％,11.88％,6.38％ and 22.6 months,respectively.The results of univariate analysis showed that the CEA levels,bowel obstruction,primary tumor resection,peritoneal implantation,distal metastasis,lymph node metastasis,tumor differentiation,postoperative adjuvant therapy were related factors affecting the prognosis of patients undergoing palliative resection (x2=3.742,18.795,37.641,13.470,4.228,5.835,4.108,6.875,P ＜0.05).The results of multivariate analysis showed that the bowel obstruction,without primary tumor resection,peritoneal implantation,low-differentiation of tumor and without postoperative adjuvant therapy were the independent risk factors affecting the prognosis of patients undergoing palliative resection (RR =1.674,2.273,1.947,1.582,1.342,95％ confidence interval:1.193-2.485,1.646-4.376,1.497-3.587,1.184-2.382,1.032-2.074,P ＜ 0.05).Conclusion The low-differentiation of tumor,peritoneal implantation,bowel obstruction,without primary tumor resection and without postoperative adjuvant therapy are the independent risk factors affecting the prognosis of patients with colorectal cancer undergoing palliative resection.

ObjectiveTo investigate the prevalence of 15 skin diseases in adolescents from Liangshan prefecture in Sichuan Province.Methods A stratified cluster random sampling method was used to select subjects.Adolescents from 2 urban and 3 rural middle schools were investigated,who were required to fulfill self-report questionnaires and received physical examinations by doctors.ResultsA total of 7747 adolescents aged from 12 to 20(15.86 ± 1.86) years were included in the investigation,and skin diseases were present in 6379 adolescents,with a total incidence of 82.34％.In average,each subject suffered from 1.3372 ± 0.96861 skin diseases.Of the adolescents,4698(60.64％) had acne,2219(28.64％) freckle,966(12.47％) lichen pilaris,792(10.22％) eczema or dermatitis,511(6.60％) urticaria,195(2.52％) papular urticaria,37 (0.48％) vitiligo,55 (0.71％) psoriasis,166 (2.14％) verruca vulgaris,168 (2.17％) flat wart,317 (4.09％) tinea manus and pedis,142 (1.83％) tinea corporis,62 (0.80％) chloasma,26 (0.34％) nevus flammeus,15 (0.19％) nevus of ota.Male adolescents showed a higher incidence of acne(63.91％ vs.58.50％),but a lower incidence of eczema,lichen pilaris,freckle,chloasma and psoriasis compared with female adolescents.The incidence of acne,vitiligo,psoriasis and melasma were higher,while that of freckele was lower(25.93％ vs.29.58％ ) in Yi adolescents than in Han adolescents.Increased incidence of acne and papular urticaria and decreased prevalence of urticaria,freckle,melasma and lichen pilaris were observed in urban adolescents compared with rural adolescents.ConclusionsThe prevalence of skin diseases is high in adolescents from Liangshan prefecture.Of these 15 skin diseases,acne,freckle,lichen pilaris,eczema and urticaria are the 5 most common diseases in the area.Differences exist in the incidence of skin diseases between male and female,Han and Yi,urban and rural,adolescents.

BACKGROUND: Abnormal lipid metabolism is one of the risk factors in patients with ischemic cerebral disorders, and is correlated with the changes of lecithin cholesterol acyltransferase activity.OBJECTIVE: To observe the relationship between the changes of lecithin cholesterol acyltransferase activity and lipid content in red blood cell membrane.DESIGN: A case-control study(experimental group with control as standard level).SETTING: Department of clinical laboratory, emergency room and department of neurology of a hospital affiliated to a medical college of a university.PARTICIPANTS: Totally 105 inpatients and outpatients with cerebrovascular diseases were selected from the Department of Neurology, Affiliated Hospital of Medical College of Qingdao University, from March 2002 to December 2003. They accorded with the Diagnostic Criteria set at the Second National Conference on Cerebrovascular Diseases. A total of 42 patients with cerebral arteriosclerosis and 63 patients with cerebral infarction were selected as patients group consisting of 67 males and 38 females. Another 65 healthy people receiving physical examination in the hospital, 36 males and 29 females, were selected as control group.METHODS: Venous blood of 8 mL was drawn from the participants on an empty stomach. We assayed the activity of lecithin cholesterol acyltransferase,high density lipoprotein cholesterol, low density lipoprotein cholesterol,apolipoprotein A1 and apolipoprotein B. Red blood cell membrane cholesterol was determined by phthalyl aldehyde-acetometry and red blood cell membrane phospholipid was determined by chemical quantitative analysis.MAIN OUTCOME MEASURES: Changes of lecithin cholesterol acyltransferase activity and lipid content in red blood cell membrane in patients group and control group.RESULTS: According to intention analysis, all the 105 patients in patients group and 65 patients in control group entered the results analysis. Activity of lecithin cholesterol acyltransferase: Activity changes in cerebral arteriosclerosis group and cerebral infarction group were obvious lower than those in control group[(2.14±0.72) kat/L, (2.06±0.80) kat/L, and(2.61± 0. 74) kat/L, P ＜ 0.01 ] . Level of high density lipoprotein cholesterol and apolipoprotein A1: The level in cerebral arteriosclerosis group and cerebral infarction group was obvious lower than that in control group[ (1.32±0.33) mmol/L, (1.37±0.33) g/L, (1.28±0.33) mmol/L; (1.27±0.31) g/L, (1.60±0.43) mmol/L, (1.60±0.43) g/L, t=2.72 to 5.01, P ＜ 0.01 ]. Content of low density lipoprotein cholesterol and red blood cell membrane-cholesterol: The content in cerebral arteriosclerosis group and cerebral infarction group was obvious higher than that in control group [ (2.94 ± 0. 82) mmol/L, (0.63 ±0.05) mmol/g, (3.02 ±0.79) mmol/L;(0.60 ±0.07) mmol/g, (2.56 ±0. 58) mmol/L, (0.57 ±0.05) mmol/g, P ＜ 0. 01 ] . Moreover, the activity of lecithin cholesterol acyltransferase was positively correlated with high density lipoprotein cholesterol and apolipoprotein A1(r=0.247, P ＜0.05; r=0.303, P ＜0.01), but was negatively correlated with low density lipoprotein cholesterol and red blood cell membrane cholesterol(r= -0.212, P ＜0.05;r= -0.346, P ＜0.01).CONCLUSION: In patients with ischemic cerebral disorders, the major change of plasma lipid is the decrease of lecithin cholesterol acyltransferase,but it is not secondary to cerebral infarction. The activity of lecithin cholesterol acyltransferase is positively correlated with high density lipoprotein cholesterol and apolipoprotein A1, but is negatively correlated with low density lipoprotein cholesterol and red blood cell membrane cholesterol.