Objective To probe into the characteristics of strain and strain rate in different time points of coronary artery disease (CAD) patients before and after the improvement of myocardial ischemia, to evaluate the value of two-dimensional strain (2DS) imaging in assessing curative effect of CAD patients. Methods The changes of strain and strain rate in local lesion segments before revascularization,and one week,one month and three months after revascularization of 24 CAD patients accepting revascularization therapy were detected by 2DS. Results Before revascularization treatment,the outlines of strain-time curves and strain-rate-time curves of lesion segments of CAD patients in whole cardiac circle were cluttered. The peak strain (S),the peak systolic strain rate (SRS) and the peak early diastolic strain rate (SRE) were low and calm. The peaks of strain-time curves in some segments of CAD patients were inverted. One week after treatment,the S, SRS,SRE and the peak late diastolic strain rate (SRA) of lesion segments of CAD cases elevated to certain extent. However, there were no statistical significant differences between them (P0.05). One month after treatment,the S and SRE of lesion segments of CAD patients elevated significantly compared to that of before the treatment (P<0.01). Three months after treatment,the outlines of strain-time curves and strain-rate-time curves of lesion segments of CAD patients trended to be regular,and the S, SRS, SRE and SRA elevated markedly compared to that of before treatment (P<0.01). There were statistical significant differences in terms of the S, SRS and SRA compared to that of one week and one month after treatment (P<0.01). Conclusions 2DS can evaluate the strain and strain rate non-invasively and quantitatively at different time points after revascularization of CAD patients. And it can evaluate regional myocardial systolic and diastolic function for CAD patients.

Objective To probe into the value of the evaluation of left ventricular myocardial function by two dimensional strain(2DS) for coronary artery disease(CAD) patients with different degrees of left anterior descending(LAD) branch stenosis. Methods Fifty-five eases without myocardial infarction among a total of 72 patients with CAD were divided in to 3 groups based on the extent of LAD stenosis,that was group A(stenosis<50%, n = 24) ,group B(stenosis50% to 75%, n = 19) ,and group C(stenosis>75%, n = 12). Another 17 eases of CAD with myocardial infarction were selected as group D. Strain and strain rate of the whole 11 segments that blood supplied by LAD of all cases were measured with 2DS. Results The 2DS ultrasound showed that the peak strain(S), the peak systolic strain rate(SRs) and the peak early diastolic strain rate (SRE) in all the 11 segments of group A were high and sharp. The above mentioned parameters of group B decreased compared with that of group A, however, there was no statistical significant difference (P >0.05). The S, SRs and SRE of group C cases decreased in some segments compared with that of group A and group B (P< 0.05 or P<0.01). As for group D, the S, SRS and SRE decreased significantly in all segments. In terms of the peak late diastolic strain rate (SRA), there were no statistical significant differences among group A,B and C (P>0.05). While in group D cases, the SRA decreased markedly. The SRE/SRA was more than 1 in group A. However, in group B, C and D cases, the SRE/SRA were all less than 1. Conclusions 2DS can sensitively reflect the decrease of regional myocardial systolic and diastolic function caused by the reduction of perfusion,and it may be beneficial to find myocardial ischemia for patients as early as possible.

Objective:To obtain phage-displayed ScFv library targeting tumor tissues and to screen for antibodies specifically binding to tumor vessels using in vivo phage display,so as to lay a foundation for diagnosis and treatment of cancer.Methods:The membrane proteins were extracted from the specimens of esophageal carcinoma,stomach carcinoma,brain cancer,lung cancer,and spinal cord tumor.The recombinant phage-antibody system was used to construct a single-chain Fv fragment(ScFv)cDNA library from the total RNA of the BALB/c mice immunized with purified membrane protein.The specific primers of VH and VL were used to amplify the cDNA of VH and VL,respectively,which were then assembled into ScFv gene with a specially constructed linker DNA.The ScFv gene was ligated into the phagemid vector pCANTAB 5E and the ligated samples were transformed into competent E.coli TG1.The transformed cells were infected with M13KO7 helper phage to yield recombinant phage.Using the animal model of human cervical carcinoma(HeLa cells),sepecific phage-ScFvs were selected by phage displaying and panning in vivo.After four rounds,24 phage-ScFvs,which were identified by PCR,were analyzed immunohistochemically.The ScFvs expressed in the tumor tissue slices and negative in control kidney tissue slices were sequenced.Results:Tomors-bearing animal models were established with 7 different kinds of carcinoma cell lines in BALB/c nude mice.It was found that inoculation with HeLa cells resulted in most satisfactory tumorigenesis in nude mice.A ScFv library of 1.6?106 was obtained and a tumor vessel specific phage-ScFv named ScFvH1(VH-linker-VL)was selected from the library.Conclusion:A tumor targeting ScFv library has been successfully constructed and a tumor vessel-specifrc antibody has been identified from the library,which provides a new way for the early diagnosis and therapy of cancer.

