BACKGROUND:Now a correspondingly stable project was performed in the rehabilitative treatment for patients with chronic heart failure in China,but it was difficult to be carried out on the wide range because of difficulties in adjusting movement capacity,lower compliance and so on,especially for the elder patients or those with severe chronic heart failure.The movement project will be required with the advantages of good compliance,moderatemovementcapacityandreproducibilityin clinic.OBJECTIVE:To investigate the change of exercise tolerance and cardiac function after the intervention in movement training in patients with chronic heart failure.DESIGN: Randomized and controlled observation.PARTICIPANTS:Seventy inpatients with stable chronic heart failure were chosen from the Department of Gerontology in Wuhan Union Hospital of Hubei Province from August 2002 to October 2003.All patients agreed to this test. Functional class of New York Heart Association (NYHA)was (2.69±0.13).Chronic heart failure duration of all patients was over six months. Seventy patients were randomly divided into movement group(n=34) and control group(n=36).In the movement group with 19 males and 15 females,functional class was(2.68±0.12).In the control group,there were 19 males and 17females.METHODS:Thepatientsinthemovementgroupunderwentthree weeks of movement training (bicycle ergometer,treadmill walking and walking on foot). The patients in the control group underwent three weeks of activity restriction. All patients received the 6-minute walking test under the condition of the same rating of perceived exertion before and after the test. Totally 5 mL of venous blood was drawn without eating anything in the morning before and after the test.The levels of interleukin-6 and norepinephrine were evaluated and left ventricle ejection fraction was observed and determined.MAIN OUTCOME MEASURES:Comparison of walking distance,interleukin-6,norepinephrine,l.eftventricleejectionfractionandcardiac functional class before and after the intervention in all patients.RESULTS:Seventy patients with chronic heart failure were involved in the statistical analysis at last. After the intervention,walking distance covered during 6minutes and left ventricle ejection fraction in the movement group were obviously longer and higher than those before the intervention and in the control group [(385±30)m,(43±5)％;(324±35)m,(39±6)％;(292±30)m,(35±4)％,P＜ 0.05].After the intervention,the levels of plasma interleukin-6 and norepinephrine and cardiac functional class in the movement group were lower than those in the control group and before the intervention[(0.86±0.25) pmol/L,(2.05±0.48) nmol/L,(1.89±0.11);(1.00±0.25)pmol/L,(2.21 ±0.47)nmol/L, (2.45 ±0.12);(1.12±0.23) pmol/L,(2.46 ±0.53) nmol/L,(2.68±0.12),P＜ 0.05-0.01].CONCLUSION:Theprojectof movementtrainingdesignedinour study can improve exercise tolerance and ameliorate cardiac function in patients with chronic heart failure. This project has the advantage of better compliance designed according to oneself.

Objective To investigate the effect of skeletal muscle training on exercise tolerance in patients with chronic heart failure(CHF). MethodsSeventy patients with CHF were divided into group A( n =34),undergoing 3 weeks of exercise training(bicycle ergometer, treadmill walking and walking on foot),and group B( n =36), undergoing 3 weeks of activity restriction. Before and after exercise training and after activity restriction, 6 minutes of walking test was performed and levels of interleukin-6(IL-6), norepinephrine(NE) and left ventricle ejection fraction(LVEF) were evaluated. ResultsAfter exercise training in group A, the maximum distance walked was (385?30.12)m. The levels of LVEF, plasma IL-6 and NE were (43?5.23)%,(0.86?0.25)pmol/L and (2.05? 0.48 )nmol/L,respectively. All the above parameters were significantly ameliorated when compared with group B ( P 0.05). ConclusionThe skeletal muscle training could improve exercises tolerance and ameliorate cardiac function in patients with chronic heart failure,which was beneficial for the rehabilitative treatment.

