Purpose To evaluate the correlation among diffusion weighted imaging (DWI), tumor Cellularity and hypoxia-inducible factor-1α (HIF-1α) for the high and low grade astrocytoma. Materials and Methods DWI was applied with 33 patients with astrocytoma confirmed by pathology, and ADC value was measured. Tumor Cellularity was measured using Scion Image 4.0.3.2. The expression of HIF-1α was tested using immunohistochemisty. Results Mean ADC value was higher in the low grade astrocytoma than that in the high grade astrocytoma (t=7.300, P<0.001). The tumor Cellularity was higher in the high grade astrocytoma than that in the low grade astrocytoma (t=-3.845, P<0.01). HIF-1αexpression could be demonstrated in the low grade [(20.08±10.01)%] and high grade [(47.91±19.03)%] astrocytoma. The negative correlation was demonstrated between ADC value and HIF-1αand tumor Cellularity (r=-0.756,-0.617;P<0.001). The positive correlation was demonstrated between HIF-1αand tumor Cellularity (r=0.622, P<0.001). Conclusion ADC value can be used to discriminate the low and high grade astrocytoma, and the role of HIF-1αshould be further to study with enlarged sample.

In recent years, the Gut Microbiota-Brain Axis theory has pointed out that there is an interaction between gut microbiota and central nervous system diseases.A number of studies have shown that there is a link between gut microbiota and depression, Parkinson's disease, and Alzheimer's disease.The association between gut microbiota and stroke has also attracted wide attention.This article reviews the association between gut microbiota and stroke.

Objective To evaluate the implementation of the national essential medicine system in Shaanxi Province.Methods Using a standardized methodology (2008 Edition) developed by the World Health Organization(WHO) and Health Action International(HAD,data on the prices and availability of 38 essential medicines were collected from 120 primary,secondary and tertiary public hospitals in ten cities of Shaanxi Province from March to May 2012.Results The availability of essential medicines is generally low at public hospitals in Shaanxi province,as the average availability of originator brands is but 5.9％,and that of generics of the lowest prices is but 23.9％,while this availability at tertiary hospitals is higher than hospitals of lower levels.The procurement prices of originator drugs within essential medicines are distinctly higher than the international reference prices for the originator brands,and slightly higher for the lowest priced generics.The procurement prices at primary care hospitals are slightly lower than that of other hospitals.Retail prices of essential medicine are not significantly different among regions of different income levels.Affordability of originator brands is poor,while that of their generic equivalents is good.Conclusion The government is recommended to adjust the national essential medicine list,expand the variety of essential medicine moderately,improve the medicine pricing mechanism,and deepen public hospitals reform.

ABSTRACT:Objective To investigate the effects of total flavones of oldenlandia diffusa (FOD)on epithelial-mesenchymal transition in hepatocellular cancer cell line MHCC97-H.Methods TGF-β1 induced EMT in routinely cultured liver cancer cell line MHCC97-H;then MHCC97-H cell was divided into 5 groups:normal control group, TGF-β1 group,TGF-β1 + FOD group,TGF-β1 + 5-FU group,and TGF-β1 + FOD + 5-FU group.After 48 h of treatment,the invasion ability of MHCC97-H cell was detected by Transwell;the proteins of E-cadherin and vimentin were determined by Western blot.Results Compared with the normal form of MHCC97-H cell line,the cell had obvious long fusiform after TGF-β1 induction,and the invasion ability enhanced (P = 0.02 ).But after treatment,the invasion ability of MHCC97-H cell decreased in FOD group and 5-FU group compared with that in TGF-β1 group (P = 0.03,P = 0.02 ),and decreased more significantly in FOD + 5-FU group (P = 0.01 ).The expression of E-cadherin at the protein level decreased significantly (P = 0.01 )in TGF-β1 group,which was abolished in FOD group (P =0.03 )and 5-FU group (P = 0.02 ).The expression of vimentin at the protein level increased significantly (P =0.01)in TGF-β1 group,which was abolished in FOD group (P =0.04)and 5-FU group (P =0.03)and more obviously in FOD+5-FU group (P =0.01).Conclusion FOD can reverse the invasion of MHCC97-H cells in EMT induced by TGF-β1 through decreasing the expression of E-cadherin protein and inhibiting the epithelial-mesenchymal transition of MHCC97-H cell.

