Pulmonary rehabilitation has been shown to be effective in reducing dyspnea and improving exercise capacity and health-related quality of life in people with COPD.COPD patients with varying severity can benefit from pulmonary rehabilitation which includes exercise training,inspiratory muscle training and nutritional intervention,et al.Exercise training is the basis of pulmonary rehabilitation.In the last decade,new strategies have been developed to enhance the effects of pulmonary rehabilitation,which include promoting exercise and activity,education and self-management,psychosocial intervention.Although pulmonary rehabilitation has traditionally been provided in stable COPD patients,pulmonary rehabilitation could be started as soon as infection is controlled for AECOPD patients.As pulmonary rehabilitation is administrated,the patients should be encouraged to do exercise as much as possible with different kind of training.

OBJECTIVEA study was conducted to investigate the effects of Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) on the expression of regulated upon activation normal T-cell expressed and secreted (RANTES) and fractalkine in human umbilical vein endothelial cells (HUVECs).

METHODSHUVECs were incubated with different concentrations of Pg-LPS (200, 500, and 1000 ng x mL(-1)) for 1, 6, 12, and 24 h, respectively. Then real time quantitative polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent method (ELISA) were adopted to detect the protein levels and mRNA levels of RANTES and fractalkine.

RESULTSThe RANTES protein levels and mRNA levels, as well as fractalkine mRNA levels, were significantly higher in all experimental groups of 1, 6, and 12 h than in the control group (P<0.05), except the expression of RANTES mRNA in 200 ng x mL(-1) group of 12 h and RANTES protein in 200 ng x mL(-1) group of 1 h. The expression levels of RANTES mRNA and fractalkine mRNA were highest in 1000 ng x mL(-1) group of 6 h and were 4.88- and 6.20-fold higher, respectively, than those in the control group. The expression levels of RANTES protein, mRNA, and fractalkine mRNA decreased 6 h after stimulation, and were significantly higher than those in the control group (P<0.05) in the RANTES and fractalkine in HUVEC, and such expression is important in the development of atherosclerosis 500 ng x mL(-1) group of 24 h. There was a significant difference between the expression of fractalkine mRNA in 1000 ng x mL(-1) group of 6 and 12 h than in the control group (P<0.05).

CONCLUSIONPg-LPS infection might up-regulate the expression of RANTES and fractalkine in HUVEC, and such expression is important in the development of atherosclerosis.

Atherosclerosis ; Cells, Cultured ; Chemokine CCL5 ; genetics ; metabolism ; Chemokine CX3CL1 ; analysis ; genetics ; metabolism ; Enzyme-Linked Immunosorbent Assay ; Human Umbilical Vein Endothelial Cells ; metabolism ; Humans ; Lipopolysaccharides ; pharmacology ; Porphyromonas gingivalis ; immunology ; isolation & purification ; RNA, Messenger ; analysis ; Reverse Transcriptase Polymerase Chain Reaction ; Up-Regulation

Objective To explore the fibrotic stroma characteristics of orthotopic liver cancer in rat and the relationship with MR delayed contrast enhancement.Methods 4 Wistar rats with orthotopic liver cancer underwent conventional triphasal and longer-de-layed contrast-enhancement MR scanning.12 HCC specimens obtained from the four Wistar rats were sliced and stained with HE, picric-sirius red,Verhoeff Van-Gieson elastic fiber,Gordon-Sweets reticular fiber and anti-α-SMA immunohistochemical staining.The relationshp between intratumoral fibrotic stroma and MR delayed phases of the 1 2 tumors were analyzed.Results Collagen fiber was expressed mainly in tumor fibrous septum.Elastic fiber distributed in tumor fibrous septum and the artery wall.Reticular fiber dis-tributed in fibrous septum of the regenerative nodules,portal area and tumor psuedocapsule.Integrated optical density (IOD)value of collagen fiber,elastic fiber and reticular fiber analyzed by Image-pro Plus6.0 were 0.102±0.020,0.063±0.018 and 0.109±0.032, respectively.As a result,the amount of collagen and elastic fibers were statistically different (P<0.01),and so were reticular fibers and elastic fibers (P<0.01).And there was a positive correlation between collagen fiber and MR delayed contrast enhancement (P<0.05).Conclusion MR delayed contrast enhancement of hepatic cancer in rat is closely associated with the collagen fiber,thus this fiber in liver cancer can be evaluated noninvasively by MRI.

