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.

OBJECTIVETo establish a perceived fatigue evaluating model during simulated load carriage that is based on objective variables through analyzing the characteristics and trends of shoulder force, shoulder pressure, waist pressure, back pressure, and perceived fatigue, and to provide an analytical technique for research on load carriage.

METHODSA 50-min simulated walking (at a speed of 5 km/h and a slope of 0%) experiment including 14 healthy male adults was conducted under four levels of backpack payloads (25, 29, 34, 37 kg). Shoulder force and trunk pressure were sampled simultaneously and analyzed with time- and frequency- domain methods. Multivariable linear regression was used to build a perceived fatigue evaluating model during load carriage.

RESULTSThe perceived fatigue evaluating model based on shoulder force, trunk pressure distribution ratio, load, and body mass index (BMI) was established. Its adjusted determination coefficient (aR2) was 0.709 and the absolute percentage error (APE) at the end of the experiment was less than 20%. The goodness of fit of the model based on frequency-domain independent variables was much higher compared with the model based on time-domain independent variables. The addition of BMI that represents the individual differences to the model obviously improved the goodness of fit.

CONCLUSIONThe perceived fatigue evaluating model established in this study does not rely on the physiological changes of individuals, and thus can be used to establish an evaluation system for human load carriage with dummy as a substitution for human in experiments and to provide a scientific basis for efficient human load carriage.

Objective To investigate the treatment and nursing of patients with pulmonary embolism after ovarian cancer combined with common variant immunoglobulin deficiency. Methods The clinical data of 1 case of acute pulmonary embolism after operation in a patient with ovarian cancer merger immunoglobulin defects were analyzed retrospectively. Results After the rescue patients, close observation of vital signs change, according to nursing bleeding and thrombosis, strengthen psychological support and other measures. The patient was discharged after 56 days of treatment and care. Conclusions The early detection of acute pulmonary embolism, timely diagnosis and treatment, close observation of vital signs, the nursing care of bleeding and thrombosis, in order to improve the success rate of treatment of acute pulmonary embolism.

Nowadays the pathogenesis of early-onset depression is still uncertain. Only SSRIs are currently approved for clinical use as antidepressants in children and adolescents, indicating that 5-HT is the most important neurotransmitter involved in the dis-ease. Current studies with regard to central 5-HTergic system in early-onset depression mainly focus on 5-HT synthesis deficien-cy, 5-HT transportation dysregulation, as well as the earlier mat-uration of 5-HT system than norepinephrine system. 5-HT precur-sor tryptophan malabsorption and dysregulation of 5-HT synthesis can contribute to 5-HT deficiency. Moreover, the 5-HTTLPR low-expressing genotypes may increase the risk of early-onset de-pression. It is necessary to make preclinical and clinical studies more widely and deeply about the effect of central 5-HTergic sys-tem in early-onset depression in future.

OBJECTIVE: To evaluate the effect of Xiangdan Injection on mRNA expression of the endothelial vaso-active factors of patients with coronary heart disease and blood stasis. METHODS: Fifty-six patients were randomly divided into two groups:twenty-eight patients were treated according to the therapeutic guide for coronary heart disease as the control group and 28 were given the same treatment plus Xiangdan Injection as the treated group. The expressions of ET-1 and eNOS mRNA were examined with RT-PCR before experiment and ten days later. RESULTS: The positive rate of eNOS mRNA of the treated group increased, while the positive rate of ET-1 mRNA of the treated group decreased after ten day's treatment, with significant differences as compared with that before the experiment. Xiangdan Injection up-regulated the eNOS mRNA expression and suppressed the ET-1 mRNA expression. Changes of expression were not observed in the control group. CONCLUSION: Xiangdan Injection improves the endothelial function of patients with coronary heart disease and blood stasis by regulating the expressions of ET-1 and eNOS mRNA.

