Investigation on the chronic disease management of hypertension in county-level medical institutions in China / 中华医院管理杂志

Objective:To investigate the development of hypertension specialty and chronic disease management of county-level hospitals in China, for reference in improving the standardized chronic disease management level of hypertension in the counties.Methods:From September to November 2020, a questionnaire survey on 597 county-level hospitals in 24 provinces was conducted on a voluntary basis. The survey covered such areas as the setup of hypertension specialty, team building of professionals and the management regulations of chronic hypertension of the hospital. The survey data were analyzed by descriptive statistics.Results:Among the 597 county-level hospitals, 54(13.5%) hospitals had independent hypertension departments, 147(24.6%) had hypertension clinics, and 143(24.0%) hospitals had hypertension beds. 431(72.2%) hospitals had hypertension diagnosis and treatment process in outpatient clinics, 454(76.0%) hospitals had hypertension diagnosis and treatment process in wards, and 535(89.6%) hospitals had graded diagnosis and treatment process of hypertension. 473(79.2%) hospitals had established county medical alliance as the lead unit, including 167 compact medical alliances. 97.7% of the hospitals were equipped with basic hypertension risk stratification screening items, and 63.8% could carry out primary screening of secondary hypertension.Conclusions:The pattern of chronic diseases management of hypertension in county-level medical institutions has basically taken shape, but there is still room for improvement. In the future, we should focus on the construction of professional teams of hypertension, the standardized management of diagnosis and treatment of hypertension, and a smoother path of tiered medical service, so as to increase the health management level of hypertension in China.

Fairness of blood bank resources allocation in China / 中国输血杂志

【Objective】 To study the fairness of blood bank resources allocation in China, aimed at providing references for reasonable allocation of blood bank resources. 【Methods】 A questionnaire survey was conducted among 32 provincial blood centers and 321 regional central blood banks across China in August 1~25, 2018. Resource allocation of blood banks in China was analyzed using descriptive methods, and the fairness of resource allocation were analyzed using Lorenz curve, Gini coefficient and Theil index. 【Results】 Blood bank resources and services showed an overall upward trend from 2013 to 2017. The fairness of institutional coverage was optimal in 2017 according to the Lorenz curve and Gini coefficient, suggesting the allocation of blood bank resources according to the population was better than geographic area. The fairness of health technicians staffing was the worst from the perspective of geographic area. The total Theil index was 0.448 5~0.526 7, and the differences was contributed more by intra group comparison than that of inter group. 【Conclusion】 The unbalanced development underlying in the provincial and regional blood centers has been observed, and the service capacity needs to be further improved. The resource allocation varies greatly among regions, and it is recommended to optimize the regional planning of blood bank resources.

Hepatic long-term metastatic malignant insulinoma: one case report and literature review / 中华内分泌代谢杂志

This article reported a case of malignant insulinoma which recurred as liver metastasis 12 years after the initial pancreatic insulinoma resection. The patient was a 48-year-old woman who was firstly diagnosed as pancreatic insulinoma in 2006 and underwent the surgery involved complete resection of a 1.9 cm×1.3 cm tumor located in pancreas. No signs of either invasion or metastasis was detected according to preoperative imaging examination and intraoperative exploration. The tumor was diagnosed as a benign insulinoma according to histopathological results. The patient had no hypoglycemia and the fasting blood glucose was normal during the subsequent 12 years. The patient underwent a fasting blood glucose of 2.8 mmol/L in 2018, and gradually experienced palpitation and cold sweats, which was relieved by eating. She was hospitalized in May 2018 with blood glucose of 1.73 mmol/L and insulin of 1 128 pmol/L. CT and MRI revealed morphologic changes of postoperative pancreas and abnormal liver signal, the liver tumor was finally identified as insulinoma by modified selective intra-arterial calcium stimulated venous sampling (ASVS). Partial liver resection was performed and the histopathological result was neuroendocrine tumor. Therefore, the disease was diagnosed as liver metastatic malignant insulinoma.

