Objective To investigate the correlation among Lp (a),cerebral infarction and carotid atherosclerosis.Methods 180 cases were equally divided into 3 groups (60 cases in each group).The patients with both cerebral infarction and carotid atherosclerosis composed one group(cerebral infarction group for short) ;the patients of carotid atherosclerosis which without cerebral infarction composed another group(no cerebral infarction group for short) ;the control group composed with those who had neither cerebral infarction nor carotid atherosclerosis.The level,outlier detection rate about Lp(a) and usual risk factors of cerebral infarction were compared in this research.Results The level and detection rate of Lp(a) in the cerebral infarction group were (512 ± 156) mg/L and 46.7％ ;the level and detection rate of Lp(a) in the no cerebral infarction group were (316 ± 87)mg/L and 20.0％ ;the level and detection rate of Lp(a) in the control group were (199 ± 123) mg/L and 5.0％.The differences of the level and outlier detection rate of Lp(a) among the three group were significant(F=13.87,x2 =29.394,P ＜0.01).Cerebral infarction patients had more usual risk factors of cerebral infarction (hypertension,diabetes,hyperlipemia,drinking,smoking,obesity and lack of exercise) than those who without cerebral infarction (x2 =15.523,P ＜ 0.01).Conclusion The abnormal of Lp(a) was an important risk factor of cerebral infarction.The general survey of Lp(a) was significant in the primary and secondary prevention of stroke.To the people whose assay of Lp(a) was abnormal,the control of governable risk factors of cerebral infarction should actively be carried out.

Objective To compare the effect of different needle-retaining time on post-stroke hypermyotonia in acupuncture treatment.Method Ninety patients with post-stoke hypermyotonia were randomized into group A, group B, and group C, 30 in each group. The three groups were all treated by the twelve hand-foot needling method from the thirteen therapies invented by acupuncture master WANG Le-ting, once a day, 5 times a week, 20 times in total. For group A, needles were removed right after needling qi arrived; for group B, needles were retained for 30 min after needling qi arrived; for group C, needles were retained for 60 min after needling qi arrived. The modified Ashworth Scale (MAS), Clinical Spasticity Index (CSI), and Fugl-Meyer assessment scale (FAS) were adopted for observation before and after intervention.Result After treatment, the MAS was significantly changed in all three groups (P<0.05). The CSI score and FAS score of the affected limb were significantly changed in all three groups after intervention (P<0.05). Both group A and B were significantly different from group C in comparing the CSI and FAS scores (P<0.05).Conclusion Compared to retaining needles for 60 min, acupuncture without retaining needles or retaining needles for 30 min can produce better effect in improving post-stroke hypermyotonia, spasticity, and motions of limbs.

Resident standardization training is an essential way in cultivating medical professionals. It is important for subject development and talent reserve. For cultivating high-quality resident physicians with comprehensive theory, independent clinical thinking, great practical ability, and innovative scientific idea, it recourses to both optimizing training scheme and evaluation system with highly specialization and comprehensive quality. In this study, the authors proposed incorporate training patterns includingoptimiz-ing design, innovating training, and standardized assessment based on their recent experience on resident standardization training.

