Objective To study the effect of irbesartan combined with spironolactone on chronic heart failure and its effect on cardiac function.Methods 60 cases of patients with chronic heart failure treated in our hospital from February 2015 to February 2016 were randomly divided into the control group and the observation group, 30 cases in each group.The control group was treated with conventional therapy, the observation group was treated with irbesartan and spironolactone.The clinical efficacy, cardiac function indexes,blood pressure,heart rate,serum BNP and hs-CRP levels were observed in the 2 groups.Results After treatment, the total effective rate of the observation group was 86.67%(28/30)compared with the control group 63.33%(19/30), and the difference was statistically significant(P<0.05);cardiac function was improved in the two groups compared with before treatment, but the improvement in the observation group was more obvious[LVDd(52.33±4.92)mm vs(59.46±5.57)mm, LVSd(40.24±4.13)mm vs(46.95±4.87)mm, LVEF(48.62±7.13)% vs(42.41±6.65)%], the difference was statistically significant(P<0.05);Blood pressure and heart rate were decreased in the two groups before treatment, but the observation group decreased more significantly[diastolic pressure(75.36±3.54)mmHg vs(85.47±4.09)mmHg, systolic pressure(130.65±8.74)mmHg vs(139.22±9.35)mmHg, heart rate(76.72±10.56)times/min vs(82.59±11.34)times/min], the difference was statistically significant(P<0.05);the levels of BNP and hs-CRP in the two groups were lower than before treatment, but the observation group decreased more significantly[BNP(1.71±0.34)ng/mL vs(2.48±0.57)ng/mL,hs-CRP(6.26±1.03)μg/mL vs(8.79±1.12)μg/mL,the difference was statistically significant(P<0.05).Conclusion Irbesartan combine spironolactone treat with chronic heart failure have reliable curative effect, and it can effectively improve the patient's heart function, delay the development of the disease.

With the development of modern medical model,higher requirements are raised on medical humanity quality education.Based on the analysis and comparison of the current situation in terms of the set up of the course,course arrangement,teaching method and teaching strength,the author raises the solution of strengthening the medical students’humanity quality.

Objective To compare the efficacy of domestic low-dose versus conventional-dose clopidogrel for patients with unstable angina pectoris (UAP). Methods A total of 206 UAP patients were randomly assigned to low-dose clopidogrel (50 mg/day) as treatment group and conventional-dose clopidogrel (75 mg/day) as control group. Treatment continued for 12 months to observe the extent of alleviating angina and major adverse cardiac events (MACE). Results The numbers of markedly effective, effective, ineffective and worse patients were 56(52.8%), 22 (20.8%), 11(10.4%) and 17(16.0%) in treatment group, and those were 52(51.0%), 20 (19.6%), 12(11.8%) and 18(17.7%) in control group (all P>0. 05). There was death in 3 cases, non-fatal myocardial infarction in 2 cases in treatment group, and death in 4 cases, non-fatal myocardial infarction in 2 cases in control group (χ~2 =0. 620, P>0. 05). Low-dose group had a lower incidence of adverse reactions. Conclusions The efficacy of low-dose clopidogrel for patients with UAP is not inferior to conventional-dose, and the safety is well.

5.Negative nitrogen balance nutritional index in the study group were significantly better than that of the control group(P

