Objective To compare the curative effect of tiotropium bromide combined with salmeterol flutica-sone of different specifications in treatment of chronic obstructive pulmonary disease(COPD)at stable stage in senile patients.Methods 84 senile patients of COPD were selected.All the patients were divided into observation group (42 cases)and control group(42 cases).And both groups were provided with basic treatment of tiotropium bromide, on the basic treatment,the patients in the observation group were provided with 50μg/250μg salmeterol fluticasone, and the control group with 50μg/500μg salmeterol fluticasone.The course of treatment in the two groups was 12 months.The arterial blood gas,lung function,motor function and clinical efficacy were compared between the two groups after treatment.Results 12 months after treatment,the arterial oxygen partial pressure(PaO2 ),arterial carbon dioxide partial pressure(PaCO2 ),forced expiratory volume in one second(FEV1 ),forced vital capacity(FVC),1 second forced expiratory volume accounted for the percentage of forced vital capacity(FEV1 /FVC)of the control group were (51.66 ±3.96)mmHg,(66.58 ±4.90)mmHg,(1.39 ±0.09)L,(2.41 ±0.09)L,(60.40 ±4.25)%,(366.01 ± 17.21)m respectively,which of the observation group were (46.29 ±3.38)mmHg,(75.83 ±5.09)mmHg,(1.59 ± 0.12)L,(2.65 ±0.10)L,(67.33 ±485)%,(325.69 ±15.62)m respectively.The arterial blood gas,lung function and exercise capacity of the two groups were significantly improved,among them,PaO2 of the control group was significantly better than that of the observation group,the difference was statistically significant (t =6.684,P <0.001).PaCO2 of the control group was significantly better than that of the observation group,the difference was statistically significant(t =-8.485,P <0.001).FEV1 of the control group was significantly better than that of the observation group,the difference was statistically significant(t =-8.641,P <0.001).FVC of the control group was significantly better than that of the observation group,the difference was statistically significant(t =-11.561,P <0.001).FEV1 /FVC of the control group was significantly better than that of the observation group,the difference was statistically significant(t =-6.964,P <0.001).6MWD of the control group was significantly better than that of the observation group,the difference was statistically significant(t =-11.243,P <0.001).After 12 months of treatment, the total effective rate of the observation group was 97.62%,which was significantly higher than that of the control group 85.71%(χ2 =3.896,P =0.048).Conclusion The comprehensive effect of tiotropium bromide combined with 50μg/500μg salmeterol fluticasone is better than that of tiotropium bromide combined with 50μg/250μg salmeterol fluticasone.

0 05) Conclusions Mifepristone with misoprostol for terminating early pnegnaney might be affect the expression of lymphocyte and cytokines and induce the disorder of decidual micro environment which might be the reason of medical abortion

Objective To investigate the regulatory effects of mifepristone and progesterone on the secretion of interleukin 6 (IL 6) by endometrial and endometriosis cells in vitro. Methods Primary cultures of eutopic and ectopic endometrial cells from 9 cases of endometriosis were exposed to mifepristone (10 -6 mol/L, 10 -4 mol/L) and progesterone (1?10 -7 mol/L, 1?10 -5 mol/L) respectively. IL 6 secretion was analyzed in the culture medium by enzyme linked immunosorbent assay (ELISA). Results Mifepristone inhibited the IL 6 secretion of ectopic endometrial cells, with the concentrations of IL 6 was (1 914 33?799 28) ?g/L in the 1?10 -6 mol/L group ( P 0 05). Conclusion The inhibitory effects on the secretion of IL 6 by ectopic and (or) eutopic endometrium may provide one of the cellular therapeutic mechanisms of mifepristone and progesterone on endometriosis.

