Objective To analyze the characteristics of pulse pressure index(PPI) and its value in predicting the risk for cerebral and cardiac vascular events in old males with hypertension. Meth-ods The 24-hours ambulatory blood pressure monitoring was performed in a total of 265 elderly men with essential hypertension(EH). The patients were classified into 3 groups based on the lev-el of PPI.PPI≤0.400(103) ,0. 401-0. 500(124) ,and≥0.501(38). Results There was significant difference in PP between day-time and night-time in hypertensive patients. The change of PPI was less than that of PP. With the increase in PPI, SBP(24 h, day-time, night-time), PP(24 h, day-time, night-time), the load of SBP(night-time), systolic blood pressure variation(BPV, 24 h, day-time) were raised significantly (P<0.01); while DBP(24 h, day-time, night-time), nocturnal de-cline in BP and the load of DBP(day-time) declined with the decrease in PPI (P<0.01). High PPI would increase the incidence of cardiac-cerebral vascular events (P < 0.01). Conclusion PPI is a useful parameter in clinical evaluation of arteriosclerosis. It may also have prognostic value for cardiac-cerebral vascular events in elderly men with EH.

This paper analyzed the economic background,contents and effects of the existing business model of the hospital.On this basis,further study and reform are made on optimal business model of the hospital.The authors recommended that appropriate regional health scale,appropriate technical service,appropriate pricing for charges,appropriate operating cost and appropriate incentive constraints be adopted.These measures will safeguard state assets,public benefit nature of the hospital,enhanced hospital power in general,and compliance in operations,making the people satisfied and healthy.

Clinical competence was estimated for grades 2011-2013 general practitioners (GPs)trained by the DxR Clinician software.Clinical cases were solved on computer.And the abilities of diagnosis,thinking and handling were assessed.The average score of all GPs was 61.68 ± 10.69.The average score of diagnostic ability was the highest at 71.82 ± 15.47 (weighted score of 25.1).The average score of thinking ability was 62.36 ± 10.40 (weighted score of 28.1).And the average score of handling ability was the least at 42.27 ± 18.22 (weighted score of 8.5).Significant differences in average scores existed between grades 2011 and 2013 (P ＜ 0.05).Significant differences in score of clinical thinking ability existed between grades 2011,2012 and 2013 (P ＜ 0.01) respectively.None of them passed the part of handling.The longer period of training,the higher scores the residents obtained.Since the ability of clinical handling fared the worst,targeted training should be strengthened.

Objective To understand the drug resistance and changes of Pseudomonas aeruginosa in Tianjin Medical University Eye Hospita and to explore the relationship between the drug resistance and the dosage of antimicrobial agents, so as to provide the basis for clinical rational drug use.MethodsUsage of antibiotics in our hospital during 2012 to 2016 were analyzed retrospectively, and the drug resistance of pseudomonas aeruginosa were calculated respectively.SPSS 22.0 software was used to analyze the drug resistance and the frequency of use of antimicrobial agents (DDDs).ResultsResistance rate of pseudomonas aeruginosa to aztreonam, ceftazidime and meropenem were decreased gradually.Resistance rate of pseudomonas aeruginosa to gentamicin increased gradually.The resistance of pseudomonas aeruginosa to piperacillin, imipenem, cefepime, evil ciprofloxacin, piperacillin/tazobactam tazobactam and cefempidone/sulbactam is in a state of fluctuation.Piperacillin DDDs were significantly negatively correlated with gentamicin resistance.There was a significant positive correlation between imipenem DDDs and gentamicin resistance and there was a significant negative correlation between imipenem DDDs and drug resistance rates of piperacillin, imipenem, ceftazidime, meropenem, levofloxacin and cefoperazone/sulbactam.There was a significant positive correlation between aztreonam DDDs and ceftazidime, meropenem, ciprofloxacin and cefoperazone/sulbactam, There was a significant negative correlation between cephalosporin DDDs and gentamicin resistance rates.There was a significant positive correlation between the DDDs of piperacillin/tazobactam and the resistance rate of piperacillin/tazobactam;the resistance rates of cefoperazone/sulbactam DDDs to aztreonam and meropenem were Significant negative correlation.ConclusionDrug resistance of pseudomonas aeruginosa and the dosage of clinical antibacterial drug is closely related, suggesting that clinicians should use antibiotics for clinical rationally, in order to reduce the number of drug resistance of pseudomonas aeruginosa.

