ObjectiveTo investigate the effects of atorvastatin on cardiomyocyte apoptosis and caspase-3 expression in acute myocardial infarction in rats.MethodsFifty SD rats were randomly divided into 3 group:sham group,control group( normal saline),atorvastatin pretreatment group ( 10mg/kg),The atorvastatin group were pretreated with atorvastatin ( 10mg/kg ) for 3 days,and those in the control group were pretreated with normal saline instead.All rats underwent coronary ligation of left anterior descending branch to establish AMI rat s model on the fourth day except the sham group,while sham group only received thoracotomy without coronary ligation.Then,The infarct size area at risk were defined by Evans blue and TTC staining,the caspase-3 mRNA expression of myocardium was measured with reverse-transcriptase polymerase chain reaction(RT-PCR) and the apoptosis index was analyzed by TUNEL staining.Results Compared with control group,the infarct size,the caspase-3 mRNA expression of myocardium,the apoptotic index were decreased significant in the atorvastatin group ( P ＜ 0.05 ).ConclusionPretreatment with atorvastatin has protective effect on the acute ischemic cardiomyocytes,which may probably be associated with the reduction of the expression of caspase-3 mRNA in the myocardium and the apoptotic index.

Objective To investigate the short-term outcomes and oncological safety of laparoscopy resection for colorectal cancer. Methods Between January 2004 and March 2009, 35 patients with colorectal cancer underwent laparoscopic-assisted surgery in our hospital, among which 32 underwent radical resection, 1 underwent laparoscopic exploration, and 2 were converted to open surgery. These patients were allocated in the laparoscopic group. Same numbers of patients who underwent conventional open surgery during the same period of time were identified and allocated in the open group. Short-term data, including surgical time, intra-operative blood loss, intra-operative blood transfusion, length of incision, histopathological data, post-operative complications and post-operative functions, were collected and compared between the two groups. Results A total of 67 patients were enrolled (32 in both laparoscopy and open groups). The other 3 cases were analyzed separately (1 underwent laparoscopic exploration and 2 converted to open surgery). The two groups were well balanced as to age, gender, and TNM staging and location of tumour. Histopathologically, the laparoscopic approach was equal to conventional approach as regard to resection margin (distal margin, 5 cm vs 5 cm, P=0.664) and lymph node yield (7 vs 8, P=0.228). This study also showed a longer surgical time (250 min vs 180 min, P=0.006), but shorter length of incision (10 cm vs 20 cm, P<0.001), less demand of intra-operative blood transfusion (1 case vs 10 cases, P=0.003), reduced use of analgesics (12 cases vs 25 cases, P=0.004), shorter post-operative stay (9.5 days vs 11 days, P=0.008) and earlier recovery of bowel function of the laparoscopic group. There was no statistical difference of intra-operative blood loss (200 mL vs 200 mL, P=0.098), incidence of post-operative complications (8 cases vs 6 cases, P=0.545) and volume of post-operative negative drainage (507.5 mL vs 669.0 mL, P=0.475) between the two groups. Conclusions Though limited by a relatively small sample size, our study showed that laparoscopy approach for colorectal cancer is equal to open approach in terms of oncological safety and short-term outcome.

Objective To investigate the expression of visfatin mRNA in abdominal omental adipose tissue and its relationship with blood lipid in type 2 diabetes mellitus.Methods 161 type 2 diabetic patients were divided into two groups according to triglyceride ( TG ),high triglyceride group ( TG ≥ 1.7mmol/L) and normal triglyceride group(TG ＜ 1.7 mmol/L).The expression of visfatin mRNA in abdominal omental adipose tissue was measured with Northern Blot.Visfatin plasma concentration,fasting plasma glucose (FPG),blood lipid profiles and other biochemical indicators were also measured.Results Comparing with normal triglyceride group,the diabetic patients in high triglyceride group had significantly increased levels of visfatin plasma concentration [ ( 129.07 ± 21.35)ng/mL vs ( 101.65 ± 15.23 ) ng/mL,t =2.295,P ＜0.05]and mRNA expression in omental adipose tissue( P ＜0.05).Visfatin plasma concentration was positively correlated with TG( β =0.592,P ＜0.05 ) and FPG( β =0.763,P ＜0.01 ).Visfatin mRNA expression in omental adipose tissue had no correlation with FPG,TG and other biochemical indicators.Conclusions The plasma visfatin level in T2DM patients may be associated with triglyceride metabolism.

