Pregnancy-associated plasma protein-A (PAPP-A),a high-molecular-weight zinc-binding metrix metalloproteinase,is expressed abundantly in the ruptured atherosclerostic plaque. PAPP-A can be used as a novel biological marker of plaque instability and cardiovascular events in patients with acute coronary syndrome. However,the role of PAPP-A in iscbemic stroke remains unclear. This article reviews the value of VAPP-A in predicting the risks of ischemic stroke events.

Objective To investigate the correlation between interleukin 18 (IL-18) gene promoter -137 G/C polymorphism and plasma levels of IL-18 and cerebral infraction.Methods A total of 218 Han patients with acute cerebral infarction in northern China were recruited and 218 sex- and age-matched health subjects were used as control group. Enzyme-linked irnmunosorbent assay was used to detcet the level of IL-18. Sequence specific primer-polymerase chain reaction was used to detect IL-18 gene promoter - 137 G/C polymorphism. Results The plasma IL-18 levels (1 47. 47 ±29. 79 ng/L vs. 78. 78 ± 16. 42 ng/L; t =29. 816, P ＜0. 01)and the frequency of - 137 GG genotype (79. 8％ vs. 67. 0％;x2 =8. 563, P =0. 032) in the acute cerebral infarction group were significantly higher than those in the control group. The risk of cerebral infarction in individuals with - 137GG genotype was 1.95 times higher than that in individuals without - 137GG genotype (odds ratio 1.95, 95％ confidence interval 1. 263-3. 012,P =0. 002); plasma IL-18 levels in patients with CG genotype were significantly higher than those in patients with CG +CC genotype (150. 00 ±27. 26 ng/L vs. 118. 47 ±21.62 ng/L, t =8. 222, P ＜0. 01). Conclusions The IL-18 gene promoter - 137 G/C polymorphism correlates with cerebral infarction in Han population in north China. The risk of cerebral infarction in individuals with GG genotype is significantly higher, and it may be associated with its influence on plasma level of IL-18.

Objective To establish Cox proportional hazards regression model and individual prognosis index (PI) equation for the 3-year recurrence of ischemic stroke and to verify their external reality according to their propective application.Methods A total of 1058 first-ever ischemic stroke patients admitted to our hospital were followed up from 2013-01-01 to 2013-12-31,during which the recurrence of ischemic stroke was recorded.Cox proportional hazards regression model and PI equation for the 3-year recurrence of ischemic stroke were established.Six hundred and sixteen first-ever ischemic stroke patients admitted to our hospital were followed up from 2016-01-01 to 2016-12-31.The external reality of Cox proportional hazards regression model for the 3-year recurrence of ischemic stroke was verified according to the established PI equation.Results Of the patients who were followed up in 2013,ischemic stroke reoccurred in 184.Cox proportional hazards regression model analysis showed that age,heart disease,hypertension,diabetes mellitus and TC were the independent risk factors for the recurrence of ischemic stroke.Of the patients who were followed up in 2016,ischemic stroke reoccurred in 114.The sensitivity,specificity and accuracy of PI equation in predicting the recurrence of ischemic stroke were 71.9％,76.9％ and 80.0％ respectively.Conclusion Establishment of PI equation for the 3-year recurrence of ischemic stroke can predict the recurrence of ischemic stroke.

The diagnosis of myocardial damage in systemic lupus erythematosus(SLE) is mainly based on clinical symptoms,physical examinations and electrocardiographic abnormality,echocardiographic changes,and myocardial enzymologic diversity in general.In recent years,it has been suggested that cardiac troponin I possesses high sensitivity and specificity in the diagnosis of myocardial damage.Lupus myocardial damage is diagnosed definitively depending on endomyocardial biopsy.Its treatment has been empirical,and hormone combined with immunodepressive is routine treatment.According to pathogenetic condition,there are still several therapies such as intravenous immunoglobulin therapy,blood purification and autologous hematopoietic stem cell transplantation,extracorporeal membrane oxygenation,and so on.Most often,myocardial dysfunction in SLE is of subclinical progression,and that early diagnosis and prompt treatment may play an important role in relieving patients' condition,raising quality of life and improving prognosis.

