Objective To explore the value of tiotropium bromide in the treatment of patients with bronchiectasis accompanied by obstructive ventilation dysfunction.Methods 45 patients with bronchiectasis accompanied by obstructive ventilation dysfunction who were treated in the third people’s hospital of Haikou city from January 2014 to January 2015 were selected, and divided into control group (22 cases) and experimental group (23 cases) with the randomized controlled methods.The control group received routine treatment and experimental group received tiotropium bromide powder inhalation for a 8 week’s consecutive treatment.The pulmonary function, blood gas were compared and analyzed by BORG dyspnea score, six-minutes walk test (6MWT) and St.George’s respiratory questionnaire ( SGRQ).Results After treatment, maximal voluntary ventilation ( MVV) (%) in experimental group was significantly higher than that in control group(P<0.05), but there were no significant differences in forced expiratory volume in one second (FEV1), FEV1 (%), forced vital capacity ( FVC) (%) and FEV1/FVC between two groups.The PaCO2 in experimental group was significantly higher than that in control group ( P <0.05 ), but there was no significant difference in PaO2 between two groups.The 6MWD in experimental group was significantly higher and SGRQ values was lower than those in control group(P<0.05).Conclusion Long-term and regular usage of tiotropium bromide powder inhalation could improve pulmonary ventilation function and improve the quality of life of patients with bronchiectasis accompanied by obstructive ventilation dysfunction.

Objective To study the expression and significance of P53 and nm23 in colorectal adenocarcinoma.Methods The expression of P53 and nm23 was examined by immunohistochemical technique in 83 cases of colorectal adenocarcinoma.Results In colorectal adenocarcinoma,the positive intensities of P53 and nm23 was associated with tumour depth,histological grade,lymph node metastasis diseases and distant metastasis disease(P0.05).Conclusion P53 and nm23 may play an important role in the development and metastasis of colorectal adenocarcinoma.It is an useful marker for predictinng the prognosis of colorectal adenocarcinoma.

Objective To investigate the efficacy and tolerability of dose-dense chemotherapy with cisplatin plus 5-fluorouracil( PF regimen)in distant metastatic nasopharyngeal carcinoma( NPC)patients. Methods From April 1,2008 to April 30,2014,168 patients were assigned to traditional group(n = 83) and dose-dense group(n = 85)using digital random table in 1 : 1 ratio. All patients received PF regimen,and once every 28 days in traditional group and once every 14 days in dose-dense group. The primary endpoint was progression-free survival(PFS)and the secondary endpoint was overall survival(OS),toxicity and response rate. Results The median PFS,median OS,1,2,3-year survival rate,complete response rate and objective response rate were significantly improved in dose-dense group which were 13. 3 months,20. 2 months,80. 2% , 36. 0% ,16. 1% ,16. 5% ,84. 7% ,and those in control group were 10. 0 months,16. 1 months,59. 6% , 10. 1% ,0,3. 6% ,54. 2% respectively(χ2 = 24. 47,P = 0. 000;χ2 = 16. 65,P = 0. 000;χ2 = 8. 41,P =0. 004;χ2 = 16. 96,P = 0. 000;χ2 = 14. 91,P = 0. 000;χ2 = 7. 63,P = 0. 006;χ2 = 18. 47,P = 0. 000). The rates of grade 3-4 adverse events in dose-dense and traditional group were 38. 8% and 6. 0%(χ2 = 25. 81, P = 0. 000). Conclusion Dose-dense chemotherapy of PF is more efficient and acceptable toxic than the tra-ditional one. It can be a new treatment option for patients with distant metastases of NPC.