Objective The risk of ovarian/pelvic serous cancer can be reduced by prophylactic bilateral salpingectomy ( PBS) at the time of hysterectomy .This study was to evaluate the short-term influence of PBS plus hysterectomy on ovarian reserve in premenopausal women . Methods We retrospectively analyzed the clinical data about 60 premenopausal women treated by total lapa-roscopic hysterectomy ( TLH) for benign indications , 30 undergoing PBS at the same time ( the experimental group ) while the other 30 with the ovary preserved ( the control group ) .We compared the levels of FSH, LH, E2, and anti-Müllerian hormone ( AMH) and the inci-dence of peri-menopausal symptoms between the two groups of patients before and at 1 and 3 months after operation . Results Statistically significant differences were not observed between the two groups in the such baseline clinical characteristics as age , gravidity, parity, men-strual cycle, comorbidity, diagnosis, comorbidities, and history of abdominal surgery (P>0.05), nor in the AMH level at the baseline ([1.08±0.08] vs [1.04±0.10] ng/mL) or at 1 month ([0.86± 0.44] vs [0.81±0.48] ng/mL) or 3 months postoperatively ([0.84±0.94] vs [0.68±0.42] ng/mL) (F=0.247, P=0.746).Howev-er, the mean level of AMH was markedly reduced at 1 and 3 months after operation as compared with the baseline ( P<0.05) , though with no significant difference between 1 and 3 months ( P>0.05) .There were not any statistically significant differences in the levels FSH, LH, and E2 between the two groups before or at 1 and 3 months after surgery (P>0.05), nor in the incidence rates of peri-menopausal symptoms at 1 month (6.7%vs 3.3%, P>0.05) or 3 months postoperatively (10.0%vs 6.7%, P>0.05). Conclusion PBS at the time of total hysterectomy in premenopausal women does not affect ovarian reserve in the short term .The level of AMH has a higher sensitivity than those of FSH , LH and E2 in the assessment of postoperative ovarian function .

Objective To explore the relationship between the level of morning blood pressure surge (MBPS) and High-sensitivity C-reactive protein( hs-CRP) in acute coronary events among old patients and to evaluate their clinical value. Methods One hundred and twenty - three patients with coronary disease were divided into two groups, each of which was old myocardial infarction(OMI, n = 55) and old myocardial infarction with acute cardiovascular syndrome (OMI + ACS, n =68). The control group includes the patients without coronary disease( n =50). The patients who have infection, malignant tumors, liver and kidney dysfunction, blood diseases, valvular heart diseases, congenital heart diseases, aortic dissection,secondary hypertension were not included. All groups were received 24 hours ambulatory blood pressure monitoring to calculate MBPS and the determination of hs-CRP in serum. Results Compared with each two groups, the levels of MBPS and hs-CRP in OMI group were significantly higher than those of the control group (0. 01 ＜ P ＜0. 05) , and had more significance in the other groups ( P ＜0.01). The levels of MBPS and hs-CRP had positive relationship in coronary events in the elderly ( r =0. 76, P ＜0. 01) . Conclusion The level of MBPS is positively correlated with serum hs-CRP which is one of key risk factors of inflammatory reactions by impairing vessels in body. The two factors both play important roles in the occurrence and the development of coronary events among old patients. They both have important clinical value in recurrent acute coronary events among old patients.

