Objective To study in patients with stable chronic obstructive pulmonary disease treatment, the use of Tiotropium Bromide Powder for Inhalation treatment combined with psychological intervention effect.Methods In 40 cases of patients with stable chronic obstructive pulmonary disease treatment using tiotropium bromide powder for inhalation, and classified as the control group, the other 40 patients in the control group based on the use of psychological intervention combined with treatment the treatment, and classified as the observation group, two groups of patients were in our hospital from January 2016 to January 2017.Results There was no significant difference in anxiety and depression of patients in the two groups before intervention, after the intervention group patients in the observation group improved significantly better;two groups of patients before intervention PaCO2, there was no significant difference in PaO2 index, after group intervention of patients in the observation group improved significantly better;compared two groups of patients with the treatment efficiency, the obvious observation group were higher, there were significant differences (P<0.05).Conclusion Tiotropium Bromide Powder for Inhalation combined psychological intervention treatment of patients with stable chronic pulmonary disease blocking was observed, which can improve the patient's condition, and improve the treatment effect, the patient's mental state adjustment also has a positive effect, it is worthy of reference.

Objective To study the influencing factors of raised D-dimer levels in elderly people.Methods 592 elderly people underwent physical examination in our hospital were selected.They were divided into observation group and control group according to the level of D-dimer.The clinical data,liver and kidney function and blood lipid levels between both groups were compared.Re-sults There were no significant difference on gender,BMI,FBG,ALT,AST and Cr between both groups (P >0.05),but the age of patients in the observation group were significantly higher than that of the control group(P <0.05).The PT,CRP,bacterial pneu-monia and (or)of acute exacerbations of chronic bronchitis,cancer,diabetes patients in the observation group were significantly higher than those in control group,while LDL-C,TC were significantly lower than that of the control group,there were significant differences (P <0.05).The plasma D-dimer level in patients showed positive correlation with CRP and age (r =0.27,0.25,P <0.05).Conclusion Malignant tumor,type 2 diabetes,bacterial pneumonia,acute exacerbation of chronic bronchitis are the risk fac-tors of raised plasma D-dimer levels in the elderly.

Objective To study the image features and clinical significance of 3-dimensional (3-D)and multiplanar reconstruction with spiral CT(SCT) in cervical spinal fractures.MethodPlain film radiography and spiral CT scanning were taken for 26 cases of cervical spinal fractures.The type of fractures, diagnositic successful rate, parameter of scanning and late stage managing methods were investigated retrospectively to find out the effective difference between the diagnosis of plain X-ray and SCT. The imagin location of fractures,sequence of cenrum, heighth of centrum, fracture line, auxillary structure and rotation/dislocation of the fractures were emphasized to evaluate the advantages of 3-D imaging.ResultIn the 26 cases, there were 4 Jefferson fractures, (in which 1 combined with articular dislocations), 17 C2 spinous process fractures, (in which 1 had failure of plain X-ray diagnostic), 1 Hangman fracture, 2 C1～2 imbalance, (in which 1 had failure of plain X-ray diagnostic).There were 2 cases of axoid longitudinal fractures without obvious dislocation. The diagnositic successful rate were 100% in SCT group, while 65% in X-ray group in which 6 cases had diagnostic failure and 3 cases had fracture mis-diagnozing as dislocation.The anatomical structure of upper cervical spine was complicated and was significantly different from other cervical spine constructions. Spiral CT could reveal high resolution images of the upper cervical spine, morphosis of vertibral canal, dislocation information of fracture mass and its relation with neighbouring tissues. Especially in C1 burst fracture,C2 dens fracture and C1～2 dislocation, SCT could provide clear 3-D information of the size of collateral mass and the dislocation degree, furthermore, images could be rotated freely to observe the fracture in any proper section. That provides important information for the decision of operation, selection of operation types and evaluation of operation dager.ConclusionThe spiral CT scan and 3D reconstruction can reveal fracture better.The advantages of SCT are suggested that this diagnostic modality may be the standard method for the initial evaluation of the upper cervical spine injury.

Objective To improve the quality of antibiotics prescriptions in outpatient and emergency departments, to reduce the irrational use of antimicrobial drugs and to improve the quality of pharmacy service through system of rational drug administration.MethodsAnalyzing and evaluating the data of irrational administration of antimicrobial drugs between 2014 and 2015.The data was collected by the system of rational drug administration.ResultsFrom 2014 to 2015, the qualified rate of antibiotics prescriptions increased from 95.40% to 98.71%.Different types of irrational use of antimicrobial agents significantly reduced.ConclusionThe application of system of rational drug administration can improve the qualified rate of antibiotics prescriptions in outpatient and emergency departments and can promote pharmacy service.