Objective To know the usage of Chinese patent medicine of western medicine doctors in general hospitals. Methods By means of informal discussion with experts, present situation was known; By means of screening questions in questionnaire, nationwide investigation was conducted by this questionnaire about Chinese patent medicine and the results were examined by statistical analysis. Results That the abuse of Chinese patent medicine by western medical doctors was quite common. The overall quality of their prescriptions was not good. Most of the doctors have never received specialized continuing education of traditional Chinese medicine, only having preliminary knowledge or nothing on syndrome differentiation and treatment of traditional Chinese medicine. Conclusion The management department should take following measures: further enhance continuing education of TCM;formulate related policies;improve present situation.

Objective To investigate the key points in the nursing work of esophageal waterperfused high-resolution manometry (WHRM).Methods Summarized the nursing experiences before,during and after WHRM of 153 patients.Results Only 5 cases could not finish the test due to failure of intubation.23 cases complained about nasopharyngeal discomfort but follow-up monitoring was unremarkable.Conclusion In order to ensure the completion of WHRM,nursing cooperation requires serious assessment and preparation before manometry,intimate observation of patients' condition during manometry,and keep the catheter disinfection after manometry.

Objective To explore the effects of physical training on serum activity of some peripheral inflammatory markers associated with endothelial dysfunction, such as granulocyte macrophage-colony stimulating factor (GM-CSF), macrophage chemoattractant protein-1 (MCP-1), soluble intercellular adhesion molecule-1(sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in patients with chronic heart failure. Methods Forty-eight patients were enrolled and randomly divided into two groups: a training group and a rest group. The patients of both groups were both given conventional internal medicine therapy, and the patients of the training group were given physical training in addition. The serum levels of GM-CSF, MCP-1, sICAM-1 and sVCAM-1 in patients of the two groups were determined with stable chronic heart failure before and after 12 weeks of programmed physical training. At the same time, the motor functional status of chronic heart failure patients was evaluated by using the 6-minute walking test. Results It was shown that the physical training produced a significant reduction in serum GM-CSF, MCP-1, sICAM-1 and sVCAM-1 as well as a significant improvement in performance of the 6-minute walking test. Conclusion The physical training could significantly alleviate the inflammation reaction and improve the motor function of patients with chronic heart failure.

?AIM: To compare postoperative anti -inflammation effect and safety between bromfenac sodium eye drops and pranoprofen eye drops in patients after laser epithelial keratomileusis ( LASEK) .? METHODS: In the prospective, randomized and controlled study, 100 patients ( 200 eyes ) undergoing LASEK were randomized into the bromfenac sodium group (100 eyes) and control group (100 eyes).Patients in bromfenac sodium group received bromfenac sodium hydrate ophthalmic solution eye drops twice a day in 3d before surgery and 2wk after surgery, while the patients from the control group were given proanoprofen eye drops 4 times a day in the same period.At 1, 3, 5d, 1 and 3mo after surgery, irritative symptoms grade, duration of irritation, time for corneal epithelial healing, cornel haze, uncorrected visual acuity and intraocular pressure ( IOP ) were observed and compared between the two groups. Quantitative data were analyzed using independent samples t-test and ranked data were statistically analyzed using the Mann-Whiteney rank sun test.?RESULTS:There was no significant difference between two groups in irritative symptoms grade ( P =0.317 ), neither was existed between two groups in uncorrected visual acuity after surgery (P>0.05).There was no statistical significance in the time for corneal epithelial healing between two groups (P=0.551).?CONCLUSION: Bromfenac sodium eye drops ( 1g/L ) can achieve the same therapeutic effect as pranoprofen eye drops after LASEK.

