Pulmonary arterial hypertension is the result of a variety of heart,lung disease and finally leads to right heart failure and death.Pulmonary arterial hypertension is characterized by the progressive increasing of artery pressure and the gradually increasing of pulmonary vascular resistance,and its pathogenesis has not been fully elucidated.Recent studies have found that transforming growth factor beta/bone morphogenetic protein pathway plays an important role in pulmonary arterial hypertension.The research about transforming growth factor betal bone morphagenetic protein pathway provides a new theoretical basis for the prevention and treatment of pulmonary arterial hypertension.This review focuses on progress of transforming growth factor beta/bone morphogenetic protein pathway and genetic mechanisms of pulmonary arterial hypertension.

The pathogenesis of children's primary nephrotic syndrome has not been completely clear at present.In the past few years,The polymorphism of these genes,such as angiotensin-converting enzyme gene,apolipoprotein E gene,platelet-activating factor acetylhydrolase gene,human histocompatibility leukocyte antigen gene,glucocorticoid receptor gene and cytokine gene,ect have been discovered that were significantly correlated with susceptibility,pathological progress,steroid response,disease recurrence and prognosis of primary nephrotic syndrome.This article reviewed the research progress of PNS and gene polymorphism.

Objective To investigate the clinical risk factors of diabetic ketoacidosis (DKA ) combined with elevated serum amylase(AMS). Methods Totally 263 patients with DKA were enrolled in our study. They were divided into 2 groups according to the level of AMS:DKA with normal AMS (DKA,n=188);DKA with elevated AMS(HAMS,n = 75 ). HAMS patients then were divided into two subgroups according to the diagnosis with acute pancreatitis(AP)(HAMS+ AP,n = 25 )and without AP (HAMS,n = 50 ). TG,FPG and AMS were measured and analyzed with univariate analysis and multivariate analysis. Results HAMS group patients had a ratio of 28.5％ with elevated AMS and 9.5％ with AP.HAMS group had higher FPG,TG,HbA1 c,Na+ ,osmolality,BUN and Scr than DKA group(P <0.05).The levels of FPG,TG,osmolality,BUN and the time of CO2 CP recovery in HAMS+AP subgroup were all significantly higher than those in HAMS patients without AP (P < 0.05 ). Correlation analysis showed that HAMS was positively correlated with TG,FPG,Na+ ,Osmolality and BUN(P <0.05).Logistic regression analysis showed that hypertriglyceridemia was the independent risk factor of DKA combined with HAMS(OR 1.244,P <0.01),and was the independent risk factor of DKA combined with AP(OR 1.211,P <0.05). Conclusion Hypertriglyceridemia is the related risk factor of DKA combined with HAMS and AP. This study provides a theoretical basis to early screen patients with hyperamylasemia in DKA.

Objective To understand the current situation of smoking and quitting smoking in patients with cardiovascular disease. Methods 184 cases of inpatients or outpatients with cardiovascular disease treated in the First People's Hospital of Kunming were surveyed about quitting smoking, and the smoking and smoking cessation-related clinical features of patients with cardiovascular disease were analyzed. Results ( 1) Cardiovascular diseases in smokers was male-dominated (100%), mainly hypertension and/or coronary heart disease (179, 97.3%) . (2) Average age of starting smoking was 21.5, 97.8%of patients had smoked more than 10 years, with an average of 35.1 ±13.4 years, 69.6% of patients smoked ≥10 cigarettes/day, with an average of 16.3 ± 10.1 cigarettes/day, 65.8%of patients were in the low level of nicotine dependence, 81.5%of the patients thought that quitting smoking was important, 76.1% had quitting smoking ideas, 67.4% had confidence in the success of quitting smoking, 50.5%thought that it was difficult to quit smoking, 127 (69%) patients had seriously quit smoking. (3) 65 cases (51.2%) who seriously quit smoking had succeeded, 54 patients (83.1%) received varying degrees of medical staff advised to quit smoking, 62 cases (48.8%) in relapse, only 34 patients (54.8%) accepted medical personnel advised to quit. Two sets of chi-square test, p=0.000, prompted difference was statistically significant. Relapse reasons were pressure, craving and around other smokers. Conclusions Smoking patients with cardiovascular disease are mainly constituted by male patients with hypertension and/or coronary heart disease. Most of the patients recognize that quitting smoking is important, and have idea and seriously quit smoking. However, lack of confidence and smoking which has also become a lifestyle significantly affect the success of smoking cessation. The medical staffs' recommending smoking cessation persuasion can largely improve the success of smoking cessation for patients.

Objective: To analyze the present situation of the management of large-scale instruments in a medical school and give some reasonable suggestions. Methods: Through the research on the use of 85 large-scale instruments in our university, we tried to find out the methods of improving the utilization ratio of large-scale instruments. Results:There are many reasons of the poor management and low utilization rate of large-scale instruments in medical schools. Conclusion: Taking some measures could effectively improve the utilization rate of large-scale instruments in medical schools, such as simplifying the working procedure, solving the operating and repair expenses, strictly controlling argumentation, drawing up scientific evaluation and incentive measures and so on.