Objective: To investigate the targeting and anti-tumor ability of the tumor vessel-specific antibody ScFvH1 selected from phage-ScFv library, and to discuss the application of the antibody in clinical diagnosis and therapy of cancer. Methods: The ScFvH1 gene was inserted into pET-28a(+)/EGFP vector containing green fluorescent protein(GFP) gene and pTIG-Trx vector containing thioredoxin gene; the products were then expressed in E.coli and purified by using Ni-NTA. Tumor-bearing mice model was established by subcutanuous injection of cervical cancer cell line HeLa. The mice were injected with purified ScFv-EGFP fusion protein through vena caudalis and the GFP signals were observed by fluorescent microscope to evaluate the targeting ability of the antibody. Meanwhile, the mice model also received intratumoral injection of purified ScFv-EGFP fusion protein to evaluate the anti-tumor effect of the antibody. Results: Soluble ScFvH1 gene and ScFvH1-EGFP protein were successfully expressed in E.coli; a single band was showed in SDS-PAGE after the purification by Ni-NTA. We found that ScFvH1-EGFP fusion protein was enriched to tumor tissues, but there was only weak fluorescent signal when EGFP protein was injected. No EGFP signal was observed in the lung of tumor-bearing mice. Tumor inhibition experiment showed that the tumor growth in the antibody treatment group was similar to that of the PBS control group. Conclusion: The tumor vessel-specific antibody ScFvH1 selected from phage-ScFv library can specifically target tumor vessels, but it has no obvious inhibitory effect on tumor growth. Our findings pave a way for antibody in cancer diagnosis and treatment.

Objective To find out the exposure level and distributional characteristics of risk factors for stroke in health checkup population. Methods Target population was selected from two health management centers including Qianfoshan Hospital Affiliated to Shandong University and Shandong Provincial Hospital Affiliated to Shandong University in Shandong province. Data were investigated with a questionnaire which included general information, physical examination, laboratory examination and electrocardiography. Exposure rate of risk factors and its distributional characteristics were described. Results A total of 95 909 individuals were enrolled into data analysis, including 59 686 males (age:44.48± 14.43), 36 223 females (age: 44.80 ± 13.90). The major risk factors were lack of exercises (68.02%), overweight (60.54%)and dyslipidemia (58.27%). There were significant differences in age groups and sex. Conclusion Exposure rate of risk factor for stroke was high and there were substantial differences between sex and age in health checkup population. Screening and health management for stroke risks might be a necessary strategy for the preventive intervention.

Objective To evaluate the assessment index system of internal medicine, and to analyze the factors of practical effects on internal medicine. Methods The assessment index system of clinical skills was developed by expert group based on the clinical syllabus and objectives. Internal medicine index system was divided into four items such as history-taking, physical examination, hos-pital records and case questions. 49 five-year clinical interns who took internal medicine exams were researched. Reliability, validity, discrimination, difficulty were used to analyze the quality of assess-ment index system. Gender, teaching hospital and the preparation of postgraduate examination were used to explore the influencing factors of practical effects with independent t-test and Wilcoxon signed rank tests. Results The reliability, discrimination, difficulty of the assessment index system were 0.50, 0.15 and 0.85, respectively. The removing item coefficient of history collection, physical ex-amination, hospital records, case questions were 0.38, 0.26, 0.47 and 0.53, separately, and the discrimination were 0.18, 0.17,0.27 and 0.37, separately, and the difficulty were 0.87, 0.89, 0.79, and 0.78, respectively. The scores of assessment index system of girls were higher than those of the boys(P<0.05). Moreover, the girls scored higher in history collection and physical examination, compared with the boys(P<0.05). The discrepancy scores were not statistically significant among teaching hospitals (P>0.05). The students who prepared the postgraduate examination scored lower than the others(P<0.05). Conclusions The assessment index system of internal medicine is reason-able and reliable, but the assessment of case questions still needs to be standardized. Teaching hospi-tals have little effect on internship while gender and the preparation for postgraduate examination influence practice effects in internal medicine.

OBJECTIVE:To explore the role of clinical pharmacists in the process of drug treatment for leukemia children with neutrophil deficiency complicated with fever (NDCF). METHODS:Clinical pharmacists participated in the treatment for a leuke-mia child with NDCF. Considering about continuous decrease of platelet accompanied by epistaxis,combined with age,clinical symptom,lab indexes and related guidelines,clinical pharmacists thought it was possibly associated with bone marrow induced by chemotherapy drugs and drug-induced hemorrhage induced by cefoperazone sodium and sulbactam sodium. It was suggested to stop using cefoperazone sodium and sulbactam sodium;use Meropenem for injection 1.0 g,ivgtt,q8 h instead for anti-infection;addi-tionally use Recombinant human thrombopoietin injection 15000 U,sc,qd for elevating platelet. During treatment,taking into ac-count the low levels of neutrophils(0.17×109 L-1)and platelets(11×109 L-1)in this child,it was recommended to continue anti-in-fection and elevating platelet treatment,and continue to use Lienal polypeptide injection to auxiliarily enhance hematopoietic func-tion. When the child's condition was stable and neutrophils returned to normal,it was successively recommended to stop elevating platelet and anti-infection treatment;at the same time,conduct pharmaceutical care as body temperature examination,related indi-cator examination (such as routine blood test) and ADR monitoring,etc. RESULTS:Physicians adopted the clinical pharmacist's suggestions. The body temperature of the child was decreased,the hemogram recovered gradually,no infection occurred,and the next round of chemotherapy was successfully carried out. CONCLUSIONS:The clinical pharmacists participate in drug treatment for leukemia children with NDCF,pay attention to the prevention,diagnosis and treatment of drug-induced disease,and make com-prehensive analysis by using their own professional advantage,taking the possible effects of drugs on blood system,pharmacody-namics and pharmacokinetic characteristics as the breakthrough point,combing with the specific situation of children's age and ill-ness;assist physicians to formulate and optimize drug therapy plan so as to guarantee safe and effective drug use.

