ObjectiveTo investigate prognostic factors in acute exacerbation of COPD (AECOPD).Methods352 AECOPD patients were investigated.26 possible variables were analyzed.Multivariate Logistic and Cox proportional-hazards regression analysis were used.ResultsAccording to multivariate Logistic regression,it showed seven factors were statistically significant for short term prognosis ( P ＜0.05 ),including PaO2 ( OR =0.082),CKMB ( OR =4.967 ),mechanical ventilation ( OR =6.903 ),albumin ( OR =0.221 ),FEV1％ ( OR =0.255 ),charlson index ( OR =8.406 ) and hospital day ( OR =0.075).According to multivariate Cox regression,it showed seven factors were statistically significant for long term survival ( P ＜ 0.05 ) including acute exacerbation frequency( HR =1.611 ),charlson index( HR =4.319),SaO2 ( HR =0.224 ),troponin Ⅰ ( HR =3.824 ),albumin ( HR =0.569 ),hospital day ( HR =0.456) and FEV1％ (HR =0.494).Acute exacerbation frequency was correlated with dyspnea scale( rs =0.508,P ＜ 0.01 ).ConclusionsPaO2,albumin,FEV1％,CKMB and charlson index were related with short term prognosis.SaO2,albumin,FEV1 ％,troponin Ⅰ,charlson index and acute exacerbation frequency were related with long term survival.Higher acute exacerbation frequency contributed to more severe breathing difficulties and worse quality of life.

Objective To investigate the effects of different doses of dexmedetomidine on the minimum alveolar concentration of sevoflurane for blunting responses to skin incision ( MACBAR ) in patients undergoing lower abdominal surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 25-55 yr, weighing 45-75 kg, undergoing electire lower abdominal surgery under general anesthesia, were randomly divided into 4 groups ( n = 15 each): control group (Do group) and 3 dexmedetomidine groups (D1, D2 and D3 groups). The patients were unpremedicated.Dexmedetomidine was not used in group D0. A loading dose of dexmedetomidine 0.1μg/kg was injected iv over 10 min, and then dexmedetomidine was infused at a rate of 0.4, 0.8 and 1.2 μg· kg- 1 · h - 1 for 30 min in groups D1-3 respectively. Anesthesia was induced with inhalation of 8 % sevoflurane. Laryngeal mask airway was inserted when BIS value decreased to 45-55. The patients were mechanically ventilated with inhalation of sevoflurane and a mixture of 50% nitrous oxide and 50% oxygen, and the fresh gas flow was set at 1 L/min. In D0-3 groups, the initial end-tidal concentrations of sevoflurane were 3.0%, 2.5%, 2.0% and 1.5% respectively. The patients' response to skin incision was described as effective if MR or MAP increased by ＜ 15%, or ineffective (MR or MAP increased by ≥ 15%). When the response was effective, the end-tidal concentration of sevoflurane was decreased in the next patient, when ineffective, increased, and the ratio between the two successive concentrations was 0.9.The MRCBAR of sevoflurane was determined by up-and-down method, and 95% confidence interval was calculated.Results The MRCBAR (95% confidence interval) of sevoflurane was 2.85% (2.44%-3.32%), 1.91%(1.61%-2.26%), 1.52% (1.31%-1.77%), and 1.34% (1.15%-1.57%)in D0-3 groups respectively. The MRCBAR of sevoflurane was significantly lower in D1-3 groups than in D0 group, and in D2 and D3 groups than in group D1 (P ＜0.05＝. There was no significant difference in MRCBAR of sevoflurane between D2 and D3 groups (P ＞0.05) .ConclusionContinuous infusion of dexmedetomidine at 0.4, 0.8 and 1.2 μg·kg-1 ·h-1 for 30 min results in a decrease in MACBAR of sevoflurane and enhances the inhibitory effect of sevoflurane on the stress response, and in a dose-dependent manner.

