OBJECTIVE:To investigate the safety and effects of different doses of budesonide combined with ipratropium bro-mide on rational symptom,lung function and arterial blood gas indexes of patients with acute exacerbation of chronic obstructive pulmonary diseases (AECOPD). METHODS:186 AECOPD inpatients were selected and randomly divided into low-dose,medi-um-dose and high-dose groups,with 61 cases in each group. All groups received routine treatment as ipratropium bromide 500 μg+0.9%Sodium chloride injection(NS)2 ml,oral inhalation with oxygen drive atomization nebulizer,oxygen flow rate of 4-5 L/min, 15-20 min/time,tid. Low-dose,medium-dose and high-dose group were additionally given Budesonide suspension 0.5,1.0,2.0 mg+NS 2 ml respectively,oral inhalation with oxygen drive atomization nebulizer,oxygen flow rate of 4-5 L/min 20 min/time,bid. Pa-tients in 3 groups were treated for 7 days. Pulmonary function,MRC score,arterial blood gas indexes and ADR were compared among 3 groups before treatment,3 and 7 days after treatment. RESULTS:FEV1% of 3 groups were significantly improved after treatment;3 and 7 days after treatment,FEV1% of high-dose group was higher than that of medium-dose and higher than that of low-dose group,with statistical significance(P<0.05). The MRC scales of 3 groups were significantly decreased after treatment;3 days after treatment,MRC scale of high-dose group was lower than those of medium-dose and lower than that of low-dose group,with statistical significance(P<0.05). 7 days after treatment,MRC scales of medium-dose and low-dose groups were low-er than that of low-dose group,with statistical significance (P<0.05),but there was no statistical significance in MRC scale be-tween high-dose group and medium-dose group after treatment 7 days(P>0.05). After treatment,there was statistical significance in PaCO2 and PaO2 among 3 groups (P<0.05),and the improvement of high-dose group was better than those of medium-dose and better than that of low-dose group,with statistical significance(P<0.05). No severe ADR was found in 3 groups. CONCLU-SIONS:Aerosol inhalation of 2.0 mg budesonide combined with ipratropium bromide can effectively improve pulmonary function, rational symptoms and arterial blood gas indexes with good safety.

OBJECTIVE:To investigate the effects and safety of 2 kinds of glucocorticoid administration regimens including 5 d and 15 d on clinical efficacy,pulmonary function,quality of life in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). METHODS:A total of 160 elderly patients with AECOPD selected from Haikou Forth People's Hos-pital during May 2013-Dec. 2015 were divided into group A and B according to lottery method,with 80 cases in each group. Both groups received symptomatic treatment as eliminating phlegm and relieving asthma,controlling infection,etc. Based on it,group A was given Methylprednisolone sodium succinate for injection,40 mg/d for 15 d;group B was given Methylprednisolone sodium succinate for injection,40 mg/d for 5 d. Clinical efficacies were compared between 2 groups as well as the levels of pulmonary ven-tilation function indexes,blood gas analysis indexes,Spitzer life quality index scale (QLI) scores before and after treatment. The occurrence of ADR was also compared between 2 groups. RESULTS:Total response rate of group A was 92.50%,and that of group B was 90.00%,without statistical significance(P>0.05). Before treatment,there was no statistical significance in the levels of pulmonary ventilation function indexes,blood gas analysis indexes,QLI scores between 2 groups (P>0.05). After treatment, FVC,FEV1,FEV1% and PaO2 of 2 groups were significantly higher than before treatment,while PaCO2 was significantly lower than before treatment,with statistical significance (P<0.05);there was no statistical significance between 2 groups (P>0.05). QLI scores of 2 groups were significantly higher than before treatment,and the group B was significantly higher than the group A, with statistical significance (P<0.05). The incidence of ADR in group B (6.25%) was significantly lower than group A (22.50%),with statistical significance(P<0.05). CONCLUSIONS:Glucocorticoid administration regimen including 5 d and 15 d in the treatment of elderly patients with AECOPD possess the same effects in improving lung function;glucocorticoid administra-tion regimen for 5 d application is superior in effectively improving the quality of life of patients,reducing the risk of ADR,and has clinical value.

OBJECTIVETo study the value of contrast-enhanced ultrasound with high-frequency linear-array transducer in the diagnosis of carotid stenosis.

METHODSThe carotid arteries of 31 patients was examined with color Doppler ultrasound (CDU), harmonic contrast ultrasound (HCU) and digital subtractive angiography (DSA), respectively. The result of DSA was used as the golden standard for evaluating the accuracy, sensitivity and specificity of CDU and HCU in the diagnosis of carotid stenosis.