BACKGROUND: When one is in a stress state, some amino acids as neurotransmitter in his brain are of important regulating action to his cerebral functions and his psychic behaviors,and some traditional Chinese drugs can regulate the stress state of the body.OBJECTIVE:To observe the content changes of glutamic acid,aspartic acid, γ-aminobutyric acid and taurine in the hypothalamus and hippocampus of rats under repeatedly psychic stress so as to investigate the effects of tiaogan recipe, jianpi recipe, bushen recipe and ginsenoside on them.DESIGN: A randomized grouping and controlled observation trial.SETTING:Department of Basic Theory of Traditional Chinese Medicine(TCM) of Basic Medical Science College, Guangzhou University of TCM.MATERIALS:The experiment was completed from March 2002 to January 2003 at the Animal Center of Guangzhou University of TCM.Totally60 Wistar rats were randomly divided into 6 groups: normal, model, tiaogan, bushen, jianpi and ginsenoside groups, with 10 in each group. Compositions and doses of tiaogan recipe: radix bupleuri 5 g, fruetus gardeniae 5 g,radix paeoniae alba 15 g,fructus lycii 15 g,fructus aurantii 6 g,radix rehmanniae 18 g, concha haliotidis 30 g. Compositions and doses of shenqi pill: radix rehmanniae 30 g, rhizoma dioscoreae 15 g, fructus corni 15 g,rhizoma alismatis 10 g,poria 10 g,cortex moutan radicis 10 g,ramulus cinnamomi 4 g, radix aconiti praeparata 4 g. Compositions and doses of sijunzi decoction:radix codonopsis pilosulae 20 g,rhizoma atractylodis macrocephalae 15 g, poria 15 g, radix glycyrrhizae preparata 6 g.METHODS:① The traditional Chinese medicines were conventionally decocted; and the tiaogan recipe condensed to the liquid containing1.69 g/mL crude drug, shenqi pill containing 1.76 g/mL crude drug,sijunzi decoction containing 1.01 g/mL crude drug.Ginsenoside was prepared as 7 g/L water solution.The rats in the normal and model groups were by gavage given 2 mL of 9.0 g/L sodium chloride injection.The rats in the tiaogan, bushen, jianpi and ginsenoside groups were respectively by gavage given 2 mL of tiaogan recipe, shenqi pill, sijunzi decoction and ginsenoside solution 1 hour before immobilization stress. ② Except for rats in the normal group, those in the rest groups were all conducted for establishment of psychic stress reaction model.The rats were put into an immobilization tube,their action space was gradually reduced by using a mobile insertion piece,they were regulated to a nervous state without prpduction of intense revolting, which was done once a day, starting with 4 hours immobilization on the first day, and later on increased by 30-60 minutes per day, for consecutive 14 days. ③ The whole brain of the rats in each group was collected by decapitation,OPA high-performance liquid chromatography was used for assays of the contents of glutamic acid, aspartic acid, γaminobutyric acid and taurine in hypothalamus and hippocampus of the rats.MAIN OUTCOME MEASURES: The content changes of glutamic acid,aspartic acid,γ-aminobutyric acid and tanrine in the hypothalamus and hippocampus of rats in each group.RESULTS: Totally 60 rats involved all entered into the result analysis. ①The content changes of glutamic acid in the hypothalamus and hippocampus of rats in each group:Compared with normal group,the contents of glutamic acid in hypothalamus of rats in the tiaogan, jianpi,bushen and ginsenoside groups were markedly decreased [(21.85±8.19), (15.76±1.80),(14.68±7.91), (21.46±5.45), (13.43±7.68) μmoL/g]; compared with model group,the contents in the tiaogan, bushen, jianpi and ginsenoside groups were obviously raised [(11.04±3.65), (11.78±2.17), (18.67±2.98), (20.91 ±3.96),(17.71±1.83) μ moL/g, P ＜ 0.05, P ＜ 0.01, P ＜ 0.01, P ＜ 0.05]. ② The content changes of aspartic acid in the hypothalamus and hippocampus of rats in each group:Compared with model group,the contents of aspartic acid in the hypothalamus in the jianpi and ginsenoside groups were obviously decreased [(8.65±1.18), (5.72±1.32), (4.67±1.88) μmoL/g, P ＜ 0.01,P ＜ 0.01], while the contents in the hippocampus of rats in the jianpi,bushen and ginsenoside groups were markedly raised[(2.58 ±0.87),(3.93±0.49), (4.52±0.98), (3.83±0.41) μmoL/g, P ＜ 0.01, P ＜ 0.01, P ＜ 0.05].③ The content changes of γ-aminobutyric acid in the hypothalamus and hippocampus of rats in each group:Compared with model group,the contents of γ-aminobutyric acid in the hypothalamus of rats in the tiaogan,jianpi,bushen and ginsenoside groups were markedly decreased[(20.92±4.96), (15.87±2.90), (13.84±2.63), (14.94±3.98), (10.94±3.68) μ moL/g,P ＜ 0.05, P ＜ 0.05, P ＜ 0.01, P ＜ 0.01], while the contents in the hypothalamus were obviously raised [(4.12±1.66), (4.18±1.04), (6.67±1.29),(6.11±0.99), (6.37±0.78) μmoL/g, P＜ 0.05, P＜ 0.01, P＜ 0.01, P＜ 0.01].④ The content changes of taurine in the hypothalamus and hippocampus of rats in each group: Compared with model group, the contents of taurine in the hypothalamus of rats in the tiaogan, jianpi, bushen and ginsenoside groups were markedly decreased [(10.24±1.72), (7.82±1.14), (8.00±2.05),(6.42±3.17) μmoL/g, P ＜ 0.05, P ＜ 0.05, P ＜ 0.01], while the contents in the hippocampus in the jianpi and ginsenoside groups were obviously raised [(12.61±3.51), (17.03±2.74), (18.04±2.14) μnoL/g, P＜ 0.01, P＜ 0.01].CONCLUSION:The central acting site of tiaogan recipe may mainly be in the hypothalamus,possibly being related with down-regulating amino acids.While the central acting sites ofjianpi recipe,bushen recipe and ginsenoside may include the hippocampus and hypothalamus, being mainly related with up-regulating amino acids,through enhancing the integration of the hippocampus on stress so as to gain the effect of anti-injury of stress.