Objective To compare the efficacy and safety of mifepristone and danazol after conservative surgery in the treatment of patients with endometriosis Methods Sixty one patients with endometriosis (RAFS stage Ⅰ～Ⅳ) after conservative surgery were treated orally either with mifepristone 10 mg/d (group M, n =31) or danazol 200 mg 2～3 times/d (group D, n =30) for 3 months Changes of symptoms and signs, serum reproductive hormone levels as well as side effects were assessed before and at the end of therapy Moreover, biochemical parameters of bone metabolism: urinary deoxypyridine /creatinine (UDpd/Cr),serum alkaline phosphatase (AKP) and bone gala protein (BGP) were also measured before and after treatments Results During treatment symptoms and signs were remarkbly relieved in both groups Side effects including hot flushes, irregular vaginal bleeding, back pain, weight gain and acne, were less commnly seen in group M as compared with group D Serum luteal hormone (LH), follicular stimulating homone (FSH) levels remained in the range of follicular phase in both groups So was serum estradiol (E 2) levels in group M[(204 9?45 3 ) pmol/L], but declined to postmenopausal level in group D [(94 3?33 0) pmol/L] About two weeks after discontinuation of the thrapy, serum E 2 levels [(1 221 6? 384 2) pmol/L] was not significantly different from the normal ovulatory range in group M, but significantly lower in group D [(815 1?376 0) pmo/L, P

Skeletal muscle is essential for the glucose disposal in organism, which is one of the major sites of insulin resistance.The over-activity of classical renin-angiotensin system ( RAS) induces the oxidative stress, leads to the impairment of insulin signaling and glucose transport, resulting in insulin resistance of skeleton muscle.The activation of non-classical RAS by inhibiting classical RAS activity, can ameliorate insulin resistance in skeletal muscle tissue.

Objective To explore the expression and clinical significance of CD 8 +CD28 -T lymphocytes in the patients with endometriosis ( EMT) complicating with pelvic fluid .Methods Eighty patients with endometriosis complicating with pelvic fluid ( ca-ses of ⅠtoⅣwere 15, 12, 22, and 31, respectively) were enrolled.The peripheral blood as well as the pelvic fluid were collected and flow cytometry was applied to detect the frequencies of CD 8 +CD28 -T lymphocytes and their intracellular cytokines , including transforming growth factor β1 (TGF-β1) and interleukin 10 (IL-10).Twenty health women with the same range of age were enrolled as the control group .Results Compared with the control ones , the frequencies of peripheral blood CD 8 +CD28 -T lymphocytes , TGF-β1, and IL-10 of the EMT subjects were increased significantly (all P <0.05), which presented the order Ⅳ>Ⅲ>Ⅱ>Ⅰand the difference between every two of the Ⅰ~Ⅳgroups was significant (all P <0.05).Similarly, the data of CD8 +CD28 -T lymphocytes, TGF-β1, and IL-10 in pelvic fluid also presented as Ⅳ>Ⅲ>Ⅱ>Ⅰ.Moreover, the difference of pelvic fluid TGF-β1 between any two groups was more apparent compared with CD 8 +CD28 -T lymphocytes and IL-10 ( P <0.05 ) .Spearman correlation analysis showed that any one of CD8 +CD28 -T lymphocytes, TGF-β1, and IL-10 positively correlated with any stage of ⅠtoⅣ( rs =0.791, 0.753,0.726 and all P <0.05).Conclusions CD8 +CD28 -T lymphocytes, TGF-β1, and IL-10 were closely related to the stages and could be the negative roles in the pathogenesis of EMT .TGF-β1 played a vital role in the formation of pelvic fluid .

Objective To evaluate the clinical efficacy of Bilevel non -invasive positive air pressure ventila-tion(BiPAP)in the treatment of stable COPD patients with typeⅡrespiratory failure.Methods 36 patients had stable COPD with typeⅡrespiratory failure was treated with BiPAP.And observed the changes of clinical symptoms and arte-rial blood gases before and after the treatment.Results The Blood gas index[(7.28 ±0.04)vs (7.37 ±0.06)], heart rate[(116 ±11)times/min vs (85 ±10)times/min],breath rate[(26 ±4)times/min,(17 ±3)times/min], frequence of hospitalization[(3.50 ±0.89)times vs (0.23 ±0.11)times],and hospital days[(22.3 ±8.8)d vs (11.4 ±4.6)d]significantly changed after treatment(all P <0.01),the symptoms,including the shortness of breath, and chest distress improved greatly,and also the exercise tolerance were much better than patients did before treatment.Conclusion BiPAP is an efficient treatment method,and valuable for stable COPD patients with type Ⅱrespiratory failure.