Fibular head composite flap for bone and skin defect at medial malleolus in children / 中华创伤杂志

Objective:To investigate the therapeutic effect of the fibular head composite flaps for reconstruction of bone and skin defect at medial malleolus in children.Methods:A retrospective case series study was conducted to analyze 5 children (3 males and 2 females, aged 3-12 years) with internal malleolus and skin soft tissue defects admitted to the Yidu Central Hospital of Weifang between March 2010 and June 2018. The medial malleolus was defected (3 children at the right foot and 2 at the left foot) combined with skin defect around the medial malleolus. Dimension of skin defect was 3.0 cm×3.5 cm to 6.0 cm×10.5 cm, and of bone defect was 1.0 cm×1.0 cm to 2.0 cm×3.0 cm. The complex of the vascularized fibular head epiphysis was adopted to repair the defects at one stage. The donor sites were repaired with direct suture in 4 children and with skin graft in 1. Appearance, texture, elasticity and color of the flaps, length of lower limbs, ankle joint deformity, ankle joint range of motion, function of knee and ankle joint evaluated by using American Orthopedic Foot and Ankle Society (AOFAS) score and image change were observed. The flap donor area was evaluated for deformity, pain and sensory abnormality in the common peroneal nerve innervation area, and range of motion.Results:All the composite tissue flap survived with good blood circulation, and the wound healed by first intention. All children were followed up for 6-30 months (mean, 21 months). The appearance of the flap was good, and the texture, elasticity and color were similar to the surrounding area, without cicatricial contracture. The legs were the same length, and there was no deformity of the ankle joint. None had ankle joint deformity, with satisfactory loading and walking function. Comparison of ankle movement before and after operation showed significant differences: dorsal extension angle [(4.4±1.1)° vs. (13.2±2.4)°], plantar flexion angle [(12.4±1.8)° vs. (34.8±4.8)°] (both P< 0.05). Three children were graded as excellent and two good according to AOFAS score. X-ray showed that the gap between ankle acupoints and longitudinal development of the medial malleolus were almost synchronized with the healthy limbs. No signs of joint wear or early closure of epiphysis of medial malleolus was observed, and ossification center was obvious or showed gradually increase. The donor knee joint had normal flexion and extension function, without deformity, pain, or abnormal sensation in the common peroneal nerve innervation area. Conclusions:The complex of vascularized fibular head epiphysis and tissue flap can repair the bone and adjacent soft tissue defect of the medial malleolus in children at one stage, with good appearance recovery and ankle joint function recovery. The reconstructed medial malleolus can develop with the growth of children and has no effect on the function and feel of the knee joint in the donor area. It is a satisfactory method of reconstructing the traumatic defect of medial malleolus in children.

Effects of Different Penetration Enhancers on in vitro Transdermal Permeation of Flavaspidic Acid BB Cream / 中国药房

OBJECTIVE：To study the effects of different penetration enhancers on in vitro transdermal permeation of Flavaspidic acid BB cream. METHODS ：Flavaspidic acid BB cream was prepared ，containing 11 kinds of different penetration enhancers as 1％ azone，2％ azone，3％ azone，4％ azone，1％ menthol，1％ propylene glycol ，1％ oleic acid ，1％ azone+1％ menthol，1％ azone+1％ propanediol，1％ azone+1％ oleic acid or 1％ menthol+1％ propanediol. Modified Franz diffusion cell was adopted using abdominal skin of isolated male rat as transdermal barrier. The content of flavaspidic acid BB was determined by UPLC. The accumulative transdermal amount （Q24 h）and percutaneous permeability （Jss）within 24 h were calculated ；and compared with Flavaspidic acid BB cream without transdermal enhancer ，the enhancement ratio （ER）was calculated. RESULTS ： Q24 h of Flavaspidic acid BB cream with above 11 kinds of transdermal enhancers were （82.96±7.15），（80.17±0.66），（78.22± 1.87），（73.53±1.24），（35.65±2.23），（34.02±1.73），（42.68±2.66），（33.94±1.37），（34.16±1.54），（46.78±1.21），（43.66±1.69） μg/cm2，respectively. Jss value were （5.26±0.10），（4.69±0.12），（4.45±0.45），（4.00±0.06），（3.74±0.33），（3.23±0.18）， （3.73±0.53），（3.14±0.47），（3.54±0.11），（3.98±0.34），（4.34±0.14）μg（/ cm2·h），respectively. ER were 2.055，1.831，1.738， 1.564，1.462，1.263，1.456，1.227，1.385，1.557，1.698，respectively. CONCLUSIONS ：All of the above transdermal absorption enhancers can enhance the percutaneous absorption of Flavaspidic acid BB cream ，among which ，1％ azone is the best.