RESULTSSatisfactory images of 62 carotid arteries were obtained from the patients using HCU with high-frequency linear-array transducer. After intravenous injection of contrast agent, densely dotted hyperechogenic signals were found in the vascular lumen, with stronger intensity than that of the vascular walls. The filling defect areas in the lumen indicated vascular stenosis. Thirty carotid stenoses were detected by DSA, and 25 by CDU. The accuracy, sensitivity and specificity of CDU was 83.3%, 82.0% and 84.9%, respectively. HCU identified 29 carotid stenoses with accuracy, sensitivity and specificity of 96.7%, 96.7% and 97.0%, respectively, significantly higher than those of CDU (P<0.05).

CONCLUSIONHCU with high frequency linear-array transducer has better the accuracy than CDU and may serve as a good alternative for diagnosis of carotid stenosis.

Aged ; Angiography, Digital Subtraction ; Carotid Arteries ; diagnostic imaging ; Carotid Stenosis ; diagnosis ; Female ; Humans ; Image Enhancement ; Male ; Middle Aged ; Transducers ; Ultrasonography, Doppler, Color ; instrumentation ; methods

BACKGROUND: Vascular endothelial growth factor (VEGF) can accelerate neovascularization and, as a multifunctional cytokine, performs critical functions via its receptors in angiogenesis.OBJECTIVE: To investigate the expression of VEGF and its receptor FLT-1 and FLK-1 mRNA during the early stage of acute focal cerebral brain ischemia, and examine the relationship between the timing and location of their expressions.DESIGN: Randomized controlled study.SETTING: Department of Neurology of the First Hospital Affiliated to Jilin University and Teaching and Research Section of Pathology, Bethune Medical College of Jilin University.MATERIALS: This study was carried out between June 2001 and April 2002. Totally 130 adult SD rats were selected, with male and female in half, and randomly divided into normal control group (n=10), sham operation group (n=10), and cerebral ischemia group (n=110). The rats in cerebral ischemia group were further divided equally into 11 subgroups and examined at 0, 1, 2, 3, 6, 24, 48 hours and 1, 2, 3, 4 weeks after cerebral ischemia model establishment, respectively.METHODS: Permanent middle cerebral artery occlusion (MCAO) model was established in rats in cerebral ischemia group by ligation of the left common carotid artery, while the rats in the sham operation group received no artery ligation but with identical other treatments. The rats in the control group did not have any treatment. Reverse transcriptional (RT) PCR was used to detect the expression of VEGF and its receptor mRNA at different time points after ischemic model establishment, and neovascularization in the rats'brain was observed.MAIN OUTCOME MEASURES: ① Expression of VEGF and its receptor mRNA and ② neovascularization in the brain tissue at different time points of cerebral ischemia.RESULTS: Data of the 130 mice were statistically analyzed without losses.At 3, 6, 24, and 48 hours of ischemia, the number of cells positive for VEGF expression was 31.13±2.21, 43.11±2.43, 85.41±2.75 and 98.66±1.76 in each vision filed in the surrounding ischemic region, greater than the numbers in the central ischemic region at the corresponding time points (13.32±1.31, 19.40±3.22, 47.63±2.45, 57.32±3.35 in each vision field, respectively, P ＜ 0.05). VEGF mRNA expression gradually decreased since 48 hours after model establishment till recovering the control level by 2weeks. The expression of VEGF receptor FLT-1 mRNA, determined by the number of positive cells in each vision field at 3, 6, 24, and 48 hour after the ischemia in each vision field for FLK-1 mRNA at these time points in the peripheral ischemic regions, higher than those in the central ischemic regions (P ＜ 0.05), which recovered the control level 3 weeks after the ischemia (P ＜ 0.05). At 48 hours and 1 week after the ischemia, the number of microvessels in each vision field was 47.2±2.11 and 199.2±3.45 in the peripheral ischemic region, significantly higher than the number in the central ischemic region (29.4±2.37 and 76.6±4.62, P ＜ 0.05).CONCLUSION: VEGF and its receptors FLT-1 and FLK-1 mRNA are expressed in the neurons, glial cells and endothelial cells during the early stage of acute focal cerebral ischemia, and the expressions are significantly enhanced in response to ischemia, exhibiting temporal and spatial expression patterns.

