Objective To investigate the effect of p 38 mitogen-activated protein kinase ( MARK) on expression of matrix metalloproteinase-9(MMP-9) and formation of cerebral edema in rats with cerebral ischemia-reperfusion. Methods Fifty-four SPF male SD rats were randomly divided into sham operation group ( Sham group ) , ischemia-reperfusion group(I/R group) and p38 inhibitor group(SB group).Middle cerebral artery ischemia-reperfusion model was made by modified line plug method .The neurologic exams were assessed at 24 h after reperfusion , Evans Blue method was used tomeasurement Blood-brain barrier`s permeability,the wet-dry ratio was used to measured to estimate cerebral edema ,Western blot was used to detect the expression of phosphorylation p 38 ( p-p38 ) and MMP-9 in the infarct region .Results Compared with Sham group , I/R group had aggravated neurological deficits ( P<0.05 );compared with the I/R group, SB group had alleviate neurological deficits (P<0.05).Compared with Sham group, blood-brain barrier permeability and brain water content of I /R group were significantly increased ( all P<0.05 );compared with the I/R group, blood-brain barrier permeability and brain water content of SB group were significantly decreased(all P<0.05).Compared with Sham group , the expression of p-p38, MMP-9 in margin of ischemia of I/R group were significantly increased (all P<0.05);compared with the I/R group, the expression of p-p38, MMP-9 in margin of ischemia of SB group were significantly decreased (all P<0.05).Conclusions p38 MAPK involved in the formation of brain edema in rats with cerebral ischemia-reperfusion , and its mechanism may be cerebral ischemia-reperfusion activates p38MAPK,and it make the expression of MMP-9 in margin of ischemia up-regulated,damaging blood-brain barrier permeability ,leading to cerebral edema .

Introduced in the paper are the background,mode and development course of Taizhou Enze Medical Center (Group),with special focus on the concrete measures of its group management,including the reconstruction of human resource,finance,property,information,professional skills and knowledge resources.It also made recommendations based on its practice and experience.

The key to clinical paths administration lies in the optimization of the key processes and sectors in medical service, which will achieve an integration that is based on patients and span departments to cover all medical service sectors and processes. The clinical path practice was introduced into the hospital in 2005, and the clinical paths have been put into practice for over 20,000 cases/occasions by the end of 2009, scoring satisfactory social and economic outcomes as of now. For the purposes of speeding up the clinical path practice for expected outcomes in optimizing key medical service processes, we have got the following eight experiences and lessons: (1) Build shared demands; (2)Establish a powerful leadership; (3) Develop and promote visions; (4) Eliminate resistance and pool the forces; (5) Keep on the efforts and focus on details; (6) Reward involvements; (7) Recruit and develop key operators within the hospital; (8) Systemize and supervise the experiences of implementation.Promotion of clinical paths is a renovation in management with its inherent rules. Adoption of appropriate technical strategies and cultural strategies will upgrade the quality and acceptance of clinical path implementation.

Objective To investigate status about the heart rate variability and executive function in patients with insomnia.Methods The study involves 165 cases of patients with insomnia and 92 cases normal.The Pittsburgh Sleep Quality Index (PSQI) screening for insomnia,Wisconsin Card Sorting Test (WCST) for the assessment of executive function and Self-generate Physiological Coherence System (SPCS) were used to collect the data of heart rate variability (HRV).Results The SDNN,RMSSD,TP,LF,HF of HRV of the insomnia group were significantly higher than these factors of control group (t=2.712,2.726,2.427,2.542,2.338,P＜0.05 or P＜ 0.01).In the WCST,number of completed categories,conceptualization percentage of the group of patients with insomnia were significantly lower than the control group (t=-2.368,-2.165,all P＜0.05),persistent errors,persistent error percentages,continuous number of responses of patients' group were significantly higher than the control group (t=2.712,2.991,2.690,all P＜0.01).TP,LF,HF,LF/HF of HRV and the number of error responses,persistent errors,persistent error percentages,continuous number of responses of WCST had significant negative correlations (r=-0.171--0.245,P＜0.05 or P＜0.01),while the conceptualization percentage were significantly positively correlated (r=0.198-0.227,P＜0.05 or P＜0.01).Conclusion The results show that insomnia not only cause individual autonomic disorders,but damage the executive function of prefrontal.HRV and executive function in patients with insomnia have close relationships.

