Objective To observe the therapeutic efficacy and safety of acupuncture and epidural anesthesia during full-term labor. Method A total of 199 eligible subjects experiencing natural labor were randomized into four groups. The acupuncture group was intervened by acupuncture at acupoints; the epidural group was given epidural anesthesia;the combined analgesia group was given acupuncture at acupoints plus epidural anesthesia; the control group was not given any interventions for analgesia. The Visual Analogue Scale (VAS) was adopted to record and compare labor pain (cervix dilation 3 cm at 0 min, 30 min, and 60 min, and at full cervix dilation); meanwhile, the active period of the first stage of labor, cervix dilation speed, the second stage of labor, Caesarean section (C-section) rate, instrumental delivery rate, Apgar score, and post-labor bleeding amount (2 h) were also recorded. The contents of blood β-endorphin (β-EP) and 5-hydroxytryptamine (5-HT) were monitored during the first stage of labor. Result Compared with the control group, the VAS scores dropped in the other three groups, and the decreases were similar in the epidural group and combined analgesia group, while the decrease in the acupuncture group was the least significant. Regarding the labor-related indexes, the cervix dilation speed was higher in the acupuncture group than in the control group(P<0.05), while there was no significant difference between the acupuncture group and control group in comparing the duration of the second labor stage(P>0.05). There were no significant between-group differencesin comparing the post-labor bleeding amount and Apgar score of the new-born babies(P>0.05), but compared with the epidural group, there was no use of assisted delivery. The content of blood β-EP during the first stage of labor increased in the acupuncture group and combined analgesic group(P<0.05), but there were no significant changes in the epidural group and control group(P>0.05). Conclusion Acupuncture analgesia can reduce labor pain and shorten labor duration without affecting the second stage of labor and security-related indexes.

Objective: To study the mechanism of Gengnianle Water-paste Pills in resisting climacteric aging. Methods: Rats were randomly divided into blank group, model group, high and low dosage groups of Gengnianle, positive control group. The climacteric rat model were established by ectomizing the bilateral ovaries. The E2, follicle-stimulating hormone (FSH), luteinizing hormone (LH), triiodothyronine (T3), thyroid hormone (T4), thyroid-stimulating hormone (TSH) were detected. Results: Compared with model group, in high dose of Gengnianle group, the levels of E2, T3, T4 increased and the levels of FSH, LH, TSH reduced. The effect of high dose of Gengnianle in improving the adjustment function of the thalamus-hypophysis-ovary axis and the thalamus- hypophysis-thyroid gland axis is better than that of positive control group (P

Objective To investigate the correhtion between cognitive impairment and cerebral atherosclerosis in patients with acute ischemic stroke.Methods Acute ischemic stroke patients without cognitive impairment were recruited before symptom onset.The Montreal cognitive assessment (MoCA) was used to evaluate the cognitive function.Magnetic resonance imaging (MRI) was used to identify the infarct locations and sides.Magnetic resonance angiography,CT angiography and digital subtraction angiography were used to identify atherosclerotic arteries.Resul~ A total of 101 patients with acute ischemic stroke were enrolled,including 75 (74.3％) with cognitive impairment.The proportions of age (54.54 ± 12.59 years vs.64.43 ± 10.37 years;t =-3.960,P ＜0.001),years of education ≤6 years (50.7％ vs.11.5％;x2 =12.257,P ＜ 0.001),and cerebral atherosclerosis (89.3％ vs.50.0％;x2 =18.137,P ＜0.001) of the cognitive impairment group were significantly higher than those of the normal cognitive function group.Multivariate logistic regression analysis showed that cerebral atherosclerosis was an independent risk factor for cognitive impairment in patients with acute ischemic stroke (odds ratio 1.720,95％ confidence interval 1.005-2.942;P=0.048).MoCA score was negatively correlated with the offending vessels (r=-0.365,P＜ 0.001) and the most severe vessels of atherosclerotic degree (r=-0.243,P =0.014).Conclusions Most patients with acute ischemic stroke had cognitive impairment in the early stage after onset,and the MoCA scores was negatively correlated with the degree of cerebral atherosclerosis.Cerebral atherosclerosis was an independent risk factor for cognitive impairment in patientswith acute ischemic stroke.