Objective To observe the curative effect of continuous gastrointestinal decompression after gastric lavage with edible oil on saving patients with oral aluminum phosphide poisoning.Methods Seventy-eight patients with oral aluminum phosphide admitted to the Department of Internal Emergency of the Second People's Hospital of Yunnan Province from October 2009 to October 2016 were divided into a mild poisoning group (39 cases), a moderate poisoning group (26 cases) and a severe poisoning group (13 cases) according to clinical manifestations and laboratory examinations, all the patients were treated with continuous gastrointestinal decompression after early gastric lavage with edible oil, including scavenging toxicant, correcting intracellular oxygen intake and metabolic disturbance, and inhibiting and eliminating inflammatory mediators. The difference of remission times of clinical symptoms, recovery times of abnormal indexes and hospitalization times were compared among patients with different disease severities. Results With the aggravation of disease, the remission times of clinical symptoms (hours: from mild to severe were 24±12, 54±18, 84±12), recovery times of abnormal indexes (hours: from mild to severe were 18±6, 72±0, 108±12) and hospitalization times (hours: from mild to severe 48±24, 120±24, 144±24) were all gradually extended. Of the 13 patients with severe poisoning, 2 patients died of multiple organ functional failure (MOF) after 28 hours of treatment because they were incapable of cooperating with continuous gastrointestinal decompression. There were 76 patients were clinically cured, the cure rate being 97.4%. In the follow-ups at 1 month and 6 months after the treatment, no abnormalities were seen.Conclusion Continuous gastrointestinal decompression after early gastric lavage with edible oil for saving patients with oral aluminum phosphide poisoning is an effective therapy worthwhile to be popularized.

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 investigate the function and mechanism of miR-149 in nasopharyngeal carcinoma (NPC).Methods The expression of miR-149 was examined by real-time PCR and calculated by 2-△△Ct method. The cell proliferation was analyzed by MTT assay. The cell migration and invasion were shown by the wound healing assay and transwell migration assay, and the expression of E-cadherin was detected by Western blot. Results The expression of miR-149 was higher in NPC cell lines 5-8F and 6-10B than that in normal immortalized nasopharyngeal epithelial NP69. MTT assay showed that miR-149 promoted the proliferation of NPC cell lines. The wound healing assay showed miR-149 promoted the mobility and invasion of NPC cell lines. Inhibition of miR-149 reduced the ability of NPC cell lines to proliferate and invade. miR-149 downregulated the expression of E-cadherin, whereas antagomir which mediated knockdown of miR-149 significantly upregulated the expression of E-cadherin. Conclusion miR-149 might be involved in the invasion and metastasis of NPC through regulation of epithelial-mesenchymal transition (EMT).

Primary testicular lymphoma comprises 1% to 9% of testicular neoplasms and represents 1% to 2% of all non-Hodg-kin lymphomas. Histologically, the majority of the tumor consists of diffuse large B-cell non-Hodgkin lymphomas that are of intermedi-ate- or high-grade neoplasm. Clinically, the disease typically presents as a painless testicular swelling that develops over a span of weeks to months. B symptoms such as fever, weight loss, and anorexia are present in 25% to 41% of the patients. This tumor is an ag-gressive type, with frequent invasion of the epididymis, spermatic cord, and scrotum, as well as a marked tendency to relapse, especial-ly in the CNS. The treatment is mainly based on orchiectomy (mostly in stages ⅠE and ⅡE) regardless of its association with prophy-lactic irradiation of the scrotum and administration of intrathecal chemotherapy, cyclophosphamide, doxorubicin, vincristine, and pred-nisone regimen chemotherapy plus rituximab (R-CHOP) (stages ⅢE and ⅣE) and radiotherapy. The multi-modality treatment marked-ly improved progression-free and overall survival. We introduce as reference one case that received a multidisciplinary comprehensive discussion in the Department Lymphoma, Tianjin Medical University Cancer Hospital.