Thrombolysis is still an important treatment modality in patients with ST-segment elevation myocardial infarction (STEMI) in a hospital without percutaneous coronary intervention (PCI) facility. However, the optimal treatment after thrombolysis is still unclear. Conservative treatment after thrombolysis was recommended in the past. "Guidelines for percutaneous coronary intervention (2009)" also suggested that the condition of STEMI patients should be evaluated to determine whether the patient should be transferred to a hospital with PCI facility. But this suggestion lacksed evidence-based support. In recent years, several clinical trials suggested that immediate transfer to the nearest interventional centre for PCI was plausible regardless of success or failure in thrombolysis in local hospital, and this might reduce the incidence of cardiovascular events in patients with STEMI.

Objective:To systematically evaluate the clinical efficacy and adverse reactions of tegafur combined with apatinib mesylate in treatment of advanced gastric cancer.Methods:The databases such as PubMed, Cochrane Library, CNKI and WanFang data were searched by computer, and the relevant randomized controlled trials were searched. The retrieval time was from the establishment of the database to May 2018. After literatures were selected according to the inclusion and exclusion criteria, the data were extracted and the quality of the included studies were evaluated, meta analysis was conducted by using RevMan 5.3 software.Results:There were 7 studies included in total. Tegafur combined with apatinib mesylate could achieve higher complete remission rate ( RR = 2.00, 95% CI 1.04-3.86, P = 0.04), partial remission rate ( RR = 1.43, 95% CI 1.01-2.03, P = 0.04), and lower inefficiencies rate ( RR = 1.28, 95% CI 1.07-1.53, P = 0.008), but the incidence of adverse reactions such as hypertension was also increased. Conclusion:Tegafur combined with apatinib mesylate in treatment of advanced gastric cancer can achieve better clinical efficacy, but at the same time it can increase the incidence of adverse reactions.

OBJECTIVE: To investigate the effect of enzymatically modified low density lipoprotein(E-LDL) on differation and maturation of human dendritic cells(DC) in peripheral blood and the effect of diltiazem on it.METHODS: Human monocytes were isolated by using gradient centrifugation method and cultured in DC Cellgro medium containing rhGM-CSF and rhIL-4 for 5 days,then DC was then obtained.DC were treated with E-LDL or E-LDL plus diltiazem for 48 hours,the morphological changes were observed under the microscope,and the FACS was used to investigate the expression of DC(CD1a,CD80,CD86 and HLA-DR).PBS group was set up for comparison.RESULTS: The morphological changes were nor observed.The expressions of CD1a,CD80,CD86 and HLA-DR in each groups were significant different(P

Objective To investigate the effect of umbilical cord serum(UCS)during induction of dendritic cells derived from umbilical cord blood. Methods Umbilical cord blood was collected aseptically and interface cells were collected with density gradient centrifugation method,CD34 +cells were purified and collected with Mini-MACS technique. Pro-DC were obtained and were divided into 3 groups:①cultured in RPMI-1640 medium with 10%UCS and cytokine,②cultured in RPMI-1640 medium with 10%FCS and cytokine③cultured in RPMI-1640 medium with 10%FCS .Interleukin-4(IL-4),granulocyte-macrophage colony-stimulating factor(GM-CSF)and tumor necrosis factor(TNF-a)were used in the first 2 groups, but not in control group (group 3). Some cells were collected on the 8th d for phenotypes analysis. Results The expression of CD80 ,CD54 and HLA-DR on the surface of DC cultured in UCS medium had no significant difference compared with that of DC cultured in FCS medium. The expression of surface molecules in UCS-DC group and FCS-DC group were both enhanced compared with the control group. Conclusion Mature DC could be induced from pro-DC derived from umbilical cord blood when cultured with UCS instead of FCS. That provides a new approach for the clinical application of DC.

Objective To establish the qualitative and quantitative detective methods of Fuyang granules.Methods The TLC methods for identification of Fructus kochiae and Herba solani lyrati were established.A simple HPLC was established for the determination of hydroxysafflor A(HYSA).The mobile phase was methanol-acetonitrile-0.7% phosphoric acid(24:6:70).UV detecting wavelength was at 403 nm.Results Fructus kochiae and Herba solani lyrati could be identified by TLC.HYSA showed a linear relationship at the concentration range of 0.128～1.024 ?g,r =0.999 8.The average recovery was 99.52% and RSD= 1.97%(n = 5).Conclusion The method can be used for qualitative identification and quantization determination of Fuyang granules.