Objective:To observe the influence of SBAR communication mode on the condition of patients undergoing thoracolaparoscopic combined with esophageal cancer resection.Methods:A total of 200 patients who were admitted to the Department of Gastroenterology and Oncology from October 2017 to October 2019 in Affiliated Hospital of Southwest Medical University were selected for elective thoracolaparoscopic combined with esophageal cancer resection. According to the random number method, they were divided into 100 cases in the control group and the SBAR group. The control group used conventional preoperative communication visit mode, and the SBAR group used SBAR communication mode and preoperative visit based on the control group. The following items such as the preoperative negative mentality scores, quality of life score, postoperative complications and nursing satisfaction rate of the two groups before and after nursing interventionwere compared.Results:Before the intervention, the difference of the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores of the two groups was not statistically significant ( P>0.05). After the intervention, the SAS and SDS scores of the two groups were 49.32±4.96, 55.95±5.32, 50.93±4.74, and 56.33±5.89, respectively, which were significantly reduced. The SDS and SAS scores of the SBAR group were lower than those of the control group ( t values were -9.115 and -7.142, P<0.001). The difference of the World Health Organization Brief Table on Quality of Life (WHOQOL-BREF) scores of the two groups before the intervention was not statistically significant ( P>0.05). After the intervention, the WHOQOL-BREF scores of the two groups were 12.27±1.39 vs. 9.18±1.24, 16.13±1.51 vs. 12.48±1.22, 16.13±1.95 vs. 12.71±1.28, 15.09±1.81 vs. 13.08±1.48, 18.11±1.82 vs. 13.51±1.47, 14.09±1.61 vs. 12.98±1.28. The scores of the SBAR group were higher than those of the control group ( t values were 5.397-19.662, P<0.001). The postoperative complications rate of the SBAR group was 3.00% (3/100), which was less than 18.00% (18/100) of the control group ( χ 2 value was 11.971, P<0.001). The overall satisfaction rate of patients in the SBAR group with care was 100.00% (100/100), which was higher than the 84.00% (100/100) in the control group ( χ 2 value was 17.391, P<0.001). Conclusions:In patients with esophageal cancer undergoing thoracic laparoscopy combined with esophageal cancer resection, the use of SBAR communication mode for the patient′s preoperative visit can significantly reduce the patient′s preoperative anxiety and depression negative scores and improve the patient′s quality of life, reduce the occurrence of postoperative complications, improve patient satisfaction with nursing with ideal effect.

Objective To explore the effect of bilateral vagal nerves transection on the inflammatory reaction of rats induced by lung ischemia and reperfusion.Methods Twenty-four adult male SD rats weighed 250-320g were randomly divided into 3 groups (8 each): Sham group (S group), ischemia reperfusion group (IR group) and bilateral vagal nerves transaction and ischemia-reperfusion group (NIR group). Blood gas analysis with arterial blood was performed to detect the arterial partial pressure of oxygen (PaO2) and arterial-alveolar oxygen pressure gradient (A-aDO2) before ischemia and 0.5 and 4 hours after reperfusion. At the end of the experiment, the left lung tissues were collected to measure wet/dry ratio, the pathological changes were observed by light microscopy, and inflammatory indicators, including tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10) levels and myeloperoxidase (MPO) activity were detected.Results Compared with S group, ischemia and reperfusion injury sharply decreased PaO2 and increased A-aDO2; the MPO activity, the contents of TNF-α and IL-10 and the wet/dry ratio obviously increased in IR group; more infiltration of inflammatory cells, hemorrhage, thickening and swelling of alveolar walls were observed. Compared with IR group, PaO2 further decreased while A-aDO2 had no obvious change in NIR group, the inflammatory reaction and pathologic lesions in lung tissues were getting worse.ConclusionBilateral vagal nerves transaction may aggravate lung ischemia and reperfusion injury, suggesting that the integrity of vagal nerves play a significant role in regulating inflammatory reaction of lung ischemia and reperfusion injury in rats.

Objective To explore the practical method and teaching effect of problem-based learning (PBL) pattern in teaching of gastrointestinal disease for seven-year-program students during their internal medical probation.Methods The traditional pattern (gastrointestinal diseases) and PBL pattern (hepatobiliary diseases) were applied in these students to assess the teaching effects by exam scores and questionnaire.Results ① There was no significant difference between traditional training and PBL by exam scores (P＞0.05).② The PBL approach was widely accepted by students,which could contribute to the improvement of their learning motivation.It developed skills,including self-directed learning,summarizing,and clinical thinking capability and so on.Conclusion The PBL approach is a practical learning strategy that can improve the teaching effect; therefore it should be wildly practiced in future works.