Objective To investigate the mechanism of live combined Bifidobacterium and Lactobacillus tablets in acute liver failure (ALF) treatment.Methods Ten mice were injected intraperitoneally with 3.0 g/kg D-galactosamine to establish the model of ALF and treated with live combined Bifidobacterium and Lactobacillus tablets.Protein levels of Jagged1,Notch1,Notch intracellular domain (NICD),Hes5 and the mRNA expressions of Jagged1,Notch1,Hes5 were measured via Western blot and real time-polymerase chain reaction (PCR),respectively.The protein level of CD68 was detected by immunohistochemical staining method.Meanwhile,serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),interleukin (IL)-10,high mobility group protein B1 (HMGB1) and plasma lipopolysaccharide (LPS) were measured.Moreover,model group and control group were also established with 10 mice each.In vitro,RAW264.7 cells were cultured with normal mice plasma,plasma of ALF mice and plasma of treated mice,respectively.Real time-PCR and Western blot were used to determine the mRNA expressions of Jagged1,Notch1,Hes5 and proteins levels of Jagged1,Notch1,NICD,Hes5.The levels of IL-10,HMGB1 and LPS in the supernatant of RAW264.7 cells were detected as well.The total significant differences among groups were compared by one way ANOVA,and q test was used to evaluate the significance of subgroup differences.Results The levels of serum ALT,AST,HMGB1,IL10,plasma LPS,and the expressions of Jagged1,Notch1,NICD,Hes5,CD68 were higher in ALF model group than control group (all P＜0.01).Compared with the ALF model group,all of these indexes could be improved in mice with live combined Bifidobacterium and Lactobacillus tablets (HMGB1:[82.6±9.7] μg/L vs [101.9±12.4] μg/L,q=6.36,P＜0.01; IL-10.:[3 183±769] pg/mL vs [4 628±842] pg/mL,q=6.79,P＜0.01; plasma LPS:[7.40±0.92] EU/mL vs [11.80±0.89] EU/mL,q=18.81,P＜0.01; Jagged1 mRNA:5.55±0.71 vs 7.63±1.41,q=7.22,P＜0.01;Jagged1 protein:0.56±0.07 vs 0.71±0.07,q=7.20,P＜0.01; Notch1 mRNA:3.66±0.67 vs 7.10±0.66,q=20.06,P＜0.01; Notch1 protein:0.38±0.08 vs 0.66±0.11,q=9.57,P＜0.01;NICD protein:0.47±0.05 vs 0.76±0.07,q=12.68,P＜0.01; Hes5 mRNA:3.94±0.68 vs 7.95± 0.71,q=22.40,P＜0.01; Hes5 protein:1.04±0.12 vs 1.20±0.07,q=5.61,P＜0.01; CD68 protein:5 180±610 vs 7 685 ±417,q=16.38,P＜0.01).And the differences were statistically significant.After RAW264.7 cells cultured with the plasma of ALF model mice,the levels of HMGB1,IL-10 and LPS in the supernatant and the expressions of Jagged1,Notch1,NICD and Hes5 in cells were increased,whereas if RAW264.7 cells were cultured with the plasma of treated mice,indexes mentioned above were significantly decreased (all P＜0.01).Conclusions Live combined Bifidobacterium and Lactobacillus tablet could prevent the occurrence and development of ALF by decreasing the plasma level of LPS,inhibiting the activation of Notch signaling pathway in macrophages and reducing the secretion of HMGB1 and IL-10.

ObjectiveTo investigate the effects and molecular mechanism of simvastatin in liver fibrosis model of non-alcoholic fatty liver disease (NAFLD) in vivo and hepatic stellate cell in vitro.MethodsFirstly,the rat liver fibrosis model of NAFLD was established by high-fat diet administration and intervened with simvastatin.The expression of endothelial nitric oxide synthase (eNOS),inducible nitric oxide synthase (iNOS) and Collagen Ⅰ at mRNA and protein level were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.Secondly,quiescent phenotype of LX-2 cell line was induced by promoting adipocyte differentiation medium in vitro,and then the quiescent phenotype of LX-2 cell were treated with transforming growth factor β1(TGF-β1),Nitroso-L-arginine methyl ester (L-NAME) which was NOS inhibitor,simvastatin,TGFβ1 with simvastatin,and L-NAME with simvastatin separately.The changes of eNOS,iNOS,αsmooth muscle actin (α-SMA) and Collagen Ⅰexpressions at mRNA and protein level were determined by RT-PCR and Western blot.ResultsAs modeling time extended,the expressions of eNOS in rat's liver tissue of model group at mRNA and protein level decreased gradually,however the expression of iNOS and Collagen Ⅰ at mRNA and protein level increased gradually,compared with normal control group and the differences were statistically significant (P ＜0.05 and 0.01).By 24weeks,the expressions of eNOS in rat's liver tissue of simvastatin group at mRNA and protein level were increased,the expression of iNOS at mRNA and protein level were decreased and the expression of Collagen Ⅰ at mRNA and protein level were decreased (all P ＜0.05).The expression of eNOS in rat's liver tissue of model group negatively correlated with the expression of Collagen Ⅰ at mRNA and protein level (all P ＜0.01).The expression of iNOS positively correlated with that of Collagen Ⅰ at mRNA and protein level (all P ＜0.01).In LX-2 cell culture,L-NAME inhibited the activation of LX-2,reduced eNOS and iNOS expression and increased α-SMA and CollagenⅠexpression,consistent with the role of TGF-β1.Simvastatin could directly increase the eNOS expression both in quiescent and activated LX-2 cells,decrease iNOS expression,maintain quiescent phenotype and inhibit its activation.ConclusionsSimvastatin ameliorated the genesis and progression of liver fibrosis by increasing eNOS expression in LX-2 cells and reducing iNOS,α-SMA and Collagen Ⅰ expression.

