Autophagy and apoptosis are two kinds of important ways of neuronal death in cerebral ischemia.The interaction of both in ischemic penumbra may alleviate or aggravate cerebral ischemic injury.This article reviews the role of autophagy and apoptosis in cerebral ischemia and their potential regulating mechanisms of interaction.

Specific detection of amatoxins and phallotoxins in body fluids is necessary for an early diagnosis of an intoxication with mushrooms.In this study, a rapid method for the simultaneous determination of α-, (β-and γ-amanitin, phalloidin and phallacidin in human urine and plasma was first developed by ultra-perform ance liquid chromatography-tandem mass spectrometry.Urine sample was directly injected into the separation system and plasma sample was initially prepared by precipitation of proteins with 1% acetic acid in acetoni trile.The toxin was analyzed on an ACQUITY UPLC HSS T3 column using a gradient program with a cycle time of 9 min, and detected by positive electrospray ionization tandem mass spectrometry in the MRM mode, and quantified by matrix-match standard solution.The detection limits (S/N = 3) of the toxins were within 0.2-1 μg/L and 0.1-0.5 μg/L for urine and plasma, respectively.The standard curves were linear in the range of 2-100 μg/L for urine and 1-100 μg/L for plasma.The average recoveries were 92.0%-108.0% and 85.0%-100.0% for the toxins spiked in urine and plasma, with RSDs of 1.0%-22.0% and 2.0%-22.0% (n = 6), respectively.The method was simple, selective and sensitive to detect the amatoxins and phallotoxins in urine and plasma for both clinical and forensic purposes.

A rapid method for the detection of tetrodotoxin(TTX) in human plasma and urine was developed by hydrophilic interaction liquid chromatography-tandem mass spectrometry. After a simple protein precipitation step was undertaken, the subsequent analysis of TTX was achieved on a TSK-gel amide-80 column using an ammonium formate-methanol-acetonitrile gradient with a cycle time of 13 min, and detected by positive electrospray ionization tandem mass spectrometry in the MRM mode, and quantified by matrix-match standard solution. It was found that linearity in urine was observed within concentration ranged from 3 μg/L to 500 μg/L, that in plasma 1 μg/L to 200 μg/L and that limits of detection(S/N=3) for urine and plasma were 1 and 0.3 μg/L, respectively. The average recoveries were 96%-108% and 100%-105% for TTX spiked in urine and plasma, respectively, with relative standard deviations of 1.7%-8.6% and 8.9%-16%(n=6). This method was simple, selective and sensitive to detect TTX in urine and plasma for both clinical and forensic purposes.

Objective To investigate the relationship of thyroid hormones and serum lipid profile during Pregnancy. Methods 30 cases of healthy pregnant women were recruited in the study. The thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and serum lipid profile were examined at 9 ~ 12, 14 ~ 17, 23 ~ 26 and 37 ~ 40 weeks of gestation and the correlations between them were analyzed. Results Positive correlation could be found between serum TSH and total cholesterol (CHOL), triglyceride (TRIG), low density lipoprotein cholesterol (LDL-C), ApolipoproteinA-I (APOA-I), ApolipoproteinB (APOB). Negative correlations could be found between serum FT3, FT4 and total cholesterol (CHOL), triglyceride (TRIG), low density lipoprotein cholesterol (LDL-C), ApolipoproteinA-I (APOA-I), ApolipoproteinB (APOB). And no correlation was found between serum thyroid hormones and high density lipoprotein cholesterol (HDL-C). Conclusion The thyroid hormones were closely related to serum lipid profile except of HDL-C.