Objective To investigate the effects of collateral pathways on prognosis of cerebral infarct patients with prior transient ischemic attack (TIA) and its role in neuroprotective mechanism of TIA. Methods A total of 164 cases of the first ever cerebral infarct patients were consecutively allocated into three groups: A , B and C group according to their age.Three groups were divided into two subgroups respectively based on the absence or presence of prior ipsilateral TIA: A1, A2, B1, B2, C1, C2 group. Neurological dysfunctional scores at admission and 1 month after treatment, barthel index, collateral pathways status, and cerebral infarction volume were evaluated respectively. The relationship between development of collateral pathways and prognosis was assessed at the same time. Results The neurological dysfunctional scores and cerebral infarction volume of patients in A1 group and B1 group were significantly lower than those of A2 group and B2 group (P

Objective To explore the most suitable equation in accessing renal function for the elderly type 2 diabetic patients, and its clinical utility in combination with hypersensitive C-reactive protein (hsCRP). Methods The new Cystatin C-based equations for estimated glomerular filtration rate (Cys-eGFR) and conventional predictive equations were compared with isotopic GFR (iGFR) by linear regression analysis, paired t-test, Bland and Altman procedures and non-parametric receiver operating characteristic (ROC) curves. The new Cys-eGFR equation and hsCRP were also incorporated for detecting renal disease in this population. Results The new Cys-eGFR equation had a better relativity with iGFR (r= 0.767, P＜0.001), a less bias (bias: 0.0007, P＞0.05), a higher conformance (2SD: 21.56), higher sensitivity (90.7%) and specificity (88.6%) for diagnosing moderate decrease in renal function. There was a negative relationship between the new Cys-eGFR and hsCRP (r=-0.655, P＜0.01). When the new Cys-eGFR was 67.06 ml· min-1 ·1.73 m-2 and hsCRP was 5.65 mg/L, the combination of Cys-eGFR and hsCRP was better than the combination of serum creatinine and urine albumin/creatinine ratio in screening stage 3 chronic kidney disease (95%vs.46%). Conclusions The combination of new Cys-eGFR equation and hsCRP may screen an early decrease of moderate GFR.

Objective To investigate the effect of pathophysiology case-based learning(CBL)method on scores of pediatrics.Methods Undergraduates from 2005 grade at Chengde medical college were divided into two groups:experimental group(n=138,CBL method)and control group(n=136,conventional teaching method).The scores of pediatrics between the two groups were compared.The pediatrics test paper was divided into two types:type B,which was tightly connected with the pathophysiology knowledge and type F,which had less connection with pathophysiology knowledge.The accuracy rates of both groups were compared.Correlation analysis on scores between pathophysiology and internal medicine,surgery,pediatrics,obstetircs and gynaecology was made.Results No significant difference in total scores of pediatrics was observed between the two groups(P＞0.05);total accuracy rate of experimental group was higher than that of control group(P＞0.05);similar total accuracy rates of type F test paper were observed in both groups(P＞0.05);positive correlations in scores between pathophysiology and internal medicine,surgery,pediatrics,obstetircs and gynaecology were found.Conclusions Satisfactory long-term effect are received by applying pathophysiological CBL model since it can promote the application of pathophysiological knowledge in pediatrics,however,no apparent effect on students'clinical ability can be obtained from the mere application of CBL in pathophysiology course.