Objective To investigate the change of 25-hydroxyl vitamin D level and its impact on glucose metabolism and bone mineral density in type 2 diabetic patients.MethodsTwo hundred and fifty-eight cases of type 2 diabetic patients in our hospital were collected.In accordance with 25 (OH) D =50 nmol/L for the critical values,they were grouped into vitamin D deficiency group ( n =192) and the relative lack of vitamin D group ( n =66).Dual-energy X-ray absorptiometry (DXA) measurement of the lumbar vertebrae L2 - L4 and femoral neck bone mineral density were undertaking.Taking the total value of the lumbar spine,femoral neck and total value as judgment indicators,homeostasis model assessment of insulin resistance (HOMA-IR),we collected and statistically analyzed glucose metabolism and bone metabolism indicators in patients with diabetes.Results Among 258 cases of type 2 diabetes,there were 57 cases of osteoporosis accounting for 22.1％.There was significant difference on the duration of diabetes [ (7.98 ± 1.09 ) years old vs (3.77 ± 1.21 ) years old,t =4.849,P ＜0.05],FINS [ (6.42 ± 1.30) mU/L vs (5.79 ± 1.08) mU/L,t =3.871,P ＜0.05] and HOMA-IR [ (2.35 ±0.54) vs ( 1.85 ±0.41 ),t =2.705,P ＜0.05],but no significant difference on the FPG and HbA1c ( P ＞ 0.05 ) between two groups.PTH [ ( 36.51 ± 7.59) ng/L vs ( 32.02 ± 6.89 ) ng/L,t =2.008,P ＜ 0.05 ],bone mineral density in the lumbar total value [ (0.87 ±0.14) g/cm2 vs (0.99 ±0.12) g/cm2,t =2.799,P ＜0.05 ],femoral neck Neck [ ( 0.70 ± 0.10 ) g/cm2 vs ( 0.79 ± 0.11 ) g/cm2,t =2.564,P ＜ 0.05 ] and Total [ (0.84 ± 0.14) g/cm2 vs (0.97 ± 0.15 ) g/cm2,t =3.340 P ＜ 0.05 ] were statistically different,but no significant difference on the rest of the indicators.Conclusion The prevalence of vitamin D deficiency was found in patients with diabetes.Vitamin D level could affect insulin resistance and glycemic control and bone mineral density level.Therefore,routine vitamin D testing to the diabetic patients and giving vitamin D replacement therapy to vitamin D deficiency patients in a timely manner were necessary.

Objective:To evaluate the efficacy of high-risk HPV (HR-HPV) genotyping with vaginal self-sampling in primary screening and combining cytology or viral load for HR-HPV positive as secondary screening strategies.Methods:The data referring to HR-HPV genotyping of self-collected sample with mass array matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF-MS), HR-HPV viral load of physician-collected sample with hybrid capture Ⅱ (HC-Ⅱ), liquid-based cytology and histology of 8 556 women were from Shenzhen cervical cancer screening trial Ⅱ (SHENCCAST-Ⅱ) conducted between April 2009 and April 2010. The data were reanalyzed to determine the sensitivity and specificity to cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN Ⅱ +), CIN of grade 3 or worse (CIN Ⅲ +) when HR-HPV genotyping combining with colposcopy as primary screening strategy based on varied HR-HPV subtype (strategy 1, including 5 sub-strategies: 1a: HPV 16/18 positive; 1b: HPV 16/18/58 positive; 1c: HPV 16/18/58/31/33 positive; 1d: HPV 16/18/58/31/33/52 positive; 1e: any HR-HPV positive). The data were also compared to determine the efficacy of cytology (strategy 2, including 5 sub-strategies: 2a, 2b, 2c, 2d, 2e) or HR-HPV viral load (strategy 3, including 4 sub-strategies: 3a, 3b, 3c, 3d) of physician-collected sample as a triage with HR-HPV genotyping for self-sampling HR-HPV positives. Results:(1) The HR-HPV positive rate was 13.77% (1 178/8 556) in the self-collected samples of 8 556 pregnant women. Of them,the prevalences of HPV 16/18, HPV 16/18/58, HPV 16/18/58/31/33 and HPV 16/18/58/31/33/52 were 3.16% (270/8 556), 5.14% (440/8 556), 6.66% (570/8 556) and 9.81% (839/8 556), respectively. The HR-HPV viral load ≥10 relative light units/control (RLU/CO) was 8.87%(759/ 8 556), while cytological results ≥atypical squamous cell of undetermined signification (ASCUS) were 12.05% (1 031/8 556). (2) The strategy 1e had the highest sensitivities for CIN Ⅱ +, CIN Ⅲ + which were 92.70% and 94.33%,respectively,among 14 sub-strategies,while the lowest specificity and positive predictive value (PPV). Meanwhile,the required colposcopy referral rates were much higher than other 13 sub-strategies (13.77%). The other 4 sub-strategies of strategy 1 (1a, 1b, 1c, 1d), strategy 1a had the highest specificities for CIN Ⅱ + and CIN Ⅲ + (97.92%, 97.69%, respectively), while 1d had the highest sensitivities for CIN Ⅱ + and CIN Ⅲ + (88.41%, 92.20%, respectively). (3) Both strategies of referring self-sampling HPV 16/18 positives for immediate colposcopy followed by triage physician-collected sample cytology (≥ASCUS) or viral load (≥10 RLU/CO) for non-HPV 16/18 positives had significantly higher sensitivity and specificity for CIN Ⅱ, CIN Ⅲ +, as well as lower referral rates (strategy 2a and 3a). Additionally, based on these two secondary screening strategies, cumulatively using the other four HR-HPV (HPV 58, 31, 33 and 52) positives as triage for immediate colposcopy showed an enhanced sensitivity. Conclusions:Primary HR-HPV cervical cancer screening strategy based on self-sampling with triage of cytology (≥ASCUS) or viral load (≥10 RUL/CO) provides a good balance among sensitivity, specificity for CIN Ⅱ + and CIN Ⅲ + and the number of tests required, referral rates. The efficacy of HR-HPV genotyping combining cytology or viral load secondary screening strategies will have a spiral escalation when HPV 58, 31, 33, 52 are included.