Objective To investigate the significance of modified gold nanocages ( GNCs ) in photothermal therapy and radiosensitivity enhancement for murine mammary carcinoma 4T1 cells.Methods A molecule probe, CD44-PEG-GNCs, was constructed on the basis of GNCs.Inductively coupled plasma mass spectrometry ( ICP-MS) and transmission electron microscopy ( TEM) were used to analyze Au uptake by 4T1 cells.The cell counting kit-8( CCK-8) assay was used to determine the impact of the probe on the viability of 4T1 cells.The CCK-8 assay and the Hoechst/PI double staining were used to evaluate the photothermal killing effects of near infrared laser (NIR).The colony forming assay and the Hoechst/PI double staining were used to measure the viability of 4T1 cells after irradiation with 6 MV of X-ray.Results ICP-MS and TEM showed that 4T1 cells had an uptake of a large number of GNCs, in which the number of CD44-PEG-GNCs taken up by 4T1 was 3-4 times larger than that of PEG-GNCs.The cell toxicity assay revealed that in a certain range of concentration, GNCs showed little effect on the viability of 4T1 cells, which was reduced to 81.2%in 48 hours.The CCK-8 assay, the Hoechst/PI double staining, and the colony forming assay showed that after NIR irradiation and radiotherapy, large-scale apoptosis was induced in CD44-PEG-GNCs-contained tumor cells by photothermal therapy combined with radiotherapy, which had substantially better outcomes than other groups.Conclusions The GNC-based molecular probe actively targets 4T1 cells with little cytotoxicity, indicating that it enhances the sensitivity of tumor towards photothermal therapy and radiotherapy.

Objective To summarize the imaging features of intra-pancreatic accessory spleen (IPAS)with multidetector computed tomography (MDCT) and improve the awareness and correct diagnosis of IPAS.Methods MDCT images of seven consecutive patients with surgically and pathologically confirmed IPAS were reviewed retrospectively.The investigated features included the location,size,shape,margin,density,and enhancement of the lesions.Results Four patients were male and three were female with a mean age of 49 years old.All the lesions were located at the dorsal side of parenchyma under the capsule of pancreatic tail.Three lesions were in round-like shape,and 4 in oval shape and all were well-defined.All the lesions were mass-like without necrosis and calcification.The maximum diameter of lesion ranged from 0.9 ～ 1.8 cm with a mean value of 1.4 cm.Compared with pancreatic parenchyma,the density of lesions were homogeneous on unenhanced CT,in arterial phase,slightly increased heterogeneous density was observed in 3 patients,slightly increased homogeneous density was observed in 4 patients.All the lesions appeared as slightly increased homogeneous density in portal phase.The CT value in unenhanced phase ranged from 50 ～ 61 Hu with a mean number of 55 Hu; and it ranged from 80 ～ 110 Hu with a mean number of 97 Hu in arterial phase; and the corresponding value was from 99 ～ 120 Hu with a mean number of 102 Hu in portal phase.Among the three patients underwent MDCT angiography,neither artery nor vein was compressed or invaded,and there was no vessel connected with lesions.Conclusions IPAS has some MDCT characteristics.For small solid mass in pancreatic tail,if the density and enhancement pattern is similar to that of spleen,the diagnosis of IPAS should be considered.