Objective To investigate the differences of expression and activation of natural killer (NK) cell G2D (NKG2D) in patients with different immune status of chronic hepatitis B virus (HBV) infection, and to explore the significance of NKG2D-mediated immune injury in HBV infection.Methods Fifteen chronic HBV carriers (immune tolerance),15 chronic hepatitis B (CHB, immune activation) patients, 15 HBV-related acute/subacute-on-chronic liver failure (HBV-ACLF, immune over-activation) patients were enro1led in this study from January 2010 to December 2011 in the Third Hospital of Hebei Medical University.The frequencies of NK cells and NKG2D+ NK cells in peripheral blood mononuclear cells (PBMC) were detected by flow cytometry.The NKG2D mRNA expressions were measured by real-time fluorescent quantitative polymerase chain reaction.Localization and hemi-quantitative analysis of NKG2D+ cells in liver tissue were performed by immunohistochemistry staining.Concentrations of serum interferon(IFN)-γ, tumor necrosis factor(TNF)-α, perforin and granzyme B were quantified by enzyme 1inked immunosorbent assay (ELISA).Normally distributed continuous variables were analyzed using one-way analysis of variance (ANOVA), followed by Student-Newman-Keuls q test for evaluating variances between each two groups.For non-normally distributed data or heterogeneity of variance, differences between groups were analyzed using nonparametric Kruskal-Wallis H test, followed by Nemenyi test for pairwise comparisons.Pearson chi-square test was used to analyze categorical variables.Results The percentages of NK cells in PBMC were (13.58±3.24)% in healthy controls, (5.42±2.18)% in chronic HBV carriers, (7.92±2.85)% in HBV-ACLF group and (8.43±2.92)% in CHB group.The percentage of NK cells in PBMCs was lower in each chronic HBV-infected group compared with healthy controls (F=22.04, P<0.05).The frequency of NKG2D+ NK cells in HBV-ACLF group (18.92±5.85)% was the highest, followed by CHB group (12.85±3.39)%, healthy controls (8.45±2.86)%, and chronic HBV carriers (3.36±1.05%), with the statistically significant differences between each two groups (H=46.09, P<0.01).Intrahepatic NKG2D mRNA expression and NKG2D+ cells density were highest in HBV-ACLF group (6.58±1.86 and 30.69±6.67, respectively), followed by CHB group (3.25±0.95 and 17.36±4.13, respectively) and chronic HBV carriers (0.69±0.20 and 3.16±1.24, respectively), with the statistically significant differences between each two groups (H=52.10 and 52.73 respectively, both P<0.01).The similar patterns were observed in serum IFN-γ, TNF-α, perforin and granzyme B concentrations.Conclusions NKG2D expresses variously in patients with different immune status of chronic HBV infection.Activation of NKG2D may take part in the immune pathogenesis of chronic HBV infection.

Objective To explore the effects of acute mild and moderate hypoxia on human mood state.Method The mood states of 18 healthy male volunteers were evaluated by self-assessment questionnaires,profile of mood state (POMS) and state anxiety inventory (S-AI) after random exposure to simulated altitude of 300 m (control),2800m,3600 m and 4400 m for 1 h in a hypobaric chamber.Result The data at 300 m level were taken as the baseline control.The negative mood state factor points (tension,fatigue etc.) increased gradually as the altitude level increased while V (vigor-activity) points had a tendency to decrease (P<0.05 or P<0.01).No significant difference was found in the points of (D,A) even under exposure to 4400 m(P>0.05).At the early period of 2800 m exposure the tension points of POMS and S-AI scores were higher than those of control level (P<0.05) then dropped to baseline level when exposure to this altitude for 1 h.Conclusion Exposure to acute mild hypobaric hypoxia at 2800 m for 1 h has adverse effect on mood state of healthy person and the negative effect was further aggravated with the increment of altitude level.