BACKGROUND:Different methods of internal fixation can be selected during the repair of femoral shaft fractures in the clinic, including bridging combined internal fixation and metal locking plate screw fixation.
OBJECTIVE: To compare the biomechanical properties of bridging combined internal fixation and metal locking plate screw fixation for femoral shaft fracture.
METHODS:Eighteen femoral samples were colected and randomly divided to three groups, with six in each group. In the normal control group, no treatment was given. In the other groups, models of femoral shaft fracture were established. In the bridging combination group, samples underwent bridging combined internal fixation. In the locking plate screw group, samples underwent metal locking plate screw fixation. Biomechanical test was conducted in samples of the three groups. In the femoral compression experiments, we recorded the maximum displacement under the maximal load 500 N. In the femoral flexion experiment, we recorded the maximum displacement under the maximal load of 100 N. In the femoral retroversion experiment, we recorded the maximum displacement under the maximal load of 100 N.
RESULTS AND CONCLUSION: (1) Compression experiment at different loads: the maximum displacement was larger in the bridging combination group and locking plate screw group than in the normal control group. Under the maximum load of 500 N, the maximum displacement was significantly larger in the bridging combination group and locking plate screw group than in the normal control group (P < 0.05). Moreover, the maximum displacement was significantly less in the bridging combination group than in the locking plate screw group (P< 0.05). (2) Flexion experiment under different loads: the maximum displacement was larger in the bridging combination group and locking plate screw group than in the normal control group. Under the maximal load of 100 N, the maximum displacement was significantly larger in the bridging combination group and locking plate screw group than in the normal control group (P< 0.05). Moreover, the maximum displacement was significantly smaler in the bridging combination group than in the locking plate screw group (P < 0.05). (3) Retroflexion experiment under different loads: the maximum displacement was larger in the bridging combination group and locking plate screw group than in the normal control group. Under the maximal load of 100 N, the maximum displacement was significantly larger in the bridging combination group and locking plate screw group than in the normal control group (P < 0.05). Moreover, the maximum displacement was significantly smaler in the bridging combination group than in the locking plate screw group (P < 0.05). (4) These results suggested thatin vitro simulated femoral shaft fracture bridging combination fixation and metal locking plate screw system can obtain good fixation effect; the design meets the principle of biomechanics. Among them, bridging combined internal fixation can maintain a smaler displacement, suggesting good deformation resistance under compressive stress, anteflexion and retroflexion stress.

Objective:To observe and study the short-term efficacy of levocarnitine combined with trimetazidine in the treatment of elderly heart failure of ischemic cardiomyopathy. Methods:Totally 106 elderly patients with ischemic cardiomyopathy and heart failure were randomly divided into the observation group and the control group with 53 ones in each. All the patients were given anti-platelet, anti-myocardial ischemia and lipid-lowering therapy as well as the conventional therapy on myocardial ischemia. The control group was treated with trimetazidine,20mg,po,tid,while the observation group was additionally treated with 2g levocarnitine with 0. 9% sodium chloride injections,100ml,ivd,qd. The treatment course was 4 weeks. The improvement of heart function and the changes in cardiac function indices( including LVEDD,LVESD and LVEF)and cardiac ischemia markers( CKMB,TüI and BüP)before and after the treatment were compared between the two groups. The incidence of adverse drug reactions,the rate of re-hospitalization and mortality in the two groups were also compared. Results:The significant efficiency and total effective rate in the observation group were much higher than those in the control group(P<0. 05 or 0. 000 1). After the treatment,LVEDD and LVESD in the two groups were declined, LVEF was increased(P<0. 05),and the changes in the observation group were more notable than those in the control group(P<0. 05 or 0. 000 1). After the treatment,the contents of CKMB,TüI and BüP in the two groups were lower than those before the treat-ment(P<0. 05),and the decrease in the observation group was more notable than that in the control group(P<0. 05). There were no significant differences in the incidence of adverse reactions,re-admission rate and mortality between the two groups(P>0. 05). Conclusion:Levocarnitine combined with trimetazidine on the basis of the conditional therapy in the treatment of elderly patients with ischemic cardiomyopathy and heart failure can effectively improve heart function with better clinical efficacy,which is worthy of promo-tion in clinic.

