Objective To observe the effect of penehyclidine hydrochloride (PHCD) combined with mechanical ventilation on inflammatory response in rats with acute respiratory distress syndrome(ARDS)induced by hydrochloric acid(HCl)inhalation. Methods 32 adult healthy male Sprague-Dawley(SD)rats were randomly divided into four groups:sham operation group,ARDS model group,PHCD group(intraperitoneal injection of 0.5 mg/kg PHCD at 30 minutes before HCl instillation)and mechanical ventilation group〔mechanical ventilation was given after PHCD treatment,ventilator settings were as follows:tidal volume(VT)=4 mL/kg,respiratory rate(RR)= 70 beats/min,the time ratio of inspiration to expiration(I:E)=1:2,fraction of inspired oxygen concentration(FiO2)=0.21〕,8 rats in each group. The rat ARDS model was created by HCl(0.1 mol/L,1.2 mL/kg) intratracheal instillation. After mechanical ventilation for 4 hours,the experiment was stopped. Arterial partial pressure of oxygen(PaO2)was measured,and the oxygenation index as well as lung wet/dry weight ratio(W/D)were calculated respectively. The pathological changes in lung tissues were observed under light microscope,and the pathological score was evaluated. The levels of myeloperoxidase(MPO),interlukin-8(IL-8)and nuclear factor-κB (NF-κB)in homogenate of lung tissues were all measured respectively by enzyme linked immunosorbent assay (ELISA). Results In rats of ARDS model group, there were significant infiltration of inflammatory cells, collapse of extensive pulmonary alveoli and hyaline membrane formation in lung tissues,but the edema in pulmonary mesenchymal tissue and congestion of micro vessels were not obvious. Compared with sham operation group,the lung tissue pathological score(9.88±2.03 vs. 1.38±0.92),lung W/D ratio(7.67±0.96 vs. 4.08±0.65)were significantly increased(both P<0.01),while oxygenation index〔mmHg(1 mmHg=0.133 kPa):213±29 vs. 428±28〕was markedly decreased in model group(P<0.01);and the concentrations of MPO(μg/L:34.18±3.99 vs. 20.92±1.40), IL-8(ng/L:864±53 vs. 583±91)and NF-κB(ng/L:1 229±133 vs. 803±130)in homogenate of lung tissues were significantly higher in model group(all P<0.01). The pathological changes in lung tissues including inflammatory cell infiltration,collapse of alveoli and pulmonary edema,etc. were obviously improved when treated by PHCD or mechanical ventilation and the lung pathological score and W/D ratio were significantly decreased compared with those of model group,oxygenation index in these two groups were both significantly increased,meanwhile, the concentrations of MPO,IL-8 and NF-κB were sharply decreased when compared with those of model group (all P<0.05). The degree of improvement in all above indexes were greater in mechanical ventilation group than those in PHCD group(lung injury score:5.63±1.85 vs. 7.63±1.67,lung W/D ratio:5.35±1.05 vs. 6.46±1.17, oxygenation index:325±57 vs. 272±44,MPO:25.80±3.36 vs. 29.88±3.93,IL-8:736±53 vs. 802±53, NF-κB:984±75 vs. 1 109±118,all P<0.05),however they did not reach the levels of the sham operation group (P<0.05 or P<0.01). Conclusion PHCD can inhibit the inflammatory response in ARDS rats induced by HCl inhalation,thus it may protect the lung tissue from injury induced by HCl,and the protective role of PHCD plus menchanical ventilation is superior to that of PHCD only.

Objective To explore the criterion of constitution with Yin-deficiency and provide the evidence for further development of establishing the criterion.Method According to reference documents on TCM,a questionnaire on the criterion of constitution with Yin-deficiency was developed and distributed to 51 experts of TCM in Zhejiang province.Results The mean scores of forty-six items ranged from 2.02 to 2.78 and top sixteen symptoms were dry mouth,dry stools,dry throat,feverish palms and soles,thready pulse,constipation,emaciation,yellowish urine,red tongue,rapid pulse,vertigo,thirst with preference for cold drinks,vexation,dry lips,little coating,thirst with frequent drinking.Modes of 46 items ranged from 1 to 4.Coefficients of weight for diagnosis ranged from 0.018 to 0.024 and variance of coefficients were from 0.540 to 1.572.Conclusion Forty-six items could become the content of the criterion of constitution.

