ObjectiveTo observe the therapeutic effect of nicorandil in treatment of angina pectoris. Methods155 cases of angina pectoris patients were randomly divided into the therapeutic group(85 cases)and control group(70 cases),both of which took normal doses of aspirin vitamin C effervescent tablets 0.1g/day,clopidogrel 50mg/day,elantan 50mg/day and simvastatin 40mg/day,where hypertensions or diabetics were given blood pressure and sugar control and heart failure patients were given proper diuretic therapy and other methods to release heart Ioad.Patients in the therapeutic group were additionally given 5 mg nicorandil,3 times/day.The two groups were both given one period of treatment about one month. ResultsIn therapeutic group,32 cases had significant therapeutic effectiveness,34 cases had effectiveness and 14 cases had no effectiveness with a total effective rate of 82.5%.In the control group,23 cases had significant therapeutic effectiveness,28 cases had effectiveness and 24 cases had no effectiveness with a total effective rate of 67.0%.The comparative difference of the total effectiveness of the twogroups had statistical significance(x2 =4.40,P＜0.05).No other significant adverse reaction was found except several cases of light dizzy in the two groups. ConclusionNicorandil has good therapeutic effective in treatment of angina pectoris and no significant adverse reaction.

AIM:To investigate the effects of 17β-estradiol on the expression of macrophage migration inhibi-tory factor ( MIF) in cultured endometrial stromal cells from endometriosis .METHODS:Immunohistochemistry was used to identify the endometrial stromal cells .The expression of MIF at mRNA and protein levels was assessed by RT-PCR and Western blotting .RESULTS:Elevated expression of MIF at mRNA and protein levels was observed in the cultured endom-etrial stromal cells treated with 17β-estradiol.In endometrial stromal cells from the women with endometriosis , the level of MIF up-regulation by 17β-estradiol was significantly higher than that in the cells from the women without endometriosis . CONCLUSION:Endometrial stromal cells from endometriosis are more sensitive to 17β-estradiol, which up-regulates the expression of MIF and contribute to the pathogenesis and progression of endometriosis .

Objective To observe the effects and mechanism of pretreatment in rats with prostaglandin E1 on liver after hemorrhagic shock and resuscitation(HSR).Method In total,32 male SD rats were randomly(random number)divided into four groups(n=8):group A(sham group),group B(shock group),group C(HSR group)and group D(Lipo-PGEl+HSR).In group B,rats were sacrificed 90 min after shock,and in group C,rats were anesthetized and then subjected to hemorrhagic shock followed by resuscitation.In group D,rats were pretreated with Lipo-PGEI one hour before HSR.Liver function,NO and ET.1 were measured,and pathological changes of liver tissue in each group were observed,and the expres8ions of iNOS and ET.1 of liver tissue were measured by using immunohistochemistry 6 hours after HSR.Data were analyzed by analysis of variance,and P<0.05 was considered as significantly different in statitistics.Results The levels of liver iNOS and ET-I increased in HSR group compared with shock group [(O.225±0.080)vs.(0.082±0.021)and(0.292±0.047)vs.(0.082±0.035),P<0.05].Pretreatment with Lipo-PGEl markedly reduced the damage of Liver function,and lowered the levels of NO and ET-I.which were consistent with decrease in iNOS and ET-16 hours after HSR[(0.116±0.034)vs.(0.225±0.080)and(0.198±0.041)vs.(0.292±0.047),P<0.05].Conclusions Pretreatment with Lipo-PGEl could reduce liver injury after HSR.The mechanisms might be attributed to inhibiting iNOS and ET-1,regulating the balance of NO/ET-I.

Objective To compared the clinical efficacy of laparoscopic-assisted vaginal and laparotomy in the treatment of early endometrial cancer.Methods CLinical data of 180 patients with endometrial cancer were analyzed retrospectively,which were randomly divided into two groups:The laparotomy group were underwent conventional abdominal hysterectomy and pelvic lymphadenectomy;Laparoscopic group were underwent laparoscopic-assisted vaginal hysterectomy and pelvic lymph node dissection.Operative time,blood loss,recovery time of gastrointestinal function,length of stay,the number of harvested lymph nodes,complications were compared.Results There were no significant differences in operative time,blood loss,the number of lymph nodes cleaned up between two groups(P ＞0.05).Recovery time of gastrointestinal function,and length of stay in the laparoscopic group was significantly shorter than the laparotomy group,the differences were statistically significant(t =2.898,2.564,P ＜0.05).The complication rates(11.0％ vs 19.1％) were no significant difference(P ＞ 0.05).Following up for 3 months to 27 months,recurfence rates(6.6％ vs 5.6％) and survival rates(98.9％ vs 97.8 ％) were no significant difference(all P ＞ 0.05).Conciusion The clinical efficacy of laparoscopic-assisted vaginal surgical treatment for early endornetrial cancer was significantly superior to laparotomy surgery with advantage of minimally invasive,quick recovery.

