ObjectiveTo explore the clinical value of application of metoprolol and nifedipine in the treatment of asymptomatic myocardial ischemia for the elderly.Methods56 cases of elderly patients with silent myocardial ischemia were chosen.They were randomly divideded into the metoprolol group of 28 cases and nifedipine group with 28 cases according to the number table.The incidence of complications during treatment in the metoprolol and nifedipine group were analyzed.The seizure frequency and onset time in the two groups of patients were compared before and after treatment.ResultsThe onset time in the two groups,before treatment had no statistically significant difference[the number of attacks:(19.6±3.2) times/week compared with(18.9±2.8) times/week;attack time:(5131±352)s vs (5130 ± 348 ) s,all ( P ＞ 0.05 ).After treatment,there were statistically significant differences for the number of attacks and attack time [the number of attacks:(4.6 ± 2.1 ) times/week compared with ( 7.4 ± 2.1 )times/week,onset tine:(900 ± 140) s vs ( 1440 ± 240 ) s ( all P ＜ 0.05 ).All patients can tolerate the treatment period,there was no cases of myocardial infarction occurs.ConclusionThe metoprolol and nifedipine for the elderly treatment of silent myocardial ischemia was more secure,and metoprolol was more effective than nifedipine.

Objective To evaluate the excursion of the diaphragm and analyze the value in predicting weaning from mechanical ventilation in intensive care unit patients.Methods The patients with mechanical ventilation (＞48 hours) in ICU at Hebei Forth Medical University Hospital from June 2014 to December were classified into a success group or a failure group according to the weaning outcome.T-piece spontaneous breathing (SBT),airway occlusion pressure at 0.1 sec (P0.1) and maximal inspiratory pressure (MIP),rapid shallow breathing index (RSBI) and P0.1/MIP were measured or calculated.During the period of the 1 st hour SBT,the excursion of diaphragm was measured with ultrasonography.The predictive value of each parameter to weaning was evaluated with ROC curve.Results A total of 98 patients were enrolled in this study,including 74 successfully weaning and 24 failed.There were significant differences between two groups (success group and failure group) in P0.1 [(2.00 ± 2.00) cmH2O (1 cmH2O =0.098 kPa) vs (3.00 ±2.75)cmH2O,P ＜0.05],RSBI (39.14 ± 16.81 vs 52.00 ± 19.18,P ＜0.05),left diaphragmatic excursion [(1.12 ± 0.97) cm vs (0.69 ± 1.00) cm,P ＜ 0.001],right diaphragmatic excursion(1.87 ± 0.75) cm vs (1.17 ± 0.76) cm,P ＜ 0.001] and mean value of left and right diaphragmatic excursion [(1.57 ± 0.52) cm vs (0.83 ± 0.53) cm,and P ＜ 0.001].The ventilation time [2.00 (2.00-4.00) d vs 4.00 (2.00-5.00) d],ICU hospital lengths of stay [4.50 (3.00-7.25) d vs 8.50 (6.25-15.25) d] and total hospital lengths of stay [20.00 (15.00-25.25) d vs 25.00 (20.25-37.25)d] were also statistically significant in success group and failure group respectively (all P ＜ 0.05).The cutoff value of diaphragmatic excursion for predicting successful extubation was determined to be 1.14 cm by ROC curve analysis.The sensitivity of diaphragmatic excursion to predict successful weaning was 89.2％ and the specificity was 75.0％,the AUCROC was 0.849.Conclusion As an early predictor of diaphragmatic dysfunction,diaphragmatic excursion is probably superior to the traditional parameters in predicting weaning from ventilator in ICU patients.