Objective To detect and analyze the resistance at the stomach meridian acupoints in chronic atrophic gastritis (CAG) patients with spleen-stomach deficiency-cold syndromes, summarize the status of asthenia-sthenia at stomach meridian under this condition, in order to guide the clinical therapy with acupuncture and moxibustion.Methods From 2010 January to 2013 December, 83 CAG patients with spleen-stomach deficiency-cold syndromes were collected from No.306 Hospital of the PLA, the surface resistances on the bilateral stomach meridian stomach acupoints were detected,including Lidui, Neiting, Xiangu,Chongyang, Jiexi, Fenglong, Zusanli, Liangqiu, and the non-acupoints 1cm lateral to the point were set as controls. Zhu auricle holographic detector was adopted to detect the resistance at 20 points (about 0.5 cm2around the acupoints) in each acupoint, and the average value was calculated as the resistance value.Results Theresistances on the leftChongyang andright Chongyang were (9.64 ± 2.03) k? and (9.68 ± 2.02) k?, respectively, both were significantly lower than those on other acupoints, with statistically significant difference (allP<0.01); theresistances on the leftLiangqiu andright Liangqiu were (13.44 ± 2.11) k? and (13.68 ± 2.12) k?, respectively, both were significantly higher than those on other acupoints (all P<0.01).Conclusions The resistance on the stomach meridian stomach acupoints in CAG patients with spleen-stomach deficiency-cold syndromes is different, which may reflect the basic pathogenesis of CAG being the weakness of the spleen and stomach, qi stagnation and blood stasis.

Objective To know the levels of antibodies against influenza A virus subtypes H1 and H3 of population in Shanghai during 2009, and the detection of antibodies against avian influenza virus subtypes H5 and H9 in population which contacts with avian. Methods The serological survey of the antibodies against influenza A viruses subtypes H1, H3, H5 and H9 in 356 close contacts with avian (professional population) and 332 general subjects (general population) at various age groups were carried out using hemagglutinin inhibit (HI) test. Results The positive rates of antibodies against influenza virus A/Brisbane/59/2007 (H1N1) in general population and professional population were 82.8% (275/332) and 73.9% (263/356), respectively; those of A/Brisbane/10/2007 (H3N2)were 50.6% (168/332) and 54.8% (195/356), respectively. The positive rate of antibodies against influenza virus A/Brisbane/59/2007 (H1N1 )was significantly higher than that of influenza A viruses subtype H3, which was consistent with etiological survey of influenza virus in Shanghai during 2008.The positive rates of antibodies against influenza A virus subtype H5 in professional population and general population were 4.2% (15/356) and 0.3% (1/332), respectively; those of influenza A virus subtype H9 were 34.6% (123/356) and 2.4% (8/332), respectively. The positive rates of antibodies against influenza virus A/Brisbane/59/2007 (H1N1 ) and A/Brisbane/10/2007 (H3N2) in age groups of 6 months-5 years and ≥60 years were lower than other age groups. Conclusions The immune protective response against seasonal influenza A subtype H1 and H3 of population in Shanghai is high,while those of children and the elders were low. The levels of antibodies against influenza A viruses subtype H5 and H9 in professinal population present obviously ascending trend, which indicates that the etiological and serological survey of influenza virus in this population should be enhanced.

Objective To investigate the effects of early intensive therapy on P cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients with different recruiting fasting plasma glucose (FPG) levels.Methods A total of 382 newly diagnosed type 2 diabetic patients with FPG 7.0-16.7 mmol/L were randomly assigned to therapy with insulin in the form of continuous subcutaneous insulin infusion (CSII) or multiple daily injection (MDI) or oral hypoglycemic agents (OHA, by using gliclazide and/or metformin) for initial rapid correction of hyperglycemia.The treatments were stopped after euglycemia had been maintained for 2 weeks.The patients were followed longitudinally on diet alone for 1 year.Intravenous glucose tolerances tests (IVCTTs) were performed and blood glucose, insulin and proinsulin were measured before and after therapy as well as at 1-year follow-up.Homeostasis model assessment ( HOMA) of β cell function and insulin resistance index ( HOMA-β and HOMA-IR ) were calculated.All the patients were stratified on the recruiting FPG: stratum A (7.0 mmol/L≤ FPG < 11.1 mmol/L) , stratum B (11.1 mmol/L≤ FPG ≤ 16.7 mmol/L).Results More patients in stratum A achieved target glycemic control (94.4% vs 89.8% ) and in shorter time [(5.9 ±3.8)d vs(6.9 ±3.6)d, P <0.05] as compared with those in stratum B.B cell function represented by HOMA-β and acute insulin response ( AIR) improved significantly after intensive interventions in both stratum A and B patients.However, the remission rate at 1 year was significantly higher in stratum A patients (47.8% ) than those in stratum B (35.7%, P < 0.05).The patients treated with insulin (especially with CSII) had higher remission rates and better improvement of AIR at 1 year follow-up irrespective of the recruiting FPG (CSII or MDI vs OHA: 57.1% , 51.8% vs 32.8% in stratum A, P <0.05; 44.4% , 38.7% vs 18.6% in stratum B, P <0.05).Conclusions Compared with OHA, early short time intensive insulin treatment had more favorable outcomes on maintaining AIR and prolonged glycemic remission in newly diagnosed type 2 diabetic patients irrespective of the recruiting FPG levels.

