The changes of[Ca~(2+)]and metabolism of lipid in human monocyte-macrophages as inter- acted with glycosylated LDL(glc-LDL)were observed.The intracellular[Ca~(2+)]was higher than that of LDL(P

Objective To investigate the impact of hs-CRP and IVUS on major adverse cardiac event in patients who after coronary artery intermediate lesions stent implantation.Methods 82 patients with clinical diagnosis of coronary heart disease who had a segmental stenosis degree is 40％ ～ 70％ in one major coronary artery on coronary angiography,all of the patients do intravascular ultrasound,patients had minimal lumen area(MLA) of intermediate lesions ≤ 4mm2( the left main coronary artery)or≤ 6mm2( left main coronary artery) who received percutaneous coronary intervention(PCI),and the patients were divided into 2 groups,hs-CRP rise group(≥3mg/L) and hs-CRP normal group(＜3mg/L),compared the rate between the two groups in hospital and follow up periods by typical angina,nonfatal myocardial infarction,cardiac death and target-vessel revascularization and other major adverse cardiac events (MACE).Results The rate on major adverse cardiac event in hs-CRP rise group was significantly higher than the normal group(P ＜0.01 );the restenosis rate in hs-CRP rise group higher than hs-CRP normal group(P ＜0.01 ).Conclusion hs-CRP could predict the rate on major adverse cardiac event in patients with after coronary artery intermediate lesions stent implantation,the patients of hs-CRP rise group should strengthen antiplatelet,anti-inflammatory treatment etc.

Hepatic myelopathy is one of special category changes of nervous system,which was secondary to the end-stage hepatic diseases and is a syndrome of myeleterosis.It usually occurred after portosystemic shunt surgery or collateral circulation of portosystemic vein.The prognosis of hepatic myelopathy is poor,and the progression of this disease is slow.Surgical approaches such as dissociation of colon and anastomosis of ileum and rectum aimed at reducing the absorption of toxic substance and thus to breakdown the blood ammonia and improve the symptoms of nervous system,but the effects are not satisfactory.The clinical data of 1 patient with hepatic myelopathy who received liver transplantation at the Second Affiliated Hospital of Dalian Medical University in April 2012 were retrospectively analyzed.The clinical symptoms and physical signs were improved,and muscle strength was effectively recovered in the patient.Liver transplantation might be an effective method for the treatment of hepatic myelopathy.

Objective To summarize the clinical features,treatment and follow-up of patients with severe coronary artery spasm.Methods Twenty-one patients with confirmed coronary artery spasm were selected.The study reviewed the patients' general conditions including age,gender,complication,smoking and drug situations.The clinical features,electrocardiogram and coronary angiography data were analyzed.Their diagnosis,treatment and prognosis were evaluated.Results Male (86％,18/21) had higher incidence in severe coronary artery spasm.Smoking (62％,13/21) was a major risk factor.Coronary artery spasm often happened on the base of a fixed narrow (57％,12/21),and the clinical process was treacherous.Coronary angiography was very important for early diagnosis.Calcium antagonist was the core of the treatments and should be sustained at full dose.Interventional therapy was not efficacious.Although patients in acute phase had higher risk,long-term prognosis was good.Conclusions Coronary artery spasm is a common problem,but it is often overlooked.Timely diagnosis is the key to prevent fatal events.Calcium antagonist is the core of the coronary artery spasm drugs.The long-term prognosis of coronary artery spasm is good.

Objective Aiming at the characteristics of the course of acupuncture and massage,to discuss the application of Situational heuristic teaching.Methods 60 undergraduate students in Grade Four of Jiangxi University of Traditional Chinese Medicine (clinical practice) were even divided into 2 groups,that was situational teaching group (the experimental group) and the traditional teaching group (control group).The students in the experimental group received basic theory course of 30 hours,60 hours in the course of situational teaching.The clinical cases of teaching were carefully designed according to the simulated hospital scene in each chapter,including large cases,acupuncture and massage therapy program,which were conducted between teachers and students through interactive and positive research and other forms.In the control group the teachers taught the content to students in class for full 90 hours in accordance with the requirements of the teaching syllabus.Taking objective theoretical examination,subjective questionnaire survey,and subjective clinical return visit questionnaire scores as indicators the difference of the two kinds of teaching methods were compared and statistical analysis was carried out by SPSS 19.0 software,chi square test and t test.Results By comparison of objective theoretical examination results of two groups of subjects,the number of good students in the experimental group was 10,and the number of outstanding students was 7,with an average of (80.63 ± 1.35) points.In the control group,the number of good students was 9,the number of outstanding students was 6,with the average score of (80.54 ± 1.32),and the average score of the objective theory test scores were not statistically significant (P＞0.05).The learning satisfaction of the students in the experimental group was (3.91 ± 0.29).Students in the experimental group thought situation heuristic teaching was conducive to professional development (3.23 ± 0.39),to improving the learning quality (3.68 ± 0.72),clinical thinking culture (4.11 ± 0.24),clinical ability (3.72 ± 0.27),clinical physician-patient communication skills (3.28 ± 0.79),basic clinical skills (3.48 ± 0.42) points,with teaching satisfaction (4.19 ± 0.25),which were all higher than the control group,and the difference was statistically significant (P＜0.05).Conclusion Situational heuristic teaching method is better than the traditional teaching method in stimulating students' learning enthusiasm,innovation ability,cultivating professional interest and cultivating students' clinical practice ability.The teaching practice of teachers should give full play to the advantages of the method and improve the teaching effect,which is worthy of further research and promotion.