Objective To evaluate the effect of dexmedetomidine on the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.Methods Forty-two patients of either sex with intracranial aneurysm,aged 57-78 yr,weighing 53-86 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective balloon occlusion test of the internal carotid artery under general anesthesia,were assigned into 2 groups (n =21 each) using a random number table:propofol conbined with remifentanil group (group PR) and dexmedetomidine combined with propofol and remifentanil group (group DPR).In group DPR,dexmedetomidine was intravenously infused over 15 min in a loading dose of 0.5 μg · kg-1 before induction of anesthesia,followed by an infusion of 0.3 μg · kg-1 · h-1 throughout surgery.Propofol and remifentanil were given by target-controlled infusion (TCI) after infusion of the loading dose.The patients were mechanically ventilated after placement of the laryngeal mask airway.Maintenance of anesthesia was as follows:propofol and remifentanil were given by TCI with the target plasma concentrations of 0.5-1.0 μg/ml and 1-3 ng/ml,respectively,in group DPR;propofol and remifentanil were given by TCI with the target plasma concentrations of 3-5 μg/ml and 3-6 ng/ml,respectively,in group PR.Bispectral index (BIS) value was maintained at 40-60.Before wakeup test,propofol infusion was stopped and the target plasma concentration of remifentanil was decreased to 0.5 ng/ml in two groups,and the infusion rate of dexmedetomidine was decreased to 0.1 pg · kg-1 · h-1 in group DPR.The wake-up time was recorded and the wake-up quality was assessed.After admission to the operating room (T0,baseline),at 10 min before wake-up test (T1),immediately after patients were wakened (T2),at 10 min after patients were wakened (T3) and at the end of wake-up test (T4),the mean blood pressure (MAP),heart rate,respiratory rate (RR),SpO2 and BIS values were recorded.The development of intraoperative awareness,emergence time,postoperative agitation,nausea and vomiting,regurgitation and aspiration and severe pain was recorded.Results MAP,heart rate,SpO2 and RR were all within the normal range during wake-up period in two groups.Compared with the baseline at To,MAP was significantly decreased at Ti,3,4 in group PR,and BIS value was decreased at T1-4 in DPR and PR groups (P＜0.05).Compared with group PR,MAP was significantly increased at T1.3,BIS value was decreased at T24,the wake-up time was shortened,Ramsay sedation score and wake-up quality were increased,the emergence time was shortened,and the incidence of agitation was deceased (P＜0.05),and no significant change was found in verbal rating scale scores assessed after extubation in group DPR (P ＞ 0.05).No cardiovascular events,respiratory depression,intraoperative awareness,postoperative nausea and voniting,regurgitation and aspiration or severe pain was found in two groups.Conclusion Dexmedetomidine can raise the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.

Objective To retrospectively analyze imaging features of multi-slica computed tomography (MSCT) and clinical characteristics of male patients with pancreas solid pseudopapillary tumor (SPT) and compare with that of female patients.Methods From November 2000 to October 2012,clinical data of 18 male patients and 94 female patients underwent MSCT examination and pathological diagnosed as SPT were retrospectively analyzed.Clinical characteristics and imaging features of MSCT of male and female patients with SPT were analyzed,which included lesion location,size,shape,encapsulation,calcification,internal composition,density and enhancement pattern of tumors.Rank sum test or x2 test was performed for statistical analysis.Results The median age of male patients with SPT was significantly older than that of female patients (39.0 (15.0,67.0) years vs 27.5 (11.0,63.0) years; U=2.865,P =0.005).There were no significant differences in clinical manifestation,lesion location and composition ratio of benign and malignant tumors between male and female patients with SPT (all P＞0.05).Imaging of MSCT indicated that the median maximum tumor diameter of male patients with SPT was significantly shorter than that of female patients (5.1 (1.0,11.6) cm vs 7.9 (2.5,18.7) cm; U=3.161,P=0.002).Solid tumors were more common in male patients compared with female patients (9/18 vs 5.3％ (5/94) ; x2 =30.606,P＜0.01).Conclusions The imaging features of male patients with SPT are different with those of females.For pancreas lesion in males,if imaging of MSCT shows more solid composition,small lesion and with typical enhancement patterns of SPT,the possibility of SPT should be considered.

