Objective To observe the effect of different doses of atorvastatin in the treatment of chronic heart failure of coronary heart disease (CHD), and to provide scientific reference for the choice of clinical medication. Methods 54 cases from June 2015 ~2017 year in April in our hospital with 20mg/d atorvastatin therapy regimen in the treatment of chronic heart failure of coronary heart disease patients as the study group, 54 cases of chronic heart failure of coronary heart disease patients with another force selected by 40mg/d atorvastatin therapy regimen as study group. LDL-C, LVESD, LVEDD, LVEF, hs-CRP, 6MWT, NT-proBNP and other indicators as evaluation basis, through the observation of the two groups before and after treatment the indexes to evaluate clinical efficacy, adverse events were observed after treatment in two groups. Results There was no significant difference between the groups before and after treatment, and there was no statistical significance(P<0.05). The indexes of clinical curative effect were improved in different degree after treatment, and the improvement effect in observation group was better than that in control group (P<0.05). Conclusion Atorvastatin 40mg daily oral drug treatment of chronic heart failure in patients with coronary heart disease is the best choice of atorvastatin dose, the dose range of atorvastatin treatment effectiveness and safety protection, improve clinical symptoms, promote the improvement of the quality of life, worthy of clinical application.

Objective To investigate the effect of non-alcoholic fatty liver disease (NAFLD) on virologic response in chronic hepatitis B patients treated with nucleos(t)ide analogues.Methods Three hundred and thirty-two treatment-naive patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) who visited clinic or hospitalized in the First Affiliated Hospital of Wenzhou Medical College from January 2007 to December 2009 were enrolled and finally 316 patients completed the research.Among them,106 patients were diagnosed with CHB complicated with NAFLD by ultrasonography (NAFLD group),and the remaining 210 patients were diagnosed with simple CHB (CHB group).Patients in both groups were treated with combination therapy of lamivudine (LAM) plus adefovir dipivoxil (ADV) or entecavir (ETV) monotherapy for 96 weeks.Alanine aminotransferase (ALT) levels,virologic response and serological response were compared pre-and post-treatment in both groups.Enumeration data was compared using x2 test,and correlation analysis was performed using Logistic multivariate regression analysis.Results Rates of hepatitis B virus (HBV) DNA clearance in the NAFLD group at week 12,24 and 48 were 46.2％,61.3％ and 74.5％,respectively,which were all significantly lower than those in CHB group (61.9％,73.8％ and 83.8％,x2 =7.051,5.195,3.895,respectively; all P＜0.05).However,rates of HBV DNA clearance were 85.8％ in the NAFLD group and 91.9％ in the CHB group at week 96.This difference did not reach the level of significance (x2 =2.838,P＞0.05).Rates of HBeAg loss in the NAFLD group were 27.4％ at week 48 and 37.7％ at week 96,compared to 33.3％ and 44.8％ in the CHB group.There was no significant difference in these two groups (x2 =1.169,1.424,both P＞0.05).Rate of HBeAg seroconversion in the NAFLD group was significantly lower than that in the CHB group at week 96 (17.9％ vs29.5％,x2=4.972,P＜0.05).Rates of ALT normalization were also found to be significantly lower in the NAFLD group than those in the CHB group at week 48 (69.8％ vs 80.5％,P＜0.05) and at week 96 (82.1％ vs 91.0％,P＜0.05).Multivariate regression analysis demonstrated that serum levels of triacylglycerol (OR=3.725,P=0.000),uric acid (OR=1.005,P=0.040) and fasting blood-glucose (OR=3.067,P=0.000) were independent risk factors associated with NAFLD.NAFLD was found to be a risk factor of virologic response at each time point throughout the treatment.(week 12,OR=2.749,P=0.001; week 24,OR=1.981,P=0.030; week48,OR=2.348,P=0.021; week 96,OR=8.053,P=0.001).Conclusions During antiviral therapy,NAFLD may affect biochemical and serological responses in CHB patients treated with nucleos(t) ide analogues,and may affect early virologic response in these patients.

Objective To investigate the effective ways of improving medical students' clinical competence during the process of internship. Methods Totally 398 students of clinical medicine from 2006 and 2007 grade in Soochow University were enrolled as research objects. Forty objects distribut-ed to the First Affiliated Hospital were taken as experiment group while 358 objects distributed to other hospital as control group. In experiment group, objective structured clinical examination (OSCE) was introduced during regular internship, innovation was made on test on completion of a course and autonomous learning and clinical practice was advocated and enhanced. Traditional practice and ex-amination method was used in control group. SPSS 19.0 was used to do statistical analysis on the test scores of students. Paired sample t test and independent sample t test were employed. Measurement data is expressed as x±s and P<0.05 signifies statistically significant differences. Results Clinical practice ability of students in experiment group was enhanced to various degrees after internship com-pared with that before internship. ECG interpretation, heart and lung auscultation, interrogation tech-nique, medical and surgical operation performances of students in experiment group were promoted significantly (P<0.05). Students' overall competence in the final graduation skill test was better in ex-periment group than in control group (P<0.05). Conclusions OSCE-test on completion of a course not only make intern management more effective, but also make students' aim more definite, therefore it is conducive to enhancing clinical competence.