Objective To investigate the effect of cognitive intervention on language function and quality of life (QOL) in elderly patients with post-stroke aphasia.Methods Fifty-five elderly patients with post-stroke aphasia were randomly divided into the control group (n =27) and the experimental group (n=28).The control group received comprehensive treatment including speech-language therapy (SLT),while the experimental group was subjected to additional cognitive intervention.All patients were enrolled in an eight-week rehabilitation program.The mini-mental state examination (MMSE) was used to assess cognitive function,a device for diagnosis and treatment of language disorders,ZM 2.1,was used to evaluate language function,and the 36-item short-form health survey (SF-36) (Chinese version) was used to assess quality of life (QOL),before and after treatment.Results After treatment,MMSE scores,language function scores in all categories and QOL scores in all dimensions improved in both groups (P＜0.05 for both).Furthermore,after treatment,there were significant differences between the two groups in MMSE scores of orientation,recall,attention and calculation,and in scores of overall language ability and the individual categories (P＜0.05 for all).Scores of the experimental group vs.the control group for the individual categories of language function were as follows:simple instructions (76.6 ± 14.1 vs.67.4± 19.3),complex instructions (66.1±12.8 vs.58.2±14.9),yes or no (72.5±12.1 vs.63.0±14.1),naming (55.0 19.5 vs.43.3±22.2),simple comprehension (67.5±21.4 vs.55.620.6),complex comprehension (44.8±17.0 vs.35.0±18.9),listening and reading words (65.4±16.7 vs.53.7±19.3),calculation (39.3±25.8 vs.25.9±19.2),memory (36.4±18.7 vs.26.3±17.8),matching (75.9±18.6 vs.65.3±17.1),simple general knowledge (68.3±18.2 vs.58.0±19.5),complex general knowledge (58.7±17.4 vs.50.0±13.3),orientation (70.7±19.6 vs.60.5±17.2) and comparison (59.9± 14.6 vs.50.2±17.5) (P＜0.05 for all).There were significant differences between the two groups in emotional function (66.7±18.2 vs.53.1±21.2),general health (67.2±12.6 vs.60.7±9.8),mental health (71.0±5.6 vs.63.1±4.2),social functioning (64.7±9.0 vs.59.3±10.2) and vitality (55.4±14.8 vs.46.9±15.6) (P＜0.05 for all).Conclusions Cognitive intervention combined with SLT can contribute to the recovery of language function and the improvement of QOL in elderly patients with post-stroke aphasia.

Resveratrol is a polyphenolic compounds in many plants.It has many effects inchuding antioxidation,anti-inflammation,inhibiting apoptosis,and scavenging free radicals.Resveratrol preconditioning has neuroprotective effect in ischemia-reperfusion in rats by activating silent information regulator 2 homolog 1.This effect is similar to brain ischemic preconditioning.In addition,resveratrol can also attenuate the brain infraction volume of cerebral ischemia/reperfusion in mice and improve neurological function.This article reviews the neuroprotective effect of resveratrol and its mechanisms in cerebral ischemia.

Objective To explore the clinical effect of restructuring human brain natriuretic peptide in treatment of heart failure associated with severe acute myocarditis.Methods Fifty cases of heart failure associated with severe acute myocarditis were divided into experimental group and control group according random number table method,each group 25 cases.The patients in control group were given conventional treatment,and the patients in experimental group were given restructuring human brain natriuretic peptide on the basis of conventional treatment.The clinical effects of two groups were observed.Results The level of N terminal brain natriuretic peptide,left ventricular ejection fraction,urine volume,creatinine in two groups had no significant difference before treatment (P ＞ 0.05).After treatment,these index in experimental group were better than those in control group [(7 785 ± 432) ng/L vs.(10 022 ± 447) ng/L,(45.28 ± 2.67)％ vs.(41.34 ±3.11)％,(1 833 ±49) ml/24 h vs.(1 456 ±47) ml/24 h,(109.34 ± 10.77) μmol/L vs.(125.44 ± 11.00) μ mol/L] (P ＜ 0.05).The rate of clinical symptoms improving in experimental group was significantly higher than that in control group [71.4％ (55/77) vs.26.0％ (20/77)] (P ＜0.01).Conclusion Restructuring human brain natriuretic peptide with conventional treatment can effectively improve heart failure associated with severe clinical symptoms of acute myocarditis,improve the clinical therapeutic effect.