OBJECTIVE:To observe the efficacy and safety of atorvastatin calcium combined with metoprolol in the treatment of chronic congestive heart failure (CHF). METHODS:207 CHF patients were randomly divided into control group (102 cases) and observation group (105 cases). Control group received cardiac,diuretic,vasodilating and oxygen inhalation,Metoprolol tar-trate tablet with initial dose of 6.25 mg,2-3 times a day,then increased 6.25-12.5 mg based on the improvement,2-3 times a day. Observation group additionally received 80 mg Atorvastatin tablet,twice a day. The treatment course for both groups was 16 w. Clinical efficacy,cardiac functions [left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),mi-tral early diastolic and late diastolic peak flow velocity ratio(E/A)],blood lipids [lipoprotein(a)Lp(a),triglyceride(TG),total cholesterol(TC)] levels before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in observation group was significantly higher than control group,the difference was statistically significant (P<0.05). Before treatment,there were no significant differences in cardiac functions and blood lipids in 2 groups(P>0.05). Af-ter treatment,the LVEF and E/A in 2 groups were significantly higher than before,and observation group was higher than control group,LVESD,Lp(a),TG and TC were significantly lower than before,and observation group was lower than control group,the differences were statistically significant (P<0.05). And there was no significant difference in the incidence of adverse reactions (P>0.05). CONCLUSIONS:Based on conventional treatment,the efficacy of atorvastatin calcium combined with metoprolol is su-perior to metoprolol in the treatment of CHF,with better safety.

Objective To study the clinical value of exposure of recurrent laryngeal nerve in thyroid operation for the prevention of recurrent laryngeal nerve injury. Methods A total of 90 patients received thyroid operation in our hospital from April 2012 to August 2014 were enrolled and randomly divided into observation group(n=45) and control group(n=45) according to whether the recurrent laryngeal nerve were exposed during operation. The patients in observation group received thyroid operation with recurrent laryngeal nerve exposure, and the patients in control group received conventional thyroid operation. Then recurrent laryngeal nerve injury situation and operation situa-tion were compared. Results Recurrent laryngeal nerve injury symptoms were less in the observation group (2. 22%) compared with that of the control group (15. 56%) with a statistically singnificant difference(P<0. 05). The operation time of observation group (54. 45 ± 6. 62) min was longer than that of the control group (41. 29 ± 5. 82) min with a statistically singnificant difference (P<0. 05). The recovery time of observation group (5. 85 ± 0. 85) d was shorter than that of the control group (8. 02 ± 1. 12) d, with a statistically singnificant differ-ence (P<0. 05). There was no significant difference in bleeding volume during operation,postoperative drainage volume and drainage dura-tion between two groups(P>0. 05). Conclusion Exposure of recurrent laryngeal nerve in thyroid operation is helpful to prevent recurrent laryngeal nerve injury,which reduce the damage recovery time,although it will extend the operation time,does not increase bleeding and drainage volume.

Through the literature combing the interest groups of hospital information disclosure in the United States, the demand and practice of the main interest groups are analyzed. This paper uses policy maker4. 0 software to further analyze the interests of various interest groups, power and the degree of influence by the policy of hospital information disclosure. The results showed that interest groups involved in hospital information disclosure in the Unit-ed States can be mainly divided into five categories:consumers, employers, health insurance companies, hospitals, and decision makers ( government) . In order to balance the cost-effectiveness of various insurance schemes, health insurance companies choose high-quality service providers to restrict poor-service providers and insurers, and hospi-tals need to use public information to manage and improve health care. In order to monitor and improve the quality of medical services, employers need to weigh various insurance plans, health insurance companies have to measure the service quality of themselves and competitors, and hospitals need to manage and improve the medical quality and in-crease market share. As the largest stake in the hospital information disclosure, the results show that the consumer's position on the hospital information disclosure is low support. From the consumer as a main, although the hospital in-formation disclosure practices but the right to speak and other small powers have a limited participation. Analyzing the of the interest groups of hospital information disclosure in the United States, they all push forward the hospital infor-mation disclosure work to provide evidence to support.