Objective To discuss theoretical structure model for the scale of recurrent oral ulcer (ROU) with traditional Chinese medicine characteristics; To lay a theoretical foundation for further developing scale. Methods This study followed international patients reported outcome (PRO) scale development specification, combined TCM theories, including the theory of mouth dominate and five internal organs correlation, uniformed spirit and body, correspondence between human and the universe, seven emotions, constructed theoretical structure of PRO scale of ROU. Results The theoretical structure of PRO scale of ROU included four major areas as physiology, psychology, independence, and society and nature. Conclusion Theoretical model of PRO scale of ROU laies the foundation and provides the oretical guidance for the formulation of PRO scale of the ROU.

Objective To investigate the mRNA expression of toll like receptor-9 (TLR9) and interferon regulatory factors-5 (IRF5) of AS2O3 on peripheral blood mononuclear cells (PBMCs) in systemic lupus erythematosus (SLE) patients.Methods PBMCs of 15 SLE patients and 15 healthy subjects were treated with different concentrations of AS2O3 and cyclophosphamide (CTX) in vitro.Real-time quantitative polymerase chain reaction was used to amplify TLR9 and IRF5 gene before and after 12 and 24 hours drug intervention and the mRNA expressions were measured.Differences between groups were analyzed by paired t test or variance analysis.Results The mRNA expression levels of TLR9 [12 h(1.38±0.26) and 24 h (1.28±0.35)] on PBMCs in SLE patients were significantly higher than those in healthy controls [12 h(1.05±0.35) and 24 h (0.97±0.19)](t=2.37,P=0.03; t=2.44,P=0.02).The IRF5 mRNA expression levels [12 h (0.95±0.27) and 24 h (0.91 ±0.35)] in SLE patients were obviously higher than those in healthy controls [12 h (0.62 ±0.23) and 24 h (0.60±0.39)] (t =3.07,P=0.01 ; t =3.45,P＜0.01).AS2O3 could suppress the mRNA expression of TLR9 on PBMCs and the effect was gradually increasing with the increasing concentration of AS2O3 and processing time [0.2 mg/L AS2O3 group 12 h (0.430±0.110) and 24 h(0.290±0.050),0.4 mg/L AS2O3 group 12 h (0.170±0.038) and 24 h (0.090±0.017),0.8 mg/L AS2O3 group 12 h (0.023±0.011) and 24 h (0.003±0.001)].Comparing with CTX [12 h (0.814±0.081) and 24 h(0.755±0.139)],AS2O3 had a more significant strong effect on inhibiting the expression of TLR9 mRNA in SLE patients [F=165.32(12 h),P＜0.01; F=99.20 (24 h),P＜0.01].The mRNA expression of IRF5 on PBMCs was not suppressed by AS2O3 and CTX and there was no statistically significant difference between groups (P＞0.05).Conclusion There is abnormal expression of IRF5 and TLR9 mRNA in SLE patients.AS2O3 may suppress the TLR9 mRNA expression in SLE patients,which may be one mechanism of clinical effectiveness.

Objectives To explore the efficacy of CaNa2EDTA in the treatment of chronic moderate lead poisoning, so as to optimize the chelation therapy for lead poisoning in children. Methods The clinical data of 14 patients with chronic moderate lead poisoning treated with CaNa2EDTA for 3 consecutive courses of lead removal during September 2014 to December 2016 were analyzed retrospectively. Twenty-four hour urinary lead levels during hospitalization were analyzed. The changes of blood lead levels before treatment, 3 days, and 5 days after treatment were also analyzed. Results In the 14 children (4 males and 10 females) average age was 2.35±1.47 years. After treatment with CaNa2EDTA for 3 consecutive courses, the blood lead levels were decreased significantly in all the patients, and the blood lead levels at 3 days after treatment were 0.76, 0.77, 0.72 times those at 5 days after treatment respectively. The decrease of blood lead levels per unit of drug in the first 3 days of treatment were significantly higher than those in 5 days of treatment (P<0.05). The decrease of blood lead levels at 3 days after treatment was 0.65, 0.71, 0.70 times , those in 5 days' treatment respectively. The decrease of urine lead levels per unit of drug in the first 3 days of treatment were significantly higher than those in 5 days of treatment (P<0.05). Conclusions CaNa2EDTA has an obvious effect on removal of lead.The efficiency of lead removal in 3 days of treatment was higher than in 5 days of treatment. Thus, a course of treatment for 3 days may be an altenative for a course of 5 days.