Objective To study the therapeutic effect of ankylosing spondylitis treated with sacroiliac joint injection under C-arm X-ray guidance. Methods Four hundred and eighty-three patients of ankylosing spondylitis were divided randomly into two groups according to the treatment method. Four hundred and twenty-one cases were in group A:sacroiliac joint injection under C-arm X-ray, the injection medicine were diprospan or triamcinolone acetonide and methotrexate, and with oral sulfasalazine (SASP) as well. Sixty-two cases were in group B: oral medicion SASP and meloxicam alone without injection. Self-evaluation, finger-to-floor distance, changes in Schober's sign, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) before and after treatment of 3 d, 1 week,2 weeks, 3 weeks, 4 weeks and 3 months were observed. Results Two indicators including self-evaluation and finger-to-floor distance at initial 3 d were significantly lower than those before treatment in group A: (6.18 ±0.55) scores vs. (8.89 ±0.53) scores, (30.10 ±3.94) cm vs. (50.20 ±3.93) cm, P<0.05. Schober's sign and occiput-to-wall distance at 1 week after treatment were significantly lower than those before treatment in group A:(3.44± 0.32) cm vs.(3.19±0.47) cm, (9.49±0.68) cm vs. (10.72±2.36) cm, P<0.05. Two indicators including self-evaluation and finger-to-floor distance at 1 week after treatment were significantly lower than those before treatment in group B:(7.07 ± 0.72) scores vs. (9.08 ±0.46) scores, (48.14 ±5.62) cm vs. (50.84 ±4.33) cm, P<0.05. Schober's sign at 4 weeks after treatment was significantly lower than that than before treatment in group B:(3.49± 0.56) cm vs. (3.22±0.58) cm, P<0.05. Occiput-to-wall distance at 2 weeks after treatment was significantly lower than that before treatment in group B:(9.08±1.54) cm vs. (10.11±1.58) cm, P<0.05. Conclusion The method of C-arm X-ray guided sacroiliac joint injection for treatment of ankylosing spondylitis is effective and feasible.

Objective To investigate the effect of partial sleep deprivation (PSD) on cardiac electric activity and function of vascular endothelium. Methods Eighteen Sprague-Dawley rats were randomly divided into two groups (9 each):PSD group and control group. PSD lasted 10 days,20 hours each day. Body weight and surface electrocardiogram (S-ECG) were examined and recorded 1d before PSD,and 1d,4d,7d and 10d after PSD. Serum concentrations of glucose,total cholesterol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),creatin kinase (CK),creatin kinase-MB (CK-MB),high-sensitivity C-reactive protein (hs-CRP),nitric oxide (NO),von Willebrand factor (vWf),endothelin-1 (ET-1) and E-selectin were determined the next day after 10d of PSD. Results Compared to that 1d before PSD,body weight in PSD groups decreased significantly,while increased obviously in control group. Compared to that in control group,the body weight of rats decreased significantly (P

Objective To evaluate the effects of sevoflurane preconditioning on postoperative cognitive dysfunction in aged rats.Methods One hundred and twenty healthy male Sprague-Dawley rats,aged 18 months,weighing 400-450 g,were randomly divided into 3 groups (n =40 each) using a random number table:control group (group C),operation group (group O),and sevoflurane preconditioning group (group Sev).In group C,the rats were only anesthetized with pentobarbital sodium and did not undergo operation.In group O,the rats were anesthetized with pentobarbital sodium and underwent 30 min of exploratory laparotomy.In group Sev,the rats inhaled 2.4％ sevoflurane for 30 min and then inhaled air for 30 min,and the other procedures were similar to those previously described in group O.At 30 min before operation and on 1st,3rd,5th and 7th days after operation,Morris water maze test was performed to record the escape latency,time of staying at the original platform quadrant and frequency of crossing the original platform.At 30 min before operation and on 1st and 7th days after operation,10 rats in each group were sacrificed and hippocampi were isolated to detect the apoptotic rate and intracellular [Ca2 +] i (using flow cytometry) and the ultrastructure of hippocampal neurons was observed with transmission electron microscope.Results Compared with group C,the escape latency was significantly prolonged,the time of staying at the original platform quadrant was shortened,the frequency of crossing the original platform was decreased,and the apoptotic rate and intracellular [Ca2 +] i were increased after operation in O and Sev groups (P ＜0.05).Compared with group O,the escape latency was significantly shorten,the time of staying at the original platform quadrant was prolonged,the frequency of crossing the original platform was increased,and the apoptotic rate and intracellular [Ca2+]i were decreased after operation in group Sev (P ＜ 0.05).Microscopic examination showed no abnormality in the ultrastructure of hippocampal neurons in group C,and the pathological changes of the ultrastructure of hippocampal neurons were obvious in group O,and were significantly attenuated in group Sev.Conclusion 2.4％ sevoflurane preconditioning can reduce postoperative cognitive dysfunction in aged rats,and regulation of imbalance of calcium homeostasis and reduction of cell apoptosis are involved in the mechanism.