Objective Construct the reasonably effective performance assessment mode of clinical departments,which is suitable for the continuous development of modern hospital.Method Use of balanced scorecard (BSC) principle,using the analytic hierarchy process (AHP) and Rank sum ratio method (RSR)to establish a performance assessment system. Results Constructed the performance assessment mode of clinical departments,which can be dynamically adjusted based on management objectives strategy.The mode takes the BSC as the baseline,the strategy of hospital development as the guide,performance assessment index system as the key element. Conclusion The performance assessment mode of clinical departments,base on BSC,achieve the strategic performance management,and is conducive to the hospital for continuous improvement of medical care quality,in line with the long-term strategic needs of the hospital.

Objective To explore atechnical modification bytransperineal Da-Wanorectoplasty(Da-WARP) ontreatinglow,intermedi-ate anorectal anomalies(AA) andto evaluate the results of long-termfollowup.Methods Forty-six cases of AAunderwent a Da-WARP,whichinvolved preservation of the rectal end of the fistula andinvagination of the perineal skinflapthroughthe neoanus.The clinical records werereviewed and analyzedretrospectively.Results The medianfollow-up period was 7 years and 2 months.All of themachieved a goodfecal conti-nence exception of 1 patient withintermediate AAand associated anomaly,hadfair result.Conclusions The Da-WARPis relativelysimple andpractical methods for surgical treatment of low,intermediate AA,with goodlong-termresults.

Objective To explore a technical modification by transperineal Da-W anorectoplasty(Da-W ARP) on treating low,intermediate anorectal anomalies(AA) and to evaluate the results of long-term follow up.Methods Forty-six cases of AA underwent a Da-W ARP,which involved preservation of the rectal end of the fistula and invagination of the perineal skin flap through the neoanus.The clinical records were reviewed and analyzed retrospectively.Results The median follow-up period was 7 years and 2 months.All of them achieved a good fecal continence exception of 1 patient with intermediate AA and associated anomaly,had fair result.Conclusions The Da-W ARP is relatively simple and practical methods for surgical treatment of low,intermediate AA,with good long-term results.

Objective To explore a technical modification by transperineal Da- W anorectoplasty (Da WARP) on treating low, intermediate anorectal anomalies(AA) and to evaluate the results of long - term follow up. Methods Forty six cases of AA underwent a Da-W ARP,which involved preservation of the rectal end of the fistula and invagination of the perineal skin flap through the neoanus.The clinical records were reviewed and analyzed retrospectively. Results The median follow - up period was 7 years and 2 months. All of them achieved a good fecal continence exception of 1 patient with intermediate AA and associated anomaly,had fair result. Conclusions The Da - WARP is relatively simple and practical methods for surgical treatment of low, intermediate AA, with good long - term results.

In order to evaluate our teaching results and improve the teaching quality,we designed this study to analyze the scores of nuclear medicine examination for the students of 2001 majoring in clinical medicine.There were 345 students participating in the examination.The results showed that the scores was Gassion distribution,the average score was 82.26,and the difficulty and discrimination of the test paper were appropriate.This analysis method as an objective index can be used to evaluate the response of teaching in nuclear medicine as well as improve the quality of test paper.

Objective:To explore the application effect of case-based learning (CBL) in teaching magnetic resonance imaging (MRI) for non-imaging clinical professional postgraduates.Methods:Eighty non-imaging clinical professional postgraduates who had standardized residency training from 2017 to 2019 were selected as the participants and were randomly divided into two groups, experimental group and control group. The experimental group adopted CBL, and the control group adopted traditional teaching mode. After the standardized training in the radiology department, the differences in image reading scores, theoretical scores and course evaluation were compared between the two groups. SPSS 25.0 statistical software was used for analysis. Independent t test was used for the measurement data of normal distribution, Mann-Whitney U test was used for the measurement data of skewed distribution, and categorical variables were compared by chi-square test. Results:In the reading scores of MRI, the scores of the experimental group and the control group were (82.53 ± 5.72) points and (77.38 ± 6.14) points respectively, and the number of students in the experimental group whose reading scores were between 80-100 segment was 63.6% higher than that in the control group, with significant differences between the two groups ( P < 0.001), but without significant differences in theoretical average scores between the two groups ( P > 0.05). In addition, in the course evaluation, except for the index of learning burden, there were significant differences in other indexes between the experimental group and the control group ( P < 0.05). Conclusion:In the teaching of MRI, the application of the CBL helps non-imaging clinical professional postgraduates improve their MRI diagnostic thinking and independent reading ability.