ObjectiveTo investigate anatomical characteristics of the medial foot vessels and effects of different vascular pedicle skin flaps in repair of foot and ankle trauma.MethodsThirty adult cadaveric lower limbs were injected with red latex through the popliteal artery and posterior tibial artery to anatomically observe the cutaneous arterial origin,branches,distribution and anastomosis of the medial foot.Then,anterior medial malleolar artery perforator flaps and distally-based medial foot flaps were harvested and used for repairing foot and ankle trauma of 16 patients.Results The origin of cutaneous blood vessels of the medial foot was diversified and mainly included the anterior medial malleolar artery,medial tarsal artery,and arterial arcades anastomosing with anterior posterior branches of the two former arteries and the superficial branches of plantar digital artery and the medial plantar artery.According to distribution area of the anterior medial malleolar artery and the medial tarsal artery,the vascular anatomy of the medial foot skin was classified into three types.Clinically,all the flaps survived.Follow-up ranged from 2 weeks to 20 months,which showed normal color,good shape and good pain and warm sensation of the flaps.ConclusionThe anterior medial malleolar artery perforator flaps present good reconstruction of soft tissue defects around the ankle,whereas the distally-based medial foot flaps present good reconstruction of soft tissue defects of the mid-forefoot.

Objective:To explore the role of peripheral blood monocyte subsets in the pathogenesis of rheumatoid arthritis (RA),we therefore decided to compare the percentage of monocyte subpopulations in peripheral blood,as well as cytokines secretion function,to that of healthy controls. Methods:22 patients with RA and 22 cases of healthy controls ( HC) were drew 3 ml fresh venous blood into a tube containing heparin. The percentage of monocyte subsets,expression of Toll-like receptor(TLR)2,HLA-DR,triggering receptor expressed on myeloid cells-1(TREM-1) on intermediate monocyte and mean fluorescence intensity(MFI) of intracellular tumor necrosis factor-α ( TNF-α) were evaluated with the methods of flow cytometry ( FCM ) . The correlation between percentage of monocyte subsets and serum cytokines was explored. Statistical significance between parametric data was determined by the students't-test. Results:Compared to HC controls, the percentages of intermediate monocytes were significant higher in RA patients [ ( 11. 7 ± 1. 6)% vs (4. 6±1. 2)%,P<0. 05],as well as the expression(MFI) of TLR2 (750. 2±110. 3 vs 526. 8±98. 6) and TREM-1 (58. 4± 12. 1 vs 40. 3±10. 2) on intermediate monocytes (P<0. 05). The expression of HLA-DR on intermediate monocytes of RA patients had no difference with HC controls (P>0. 05),while MFI of intracellular TNF-αin intermediate monocytes of RA patients were significant higher than that of HC controls (46. 3±6. 4 vs 36. 7±8. 3,P<0. 05). In addition,RA patients showed a positive correlation between the percentage of CD14highCD16+ monocytes and DAS28 scores(r=0. 538,P=0. 009),as well as the serum levels of TNF-α,IL-17 ( r=0. 471,P=0. 027;r=0. 593,P=0. 003). Conclusion:Monocyte subpopulations from RA patients are abnormally skewed toward to in-termediate monocytes which has high expression of TLR2 , TREM-1 and the function of TNF-α secretion. Therefore, intermediate monocytes may play a role in the pathophysiology of RA. By modulating polarization or blocking monocyte cell surface receptors could be a new treatment of RA.

Objective To investigate the effect of combination therapy by observing the salivary glands function and related organ pathology after given methotrexate (MTX) and cyclophosphamide (CTX) intermittently in induced mice model of Sjogren's syndrome (SS). To further explore the synergistic effect of combination therapy by detecting the immunological regulatory factor B cell activation factor belonging to the TNF family (BAFF) expression. Methods The ingredients of Lewis rat's exocrine glands homogenate were injected into female C57BL/6 mice to set up the mice model of SS. After established the SS mice model successfully, they were randomly divided into six SS model group, including low-dose MTX treatment group (0.02 mg/w), high-dose MTX treatment group (0.06 mg/w), CTX pause treatment group (1.2 mg/3 w), CTX alternate day treatment group (0.6 mg/2 d), MTX+CTX combination treatment group (MTX 0.02 mg/3 w+ CTX 1.2 mg/3 w). Treatment effects were assessed both clinically and histologically. Results Eighteen weeks after the first treatment, the improvement of the salivary secretion of the CTX alternate day treatment group and MTX+CTX combination treatment group were higher than other groups, which showed statistically significant difference (P<0.01). Compared with the SS model control group, HE staining showed that the lymphocytic infiltration of exoerine glands was decreased in the treatment group. In the CTX alternate day treatment group and MTX+CTX combination treatment group, few amount of inflammatory cell infiltration were found, and the expression intensity of BAFF mRNA and protein were decreased markedly in salivary gland than others by RT-PCR and immunohistochemistry assay (P<0.01). Conclusion MTX and CTX can inhibit lymphocytic infiltration of the salivary glands, inhibit BAFF transcriptional level and production of BAFF protein, leading to an increase of fluid production. It suggests that modulation of signaling via BAFF pathways may be a mechanism of action. MTX and CTX combination therapy is more effective than single-agent therapy. The inhibitory effects of MTX and CTX on BAFF-mediated inflammatory pathways are primarily synergistic.