Objective To study the value of 99Tcm-DTPA dynamic renography in evaluating the function of duplex kidneys in pediatric patients.Methods Twenty-five pediatric patients with duplex kidneys diagnosed by ultrasound or MR urography (MRU) were included (9 males,16 females; mean age:(23.80 ± 20.97) months,range:2-72 months).Twenty patients (9 males,11 females; mean age:(32.95 ± 23.58) months,range:2-72 months) with urinary tract infection but without duplex kidneys confirmed by ultrasound or MRU were chosen as control group during the same period of this study.All patients and controls were divided into two subgroups according to their ages (group Ⅰ,0-24 months; group Ⅱ,25-72 months).The research was approved by the ethics committee,and all patients' parents (or guardians) signed informed consents.The time-activity curve was generated on the dynamic imaging data automatically with GFR calculated.The uptake rates of the upper and lower moieties were measured by drawing the corresponding ROIs in the duplex kidney.Dunnett-t test was used for statistical analysis.Results There were 25 patients with 26 duplex kidneys (1 case bilateral),16 on the left and 10 on the right.The time-activity curve of 6 cases was normal,9 with continuously upward type,4 with high level plateau type,2 with parabolic type and 5 with low level plateau type.There were 19 abnormal kidneys in group Ⅰ and 7 in group Ⅱ,and 20 kidneys in each control subgroup.The GFR of patients with normal renography was (78.81 ± 15.97) ml/min (group Ⅰ) and (64.68 ± 11.15) ml/min (group Ⅱ),continuously upward type was (72.11 ±22.76) ml/min (group Ⅰ) and (63.41 ± 16.42) ml/min (group Ⅱ),high level plateau and parabolic types were (68.74 ± 16.17) ml/min and (65.26 ± 15.27) ml/min in group Ⅰ,respectively.There was no statistically significant difference between the GFR of different renography type groups and that of the controls (group Ⅰ:(79.35 ±13.31) ml/min,group Ⅱ (76.46 ±9.69) ml/min;all P ＞0.05).The GFR of patients with low level plateau type was (45.83 ± 10.17) ml/min (group Ⅰ) and (45.53 ± 10.42) ml/min (group Ⅱ).There was statistically significant difference between the GFR of two subgroups of low level plateau type and that of control group,respectively (both P ＜ 0.05).Among the 26 abnormal kidneys,23 could be separated into upper and lower moieties.Among the 23 duplex kidneys,15 cases had uptake rate less than 10％ of that of the whole kidney,5 cases ranging from 10％ to 30％,and 3 cases greater than 30％.Conclusions Quantitative evaluation of duplex kidney functions can be performed with 99Tcm-DTPA renography.It may provide important information for the management of pediatric patients with duplex kidneys.

ObjectiveTo study the nursing strategy and high risk factors of critically ill patients complicated with lower respiratory tract infection in department of neurosurgery. Methods672 critically ill patients in department of neurosurgery in our hospital from January 2007 to September 2011 were selected as research object,and the rate of lower respiratory tract infection and high risk factors were studied and analyzed,and they were taken care of with special nursing. Results54 cases of 672 patients were with lower respiratory tract infection,the rate was 8.04％.Infection rate of elderly patients,patients of poor nutrition state,patients with underlying diseases was higher than those of other patients.Infection rate of patients with invasive operation,sputum suction,application of respirator,longer operative time and oxygen inhalation time was higher than those of other patients.Infection rate of patients with longer hospitalization time,emergency operation,application of many antibiotics and complication of preoperative infection of other site was higher than those of other patients,there were significant differences.The infection was well controlled with special nursing and treatment,four patients died of primary diseases. ConclusionsThe high risk factors of critically ill patients complicated with lower respiratory tract infection in department of neurosurgery include personal factors,treatment operation factors and other factors,and it can be controlled by special nursing and treatment.

Objective To research and analyze about the quality of life of patients after liver or kid-ney transplantation and return to work aiming at understanding the influence of return to work on their quality of life. Methods The general condition questionnaire and the generic quality of life inventory- 74 (GQOLI-74) were used to survey the quality of life of 30 patients who returned to work after liver or kidney transplantation (the experimental group), the results were compared with 30 cases of the same kinds who did not return to work (the control group). The influence of return to work after liver or kidney transplanta-tion on quality of life was analyzed. Results The total score of quality of life,the score of every dimension and factor were higher in the experimental group than those in the control group. Conclusions Return to work contributes to improvement of quality of life for patients after liver or kidney transplantation.

Objective To establish RT-PCR-RFLP method for studying the genotype of wild mea-sles virus strains isolated from Tianjin area from 2002 to 2008. Methods Isolations of measles virus were carried out by tissue culture method from urine and throat swab specimens collected from suspected cases. RNA were extracted from the virus specimens. The 594 bp fragment of C terminal of the N (nucleoprotein) gene was amplified by one-step RT-PCR, then the PCR products were digested with Bcn I , separated on agarose gel electrophoresis and then analyzed by the method of RFLP (restriction fragment length polymor-phism). In addition, above results were compared with DNA sequencing. Phylogenetic tree was plotted based on the results for the genetic relationship and distance analysis. Results Sixty-nine measles virus strains were isolated from 189 specimens from 2002 to 2008, of which the C terminals of N gene were all de-tected positive. Among the 69 strains of measles virus isolates, 98.55% (68/69) belonged to Hla sub-geno-type which was the predominant sub-genotype, and only one strain (1.45%) belonged to H1b sub-genotype by RFLP analysis which was in accordance with the results by DNA sequencing method. Phylogenetic tree analysis indicated the H1a sub-genotype measles virus strains should be further divided into 2 clades, and the variation fluctuated between 0.2% and 3.8%. There were transmission chains caused by different virus strains co-cireulation. Conclusion A genotype, H1a and H1b sub-genotype can be identified by RT-PCR-RFLP assay specically based on the restriction enzyme Bcn I .The RT-PCR-RFLP assay can be a rapid, simple, accurate and efficient method for large-scale surveillance of measles virus strains in China.

