Objective To evaluate the clinical effectivity of continuous positive airway pressure in treatment of chronic obstructive pulmonary disease complicated with left heart failure.Methods Totally 103 patients (aged 63-78 years) with chronic obstructive pulmonary disease complicated with left heart failure were randomly divided into two groups:treatment group (received noninvasive ventilation combined with routine medication) and control group (received conventional drug therapy).The patients of two groups were observed in the treatment of 1 hour to one week that blood pressure (SBP),heart rate (HR),arterial blood gas analysis,respiratory rate (RR),brain natriuretic peptide (BNP) and other indicators to improve the situation.Results After treatment,the PaO2 level of patients in treatment group was significantly increased from (56.1 ± 7.8) mm Hg to (91.1 ±11.3)mm Hg,(t=449.94,P＜0.05),PaCO2 decreased from (60.1± 10.9) mm Hg to (42.3± 9.3)mm Hg,(t=4.66,P＜0.05),pH value was improved from (7.26±0.12) to (7.36±0.17) (t=5.88,P＜0.05) and BNP was decreased from (350±181) ng/L to (961±376) ng/L (t=8.07,P＜0.05).In control group,the PaO2 was significantly increased from (55.0±8.1) mm Hg to (89.1±12.0) mm Hg (t=43.17,P＜0.05) after treatment,PaCO2 by decreased from (48.9±10.8) mm Hg,(58.9±10.8) mm Hg to (t=5.13,P＜0.05),pH value by up to (7.27 ±0.08),BNP by decreased from (439 ± 246) ng/L to (947 ±407) ng/L t=9.81,P＜0.05.Compared with the control group,the difference of PaO2 and BNP had no significantly significant.PaCO2 in treatment group was increased more sharply than it in the control group,and pH decreased more (P＜0.05 or P＜0.01).Conclusions The use of continuous positive airway pressure to treatment chronic obstructive pulmonary disease complicated with left heart failure can alleviate fatigue and prevent the respiratory failure.It is remarkable treatment effect and worthy of clinical application.

The essay discussed the necessity and essentiality of medical moral education to intern,in the background of market-oriented economy.To summarize ways of medical moral education to intern.

Objective To characterize the effects of AQP1 expression on kidney damage in rat disseminated intravascular coagulation(DIC) caused by lipopolysaccharide(LPS) dosing. Method Fifty male Wistar rats (clean grade) were randomly assigned into 5 groups of 10 rats. The 10 control rats were dosed with 10 ml of 0.9%NaCl solution by a drip via the vena caudalis within 4 h, and blood and tissues were obtained after treatment completion. In the DIC groups, the rats were dosed with LPS (30 mg/kg body weight in 10 ml of 0.9% NaCl solution) by a drip via the vena caudalis within 4 h, and blood and tissues were obtained at 4, 6, 8 and 10 h. The blood platelet(PLT) count, prothrombin time(PT) , activated partial thromboplastin time(APTT), fibrin(FIB) and D-dimer(D-D) were detected. Hematoxylin and eosin(HE) staining was used to examine the pathologic changes in the lung and kidney tissues of each group (both hematologic parameters and tissue pathologic changes were used to judge the course of DIC). The AQP1 gene expression levels in the kidney tissues from the groups were evaluated by the mRNA levels using RT-PCR. Statistical analyses were performed by the SNK- q method. Results The PLT count, PT, APTT, FIB and D-D examinations revealed remarkable changes in all DIC groups compared with the control group (P < 0.01). The AQP1 mRNA level was significantly decreased in the DIC group at 4 h compared with the control group (P < 0.01) , and further decreased to the minimum level in the DIC group at 6 h. Moreover, cloudy swelling of renal tubular cells was observed at 6 h and cell degeneration and necrosis were observed at 8 h among the DIC groups. Conclusions Downregulation of AQP1 mRNA expression occurred before damage to the renal tubular cells in DIC, indicating that AQP1 expression may be involved in the kidney damage observed in rat DIC.