Objective Quantitative evaluation was conducted to assess the development level and trend,as well as discipline distribution of basic medical research in China,based on SCI publications.Methods Descriptive analysis and trend analysis by 5-year moving time window were applied to analyze the quantity,quality,discipline distribution and current status and trend of development of medical research papers published by Chinese scientists during 2004 and 2013;Results Among a total of 280,200 medical research papers published from 2004 to 2013 period,China ranked # 5 in the world in terms of the quantity of papers.However,the average citation of 8.34 for Chinese paper was far below the global average of 14.11.Among all papers published by Chinese scientists,the percentages of papers in the field of psychiatry/psychology,neuroscience/behavior,immunology and clinical medicine were 2.20％,7.59％,3.93％ and 40.67％,respectively,lower than those of global average (6.71％,9.41％,4.62％ and 47.45％).The percentages of papers in other disciplines were higher for China than for global average.Regarding to the development trend,the annual increase in the number of publications of 5 years was 22.24 ％,while the 5-year citation per paper was only 2.03 ％.Conclusions The quantity of basic medical research in China is large and growing rapidly,while the quality of these researches remains in relatively lower level,and need to be improved substantially.With the discipline distribution different from the global average,psychiatry/psychology,neuroscience/behavior,immunology and clinical medicine should be strengthened in the future.

Objective To explore the influencing factors of hypotension in hemodialysis patients with end stage of diabetic nephropathy.Methods 106 patients of advanced diabetic nephropathy who received maintenance hemodialysis were selected in the present study.According to the patients'condition needs, chose different dialysis modes,dialyzers, dialysis blood flow and ultrafiltration rate, compared the frequency of occurrence of hypotension during treatment.Results By multivariate regression analysis,gender,dialysis mode,dialysis and blood flow had no correlation with hypotension during dialysis.The age, hemoglobin, serum albumin, cardiac function and individual ultrafiltration rate were correlated with the incidence of hypotension in patients with diabetic nephropathy.Individual-ized ultrafiltration rate was less than or equal to 10 mL · kg-1 · min-1 and individual ultrafiltration rate was up to 10 mL· kg-1 · min-1 ,the incidence rates of hypotension were 18.9% and 25.9%,the difference was statistically significant (χ2 =7.102,P<0.05).Conclusion Diabetic nephropathy patients during dialysis,ultrafiltration rate control individuals can effectively reduce the frequency of occurrence of hypotension during dialysis, hemodialysis patients may improve tolerability.

Objective To explore the effect of immobilization with plaster cast applying in children's rehabilitation after knee arthroscopic surgery,and discuss the clinical significance of immobilization with plaster cast in children's rehabilitation after knee arthroscopic surgery.Methods A total of 72 objectives suffered from knee joint diseases were chosen and received knee arthroscopic surgery from January 2013 to November 2014.They were classified into the experimental group and the control group with the random digit table with 36 patients in each group.The control only underwent the regular rehabilitation exercise.The experimental group was given fixation with plaster caster before they got rehabilitation exercise.The three indexes such as pain degree,the compliance of children knee function exercise and the range of knee motion in different time courses were compared after operation.Results The VAS pain scores of the experimental group and the control group were (2.12±0.70),(2.37±0.61) respectively with statistical significance,P＜0.05.On the third day,one week and two weeks after operation,the complete compliance of children with knee function exercise was 83.3％ (30/36) vs.8.3％ (3/36),97.2％ (35/36) vs.22.2％ (8/36),97.2％ (35/36) vs.22.2％ (8/36) in the experimental group and the control group,Z values were-6.343,-6.400,-6.400,P＜ 0.01.On the second,third and fourth weeks after operation,the good rates of knee motion range in the experimental group and the control group were 50.0％ (18/36) vs.16.7％ (6/36),94.4％ (34/36) vs.83.3 (30/36),97.2％ (35/36) vs.81.6％ (31/36),Z values were-3.345,-2.861,-2.012,P＜0.01.Conclusions The use of immobilization with cast plaster in children's rehabilitation after the knee arthroscopic operation could significantly relieve the pain brought by the surgery,as well as increase the level of appliance of knee function exercises and improve the range of knee motion greatly.Therefore,it could help children to restore the knee function earlier and furthermore to promote life quality after receiving knee arthroscopic surgery.

Platelet-activating factor (PAF), an endogenous bioactive lipid generated by phospholipase A2 and other pathways, displays a variety of biological activities in the nervous system. It has been suggested that PAF plays important roles in neuronal physiological functions including acting as a retrograde messenger to enhance synapse plasticity and memory formation, via activation of its specific membrane receptors.Therefore,the drugs that mimic the action of PAF or modulate the production and inactivation of PAF maybe promising in memory-enhancing. However, under certain pathological conditions, such as Alzheimer's disease, HIV-associated dementia or post-ischemic neuronal death, acting as a potent inflammatory mediator and neurotoxin, PAF has been implicated in the pathophysiology of brain injury. So, modulating the metabolism and effects of PAF (e.g., blocking the PAF receptor) may become important strategies of intervention of Alzheimer's disease, HIV-associated dementia or post-ischemic neuronal death.

Objective To investigate the incidence of postoperation constipation in patients who experienced thoracolumbar fractures screw fixation surgery.Methods A prospective cohort study was performed by investigating 99 cases who experienced thoracolumbar fractures screw fixation surgery.The patients were followed up for 1 month.The postoperative constipation relief situation was observed.Kaplan-Meier method was used to draw a plot of survival,Cox proportional hazards regression model analysis was adopted for single factor and multiple factors analysis and the prediction model of constipation relief after surgery was established.Results The trend of postoperative constipation relief of patients showed a trend of first increased and then decreased,the number of cases reached high peak on the second week,the constipation relief median time was (14.00±0.76) days.Cox multiple factors regression analysis showed that prediction function model of postoperative constipation relief was h(t)=[h0(t)]e(-0.826X1+0.353X2+0.381X3-1.404X4).Conclusions There was a high incidence of constipation in patients with thora-columbar fractures after surgery and it is difficult to relieve,clinical nurses should pay more attention to the influencing factors of postoperative constipation relief and help patients reestablish normal bowel movement as soon as possible.