Objective To study the cell killing effect on isolated sarcoma 180 cells by ultrasound activating Protoporphyrin IX and to explore its biological mechanism.Methods The sonodynamical effect was investigated on S180 tumor cells exposed to the combination of 120 mol/L protoporphyrin Ⅸ (PPⅨ) and focused ultrasound at the frequency of 2.2 MHz and an intensity of 3W/cm2. The livability of cells was evaluated by trypan blue staining. Scanning electron microscope (SEM) observation of the surface of cells was performed to evaluate the morphological changes induced by ultrasonic irradiation. The generation of oxygen free radicals in cell suspensions was immediately detected after treatment by the active oxygen detection kit. Oxidative stress was assessed by measuring the activities of key antioxidant enzymes (ie, Superoxide dismutase[SOD], Glutathione peroxidase [GSH-PX], Catalase [CAT]) in S180 cells after SDT.Results The cell damage rate of ultrasound combined with PPIX was significantly higher than that treated with ultrasound alone only, and PPIX alone had no killing effect on S180 cells. Enzymatic chemical methods showed the content of MDA significantly increased after treatment, while the activities of key antioxidant enzymes in tumor cells all decreased at different levels, and was associated to the generation of oxygen free radicals in cell suspension after treatment. Conclusion Oxygen free radical may play an important role inimproving the membrane lipid peroxidation, decreasing the activities of key antioxidant enzymes in cells, and the biological mechanism might be involved in mediating the killing effect of S180 cells in SDT.

Objective To investigate the effect and safety of Guard wire technology in percutaneous coronary intervention( PCI) of ostial lesions and the treatment of passing ostial lesions. Methods Thirty?five cases patients needing PCI of ostial lesions were selected and divide randomly in to A group(n=18) and B group(n=17) . A group used Guard wire technology and B group used common method. The X?ray exposure time,complications,the amount of contrast agents of two groups were analyzed. Forty?six cases patients needing the treatment of passing ostial lesions were divided randomly into C group( n=25) and D group( n=21) . C group used Guard wire technology and D group used common method. Complications of two groups were investigated. Results The X?ray exposure time, the amount of contrast agents and complications of A group were fewer than that of B group,the difference were significant((5. 7±0. 6) min vs. (9. 3±1. 1) min,(84. 3 ±6. 4) ml vs. (94. 1±10. 0) ml,6%(1/18) vs. 35%(6/17);t or χ2=-11. 80,-3. 50,4. 80;P<0. 05). The complications of C group was lower than that of D group,and the difference was significant( 4%( 1/25) vs. 29%( 6/21);χ2=5. 30,P<0. 05) . Conclusion Guard wire technology is safe and useful in percutaneous coronary intervention of ostial lesions and the treatment of passing ostial lesions,and it is feasible in clinical practice.

Objective To investigate the effects of levosimendan on percutaneous coronary intervention ( PCI) in patients with ischemic heart failure. Methods From January 2013 to June 2016,eighty patients with ischemic heart failure undergoing coronary intervention in Pingdingshan People′s Hospital No. 1 were randomly divided into treatment group ( 40 cases) and control group ( 40 cases) . The treatment group was treated with levosimendan on the basis of routine medicine 2 days before operation,and the control group was given routine medication before operation. The baseline clinical data, operative success rate, complications, left ventricular ejection fraction ( LVEF%) after 1 month, 6 min walking distance, plasma brain natriuretic peptide ( BNP ) , creatinine and other cardiac and renal functions were observed and compared between the two groups. Results The differences of the baseline clinical characteristics including age (65. 5±3. 9 vs. 63. 9±3. 6),male (26 cases (65. 0%) vs. 23 cases (57. 5%) ),hypertension (21 cases (52. 5%) vs. 19 cases (47. 5%) ),diabetes (17 cases ( 42. 5%) vs. 14 cases ( 35. 0%) ) , hyperlipidaemia ( 30 cases ( 75. 0%) vs. 29 cases ( 72. 5%) ) , smoking (21 cases (52. 5%) vs. 19 cases (47. 5%) ),COPD (7 cases (17. 5%) vs. 6 cases (15. 0)%), LDL?C ( (4. 5±1. 0) mmol/L vs. (4. 4±1. 1) mmol/L),BMI ( (25. 9±3. 3) vs. (25. 6±3. 5) ) were not significant (t/χ2=1. 30,0. 47,0. 20,0. 47,0. 07,0. 20,0. 09,0. 49,0. 39,P=0. 20,0. 49,0. 66,0. 49,0. 80, 0. 66,0. 76, 0. 63, 0. 70 ) . There was no significant difference in coronary artery lesion between two groups, including single vessel lesion (11 cases (27. 5%) vs. 15 cases (37. 5%) ),double vessel lesion ( (22 cases ( 55. 0%) vs. 19 cases ( 47. 5%) ) ,three vessel lesion ( ( 7 cases ( 17. 5%) vs. 6 cases ( 15. 0%) ) and left main coronary artery disease (7 cases (17. 5%) vs. 6 cases (15. 0%) ) (Z=-0. 88,P=0. 38). The time of percutaneous coronary intervention ( ( 51. 0±8. 6) min vs. (49. 6 ±9. 6) min),the time of X?ray exposure ( (20. 3±7. 0) min vs. (18. 4±5. 6) min),material consumption ( (123. 2±16. 6) ml vs. (117. 3±25. 1) ml) between two groups have no difference ( t/χ2=0. 70,1. 39,1. 24,P=0. 49,0. 17,0. 22) . There were significant differences between the two groups in the success rate of operation ( 38 cases ( 95. 0%) vs. 31cases ( 77. 5%) , heart failure ( 1 cases ( 2. 5%) vs. 6cases ( 15. 0%) ) and complications ( 2 cases ( 5. 0%) vs. 11 cases (27. 5%) ) (χ2=5. 17,3. 91,7. 44,P=0. 02,<0. 05,<0. 01). Compared with the control group,the treatment group had greater advancement in LVEF,6 min walking distance,BNP and creatinine level at one month after operation ( F=6. 10,63. 60,51. 00,348. 00,P=0. 02,<0. 01,<0. 01,<0. 01) . Conclusion Levosimendan can effectively improve the heart function and renal function, improve the success rate of PCI in patients with ischemic heart failure and reduce the incidence of complications.

