[Objective]To observe the relationship between blood uric acid(UA)level and carotid atherosclerosis(CAS)in perimenopausal women.[Methods] Two hundred and thirty-three perimenopausal women were selected.Intima media thickness(IMT)of bilateral carotid arteries were measured by colour Doppler ultrasound.They were divided into normal group(162 cases)and CAS group(71 cases)according to the results of colour Doppler ultrasound.The level of blood UA between two groups was compared and the influence factors of CAS we re analyzed.[Results] The level of blood UA in CAS group was significantly higher than that in normal group[(341 ± 86)μ mol/L vs.(293±78)μ mol/L](P ＜ 0.05).The detection rate of hyperuricemia in normal group was 10.49％(17/162),while the detection rate in CAS group was 40.85％(29/71),which had statistical significance between two groupe(P＜0.01).Pearson correlation analysis showed that CAS had positive correlation with age(r=0.233,P=0.028),body mass index(BMI)(r=0.215,P=0.044),bloodUA(r=0.249,P=0.019)and fasting plasma ghcose(r=0.214,P=0.046).AndCASwas negatively correlated with high density lipoprotein cholesterol(r=-0.224,P=0.036).Logistic regression analysis showed that after the factors of age and BMI were corrected,CAS still had significantly positive correlation with the level of blood UA(OR＝4.805,95％ CI 1.700-11.673,P ＜ 0.05).[Conclusion]Hyperuricemia is a related risk factor of the incidence of carotid atherosclerosis in perimenopausal women.

Traditional Chinese medicine (TCM) emphasizes treatment based on syndrome differentiation, which em-bodies the concept of individualized diagnosis and dynamic treatment on a holistic view. RCT was frequently used in TCM clinical study. However, it cannot reflect the concept of treatment based on syndrome differentiation. The use of adaptive treatment strategies (ATS) in clinical research can adjust therapy in patients according to the change of disease, so it can reflect personalized medicine and dynamic treatment. From this perspective, the process of treat-ment based on syndrome differentiation was a process of adaptive treatment decision. So the method for developing ATS can effectively evaluate the efficacy of different treatment strategies in TCM clinical study. ATS had been used in some clinical studies from published literatures abroad. However, the use of ATS in domestic clinical research was seldom been reported. This paper gave an outline of the concept of ATS. In addition, this paper focused on three methods which can take the delayed effects of current treatment action into consideration and can compare the over-all effect of different ATS. It was hoped to lay foundation for future scientific research of TCM in the implementation of SMART and provide a new idea.

Traditional Chinese medicine (TCM) emphasizes treatment based on syndrome differentiation, which is the core technology that can embody the characteristics and advantages of TCM diagnosis and treatment. This is based on holistic view to illustrate individual diagnosis and treatment and dynamic treatment. However, RCT, which is frequently used in TCM clinical studies, can not reflect the concept of treatment based on syndrome differentiation. The use of adaptive treatment strategies in clinical researches can adjust therapy in patients according to the changes of diseases, so it can reflect individual diagnosis and treatment and dynamic treatment. From this perspective, the process of treatment based on syndrome differentiation is a process of decision-making of adaptive treatment. So the method for developing adaptive treatment strategies can effectively evaluate the efficacy of different treatment strategies in TCM clinical studies. Adaptive treatment strategies have been used in some clinical studies from some published foreign literatures. However, the use of adaptive treatment strategies in domestic clinical researches is seldom reported. This article discussed the concept of adaptive treatment strategies and their important components in detail. In addition, it presented three methods which can take the delayed effects of the current treatment action into consideration and can compare the overall effect of different adaptive treatment strategies, with a purpose to lay some foundation for future TCM researches in the development of optimal clinical pathway and provide new ideas and methods for researches.

DICOM is a standard for data format and transmission of digital medical image. DICOM Data Set is a binary data stream using DICOM encoding rule. DICOM Nesting Data Set is a kind of complex Data Set with a tree structure, and is widely used in DICOM services and encoding of DICOM files for its special structure. In this article, the functions and encoding rule of Data Set and Nesting Data Set in DICOM format are presented, and the way of parsing and organizing of them is put forward. The realization method and practical application are also discussed.