BACKGROUND: Numerous experiments and clinical practice show that human hair keratin artificial tendon induces the organism to form autogenous tendon. The process of autogenous tendon formation mainly involves the synthesis, secretion and package of collagen subtype I.OBJECTIVE: To explore the role of collagen subtype I mRNA expression in autologous tendon formation after human hair keratin artificial tendon implantation.DESIGN: A completely randomized controlled experiment based on the experimental animals.SETTING: Department of Histology and Embryology and Department of Biochemistry and Molecular Biology of Southern Medical University.MATERIALS: The experiment was conducted in the Experimental Animal Center of the First Military Medical University of Chinese PLA from May 2003 to September 2004. Totally 33 New Zealand rabbits of either gender,weighing 2.0 to 2. 5 kg, were provided by the center. The animals were randomly divided into experiment 3, 6, 9, 12, 16 and 20 weeks groups, negative control 9 and 20 weeks groups and normal control group. Among them,experiment 3 and 6 weeks group and normal control group had 3 rabbits in each and the other groups had 4 rabbits. Human hair keratin artificial tendons were normal human hair treated by a series of biochemical methods and were supplied by the Department of Biochemistry & Molecular Biology of the university. The human hair keratin artificial tendons were divided into three groups with different degradation rates, namely, fast(F), medium(B) and slow(Z). The tendons were made up of the fast, medium and slow degradation groups mixed at the ratio of 4: 3: 3.off by 1.0- 2.0 cm, human hair keratin artificial tendon was grafted by end-to-end anastomosis with both ends of the broken tendon before sewing control group, no artificial tendon was implanted although the animals ungroup was normal rabbits' tendon. Sampling was carried out at 3, 6, 9, 12, 16and 20 weeks after human hair keratin artificial tendon implantation in experiment groups, and at 9 and 20 weeks after operation in negative control group, respectively. The expression of collagen subtype I mRNA was detected at weeks 3, 6, 9, 12, 16 and 20 after grafting using reverse transcription polymerase chain reaction technique.MAIN OUTCOME MEASURES: The ratio of collagen subtype I mRNA to Glyceraldehyde-3-phosphate dehydrogenase(GADPH) mRNA in normal tendon and autogenous tendon induced by human hair keratin artificial tendon at all time points was calculated, and significance test between all these paired groups were performed.collagen subtype I mRNA/GADPH mRNA expression was 0.96 ±0.02 in expression of collagen subtype I mRNA/GADPH mRNA in autogenous tendon induced by human hair keratin artificial tendon in experiment group appeared at week 3, increased rapidly at week 3 to 6, peaked at week 6, and remained stable at week 9 to 20. The expression at week 6 was significantly higher in experiment group than in normal control group( F = 6. 254, P ＜ 0.05); the expression at other weeks was also significantly higher in experiment group than in normal control group( F= 1. 258 - 1. 987, P ＞ 0.05).CONCLUSION: The activation, proliferation and secretion of collagen protein as well as the synthesis of collagen subtype I by tenocytes may be responsible for autologous tendon formation after human hair keratin artificial tendon implantation.

Objective To explore the role of COX-2 and VEGF in oncongensis and development of gestation-al trophoblastic disease,and evaluate prognosis of gestational trophoblastic tumor. Methods The expression of COX-2 and VEGF in normal chorion of early gestation and in gestational trophoblastic disease were detected by immunohis-tochemistry. Results In gestational trophoblastic tumor group,the positive rate of COX-2 and VEGF were significantly highter than that of normal chorion of early gestation group and the hydatidiform mole group respectively ( P < 0.01). There were positive correlation between COX-2 and VEGF in gestational trophoblastic tumor ( r = 0.795, P < 0.01). Conclusion The collaborative and over expression of COX-2 and VEGF were probably associated with the malignant change of trophoblastic cell,which suggest the worse prognosis of the gestational trophoblastic disease.

Underlying both the angles of norm-referenced test and criterion-referenced test, the qualitative or(and)quantitative analysis and evaluation were made on the tests of 10 medical academic courses in recent 4 years in reliabil-ity and item quality. From the angle of norm-referenced test, 67.4 percent of the items had good quality, 60 percent ofthe tests could differentiate the classes and 12.5 percent of the papers could differentiate the individual person accord-ing to their reliability. However, from the angle of criterion-referenced test, approximately 90 percent of the items werequalified; 87.5% had high reliability to determine whether an examinee passes the test or not.[

Acute Coronary Syndrome ; chemically induced ; Anesthetics, Dissociative ; adverse effects ; Humans ; Ketamine ; adverse effects

