Owing to the increasing morbidity and pulmonary infection,management of pulmonary function has become an important problem for COPD patients who undergo surgery.Surgical patient with respiratory disease such as COPD has declined lung function before operation,then increased the risk of post-operative pulmonary complications.Ipratropium bromide can significantly improve pulmonary function.Therefore,we hypothesis the treatment with nebulized ipratropium bromide will benefit the perioperative patients with COPD.A randomized,double-blind,placebo-controlled,parallel-group,multi-center trial (Ipratropium bromide in Peri-Operative COPD study,IPO-COPD study)has been conducted to evaluate the efficacy and safety of nebulized ipratropium bromide in Chinese perioperative patients with COPD under general anaesthesia.A total of 192 COPD patients who satisfied the eligibility criteria were randomly assigned(1∶1) to one of the two treatment groups(ipratropium bromide 500 μg or normal saline 4 ml) for 11 days.Measurements will include the change of the forced expiratory volume in 1 second(FEV1),the forced vital capacity(FVC),blood gas analyses and main post-operative pulmonary complications.

OBJECTIVE:To provide reference for promoting the further implementation of national essential medicine system and rational use of drugs in community health service center. METHODS:Outpatients’information in Changqiao Street Communi-ty Health Service Center from Sept. 2,2009 to Nov. 25,2014 was collected to statistically analyze the drug variety,the number of prescriptions,the consumption sum and the DDDs before and after the implementation of essential medicine system and after the supplement of non essential medicines. RESULTS:Essential medicines occupied the main position of drug utilization in each stage, with substantial growth in respects of consumption sum and number of prescriptions;the sum of Chinese patent drugs and essential cardiovascular drugs occupied more than 50% of the total consumption sum and number of prescriptions,with higher growth rate;essential medicines occupied the top 10 in respects of consumption sum and DDDs,among which most were the drug varieties in“Shanghai supplement essential drugs in community health service center”(2010 Edition),with some overlap the varieties in“Na-tional Essential Medicine System”(2012 Edition);cardio-cerebrovascular drugs occupied the dominant position;the growth rates of cefotiam and atorvastatin took up the top 2 ranking in the list of consumption sum,while the growth rates of calcium carbonate D3 and irbesartan and hydrochlorothiazide took up the top 2 ranking in the list of DDDs. CONCLUSIONS:Essential medicine cata-log covers the common drugs in the community health service center,in which the rational use of Chinese patent drugs and antibac-terial deserves needs to be noticed. The clinical rational use of the essential medicines should be strengthened,the essential medi-cine catalog should be adjusted and non essential medicines should be supplied when necessary in order to truly meet the needs of patients and optimize the allocation of medical resources.

Background The incidence of dry eye is gradually increased,and researches showed that inflammation participated in the pathogenesis and development of dry eye.The current therapy for dry eye can only relieve symptom but not achieve final cure.Stem cell therapy has been used in the treatment of limbal stem cell deficiency.However,whether it is feasible for the stem cell treating dry eye is still unclear.Objective This study attempted to investigate a new approach to treat dry eye syndrom by using human umbilical cord mesenchymal stem cells (HUCMSCs).Methods The use and care of experimental animals complied with the Tsinghua University School of Medicine Laboratory Animal Care Details.HUCMSCs were cultured and cell suspension was prepared with the cell density of 5×105/ml.Twenty 24-week-old male NOD/Ltj mice were randomized into 4 groups.0.1 ml PBSHUCMSCs suspension was injected via tail vein or lacrimal respectively in the caudal vein injection group and lacrimal injection group,and 10 μ1 PBS-HUCMSCs suspension was topically administed in the eye drops group.The NOD/Ltj mice without any treatment served as the model group.Five male ICR mice were used as the normal control group.Tear secretion was quantitatively detected with phenol red cotton thread in 1,2,3 weeks after injection,and corneal epithelial defect was scored by fluorescein staining.The serum levels of interleukin (IL)-6,IL-17a,tumor necrosis factor-α (TNF-αt) and interferon-γ (IFN-γ) were assayed by ELISA.The relative expression levels of p65,Stat3,Stat5 and extracellular signal-regulated kinases (Erk)-1 in lacrimal gland were detected by Western blot.Results The tear secretion amount was significantly different among the model group,caudal vein injection group,lacrimal injection group and eye drops group in various time points (1 week:F =3.700,P =0.040;2 weeks:F =5.150,P =0.008;3 weeks:F=10.130,P＜0.001).The tear secretion amount was increased in the caudal vein injection group and lacrimal injection group compared with the model group in different time points (all at P＜0.05),and no significant difference was seen in tear secretion amount between eye drops group and model group among various time points (all at P＞0.05).The fluorescein staining score was 3.00±0.63,9.40±1.62,5.20±1.17,4.20±1.17 and 7.20±0.98 in the ICR mouse control group,model group,caudal vein injection group,lacrimal injection group and eye drops group 1 week after injection respectively,and the scores were significantly lower in the caudal vein injection group,lacrimal injection group and eye drops group than those in the model group (P =0.001,0.000,0.033).The serum levels of IL-6,IL-17a and TNF-α in the caudal vein injection group were evidently lower than those in the model group (t =4.70,3.46,11.0,all at P＜0.01),but no significant difference was displayed in the serum IFN-γ level among the five groups (F=1.740,P=0.170).The expressions of STAT5 were significantly decreased in the mice treated with tail vein injection and lacrimal injection compared with mice without treatment (both at P＜0.05).Conclusions Administration of HUCMSCs via intravenous and lacrimal injection can alleviate the inflammatory response during progression of dry eye syndrome by down-regulating the serum level and expression of inflammation-related factors in NOD/Ltj mice.The topical administration of HUCMSCs eye drops can attenuate the symptom of dry eyes by lubricating the cornea and suppling nutrition.

