Objective To evaluate the health status ,dyspnea and exercise endurance in the patients with chronic obstructive pul-monary disease(COPD) by the CAT scale ,modified medical research council(mMRC) dyspnea scale and 6-min walk test(6MWT) and to analyze the correlation between their evaluation results with the percentage (FEV1% pred) of the forced expiratory volume at 1 second(FEV1) in the predict value and whether complicating pulmonary hypertension (PH) .Methods 70 patients with COPD were performed the examinations of the lung function ,CAT scale ,mMRC score and 6MWT .The correlation among the various e-valuation systems and between each evaluation system with the severity of the pulmonary function airway limitation were compre -hensively evaluated .The CAT scores ,mMRC scores and 6 min walking distance(6MWD) were compared between the COPD com-plicating PH group and the simple COPD group .Results The CAT scale was negatively correlated with 6MWD(r= -0 .623 ,P<0 .01) and had no correlation with FEV1% pred(P=0 .159) .The CAT scale was positively correlated with mMRC (r=0 .492 ,P=0 .000) .mMRC was negatively correlated with 6MWD(r= -0 .514 ,P= 0 .000) and had no correlation with FEV1% pred(P>0 .05) .The CAT scores had statistical difference between the COPD complicating PH group and the simple COPD group (P<0 .01) .6MWD had the highest accuracy for screening COPD whether complicating PH ,followed by CAT .The diagnostic cut-off point by adopting CAT for judging the risk of COPD complicating PH was 21 .Conclusion The CAT scale has good correlation with 6MWD and no correlation with FEV1% pred .The CAT scale is more suitable for the overall assessment of the total severity of COPD .Patients with the high CAT scores have higher risk of suffering from PH .

OBJECTIVE To find out the way to prevent the infection of surgical wound.METHODS Predisposing factors in surgical site infection were elucidated.Precaution was improved directionally.The administration and monitoring of the aseptics in the operation were emphasized.The qualified rates of disinfection and sterilization for the predisposing factors were analyzed before and after the improvment.RESULTS The total qualified rate was 96.2% before the improvement,while after the improvement was 99.6%.And the difference was statistically significant.Especially the qualified rates of disinfection and sterilization for the air,objects' surface and operators' hands were all improved remarkablly.CONCLUSIONS Augmentation of the administration and monitoring of the aseptics in the operation are important for prevention and nursing to prevent the infection of surgical wound.

[Objective]To explore the optimal time for the surgical operation on patients with ossification of the posterior longitudinal ligament of the cervical spine. [Methods]The clinical symptoms,the persistent time of the symptoms and the interval from exacerbation to operation in 168 patients with OPLL were analyzed.[Results]The average time was 27.6 months from the onset of myelopathy to the operation on patients with OPLL,and 17.4 months from the decrease of muscle strength in extremities to the operation,and 5.3 months from the symptomatic exacerbation of the extremities especially the decrease of muscle strength in lower extremities to the operation.[Conclusion]The patient should be treated earlier by surgical operation after his/her illness has been diagnozed as OPLL.It is the optimal time for surgical operation when the patient has imaging change of hypertrophy or ossification of the posterior longitudinal ligament and severe compression of spinal cord(more than 60% spinal canal stenosis),or the decrease of muscle strength in extremities especially in lower extremities.

Objective To explore a new microsurgical method for reconstruction of finger pulp defect.Methods From May 2008 to May 2009,10 male patients with finger pulp defect were treated in our hospital,aged from 18 to 38 years (average,26 years).The index finger was involved in 6 patients,the middle finger in 3 patients and the ring finger in 1 patient.All finger pulp defects were caused by machine injury.The defect sizes ranged from 1.5 cm×2.0 cm to 2.0 cm×3.0 cm.Six patients suffered from single skin defect,and 4 patinets suffered from skin defect combined with nail bed laceration and distal phalangeal fractures.All patients were performed emergency operations.The defects were reconstructed by using arterialized venous flap with microsurgical suture of the dorsal branch of the proper digital nerve.The fractures were fixed by Kirschner wires.The donor area was covered with skin grafts.Results All flaps survived completely.The fractures healed 8 to 10 weeks postoperatively.All patients were followed up for 4 to 6 months,all flaps presented satisfactory appearance,normal texture,with no pigmentation at the last followup.The static 2-point discrimination of the flaps ranged from 8 to 12mm.All injured fingers obtained good recovery of flexion and extension of the distal interphalangeal joints.The nails of the fingers with laceration of nail bed grew smoothly.The nail bed with laceration grew smoothly,and some new nails could be seen.The skin grafts applied to the donor area survived completely.Conclusion The arterialized venous flap with suture of the dorsal branch of the proper digital nerve is a good method for reconstruction of finger pulp defect,which had the following advantages:slight donor injury,low anesthesia risk,simple operative technique,and satisfactory postoperative function and appearance.