Rational design of type-IA receptor-derived cyclic peptides to target human bone morphogenic protein 2

Human bone morphogenetic protein 2 (BMP2) is a bone-growth regulatory factor involved in the formation of bone andcartilage, and has been recognized as an attractive therapeutic target for a variety of bone diseases and defects. Here, wereport successful design of a head-to-tail cyclic peptide based on crystal structure to target BMP2. Computational alaninescanning identifies two hotspot regions at the crystal complex interface of BMP2 with its type-IA receptor; promising one isstripped from the interface to derive a linear self-inhibitory peptide RPS2[r78-94] that covers residues 78–94 of the receptorprotein. Dynamics simulation and energetics analysis reveal that the peptide is highly flexible in isolated state and cannotspontaneously bind to BMP2. The RPS2[r78-94] peptide is further extended from its N- and C-termini until reaching twospatially vicinal residues 74 and 98 in the crystal structure of intact BMP2–receptor complex system, consequently resultingin a longer peptide RPS2[r74-98], which is then cyclized in a head-to-tail manner to obtain its cyclic counterpartcycRPS2[r74-98]. Computational analysis suggests that the cyclic peptide can well maintain in a conformation similar withits active conformation in complex crystal structure, exhibiting a smaller disorder and a larger potency than its linearcounterpart. Further assays confirm that the two linear peptides RPS2[r78-94] and RPS2[r74-98] are nonbinders of BMP2,whereas, as designed, the cyclic peptide cycRPS2[r74-98] can bind to BMP2 with a moderate affinity. The cyclic peptide isexpected as a lead molecular entity to develop new and potent peptide-based drugs for BMP2-targeted therapy.

Establishment of a culture method for primary human nail matrix cells in serum-free media / 中华皮肤科杂志

Objective To establish a culture method for primary human nail matrix cells in serumfree media.Methods Nail matrix tissues were collected from 9 patients,who received nail or toe amputation and nail bed repair in Peking University Shenzhen Hospital between January 2016 and December 2016,and cultured in the serum-free DEME/F-12 media at a 37℃ incubator with an atmosphere of 5％ CO2 in air for 2-3 days.Then,primary human nail matrix cells were cultured in keratinocyte serumfree media (CnT-07),and the morphology of human nail matrix cells was observed by microscopy during the culture process.Immunofluorescence cytochemistry with anti-keratin 5 (K5) and K10 was performed to identify the acquired cells,and flow cytometry to analyze the cell purity.Results After 2 or 3 days of the culture,some cells began to crawl out from the tissue.On day 10,large cell masses were formed,some cells were morphologically similar to epithelioid cells arranged in a paving stone-like pattern,and some were flat giving a spindle-shaped or star-shaped appearance.Immunofluorescence cytochemistry showed that some cells could express both K5 and K10,which proved the existence of nail matrix cells,and 37.6％ of the cells expressed K10.Conclusion Human primary nail matrix cells could be successfully cultured by using the tissue culture method with serum-free culture media,and the nail matrix cells cultured in vitro can express both K5 and K10.

Incidence of cognitive impairment and risk factors associated with prognosis in maintenance hemodialysis patients / 中华肾脏病杂志

Objective To investigate the incidence and prognosis of cognitive impairment and to find out the risk factors associated with the outcome for better understanding and preventing cognitive impairment in maintenance hemodialysis (MHD) patients. Methods The patients who met the criteria as below: MHD patients (≥3 months) in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to July 2014, ≥18 years old were enrolled and could carry on the montreal cognitive assessment (MoCA) of voluntary cooperation. According to the score of MoCA, all enrolled patients were divided into two groups: cognitive impairment (MoCA<26) group and non-cognitive impairment (MoCA≥26) group. The follow-up period was 3 years. There were 130 males, and the incidence, demography data, medical history, hemodialysis data, laboratory examination and prognosis of cognitive impairment in hemodialysis patients were prospectively compared and analyzed. Logistic regression analysis was used to investigate the risk factors of cognitive impairment. Kaplan-Meier survival curve and Cox regression model were used for prognostic analysis. Results A total of 219 MHD patients were enrolled. The incidence of cognitive impairment in MHD patients was 51.6％. There were 130 males, and the ratio of male to female was 1.46:1. Age was (60.07 ± 12.44) years old and dialysis vintage was (100.79 ± 70.23) months. Compared with non-cognitive impairment group (n=106), patients in cognitive impairment group (n=113) were older, and had higher proportion of education status<12 years, history of diabetes and anuria (all P<0.05); however, the post-dialysis systolic pressure, pre-dialysis diastolic pressure, post-dialysis diastolic pressure, platelet and spKt/V were lower (all P<0.05). Multivariate logistic regression analysis showed that education status<12 years (OR=3.428, 95％CI 1.919-6.125, P<0.001), post-dialysis diastolic pressure<73 mmHg (OR=2.234, 95％CI 1.253-3.984, P=0.006) and spKt/V<1.72(OR=1.982, 95％CI 1.102-3.564, P=0.022) were the independent risk factors for cognitive impairment in MHD patients. The Kaplan-Meier survival curve analysis showed that the survival rate of patients with cognitive impairment was lower than that of non-cognitive impairment group in MHD patients during 3 years follow-up (χ2=3.977, P=0.046). Multivariate Cox regression analysis showed that cognitive impairment was an independent risk factor for death in MHD patients (RR=2.661, 95％CI 0.967-7.321, P=0.058). Conclusions Cognitive impairment is one of the common complications and an independent risk factor for death in MHD patients. The mortality is high in patients who suffer cognitive impairment. Education status<12 years, post-dialysis diastolic pressure<73 mmHg and spKt/V<1.72 are the independent risk factors for cognitive impairment in MHD patients.