Objective To investigate the prevalence of vitamin D deficiency in patients in geriatric intensive care unit and the impact of vitamin D deficiency on the prognosis.Methods 213 hospitalized patients admitted into geriatric intensive care unit of Xinhua Hospital,Shanghai from June 2012 to December 2013 were included in the historical cohort study.Serum 25-hydroxyvitamin D [25 (OH)D] was examined in all the subjects.Main laboratory findings,the incidence of multiple organ dysfunction syndrome (MODS),Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score and mortality rate of 30-day kept in hospital were compared among patients with different serum 25-hydroxyvitamin D level.Potential risk factors for mortality were analyzed by multivariate logistic regression analysis.Results 25(OH)D deficiency was identified in 82 patients (38.5％),25(0H)D insufficiency in 90 patients (42.3％),and 25(OH)D sufficiency in 41 patients (19.2％).Compared with 25(0H)D sufficiency group,25(0H)D deficiency group showed the increased levels of APACHE Ⅱ score,plasma lactic acid,C reactive protein (CPR),the incidence of MODS and mortality rate (21.65±-8.89 vs.17.05±8.03,1.89±0.76 mmol/L vs.1.86±1.03 mmol/L,101.08±48.23 mg/L vs.92.48±38.56 mg/L,42.7％ vs.19.5％,30.5％ vs.9.8％,all P＜0.05).Multiple logistic regression analysis suggested that 25 (OH)D deficiency was an independent risk factor for mortality.25(OH)D levels were negatively correlated with length of stay in geriatric intensive care unit (r=0.18,P＜0.05).Conclusions Vitamin D deficiency is highly prevalent among patients admitted into geriatric intensive care unit.Vitamin D deficiency is associated with disease severity and may be an independent risk factor for mortality.

Objective To investigate the impact of simvastatin on blood lipid and the incidence of atrial fibrillation and ischemic-related events in patients with acute myocardial infarction accompanied by paroxysmal atrial fibrillation. Methods One hundred and three patients with acute myocardial infarction and paroxysmal atrial fibrillation were selected as subjects, and were divided into a simvastatin group and a control group. Forty-five patients were in the simvastatin group, who took simvastatin 20mg/d orally for 18 months; fifty-eight patients were in the control group, and received conventional therapy except for statins. All patients were followed up for 18months. The level of blood lipid, recurrence rate of paroxysmal atrial fibrillation, incidence rate of persistent or permanent atrial lipids did not change significantly in the control group (P＞0.05); concentrations of total cholesterol (TC) and low density lipoprotein five patients during 18 months follow-up in the simvastatin group (11.1%), whereas it occurred in 14 patients of the control group(24.1%, P＜0.05); the occurrence rate of persistent or permanent atrial fibrillation in the simvastatin group was 4.4%, which was lower than (6.6%), two rehospitalizations for deterioration of coronary heart diseases (4.4%), three cardiac deaths (6.6%), and one cerebral stroke (2.2%), which was lower evidently than in the control group (41.4%, P＜0.05). Conclusions Simvastatin can not only decrease the levels of serum TC and LDL-C but also prevent the occurrence of atrial fibrillation and ischemic-related events.

Objective To investigate the effect of clinical pathway on inpatients for rehabilitation. Methods The hospital expense, the ex-pense for medicine and length of stay in hospital were compared in patients with cerebral hemorrhage, cerebral infarction, spinal cord injury and spastic cerebral palsy before (January 1st, 2012 to April 30th, 2013) and after (May 1st, 2013 to December 31st, 2015) clinical pathway implementation, 50 inpatients for each disease, totally 200 patients. Results The length of stay in hospital reduced after of clinical pathway implementation, in all the diseases (t>5.226, P<0.001), with the decrease of hospital expense for cerebral infarction (t=3.327, P<0.001). There was no significant increase in any expense in the disease (t<1.777, P>0.05). Conclusion The implementation of rehabilitation clinical pathway can reduce the length of stay in hospital for the patients rehabilitation in hospital, without increasing their cost.

ObjectiveTo study the liver and kidney function and muscle effects of rosuvastatin in rats.MethodsIn this study,twenty healthy male rats (9-month-old) were randomly divided into two groups:normal control group and rosuvastatin treatment group.The first treated group was given conventional feed; The second treated group was given conventional feed and oral rosuvastatin [5mg/( kg · d)] of 12 weeks.The level of liver and kidney function and creatine kinase,histological changes of liver and muscle were examined before and after the treatment.ResultsOur findings demonstrate that the level of liver and kidney function and creatine kinase was no significant difference among the two experimental groups,also no difference before and after treatment( P ＞0.05).At the same time,liver and muscle showed no abnormal pathology.Conclusion These findings collectively indicate that rosuvastatin shows no significant side effects in the liver and kidney function and muscle pathology compared with control group.

Problem-based learning (PBL) is a student-centered pedagogy in which a subject is approached in the context of realistic problems.We have applied PBL into intemnal medicine of general medicine for up to three years.The results suggest that the PBL method could promote the clinical competencies and self-learning capacities of students.However there is still room for improvement.