The main problems existing in the internal control of public medical institutions are pointed out and the suggestions about how to establish and perfect it were proposed, so as to assume its due role, according to its concept and benefits, combined with the analysis of present situation of internal control in public medical institutions in Putuo District.

Objective To investigate the immune disorder in elderly patients with severe ischemic stroke and to explore whether a new type of diabetes-specific enteral nutrition formula can regulate the immune function of these patients.Methods In the randomized controlled prospective study,90 patients aged 60-80 years with acute ischemic stroke and NIHSS score more than 10 and dysphagia were randomized to two groups:receiving a new type(Group A) of,versus traditional(Group B) diabetes-specific enteral nutrition.30 Patients aged 60-80 years with acute ischemic stroke and NIHSS score ≥10 without dysphagia were enrolled as control(Group C).The immune function was observed,and the nutritional status and immunological function were compared between two different enteral nutrition groups at 7 days of treatment.Results After 7 day follow-up,the serum lipid stats significantly ameliorated in group A.An obvious suppression of immune state was observed in severe acute ischemic patients at onset of 7 days.At day 7 of treatment,the percentage of CD3+ T cells in group A was(69.25±9.93)％ after treatment vs.(63.36±7.79)％ at baseline(P＜0.001),and CD3 +CD4+T cells was(45.79±9.47)％ after treatment vs.(36.12±9.15)％ at baseline(P＜0.001),as well as CD4+/CD8+ cells were(2.27±1.40)％ after treatment vs.(1.70±0.82)％ at baseline(P=0.001).At 7 days of treatment,the percentage of CD3+ T cells was higher in group A (69.25 ±9.93) ％ than in group B(63.07± 9.47) ％ (P＜0.001),and the percentage of CD3 + CD4 cells was higher in group A(45.79 ± 9.47) ％ than in group B(41.32 ± 8.89) ％ (P=0.024).Conclusions Enteral nutrition preparations can provide sufficient energy support in the acute ischemic stroke.Immunosuppressive state exists in patients with acute phase of severe ischemic stroke.The new type of diabetic enteral nutrition formula can significantly improve immunosuppressive state in patients with acute severe stroke.

Objective To examine the epidemiological and clinical features of the adults with Henoch Schonlein Purpura (HSP),and improve the diagnosis and therapeutic efficacy of HSP.Methods Thirty five adults with HSP from the hematological department of Tianjin Medical University General Hospital between 1993.9 to 2005.12 were enrolled in this study.Epidemiological,clinical and laboratory data,therapeutic methods and efficacy were investigated.Results Most patients with HSP in our department were male and adolescent.HSP occurred more commonly in the winter.The important predisposing factors were infection and having specific food.Purpuric lesions were the most common presenting signs.Multiple organ involvement was more common.Purpura was present in all case,lower extremities were more commonly involved.Joint involvement was observed in 15 cases(42.9%),abdominal involvement in 20 cases(57.1%),renal involvement in 20 cases(57.1%).Conclusion The adult patients with HSP had more tendenecy to have severe renal damage and multiple organ involvement.

Objective To investigate the gene mutation of epithelial growth factor receptor(EGFR) and the expressions of hu‐man epiderma1 growth factor receptor 2(HER‐2) and vascular endothelial growth factor(VEGF) in lung adenocarcinoma and their relationships with the clinical pathological factors .Methods ARMS‐PCR method was used to detect the gene mutation of EGFR in 49 lung adenocarcinoma specimens and 10 normal tissue specimens .Immunohistochemical method was also used to detect the ex‐pressions of the HER‐2 and VEGF in them .Results (1) The mutation rates of EGFR and the positive rates of HER‐2 and VEGF in lung adenocarcinoma were significantly higher than those in the normal tissues(P< 0 .01) .(2) The occurs of EGFR mutation were correlated with sex and the smoking habit(P<0 .05);but not correlated with age ,the size of tumor ,differential ,lymph nodes metastasis ,TNM stages and pleural invasion(P>0 .05) .The HER‐2 and VEGF protein expressions in lung adenocarcinoma were correlated with differential ,the size of tumor ,TNM stages ,lymph nodes metastasis and pleural invasion(P<0 .05);but not correla‐ted with sex ,age ,and the smoking habit(P>0 .05) .(3) The expressions of HER‐2 and VEGF protein in the lung adenocarcinoma were positively correlated with each other(P<0 .01) .Conclusion EGFR mutation is closely related to the occurrence of lung ade‐nocarcinoma ,its high expressions in the women ,non smoking people have important clinical significance .HER‐2 and VEGF could promote the lung adenocarcinoma′s occurrence ,development and transfer .They could be used to evaluate the patients′prognosis ,and provide new molecular targeted therapy .