Objective To investigate the relationship between abnormal bone mineral density (BMD) and subclinical thyroid dysfunction. Methods Thyroid function, biochemical indicators of bone metabolism and BMD were reviewed retrospectively in the subjects who received health checkups from July 1, 2009 to January 31, 2017 in the Health Check-up Department of Peking Union Medical College Hospital. People who had thyroid dysfunction, recognized risk factors for osteoporosis, and medication history were excluded. A cross-sectional analysis of thyroid status and biochemical indicators of bone metabolism was performed by the standard methods. BMD at the lumbar spine and femoral neck was measured using dual energy X-ray absorptiometry. Results A total of 6884 subjects (3726 women and 3158 men) were enrolled in the study, with an average age of (50.74 ± 10.41) years. They were divided into three groups:subclinical hyperthyroid, subclinical hypothyroid, and euthyroidism. The alkaline phosphatase in subclinical hyperthyroid group was higher than that in the euthyroidism group[ (67.95±20.64)U/L vs. (63.88±18.99)U/L]. Calcium and phosphorus in blood were higher in both subclinical hyperthyroid and subclinical hypothyroid groups. The rate of abnormal BMD in male euthyroidism, subclinical hyperthyroid and subclinical hypothyroid groups were 36.10％(1049/2906), 29.27％(12/41) and 27.01％(57/211), respectively. The rate of abnormal BMD showed no difference between subclinical hyperthyroid group and euthyroidism group (P>0.05). The rate of abnormal BMD was lower in subclinical hypothyroid group than in euthyroidism group (χ2=7.0901, P<0.01), especially in the males aged 40-49 years (χ2=10.4618, P<0.01). The rate of abnormal BMD in female euthyroidism, subclinical hyperthyroid and subclinical hypothyroid groups was 38.81％(1286/3314), 45.83％ (33/72) and 40.88％ (139/340), respectively. The rate of abnormal BMD showed no difference among the three groups (P>0.05). Conclusion There is no significant difference in the rate of abnormal BMD between subclinical thyroid dysfunction group and euthyroidism group, possibly because abnormal serum biochemical indicators preceded the presence of low BMD. More sensitive methods used to determine the status of bone metabolism await to be developed.

Objective:To analyze the clinical features, imaging findings and gene test of patients with type Ⅱ Alexander disease.Methods:All the clinical data of three cases with type Ⅱ Alexander disease from August 2018 to June 2020 in the Department of Neurology, Qilu Hospital of Shandong University (Qingdao) and Qilu Hospital of Shandong University were collected, and their clinical and imaging findings were analyzed retrospectively.Results:All the three patients were middle aged and old men with a chronic progressive course, beginning with weakness of one or both lower limbs, followed by dizziness, dysarthria, dysphagia, sphincteral disturbances, constipation and orthostatic hypotension. Three patients all experienced misdiagnosis (hydrarthrosis, cerebral vascular disease, alcoholism, respectively) at early stage of the disease. Cranial magnetic resonance imaging (MRI) showed mild supratentorial periventricular leukodystrophy, which was not specific. Sagittal cranial MRI demonstrated medulla oblongata and upper cervical cord atrophy called “tadpole atrophy”, which had high suggestive value. The results of gene analysis showed heterozygous mutation of glial fibrillary acidic protein gene, which had been reported as pathogenic gene; c.1091C>T (p.A364V) in exon 6, c.722C>T (p.R258C) in exon 4 and c.197G>A (p.R66Q) in exon 1, respectively.Conclusions:Type Ⅱ Alexander disease is an autosomal dominant disease, most with point mutations, rarely with deletion mutations. Type Ⅱ Alexander disease should be suspected when a patient had signs of lower brainstem involvement such as dizziness, ataxia, pyramidal sign, autonomic dysfunction, especially when cranial MRI showed mild supratentorial leukodystrophy, and medulla oblongata and upper cervical cord atrophy.

ObjectiveTo explore the regulation of claudin-4 expression in endometrial adenocarcinoma cell lines by progesterone.Methods Ishikawa cells were treated with various concentrations of megestrol acetate (MA:2,5,10,15,20 mg/L).After cultured for 24,48 and 72 hours,cells growth were measured by methyl thiazolyl tetrazolium (MTT).The group of Ishikawa cells incubated with MA at the 50％ inhibitory concentration ( IC50 ) was selected for cell apoptosis assay by using transmission electron microscopy and flow cytometry method.Real-time PCR and western blot were used for detecting the mRNA and protein expression levels of claudin-4.The localization of claudin-4 was examined by immunofluorescent staining.Results The inhibitory effects of megestrol acetate on the growth of Ishikawa cells were dosedependent and time-dependent.IC50 of MA on Ishikawa cells was 15 mg/L after incubated for 72 hours.After MA treatment,Ishikawa cells showed shrinkage,nuclear chromatin condensation,fractures of nuclear membrane and endoplasmic reticulum expansion,even round apoptotic bodies were found.The apoptosis rate of cells before MA treatment was (0.076 ±0.024)％,and the rate was (3.934 ±0.816)％ by MA treated for 72 hours,in which there were signicant difference( P ＜ 0.05 ).The relative quantification of claudin-4 mRNA and protein of the cells before MA treatment were 0.64 ± 0.20 and 0.94 ± 0.18,while they were 0.47 -0.15 and 0.62 ±0.15 after MA treated.The expression of claudin-4 was significantly decreased after MA treatment ( P ＜ 0.05 ).The localization of claudin-4 transferred from cytomembrane to cytoplasm and nucleus after MA treatment.Conclusions MA could inhibite the growth of Ishikawa cells,in which the mechanism may be decrease the expression of claudin-4 and the apoptosis of cells.The distribution change of claudin-4 may be related to the anti-cancer effect of progesterone.