Objective:To explore and observe therapeutic effect of nursing exercise rehabilitation on home patients with chronic heart disease (CHF) .Methods :A total of 122 CHF patients ,who performed home‐rehabilitation in community from Jan 2012 to Feb 2015 ,were selected .According to sealed envelope extraction method ,patients were randomly and equally divided into routine nursing group (received routine nursing intervention ) and exercise intervention group (received early exercise intervention based on routine nursing group ) ,the intervention period was eight weeks for both groups .The 6min walking distance (6MWD) ,left ventricular ejection fraction (LVEF) ,scores of Minnesota living with heart failure questionnaire (MLHFQ) and self‐behavior management scale were measured and compared between two groups before and after nursing .Results:Compared with before nursing ,after nursing , there were significant rise in 6MWD ,LVEF and score of self‐behavior management in both groups , P<0.01 all . Compared with routine nursing group after nursing ,there were significant rise in 6MWD [ (482.44 ± 65.29) m vs . (546.24 ± 76.13) m] ,LVEF [ (35.69 ± 7.22)% vs .(38.83 ± 6.92)% ] and score of self‐behavior management [(89.19 ± 25.14) scores vs .(103.49 ± 22.44) scores] ,significant reductions in physical [(62.12 ± 17.97) scores vs . (42.32 ± 17.67) scores] ,emotional [ (67.76 ± 17.17) scores vs .(51.32 ± 16.41) scores] and social dimension score [ (72.43 ± 10.31) scores vs .(62.44 ± 10.45) scores] of MLHFQ in exercise intervention group ,P<0.01 all .Con‐clusion:Nursing exercise can significantly enhance heart function and athletic ability ,improve self‐care capacity , help to improve quality of life in home patients with chronic heart failure .

Objective:To study the metabolism of high density lipoprotein cholesterol ( HDL-C ) and apolipoprotein A-Ⅰ( ApoA-Ⅰ) in different thyroid function status during pregnancy. Methods:This study re-cruited thirty cases of euthyroid, with nineteen cases of subclinical hypothyroid and eight cases of subclini-cal hyperthyroid pregnancy. The concentrations of fasting serum HDL-C and ApoA-Ⅰwere detected and ana-lyzed from 9-12, 14-17, 23-26, and 37-40 gestational weeks. Friedman repeated measures ANOVA on ranks was adopted to analyze the changes of serum HDL-C and ApoA-Ⅰat different stages. General line-ar model ( GLM) was adopted to analyze the differences of serum HDL-C and ApoA-Ⅰin different thyroid function status during pregnancy. Results:There were no significant differences of maternal serum HDL-C among different stages (χ2 =5. 428,P=0. 143,χ2 =2. 027,P=0. 567,χ2 =2. 885,P=0. 410). There were significant differences of serum ApoA-Ⅰduring euthyroid and subclinical hypothyroid pregnancies (χ2 =46. 343, P<0. 001,χ2 =35. 984, P<0. 001), and no significant difference during subclinical hyperthy-roid pregnancy (χ2 =6. 750, P=0. 080). There were significant differences of serum HDL-C and ApoA-Ⅰbetween euthyroid and subclinical hyperthyroid pregnancies (P=0. 025,P=0. 027), and no significant differences between euthyroid and subclinical hypothyroid pregnancies (P=0. 378,P=0. 549). Conclu-sion:Subclinical hyperthyroidism affected the metabolism of maternal serum HDL-C and ApoA-Ⅰ, which could affect the fetal growth and development. Subclinical hypothyroidism ( after treatment with drugs) had no obvious effect on the metabolism of maternal serum HDL-C and ApoA-Ⅰ.

Congenital hypertrophic pyloric stenosis(CHPS)is a common gastrointestinal congenital mal-formation in neonate and small infants.Pyloromyotomy is an effective method for treatment of CHPS,including several methods.Traditional open pyloromyotomy for the patient's body injury is serious,such as accident of an-esthesia,postoperative infection,skin scar;laparoscopic pyloromyotomy can cause the pylorus muscle incision uncomplete,invasive operation damage,etc.Endoscopic pyloromyotomy for neonatal has some advantages:a lit-tle injury,no scars,simple operation,less complications,quicker recovery of feeding.Endoscopic mucosal pyloro-myotomy may be a new method of treatment,needing further exploration and research.