OBJECTIVE:To explore the effects of tirofiban with different medication timing on blood flow and complications in patients with acute myocardial infarction after percutaneous coronary intervention(PCI). METHODS:214 cases of acute ST-seg-ment elevation myocardial infarction were divided into late stage group(n=98)and early stage group(n=116)based on the order of admission. Te latter was given intravenous injection of tirofiban after PCI;the former was given intravenous injection of tirofi-ban before entered emergency room [1-2 h before PCI]. The injection-balloon dilation time was compared between 2 groups. The coronary TIMI flow situation,cardiac function and microcirculatory perfusion index before and after operation,and complications during hospitalization were also compared. RESULTS:Intravenous injection of tirofiban to balloon dilation time were 3-40 min in early stage group,and 30-65 min in late stage group,with statistical significance (t=8.94,P=0.00);during angiography,the number of patients with IRA prorsal blood flow rate to reach 2 and 3 grade was 16 cases(13.8% and 20 cases(17.2%)in early stage group,which were higher than in late stage group [7 cases (7.1%),9 cases (9.2%)],with statistical significance (P<0.05). After PCI,occluded artery of 2 groups opened up,there were 2 cases of no-reflow in early stage group and 6 cases of no-re-flow;there was no statistical significance in 3 grade blood flow of TIMI between 2 groups(χ2=1.21,P>0.05). The amount of 4 and 8 h creatine kinase MB,and postoperative 24 h LVEF of 2 groups were similar after operation,without statistical significance (P>0.05);ST segment of early stage group drop value was (1.93 ± 0.57) mm,which was significantly higher than that of late stage group(1.07±0.29)mm,with statistical significance(P<0.05);the incidence of cardiac adverse events and bleeding compli-cation were 3.45%and 7.76%in early stage group,and 4.08%and 5.10%in late-stage group,without statistical significance(P<0.05). CONCLUSIONS:Different medication timing has no significant effect on the safety of tirofiban,but clinical outcomes and angiographic results are consistent. However,early treatment can improve IRA prorsal blood flow rate before PCI,which is the good medication timing of tirofiban.

Patients with non-alcoholic fatty liver disease (NAFLD) have unhealthy diets, sedentary behavior and lack of physical activity. This lifestyle triggers liver disease and probably favors its progression. It is now the most common significant cause of end-stage liver disease and hepatocellular carcinoma. From the perspective of non-pharmacological intervention, lifestyle modifications including diet, exercise, and weight loss remain the most effective therapy for nonalcoholic fatty liver disease. Bariatric surgery in morbidly obese individuals who have failed to lose weight through lifestyle modifications can improve steatosis, inflammation, and fibrosis. Comprehensive treatment measures can produce synergistic effect, but long-term adherence is particularly critical.

In recent years, there were several extreme conflicts between doctors and patients in Otorhinolaryn-gology department. Medical field always contributes the disputes to medical system and patients′quality, however, the public blames the doctors′morality. This article analyzes these incidents in the perspective of ethics and social medicine, trying to find the causes. And it puts forward the countermeasures in terms of medical education, hospi-tal, and the medical personnel.

Objective To explore the correlation of TCM syndrome patterns of chronic pharyngitis(CP)with etiological factors.Methods A questionnaire investigation was carried out in 102 CP patients,of which 30 were differentiated as lung-kidney yin deficiency,30 as spleen-stomach deficiency,30 as phlegm coagulation and blood stasis,and 12 as spleen-kidney yang deficiency.The dietary hobbies,living and working environment,systemic diseases and living habits of the patients were recorded.Meanwhile,parameters of the pharyngeal microorganism and immunology were detected.Results The results of nonparametric test showed significant difference between the age and the mean disease course of the four syndrome patterns(P0.05). There existed significant difference between indulging in spicy food,indulging in cold and raw food,and staying up at night in the four syndromes (P0.05).The distribution of the four syndromes was different in the population with medical history of tonsillitis,dental caries,chronic cough,chronic gastritis and chronic colitis(P0.05).Conclusion The syndrome patterns of chronic pharyngitis are correlated with age,disease course,dietary habits of indulging in spicy food and cold-raw food,living habit of staying up at night,systemic disease or disease of organs around the throat,but are not correlated with sex,household registration,job,working and living environment,indulging in frying food,hobbies of smoking and drinking,living habits,emotional factors,throat swab culture results and immune parameters.

Objectives To evaluate the valproate plasma l ev els,the clinical efficacy and adverse effects in patients with epilepsy treated with the conventional preparations and the sustained-release preparations of sodium valproate (VPA-Na?SR).Methods 33 patients received oral conventional formul ation of sodium valproate for over six months and a similar dosage of VPA-Na?SR for 4 weeks.After 12 or 24 hours,the valproate plasma concentr ations of the two formulations were measured respectively before taking drugs in the early mor ning.The valproate plasma concentrations and the clinical efficacy of the VPA-N a?SR were assessed by comparing with that of conventional valproate.The adverse effects were recorded.Results The average valproate plasma trough concentration was s ignificantly higher in patients receiving VPA-Na?SR than that of those receiving conventional valproate.Seizure free in patients was achi eved by 76%(n=25) with VPA-Na?SR and by 45%(n=15) with conventional valproate resp ectively.There was statistical difference between the two formulations.The seizu re frequency was significantly reduced in 5 patients treated with VPA-Na?SR.A dverse ef fects were observed in 2 patients with conventional valproate,5 patients with V PA-Na?SR whose valproate plasma levels were higher than that of conventional p reparations.Adverse effects were related to increased valproate plasm a levels and individual drugtolerance. Conclusions The advantage of VPA-Na?SR is that serum valproa te con centrations may increase smoothly and minimize fluctuation in serum dr ug concentrations during a dosing interval. It is a more effective and more convenient antiepileptic agent.