Objective To evaluate the applicable value of two - dimensional speckle tracking imaging on assessing the local function and coronary collateral circulation of acute myocardial ischemia in dogs.Methods Open-chest model to induce acute myocardial ischemia in 10 dogs was established by ligating their anterior descending coronary artery(LAD). Two-dimensional dynamic gray- scale images of two standard left ventricular short axis views at the levels of mitral annulus and papillary muscle were acquired for the off -line comparative analysis before the operation and 0, 30, 60, 120, 240 and 360 minutes after the operation respectively. Peak systolic circumferential strain(CS), peak systolic radial strain(RS) and left ventricular fraction shortenting(LVFS) of 12 segments at the levels of mitral annulus and papillary muscle were analyzed with QLAB software. After the lab experiment,the fresh hearts of dogs were dyed by TTC.Results ①Compared with the preoperative value , the peak systolic CS and RS of ischemia myocardial regions(anteroseptum,anterior and lateral) in left ventricular short-axis decreased significantly( P ＜0. 05)during 30 to 60 minutes after ligating LAD. Sixty minutes later, the peak systolic CS and RS had a tendency to return to the level before the operation,although the statistical difference was existing. The peak systolic RS and CS also decreased in certain nonischemic regions (inferolateral and inferior). But CS and RS in inferoseptal regions didn't alter significantly. ②Compared with the preoperative value,LVFS in the ischemia regions were significantly decreased( P ＜0.05), while nonischemic regions had no significant difference. ③The results of TTC dyeing showed that the infarcted regions in left ventricular short-axis were anteroseptum, anterior and lateral with blood supplied by LAD, which were consistent with the results of RS and CS. Conclusions RS and CS,as the parameters of myocardial strain may reflect the range and extent of acute myocardial ischemia,and the strain changes of local myocardial segments after the construction of coronary collateral circulatory.

Objective This study investigated a method to rapidly inactivate tumor cells on surgical instruments intraoperatively.Methods Tumor cells were collected by immersing and washing the surgical instruments in 37 ℃ saline.The precipitation was collected by low speed centrifugation and then was cultured to harvest the tumor cells.The tumor cells were immersed in saline and distilled water of different temperatures for different duration of time.Inverted microscopy was used to investigate the changes in morphology.Results After immersion in 55 ℃ distilled water for 60 seconds,the tumor cells were swollen,the cell membranes disappeared,the sizes of the nuclei were reduced,the chromatin was condensed,and some cells lysed and separated from each other.Additionally,these tumor cells floated in the culture medium and lacked any living cells adhering to the walls of the bottle.In the group of tumor cells treated with 55 ℃ saline for 60 seconds,there were no obvious morphological changes of the tumor cell or nucleus.Conclusion The intraoperative immersion of surgical instruments in 55 ℃ distilled water for 60 seconds could completely inactivate tumor cells.

Objective To evaluate potential clinical risk factors for the development of early-onset myocardial damage following multiple trauma (MT), and to determine whether early-onset myocardial damage was caused by the combined effects of thoracic and systemic injury factors in MT patients.Methods A total of 231 patients with MT over the last 3 years were retrospectively reviewed. With myocardial damage being a dependent variable and other twenty factors being independent variables, univariate and multivariate logistic regressions were applied to investigate the risk factors for early-onset myocardial damage and to identify the association of thoracic and systemic risk factors with early-onset myocardial damage.Results Multivariable logistic regressions showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score ≥10, injury severity score (ISS) ≥ 25, shock index ≥ 2,coexisting chest trauma, abbreviated injury scale (AIS) of chest≥3, and hypoxia time ≥ 0.5 h were risk factors. The risk of earlyonset myocardial damage following MT obviously increased when thoracic and systemic injury risk factors were coexisting.Conclusion Our results indicated that thoracic injury combined with systemic injury increased the overall risk of early-onset myocardial damage following MT. Prospective validation of these findings in other clinical settings is warranted.