Objective To investigate the clinical efficacy of TongluoShu Liquid in treating rheumatoid arthritis at early stage. Methods 100 cases were randomly recruited into a control group and a treatment group with 50 cases in each group. The treatment group was given TongluoShu liquid, 150ml / time, twice a day; and the control group was given Diclofenac Sodium Sustained Release Tablets (Deegan), one granule for each time, twice a day, and Methotrexate 7.5mg / time, once per week. Results In the treatment group, symptoms, signs and biochemical indicators were significantly improved, and the swelling of the soft tissue around the joints in stage Ⅰ and Ⅱ were also reduced. Besides, osteoporosis was controlled and the progress of destruction to the cartilage of stage Ⅲ was detained, though there was no statistical difference between the two groups after the treatment. Conclusion ShuTongluo liquid is a safe and effective medicine with less adverse reactions in treating rheumatoid arthritis.

Objective To investigate the role of mitochondrial ATP-sensitive potassium(mito-KATP)channels in attenuation of ischemia-reperfusion(I/R)injury by lidocaine pretreatment in the isolated rat heart.Methods Adult female Wistar rats weighing 220-250 g were anesthetized with intraperitoneal 3% pentobarbital 35 mg/kg.Their hearts were excised and perfused in a Langendorff apparatus with K-H solution saturated with 95%O2-5%CO2 at 37 ℃.Twenty-four isolated rat hearts with I/R injury were randomly divided into 3 groups(n = 8 each):group I/R,lidocaine group(group L)and lidocaine + glibenclamide group(group LG).After 10 min of equilibration,group C,L and LG received 20 min of perfusion with K-H solution,K-H solution containing lidocaine 2.5 mg/L and K-H solution containing lidocaine 2.5 mg/L + glibenclamide(a blocker of mito-KATP channels)10 μmol/L,respectively,then subjected to 30 min of ischemia followed by 60 min of reperfusion.HR,left ventricular developed pressure(LVDP),+ dp/dtmax and - dp/dtmax were recorded at the end of equilibration(T0)and at 15,30,45 and 60 min of reperfusion(T1-4).Coronary effluent was collected at T0 and T4 for determination of lactate dehydrogenase(LDH)and creatine kinase(CK)activities.Myocardial tissues were obtained from cardiac apex at T4 for determination of Na+ -K+ -ATPase and SOD activities and MDA and Ca2+ contents.Results Compared with group I/R,HR,LVDP,+ dp/dtmax and - dp/dtmax were significantly increased,CK and LHD activities were decreased,Na+ -K+-ATPase and SOD activities were increased,and MDA and Ca2+ contents were decreased in group L(P ＜0.05).Compared with group L,HR,LVDP,+ dp/dtmax and -dp/dtmax were significantly decreased,CK and LHD activities were increased,Na+ -K+ -ATPase and SOD activities were decreased,and MDA and Ca2+ contents were increased in group LG(P＜0.05).Conclusion The mechanism by which lidocaine pretreatment attenuates I/R injury to the isolated rat heart is related to mito-KATP channel opening.

Objective To investigate the effect of methylprednisolone pretreatment on cardiopulmonary bypass(CPB)-induced intestinal barrier injury in patients undergoing cardiac surgery.Methods Ninety NYHA Ⅰor Ⅱ patients,aged 30-50 yr,weighing 50-75 kg,scheduled for elective cardiac surgery with CPB,were randomly divided into 3 gnoups(n =30 each):control group without CPB(group Ⅰ),control group with CPB(group Ⅱ)and administration of methylprednisolone before CPB group(group Ⅲ).Anesthesia was induced with midszolam,fentanyl,etomidate and rocuronium and maintained with intravenous infusion of propofol and intermittent iv boluses of fentanyl and rocuronium.The patients were mechanically ventilated after tracheal intubation.In group Ⅲ,methylprednisolone 10 mg/kg was injected intravenously before operation and CPB.While in groups Ⅰ and Ⅱ,the equal volume of normal saline was injected instead.The blood samples were taken from the central vein before induetion of anesthesia(T1),before CPB(T2),at 30 min after the beginning of CPB(T3),at 30 rin afier the end of CPB(T4)and at 120 min after operation(T5)for determination of the plasma endotoxin concentration.Infection was recorded within 7 days after operation.Results The plasma endotoxin concentrations at T1 were within the normal range in all groups,without significant difference among the three gnoups(P ＞0.05).The plasma endotoxin concentration at T3-5 and incidence of postoperative infection in group Ⅲ were significantly lower than those in group Ⅱ,while higher than those in group Ⅰ(P ＜ 0.05).Conclusion Methylprednisolone pretreatment can reduce CPB-induced impairment of the intestinal harrier function in patients undergoing cardiac surgery.