Aim To investigate the effects of co-administration of L-Arginine (L-Arg) and aspirin (ASA) on platelet aggregation in vitro and gastric damage in vivo. Methods Citrate anti-coagulation venous blood was obtained from rabbits. The blood was centrifuged at 1 100 r?min-1 for 10 min to obtain platelet-rich plasma (PRP). 500 ?l of PRP was poured into a cuvette, and then incubated with various concentrations of L-Arg and a small dose of ASA for 5 min. Platelet aggregation was assayed with Chrono-Log platelet aggregometer by changes in light transmission of platelet suspensions. After co-administration of L-Arg and ASA for 7days to rats, gastric damages were induced by water immersion restraint stress or reserpine. Results Co-administrateion of L-Arg and a small dose of ASA strengthened the inhibitory effects on platelet aggregation. Platelet aggregation rate was 6.6% using 3 mmol?L-1 of L-Arg and small dose of ASA. Platelet aggregation rate was 93.9% using the same concentration of L-Arg alone. 1 g?kg-1 of L-Arg and 0.1 g?kg-1ofASA co-administration for 7 days,significantly reduced gastric damage induced by water immersion restraint stress on Wistar rat. Similar results were observed on other animal experiments with gastric lesions induced by reserpine. The effects of L-Arg on prevention of gastric lesion were almost same as that of famotidine. Conclusion Co-administration of L-Arg and ASA can enhance the inhibitory effects on platelet aggregation and prevent gastric damage.

BACKGROUND:Transoral ventral release and posterior fusion have predominated in the treatment of irreducible atlantoaxial dislocation, but there is no consistent conclusion on the clinical efficacy.
OBJECTIVE:To explore the clinical outcomes of transoral ventral release and posterior fusion and screw/rod implantation in the treatment of irreducible atlantoaxial dislocation.
METHODS:A total of 32 patients with irreducible atlantoaxial dislocation undergoing thetransoral ventral release and posterior fusion were selected. After treatment, they received cervical anteroposterior and lateral digital DR and cervical MRI examinations to understand the conditions of nerve compression and bone fusion. The recovery of nerve function was evaluated using Japanese Orthopaedic Association before treatment, 6 months after treatment and during final fol ow-up.
RESULTS AND CONCLUSION:Post-treatment, 29 patients were fol owed-up for an average period of 12 months. (1) Al the patients obtained perfect atlantoaxial joint reduction and bone fusion. This achieved reduction and reconstruction of spinal column stability. (2) Spinal compression was obviously lessened after treatment in al patients, and nerve functions were improved to different degrees. Significant differences in Japanese Orthopaedic Association score were detected between 6 months post-treatment, final fol ow-up and pre-treatment (P<0.05). (3) There were no serious intraoperative complications such as spinal cord or vertebral artery injuries. Postoperative complications such as infection or burst were also not found. (4) Imaging evaluation revealed that transoral ventral release and posterior fusion is safe and effective for treatment of irreducible atlantoaxial dislocation.

BACKGROUND:The enamel matrix derivative has been used in the clinical treatment of severe periodontitis; however, the mechanism(s) by which enamel matrix derivative promotes periodontal regeneration is stil obscure. OBJECTIVE:To explore the effects of enamel matrix derivatives on the differentiation and proliferation of periodontal ligament stem cels. METHODS:Periodontal ligament stem cels were isolated and identified from human teeth. Cloning forming efficiency, surface antigen expression and pluripotency were detected and identified. Enamel matrix derivatives with different concentrations (20, 50, 100 mg/L) were used to culture periodontal ligament stem cels for 2 and 4 weeks. Colagen synthesis and mineralized nodule formation were detected using Trichrom staining and Von Kosa’s staining, respectively; real-time RT-PCR was employed to detect expressions of colagen type I, osteocalcin, and RUX2; MTT and cel growth rate assay were used to detect the proliferation of periodontal ligament stem cels. RESULTS AND CONCLUSION:Periodontal ligament stem cels were spindle-shaped and showed a higher colony forming efficiency than periodontal ligament cels. The expressions of surface antigens of periodontal ligament stem cels-CD105, CD29, CD45, CD44 were respectively 99.8%, 99.7%, 1.26%, 98.8%, indicating periodontal ligament stem cels have the multilineage differentiation potential. Enamel matrix derivatives improve the colagen synthesis and mineralization nodule formation of periodontal ligament stem cels in a time-dose dependent manner. They also can improve the expression of osteogensis-related genes colagen type I, osteocalcin, RUX2 and proliferation of periodontal ligament stem cels.