Objective To investigate the relationship between positive peritoneal exfoliated cancer cells and the clinicopathological features of patients with hepatocellular carcinoma before any invasive treatment.Methods Of the 92 patients with hepatocellular carcinoma who underwent laparotomy,ascites fluid was collected in the patients with peritoneal ascites; and peritoneal lavage fluid was collected in those patients without peritoneal ascites.Then,shedded cancer cells in these fluid samples were detected.Results The positive rates of peritoneal cancer cells were associated with the TNM stage,tumor location and tumor size.The positive detection rate of cancer cells in TNM stage Ⅲ and Ⅳ was significantly higher than stage Ⅰ and Ⅱ (38.1％ vs 8.0％ ; P =0.0005).The positive detection rate was higher in tumors located closer to the surface (P =0.0 002),and with larger diameter (P =0.00 007).Conclusion Peritoneal cancer cells were significantly correlated with tumor stage,tumor location and size in hepatocellular carcinoma.

Objective To investigate the core competency of nurses in the operating rooms from 8 first-class grade A general hospitals in Guangzhou.Method A total of 408 nurses in the operating rooms from 8 first-class grade A general hospitals in Guangzhou were involved in the survey by completing the questionnaire of Competency Inventory for Registered Nurses.Results The total score of core competency was(161.49±3.70).The average score of different items was(2.78±0.44).The first three items scored the highest including legal/ethical practice(2.93±0.61),professional development(2.85±0.61)and leadership(2.80±0.58).The item scored the least was critical thinking(2.66 ±0.64).Conclusions The core competence of nurses in the operating rooms from 8 first-class grade A general hospitals in Guangzhou falls at the intermediate level,their strengths including legal/ethical practice, professional development and leadership.They are poor and weak at critical thinking and scientific research.

Rats were divided into 6 groups fed with 2 levels of zinc (1.41 and 100 ppm) and 3 levels of vitamin A (retinyl acetate 0, 7 and 46 mg/kg). Each group of the rats was tube-fed for 18 days and killed on the 19th day of experiment. Growth rate, zinc and vitamin A levels in serum and tissues, alkaline phosphatase (AKP) activity in serum, total protein and hemoglobin concentrations were measured. Both zinc levels in serum and tissues and AKP activity of the zinc deficient groups were significantly lower than those of the control group. The serum vitamin A values were distinctively depressed in the vitamin A free and vitamin A normal group. The serum vitamin A values in the vitamin A enriched group were not affected by zinc deficient diet and its serum zinc levels was higher than vitamin A free and normal group. The results suggest that zinc deficiency will interfere the release of vitamin A from liver and lead to the decrease of blood vitamin A, which may occurs only when the blood zinc is lower than a certain "critical level" . Different levels of vitamin A have different effect on rats of zinc deficiency, such as vitamin A deficiency will aggravate the zinc deficient symptoms and the increase of vitamin A intake can alleviate zinc deficient harms.

Objective: To obtain monoclonal antibodies against putative protein X4 of SARS-CoV for further study of the structure and function of protein X4. Methods: Balb/c mice were immunized with recombinant Protein X4, hybridoma cell lines secreting monoclonal antibodies against protein X4 were screened by regular cell fusion and subcloning approach. The specificities of these monoclonal antibodies were determined by Western blotting and Immunofluorescecence assay. Results: Three hybridoma cell lines (8A5, 8H6 and 4A2) stable in secreting specific monoclonal antibodies were successfully obtained. They could bind specifically to protein X4 proved by Western blotting. All of them belonged to the IgG2a isotype proved by antigen mediated ELISA. Indirect Immunofluorescence assay indicated that they could specifically bind to protein X4 expressed in SARS-CoV infected Vero E6 cells. Conclusion: Monoclonal antibodies of high specificity against protein X4 have been successfully prepared, which laid the foundation for the further study of protein X4.