BACKGROUND: Based on our previous researches in mechanism studies and clinical applications of human hair keratin (HHK), a new concept "in vivol in situ tissue engineering" has been proposed. Under the guidance of this theory, a scaffold of HHK-collagan sponge (inner layer) combined with poly (2-hydroxyethyl methacrylate) (PHEMA) (outer layer as a drug delivery carrier) would be developed to investigate its feasibility to be as a dermal dressing. OBJECTIVE: To develop a scaffold composed of HHK-collagan sponge (inner layer) combined with PHEMA film containing polydatin(PD)(outer layer as a drug delivery carrier) and to evaluate the therapeutic efficacy of the HHK-collagen sponge-PHEMA/PD complex on burn wound healing. DESIGN, TIME AND SETTING: A randomized controlled animal experiment was performed at the Department of Histology and Embryology, Southern Medical University between March and December 2005. MATERIALS: Burn was induced in 15 male Sprague-Dawiey (SD) rats, Rat models of burn were evenly randomized to 3 groups: experimental, positive control, and negative control. METHODS: ①HHK-collagen sponge was prepared through combination of a HHK meshwork (1mm × 1 mm in size for each grid) made up of three components (determined according to biochemical procedures of various degrees, i.e., light, medial, and severe) at a ratio of 4:3:3 with primary collagen sponge extracted from bovine tendons in a mould. Sponge film (used as inner layer dressing) was made by vacuum freeze-drying. ② PHEMA was prepared by polymerization. Than PD was added to prepare PHEMNPD film (used as outer layer dressing).③ Degree Ⅱ burn wound models were established in SD rats by scalding, Superficial necrotic tissue was removed from burn wounds at postnatal 3 days and leave the denatured dermis remained. The wounds were either covered with human HHK-collagen- PHEMNPD complex in the experimental group, or with glutaraldehyde-treated porcine skin in the positive control group, and sterile absorbent gauze was used in the negative control group. MAIN OUTCOME MEASURES: ① Complete epithelization was taken as the standards, and at postoperative 7, 14, and 21 days, wound healing was respectively calculated. ② At postoperative 1, 2, 4, 6, and 8 weeks, the whole wound surface and its peripheral tissue were dissected for observing granulation tissue growing under an optical microscope and detecting the collagen fiber and elastic fiber in the newly formed tissue by immunohistochemical staining. RESULTS: ① Gross observation results revealed that in the experimental group, the volume of the diffusate under the ideal moisture was less compared with the positive control group; the healing time was slightly shorter in both the experimental group and the positive control group than in the negative control group (P= 0.000); At postoperative 7, 14, and 21 days, the healing rate was higher in the experimental and positive control groups than in the negative control group (P=0.000), in addition, the experimental group exhibited higher healing rate than the positive control group at postoperative 14 days ( P ＜ 0.05). ②Optical microscope results showed that at postoperative 2 weeks, a small quantity of collagen fibers were found in the wound granulation tissue in all 3 groups, in particular in the experimental group. Immunohistochemical staining results regarding collagen protein and elastin revealed that at postoperative 2 weeks, both the fine strip-like type Ⅰ collagen fibers and a few silk-like elastic fibers were stained yellowish-brown in the dermal matrix in the experimental group, which were weakly positive in the positive control group, while there was no elastin detectable in the negative control group; at postoperative 8 weeks, burn wounds in all the 3 groups werefully recovered. Remodeling of collagen fibers was more obvious in the experimental and positive control groups than in thenegative control group, while the tendency to scar formation with derangement of epithelial cells and collagen fibers in dermis was more prominent in the negative control group than in the remaining two groups.CONCLUSION: HHK-collagen sponge-PHEMA/PD complex may be a new burn dressing via in vivo construction of tissueengineered epidermis, in which PHEMA may be a feasible drug-delivery carrier.

Objective To characterize the clinical features of patients with cardiac amyloidosis (CA).Methods Totally 42 patients with CA admitted to Guangdong General Hospital since 2008 were included and retrospectively analyzed in the present study.CA was confirmed by abdomen and endocardium biopsy examination.Clinical manifestations,electrocardiogram and echocardiography were collected for the evaluation.Results Several clinic features are common in CA.In the present study,37 cases (88.1％) presented with chest tightness,dyspnea,20 cases(47.6％) with chest pain,27 cases(64.3％) with right heart failure,27 cases (64.3％) with fatigue,and 30 cases (71.4％) with renal insufficiency and proteinuria.Electrocardiogram (ECG) showed that 32 of the patients (76.2％) were with low voltage in limb leads,29 cases (69％) of them were with poor R wave progression in precordial leads,17 cases (40.5％) with ST-T change,28 cases(66.7％) with pseudo-necrotic Q wave and 36 cases (85.7％) with various kinds of arrhythmia.Echocardiography indicated that all of the subjects (100％) were with different degrees of left ventricular posterior wall or ventricular septal thickness,and left atrial hypertrophy with different degree of myocardial grain appearance or ground-glass opacity.Thirty-six cases (85.7％) were with pericardial effusion,and 27 cases (64.3％) were with abnormal left ventricular eject function.Conclusion For those who were with unexplained clinical cardiac insufficiency,renal insufficiency,myocardial hypertrophy,but normal of ventricular size in echocardiography and low voltage on ECG limb leads,a tissue biopsy from abdomen,labial glands or endocardium should be considered in the diagnosis of CA.