Standardizing management of fine needle aspiration for thyroid nodules / 中华内分泌代谢杂志

Thyroid nodules are very common in the clinical practice. Fine needle aspiration ( FNA) is a major method for the final diagnosis of thyroid nodules. This review tried to cover the definition, current status, clinical significance, indications, contraindications, ultrasound evaluation, as well as preparations, steps, molecular diagnosis, cytology diagnosis, and possible pitfalls of this technique. Our purpose is trying to make this procedure universalized and standardized in order to serve more patients by providing clinicians with some helpful references and advice.

Incidence of cognitive impairment and risk factors associated with prognosis in maintenance hemodialysis patients / 中华肾脏病杂志

Objective@#To investigate the incidence and prognosis of cognitive impairment and to find out the risk factors associated with the outcome for better understanding and preventing cognitive impairment in maintenance hemodialysis (MHD) patients.@*Methods@#The patients who met the criteria as below: MHD patients (≥3 months) in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to July 2014, ≥18 years old were enrolled and could carry on the montreal cognitive assessment (MoCA) of voluntary cooperation. According to the score of MoCA, all enrolled patients were divided into two groups: cognitive impairment (MoCA<26) group and non-cognitive impairment (MoCA≥26) group. The follow-up period was 3 years. There were 130 males, and the incidence, demography data, medical history, hemodialysis data, laboratory examination and prognosis of cognitive impairment in hemodialysis patients were prospectively compared and analyzed. Logistic regression analysis was used to investigate the risk factors of cognitive impairment. Kaplan-Meier survival curve and Cox regression model were used for prognostic analysis.@*Results@#A total of 219 MHD patients were enrolled. The incidence of cognitive impairment in MHD patients was 51.6%. There were 130 males, and the ratio of male to female was 1.46∶1. Age was (60.07±12.44) years old and dialysis vintage was (100.79±70.23) months. Compared with non-cognitive impairment group (n=106), patients in cognitive impairment group (n=113) were older, and had higher proportion of education status<12 years, history of diabetes and anuria (all P<0.05); however, the post-dialysis systolic pressure, pre-dialysis diastolic pressure, post-dialysis diastolic pressure, platelet and spKt/V were lower (all P<0.05). Multivariate logistic regression analysis showed that education status<12 years (OR=3.428, 95%CI 1.919-6.125, P<0.001), post-dialysis diastolic pressure<73 mmHg (OR=2.234, 95%CI 1.253-3.984, P=0.006) and spKt/V<1.72(OR=1.982, 95%CI 1.102-3.564, P=0.022) were the independent risk factors for cognitive impairment in MHD patients. The Kaplan-Meier survival curve analysis showed that the survival rate of patients with cognitive impairment was lower than that of non-cognitive impairment group in MHD patients during 3 years follow-up (χ2=3.977, P=0.046). Multivariate Cox regression analysis showed that cognitive impairment was an independent risk factor for death in MHD patients (RR=2.661, 95%CI 0.967-7.321, P=0.058).@*Conclusions@#Cognitive impairment is one of the common complications and an independent risk factor for death in MHD patients. The mortality is high in patients who suffer cognitive impairment. Education status<12 years, post-dialysis diastolic pressure<73 mmHg and spKt/V<1.72 are the independent risk factors for cognitive impairment in MHD patients.