Objective:To investigate the value of quantitative electroencephalography (qEEG) in the evaluation of thrombolytic efficacy in acute cerebral infarction.Methods:A prospective cohort study was conducted. Ninety-four patients with acute cerebral infarction who received intravenous thrombolysis admitted to the department of emergency of Qinhuangdao First Hospital from October 2019 to September 2020 were enrolled. The relative energy values of δ, θ, α and β waves in qEEG before and 2 hours, 24 hours and 7 days after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis were dynamically monitored, and the power ratio index [DTABR, DTABR = (δ+θ)/(α+β)] was calculated. The National Institutes of Health stroke scale (NIHSS) score was also recorded. The reduction of NIHSS score ≥ 3 or the disappearance of neurological symptoms were regarded as effective thrombolytic therapy. The changes of DTABR before and after thrombolysis in patients with effective and ineffective thrombolysis were analyzed, and the correlation between DTABR and NIHSS score was analyzed by Pearson method.Results:A total of 94 patients were enrolled, including 64 males and 30 females. The average age was (61.71±10.11) years from 36 to 89 years old. Thrombolysis was effective in 57 cases and ineffective in 37 cases. Compared with before thrombolysis, DTABR of the effective group was significantly decreased at 2 hours, 24 hours and 7 days after thrombolysis (left cerebral infarction: 1.87±1.45, 1.59±0.88, 1.58±0.90 vs. 3.82±2.60; right cerebral infarction: 1.55±0.57, 1.41±0.50, 1.35±0.44 vs. 3.20±1.63, all P < 0.05). DTABR did not change or increase significantly at 2 hours, 24 hours and 7 days after thrombolysis compared with before thrombolysis (left cerebral infarction: 3.56±2.57, 3.48±2.19, 3.54±2.50 vs. 3.11±1.62; right cerebral infarction: 5.29±3.93, 5.33±3.94, 5.19±4.52 vs. 4.73±2.43, all P > 0.05). Pearson correlation analysis showed a significant positive correlation between DTABR and NIHSS score in patients with acute cerebral infarction (r = 0.691, P < 0.01).Conclusion:The quantitative index of qEEG, DTABR, can accurately and quickly monitor the process of thrombolysis in acute cerebral infarction, and can effectively evaluate the effect of thrombolysis in patients.

Objective To investigate the application of MRI in evaluation of the traumatic temporomandibular joint (TMJ) injury induced by type Ⅵ condylar fracture. MethodsMRI was performed in TMJs in 18 patients with type Ⅵ condylar fractures at days 3-14 post-injury and the MRI findings were analyzed. ResultsMRI findings of 18 patients with traumatic TMJ injury with 19 sides of type Ⅵ condylar fractures showed 15 sides of TMJ disk displacement,nine sides of capsule tear,16 sides of retrodiscal tissue tear (double-plate area) and 19 sides of joint effusion change. Conclusions MRI is very important in the diagnosis and evaluation of traumatic TMJ injury,since it can clearly display the TMJ injuries in type Ⅵ condylar fractures.Therefore,the clinical application of MRI is beneficial for selection of the therapeutic schedules.