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Objective:To investigation of efficacy and safety of Ticagrelor vs.Clopidogrel as add-on to a common therapy of Aspirin in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)and undergoing percutaneous coronary intervention(PCI). Methods:A total of 208 elderly patients with STEMI and receiving PCI were divided into the Ticagrelor group(n=103, receiving Ticagrelor 180 mg, followed by 90 mg twice a day)and the Clopidogrel group(n=105, receiving Clopidogrel 600 mg, followed by 75 mg/d)as add-on to a common therapy of Aspirin(300 mg before operation, followed by 100 mg/d). Both groups were treated for 12 months.Coronary artery blood flow, platelet aggregation rate, left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), bleeding events and major adverse cardiovascular events(MACE)after PCI were compared between the two groups.Results:The TIMI(thrombolysis in myocardial infarction)grading after PCI was better in the Ticagrelor group than in the Clopidogrel group( Z=2.58, P=0.010). The incidence of no-reflow or slow blood flow was lower in the Ticagrelor group than in the Clopidogrel group(6.8% or 7/103 vs. 19.1% or 20/105, χ2=6.91, P=0.009). The variance analysis of repeated data showed that the platelet aggregation rate was decreased along with time in both groups( Ftime=87.54, P<0.001). The decrement of platelet aggregation rate was higher in the Ticagrelor group than in the Clopidogrel group( Ftime×group=6.16, P<0.001). The overall level of platelet aggregation was lower in the Ticagrelor group than in the Clopidogrel group( Fgroup=17.84, P<0.001). The platelet aggregation rates at 1 hour, 1 day and 3 days after operation were lower in the Ticagrelor group than in the Clopidogrel group( t=14.39, 13.19 and 6.53, respectively, P<0.001). LVEF was increased in both groups after PCI( t=7.46 and 4.33, all P<0.001), while LVEF was higher in the ticagrelor group than in the clopidogrel group( t=4.28, P<0.001). LVEDD was decreased in both groups after PCI( t=9.36 and 6.47, all P<0.001), while LVEDD was lower in the ticagrelor group than in the clopidogrel group( t=4.38, P<0.001). There were no significant differences in the incidences of hemorrhage and MACE between the two groups( χ2=0.91 and 2.32, all P>0.05). Conclusions:Ticagrelor has good anti-platelet aggregation effect in the treatment of STEMI after PCI in the elderly, and it reduces the incidences of no-or slow reflow, improves cardiac function.
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Objective To investigate the clinical value of transvaginal color doppler ultrasonography and hysteroscopy uteroscope in the diagnosis of endometrial lesions in postmenopausal women.Methods A total of 135 postmenopausal women with endometrial lesions were selected in this research.The patients were divided into observation group(67 patients)and control group(68 patients)according to random number table.The observation group adopted transvaginal color doppler ultrasonography and hysteroscopy uteroscope,the control group adopted transvaginal color doppler ultrasonography.The patients' treatment effect in the two groups were collected and analyzed.Results Of 67 patients in the observation group,there were 4 cases of endometrial polyp,23 cases of endometrial cyst,25 cases of adenomyomatous endometrial polyp and 15 cases of endometrial cancer,the diagnostic accuracy was significantly higher than that of the control group,the differences were statistically significant(x2=9.129,9.131,9.128,9.132,all P<0.05).In the observation group,the diagnostic accuracy of the obvious characteristics of internal granular internal echo,sparse punctate flow endometrial and uterine wall line than before obviously pathological lesions were better than those in the control group,the differences were statistically significant(x2=8.964,9.045,8.980,9.024,all P<0.05).Conclusion Transvaginal color doppler ultrasonography and hysteroscopy uteroscope has better effect in diagnosis of endometrial lesions in postmenopausal women,which is worthy of promotion.