Correlation between capillary index score and outcome of endovascular treatment for acute anterior circulation ischemic stroke / 国际脑血管病杂志

Objective To investigate the capillary index score (CIS) and clinical outcome after endovascular treatment in patients with anterior circulation acute ischemic stroke (AIS). Methods From March 2014 to March 2017,patients with anterior circulation AIS received endovascular treatment in Jinling Hospital and Wuhu Yijishan Hospital were enrolled retrospectively. The data of intraoperative digital subtraction angiography were collected and CIS was calculated. They were divided into either a poor CIS group (score 0-1) or a good CIS group (scores 2-3). Univariate analysis was used to compare the baseline data, clinical data, and outcomes between the 2 groups. Multivariate logistic regression analysis was used to determine the correlation between CIS and symptomatic intracerebral hemorrhage (sICH), death, and functional outcome at 90 d after endovascular treatment(modified Rankin Scale score 0 to 2 was defined as good outcome). Results A total of 157 patients were enrolled, including 91 (58.0％) had poor CIS and 66 (42.0％) had good CIS.Age(P=0.020),baseline systolic pressure(P=0.014),baseline National Institutes of Health Stroke Scale score (P=0.011), early infarct size (P<0.001), as well as the proportions of internal carotid artery occlusion(P<0.001)and embolectomy >3 times(P=0.042)of the poor CIS group were significantly higher than those of the good CIS group.The vascular successful recanalization rate(P<0.001) and good outcome rate (P<0.001) at 90 d in the good CIS group were significantly higher than those in the poor CIS group, while the incidence of sICH (P=0.002) and mortality (P<0.001) were significantly lower than those of the poor CIS group. Multivariate logistic regression analysis showed that CIS were significantly correlated with the functional outcome at 90 d (odd ratio [OR] 0.581, 95％ confidence interval[CI]0.419-0.805;P=0.001)and the risk of sICH at 72 h(OR 0.611,95％ CI 0.407-0.919; P=0.018) after endovascular treatment in patients with anterior circulation AIS,but it did not have a significant correlation with the risk of death (OR 0.783, 95％ CI 0.492-1.246; P=0.301). Conclusions CIS was significantly correlated with the clinical outcome in patients with anterior circulation AIS after endovascular treatment. It can be used as a tool to select patients for endovascular treatment.

Neutrophil to lymphocyte ratio at admission for identification of large artery atherosclerosis and small vascular occlusion in patients with minor stroke / 国际脑血管病杂志

Objective To investigate the differential effect of neutrophil to lymphocyte ratio (NLR) at admission on large artery atherosclerosis (LAA) and small vessel occlusion (SVO) in patients with minor stroke.Methods Patients with first-ever acute ischemic stroke registered in Nanjing Stroke Registration System were enrolled retrospectively.Minor stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤3.Binary logistic regression was used to evaluate the independent relationship between NLR and LAA.Results A total of 417 patients with minor stroke were included,of which 242 were in a LAA group and 175 were in a SVO group.Univariate analysis showed that there were significant differences in leukocyte count,neutrophil count,lymphocyte count,NLR,glycosylated hemoglobin,highdensity lipoprotein cholesterol,onset to treatment time,and onset to NLR detection time between the patients of the LAA group and the SVO group (all P ＞0.05).Binary logistic regression analysis suggested that after adjusting for sex and high-density lipoprotein cholesterol,NLR (with the highest quartile as a reference,the first quartile:odds ratio [OR] 0.207,95％ confidence interval [CI]0.089-0.482;P ＞ 0.001;the second quartile:OR 0.277,95％ CI 0.122-0.625,P=0.002;the third quartile:OR 0.456,95％ CI 0.197-1.057;P =0.067),onset to NLR detection time (OR 1.216,95％ CI 1.038-1.424;P =0.015),and glycosylated hemoglobin (OR 1.414,95％ CI 1.142-0.751;P=0.002) were independently associated with LAA.The area under the ROC curve of NLR predicting the LAA was 0.611 in patients admitted within 7 d after onset,and was 0.673 in patients admitted within 24 h after onset.Conclusions The increased NLR was independently associated with the LAA in patients with minor stroke.Early NLR value may have higher predictive value for LAA.