OBJECTIVE To investigate the antitumor effect and toxicity of doxorubicin-heparinized mesoporous silicon nanoparticles drug carrier system (DOX-HMSN) on H22 hepatoma mice. METHODS An experimental animal model of H22 hepatoma mice was established. Fifty male Kunming mice were divided into five groups:model control group,HMSN 8 mg?kg-1 group,DOX-HMSN 4,8 mg?kg-1 groups, and DOX 2 mg?kg-1(once every other day)group. Continuous intravenous injection was given once a day for 14 d. Tumor was completely stripped and weighed,and tumor inhibitory rate was determined. Pathological change of tumor tissue was observed by HE staining in H22 mice. White blood cell count was performed and the thymus index and spleen index were calculated. Levels of serum creatinine (Scr),blood urea nitrogen(BUN),glutamic pyruvic transaminase(GPT)and glutamic-oxalacetic transaminase(GOT)in serum were determined. BCL-2,BAX and vascular endothelial growth factor (VEGF)expression of tumor tissue were analyzed using Western blot. RESULTS The inhibitory rate of tumor was 20.5%,40.4%,54.8%,and 67.5%,respectively,in HMSN 8 mg?kg-1 group,DOX-HMSN 4, 8 mg?kg-1 group and DOX 2 mg?kg-1 group(P<0.01). HE results showed that HMSN 8 mg?kg-1,DOX-HMSN 4,8 mg?kg-1and DOX 2 mg?kg-1 induced tumor necrosis and nuclear dissolution of the tumor cells in H22 mice. The white blood cell count,thymus index and spleen index of mice were not signifi?cantly different between control group and HMSN group or DOX-HMSN 4 and 8 mg?kg-1 group. The levels of Scr and BUN of mice did not change obviously in HMSN 8 mg?kg-1or DOX-HMSN 4,8 mg?kg-1 groups. Compared with the model control group,the level of GPT and GOT of mice increased in the DOX 2 mg?kg-1group but decreased in HMSN 8 mg?kg-1 and DOX-HMSN 4 and 8 mg?kg-1 group(P<0.05). Compared with the control,the BAX/BCL-2 ratio(from 0.49 ± 0.06 to 0.79 ± 0.08,1.23 ± 0.14 and 1.04±0.14)increased but the VEGF expression of tumor(from 1.39±0.14 to 1.13±0.12,0.75±0.08 and 0.94 ± 0.09)decreased significantly in DOX-HMSN 4,8 mg?kg-1 and DOX 2 mg?kg-1 group(P<0.05). CONCLUSION DOX-HMSN can inhibit the tumor growth of H22 tumor-bearing mice and its antitumor mechanism might be related to inducing tumor cell necrosis and apoptosis and inhibiting tumor angiogenesis.