Objective To investigate the effect of carbon dioxide ( CO2 ) pneumoperitoneum on the neuromuscular block of cisatracurium in patients undergoing laparoscopic operation.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 35-60 yr,with body mass index of 18-24 kg/m2,scheduled for elective hysterectomy,were randomly divided into 2 groups ( n =30 each ):pneumoperitoneum group ( group P) and control group ( group C ).Each group was further divided into 2 subgroups according to the use of the antagonist of neuromuscular block ( n =15 each):no neostigmine group ( group P0 or C0 ) and neostigmine group (group P1 or C1 ).Anesthesia was induced with fentanyl,propofol and cisatracurium and maintained with target-controlled infusion of propofol and remifentanil.Tracheal intubation was performed and the patients were mechanically ventilated.Neuromuscular function was monitored by TOF-Watch SX accelerography (Organon Co.,Organon).A train of four (TOF) stimulation of the ulnar nerve was used.When T,returned to 5％ of control height after CO2 pneumoperitoneum was established,cisatracurium 0.05 mg/kg was injected intravenously in group P.When T1 returned to 25％ of control height after the end of operation,neostigmine was injected intravenously in groups P1 andC1.The clinical duration and recovery index were recorded after CO2 pneumoperitoneum was established.Arterial blood samples were obtained immediately before induction,at 30 and 60 min of pneumoperitoneum,and at the end of operation for blood gas analysis.Results The clinical duration and recovery index were significantly longer in group P0 than in group C0,and in group P1 than in group C1 ( P ＜ 0.05).Compared with group C0,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P0 ( P ＜ 0.05).Compared with group C1,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P1 ( P ＜ 0.05).Conclusion CO2 pneumoperitoneum can strengthen the neuromuscular block induced by cisatracurium and prolong the recovery time following antangonism by neostigmine administration in patients undergoing laparoscopic operation.

Objective To screen the difference of gene expression in dorsal root ganglia (DRG)of inflammatory visceral hypersensitivity rats and to explore the role of voltage gated calcium channel (VGCC) in inflammatory visceral hypersensitivity. Methods Total 180 male Sprague-Dawley rats were in this study,the weight varied from 200 gram to 300 gram. 2,4,6-trinitrobenzenesulfonic acid (TNBS) model group was maken by 2. 0% TNBS slowly injection,the dosage was 100mg per kilogram. The normal control group was only injected with same volume of 0. 9% sodium chloride solution. After the model had been maken for four days,gene expression profiles of L6-S2 DRGs were tested by rat cDNA microarray chips. And the result was verified by RT-PCR and Western blot. The changes of intracellular Ca2+ and the voltage gated calcium currents were recorded by patch-clamp.The special Ca2+ channel blockers were given by intrathecal injection,and then the changes of visceral sensitivity were observed. The visceral sensitivity was measured by abdominal withdrawal reflex (AWR). Results There were significant changes of 172 genes expression in L6-S2 DRGs of TNBS model rats,which included Ca2+ channel,membrane receptor and intracellular second messenger. Of those,L-type Ca2+ channel (Cav1. 2) and R-type Ca2+ channel (Cav2. 3) were significantly up-regulated. The results of gene microarray chips were further confirmed by RT-PCR and Western blot.The intracellular Ca2+ testing indicated that there was no statistical significant of resting intracellular Ca2+ in colonic special sensory neuron between TNBS group and normal control group (P＞0. 05);while the evoked transients [Ca2+] significantly increased compared with normal control group (P＜0. 05). The whole cell patch clamp recording showed that the L-type and R-type calcium current were significantly increased in colonic primary sensory neurons of TNBS group compared with normal control group (P＜0. 05). The inflammatory visceral hypersensitivity was significantly reduced by intrathecal injection of nimodipine and SNX-482 (P＜0. 05). Conclusion The up-regulation of Cav1. 2and Cav2. 3 play an important role in inflammatory visceral hyperalgesia,which may be the possible potential therapeutic targets for visceral inflammatory hyperalgesia.