Objective To investigate the characteristics of falls as an adverse event in the hospitalization of elderly patients taking sedatives and hypnotics drugs.Methods Data of elderly patients treated in Department of General Internal Medicine,Beijing Chaoyang Hospital from July 2011 to July 2015 were collected.All patients were divided into medicine-taking group and non-medicinetaking group according to the history of taking sedatives and hypnotics during the hospital stay.Different characteristics of fall as an adverse event were compared between the two groups,and fall related nursing interventions were presented.Results A total of 3 834 patients were collected for analysis in this study.Of these patients,the fall as an adverse event occurred in 12 cases,the total incidence was 3.1％,in whom 8/638 (12.5％) in medicine-taking group and 4/3196 (1.3％) in nonmedicine-taking group(x2=21.72,P＜0.01).Of 8 cases with the fall as an adverse event in medicinetaking group,the fall occurred in 6 cases(75％)during 24 ∶ 00-6 ∶ 00.However,of 4 cases with the falls in non-medicine-taking group,the fall in 3 cases(75 ％)occurred during 6 ∶ 00-18 ∶ 00.In medicinetaking group,the fall occurred beside their beds in 62.5 ％ (5 cases).And in 37.5 ％ (3 cases)did in their bathrooms.In non-medicine-taking group,the fall occurred in 2 cases (50.0％) beside their beds,in 1 case did in the bathroom,1 case did in the passage.Multiple Logistic regression analysis showed that age ＞ 75 years(OR=1.26,95 ％CI:1.07-1.48),elevated nutritional risk score(NRS-2002 ≥3 scores) (OR=10.92,95％CI:1.79-66.46)and elevated risk for fall or out of bed(risk score ≥18 scores) (OR =19.08,95％ CI:4.02-90.47)were the independent risk factors for falls as an adverse event among medicine-taking group.Conclusions A use of sedatives and hypnotics is related with the increase of fall as an adverse event in elderly patients during a hospital stay.With the aim of preventing or reducing the incidence of fall as an adverse event,nursing interventions should be carried out based on the characteristics of fall as an adverse event in elderly patients taking sedatives and hypnotics.

Considering the weak relevance between the stages of C,D,I and O and the weak operability of CDIO theory in teaching,mind map is introduced into CDIO theory to drive medical English teaching.Firstly,how mind map and CDIO theory are mutually complementary is discussed,based on which,along the main clue of CDIO theory,a further discussion is carried out from four levels:conceiving the main structure and content of a passage,designing sentence teaching,implementing vocabulary memorization and operating self-directed learning,all with mind map as an assistance.Moreover,specific cases are used to exemplify how mind map is applied to CDIO medical English teaching.Using.mind maps in CDIO medical English teaching is highly coherent and operable.It helps to integrate the four stages of C,D,I and O and enhances teaching quality and learning efficiency.

Objective To evaluate the efficiency of second trimester screenings for Down syndrome using alpha-fetoprotein and β-human chorionic gonadotropin duplex.MethodsPregnant women of south Zhejiang were screened for Down syndrome fetuses by maternal alpha-fetoprotein and β-human chorionic gonadotropin duplex during second trimester.The high-risk women underwent prenatal diagnosis by amniocentesis,cell culture and chromosome analysis.The newborns followed up by the maternal and child tertiary health care network and suspected to have Down syndrome were diagnosed by peripheral blood chromosome analysis.Statistical analysis was performed using two-sample t test and x2 test.Risk probability of Down Syndrome was calculated by random screening software. Results From Oct.2007 to May 2009,1130 of 32 188 singleton pregnant women in second trimester received prenatal screening were discovered with high risk(≥1 ∶ 270).Prenatal diagnosis was performed in 90.79％ cases (1026/1130) of high risk women and seven fetuses were diagnosed as Down syndrome by amniotic fluid chromosome analysis,and the pregnancies were terminated.Among the other 104 cases without prenatal diagnosis one Down syndrome baby was delivered.Six of 31 058 pregnancy women with low risk delivered Down syndrome babies with the incidence of Down syndrome of 0.19‰ (6/31 058).Detection rate of second trimester screenings for Down syndrome using alpha-fetoprotein and β-human chorionic gonadotropin duplex was 57.14％(8/14).False positive rate was 3.48％ (1122/32 188).Positive predictive value was 7.08‰(8/1130).During the same period,there were 23 813 pregnant women who didn't receive screening and 15 fetuses with Down syndrome were diagnosed after birth.There was no statistical difference in the prevalence rate of Down syndrome between those pregnant women who received prenatal screening or not [0.43‰ (14/32 188) vs 0.63‰ (15/23 813),x2 =1.004,P＞0.05].The prevalence of Down syndrome was 0.52‰ (29/56 001) in this area. ConclusionsThe prenatal screening and diagnosis could reduce the birth rate of Down syndrome patients.However,detection rate,false positive rate and positive predictive value of which were lower than reports in other studies.It's possible that the reference data might be not suitable for Chinese.