Objective To investigate the effect of Tongxinluo capsule combined with metoprolol on elderly patients with coronary heart disease and angina pectoris and its influence on hemorheology and inflammatory factors.Methods 135 elderly patients with angina pectoris of coronary heart disease were selected,and they were randomly divided into treatment group (68 cases) and control group (67 cases).The treatment group was treated with Tongxinluo capsule combined with metoprolol,while the control group was treated with metoprolol.The two groups were treated for 8 weeks.The curative effect of the two groups was compared,the number and duration of angina pectoris,the changes of hemorheology and inflammatory factors before and after treatment were compared.Results The total effective rate of the treatment group (94.12％) was higher than 76.12％ of the control group (P ＜ 0.05).After treatment,the frequency and duration of angina pectoris in the treatment group were (6.03 ± 1.21) times/week and (3.02 ± 0.76) min/time,respectively,which were significantly lower than those in the control group [(9.87 ± 1.46) times/week and (4.86 ± 0.98) min/time] (t =16.649,12.201,all P ＜ 0.05).After treatment,the whole blood viscosity at high shear rate [(3.76 ± 0.41) mPa/s],whole blood viscosity in low shear [(8.13 ± 0.76) mPa/s],plasma viscosity [(1.23 ± 0.08) mPa/s],erythrocyte aggregation index [(2.06 ± 0.27)],fibrinogen [(2.46 ± 0.41) g/L] in the treatment group were lower than those in the control group[(4.53 ± 0.52) mPa/s,(9.61 ± 0.89) mPa/s,(2.09 ± 0.27) mPa/s,(2.63 ± 0.35),(3.53 ± 0.62) g/L] (t =9.562,10.396,25.170,10.604,11.844,all P ＜ 0.05).After treatment,the interleukin-6 (IL-6) [(8.49 ± 1.76) pg/mL],intercellular adhesion molecule-1 (ICAM-1)[(85.25 ± 8.92) pg/mL],C reactive protein (CRP) [(8.74 ± 1.76) mg/L] in the treatment group were lower than those in the control group[IL-6 (11.32 ± 2.10) pg/mL,ICAM-1 (103.42 ± 10.72) pg/mL,CRP (14.98 ± 2.24)mg/L] (t =8.491,10.712,18.012,all P＜0.05).Conclusion Tongxinluo capsule combined with metoprolol in the treatment of elderly patients with coronary heart disease angina pectoris has obvious curative effect,and can improve the patients'blood rheology and inflammatory reaction.

Anti-N-methyl-D-aspartate receptor encephalitis is an autoimmune syndrome of central nervous system.The main clinical manifestations include psychiatric symptoms,movement disorders and seizures.It is often misdiagnosed as viral encephalitis.Tumors,especially the ovarian teratoma,play an important role in the disease.The prevalence in children is beyond imagination.Anti-NMDAR antibodies are specific diagnostic tests.Immune suppression is the main treatment.The first-line treatments include corticosteroids,intravenous immunoglobulin,and plasmapheresis.The second-line treatments include biological agents and cytotoxic drugs.Early diagnosis and treatment are essential for neurologic recovery.Overall prognosis is good.

ObjectiveTo investigate the relationship between carotid atherosclerosis and progressing stroke.Methods103 patients with acute cerebral infarction within the first 24 hours from onset were tested with carotid color doppler ultrasonography during the first week from admission. Univariate and multiple logistic regression analyses were performed to examine the relationship between carotid intima media thickness (IMT), plaque structure, the degree of artery stenosis and the early deterioration of cerebral infarction.ResultsPrevalence of carotid plaque and thickness of IMT in patients with progressing stroke were higher than that in non progressing patients. In logistic regression, presence of carotid plaque was independent predictors of progressing stroke. Plaque size, extent of artery stenosis and IMT were not included in the regression model.ConclusionPlaque structure and its chemical feature may be the cause of progressing stroke.

Objective To investigate the ultrasonographic features corresponding to classification of peripheral neuropathies in neurofibromatosis type Ⅰ.Methods Thirty-six patients with peripheral neuropathies and diagnosis of neurofibromatosis type I were enrolled in this study.Ultrasound appearance of peripheral neuropathies was analyzed and divided into four groups according to their pathological classifications.There were 19 males and 17 females with age between 7-47 years.High frequency or board frequency ultrasound probes were used for scanning.Results The ultrasound findings were varied based on different pathological classifications.Multiple nodular class(n=5) was presented as multiple nodes.Ultrasound demonstrated that tumors were multiple,oval or lobulated,and had well defined margin,and the echogenic of lesions was mainly hypoechoic.Plexiform class (n=12) was presented as cluster nodes along the peripheral nerve trunk.Ultrasound showed trunk nerves in extremities became thicker in a long range and lost the normal structure,and catenular or racemosum in shape.The echogenicity was hypoechoic.Diffuse class (n=14) was diffuse subcutaneous disease.Tumors range was infiltrative.The subcutaneous soft tissue was thicken and echogenicity was increased.The structure of nerve bundle was disturbed and associated with multiple hypoechoic nodes.Mixture class (n=5) was defined as mixture of multiple nodular class and plexiform class.In this group,diffuse disorders were co-existed with multiple nodes disorder.Conclusions The ultrasonographic appearances of peripheral nerve disorders in neurofibromatosis type I was closely corresponded to their pathological characters.And the ultrasonic examination would be helpful to diagnosis and provide important information for therapy.