Objective To study the value of zoledronic acid combined with psychological intervention in osteoporotic vertebral compression fractures in percutaneous balloon kyphoplasty (PKP). Methods 72 patients with osteoporotic vertebral fractures underwent PKP operation from August 2013 to August 2015 were randomly divided into observation group and control group,with 36 cases,in each group. The patients in the control group were given salmon calcitonin after operation. The patients in the observation group were given zoledronic acid after operation. Both patients were given psychological care. The total effective rate of clinical treatment and the incidence of secondary osteoporotic vertebral compression fractures,Visual analogue pain scale before and after treatment (VAS), Oswestry dysfunction index questionnaire (ODI) score, bone mineral density T value changes were compared between the two groups. Results The total effective rate was 94.44% in the observation group and 77.78% in the control group (P<0.05). The recurrence fracture rate was significantly lower than that of the control group (P<0.05). After treatment, the scores of VAS and ODI in the observation group were significantly lower than those in the control group (P<0.05). The T value of bone mineral density was significantly higher than that of the control group (P<0.05). Conclusion Zoledronic acid combined with psychological intervention can effectively improve the effective rate of PKP after osteoporotic vertebral compression fractures, increase bone density and reduce the incidence of fracture, which is worthy of clinical application.

Objective The aim of this study was to investigate the expression of IL-6 induced by LPS in ovarian cancer and the effect of IL-6 on the expression of EZH2 mRNA and protein in ovarian cancer cell lines.MethodsCulture ovarian cancer cell lines, according to the different medium composition, establish the experimental group and the control group, detect the concentration of IL-6 in the supernatant of ovarian cancer cells by ELISA and the OD values of each group by MTT assay.Western blotting was used to detect the expression of EZH2 protein in ovarian cancer cells.The mRNA expression of EZH2 was detected by RT-PCR.ResultsThe expression of IL-6 in the supernatant of ovarian cancer cells was significantly higher than that in the control group (P<0.05).The proliferation of ovarian cancer cells was inhibited and the difference was statistically significant (P<0.05).The expression of EZH2 protein in ovarian cancer cells was significantly decreased, and there was statistical difference (P<0.05).The mRNA expression of EZH2 was significantly decreased, and there was statistical difference (P<0.05).ConclusionLPS could induce the expression of IL-6 and inhibit cell proliferation in ovarian cancer cells.IL-6 could inhibit the expression of EZH2.

Objective To investigate the risk factors of premature atherosclerotic three-vessel coronary artery dis?ease (CHD), and the association between single nucleotide polymorphism (SNP) of CD36 rs3211956, rs7755 and premature CHD. Methods Patient with premature three-vessel coronary artery disease (n=102) which were confirmed by consecutive coronary angiogram (lesion group) and patients (n=72) without CHD (control group) were enrolled in the study. Conventional CHD risk factors were compared between the two groups as well as SNPs of CD36 rs3211956 and rs7755 to disclose inde?pendent risk factor for CHD, which were measured by mass spectrometry. Results Among the conventional CHD risk fac?tors, male, HBP, high LDL-C, low HDL-C were independent risk factors of premature CHD. The GT genotype proportion of rs3211956 was significantly lower (χ2=8.042,P=0.005) in the lesion group than that in control group while the TT genotype proportion is significantly higher in lesion group compared with that in control group (χ2=6.191,P=0.014). Patients with the TT genotype have higher score of BMI than patients with GG or GT genotype (P=0.037). The G allele proportion of rs7755 in the lesion group was significantly higher than control group (χ2=3.636, P=0.047). Patients of the GG genotype have higher scores of BMI but lower level of HDL-C than those with AA or AG genotype (P<0.001). Logistic regression analysis re?vealed that after excluding a number of confounding factors, GG and TT genotype of rs3211956 and GG and GA genotype of rs7755 were respectively one of the independent risk factors for premature CHD. Conclusion The SNPs of CD36 rs7755 and rs3211956 may be the independent risk factors of premature coronary heart disease and might affect the the onset of CHD by affectting BMI and HDL-C.

Objective To establish and evaluate animal model of adult rats with vitamin D deficient and assess the association of vitamin D deficiency and hypertension .Methods Adult SD rats were divided into 3 groups :normal controls group(feed with ordina-ry forage) ,vitamin D deficient groups(feed without vitamin D)and vitamin D control group(feed with vitamin D) ,which were fed with different diets under 12 h:12 h without ultraviolet light bulb(UV-B) .After treatment for 6 weeks ,Retinal blood was collect-ed ,and Serum vitamin D levels was tested by EIA every 2 weeks .Results After treatment for 10 weeks ,Serum level of vitamin D in vitamin D deficient group were reduced to 2 .07 nmol/L ,while vitamin D group and normal control group were measured as 56 .74 nmol/L and 57 .61 nmol/L ,there was no statistically significant difference between vitamin D group and normal control group (P>0 .05) .hypertension of vitamin D deficient group was significantly higher than other two groups .Conclusion It is feasible to estab-lish model of adult rats with vitamin D by UV-B free light and diets control ,hypertension of rats vitamin D deficiency has a signifi-cant rise compared with the control group .

