The prevalence of obstructive pulmonary disease (COPD) and chronic heart failure (CHF) increased gradually with age. The coexistence of COPD and CHF was very common but often neglected. To avoid overlooking COPD in patients with known CHF, pulmonary function tests should be routinely obtained. Likewise, to avoid overlooking CHF in patients with known COPD, left ventricular function should be routinely assessed. Plasma brain natriuretic peptide was a useful index to differentiate COPD exacerbation from CHF decompensation in patients presenting with acute dyspnea. Skeletal muscle metabolic alterations and its atrophy were the common mechanisms which resulting in deterioration of function capacity in elderly patients with CHF and COPD. Contrary to the conventional belief, long-term beta adrenergic blockers should be given to elderly patients with CHF and COPD. Exercise training reverses rapidly progress of skeletal muscle metabolic alterations and atrophy and promotes independence and life quality in elderly patients.

Objective To analyze the change of the proportions of the hospitalization causes in patients with chronic heart failure(CHF) in a single-central hospital in late 20 years.Methods 1 259 hospitalized cases diagnosed primarily as chronic heart failure were selected from the First Central Hospital of Tianjin during 1983-2002,and divided into two groups with a decade interval.A comparative analysis was performed to explore the proportions of the primary,concomitant and multiple causes of hospitalization for CHF patients between two groups.Results(1) The most common primary causes in general cases was coronary artery disease(CAD,56.6%),rheumatic heart disease(RHD,20.9%) and pulmonary heart disease(PHD,9.2%).During the latter decade,the proportions of CAD and dilated cardiomyopathy(DCM) increased,while RHD,PHD,congenital heart disease(CHD) decreased.(2) The causes of concomitant disease for CHF was essential hypertension(EHT,44.0%),diabetes mellitus(DM,16.4%),chronic obstructive pulmonary disease(COPD,14.3%),cerebral-vascular disease(CVD,11.4%) and anemia(5.2%).All proportions of these concomitant diseases except COPD increased during the latter decade(P

Objective To understand the trend of the constituent ratio of atrial fibrillation(AF)and primary etiology in hospitalized cases with chronic heart failure(CHF)and complicated with AF in late 20 years.Methods 1 180 patients with CHF(thereinto,440 complicated with AF)were selected from the hospitalized cases during the past 20 years(1983—2002),and a retrospective analysis was performed with every 5 years interval.Results The constituent ratio of AF in the general cases with CHF was 37.3%,and it was higher in females than in males(41.3% vs 33.4%,P

Objective To investigate the clinical features and pathogenic characteristics of different types of deep sternal wound infection in dif?ferent types after cardiac surgery. Methods A retrospective study was performed. From January 2012 to December 2014,84 patients with sec?ondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department were recruited for the study. Re?sults The average age of 84 patients with DSWI was 54.6 ± 14.8 years old,of which typeⅡDSWI patients were the most common(49/84, 58.3%). Both typeⅠand typeⅡDSWI patients showed typical clinical manifestations and early chest X?ray or Computerized tomography(CT) showed mediastinal widening(P<0.01). Some patients with typeⅢDSWI showed only local symptoms of surgery. The organisms most common?ly isolated in patients with DSWI were gram gram?negative bacilli(GNB,54.8%). Although there was no significant difference between the 3 types of DSWI patients(P>0.05),but the pathogenic results of the 3 types of those DSWI patients showed such a trend:typeⅠDSWI patients with GNB is was more common,and typeⅡDSWI patients was more prone to complicated infection. Conclusion Different types of DSWI may dis?play different features,the prevention and treatment of DSWI should be closely combined with the clinical manifestations and local pathogenic char?acteristics.

Objective To investigate the survival rate and status of cerebral performance category in patients who received cardiopulmonary resuscitation (CPR) with return of spontaneous circulation (ROSC) (abbreviated by ROSC-CPR) after discharge,and to analyze the risk factors which influencing the prognosis of these patients.Methods A retrospective analysis of the clinic data coming from the patients who received cardiopulmonary resuscitation with return of spontaneous circulation and admitted to the Department of Intensive Care Unit from January 2009 to December 2016 was carried out to find corresponding risk factors influencing the prognosis.Results A total of 185 patients who received ROSC-CPR with 59.5％ male,the average age of (67.15 ± 17.64) years old and the average Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score (28.80 ± 7.16) were divided into two groups,the survival group (n =56) and the death group (n =129).The total survival rate was 56/185 (30.3％).Compared to the death group,the usage rate of ventilation,blood purification and target temperature management in survival group was no significant (P ＞ 0.05).The most common aetiology of the survival patients was cardiogenic disease,but the number of those patients with the good cerebral performance category (CPC 1/2) discharged from hospital were 16 cases (8.6％).According to logistic analysis,high value of APACHE Ⅱ score,the duration from CPR to ROSC over 10 minutes,admission took place out-of-hospital were unfavorable predictors for the prognosis (P ＜ 0.05),while admission took place in the second four years and cases with cardiogenic aetiology were favorable predictors for the prognosis of these patients who suffered from ROSC-CPR.Conclusions The survival rate of the patients who received CPR with ROSC after discharge was still low,especially the rate of good status of CPC was very low.To shorten the duration from CPR to ROSC as possible as we can,and to strengthen target temperature management would improve the prognosis of the patients who received CPR with ROSC in our hospital in future days.