Objective To study the technical skill and therapeutic effect of aortic isolation for treating DeBakey Ⅲ dissecting aneurysm.Methods Among 20 cases of DeBakey Ⅲ dissecting aneurysm,7 cases were with DeBakey Ⅲ a and 13 cases were with DeBakey Ⅲb.Imaging examinatin showed that among the 20 cases there were 5 cases with more than two tearings at difreret site.Covered stent was used to close left subclavian artery in 7 cases and distaI aortic isolation of left subclavian artery was conducted in other 13 cases.Restuls All cases were followed up for 3-40 months,finding that 19 cases survived but one case died because of pseudocoele bronchial fistula hemoptysis 18 months later.Conclusions Endovasular covered stent grafts is the simple,safe and effective way to treat dissecting aneurysm.

Objective To evaluate the role of renal cell apoptosis in acute kidney injury (AKI) induced by sepsis in mice. Methods Forty-five male C57BL/6 mice were randomly assigned into 3 groups ( n = 15 each):sham operation group (group S), cecum ligation and puncture group (group CLP) and CLP + caspase-3 inhibitor Ac-DEVD-CHO group (group CI). Intra-abdominal infection was induced by CLP. Ac-DEVD-CHO 4 μg/g was infused subcutaneously 30 min before CLP in group CI. Five mice in each group were sacrificed after collection of blood samples at 6, 12 and 24 h after CLP. The levels of serum blood urea nitrogen (BUN) and creatinine (Cr)were detected. The apoptosis rate and expression of caspase-3 protein and caspase-3 mRNA were determined.Pathological changes in renal tissues were observed with light microscope. Results The serum BUN and Cr concentratiors, apoptosis rate and expression of caspase-3 mRNA and caspase-3 protein were significantly higher in group CLP than in group S, but lower in group CI than in group CLP ( P ＜ 0.05). Light microscopic examination showed that the pathologic changes induced by Ac-DEVD-CHO were less severe in group CI than in group CLP.Conclusion The renal cell apoptosis is one of the mechanism of AKI induced by sepsis.

Objective To investigate the clinical efficacy and safety of high-frequency electric snare for the treatment of main airway neoplasm through bronchoscopy. Methods The clinical datas of 18 patients from July 2013 to April 2016, who had main airway neoplasm and were treated with high-frequency electric snare through bronchoscopy, were retrospectively analyzed. Meanwhile, the interventional bronchoscopic techniques partly included argon plasma coagulation and cryoablation. After operarion, the relief of symptoms and complications were observed. Results After operarion, the clinical symptoms, shortness of breath, dyspnea index score and the degree of airway stenosis were improved significantly. No serious complications such as massive hemoptysis occurred in all patients. Conclusion High-frequency electric snare is an effective and safe approach for the treatment of main airway neoplasm.

Objective To investigate the expressions of Wnt-1 and FZD-1 in small cell lung cancer(SCLC) patients and their relations with chemotherapy resistance,clinical feature and prognosis.Methods Peripheral blood specimens were collected from 41 SCLC patients.The expression of Wnt-1 and FZD-1 in peripheral blood monouclear cells (PBMC) were detected.The relationship among the expression of Wnt-1 and FZD-1,clinicopathologic feature and prognosis was analyzed.Results The relative expression of Wnt-1 and FZD-1 in chemotherapy resistant group was significantly higher than that in chemotherapy sensitive group (all P ＜ 0.05).The expression of Wnt-1was positively correlated with that of FZD-1 (r =0.186,P ＜ 0.05).The FZD-1expression level was not correlated with patients' age,sex and smoking history (all P ＞ 0.05),but closely with clinic-staging (P =0.008).The Wnt-1 expression level was not correlated with patients' clinical features (all P ＞ 0.05).There was statistical difference in median survival time between Wnt-1 and FZD-1 high-expression group and low-expression group.Conclusions Wnt-1 and FZD-1relationships with chemotherapy resistance and prognosis.Wnt-1 and FZD-1 may act as an important role in chemotherapy resistance of SCLC and could be served as indicators for the chemotherapy resistance and outcome assessment of SCLC.