Objective To explore the influence factors on hepatitis B virus (HBV) relapse after nucleos(t)ide analogues (NA) withdrawal in the chronic hepatitis B (CHB) patients who met NA cessation criteria. Methods Eighty-one consecutive CHB patients were treated with NA, 38 with lamivudine (LAM), 25 with adefovir dipivoxil (ADV), 12 with entecavir (ETV), 6 with LAM +ADV. Among recruited patients, 40 were hepatitis B virus e antigen (HBeAg) positive, 41 were HBeAg negative, 67 of them were initial treatment, 14 were retreatment due to resistance to NA at baseline. The treatment was discontinued after meeting China therapeutic end-point criteria. HBV DNA, HBV serological markers, alanine aminotransferase (ALT) were measured respectively at baseline, every month before virological response, every 3 months after virological response, every month within first 6 months and every 2 months over 6 months after drugs withdrawal. Twelve probable influence factors on relapse which were sex, age, HBV family history, baseline HBV DNA,baseline HBeAg status, baseline ALT, virological response time, total duration of treatment, duration of additional treatment, the level of hepatitis B virus surface antigen (HBsAg) at cessation therapy,initial treatment or retreatment, drug category were analyzed with univariate, multivariate Cox regression modle and stratified analysis. The cumulative relapse was calculated by the Kaplan-Meier method. Results A total of 36 patients (44. 4%) relapsed within 1 year. Initial treatment or retreatment, HBV family history, virological response time, the level of HBsAg at cessation therapy were independent risk factors. The relapse rate of retreatment was higher than that of initial treatment (78.6% vs 37. 3% , χ2 = 7. 983, P = 0. 005) , those of patients with HBV family history higher than without family history (64. 5% vs 15.0%, χ2 =12. 096,P = 0.002), those of patients obtained virological response within 3 months lower than after 3 months(34. 0% vs 64. 3% , χ2 =6. 823,P=0. 009) , those of patients with HBsAg≤150 μg/L at cessation therapy lower than >150 μg/L(27. 6% vs 53. 8%, χ2=5. 199,P=0. 023). Conclusions Retreatment, HBV family history, later virological response and higher HBsAg level at cessation therapy are risk factors of relapse after NA withdrawal. Such patients should be treated with prolonged duration after meeting end-point criteria to strengthen the efficacy.

Objective To study the effects of melatonin (MT) on mitochondrial autophagy in neonatal rats with hypoxic-ischemic brain damage (HIBD).Method Animal model of HIBD was established.Forty-five 7-day-old Sprague-Dawley (SD) rats were randomly assigned to sham operation group and HIBD group.Brain tissue were taken at 0,2,4,6,8,12,24 and 48 h after model preparation,and the expressions of mitochondrial autophagy-related protein Bnip3 and autophagy-related protein LC3-Ⅱ were detected.Seventy-two 7-day-old SD rats were randomly assigned to sham operation group,HIBD group and post-HIBD treatment group (3-MA,Mdivi-I,Rapa,MT,3-MA + MT,Mdivi-1 + MT,Rapa + MT).The sizes of cerebral infarction after different treatment were detected using triphenyltetrazolium chloride staining (TIC).Primary cortical cells of fetal SD rats (embryonic day:17 ～ 19 d) were cultured.JC-I staining was used to detect mitochondrial membrane potential and immunofluorescence method was used to observe mitochondrial autophagy.The Oxygen glucose deprivation/reperfusion/R (OGD) model was prepared.Autophagy inhibitor 3-MA,mitochondrial autophagy inhibitor Mdivi-1,autophagy activator Rapa,and MT were applied and Bnip3 and LC3-Ⅱ expressions and CCK8 (Cell Counting Kit CCK 8) for cell viability assay were examined.Result TTC staining results showed significant white infarcts in the tissue of HIBD group after hypoxia-ischemia,especially in the 3-MA and Mdivi-1 groups,and the infarcts were smaller in Rapa group and groups with MT treatment,the differences were statistical significant (P ＜ 0.05).Compared with the sham operation group,the expressions of Bnip3 and LC3-Ⅱ in the HIBD group were significantly increased (P ＜ 0.05).Compared with the normal group,the expressions of Bnip3 and LC3-Ⅱ in the OGD/R group were increased (P ＜0.05).The activities of 3-MA and Mdivi-1 cells decreased significantly,the mitochondrial membrane potential decreased,and mitochondrial autophagy were decreased (P ＜ 0.05).The cell activity,mitochondrial membrane potential,and mitochondrial autophagy of Rapa group were increased (P ＜ 0.05).The cell viability,Bnip3 and LC3-Ⅱ expressions were increased in groups with MT intervention (P ＜ 0.05).Conclusion MT may play an important protective role in the early stage of brain injury by enhancing mitochondrial autophagy of HIBD,which provide a theoretical basis for the study of specific related mechanisms.