Medical treatment technology has made a lot of breakthrough because of the rapid development of the medical devices industrial.Minimally-invasive and noninvasive medicine is the development tendency of the future medicine.To adapt to the needs of the future medicine,Chongqing medical university exerted much efforts on training of minimally-invasive and noninvasive medical talents.We explored and practiced in aspects of fixing educational conception and goal,building curriculum and teaching content,constructing professional teaching team and developing practice and innovation abilities in order to fill the void of personnel training in the minimally-invasive and noninvasive medical field.

Objective To investigate the characteristics and neural mechanisms of visual attention dysfunction in patients with hypertension using the event related potentials(ERPs).Methods Visual Oddball pattern was adopted to analyze P3a and P3b components of 15 essential hypertensives and 15 normotensives,and all the participants were submitted to cognitive assessment by Mini-Mental State Examination (MMSE).Results ①Novelty stimulus:the mean amplitude of N2 in hypertensive patients ((1.56± 1.15) μV) was decreased than normal controls ((-2.19±1.15) μV,P＜0.05),particularly at forehead-central sites (P＜0.05).In addition,the amplitude of P3a of hypertensive patients ((6.27± 1.01) μV) was different from normal controls ((7.09± 1.01) μV),but there was no statistical significance(P＞0.05).The latency of visual P3a was significantly longer in patients with hypertension group ((432.83 ± 8.22) ms) than that in control group ((403.10 ± 8.22) ms,P＞ 0.05).②Target stimulus:compared with control group ((6.75 ±0.90)μV),visual P3b amplitude in hypertension group ((4.08 ± 0.90) μV) was significantly declined (P＜ 0.05).Besides,the latency of visual P3b of hypertensive patients ((440.70 ± 6.42) ms) was different from normal controls ((436.91±6.42) ms),but there was no statistical significance(P＞0.05).③Compared with control group (27.31± 1.22),the M MSE score of patients with hypertension (24.55±2.42) was decreased (P＜0.05).The amplitude of visual P3b was positively correlated with MMSE scores in parietal region(r=0.51,P＜0.05).Conclusions The abilities of visual involuntary attention and voluntary attention are damaged in patients with hypertension,the impact degree of hypertension on two kinds of attention and the neural mechanisms are different.Moreover,there is a significant positive correlation between the amplitude of visual P3b and MMSE,which prompts that visual P3b for clinical early assessment of attention in patients with hypertension provides more objective neurophysiological basis.

Objective To evaluate the prognestic effect of thrombus aspiration combined tirofiban in patients of acute myocardial infarction. Methods 372 patients with acute ST segment elevation myocardial infarction were randomly divided into the observation group (n=183) and the control group (n=189). Patients in the observation group received thrombus aspiration combined tirofiban additional to conventional treatment, and cases in the control group received routine treatment. The curative effect, postoperative complications and adverse reactions were compared between the 2 groups. Results The postoperative TIMI classⅢperfusion was achieved in 152 cases (83.1%) in the observation group and 140 cases (74.1%) in the control group (P < 0.05). The left heart ejection fraction of the observation group on 7 and 30 days after surgery was (60.4±6.1)%and (64.3±5.6)%respectively which was higher than the control group with (52.4±5.9)% and (55.4±5.7)% on 7 and 30 days respectively (P < 0.05). Bleeding events were recorded in 36 cases(19.7%) in the observation group rensus 26 versus (13.8%) in the control group (P>0.05). MACE reorded within 30 d post operation was 10 cases(5.5%) in the observation group and 22 cases (11.6%) in the control group (P < 0.05). No thrombocytopenia recorded in both groups. Conclusions Thrombus aspiration combined tirofiban for patients with acute myocardial infarction during PCI can improve the postoperative coronary artery perfusion, left ventricular ejection function and reduce the incidence of MACE within 30 days.

Objective: To detect the protein expression and relationship between integrin-linked kinase (ILK) and E-cadherin (E-cad) in primary gallbladder cancer (PGC), as well as to evaluate their clinical significance. Methods:ILK and E-cad were examined in 48 cases with PGC, 25 with gallbladder adenoma and 25 with chronic cholecystitis tissues by immunohistochemistry. Then, the corre-lation between clinical and pathological features, as well as their relationship, was investigated. Results:The positive rate of ILK was significantly higher in the gallbladder cancer group (66.7%;32/48) than in the gallbladder adenoma (36.0%;9/25) and chronic cholecys-titis groups (24.0%;6/25) (P<0.05). However, the positive rate of E-cad, namely, 45.8%(22/48), was significantly lower than those of the benign groups (P<0.05). When the depth of invasion was aggravated and lymph node metastasis had occurred, the ILK expression level became significantly higher. Nevertheless, negative E-cad results were produced (P<0.05). A negative correlation between the ex-pression of ILK and E-cad in gallbladder cancer existed (r=-0.411, P<0.05). Conclusion:The expression of ILK and E-cad is signifi-cantly correlated with tumor invasion and metastasis. A negative correlation exists between these expressions. Detection of these two in-dexes is useful in predicting tumor progression and prognosis.