Objective:To evaluate the effect of remimazolam combined with remifentanil used for painless gastroscopy.Methods:A total of 150 patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, with body mass index of 18-30 kg/m 2, scheduled for elective painless gastroscopy, were divided into 3 groups ( n=50 each) using a random number table method: propofol combined with remifentanil group (group P), remimazolam 0.3 mg/kg combined with remifentanil group (group R1) and remimazolam 12 mg combined with remifentanil group (group R2). Drugs were administrated according to body weight, and calculation was carried out according to ideal body weight.Remifentanil 0.25 μg/kg was injected intravenously, propofol 1.5 mg/kg was then injected intravenously in group P, remimazolam 0.3 mg/kg was injected intravenously in group R1, and remimazolam 12 mg was injected intravenously in group R2.When Modified Observer′s Assessment/Alertness and Sedation (MOAA/S) score was≤3, gastroscopy was performed.It was defined as sedation failure when MOAA/S score was still ≥4 at 3 min after administration of propofol or remimazolam.When intraoperative body movement occurred, 1/4 of the initial dose of propofol was injected intravenously in group P, 1/4 of the initial dose of remimazolam was injected intravenously in group R1, and remimazolam 2.5 mg was injected intravenously in group R2 to maintain MOAA/S score ≤3.It was defined as sedation failure when sufficient sedation was not maintained after the additional drugs were given more than 3 times within 15 min.The success of sedation, time for gastroscopy, emergence time and discharge time were recorded.The occurrence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, hiccup, coughing and injection pain was recorded. Results:Compared with group P, no significant change was found in the success rate of sedation ( P>0.05), and the incidence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, hiccup, coughing and injection pain was decreased in group R1, and the success rate of sedation was significantly decreased, the incidence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, coughing and injection pain was decreased, and the incidence of hiccup was increased in group R2 ( P<0.05). Compared with group R2, the success rate of sedation was significantly increased, and the incidence of intraoperative body movement, coughing and hiccup was decreased in group R1 ( P<0.05). Conclusion:Remimazolam 0.3 mg/kg combined with remifentanil can be safely and effectively used for painless gastroscopy.

This article is based on the connotation of curriculum ideology and politics, combined with the internal connection of medical education globalization and curriculum ideology and politics, and explores the establishment of a curriculum ideological and political collaborative education system with five dimensions: system construction, curriculum type, teaching design, learning stage, and classroom type, to build an all-round, integrated, systematic, and thorough education pattern for all employees and the entire process, and cultivate socialist builders and successors with an international perspective.

Objective:To observe and analyze the risk factors related to vitreous re-hemorrhage (PVH) after anti-VEGF drugs combined with vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).Methods:Retrospective analysis study. From April 2017 to July 2018, 100 eyes of 87 PDR patients who were diagnosed in Jiaxing Eye Hospital and received anti-VEGF drugs combined with 25G PPV were included in the study. Among them, there were 44 eyes in 38 males and 56 eyes in 49 females. The age ranged from 26 to 83 years, with an average age of 57.72±8.82 years. All patients were type 2 diabetes, with an average duration of diabetes 10.84±6.03 years. All affected eyes were assisted by the same doctor with a non-contact wide-angle lens under the standard three-channel 25G PPV of the flat part of the ciliary body. Five to 7 days before the operation, intravitreal injection of ranibizumab or conbercept 0.05 ml (10 mg/ml) was performed. The incidence of PVH was observed. The age of PVH patients, duration of diabetes, vision before operation, average fasting blood glucose and average postprandial blood glucose before operation, systolic blood pressure and diastolic blood pressure before surgery, laser treatment before surgery, lens removal during operation, intraocular filling during operation, retinal laser points during operation, and fundus lesions during operation (hyperplasia film, Retinal hemorrhage, vascular occlusion, proliferative retinal traction, retinal hiatus, retinal detachment, exudation, neovascularization) were analyzed to find out the cause of PVH. Spearman bivariate correlation analysis and binary logistic regression analysis were performed on the data.Results:Of the 100 eyes of 87 patients, PVH occurred in 17 eyes (17%). There were statistically significant differences in the number of eyes with vascular occlusion and proliferative traction during surgery in patients with and without PVH ( χ2=5.741, 8.103; P<0.05). There was no significant difference in age ( t=-1.364), duration of diabetes ( t=0.538), preoperative vision ( t=1.897), preoperative fasting blood glucose level ( t=1.938), preoperative postprandial blood glucose level ( t=1.508), preoperative systolic blood pressure ( t=-0.571), preoperative diastolic blood pressure ( t=0.275), whether received laser treatment ( χ2=2.678), the number of laser points during operation ( t=0.565), whether received lens removal during operation ( χ2=0.331), whether found new blood vessels during operation ( χ2=2.741) and whether received intraocular filling during operation ( χ2=0.060) between the patients with and without PVH ( P>0.05). Spearman's bivariate correlation analysis showed that patients with low vision, poor control of fasting blood glucose levels, vascular occlusion and proliferative retinal traction during the operation were related risk factors for PVH ( rs=0.208, 0.229, 0.240, 0.285; P<0.05). Binary logistic regression analysis showed that fundus vascular occlusion and hyperplastic retinal traction may be independent risk factors for PVH during surgery ( OR=5.175, 13.915; P<0.05). Conclusion:Fundus vascular occlusion and retinal traction caused by fibrovascular membrane hyperplasia in PPV may be independent risk factors for PVH in patients with PDR after anti-VEGF drugs combined with PPV.