Objective To detect the clinical pathogenic bacteria and antimicrobial-resistant genes quickly and sensitively using DNA chip.Methods Based on the analysis of 23S rRNA gene se- quences and other genes sequences associated with antimicrobial resistance(SHV＜CTX_M),oligo nucleotide microarray was designed according to different bacteria and antimicrobial-resistant genes. The DNA fragments were amplified by labeling Cy5 fluorescence and detect clinical pathogenic bacte- rias and antimicrobial-resistant genes by hybridization.Results The result of detection(10~3-10~6 bac- teria/ml)was consistent with that of some documents in domestic and overseas under ideal circum- stances of detecting bacteria genomic DNA by the Reagent Box.And it was specific and reproducible when the detection system were evaluated with some clinical isolates and drug-resistant standard strain.DNA chip could identify 16 species and 7 generics including common diverse clinical pathogenic bacteria,and could detect the drug-resistant of extended spectrum?lactamase gene simultaneously. Conclusions The methods that we have established DNA chip is a sensitive,specific and reproducable tool for supplying routine methods.

OBJECTIVE To investigate the distribution and drug resistance status of extended-spectrum ?-lactamases producing(ESBLs) Klebsiella pneumoniae and to provide the basis for clinic anti-infective treatment.METHODS To use ATB-expression analyzer to identify the microbe.The drug susceptibility was tested with the K-B method and the ESBLs producing strains detected by diffusion confirmed test.RESULTS Among 137 strains of identified K.pneumoniae,34.3% of them(47 strains)produced ESBLs,and most had been shown in geriatrics ward.The drug resistance rate of ESBLs producing K.pneumoniae was higher than that in non-producing ESBLs one.So imipenem should be considered to be a preferred antibiotic when used on K.pneumoniae seriously infected cases.CONCLUSIONS The drug resistance of K.pneumoniae is a serious problem,we should pay attention on the status of ESBLs distribution,based on the susceptibility to choose the reasonable antibacterial to avoid the producing ESBLs bacteria spread out.

OBJECTIVE To investigate the drug resistance of ESBLs-producing Escherichia coli in community-acquired urinary tract infection for guiding the clinical drug-using.METHODS ATB-Expression analysis system was used for identification of bacteria,extra-susceptibility tests were detected by K-B method.RESULTS Totally 104 E.coli strains were detected,the isolation rate of ESBLs-producing E.coli was 13.5%,the resistant rates of E.coli were up to 70% to ampicillin,piperacillin and Co-trimoxazole,the resistant rate was up to 55% to ciprofloxacin and levofloxacin,and the susceptible rate was 100% to imipenem.CONCLUSIONS The E.coli is a main pathogen in community-acquired urinary tract infection,Its drug resistance is extremely severe.To enhance detecting drug resistance of pathogenic bacteria is of important significance for guiding the clinical rational drug-using and reducing drug-resistant strains.

OBJECTIVE To investigate the drug resistance of ESBLs-producing Escherichia coli and Klebsiella pneumoniae in local nosocomial infection,for guiding the clinical drug resistance. METHODS ATB analysis system was used for identification of bacteria,extra-susceptibility tests were detected by K-B method. RESULTS The isolation rate of ESBLs-producing E. coli and the K. pneumoniae was 29.9% and 30.8%,respectively. The drug susceptibility was indicated the resistance rate of ESBLs producing strains to antibacterial agents except imipenem was higher than that of non-ESBLs producing strains. CONCLUSIONS Detecting drug resistance of ESBLs producing strains is of important significance for guiding the clinical rational use of antibacterials and controling the epidemics.

