[Objective] To study the difference between stable angina(SA) and unstable angina(UA) on monocyte chemoattractant protein-1(MCP-1)and homocysteine(HCY)concentrations, to define its clinical meaning to angina. [Method] Select 67 cases of UA and 65 cases of SA, take 60 normal persons of similar age as healthy control group; col ect the vein blood within 12h at the last attack of UA group, col ect the vein blood in early morning for SA group and control one; measure serum MCP-1 and HCY with ELISA method. [Result] The MCP-1 and HCY levels had difference among al groups, among which, groups UA and SA were higher than control one, with difference of statistical meaning; while UA group was higher than SA group, with difference of statistical meaning. [Conclusion] In angina patients, the serum inflammatory factors MCP-1 and HCY levels are higher than healthy persons, UA higher than SA patients;to test MCP-1 and HCY levels is helpful to identifying and screening high-risk angina patients.

Brain-derived neurotrophic factor(BDNF)belongs to the neurotrophin family and abundantly expressed in the nervous system.It plays an essential role in the survival,development,function,morphogenesis and plasticity of neurons by binding to the tyresine receptor kinase B(TrkB)and subsequent downstream activation of several signal transduction pathways in the nervous system. The PI3K/Akt and the MAPK/ERK DathWays ale two major intracellular signaling network activated by BDNF involved in survival of neurons.Becently.it is investigated that BDNF and TrkB are involved in the pathophysiology of hypoxic ischemic brain damage (HIBD)and in the mechanism of action of therapeutic agents.Therefore we image changing the internal or external condIitions can increase the expression of BDNF,thsu reduce the nervous system damage of HIBD.

Objective To compare of pathogenic bacteria characteristics between praecox and tardus ventilator-associated pneumonia (VAP) in the elderly with critical illness,and to provide the guildline and evidence of clinical prevention and treatment. Methods The clinical data of 276 VAP patients aged (69.3 ± 5.3) years in our hospital were retrospectively analyzed.There were 97cases (35.14％) with praecox VAP,179 cases (64.86％) with tardus VAP.Vitek 32 system was applied to identify pathogenic bacteria. Results In patients with praecox VAP,105 pathogenic bacteria were isolated,among which 72 cases(68.57％) suffered from G- bacterium,21 cases (20.00％) from G+ and 12 (11.43％) from fungus. The most widely distributed pathogens were hemophilus (22.86％),streptococcus pneumoniae(14.28％ ) and staphylococcus aureus(14.28％).In the patients with tardive VAP,186 pathogenic bacteria were isolated including 117(62.90％) G- bacterium,54 (29.04％)G+ bacterium and 15 (8.06％) fungus; the most widely distributed pathogens were staphylococcus aureus (24.19％), pseudomonas aeruginosa (22.58％) and klebsiella pneumoniae (14.52％).The death rate of tardus VAP(24.58％) was significantly higher than of praecox VAP (10.31％ ) (x2 =8.14,P＜0.05).The durations in ICU and mechanical ventilation were much longer in tardus VAP[(10.3±4.2)d and (7.8±2.7)d] than in praecox VAP[(7.8±3.1) d and (3.7±1.1)d] (t=5.15,14.32,P＜0.05). Conclusions There is differences in pathogenic bacteria distribution between praecox and tardus VAP,and the prognosis of tardus VAP may be worse.

Medical imaging is a medical discipline with strong practicality.Picture archiving and transmission system ( PACS ) provides a convenient and effective method for the clinical teaching of diagnostic imaging,especially for the students from the University of Traditional Chinese Medicine.Applying PACS is more convenient to gain and manage typical images,more effective to study and teach individually and easier to probe novel method for medical imaging.

The onset of irreversibility of cardiovascular diseases caused by obesity has showed a rising trend,the underlying cause of the disease is the endothelial damage.Injury caused by obesity through four aspects:systolic and diastolic imbalance,anticoagulant and procoagulant imbalance,growth factors and growth factor imbalances and endothelial progenitor cell changes in endothelial damage.This paper reviews the reason and the mechanism of the endothelial damage through the change of the endothelial factors and progenitor cells.