Objective To observe the expressions of interferon gamma (IFN-γ) and IFN-γ-inducible protein 10 (IP-10) at different stages of chronic hepatitis B virus (HBV) infection,and to investigate the relationship between IP-10 with hepatic inflammation activity and hepatitis aggravation.Methods Fifteen chronic hepatitis B (CHB) patients,15 asymptomatic HBV carriers (AsC) and 15 chronic severe hepatitis B (CSHB) patients were enrolled in the study from January 2010 to December 2011 in the Third Hospital of Hebei Medical University.The liver samples were collected by percutaneous needle biopsy or from liver transplantation.The IFN-γ and IP-10 mRNA expressions were measured by quantitative real-time polymerase chain reaction (PCR).Localization and hemi-quantitative analysis of IFN-γand IP-10 proteins were performed by immunohistochemistry staining.Concentrations of serum IFN-γ and IP-10 were quantified by enzyme linked immunosorbent assay (ELISA).HBV markers and liver function were also evaluated for each patient.Results Serum IFN-y and IP-10 concentrations increased significantly in CHB [(415.27±145.52) ng/L and (6.98± 1.12) ng/L,respectively] and CSHB [(658.33 ± 213.52) ng/L and (10.78 ± 1.19) ng/L,respectively] patients compared with AsC [(142.09 ± 47.64) ng/L and (2.4 7 ± 0.60) ng/L,respectively] patients,and were highest in CSHB patients (F=43.48,256.98 ;both P＜0.05).Meanwhile,intrahepatic IFN-γ and IP-10 mRNA and protein expressions paralleled with IFN-γ and IP-10 concentrations in the serum,which was highest in CSHB patients,followed by CHB and AsC patients (F＝693.85,210.21,433.05,214.46; all P＜0.05).Furthermore,Spearman linear correlation analysis showed that serum IP-10 level was positively correlated with both hepatic inflammation activity and serum IFN-γ concentration in CHB and CSHB patients (r =0.76 and r 0.77,respectively;both P ＜ 0.05).Conclusions IP-10,one important immunologic marker of regulating anti HBV activation,indicates progression from immune tolerance phase to immune clearance phase.Furthermore,it may affect the degree of inflammation and hepatitis aggravation.

Background and Objectives: Anticoagulation clinics are widely used for anticoagulation management in many countries, but have only recently began to gain acceptance in Taiwan. Our service model is a physician-managed outpatient clinic collaborating with clinical pharmacist and nurse. This study aimed to evaluate the adequacy of anticoagulation and rates of warfarin-related complications before and after referral to our collaborative anticoagulation clinic (CAC). Methods: Stroke patients taking warfarin from the neurology department were identifi ed and referred to the CAC during the 12-month period from February 2009 to January 2010. Quality markers include percentage of international normalized ratio (INR) values in the therapeutic range, frequency of INR monitoring, and frequency of follow-up visits and the mean interval of next INR monitoring after non-therapeutic INRs were compared one year before and after management in the CAC. Using studied patients as self-control, they were included in the analysis if patients had at least 3 months follow-up or 3 INR values both before and after referral. Results: A total of 44 stroke patients were included: mean age of 75.0 ± 9.7 years, with a CHADS2 score of 3.71 ± 0.69. The adequacy of anticoagulation was signifi cantly greater during CAC care compared with the period before referral; the percentage of INR within expanded therapeutic range was 60.9% versus 53.7%, respectively (p=0.049). Reduction in sub-therapeutic INR values from 31.8% to 24.2% (p=0.023) contributed mostly to the improved quality of care. The time interval of next INR monitoring after non-therapeutic INRs ( 4.0 or 1.5) was also signifi cantly shorter. However, there was no signifi cant difference in the rates of thromboembolic and hemorrhagic events which may be attributed to a small sample size. Conclusion: Based on results of our study, a CAC may be the optimal structure for anticoagulation management service in the future.

AlM:To investigate the influence of phacoemulsification with different incision on tear film.
METHODS:Tear film was monitored in 152 patients (169 eyes) after phacoemulsification. Patients were divided into two groups according to the type of incision:group A (76 patients, 83 eyes) with a 3. 2mm corneoscleral limbus incision phacoemulsification and group B (76 patients, 86 eyes ) with a sclemtic tunnel incision. Tear break-up time ( BUT ) , cornea fluorescein staining ( CFS ) , lid-parallel conjunctival folds ( LlPCOF) and lid-wiper epitheliopathy ( LWE ) were observed at 3d preoperatively and 1wk, 1, 3 and 6mo postoperatively. The results were analyzed using a Chi-square test and t-test with SPSS 17. 0.
RESULTS:BUT: The BUT of two groups was obviously shorter at 1wk, 1mo postoperatively, the differences were statistically significant (P<0. 05), however, there were no statistically significant at 3, 6mo(P>0. 05). CFS score:There was a large increase in CFS at 1wk, 1mo postoperatively, the differences were statistically significant between the two groups(P<0. 05), however, there were no statistically significant at 3, 6mo (P>0. 05). LlPCOF:There was a large increase in LlPCOF at 1wk, 1 and 3mo postoperatively, the differences were statistically significant between the two groups (P<0. 05), however, there were no statistically significant at 6mo (P>0. 05). LWE: There was a large increase in tear osmolarity at 1wk, 1mo postoperatively. The differences were statistically significant between the two groups (P<0. 05), however, there were no statistically significant differences between the two groups at 3, 6mo (P>0. 05).
CONCLUSlON:The stability of tear film in patients with scleral tunnel incision is much better than in patients with 3. 2mm corneoscleral limbus incision phacoemulsification. There is no significant difference between the two groups during later postoperative periods.