ObjectiveTo explore the relationship between the negative co-inhibitor programmed death-1 ( PD-1 ) and the pathogenesis of myasthenia gravis ( MG), by detecting the expression of PD-1 and programmed death ligand-1 ( PD-L1 ) on peripheral blood mononuclear cells (PBMCs) and soluble PD-1 (sPD-1) in plasma from myasthenia gravis patients. MethodsPeripheral blood samples were collected from 45 MG patients and 33 healthy persons without prednisone or other immunodepressant treatment during the half year ahead of withdrawal.The expression of PD-1 and PD-L1 on PBMCs were detected using immuno-fluorescence labeling and flow cytometry, and the concentrations of sPD-1 in plasma were measured using an ELISA kit. Results(1) The proportion of CD4+ PD-1 + T cells, as well as CD14+ PD-L1 +monocytes of the MG group was higher than that of the control group. There were no significant differences in the proportion of CD4+ PD-1 + T cells or CD14+ PD-L1 + monocytes in the MG sub-groups between different genders or MG types. While the proportion of CD4+ PD-1 + T cells of the late-onset MG (age ≥40) group was higher than that of the early-onset MG group (age ＜40). And it was higher in the MG patients with thymoma or thymus hyperplasia than that from the MG patients with normal thymus. The proportion of CD14+ PD-L1 +monocytes from the MG patients with thymoma or thymus hyperplasia group decreased obviously compared with that of the patients with normal thymus group; but no difference could be found between the late-onset group and early-onset group. (2)The concentration of sPD-1 in the plasma from the group of MG patients was(6. 92 ±0. 72) ng/ml,which was higher than that of the healthy control group ( (3.28 ±0. 42) ng/ml),even more, it was significantly higher in the early-onset MG group than that of the late-onset MG group,there was a negative correlation( r =-0. 526, P =0. 000) between the age of onset and the concentration of sPD-1. ConclusionsThe increased expressions of PD-1 on CD4+ T cells and PD-L1 on CD14+ monocytes in MG patients suggested the involvement of the couple of molecules in the pathogenesis of MG.Higher concentration of soluble PD-1 in the plasma of patients with MG suggested that it might disturb the ligation of PD-1 and PD-L1 on T cells and antigen presenting cells, which might result in the abnormal transportation of the negative modulating signal, and accelerate the pathological progress of MG.

Objective To investigate the effects of duration of surgery on flash-induced visual evoked potentials (VEP) in patients undergoing spinal surgery in prone position.Methods Eighty-two ASA Ⅰ or Ⅱ patients of both sexes aged 20-76 yr weighing 43-96 kg undergoing spinal surgery in prone position were divided into 3 groups according to the duration of surgery:group S≤2 h ( n =34) ; group M 2-4 h ( n =38) and group L≥4 h ( n =10).VEP was monitored using protektor VEP monitoring device (Xltek Co.,Canada).The latency,amplitude and recovery time of wave P100 were recorded before and 10 min after induction of anesthesia and at the end of surgery.Results Compared with group S,the amplitude of wave P1000 was significantly decreased at the end of surgery in group M,the lantency of wave P100 was significantly prolonged,while the amplitude of wave P100 was decreased at the end of surgery in group L ( P ＜ 0.05).Compared with group M,the lantency of wave P100 was significantly prolonged,while the amplitude of wave P100 was decreased at the end of surgery in group L ( P ＜ 0.05).Compared with groups S and M,the recovery time of wave P100 was significantly prolonged in group L ( P ＜0.05).There was no significant difference in the recovery time of wave P100 between groups S and M ( P ＞ 0.05).Conclusion Duration of surgery (≥4 h) can affect flash-induced VEP,the longer the duration,the stronger the effects.

Objective To explore the influence of emotional care based on the intrinsic motivation theory in the treatment of patients with ovarian cyst.Methods From September 2014 to October 2016,106 patients with ovarian cysts admitted to our hospital were selected and randomly divided into control group and study group with 53 in each group.The control group and the study group received routine nursing and emotional care based on intrinsic motivation theory,respectively.The two groups were evaluated before and after the intervention using the stages of change readiness and treatment eagerness scale (SOCRATES).Result After intervention,the scores of cognitive sub-scale,hesitation sub-scale and act sub-scales of the study group were higher than those of the control group, with significant difference (P＜0.05).Conclusion Emotional nursing based on intrinsic motivation theory is effective for the improved treatment of patients with ovarian cyst surgery,worth further promotion in clinic.