Objective To study the effect of breviscapine injection on cerebral blood perfusion in patients with hypoperfusion/decreased embolic clearance type cerebral infarction.Methods 100 patients with hypoperfusion/decreased embolic clearance type cerebral infarction in our hospital were selected and randomly divided into two groups.Both group were treated with conventional western medicines, and the experimental group was additionally treated with breviscapine injection.The plasma D-dimer (D-D), fibrinogen (Fib), systolic and diastolic blood pressure and recovery of neurological function were compared between the two groups.Results D-D and Fib levels and NIHSS score in the experimental group were significantly lower than those in the control group (P< 0.05), while the systolic blood pressure was significantly higher than that in the control group (P< 0.05).Conclusion Breviscapine injection can reduce the plasma D-D and Fib levels, increase cerebral vascular blood flow and improve the neurological function in patients with hypoperfusion/decreased embolic clearance type cerebral infarction.

Objective To explore the clinical manifestations,antimicrobial therapy,and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection.Methods Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively.According to the 28-day survival after diagnosis,the patients were divided into death group (n =76) and survival group (n =77).Data related to demographic and clinical characteristics,underlying diseases,treatment,invasive procedures,bacterial resistance to antibiotics,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores at onset,and antimicrobial therapy were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.Results This study included 153 patients with Acinetobacter baumannii bloodstream infection.The 28-day mortality was 49.7％.The independent risk factors of mortality were APACHE Ⅱ score ≥22 at onset (OR =15.7,95％ CI 5.1-48.1,P ＜ 0.001),septic shock (OR =6.3,95 ％ CI 1.9-21.3,P =0.003),and administration of steroids (OR =3.6,95％ CI 1.0-12.3,P =0.043).Compared with subjects treated with non-cefoperazone-sulbactam-based regimen,those treated with cefoperazone-sulbactam for multidrug-resistant Acinetobacter baumannii (MDR-AB) had significantly lower mortality on day7,day14 and day28 (8.9％ vs 59.2％,31.1％ vs 65.8％,44.4％ vs 72.4％ respectively).Conclusions The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month.Administration of steroids and septic shock are associated with poor prognosis.APACHE Ⅱ score ≥ 22 at onset predicts adverse outcome.Cefoperazone-sulbactam-based antimicrobial therapy improves patients' survival.

Objective To investigate the effects of Tong Xin-Luo on cultured human umbilical vein endothelial cells (HUVECs) impaired by Lysophosphatidylcholine.Methods The herbage-contained serum of TXL was prepared,HUVECs were cultured in vitro.The study was designated to 4 group:normal control,LPC group,TXL group,and TXL + LPC intervened group.The cell function was determined by cell morphology and MTT colorimetric assay.Results Compaired with normal control group (0.380 ±0.023 ),LPC ( 0.320 ± 0.024 ) could significantly decrease the cells activity,promote cells death ( P ＜0.05 ).After TXL intervened(0.424 ±0.034),cells activity was significantly increased,cells death was d significantly decreased( P ＜0.05 ).Conclusions Tong Xin-Luo could protect human umbilical vein endothelial cells function by against the LPC-induced damage.

Objective To retrospectively analyze the diagnosis and treatment of the extra-articular inflammatory pseudotumor after well-fixed metal-polyethylene total hip arthroplasty (THA).Methods From March 2006 to June 2011,7 patients (7 hips) who presented with a progressive pain and/or swelling,discomfort in groin or upper thigh after metal-polyethylene THA were admitted to our hospital.There were 2 males and 5 females,with an average age of 48.8 years (range,32-65 years).All 7 patients were identified with a periprosthetic osteolysis at the acetabular and/or femoral components and a mass in the iliac fossa or the thigh; however,the components were all well-fixed.The masses were confirmed by CT scanning and/or ultrasound examination.The revision procedures were done through ilioinguinal approach and posterior-lateral approach,and the pseudotumors were excised and osteolytic lesions were debrided and packed tightly with morselized cancellous allograft.The liner and femoral head were also exchanged at the same time.Clinical and radiographic outcomes of revision THA were evaluated.Results All 7 patients were followed up for 3-42 months (average,30 months).At final follow-up,all hips were functioning well and the average Harris hip score was 92.4.All acetabular components remained radiographically well-fixed.All cavitary defects had complete radiographic incorporation of the bone grafts.There were no new pseudotumor or osteolytic lesions identified,and no revision of the components.Conclusion The presence of abdominal or pelvic pseudotumor in patient with a THA may be associated with polyethylene wear.Once the extra-articular pseudotumor and the periprosthetic osteolysis are identified,the surgical treatment,including pseudotumor excise,osteolytic lesion debride and bone defect grafting and bearing surface exchange,can achieve retention of well-fixed components.