Objective To develop a medical equipment management information system in CAPF so as to improve current medical equipment management and maintenance level.Methods Based on a thorough research for current medical equipment management model in CAPF,the platform of NET was utilized to develop the software.The connection,combination and operation among all medical equipment management and maintenance work were realized by hardware construction at last.Results The management information system not only met the requirement in management of medical equipment,but also supplied a data basis to directors.Conclusion The management information system provides a powerful tool for the scientific and standard management of medical equipment in CAPF.

Objective To investigate the underlying neural mechanism of left hemiparalexia and left hemialexia in reading Chinese characters. Methods A patient with reading disorders caused by brain infarctions at the left ventralis medialis occipitotemporal lobe and the splenium of the corpus callosum was studied. A series of neuropsychological tests, such as reading Chinese characters presented in the central foveal field or in the left and right half of the foveal field, were conducted with the patient, and neuroimaging techniques including high spatial resolution 3D-MRI and diffusion tensor tractography (DTT) were used to examine whether or not there were lesions of the neural pathway. Results The patient showed left hemiparalexia, which was characterized by making substitution or omission mistakes, mostly in the left parts of Chinese characters, and also left hemialexia(alexia for characters presented in left visual field). 3D-MRI demonstrated infarctions in the left ventral mesial occipitotemporal area and in the left side of the splenium of the corpus callosum. The left lateral mid-fusiform cortex, which has been identified as the visual word form area(VWFA), was almost intact. DTT indicated the major forceps fibers running through the splenium were all disconnected due to the infarction of the left splenium. Conclusion As a result of disruption of the splemium-major forceps pathway, visual character information in the left visual field which is initially projected to the right occipital cortex cannot be transferred from the right visual cortex to the left VWFA. This mechanism of left hemiparalexia and left hemialexia in reading Chinese characters is similar to that in reading English words.

Objective To study the effect of flupentioxl melitracen and pinaverium bromide treatment on the changes of anorectal motility and rectal sensation in the patients of diarrhea-predominant irritable bowel syndrome (IBS-D) accompanying with depression and/or anxiety status. Methods Forty-four patients with IBS-D accompanying with depression and/or anxiety status were divided into group A (flupentioxl melitracen and pinaverium bromide) and group B (pinaverium bromide) by random digits table,and treated for 4 weeks. Twenty-five healthy subjects were included as control group. The anorectal motility and rectal sensation before and after taking medicines were compared. Results When abdominal pressure was increased, the net increased pressure of anal sphincter was (3.0 ± 1.2 ) kPa in group A and (2.9 ± 1.2)kPa in group B. They were lower than that in control group [(3.6 ± 1.6) kPa](P＜ 0.05). The rectal lowest volume of sensory threshold, the maximal volume of tolerance and maximal compliance were (55 ± 20) ml,( 145 ± 78 ) ml, ( 21.9 ± 12.9 ) ml/kPa in group A, ( 56 ± 38 ) ml, ( 150 ± 50 ) ml, (20.8 ± 11.2) ml/kPa in group B. They were lower than those in control group [(80 ± 38 ) ml, ( 190 ± 50 ) ml, (30.8 ± 15.2 ) ml/kPa](P ＜ 0.01 ). The rectal lowest volume of sensory threshold, the maximal volume of tolerance and maximal compliance were higher than those before taking medicines. Only the rectal lowest volume of sensory threshold in group B was higher than that before taking medicines. The rectal lowest volume of sensory threshold, the maximal volume of tolerance and maximal compliance in group A after taking medicines were higher than those in group B (P ＜ 0.05 or ＜ 0.01 ). Conclusions Higher sensitivity, lower tolerance,lower compliance of rectum and weakened anal automatic control function in IBS-D may be associated with diarrhea and frequent defecation. Treatment combining flupentioxl melitracen with pinaverium bromide may preferably improve the aperception functions of rectum in the patients of IBS-D accompanying with depression and/or anxiety status.