Prognoses of patients with hematological malignancies after haploidentical or HLA-matched sibling hematopoietic stem cell transplantation / 中华器官移植杂志

Objective To compare the efficacy of haploidentical hematopoietic stem cell transplantation (HSCT) and HLA-identical transplantation for hematologic diseases,and analyze risk factors related to overall survival (OS).Methods There were 81 patients with hematological malignancies receiving Allo-HSCT from October,2011 to July,2017.The patients were divided into two groups:30 patients undergoing haploidentical HSCT and 51 cases undergoing matched sibling donor HSCT (MSD-HSCT).Implantations of hematopoietie stem cells,incidence of graft versus host disease (GVHD),OS rate,disease free survival (DFS) rate,incidence of relapse and non-relapsemortality were analyzed statistically.Multivariate analysis was used to analyze the risk factors related to OS.Results All patients achieved sustained engraftment.100 days after Allo-HSCT,thecumulative incidence for Ⅱ-Ⅳ aGVHD had no significant difference between haplo-HSCT and MSD-HSCT (56.7％ versus 11.8％,P =0.000).There was no significant difference in the 1-year cumulative incidence for cGVHD between haplo-HSCT and MSD-HSCT (20.6％ versus 45％,P =0.341).The 2-year OS rate in patients receiving haplo-HSCT and MSD-HSCT was 63.2％ and 78.4％ respectively (P =0.078).The 2-year DFS rate in patients receiving haplo-HSCT and MSD-HSCT was 54.8％ and 66.9％ respectively (P=0.159).The 2-year relapse and non-relapse-mortality rate in patients receiving haplo-HSCT and MSD-HSCT was 25.9％ and 24％,and 22.9％ and 9.5％ respectively.There were no statistically significant differences in relapse rate and mortality between two groups (P =0.465,0.118).Multivariate analysis showed that relapse and Ⅱ-Ⅳ aGVHD were independent prognostic indictors for OS with relative risk 6.671 (95％ CI 2.791-15.946) and 3.073 (95％ CI 1.296 ～ 7.284) (P ＜ 0.05).Conclusion The therapeutic effects of haploidentical transplantation were similar to those of HLA-identical sibling transplantation.Relapse and Ⅱ-Ⅳ aGVHD after transplantation have prognostic significance for the long-term survival of transplant patients.

Clinical effect of Yiqiwenyang Huoxuelishui prescription on patients with cardiorenal syndrome and its influence on gut flora / 中国中西医结合急救杂志

Objective To observe the clinical therapeutic effect of Yiqiwenyang Huoxuelishui [a traditional Chinese medicine (TCM) prescription] on patients with cardiorenal syndrome (CRS) and its influence on gut flora. Methods Sixty-nine patients with definite diagnosis of CRS accompanied by heart-kidney yang deficiency admitted to Department of Geriatrics of the Third People's Hospital of Hangzhou from January 2015 to December 2016 were enrolled, and the patients were divided into two groups according to whether they received traditional Chinese medicine (TCM) or not. The control group (33 cases) was treated with only western medicine; the combination group (32 cases) was treated with conventional western medicine in addition of 100 mL of Yiqiwenyang Huoxuelishui decoction oral administration, twice a day, and the therapeutic course of both groups was 8 weeks. Before and after treatment, the level changes of left ventricular ejection fraction (LVEF), plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), carbohydrate antigen-125 (CA-125), growth differentiation factor-15 (GDF-15), growth differentiation factor-11 (GDF-11), blood creatinine (SCr), blood urea nitrogen (BUN), gut flora changes and the incidence of adverse reactions were observed in the two groups; after treatment, the clinical therapeutic effect of the two groups were compared. Results After treatment, the levels of LVEF and bifidobacteria, lactobacilli in intestinal tract of the two groups were significantly higher than those before treatment; while the levels of NT-proBNP, DGF-15, GDF-11, CA-125, SCr, BUN and enterococcus and enterobacter in the two groups were significantly lower than those before treatment, and the changes of the above indicators in combination group were more obvious than those in the control group [LVEF: 0.51±0.10 vs. 0.46±0.08, NT-proBNP (ng/L): 658±45 vs. 814±57, GDF-15 (ng/L): 604±32 vs. 708±36, CA-125 (U/L): 4.50±0.33 vs. 5.10±0.37, GDF-11 (ng/L): 491±19 vs. 594±23, SCr (μmol/L): 105±11 vs. 125±13, BUN (mmol/L): 8.1±3.5 vs. 9.7±4.2, bifidobacteria (cfu/g): 8.23±0.46 vs. 7.54±0.33, lactobacilli (cfu/g): 7.96±0.31 vs. 7.09±0.23, enterococcus (cfu/g): 6.32±0.19 vs. 7.15±0.28, enterobacter (cfu/g): 6.13±0.33 vs. 7.18±0.37, all P < 0.05]. In the combination group, there were 2 cases with mild abdominal distension and nausea at the initial stage, and 1 case with mild diarrhea, and because the manifestations were so mild, it was not necessary to stop the treatment. No hypotension occurred in both groups, and no liver or kidney function damage was observed. The rate of total therapeutic effect in the combination group was higher than that of the control group [87.5% (28/32) vs. 60.6% (20/33), P < 0.05]. Conclusion Yiqiwenyang Huoxuelishui prescription for treatment of patients with CRS accompanied by heart-kidney yang deficiency was safe and effective, it can elevate the clinical therapeutic effect, quality of life and improve the gut flora.