Objective To explore the value of hydronephrosis volume measured by 64 slice CT scan, evaluating renal function in patients with obstructive hydronephrosis.Methods The patients performed with both single photon emission computed tomography(SPECT) renal dynamic imaging and 64 slice CT scan in three days were chosen, 176 cases included finally.The images of renal dynamic imaging were divided into normal renal function group, mild renal impairment group, moderate renal impairment group and severe renal impairment group according to glomerular filtration rate (GFR) measured by SPECT.At the same time, CT three-dimensional reconstruction technique has been used to measure the volume of hydronephrosis, compare the differences of hydronephrosis volume among these groups, and future analyze the correlation of hydronephrosis volume with renal GFR value.Results The hydronephrosis volume of the four groups were respectively (31.47±3.81) cm3,(83.43±7.81) cm3,(208.53±15.47) cm3 and (577.31±61.32) cm3.There was statistical significance among these groups (P<0.01),except between normal renal function group and mild renal impairment group.The volume of hydronephrosis showed positive correlations with renal GFR (r=-0.614).Conclusion The volume of hydronephrosis measured by 64 slice CT has positive correlation with GFR measured by SPECT, which could reflect renal function to some extent.

Objective To observe the efficacy and safety of Shenqiwuweizikeli for treating chronic insomnia.Methods One hundred and ninety-six cases of subjects were randomly divided into Shenqiwuweizikeli group (n =98) and Estazolam tablets group (n =98).The pittsburg sleep quality index (PSQI) was adopted to evaluate the clinical effects and records of adverse reactions during the study period.Also the lab routine inspection(blood routine,urine routine,liver and kidney function, electrocardiogram were conducted to evaluate safety.Results The Shenqiwuweizikeli and Estazolam tablets all had significant effects for chronic insomnia.The total effective rate of Shenqiwuweizikeli group was 92.86％ (91/98), of Estazolam tablets group was 93.88％(92/98) ,and there was no significant difference (P＞0.05).There were no abnormalities in terms of each routine inspection index.After stopping take the medicine, The adverse reactions including bounce sex insomnia(60 cases), daytime sleepiness/drowsiness (55 cases), dizziness with lacking of power and light headedness(23 cases) in Estazolam tablets group were all more than Shenqiwuweizikeli group with significant difference(P＜0.01).Conclusion The Shenqiwuweizikeli has definite efficacy and safety for treated with chronic insomnia without withdrawal of recoil and dependence.

Objective To study the clinical significance of monitoring the urine iodine level in pregnant women.Methods The urine iodine levels were detected in 391 cases of pregnant women.The relativity was analyzed among the pregnancy gestation,pregnancy complications and the urine iodine levels.The corresponding health educa-tion of iodine nutritional knowledge was conducted according to the results of the determination.Results (1 )The urine iodine value was (124.73 ±70.61)μg/L in 391 pregnant women.The severe deficiency iodine rate,deficiency iodine rate and appropriate iodine rate of pregnant women were 37.85%,64.70% and 25.06%,respectively.(2) There was no significant difference in values of urine iodine among the pregnant women during the first,second and third trimester of pregnancy[(121.76 ±71.81)μg/L,(125.52 ±69.28)μg/L,(129.30 ±75.19)μg/L](t≤0.59, all P >0.05).The mean values were all lower than the appropriate values of WHO(150 ~249 μg/L).The low iodine rates were 67.20%,63.23% and 65.12%,respectively.There was no significant difference among them(χ2 =0.56, P >0.05 ).(3 )The urine iodine value of the pregnant women complicated with hyperthyroidism [(85.76 ± 53.09)μg/L]was significantly lower than that of primary hypothyroidism combined with pregnancy [(133.65 ± 73.41)μg/L],pregnancy combined with subclinical hypothyroidism[(136.50 ±79.19)μg/L]and no pregnancy complication[(119.34 ±66.43)μg/L](t≥2.76,P <0.01).The rate of iodine deficiency(87.88%)was highest (χ2 =8.72,P <0.05).(4)The urine iodine value after iodine nutrition intervention was significantly higher than those before in 77 pregnant women[(129.74 ±68.04)μg/L vs.(107.01 ±74.36)μg/L,t =1.98,P <0.05].The iodine deficiency rate dropped from 79.22% to 63.64%(χ2 =4.58,P <0.05).Conclusion In order to improve the appropriate iodine rate of pregnant women,it should be very important significance on monitoring the urine iodine level of pregnant women in particular with a complication of pregnancy and conducting iodine nutrition intervention in whole pregnancy gestation.