Objective To evaluate the effect of phacoemulsification on the corneal endothelium and thickness of diabetic cataract patients.Methods Cataract surgery of phacoemulsification with intraocular lens implantation was performed on together 348 eyes of 348 patients,including 96 eyes of 96 patients suffered from type 2 diabetes (diabetic group) and 252 eyes of 252 patients suffered from senile cataract (elderly group).Then,tear break-up time,basal tear secretion,corneal endothelial density and central corneal thickness were detected before surgery and 1 week,4 weeks and 8 weeks after surgery.Results There were significant difference in tear break-up time,basal tear secretion,corneal endothelial density and central corneal thickness before surgery and 1 week,4 weeks and 8 weeks after surgery between the two groups (all P ＜0.05).There were significant difference in corneal endothelial density (all P ＜ 0.05),but there was no significant difference in tear break-up time,basal tear secretion and central corneal thickness before and after surgery in the elderly group (all P ＞ 0.05).Intergroup comparison of tear break-up time,basal tear secretion,corneal endothelial density and central corneal thickness were significantly different before and after operation (all P ＜ 0.05).Conclusion Cataract surgery of phacoemulsification can achieve satisfying outcomes and it is crucial to protect the corneal endothelium and ocular surfacetissue intraoperatively and postoperatively for the patient with diabetic cataract.

Objective To measure the levels of caspase-1 and its downstream factor interleukin (IL)-18 and IL-33 in rheumatoid arthritis (RA) and explore their possible mechanisms.Methods Blood samples were drown from 56 patients with RA and 22 healthy subjects.Serum levels of caspase-1,IL-18 and IL-33were tested by the method of enzyme linked immunosorbent assay (ELISA).Kruskal-Walls and Mann-Whitney test were used to compare the levels of caspase-1,[L-18 and IL-33 and Spearman's correlation test was used for correlation analysis.Results The level of caspase-1 was significantly increased in RA group compared to healthy group [(32±26) ng/ml vs (15±6) ng/ml,P＜0.01].Meanwhile,the active disease groups showed a higher level than the remission group,and level in the untreated group was higher than the treated group [(47±27) ng/ml vs (25±22) ng/ml,P＜0.01].The levels of IL-18 and IL-33 were significantly increased in RA group compared to healthy group [(121±121) ng/L vs (58±33) ng/L,(1032±1011) ng/L vs (510±231)ng/L,respectively,P＜0.05].Meanwhile,the active disease groups had a higher level than the remission group and the untreated group had higher levels than the treated group [IL-18 and IL-33 were (172±139) ng/L vs (97±106) ng/L,(1469±1039) ng/L vs (825±941) ng/L,respectively,P＜0.05].Caspase-1 was correlated withIL-18 and IL-33 (r=0.824,0.854,P＜0.01) and IL-18 was correlated with IL-33 (r=0.800,P＜0.01).But neither of the three factors was related with clinical indexes including disease duration,RF,anti-CCP antibody,tender joints count and swollen joints count.Conclusion Caspase-1 and its downstream factor IL-18,IL-33 increase in RA,and they may play important roles in RA.

Objective To investigate the roles of fiberoptic bronchoscopy in diagnosis and treatment for infants with refractory and persistent wheezing. Methods From Jun. 2012 to Dec. 2013, 52 hospitalized children with age between four 4 months and 1 year old were recruited for ifberoptic bronchoscopy, who had been wheezing for at least four weeks and treated ineffectively with conventional anti-inlfammatory agents:budesonide and compound ipratropium bromide solution. Then, the pathogenesis of refractory and persistent wheezing was summarized based on clinical features, detection of CT imaging of three-dimensional airway reconstruction and cardiac CT, results of bronchoscopy inspection, and bronchoalveolar lavage lfuid culture. Results Among the 52 cases, 40 were with ground glass-like changes (76.92%) in pulmonary spiral CT testing, 4 with mosaic perfusion syndrome (7.69%), 8 with segmental pulmonary consolidation (15.38%), 8 with obstructive pulmonary emphysema (15.38%), and 1 with left primary bronchial foreign body. In addition, through bronchofibroscopy, there were 52 cases with imlfammation (100%),3 with tracheal stenosis (5.77%), 3 with left and/or right main bronchus stenosis of the external pressure, 18 with bronchomalacia(34.62%), 2 cases with foreign body (3.84%), one in trachea (1.92%), the other in left main bronchus (1.92%), 10 with bronchial mucus plug (19.23%), and 8 (15.38%) with congenital airway malformations (including 3 at tracheal bronchus, 1 at left upper lobe bronchial stenosis and 1 at bronchial Bridge). The culture of bronchoalveolar lavage lfuid were conducted for all patients. The positive rate of bronchoalveolar lavage lfuid was 9.62%(5/52 cases), including 2 cases with tip Escherichia coli, 2 with Haemophilus inlfuenzae, and 1 with Acinetobacter baumannii. Conclusions First, infection is the primary cause of refractory and persistent wheezing, which is persistent in airway resulted from multi-drug resistant bacteriua. Second, refractory and persistent wheezing is often caused by multi-factors including infection, congenital airway malformations, the endogenous and exogenous foreign body, cardiovascular malformation, etc. These factors often lead to dififcult wheezing control. The last, the diagnosis rate of the refractory and persistent wheezing can be improved by combination of ifberoptic bronchoscopy and lung spiral CT.