Correlation of delayed diagnosis of cerebral venous sinus thrombosis with its clinical symptoms and prognosis / 医学研究生学报

Objective Cerebral venous sinus thrombosis (CVST) is easily misdiagnosed for lack of specificity in its pathogenesis and clinical symptoms and characteristics.This study was to investigate the association of the clinical features of CVST with the time of diagnosis and the impact of diagnostic delay on the prognosis of the disease.Methods We retrospectively studied the clinical data about 94 cases of CVST treated in our hospital from March 2004 to August 2016.According to the interquartile-range time of diagnosis, we divided the patients into four groups, 16 d, and analyzed the correlation between the time of diagnostic delay with the clinical characteristics of the patients.The primary and secondary endpoints were the modified Rankin Scale score (mRS) ≤1 and ≤2 respectively at 3 months after discharge.Results Papilledema, isolated intracranial hypertension syndrome, and Glasgow Coma Score of 14-15 were associated with a longer diagnostic delay than seizure and hemorrhagic or infarction lesions (P<0.05).A significantly higher rate of earlier diagnosis was found in patients with lower levels of albumin and total protein, longer thrombin time, and a higher level of C-reaction protein (P<0.05).However, no significant correlation was observed between the time of diagnostic delay and the prognosis CVST.Conclusion The symptoms and laboratory indexes of the CVST patients at admission can be used as markers for the diagnosis of CVST, which may provide some new idea for its early diagnosis.

Study on the current employment situation of targeted admission medical graduates in rural areas / 中国卫生政策研究

Objective: In order to describe the employment status of the first group of targeted admission medical graduates, evaluate the effects of targeted admission medical education program, find out the existing problems and provide relevant policy recommendations.Methods: This study conducted follow-up survey among 305 medical graduates and 315 clinical medical graduates in four medical colleges of the central and western regions.Data analyses of the contract fulfillment, their employment status, and their participation in the standardized residency training are carried out.Results: The contract fulfillment rate of rural-oriented medical graduates is 99.3%, while the percentages of rural-oriented medical graduates and clinical medical graduates are 90.7% and 2.8%, respectively.Their average monthly incomes are respectively 2,011 and 2,774 yuan, and their proportions of participating in standardized residency training are 77.8% and 43.3% respectively.From the findings it can be seen that the employment situation of the first group of targeted admission medical graduates in four medical colleges and universities is quite good, but the policy implementation process in terms of permanent post and income is less satisfactory.However, the way how medical graduates should participate in the standardized residency training is not yet clearly regulated.This paper recommends that medical colleges and universities should well coordinate with local health administrative departments and human resources and social security departments to systematically deploy medical graduates.At the same time, full consultations should be conducted to make appropriate arrangement for medical graduates to participate in standardized residency training.

Accurate Detemination of Isotopic Abundance of Intracellular Metabolites of Saccharopolysporaerythraea Based on Ultra Performance Liquid Chromatography-Triple Quadrupole Mass Spectrometry / 分析化学

A method for measuring 13C isotopic abundance of intracellular metabolites of Saccharopolysporaerythraea by ultra-high performance liquid chromatography (UPLC)-triple quadrupole mass spectrometry was established.First, the chromatographic conditions of UPLC were optimized, and then the MS conditions such as unique tube lens voltage, collision energy, and ion pair were optimized.On the bases of length of the parent and daughter ions carbon chains and whether the daughter ions contain 13C atoms, the one-to-one method, one-to-many method and SIM method were established for measuring 13C isotopic abundance.Then these methods were used to measure naturally labeled intracellular metabolite standards and 13C labeled samples, and according to the gap between the experimental value and the theoretical value, the best method was established for each metabolite of different characteristics.The results showed that one-to-one method was most effective for measuring the metabolites of daughter ions not containing 13C atoms represented by sugar phosphates, one-to-many method was the best for measuring the metabolites of both parent and daughter ions containing 13C short carbon chains represented by carboxylic acids, SIM method could play a role in measuring the metabolites of both parent and daughter ions containing 13C long carbon chains represented by coenzyme A.This method had a good measurement precision and could be applied to the measurement of Saccharopolysporaerythraea intracellular metabolites, which contributed to the consequent study of metabolic mechanism and the efficient expression of erythromycin.