Objective .To evaluate the role of cystatin c in the risk judgement of coronary artery disease. Methods 77 patients with coronary artery disease were involved in the study.They were divided into two groups:Group 1 were patients with angiographically diagnosed coronary artery disease ( CAD) with their first acute coronary syndrome ( n=55);Group 2 were patients who had clinically diagnosed coronary disease but were negative on angiog-raphy ( n=22) .Serum Cys C levels in the two groups and the correlation to CAD were analyzed.Results Serum Cys C levels in patients of Group 1 were higher than that of Group 2 [(1.23 ±1.07)mg/L vs.(0.71 ±0.32)mg/L,P=0.002],but no significant difference was found between the two groups in crea levels [(123.76 ±80.44)μmmol/L vs.(117.63 ±65.43)μmmol/L,P=0.230].A ROC analysis revealed that there was a significantly higher risk of ACS above a cystatin c level of 0.875mg/mL (sensitivity:84.3%,specificity:38.8%).A similar analysis carried out for eGFR did not find any significant cut-off points above which risk of ACS was higher.Conclusion The data showed that a high level of cystatin c level is a risk factor for ACS.This could play an important role in the early diag-nosis and prevention of adverse cardiovascular events.

Objective To explore the relationship between homocysteine (Hcy)expression and diabetic ret-inopathy(DR)in patients with type 2 diabetes mellitus (T2DM).Methods 79 patients with T2DM were selected and divided into proliferative DR group (n =26),background stage of DR group (n =25)and without DR group(n =28)according to the degree of retinopathy.28 cases of healthy physical examination were involved as control group. Blood glucose levels,Hcy and clinical significance were detected and compared among the groups.Results The FPG and Hcy levels in the control group,without retinopathy group,background stage of DR group and proliferative DR group showed an increasing trend,there were significant differences among groups (F =448.53,174.25,all P <0.01).The FPG level of the control group was (4.86 ±0.42)mmol/L,which was significantly lower than the back-ground stage of DR group[(8.73 ±0.48)mmol/L,t =31.59,P <0.01 ]and the proliferative DR group[(10.9 ± 0.95)mmol/L,t =30.59,P <0.01].The FPG level of proliferative diabetic retinopathy DR group was also signifi-cantly higher than without retinopathy group(t =17.72,P <0.01).The Hcy level of the control group was (7.93 ± 0.70)μmol/L,which was significantly lower than the background stage of DR group[(9.45 ±0.83)μmol/L,t =7.69,P <0.01]and the proliferative DR group[(13.55 ±1.56)μmol/L,t =11.0,P <0.01].The Hcy level of the proliferative DR group was also significantly higher than without retinopathy group(t =12.52,P <0.01).Conclusion Hcy may involved in the process of T2DMwith DR,it may be used as an important reference index for the degree of retinopathy.

Objective To survey health management cognition of residents in Shanghai city communities,and to analyze the causes,and to put forward related suggestions.Methods In October of 2013,this study was conducted in communities of Shanghai central district (Xuhui District),urban border area (Minhang District),and suburban area (Jinshan District); 800 residents from each health management cognition outpatient clinic (400 people from each of hospitals and community health service center),totally 2 400 residents were studied and investigated in the communities of Shanghai city,and 2 082 questionnaire were received (the questionnaire recovery rate was 86.75％).We used stratified random cluster sampling method,and self-designed investigation form,and did pre-experiment.The Survey included:Whether family doctors need to carry out the evaluation work about risk factors,to implement health management for school students,to implement health management for people over 60 years old,to implement the elderly health management for pension agencies,to implement special crowd health management for special people;conduct questionnaire of demand level for different population groups (type,age,gender,marital status,retirement,occupation,level of education and medical insurance form).Results The research results found that,when asked about the family doctor whether to carry out risk assessment,family doctor whether to implement special health management,whether family doctors need to teach health management to students, whether family doctor should undertake the health management work for the people over the age of 60,whether family doctors should implement special health management,whether a person thinks that it is indifference (9.3％,7.4％,3.8％,6.2％ and 5.7％) and unnecessary (3.6％,4.4％,2.5％,4.2％ and 3.9％)in the minority,the majority of people believe that they need (51.1％,52.9％,57.2％,55.6％ and 55.3％),then the general (24.5％,18.9％,12.4％,18.0％ and 16.5％) and very necessary (11.5％,16.4％,24.1％,16.0％ and 18.6％).Among them,the occupation,whether retired or not,level of education,medical insurance form and different age groups had different cognition and demand level for health management work.Conclusion To Strengthen the health management training,to take specific health management services according to different groups of people and to improve community health management services are very important.

Epidemiological studies are important methods to discover the characteristics of diabetes mellitus,which are also helpful in improving the effectiveness of prevention and management of the diseases.Continuous improvement in the design and implementation of epidemiological studies itself would have great significance.

Metabolic surgery has brought new hope for obese T2DM patients. Control of long‐term complications and integrated management after metabolic surgery are important for patients to obtain a long‐term benefit. Cooperation of multidisciplinary teams plays an indispensable role in this systemic work.