Objective　To investigate the incidence， clinical characters and pathogenesis of hyponatremia following acute stroke in the elderly patients.Methods　The clinical,serum natrium and CT data of 41 cases with hyponatremia following acute stroke in the elderly patients were retrospectively analysed.Results The incidence of hyponatremia following acute stroke in the elderly patients was 16.02% (taking hemorrhagic stroke),the occurrence of the patients' coma induced by hyponatremia and the fatality rate were higher than the controls (P＜0.05);Hyponatremia correlated closely with the localization of lesions in CT, the focus in brain ganglion (induding thalamus) and hematocele in the ventricles of brain caused easily hyponatremia.Conclusion　Dysfunction of hypothalamus-pituitarium was one of the risk factors in causing hyponatremia following acute stoke in the elderly patients.

ObjectiveTo evaluate the effect of health education combined with psychological counseling on mental state of patients with coronary heart disease complicated with anxiety and depression. Methods70 cases of patients with coronary heart disease with anxiety and depression were divided into the observation group and the control group with 35 cases in each group.The control group received regular professional care,while the observation group was given health education combined with psychological counseling on the basis of regular professional care.The SAS and SDS score was compared between the two groups. ResultsAfter treatment,SAS and SDS score of two groups apparently improved.After treatment,SAS and SDS score of the observation group was less than the control group. ConclusionsHealth education combined with psychological counseling for patients with coronary heart disease complicated with anxiety and depression can effectively alleviate the anxiety and depression emotion of patients and increase life quality of them.

Positive psychology focuses on enhancing individual positive emotion and promoting the development of individual positive personality.Introducing positive psychology into the first stage of internal medical resident standardized training will improve the resident ability to solve clinical problems.It's helpful for resident doctors to improve their clinical thinking ability,doctor education innovation ability and lifelong self-education ability.It inspires their creative thinking by motivating their positive emotions It would help them to avoid occupational tiredness.Using the idea of positive psychology could improve the comprehensive quality of residents.

Objective To discuss MSCT assessment of pulmonary arterial hypertension (PAH) in patients with IPF before lung transplantation.Methods Between Sep.2002 and Aug.2010,lung transplantation (LTX) was performed on 96 patients with end-stage lung disease.Thirty patients with IPF were found to have PAH,as defined by mean pulmonary artery pressure (mPAP) ≥25 mm Hg by cardiac catheterization.Fifteen control patients (mPAP ＜25 mm Hg) were also identified.The diameter of the principal pulmonary artery (PPA) and ratio of main pulmonary artery to aortic diameter (rPA) were assessed by MSCT.Results MSCT-determined PPA and rPA were (34.4 ±4.4) mm and 1.03 ± 0.09 in patients with PAH,and (25.3 ± 3.3) mm (P＜0.01) and 0.77 ± 0.12(P＜0.01) in controls.In our group of patients,PPA (28.5 mm) had a sensitivity of 86.7％ and specificity of 80％ for predicting PAH,and rPA 0.935 had a sensitivity of 96.7％ and specificity of 93.3％ for predicting PAH.There was a correlation between the degree of PAH and PPA (r =861,P ＜0.01 ),and between the degree of PAH and rPA (r =0.887,P＜ 0.01 ) in patients with IPF associated with PAH.Conclusion MSCT is useful for the detection of IPF with PAH,and CT determined rPA has an excellent diagnostic value.

Objective To explore the effect of μ-opioid receptor agonist on acute lung injury in-duced by trauma-LPS two hits in rat model.Methods Thirty-two aduld SD rats,were randomized in four groups(n=8):normal control group(group N),blank control group(group B),DAMGO group (group D)and DAMGO+CTOP group(group DC).A rat model was made by intraperitoneal injection of LPS at 6 hours after fracturing bilateral thighbone.Group N didn’t receive trauma and LPS,only anesthesia.The rats in group D received 200 μg/kg of DAMGO,group DC received 600 μg/kg of CTOP and 200 μg/kg of DAMGO,group B obtained the same amount of saline.6 hours after treat-ment,the arterial blood was collected for blood gas analysis,the lungs was harvested to observe lung tissue pathology change and dry-weight/wet-weight ratio,and the levels of MDA,TNF-α,IL-6,SOD activities in lung tissue were determined.Results The results of pathological observation showed that there was obvious inflammatory reaction in lung tissues after two-hits.Compared with group D, PaO2 ,pH and dry-weight/wet-weight ratio were significantly lower in group B and group DC(P <0.05),The score of Smith were significantly increased(P <0.05).The levels of MDA,TNF-α,IL-6 in lung tissue were significantly reduced in group D than those in group B and group DC(P <0.05), SOD activities in group D were significantly higher than those in group B and group DC(P <0.05 ). Conclusion μ-Opioid receptor DAMGO agonist has protective effect on acute lung injury induced by trauma-LPS two hits in rat model.