Objective To study the changes in tumor necrosis alpha(TNF ?), interleukin 6(IL 6), procalcitonin(PCT) and C reactive protein (CRP) levels and their values in the prediction and assisting diagnosis of infection complications in severe multiple trauma patients. Methods TNF ?, IL 6 and CRP were measured by enzyme linked immunosorbant assay(ELISA) and PCT was determined by immunoluminometric assay(ILMA) in serial samples of plasma from 34 patients with severe multiple trauma(ISS≥16) and compared with those of 11 normal control volunteers. Patients were divided into 2 groups(infection and non infection groups). The differences of the above parameters between groups were compared. In addition, all data were managed by receiver operating characteristic(ROC), and sensitivity, specificity, negative and positive predictive values for the diagnosis of infection complications were calculated. Results Plasma levels of TNF ?, IL 6, PCT and CRP in multiple trauma patients without infection complications were increased differently in the early posttrauma period. TNF ? and CRP levels in the early posttrauma period before infection were not significantly different from those in patients without infection complications, but they increased significantly following infection. However, during the whole observing period, plasma levels of PCT and IL 6 in the patients with infection complications were higher than those in patients without. The value of those parameters in assisting diagnosis of infection was evaluated. PCT was of the highest specificity and higher negative and positive predictive values. Conclusion All the parameters are of clinical value in infection diagnosis after severe multiple trauma. PCT is the best index for the prediction and assisting diagnosis of infection after multiple trauma.

Objective To report the clinical results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of type C fractures of distal femur.Methods A retrospective study was conducted to an- alyze 14 consecutive cases of distal femoral fractures who had been treated with MIPPO in our department from April 2002 to February 2005.According to AO/ASIF classification,there were three cases of type C1,six cases of type C2,and five cases of type C3.At first,the fractures of articular surface were directly reduced and fixed with spongy screws.Next,the condylar fractures were indirectly reduced and fixed with buttress or LISS (less invasive stabi- lization system) plates through transarticular approach.Results Follow-ups,ranging from 10 to 32 months for 12 cases,revealed that they all reached union.The time for their bony union was 10 weeks to 12 months (mean,4.6 months).Their functional recovery was evaluated according to criteria by Kolmert and Wulff.Four cases were rated as excellent,five as good,two as fair and one as poor.The total satisfactory rate was 75%.Conclusion MIPPO is a safe and effective procedure for the type C fractures of the distal femur with the benefits of limited invasion to soft tissues and a high rate of bone union.

OBJECTIVETo investigate the technological parameters of the purification process of total flavones from Smilax china with macroporous absorption resin.

METHODThe technical process for purification of total flavones with the optimum macroporous absorption resin was screened by yield of total flavones product.

RESULTThe D140 macroporous absorption resin had the best separating efficiency when the flavones content in the liquid was 0.5 g x mL(-1) equivalent to raw material, the volume of drug 18 BV (resin bad volume) with the adsorption-power 2 BV x h(-1), and the volume of 60% (mL x mL(-1)) ethanol as eluant 5-10 BV (resin bad volume) with desorption-power 1 BV x h(-1). The obtained flavones product has total flavones recovery rate of 84.72%.

CONCLUSIONThe treatment of regenerated resin is easy, this method is advisable.

Absorption ; Flavones ; chemistry ; isolation & purification ; Plants, Medicinal ; chemistry ; Resins, Synthetic ; chemistry ; Rhizome ; chemistry ; Smilax ; chemistry ; Technology, Pharmaceutical ; methods