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Objective:To investigate the impact on ovarian reserve function with two different homostatic methods during laparoscopic cystectomy in treatment of endometrioma.Methods:Eighty four cases with unilateral ovarian cysts which located outside of hilum of ovary undergoing laparoscopic surgery were enrolled in the study. Based on hemostasis method, all patients were divided into 2 groups. Study group included 40 cases in ultrasonic scalpel hemostasis. Control group included 44 cases with suture after excision of endometrioma. Before surgery and the 1st, 3rd cycle after surgery, serum FSH, LH and AMH, and ultrasound basal AFC and PSV were examined and compared.Results: The level of FSH, LH, AMH, AFC and PSV had significant difference between before surgery and after surgery 1st, 3rd. The level of FSH, LH, AMH, AFC and PSV had significant difference within group comparisons after surgery 1st, 3rd. The level of serum FSH and LH in study group were lower than these in control group after surgery 1st. The level of serum AMH in study group were higher than in control group after surgery 3st. The level of serum PSV in study group were higher than in control group after surgery 3st.Conclusion: Ovarian reserve function was decresed heavier in ultrasonic scalpel hemostasis during laparoscopic excision of ovarian endometrioma than in suture. Electrocoagulation of the ovarian tissue should be avoided.
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Objective To investigate the effect of Case Based Learning (CBL) method in clinical practice of internal medicine. Methods 88 clinical medicine students were divided into CBL teaching group and traditional teaching group. Traditional teaching method was introduced to traditional teaching group while CBL teaching method was carried out in the other. The test papers and questionnaires were analyzed in both groups. Result The students in CBL teaching group mastered internal medicine knowledge better than the other group. Conclusion CBL teaching mode helps improve the overall teaching quality of internal medical in clinical practice,and the interns' interest in learning and their clinical practice ability can be greatly enhanced.
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Objective To analyse the expression of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) in ovarian epithelial cancer and to investigate the relationship between PTEN and clinical pathology and prognosis of ovarian epithelial cancer.Methods Expression of PTEN in 10 normal ovarian tissues,20 benign tumors and 60 cases of ovarian epithelial cancers were detected by immunohistochemical method.Results The positive expression of PTEN in normal ovarian and benign tumor tissues were significantly higher than that in ovarian epithelial cancers (100％ (10/10) vs 80.0％ (16/20) vs 53.3％ (32/60),x2 =7.778 and 4.444 respectively,P ＜ 0.05).The expression of PTEN was correlated to clinical stage,histilogical grade,presence and metastasis of lymph node (x2 =4.339;6.465 ;3.896;10.452;P ＜0.01),but there was no correlation to age,histological type and ascites (x2 =0.004 ;0.388 ; 1.057 ; P ＞ 0.05).Conclusion The expression of PTEN is related to ovarian carcinogenesis and development and may has great value in clinical diagnosis and prognosis of ovarian carcinogenesis.
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Objective To explore the correlation between axon guidance factor Semaphorin 5A and clinicopathological features and its role in the invasion and metastasis of gastric cancer.Methods The expression of Semaphorin 5A in gastric cancer tissues of 171 patients with different gender,age,histological type and TNM stage was detected with immunohistochemistry assay.The expression of Semaphorin 5A was determined by Western blotting assay in gastric cancer cell lines SGC7901 and MKN-45 with metastatic ability and gastric cancer cell lines SNU-1 and AGS without metastatic ability.With RNA interfere technique(RNAi),Semaphorin 5A siRNA expression vector was constructed and transfected into gastric cancer cell line SGC7901.The stable gastric cancer cell line down-expressing Semaphorin 5A was established.The effect of Semaphorin 5A gene silencing on the adhesion,migration and invasion of gastric cancer cell was examined by cell adhesion test,wound healing test and transwell chamber assays.Results The expression level of Semaphorin 5A was correlated with the differentiation degree of gastric cancer(x2 =6.32,P =0.01),lymphnode metastasis(x2 =7.68,P=0.01)and distant metastasis of gastric cancer(x2 =13.67,P =0.00),not correlated with age(x2 =0.21,P=0.79),gender(x2=1.79,P=0.15)and the depth of gastric cancer invasion(x2=1.34,P=0.55).The expression of Semaphorin 5A in cell lines SGC7901 and MKN-45 was significantly higher than that of cell lines SNU-1 and AGS(P＜0.01).Semaphorin 5A gene silencing significantly suppressed the adhesion,migration and invasion abilities of gastric cancer cells.Conclusion Semaphorin 5A may play a catalytic role in the invasion and metastasis of gastric cancer through increasing the adhesion,migration and invasion abilities of gastric cancer cell.