BACKGROUND: It is difficult to conduct the operation of ossification of ligamentum flavum (OLF) in thoracic spine, and the operation needs complecated operative skill, and unmerited disposal tends to worsen neurological dysfunction.OBJECTIVE: To analyze the operative method for OLF of thoracic spineand functional restoration.DESIGN: Case analysis.SETTING: Department of Orthopaedics, Changzheng Hospital, SecondMilitary Medical University of Chinese PLA.PARTICIPANTS: Totally 56 patients with OLF of thoracic spine, whowere treated at the Department of Orthopaedics, Changzheng Hospital fromAugust 1996 to August 2003.METHODS: The operative therapy was performed in all the patients, and the method was determined by the results of MRI and CT examination: ①The 19 patients, whose OLF in thoracic spine was focal type, and range of lesion did not exceed two segments, were treated with simple resection and decompres sion in posterior wall of vertebral canal. ②Fenestration and sledging-allocating manipulation in the whole piece unilateral lamina of vertebra were carried out in 29 cases involving more than 2 segments. ③If coplanar OLF in thoracic spine combined with protrusion of thoracic spine disc or ossification of posterior longitudinal ligament, decompression of posterior midline approach+posterior lateral approach was performed, totally 8 cases.MAIN OUTCOME MEASURES: Post-operation functional restoration was evaluated with Epstein standard, excellent: recovery of sensation and exercise was near to normal; good: spinal cord function was improved significantly, and permitted to walk with brace; fair: small partial restoration of sensory and motor function, unable to walk; bad: Inefficiency or becoming severe.RESULTS: A total of 55 cases were followed up for more than one year and 1 case only for two months after operation. ①Functional restoration: excellent: 39 cases; good: 8 cases; fair: 5 cases; bad: 4 cases. ②Symptom recovery after operation was confirmed by disappearance of tight sensation, reduction of muscular tension, relieving of numbness in order. ③The recovery was rapid for 3 to 6 months after operation. Part of patients' condition was still ameliorating during one year after operation, and rare advancement 2 years later. The recovery of complete paraplegics was bad, so was the severe paraplegia with long history. CONCLUSION: Compressive myelopathy caused by OLF in thoracic spine should be treated in an earlier period by operation. Resection and decompression of posterior wall of thoracic spine and decompression of posterior approach could be choosed according to different condition.

Because of the high morbidity and mortality rate,cardio-cerebrovascular diseases,including cerebral embolism, cerebral hemorrhage,cerebral vasospasm and myocardial infarction,have become main diseases threatening human health. Tradition-al chinese medicine(TCM)holds that the basic pathogenesis is Qi imbalances,which could be improved by benefiting Qi and promot-ing blood circulation. The compatibility of Radix astragali and Radix salviae miltiorrhiae are particularly suitable for treating the car-dio-cerebrovascular system diseases by improving Qi deficiency and blood stasis. This paper focuses on the application of Radix astrag-ali,Radix s. miltiorrhiae and their compatibility for treating the cardio-cerebrovascular system diseases. Moreover,our research would offer valuable references for the development of new drugs related to the treatment of cardio-cerebrovascular system diseases.

Orthopaedic surgery is a fast developing subject in clinical surgery.Based on the characteristics of the orthopaedic surgery and aiming to enhance the medical students’practical ability of basic skills and clinical thinking we adopt the explorative clinical teaching which can be helpful to training students’initiative of finding and working out a solution by themselves and cultivating their capability of innovation and creation.