Objective To investigate the preventive effect of continuous quality improvement(CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving framework called the PDCA cycle (plan,do,check and act).The dialysis adequacy,nutritional status,inflammation and cardiovascular events were analyzed before and after PDCA.Results Compared with before PDCA,the proportion of patients with Kt/V≥1.7 and urea kinetics (Kt/V) level were increased after PDCA [71.8％ vs.93.75％,(1.97±0.36) vs.(2.08±0.33),both P＜ 0.05].Serum levels of albumin (ALB),prealbumin (PAB) and serum carbon dioxide combining power (CO2 CP) were increased after PDCA (all P＜0.05).The proportion of patients with ALB≥40 g/L was increased after PDCA as compared with before PDCA (9.4％ vs.31.3％,P＜0.05).The nutritional variables including mid-arm circumference (MAC),triceps skinfold thickness (TSF),mid arm muscle circumference (MAMC),and lean body mass (LBM),lean body mass percentage (LBM％),normalized protein equivalent of total nitrogen appearance (nPNA),handgrip strength were improved after PDCA (P＜ 0.05).High sensitivity C-reactive protein (hs-CRP) level and the proportion of patients with hs-CRP＞3 mg/L were decreased after PDCA as compared with before PDCA [(8.65±6.22) mg/L vs.(5.37±4.33) mg/L,53.1％ vs.25％,both P＜0.05].The incidence of peritoneal dialysis related peritonitis was reduced obviously from 1 case every 25.4 months to 1 case every 78.1 months after PDCA (P ＜ 0.05).The hospitalization rate due to cardiovascular events was decreased after PDCA as compared with before PDCA (25％ vs.3.13％,P＜0.05).Conclusions CQI may significantly improve the malnutrition,inflammation and dialysis adequacy,and reduce the hospitalization rate due to cardiovascular events in elderly patients undergoing peritoneal dialysis.

Objective To understand the prevalence of diabetes and its influencing factors among rural residents in Fengdu coun-ty of Chongqing and to provide the suggestion for diabetes prevention and control.Methods Rural residents aged above 18 years old were sampled by stratified clustered random sampling.The data was entered by software Epi data3.02 and analyzed by SPSS 16.0.The rate was compared by Chi-square test.The influencing factors of diabetes was identified by multivariate logistic regres-sion.Results A total of 623 rural residents was investigated.The average age was (51.3±1.4)years old.The rate of smoking at present was 20.2% and the rate of smoking at present among male rural residents was 53.0%.The rate of passive smoking was 38.2%.The rate of drinking alcohol in the past 12 months was 22.8%.And its rate of male residents was 41.7%.The awareness rate of height,body weight,waist circumference,blood pressure and blood glucose was 9.5%,13.6%,1.9%,50.1% and 12.4%respectively.The crude and adjusted prevalence of obesity,hypertension and diabetes was 11.4% and 8.3%,52.5% and 28.4%, 12.0% and 9.3%.The result of multivariate logistic regression indicated that whether parents had diabetes(OR=0.20,95%CI :0. 04-0.94)and whether participants was diagnosed to be hypertension (OR=2.31,95%CI :1.19-4.49)was the independent fac-tor of diabetes.Conclusion The prevalence of diabetes among rural residents in Fengdu county of Chongqing was high.The risk factors such as smoking,alcohol use and unbalance diet was common.It should be strengthened to conduct the comprehensive ine-trevention for diabetes in rural area.

Objective To investigate the substantia nigra (SN) and brainstem raphe (BR) echogenic features of Parkinson's disease (PD) patients with musculoskeletal pain.Methods A total of 115 PD patients recruited in the Second Affiliated Hospital of Soochow University from October 2014 to May 2016 were assessed with the following rating scales:Unified Parkinson's Disease Rating Scale (UPDRS),Hoehn and Yahr Staging Scale (H/Y),Hamilton Rating Scale for Depression (HRSD),Beck Depression Inventory Ⅱ (BDI-Ⅱ) and Visual Analogue Scale (VAS).All the subjects underwent transcranial sonography during the clinical evaluation.And the patients were divided into PD with musculoskeletal pain (n =54) and PD without musculoskeletal pain (n =61) groups,or PD with depression(n =74) and PD without depression(n =41) groups.Results Compared with PD patients without pain,PD patients with musculoskeletal pain had higher scores of UPDRS-Ⅱ,-Ⅲ,HRSD,BDI,NMSQ and H/Y (UPDRS-Ⅱ score:12.56 ±6.01 vs 8.79 ±4.38,t =-3.801,P ＜0.01;UPDRS-Ⅲ score:24.43 ± 12.43 vs 20.07 ± 11.12,t=-1.986,P=0.049;HRSD score:11.65-±6.94 vs 8.38-±5.36,t=-2.844,P=0.005;BDI score:14.09 ±6.20 vs 9.74 ±6.00,t =-3.826,P ＜0.01;NMSQ score:8.57 ± 4.06 vs 5.60 ± 3.38,t=4.193,P＜0.01;H/Y:2.0(1.5,2.6) vs 1.5(1.0,2.0),Z=-3.011,P=0.003).Positive BR was more frequent in depressed than in non-depressed PD patients without pain (63.6％ vs 14.3％;x2 =15.25,P ＜0.01).Positive BR was positively associated with sex(r =0.228,P =0.014),age(r =0.184,P =0.049),disease duration (r =0.196,P =0.035),and depression (r =0.396,P ＜ 0.01).However,positive BR did not correlate with musculoskeletal pain.No correlation was found between positive SN and clinical characteristics of PD patients.Conclusions PD patients with musculoskeletal pain have worse activity of daily living,more severe motor symptoms,more non-motor symptoms,and are more depressed.SN and BR echogenecity do not correlate with musculoskeletal pain,however,hypoechogenic or interrupted BR is associated with depression in PD patients.