To examine the effect of transcatheter arterial embolization (TAE) of liver tumors on hypoxia-inducible factor-1alpha (HIF-1alpha) expression in the residual viable tumor, a total of 30 New Zealand White rabbits implanted with VX2 liver tumor were divided into 2 groups. TAE-treated group animals (n=15) were subjected to TAE with 150-250 mum polyvinyl alcohol particles. Control group animals (n=15) underwent sham embolization with distilled water. Six hours, 3 days or 7 days after TAE, the animals were sacrificed, and samples of tumor and adjacent normal liver tissue were harvested. Expression of HIF-1alpha protein was examined immunohistochemically. Real-time PCR was performed to examine the HIF-1alpha mRNA levels. Our results showed that HIF-1alpha protein was expressed in the VX2 tumors but not in the adjacent normal liver tissue. The HIF-1alpha-positive tumor cells were located predominantly at the periphery of necrotic tumor regions. The mean levels of HIF-1alpha protein were significantly higher in TAE-treated tumors than those in control tumors (P=0.002). Among the three sacrificing time points, the difference in increase in HIF-1alpha protein was significant between the two groups at the sacrificing time point of 6 h and 3 days after TAE (P=0.020, P=0.031, respectively), whereas no significant increase was noted 7 days after TAE (P=0.502). In contrast, although HIF-1alpha mRNA was expressed in TAE-treated and control VX2 tumors, there existed no significant difference in the HIF-1alpha mRNA level between the two groups (P=0.372). It is concluded that TAE of liver tumors increases the expression of HIF-1alpha at protein level in the residual viable tumor, which could be attributed to hypoxia generated by the procedure.

BACKGROUND: Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration (CVVH). Hence blood hemoperfusion with resin adsorption combined CVVH (HP+CVVH) has higher ability of mediator clearance, and can improve clinical outcomes in theory. This study aimed to investigate the effect of blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration (HP+CVVH) on plasm cytokines like TNF-α, IL-1β, IL-6, cellular immunity and prognosis in patients with multiple organ dysfunction syndrome (MODS). METHODS: This was a prospective, randomized clinical trial. A total of 30 patients who had been diagnosed with MODS were enrolled in this study. Patients were randomly allocated to routine treatment+HP+CVVH group (treatment group) and routine treatment+only CVVH group (control group). In the treatment group, patients received blood hemoperfusion with resin adsorption for 2 hours, and then received CVVH for 10 hours every day. In the control group, patients received CVVH for 12 hours only every day. The patients in the two groups received blood purification therapy for three days. The plasma of patients in the treatment group was obtained at 0, 2, 12, 24, 26, 36, 48, 50, 60 hours, 5th day, 7th day and 10th day, respectively. The plasma of patients in the control group was obtained at 0, 12, 24, 36, 48, 60 hours, 5th day, 7th day and 10th day, respectively. APACHE II score, T-lymphocytes subpopulations, blood lactate acid concentration, heart rate, breathing rate, and oxygenation index were observed. RESULTS: Plasma cytokines like TNF-α, IL-1β, IL-6 decreased markedly after HP (P<0.01);T-lymphocytes subpopulations CD3+, CD4+, CD8+, CD4+/CD8+ increased after HP+CVVH or only CVVH. The plasma concentrations of TNF-α, IL-1β and IL-6 in the two groups were not markedly different at 12, 36, and 50 hours. But on the 5th day, the plasma concentrations of TNF-α, IL-1β and IL-6 in the treatment group were lower than those in the control group (P<0.05). On the 28th day, 5 patients died in the treatment group, and 6 patients in the control group. CONCLUSIONS: Both HP+CVVH and CVVH can clean plasma cytokines like TNF-α, IL-1β, and IL-6, and improve cellular immunity and clinical symptoms and signs of patients. Compared with only CVVH, the plasma concentrations of TNF-α, IL-1β and IL-6 were lower on the 5th day, and patients have an increased survival rate on the 28 day in the HP+CVVH group.

Objective To explore the effect of postasphyxial-serum in neonate on expression of serine protease Omi/HtrA2 in renal tubular cells(HK-2).Methods Human renal proximal tubular cell line HK-2 cell was used as target cell.The cultural cells in orifice were divided into control group and asphyxia-serum attacking group.Blood was cowected from asphyxia newborns by means of femoral venous puncture,then the serum was garthered,anticoagulated by liquemie,3 000 r/min centrifuged 20 min,abstracted serum,thermostatic waterbathed the serum at 56 ℃,so that to inactivate addiment,filtered germ by micropore filte,the attacking concentrtion of serum was 200 mL/L,the cells of the asphyxia-serum attacking group were attacked by asphyxia-serum,and the cells of control group were cultivated with normal nutritive medium when the cells was needed.After 24 hours,the cells were tixed,then the expression of Omi/HtrA2 in cytoplast was detected by the use of immunohistochemical method.Results Omi/HtrA2 was inaurate or yellow brown and localized to the cytoplast.The rate of the cell expressed Omi/HtrA2 was(9.0?2.5)% in control group,after stimulated with postasphyxial-serum,in asphyxia group the rate of the cell expressed Omi/HtrA2 was(25.15?3.5)%,there was significant difference between 2 groups(t=-15.322 P