Objective:To investigate the effects of bifidobacterium combined with salicylic acid on skin inflammation and intestinal microecology in acne patients with chloasma.Methods:Sixty acne patients with chloasma who received treatment in the Department of Cosmetic Dermatology, Wenzhou Heping Plastic Hospital from July 2020 to November 2021 were included in this study. They were randomly divided into three groups: lifestyle intervention group ( n = 20), bifidobacterium combined with salicylic acid intervention group ( n = 20), and isotretinoin intervention group ( n = 20). The lifestyle intervention group was treated by routine lifestyle care. The minocycline intervention group was administered with minocycline together with food based on lifestyle intervention. The bifidobacterium combined with salicylic acid intervention group was treated by bifidobacterium combined with salicylic acid based on lifestyle intervention. Clinical efficacy, skin condition score, changes in serum Toll like receptor 2 (TLR-2) and interleukin-17 (IL-17) levels after treatment relative to those before treatment, and the incidence of adverse reactions were compared among the three groups. Results:The response rate in the bifidobacterium combined with salicylic acid intervention group was 95.00% (19/20), which was higher than 55.00% (11/20) in the isotretinoin intervention group and significantly higher than 20.00% (4/20) in the lifestyle intervention group ( Z = 22.94, P < 0.05). After 14 weeks of treatment, the skin condition score in the bifidobacterium combined with salicylic acid intervention group was (53.15 ± 0.23) points, which was significantly higher than (32.95 ± 0.23) points in the isotretinoin intervention group and (10.18 ± 0.25) points in the lifestyle intervention group ( F = 164 761.37, P < 0.05). Serum levels of Toll-like receptor 2 and interleukin-17 in the bifidobacterium combined with salicylic acid intervention group were (35.31 ± 5.52) pg/mL and (164.23 ± 10.12) pg/mL, respectively, which were significantly lower than (52.13 ± 5.45) pg/mL and (198.32 ± 10.23) pg/mL in the isotretinoin intervention group and (62.56 ± 6.11) pg/mL and (245.23 ± 11.31) pg/mL in the lifestyle intervention group ( F = 116.33, 296.24, both P < 0.05). The incidence of adverse reactions in the bifidobacteria combined with salicylic acid intervention group was significantly lower than 65.00% (13/20) in the isotretinoin intervention group and 90.00% (18/20) in the lifestyle intervention group ( Z = 41.02, P < 0.05). Conclusion:Bifidobacterium combined with salicylic acid intervention for the treatment of acne complicated by chloasma can greatly improve skin conditions, alleviate skin inflammation, and reduce adverse reactions. Therefore, bifidobacterium combined with salicylic acid intervention is a safe and highly efficient method for the treatment of acne complicated by chloasma and deserves clinical promotion.

Objective: To understand the symptoms of depression and anxiety among rural returning adolescents and to analyze their association with physical activity related factors, so as to provide reference for interventions targeting depression and anxiety symtoms in the population. Methods: From April to June 2020, 3 495 middle school students were selected from 6 counties and districts of Shangrao City by random cluster stratified sampling sampling. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to evaluate the depressive and anxiety symptoms among middle school students. The International Physical Activity Questionnaire was used to assess their physical activity levels during the past week. Chi square test and Logistic regression analysis were used to determine the strength of the association between depression and anxiety symptoms and physical activity related factors in returning and non returning adolescents as well as the overall population. Results: Univariate analysis showed significant differences in the prevalence of depressive and anxiety symptoms between rural returning and non returning adolescents and the overall population in terms of "type of school" "family economic situation" "parental occupation" "number of sports classes per week" and "level of physical activity per week" ( χ 2=78.21, 16.56, 135.44, 107.75, 7.10, 8.62; 97.94, 24.26 , 124.07, 90.36, 9.60, 8.34, P <0.05). Multivariate regression analysis showed a correlation between the occurrence of depression and the number of sports classes per week for rural returning and non returning adolescents and the overall population (number of sports classes per week for non returning was 2 times, OR=1.22, 95%CI =1.01-1.49; returning adolescents for 1 time, OR=1.85, 95%CI =1.06-3.23; the overall population for 1 time, OR=1.34, 95%CI =1.01-1.77 and 2 times, OR=1.20, 95%CI =1.01-1.43, P <0.05). There was a correlation between anxiety symptoms and the number of sports classes per week for returning adolescents (number of sports classes per week for returning adolescents was 1 time, OR=2.10, 95%CI=1.21-3.63, P < 0.05 ). Conclusion A low frequency of weekly sports classes may be a risk factor for depressive or anxiety symptoms in rural and returning adolescents. Rural primary and secondary schools should appropriately increase the number of physical education courses or arrange sports extended classes to promote the development of adolescent mental health.