Objective To investigate the protective effect and associated mechanism of PNS in spinal cord hemisection injury.Methods fifty-five adult SD rats were randomly divided into three groups,sham group(n =5),spinal cord injury group(n =25),PNS group(n =25).The rats were evaluated in behavioral test with BBB score,pathology and immunohistochemistry at 1 d,3d,7d,14d,21d after the procedures.Results Motor recovery was significantly better in PNS group than the spinal cord injury group at 3d,7d,14d and 21d.Nissl staining showed less neuron necrosis and more integrated neural cells in morphology.cPLA2 expression was inhabited in PNS group,and less number of positive cells were found in the group.Conclusion PNS can inhibit the expression of cPLA2 after spinal cord injury,which may be one of the mechanisms of its effect on promoting motor recovery.

BACKGROUND: Disease pathogenic factors are complicated. There is not an effective method to analyze large sample data mining, and application ability of information technology of clinical doctors needs to be improved. OBJECTIVE: Using BP algorithm of artificial neural network to analyze large sample clinical cases, in order to explore inner relations between disease pathogenic factors and diseases.METHODS: Take hypertension for example, medical data of patients with hypertension in a traditional Chinese medical hospital served as experimental data, and the influence factors of the disease were simulated with Microsoft SQL Server 2005 Analysis Services, the mining data was analyzed, and a single query was used as prediction and decision support.RESULTS AND CONCLUSION: Analysis of effect of disease pathogenic factors on disease itself based on artificial neural network with BP algorithm has good predictive effect in clinical diagnosis, which is of benefit to enhance the diagnostic efficiency of medical personnel using information technology.

Objective To retrospectively analyze the short-term clinical effects of the two-stage cementless total hip arthroplasty in the treatment of chronic infection after the internal fixation of the adult proximal femoral fracture.Methods From June 2006 to June 2011,9 patients who had suffered a chronic infection after an internal fixation of the proximal femoral fracture,including 8 males and 1 female,aged from 31 to 74 years (average,52.6 years),were treated with two-stage cementless total hip arthroplasty.There were 3 cases of femoral neck fracture,and 6 cases of intertrochanteric fracture.In the first stage,after surgical debridement and thorough removal of all the implants,an antibiotic-loaded cement spacer was implanted.All patients postoperatively underwent intravenous and oral antibiotics,and the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested.When the values of ESR and CRP become normal,the second stage operation using cementless components was performed.Results The presence of infection was confirmed by a positive culture of joint fluid obtained intraoperatively in two cases;one case was staphylococcus aureus and another one was staphylococcus epidermidis.The second stage arthroplasty was performed 6-14 months (average,9 months) after the first stage operation.All 9 patients were followed up for an average of 23.2 months (range,6 to 50 months).No recurrent infection,component loosening,bone osteolysis and cement spacer or component dislocation occurred.The Harris score improved from 74.6 (range,64 to 86) before the first stage operation to 90.9 (range,86 to 97) at the final follow-up.Conclusion The two-stage cementless total hip arthroplasty is an effective strategy for the treatment of chronic infection after the internal fixation of the adult proximal femoral fracture.

Objective　To explore the relationship of pathological types of lung cancer with sex, age, site, and clinical diagnosis. Methods　The data of 1 310 patients with lung cancer diagnosed with fibrobronchoscopy, was retrospectively analyzed. Results　①The preliminary clinical diagnosed lung cancers which were comfirmed by fibrobronchoscopic biopsy later were mainly small cell lung cancer. ②The percentage of squamous carcinoma was significantly greater in male (78.0%) than in female (49.7%), but the percentage of adenocarcinoma was significantly higher in female (38.1%) than in male (13.1%)(P<0.0001). ③Among the patients with lung cancer, 53.7% was from 40 to 59 years old and 40.2% over 60. The average age of male patients (56.9 years old) was significantly greater than that of female (51.1 years old) (P<0.0001). ④ The average age of patients with squamous carcinoma and adenocarcinoma was greater in male than in female, but that with small cell carcinoma and squamous carcinoma was greater in female than in male. ⑤The percentage of male with lung cancer in the left lung (37.3%) was greater than that of female (26.0%), but the female had lung cancer in the right lung (59.7%) while male had (49.3%). The left and right upper lobe was more (45.4%) in male, but the right upper and lower lobe was more(43.3%) in female. Conclusion　①The fibrobronchoscopic examination is very important in the diagnosis of lung cancer. ②The pathological types and sites of lung cancer is different in different sex and age, which provide the exact bases for medical and surgical treatment for lung cancer.