BACKGROUND: Enteral immunonutrition (EIN) refers to addition of some specific nutrients in enteral nutrition (EN), which can help to increase the immune function, and reduce the inflammatory reaction and septic complications. This study aimed to determine whether EIN can improve the immune function in multiple trauma patients. METHODS: Thirty-two patients with multiple trauma who had been admitted to the general ICU of Changzheng Hospital, Shanghai, from March 2007 to May 2008, were randomly divided into two groups: an enteral immunonutrition group (EIN group, n=16) and an enteral nutrition group (EN group, n=16). EIN suspension (RuiNeng produced by Sino-Swed Co., Ltd) and ordinary nutrition liquid (RuiSu produced by Sino-Swed Co., Ltd) were given to patients of the EIN group and EN group respectively for at least for 14 days. Peripheral blood lymphocyte count (TLC), immunoglobulin (IgG, IgM, IgA), and T-lymphocyte subsets (CD3, CD4, CD8, CD4 / CD8) were detected on the 1st day after grouping, and the 7th day and 14th day after nutritional support. RESULTS: TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher in the EIN group on the 7th and 14th day than that on the 1st day (P<0.05), and continually increased with a prolonged time of EIN. The parameters of immune function in the EN group on the 7th day didn't change significantly compared with those on the 1st day after grouping; on the 14 th day, TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher than those on the 1st day after grouping (P<0.05), but were significantly lower than those in the EIN group on the 14th day (P<0.05). CONCLUSION: Compared with the general formula EN, EIN is more helpful for the recovery of humoral and cellular immune function in the early post-multitraumatic phase.

Objective To evaluate the clinical efficacy of multiple stents placement in the management of hilar cholangiocarcinoma,especially in the complex cases of which the hepatic ducts are invaded.Methods Forty-five consecutive patients with hilar cholangiocarcinoma were treated with percutaneous transhepatic placement of two or three self-expandable metallic endoprostheses.The cause of hilar obstructions in these patients were all cholangiocarcinoma,including Bismuth classification type Ⅱ(n 12 ),Ⅲa(n 17),Ⅲb(n 10),and Ⅳ(n 6).Two or 3 stents were placed in the configuration of T,Y or X over the strictures.Results Stent placement with 2 or 3 endoprostheses was successful in all patients.All patients showed significant decrease in serum bilirubin level.The mortality rate within 30 days of stent placement was 2.2%(1/45).The mean survival and stent patency times were 215.3 d(26— 516 d)and 181.5 d(26—473 d),respectively.Conclusion Deploying of multiple metallic stents is an effective method to treat complex hilar cholangiocarcinoma,especially for the cases of which hepatic ducts are invaded:the henatic ducts should be drained as much as nossible.

Objective To summarize the experience of the therapy and diagnosis of thoracictuberculosis. Methods Diagnosis and operation of 163 cases of thoracictuberculosis were analyzed.Results 163 cases of thoracic- tuberculosis were treated with focuspurge upon two weeks' anti-tuberculosis treatment.153 cases were cured upon one operation.10 cases suffered incision delayed healing and there were no recurrence cases.Conclusion Thoraeictu- berculosis was treated with focuspurge upon two weeks anti-tuberculosis treatment before operation.Complete purge of focus and postoperative compression band and residual cavity filled with music flap were important measures to prevent incision delayed healing and recurrence.

Coprinus comatus cultivated on cotton seed hull medium decomposed lignocellulose straggly and was high of absolute biological efficiency. Lignocellulose is the main carbon source for the fruiting stage of the fungus. There existed the positive correlation between the degradation rates of the cellulose and hemicellulose in the medium and the activities of extracellular CMCase (carboxymenthelcel lulase), FPase (filter paper cellulase) and HCase (hemicellu-lase), there also existed the positive correlation between the degradation rate of the lignin in the medium and the activity of extracellular laccase, but no correlation between the degradatio rate of the lignin in the medium and the activity of peroxidase. The activity of extracellular amylase was comparatively high at mycelial growth stage, and the protease activity peek was at teh time when the fruitbody matured.