Objective To observe the correlation between non-high density lipoprotein cholesterol levels and coronary artery disease(CAD),extent of angiographic coronary artery lesions and risk factors of CAD.Methods Serum total cholesterol ( TC ),triglyceride ( TG),high density lipoprotein cholesterol ( HDL-C ),low density lipoprotein (LDL-C),Lp(a),apoA-1 and apo B levels were measured in 282 patients with angiographic CAD meanwhile in 129 normal controls without angiographic coronary artery lesions.Non-HDL-C and LDL-C/HDL ratio was calculated.Logistic regression and partial correlation were used to find the correlation of serum non-HDL-C with CAD.Results Non-HDL-C[ (3.40 ± 1.01 ) mmol/L vs (3.08 ±0.65)mmol/L,P ＜0.05],LDL-C[ (2.63 ±0.84) mmo/L vs (2.40 ±0.54) mmol/L,P ＜0.05 ],TC[ (4.48 ± 1.07)mmol/L vs (4.23 ±0.69) mmol/L,P ＜0.05 ],and LDL-C/HDL ratio [ ( 2.52 ± 0.96) vs (2.21 ± 0.74 ),P ＜ 0.05 ] were significantly higher in the CAD group than in the control group.The four indexes also showed an increasing trend in the sequence of single,double and triple vessel lesions.Multivariate Logistic regression analysis found that among lipid factors,only non-HDL-C was independently associated with CAD.The results of partial correlation analysis demonstrated that non-HDL-C was positively correlated to the number of lesions( r =0.250,P ＜0.01 )and gensini score of CAD( r =0.116,P ＜0.05 ).Conclusion Non-HDL-C level is an independent risk factor for CAD and significantly correlated with the severity of CAD.

Objective To investigate the dynamic changes of cardiomyocyte apoptosis and Caspase-12 activation after coronary microembolization (CME) in rats. Methods The CME models were produced by injection of 42 μm microspheres (3000/0.1 ml) into the left ventricle during clampinduced ascending aorta occlusion for 10 seconds in adult male Sprague-Dawley rats (CME group).The sham-operation group was injected with saline instead (S group). The survivors were randomly divided into five groups: 3 h, 6 h, 12 h, 24 h and 4 weeks (n=10, each), respectively. In addition,10 rats were designed as normal control group. Cardiomyocyte apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining. The expressions of Caspase-3, 12 and procaspase-3 and 12 were detected with Western-blot analysis. The activity of Caspase-12 was determined with fluorometric assay kit. Results (1)Compared with the shamoperation group and normal control group, the apoptosis rates of cardiomyocytes in CME group were significantly increased at each time point respectively (all P＜0.05). Apoptotic cardiomyocytes were found mainly in the border zones and infarct foci. The apoptosis rates of cardiomyocytes at 3 h, 6 h,12 h, 24 h and 4 weeks after CME were (1.76±0.68)%, (3.17±1.26)%, (1.34±0.12)%,(1.07±0.65)% and (0.30±0.13)%, respectively. The apoptosis rates of cardiomyocytes increased at 3 h after CME, peaked at 6 h after CME (all P＜0.05), and then gradually decreased with lowest value at 4 weeks (all P＜0.01). (2)Compared with sham-operation group and normal control group,the relative activation level of Caspase-3 and 12 in CME group increased remarkably (all P＜0.05).The time courses of Caspase-3 and 12 expressions corresponded well to those of cardiomyocyte apoptosis after CME. Conclusions The amount of cardiomyocytes apoptosis is significantly increased after CME. Caspase-12 may be involved in the apoptosis of cardiomyocyte after CME.