Objective:To compare the effect of Rain Classroom and traditional teaching model on the academic achievement of domestic medical undergraduates by Meta-analysis.Methods:All literature were retrieved from CNKI, Wanfang Med Online, VIP, and CBM databases, and the retrieval time limited from the establishment of the database to October 2019. Randomized controlled trials (RTCs) for the evaluation of the effects of Rain Classroom method in undergraduate medical education were selected. Literature were screened according to the established inclusion and exclusion criteria. Data was extracted and the quality of the literature was assessed using the Jadad scale. All analyses were performed by Stata 12.0 software.Results:A total of 3 662 medical undergraduates in 20 RCTs were included. Meta-analysis results showed that student's theoretical and practical scores of the Rain Classroom teaching group were significantly higher than those of the traditional teaching group (theoretical scores: WMD = 8.52, 95%CI = 7.30 -9.74, P < 0.001; practical scores: WMD = 8.95, 95%CI = 5.42 -12.49, P < 0.001). Conclusion:The Rain Classroom teaching method can effectively improve the theoretical and practical academic achievement among medical undergraduates and enhance the teaching effect. This study has also provided the evidence -based basis for the promotion and application of the Rain Classroom teaching method in medical undergraduate courses.

Objective To investigate the operative methods and merits of nasal reconstruction in terms of the aesthetics. Methods The noses of 12 patients were reconstructed with an expanded triangle-shaped forehead flap with unilateral supratrochlear artery, a skin expander was placed obliquely under galea aponeurotica of forehead. Liquid was injected with conventional expansion method. Using the skin and the scars on nasal dorsum and tip as lining, based on intercanthal distance and aesthetic standard, a triangle-shaped forehead myocutaneous flap was designed over the expanded forehead skin tissue and used for a nasal reconstruction. The triangle-shaped flap was trimmed to different layer and reshaped based on aesthetic subunit.Results In twelve post-operative patients with nasal defect, no flap necrosis was found and the appearance of reconstructed noses were almost normal and satisfactory after follow-up for 6 months to 2 years. Conclusion The modified forehead myocutaneous flap according to aesthetic standard is safe and ideal for major nasal reconstruction. Meticulous moulding of triangle-shaped flap, nose interior with good blood supply, and primary insertion of nose stretcher are the key to a satisfactory appearance.

Objective: To explore the effect of low-dose Maren Soft Capsule (MSC) on constipation and colonic mucosa. Methods: Patients (208 cases) with colon slow transit constipation and mixed constipation were divided into treatment and control groups. MSC (two pills, once daily) and Sennae Folium (5 g) were given to the patients in the treatment and control groups, respectively, for 10 months. The recovery rate, total significant efficiency, and total efficiency were determined by defecation frequency and gastrointestinal transmission experiment. The side effects such as bloating and abdominal pain were observed. Results: The recovery rate in the treatment group was lower than that in the control group, and the total significant efficiency and total efficiency were similar to those in the control group. There was no colon melanosis in the treatment group after 10 month, while 26.9% of the patients in the control group were observed with colon melanosis. Conclusion: The low-dose MSC has the therapeutic effect on constipation with high safety.

Objective: To investigate the role of miR-19a/b in myocardial ischemia reperfusion injury (R/I) with its clinical significance. Methods: Our research included in 2 parts. Part 1: in H9c2 cells. miR-19a/b expression in H9c2 cells with 10 h hypoxia and 2 h re-oxygenation was detected by real-time PCR, miR-19a/b potential target gene was assessed by luciferase reporter activity assay. Part 2: in natural person. Control group,n=40 healthy subjects and AMI (acute myocardial infarction) group,n=40 relevant patients. Peripheral blood levels of miR-19a/b were detected as Part 1, cTnI were measured by chemiluminescence immune analysis and CK-MB were assessed by immune inhibition method. Results: Part 1: Compared with normal H9c2 cells, miR-19a/b expressions were increased 5.876 times and 2.761 times in H9c2 cells with 10 h hypoxia and 2 h re-oxygenation, bothP<0.01. With respectively transfected miR-19a/b mimic and inhibitor, miR-19a/b expression was up-regulated and down-regulated respectively. miR-19a/b and chromosome-10 deleted phosphatase, tensing homolog gene (PTEN) had the targeting effect. With up-regulated miR-19a/b expression, PTEN level was decreased and with down-regulated miR-19a/b expression, PTEN level was increased. Part 2: Compared with Control group, AMI group had elevated blood level of miR-19a/b,P<0.01. In AMI patients, miR-19a/b was increasing at 0-3 h of chest pain and reaching the peak at 6-12 h; CK-MB enzyme activity and cTnI content were elevating at 2-6 h of onset and reaching the peak at 24 h. Conclusion: miR-19a/b expression was up-regulated by myocardial ischemia reperfusion in H9c2 cells, PTEN was the potential target gene of miR-19a/b. Circulating miR-19a/b might be used as a new non-invasive biological marker for myocardial ischemia R/I diagnosis.

Objective: To observe the effect of strengthening qi and nourishing yin recipe (SQNY recipe) on the expressions of estrogen receptor ? (ER?) and CyclinD1 of Lewis lung cancer in C57BL/6 mice with immunohistochemistry, and discuss the mechanism of its anti-proliferation and anti-metastasis effects, and analyse the correlation between ER? and CyclinD1. Methods: Twenty-four C57BL/6 mice were randomly divided into three groups. They were all transplanted with Lewis lung cancer cells, and received the interventions the next day as follows: tumor-bearing control group was fed with 0.9% NaCl, and TCM group was treated with SQNY recipe, and DDP group was given intraperitoneal DDP injection. All of mice were killed on the 20th day, weighed the tumor and counted lung metastases to calculate the inhibition rates of tumor growth and metastasis. The expressions of ER?, CyclinD1 in tumor tissues were detected by immunohistochemistry. Results: The inhibition rates of tumor growth and metastasis were 35.02% and 54.20% in TCM group, and were 41.18% and 39.02% in DDP group, respectively (all P