OBJECTIVETo examine the effects of rat marrow stromal cells (rMSCs) on gene expression of local brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) after injection of rMSCs into Cistern Magnum of adult rats subjected to traumatic brain injury (TBI).

METHODSA modified Feeney's TBI model was created in 48 adult rats. rMSCs were harvested from 3-month-old rats, and injected into Cistern Magnum in 24 rats subjected to TBI (Group cell transplantation). Saline was given through Cistern Magnum to another 24 rats subjected to TBI (Group saline control). Animals were sacrificed 1, 2 and 3 weeks after intervention, and special brain tissue blocks were dissected for total RNA extraction from each block. BDNF and NGF mRNA were reverse-transcribed into cDNA and further expanded by polymerase chain reaction (PCR). The expression of target genes was evaluated using semi-quantitative methods.

RESULTSGroup cell transplantation had higher BDNF and NGF gene expressions than Group saline control during a period of less than 3 weeks (P<0.05).

CONCLUSIONSrMSCs transplantation via Cistern Magnum in rats subjected to traumatic brain injury can enhance expressions of local brain NGF and BDNF to a certain extent.

Animals ; Bone Marrow Transplantation ; Brain Injuries ; metabolism ; therapy ; Brain-Derived Neurotrophic Factor ; genetics ; Disease Models, Animal ; Electrophoresis, Agar Gel ; Gene Expression ; Immunoenzyme Techniques ; Nerve Growth Factor ; genetics ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Stromal Cells ; Up-Regulation

Objective:To study the clinical application of jejunal feeding tube (J-tube) for early enteral nutrition after surgical treatment of upper digestive tract malformation in newborns.Methods:From January 2019 to December 2021, newborns with upper digestive tract malformation received stage Ⅰ small bowel resection and anastomosis in our hospital were enrolled in this prospective randomized controlled study. According to different types of postoperative nutritional support, these patients were randomly assigned into J-tube group and control group using block randomization method. The J-tube group were given enteral nutrition vis J-tube within 48-72 h after surgery and the control group were given oral feeding after the recovery of gastrointestinal function. Calories and proteins intake, growth indicators, duration of hospital stay and parenteral nutrition, time needed for full oral feeding and complications were compared between the two groups.Results:A total of 24 patients were in J-tube group and 28 in controlled group. No significant differences existed on the general status between the two groups ( P>0.05). The average daily intake of calories and proteins in j-tube group in the first week after surgery were significantly higher than control group [(108.7±8.3) kcal/(kg·d) vs. (97.9±7.0) kcal/(kg·d), (3.4±0.3) g/(kg·d) vs. (3.1±0.2) g/(kg·d)] ( P<0.05). No significant differences existed in the average daily intake of calories and proteins during the second postoperative week between the two groups ( P>0.05). Compared with control group,J-tube group showed increased growth velocity in head circumference and weight over time ( P<0.05), while the trend over time in length growth was not significant ( P>0.05). No significant differences existed in the duration of hospital stay and parenteral nutrition, time needed for full oral feeding and complications between the two groups ( P>0.05). Conclusions:Enteral nutrition via J-tube 48-72 h after surgery is safe and feasible in the postoperative nutritional management of newborns with upper digestive tract malformation. This strategy may promote physical growth after surgery without increasing the incidences of complications.

Clopidogrel was believed to be superior to aspirin by the well-known CAPRIE trial. However, no other large clinical trials demonstrated the same results, but all focused on the combination use of clopidogrel with aspirin, and combination therapy in CREDO was called the "Emperor's New Clothes". However, no one overturned the results of these clinical trials by quantitatively analyzing them. We reviewed ten large-scale clinical trials about clopidogrel. On the basis of results of CAPRIE, CREDO and CHARISMA trials, we re-estimated their minimal sample sizes and their powers by three well-established statistical methodologies. From the results of CAPRIE, we inferred that the minimal sample size should be 85 086 or 84 968 but its power was only 30.70%. A huge gap existed. The same was also true of CREDO and CHARISMA trials. Moreover, in CAPRIE trial, 0 was included in the 95% confidence interval and 1 was included in the 95% confidence interval for the relative risk. There were some paradoxical data in CAPRIE trial. We are led to conclude that the results in CAPRIE, CREDO, and from the subgroup analysis in CHARISMA trials were questionable. These results failed to demonstrate that clopidogrel was superior to aspirin or that clopidogrel used in combination with aspirin was better than aspirin alone. The cost-effectiveness analyses by some previous studies were not reliable.