Objective To evaluate the changes in the activity of extracellular signal-regulated protein kinase 5 (ERK5) in the spinal cord in a rat model of bone cancer pain (BCP).Methods One hundred and eight female Sprague-Dawley rats,weighing 160-180 g,were randomly divided into 3 groups (n =36 each):control group (group C):sham operation (group S) and group BCP.In group BCP Walker 256 mammary gland cancer cell suspension (1 × 105 cells/ml) 5 μl was injected into the left tibia,while in group S normal saline 5μl was injected into the left tibia instead of cancer cell suspension.Group C underwent no treatment.Mechanical paw withdrawal threshold to von Frey filament stimulation (MWT) was measured at 1 day before inoculation and 3,5,7,14 and 21 days after inoculation.Six rats were sacrificed after the last measurement of MWT in groups C and S or after measurement of MWT at 3,5,7,14 and 21 days after inoculation in group BCP and the spinal cord was removed for determination of the expression of phosphorylated ERK5 (p-ERK5),ERK5 and Fos protein in the spinal dorsal horn by Western blot analysis.Results There was no significant difference in the MWT and expression of p-ERK5,ERK5 and Fos protein at each time point between groups C and S (P ＞ 0.05).Compared with groups C and S,MWT was significantly decreased at 7-21 days after inoculation,the expression of p-ERK5 and Fos protein was significantly up-regulated at 5-21 days after inoculation (P ＜ 0.05),and no significant change was found in the expression of ERK5 in group BCP (P ＞ 0.05).Conclusion Intra-tibial inoculation of Walker-256 breast cancer cells can increase the activity of ERK5 in the spinal cord in rats,leading to the increased release of Fos protein,thus inducing BCP.

Objective To assess differential expression profiles of microRNAs(miRNAs) in HaCaT human keratinocytes before and after p53 gene silencing,and to make a functional analysis of target genes.Methods Lentivirus-mediated RNA interference (RNAi) was used to silence p53 gene in HaCaT cells.Total RNA was extracted using Trizol reagent.Then,miRNAs were isolated by polyethylene glycol (PEG) and subjected to fluorescent labeling using T4RNA ligase followed by hybridization to a mammalian miRNA chip.Microarrays were scanned by a GenePix 4000B microarray scanner and fluorescence ratios were determined with the GenePix Pro 6.0 software.The TargetScan software was used to predict target genes of differentially expressed miRNAs (＞2-fold difference in expression level),and the top 20 target genes with the highest enrichment score were selected for each miRNA and subjected to functional analysis and pathway analysis through the KEGG signaling database.Results Totally,53 differentially expressed miRNAs,including 12 down-regulated and 41 up-regulated miRNAs,were identified in HaCaT cells after p53 silencing as compared to those before p53 silencing.Of these 53 differentially expressed miRNAs,5 (hsa-miR-141-3p,hsa-miR-15a-5p,hsa-miR-27a-3p,hsa-miR-130b-3p,hsa-miR-19a-3p) showed a more than 200-fold increase in expression,and 4 (hiv1-miR-TAR-3p,hsa-miR-630,hsa-miR-1246,hsa-miR-1275) experienced a more than 4-fold decrease in expression in HaCaT cells after p53 silencing.Functional analysis and pathway analysis revealed that some target genes of these differentially expressed miRNAs were involved in the mitogen-activated protein kinase (MAPK) signaling pathway,metabolic pathways,and tumor invasion.Conclusion Nine miRNAs,including hsa-miR-141-3p,may be involved in p53-mediated molecular regulation.

Objective To investigate the influence of stigma on QOL of patients with mental disorders.Methods By using Link stigma series scale and schizophrenic quality of life scale,we assessed and analyzed 406 psychiatric patients′stigma and QOL, as well as the correlation and influence between them.Results The score of perceived devaluation-discrimination dimension of the stigma scale had positive correlation with total score of QOL,score of psycho-social dimension and score of motivation and energy dimension (P <0.05).The scores of challenge dimension and separation dimension in the stigma scale had positive correlation with motivation and energy dimension of the QOL scale (P <0.05).Regression analysis showed that stigma did not have influence on QOL of patients with mental disorders.Conclusion Stigma in psychiatric patients has no significant influence on QOL,but correla-tion relationship exists between them.The higher score of perceived devaluation-discrimination dimension,challenge dimension and separation dimension of stigma scale,the poor QOL the patient would have.