The femora! arteries in 38 rabbits were transected and repaired with autogenous venous grafts with different diameters. The measurements of blood flow, patency rate and thrombosis rate, and scanning electron microscopic examination were made over a period of 14 days. The result showed that a venous graftl with a diameter 20 per cent less than that of the recipient artery was most satisfactory.

Aim To study the effects of extract of astragalus on hippocampal delayed neuronal death of totalcerebral ischemia and 7 days reperfusion in rats.Methods Global ischemia was made by four-vessel occlusion. Electron microscope was used to observe the ultramicrostructure of dorsal hippocampal neurons.Light microscope was used to survey the structure of hippocampal neurons and to count the number of normal neurons in CA1 sector. Glial fibrillary acidic protein(GFAP) was detected by immune histochemistry.Results Compared with ischemia and reperfusion group(I/R),EA improved the ultrastructure of hippocampal neurons, suppressed the decrease of normal neurons in CA1 and degraded the expression of GFAP .The number of normal neurons in I/R group was 38?11.5,and in EA(20,40 mg?kg -1) groups,63?12.8(P

Objective To study the clinical characteristics of thyroid carcinoma in young females,in order to improve the diagnosis and treatment of this disease.Methods The clinical data of 74 consecutive young female patients with thyroid carcinoma treated in our hospital in the recent ten years were analysed.In most of the cases,there was no firm texture or fixation of the thyroid nodules to surrounding structures on physical examination before operation.Ultrasonography was performed in all patients and multiple thyroid nodules were found in 61 cases(82.43%).Thyroid scintiscans were performed in 43 cases,and thyroid nodules were found in 41 cases.The cold,cool and warm nodules were found in 14,18 and 9 cases,respectively,by scintiscans.Fine needle aspiration biopsy(FNAB) was performed in 11 cases,and in 2 cases were negative,1 case showed abnormal cell,3 cases were suspicious of carcinoma,and 5 cases were confirmed papillary carcinoma.Results Papillary carcinoma was found in 70 cases,follicular carcinoma in 3 cases and medullary carcinoma in 1 case by histological examination,and benign disease was also accompanied in most cases.Lymph node metastases was found in 28 cases(37.84%),and the rate of metastases was significantly different than that of older female patients(16.46%) at the same time.There were 2 cases who died 3 years after operation because of metastases.Conclusions The lymph node metastases were prevalent in young female patients with thyroid carcinoma.The texture and mobility of the nodules cannot be used to differentiate benign from malignant nodules.We should carefully analyze every nodule found on ultrasonography.For the solid nodules with diameter larger than 1.0cm,we suggest operation;for the non-solid nodules with diameter larger than 2.0cm,we prefer scintiscans and FNAB for diagnosis.

Objective To study the clinical efficacy of unstable angina patients with the treatment of Yixin Kangtai capsule combine with diltiazem .Methods A total of 98 patients with unstable angina were randomly divided into control group and treat-ment group ,49 in each group .The control group was given conventional anti-anginal drug therapy ;while combination group was given Yixin Kangtai capsule combine with diltiazem on the basis of conventional anti-anginal medication .The course was 30 days . After the treatment ,the symptoms of angina ,ECG ST-T ,blood viscosity and markers of endothelial function NO and ET levels were observed .Results After treatment ,the total effective rate of the combination therapy group was higher than that of the con-trol group (P< 0 .05) ;the angina attacks and its duration in combination therapy group were lower than that of control group(P<0 .05) ;the total efficiency of electrocardiogram in combination therapy group was better than that of the control group (P< 0 .05) ;blood viscosity values and ET levels of combination therapy group were reduced compared with before treatment (P < 0 .05) ,but NO levels were increased(P< 0 .05) .Conclusion Yixin Kangtai capsule combine with diltiazem have significant efficacy for unsta-ble angina pectoris ,and have protective effect on endothelial function in patients with unstable angina .

Aim To study the mechanisms of protective effects of extract of astragalus against focal cerebral ischemia/reperfusion injury in rats. Methods Focal cerebral ischemia was induced by intraluminal thread occlusion of middle cerebral artery. Immunohistochemistry was used to determine expression of TNF-?,IL-1? was measured by radioimmunity, and the apoptosis was observed by TUNEL. Results EA(20、40、80 mg?kg -1,ig)could decrease the expression of TNF-? and the level of IL-1? and reduce cell apoptosis. Conclusion EA has inhibitory action on the increase in the expression of TNF-?,the level of IL-1? and the apoptosis of neurons induced by focal cerebral ischemia/reperfusion.