Study on the Effect and Its Mechanism of Fuzheng Jiedu Quyu Formula Combined with Oxaliplatin on Proliferation and Apoptosis of Human Colon Cancer HT-29 Cell / 中国药房

OBJECTIVE:To study the effect and its mechanism of Fuzheng Jiedu Quyu formula(short forFuzheng formula) combined with oxaliplatin (L-OHP) on human colon cancer HT-29 cell proliferation and apoptosis. METHODS:HT-29 cells were divided into blank control group(without drugs),Fuzheng formula group(1000 mg/L),L-OHP group(31.25 mg/L)and combi-nation group (1000 mg/L Fuzheng formula+31.25 mg/L L-OHP). After cultured with corresponding drug for 48 h,MTT method was used to detect the cell proliferation;the changes of cellular morphology were observed by invert microscope;flow cytometry was used to detect the cell cycle and apoptosis rate. Proapoptotic gene Bax,apoptotic gene Bcl-2 mRNA expressions were deter-mined by real-time fluorescence quantitative polymerase chain reaction method;Bax,Bcl-2 protein expressions were assayed by Western blot. RESULTS:Compared with blank control group,cell proliferation was inhibited in L-OHP group and combination group;cell proportion was increased in S stage,G2/M stage and decreased in G0/G1 stage(P<0.05). Cell apoptosis rate in L-OHP group,Fuzheng formula group and combination group was increased;Bax mRNA and protein expression were up-regulated,Bcl-2 mRNA expression was downregulated(P<0.05);and combination group changed more obviously than the single drug groups(P<0.05). CONCLUSIONS:Fuzheng formula combined with L-OHP can inhibit HT-29 cell proliferation and promote its apoptosis, showing better effects than either of the two drugs alone. The mechanism may be associated with up-regulation of Bax gene and pro-tein expressions and down-regulation of Bcl-2 gene expressions in cells.

Cognition of Patients with Juvenile Myclonic Epilepsy / 中国康复理论与实践

Objective To investigate the cognitive function and psychological mental state of patients with juvenile myoclonic epilepsy (JME), and the related risk factors. Methods From September, 2011 to Febrary, 2014, 21 patients with JME and 18 healthy controls matched with age, sex and educational level were assessed with Montreal Cognitive Assessment (MoCA), and Revised Chinese Wechsler Adult Intel-ligence Scale (WAIS-RC) and Symptom Checklist-90 (SCL-90). The risk factors were analyzed with Logistic regression analysis. Results There was no significant difference in the score of MoCA between two groups (t=―1.544, P=0.131). The scores of verbal intelligence quo-tient (VIQ), performance intelligence quotient (PIQ) and full intelligence quotient (FIQ) in WAIS-RC were significantly lower in the patient group than in the control group (t>4.119, P2.480, P<0.05). Logis-tic regression analysis showed that VIQ significantly decreased in patients taking valproic acid (B=―3.064, OR=0.047, 95% CI=0.002~0.920, P=0.044). Conclusion VIQ, PIQ and FIQ decreased in patients with JME. Furthermore, different levels of dysfunction were found in interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. Taking valproic acid was the risk factor of cognitive decline.

Study on inhibition role of SFRP2 on cervical cancer cell line proliferation / 重庆医学

Objective To understand the expression change of SFRP2 in human cervical cancer tissue and to investigate the effect of SFRP2 on cervical cancer cell proliferation.Methods The expression of SFRP2 in cervical cancer tissue was detected by using Western blot and qRT-PCR;the SFRP overexpressed human cervical cancer line was constructed by using lentivirus,the effect of SFRP2 on the proliferation of human cervical cancer cell line was analyzed by CCK-8 and plate cloning.The effect of SFRP2 on the expression of WNT pathway related proteins and genes in human cervical cancer cell was detected by Western Bolt and qRTPCR.Results Compared with paracancerous tissue,SFRP2 was lowly expressed in human cervical cancer tissue;overexpressed SFRP2 cervical cancer cell proliferation was inhibited;SFRP2 inhibiting cellular proliferation was occurred via WNT signal pathway.Conclusion The role of SFRP2 as a candidate gene for cervical cancer remains to be deeply studied.