Objective To understand the effect of circumcision in reducing high-risk human papilloma virus (HPV) infection in male adults. Methods One hundred and twenty-eight married adults with phimosis who underwent circumcision enrolled in the case group and high-risk HPV of urethral discharge specimens were detected before and 2 years after operation. A total of 128 cases of phimosis without circumcision were recruited in the control group. High-risk HPV infection rates were compared between the two groups. Results The highrisk HPV infection rates in the two groups were comparable at baseline. In the circumcision group, high-risk HPV infection rate was 27. 3% preoperative and it significantly decreased to 12.5% two years after operation( x2 =8. 839 ,P =0. 005). In the control group,high risk HPV infection rate was 28. 1% at baseline and it was 25.0%two years later, with no significant difference (x2 =0.320,P = 0.671).Conclusion Circumcision can significantly reduce high-risk HPV infection. Promoting circumcision actively in our country may have an important role in preventing high-risk HPV infection.

Objective:To study the in vitro and in vivo transdermal enhancement of one kind of arginine oligomer-chitosan ( CS-R9). Methods: In vitro mouse skin as the barrier, Franz diffusion cells were used to study the transdermal property of tinidazole ( TNZ) solution in vitro enhanced by CS-R9 using TNZ solution as the negative control and TNZ solution with Azone as the positive control. The rats were randomly divided into three groups, TNZ solution group ( the negative group) , TNZ solution with Azone group (the positive group) and TNZ solution with CS-R9 group. At the predetermined time intervals, 0. 5 ml blood was withdrawn from the rats and TNZ concentration was detected by HPLC to evaluate the enhancement of CS-R9 on TNZ in vivo. Results:Compared with the negative group, CS-R9 had significant enhancement on TNZ trandermal penetration in vitro(P <0.05), and showed no significant difference with Azone (P>0. 05). The in vivo results showed CS-R9 exhibited similar transdermal enhancement on TNZ as Azone at the same concentration (P>0. 05), and CS-R9 had sustalned-release property. Conclusion: CS-R9 has promising transdermal en-hancement on TNZ, which is valuable to be studied further.

Objective:To study the effect of molecular weight and degree of substitution (DS) of chitosan-poly-arginine (CS-R9) on transdermal penetration enhancement in vitro. Methods:Low molecular CS, medium molecular CS or high molecular CS was respectively used to synthesize CS-R9 with different molecular weight (LCS-R9-1, MCS-R9 and HCS-R9). Low molecular CS was used to synthesize CS-R9 with various degree of substitution by changing the mole ratio between R9 and CS (LCS-R9-1, LCS-R9-2 and LCS-R9-3). The in vitro transdermal penetration enhancement of the different CS-R9 on tinidazole ( TNZ) was studied using Franz diffusion cells. Results:According to the results of FTIR and 1 H-NMR, a series of target CS-R9 were synthesized including LCS-R9-1 with the DS of 2. 30, MCS-R9 with the DS of 2. 17, HCS-R9 with the DS of 2. 20, LCS-R9-2 with the DS of 8. 05 and LCS-R9-3 with the DS of 15. 87. Compared with the blank control group, Azone group, LCS group, R9 group and LCS+R9 group, LCS-R9-1 could enhance the in vitro transdermal penetration of TNZ significantly (P<0. 05). When the DS was unchanged, LCS-R9-1 and HCS-R9 showed similar enhancement in the first 12h, and the effects were both higher than that of MCS-R9 (P<0. 05). The enhancement of HCS-R9 was decreased during 12-24h, while compared with that of LCS-R9-1, the difference was not notable (P>0. 05). When the molecular weight of CS was unchanged, the effect was increased with the rise of DS in the first 21h, however, after that, the effect was decreased with the rise of DS. Conclusion:Molecular weight and DS both have significant effect on the in vitro transdermal penetration enhancement of CS-R9, and it is valuable to further study the in vivo transdermal penetration enhancement of CS-R9 and underlying mechanisms.

SARS coronavims is an emerging virus. A lot of animals could be infected by SARS-CoV and Himalayan palm civets, as one of important hosts, is an ideal animal model. Viral genetic factors have been implicated in the emergence of SARS-CoV, with the suggestion that this virus is a recombinant between mammalian and avian coronaviruses. However, the recombination is unlikely to explain the appearance of SARS in humans.