Objective To study the baseline level of fraction anisotropy (FA) and the normal value of apparent diffusion coefficient (ADC) in deep white matter of preterm and its application.Methods From Oct.2010 to Dec.2013,in Department of Neonatology,Jiangsu Province Hospital,magnetic resonance imaging (MRI) (T1,T2) and diffusion tensor imaging (DTI) were done on 13 preterm infants of less than 37 weeks of corrected gestational age (CA),42 preterm infants of term-matched age,and 15 term infants.ADC and FA were measured in genu and splenium of corpus callosum (CC),anterior limb and posterior limb of internal capsule (IC).Results 1.The ADC values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were higher than those in term-matched infants and in term infants.The ADC values in the 6 regions in term-matched infants and in term infants were significantly different with those in CA ＜ 37 weeks infant(F =5.559,5.775,21.948,19.462,30.586,15.452,all P ＜ 0.01).The differences of ADC values between CA ＜ 37 weeks infants and term-matched infants,between CA ＜37 weeks infants and term infants were significant(all P ＜0.05),except that in CC between CA ＜ 37 weeks infants and term-matched infants.2 The FA values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were lower than those in term-matched infants and in term infants.The FA values in the 6 regions in term-matched infants and in term infants were significantly different from those in CA ＜ 37 weeks infants (F =9.835,7.500,4.811,11.430,8.674,12.666,all P ＜ 0.01).The differences of FA values between CA ＜ 37 weeks infants and term-matched infants (P ＜ 0.05),between CA ＜ 37 weeks infants and term infants were significant (all P ＜ 0.05).Conclusions The baseline values of FA and ADC in different deep white matters were obtained.As corrected gestational age of preterm babies' increased,FA values in brain white matter increased,while ADC values decreased.The myelination in most white matter of preterm infants at matched term can catch up with that of term infants.The diagnostic value of ADC and FA needs to be studied further.

Objective To explore the management model of chronic disease like myocardial infarction through the effect of collaborative work pattern of doctors and nurses on acute myocardial infarction patients with percutaneous coronary intervention(PCI) after 1 year follow up.Methods A total of 852 patients from October 1,2011 to September 30,2013 with collaborative work pattern of doctors and nurses were as collaborative work pattern group,and 734 patients without collaborative work pattern of doctors and nurses at the same time were as control group.The patients were followed up for 1 year.The differences of treatment compliance,risk factors control,and the incidence of cardiovasc~ar events were compared between collaborative work pattern group and control group.Results The improvement of treatment compliance in collaborative work pattern group was better than that in control group.The improvement rate of improve lifestyle initiatively,completely medication,check regularly were 83.3％(710/852),97.9％(834/852),75.4％(642/852) in collaborative work pattern group and 63.5％(466/734),93.7％(688/734),59.0％(433/734) in control group,x2=81.02,17.57,26.22,P＜0.01.The control rate of risk factors including hypertension,diabetic mellitus,high blood low density lipoprotein cholesterol were 78.5％ (252/321),68.4％ (214/313),84.8％ (491/579) in collaborative work pattern group and 55.8％ (168/301),58.1％ (168/289),79.9％ (381/477) in control group,x2=36.47,6.79,4.41,P＜0.01 or ＜0.05.The incidence of treatment compliance and total cardiovascular events in collaborative work pattern group were better than those in control group.There were significant differences in the above indices,P＜0.05.Conclusions Collaborative work pattern of doctors and nurses is an effective method and supplement for patients with myocardial infarction after PCI to improve treatment compliance and control risk factors.The prognosis of patients can be improved and this pattern is an effective exploration of chronic disease management.

Objective To identify the clinical and pathological features of aggressive natural killercell leukemia (ANKL). Methods 9 cases of ANKL fulfilling the criteria defined by the World Health Organization classification were retrospectively analyzed with literature review, Results Systemic symptoms, hepatomegaly, splenomegaly, lymphadenopathy were frequently observed. Liver dysfunction, neutropenia, anemia and thrombocytopenia were often seen during the course of the disease. Most of the bone marrow shows focal or subtle infiltration by the neoplastic cells. The immunophenotype of cells was characteristic for CD+56, sCD-36, and variable expression of CD2, CD7, CD8 and CD11b. T-cell receptor (TCR) genes rearrangement were in germline configuration. Median survival time was 9 weeks. Conclusion ANKL is an entity of mature cytotoxic NK-cell neoplasms with distinct phenotype and disease presentations. The disease often has a fulminant course with a poor response to chemotherapy and a short survival time. Patients achieving CR showed significantly longer survival time, but the remission did not translate into cure of the disease.