AIM:To observe related biological parameters of 3 minutes dark-room provocative test in patients with laser peripheral iridectomy(LPI) in the fellow eyes of acute primary angle-closure (APAC) by ultrasound biomicroscopy (UBM).To explore the risk factors in primary angle closure suspect(PACS) patients with progressive angle closure after LPI.METHODS: Seventy-eight eyes of APAC patients without peripheral anterior synechia were selected.Each eye underwent 3 minutes dark-room provocative test after LPI.Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber angle open distance500 (AOD500), peripheral iris thickness (PIT), iris convex (IC), the position of iris insertion and trabecular-ciliary process distance (TCPD), and the number of positional angle closure(NPAC) were observed and analyzed by statistic methods.RESULTS:Patients with APAC were examined by UBM after LPI and 26 eyes(33%) occurs at least one positional angle closure,19 eyes(24%)were positive in 3 minutes dark-room provocative test among them.It occurs a positive relationship between the elevation intraocular pressure and the number of positional angle closure in dark-room provocative test(r=0.84, P<0.01).AOD500, IT and IC were significantly changed from normal light to darkroom between positional angle closure positive group and positional angle closure negative group(all P<0.01).In single factor analysis, AOD500(P=0.003), IT(P=0.012), IC(P=0.043), TPCD(P=0.015), the position of iris insertion(P=0.024) were correlative factors of positive results.In multiple-factor analysis, only IT(P=0.011), TPCD(P=0.009), iris root attachment points(P=0.02) were independent risk factors of positive results.CONCLUSION:A certain proportion of patients with PACS after LPI appeared positional angle closure in a dark room.Peripheral iris hypertrophy, anterior displacement of the ciliary body and iris root attachment points are vital risk factors.Long-term follow-up study and intervention treatment are required in these patients after LPI.

OBJECTIVETo investigate the early clinical efficacy of induced membrane technique for reconstruction of large bone defects after debridement in adults with chronic osteomyelitis of limbs.

METHODSFrom March 2010 to March 2012,a total of 23 adult patients with chronic osteomyelitis of limbs were treated in our department. There were 15 males and 8 females, with a mean age 35.2 years old (ranged from 26 to 49 years old). Sixteen patients had open fracture history. According to the lesion site, there were 12 cases of tibia, 7 cases of femur, 3 cases of humerus, and 1 case of both radius and ulna. Among them, 19 patients had diseases in diaphysis and 4 patients in the metaphysis. The mean interval from infection to operation was 6.9 months (ranged from 4 to 13 months). All the patients were treated by using induced membrane technique. The follow-up evaluation included clinical complications, time of bone healing and limbs function. The Chinese version of SF-36 scores was used in the assessment of quality of life pre- and post-operation.

RESULTSThe average duration of follow-up was (27.6 ± 5.3) months (ranged from 18 to 43 months). Two patients had postoperative flap edge necrosis, 1 patient had superficial iliac incision infection, no obvious complications were recorded. Twenty patients obtained radiological union at a mean time of 4.6 months (ranged from 3 to 7 months). Among them, 16 patients treated with lower limbs surgery achieved full weight-bearing at about 5.2 months (ranged from 4 to 8 months) postoperatively. Four patients suffered from reinfection during follow-up, but 3 of them achieved complete bone healing after the second surgeries with induced membrane technique. At the final follow-up, there was a substantial improvement in each dimension scores and total scores of SF-36 as compared with those before surgery.

CONCLUSIONWhen treating with adult chronic osteomyelitis of limbs, the induced membrane technique can effectively reconstruct large bone defects after debridement, significantly shorten treatment cycle, provide satisfactory results with minimal complications, promote good recovery of limbs function and require relatively simple operation technique.

Adult ; Chronic Disease ; Extremities ; surgery ; Female ; Humans ; Male ; Middle Aged ; Osteomyelitis ; surgery ; Reconstructive Surgical Procedures ; methods

Objective To discuss the effect of QGY/CDDP hepatoma lines multi-drug resistance (MDR) reversed by gene transfection of mdr1,mrp-ASODN+ultrasound contrast agent+ultrasound.Methods The QGY/CDDP cells were transfected by mdr1,mrp ASODN+ultrasound contrast agent+ultrasound irradiation respectively and detected of the various indicators:cell adhesion rate,cell sensitivity to cell drug-resistance,the mRNA expression of mdr1 and mrp gene,the expression of P-gp and MRP protein. Results After mdr1-ASODN transfection,the drug sensitivity and expression of P-gp,MRP protein of QGY/CDDP cells were smaller changes(P＞0.05),and the rate of cells adherent and expression of resistance gene mRNA were obvious changes(P＜0.05).After mrp-ASODN transfection,the cells adherent rate,the drug sensitivity,the expression of resistance gene mRNA and P-gp,MRP protein were obvious changes respectively(P＜0.05),the experiment group(group 2')had bigger effects(P＜0.05).Conclusions mdr1. mrp-ASODN+ultrasound contrast agent+ultrasound irradiation could safely partly reverse MDR of hepatoma cells,which is a potential new approach for gene therapy.