BACKGROUND:Recent studies have demonstrated that Niacinamide is capable of promoting the proliferation of intervertebral cells and improving intervertebral disc degeneration.Overloading is thought to the main cause of intervertebral disc degeneration.However,the protective effects of Niacinamide in loading induced intervertebral disc degeneration remains uncertain,OBJECTIVE:To investigate the protective effects of Niacinamide against axial loading induced degeneration of rabbit lumbar disc.DESIGN,TIME AND SETTING:A randomized controlled experiment was carded out in the Central Laboratory and the Laboratory of Department of Orthopaedics,Union Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from November 2008 to April 2009.MATERIALS:Twenty-four Japanese white rabbits (4 months old,weighing 2.0 kg).Niacinamide was supplied by Tianjin Damao Chemical Reagent Factory.METHODS:Twenty-four Japanese white rabbits were randomly divided into 6 groups.The controllable axial loading induced rabbit lumbar disc degeneration model was adopted to impose 98N pressure on the rabbit discs to induce degeneration.Various doses of Niacinamide were given intragastrically to the rabbits in different groups:2 rabbits in group 1,the loading device was installed without pressing,and no Niacinamide was given;2 rabbits in group 2,given 50 mg/kg Niacinamide for 1 week;5 rabbits in group 3,loaded with 98N for 1 week;5 rabbits in group 4,loaded with 98N for 1 week,then the pressure was released for another week's recovery;5 rabbits in group 5,loaded with 98N and given 50 mg/kg Niacinamide for 1 week;5 rabbits in group 6,loaded with 98N for 1 week and then the pressure was released for another week's recovery,50 mg/kg Niacinamide was continually given during the 2 weeks.MAIN OUTCOME MEASURES:Magnetic resonance image and Thompson's grading system were used to assess degeneration degree of the discs;hematoxylin and eosin staining,immunohistochemical staining for type Ⅱ collagen,and Safranin O staining were used to evaluate histological changes;immunohistochemical staining for P161NK4A was used to evaluate cell proliferation and senescence.RESULTS：①According to the Thompson's grading system，there was no disc exhibited degeneration in group 2；5 rabbits graded Ⅱ in group 3；4 rabbits graded Ⅱ and 1 rabbit graded Ⅲ in group 4；2 rabbits graded Ⅰ and 3 rabbits graded Ⅱ in group 5；3 rabbits graded Ⅰ and 2 rabbits graded Ⅱ in group 6.MRI results revealed the alleviated degeneration in Niacinamide given groups.②The content of type Ⅱ collagen of annulus fibrosus of group 6 was 53.2% higher than that of group 4 (P＜0.01).③Safranin O-Fast Green staining density of group 2 was higher than that of group 1；The staining density of nucleus pulposus and annulus fibrosus of groups 5 and 6 was higher than the corresponding parts of group 4，especially that of nucleus pulposus (P＜0.01，P＜0.01)，and group 6 exhibited slightly increased levels than group 5.④P16INK4A positive staining rates decreased with the extension of Niacinamide administration time.CONCLUSION：Niacinamide can help to alleviate overloading-caused damage to intervertebral disc，and can benefit the recovery of damaged intervertebral disc.

Objective To explore the the expression of Klotho mRNA and protein in placenta of macrosomia and its relationship with the birth weight of neonates. Methods The cases were from November 2014 to March 2015 in Shengjing Hospital of China Medical University, divided into 4 groups:the gestational diabetes with macrosomia group (GM), the gestational diabetes with normal birth weight group (GN), the normal pregnancy with macrosomia group (NM) and the normal pregnancy with normal birth weight group (NN). Klotho mRNA and protein expression in the placenta were detected by immunohistochemistry SP method, real-time fluorescent quantitative PCR and western blot, respectively, and were compared among the 4 groups. Results (1) Immunohistochemical detection showed the positive rate of Klotho protein was significantly higher in the placenta of GM (93%,28/30) than in the GN (73%,22/30;P<0.05). The positive rate was significantly higher in the placenta of NM (97%,29/30) than in the NN (80%,24/30;P<0.05). (2) Real-time fluorescent quantitative PCR showed the Klotho mRNA expression was significantly higher in the placenta of GM (4.3 ± 3.1) than in the GN (2.1 ± 2.4;P<0.05). The Klotho mRNA expression was also significantly higher in the placenta of NM (4.8 ± 3.4) than in the NN (2.6 ± 3.3;P<0.05). (3) Western blot showed the Klotho protein expression was significantly higher in the placenta of GM (1.27±0.90) than in the GN (0.64±0.24;P<0.05). It was also significantly higher in the placenta of NM (2.51±3.52) than in the NN (0.77±0.37;P<0.05). (4) There were no significant differences in the expression of Klotho mRNA and protein between GM and NM, GN and NN (P>0.05). Conclusions The up-regulation of Klotho gene may be associated with macrosomia. The relationship is not affected by the complication of gestational diabetes.