Objective To study the consistency among non-invasive and invasive brachial artery pressure,radial artery pressure and invasive central arterial pressure,and to explore the correlation between the severe degree of coronary artery disease and invasive central aortic pressure.Methods A total of 331 patients who underwent coronary angiography in our hospital were selected.The invasive central aortic pressure,invasive and non-invasive brachial arterial pressure,radial artery pressure in all patients were measured.The severe degrees of atherosclerosis were recorded.The differences among invasive brachial arterial pressure and invasive radial artery pressure,non-invasive brachial artery pressure and non-radial artery pressure and invasive central aortic pressure were compared.Results The systolic pressure values measured in invasive and non-invasive brachial artery and radial artery were higher than that measured by central aortic pressure,while the diastolic pressure values measured in the four peripheral artery were lower than that measured in central aorta.The pressure values measured by non-invasive brachial artery pressure were more close to that measured by invasive central aortic pressure (P＞0.05).The systolic pressure was increased and the diastolic pressure was reduced in central aortic pressure with the coronary vessel lession numbers increased.The values of systolic pressure in patients with single-vessel,double-vessel and triple-vessel lesions were (118.2± 19.5) mm Hg,(124.9 ± 19.7) mm Hg and (137.7 ± 20.6) mm Hg,respectively and the values of diastolic pressure were (86.8±8.4) mm Hg,(85.3± 10.3) mm Hg and (83.1± 9.4) mm Hg,respectively.There were significant differences in systolic and diastolic pressure values among patients with single-vessel lesions,double vessel lesions and triple-vessel lesions(F=3.93,4.31,both P＜ 0.05).Conclusions The blood pressure values measured by noninvasive brachial artery pressure are more close to that measured by invasive central aortic pressure.There is a significant correlation between the severe degree of coronary heart disease and invasive central aortic pressure.Non invasive brachial artery pressure can be used in the early detection of cardiovascular dysfunction.

Objective To observe the correlation of estrogen,fasting insulin(FINS),fasting plasma glucose (FPG),glycosylated hemoglobin(HbA1c),blood lipids and carotid arteries -membrane thickening(IMT)in the postmenopausal women with type 2 diabetes.Methods 63 postmenopausal women with type 2 diabetes were divided into normal IMT group(group A),IMT thickening group(group B),plaque group(group C)according to the vascular ultrasound carotid artery intima thickness,at the same time 15 cases of healthy physical examination as control group (group D).All of the groups were detected the plasma total cholesterol(TC),high-density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol(LDL-C),fasting insulin(FINS),fasting plasma glucose(FPG),gly-cosylated hemoglobin(HbA1c),follicle-stimulating hormone(FSH),estradiol(E2).Results Compared with group A,the levels of FINS,IR,HbA1c,TC,LDL-C in group C was higher(t=16.83,14.44,2.50,2.38,2.42,all P<0.01 or P<0.05),however,the results of E2,HDL-C was decreased(t=7.32,5.51,all P<0.01).The levels of FINS,HbA1c,TC,LDL-C,FSH,IR in group D was lower than those of group C(t=19.74,36.44,8.64,7.95, 27.13,6.71,all P<0.01),On the contrast,the levels of HDL-C,E2 were elevated(t=11.34,8.72,all P<0.01). The Pearson's correlation analysis showed that E2 had negative correlation with FINS,IR,TC,LDL-C (P<0.01 or P<0.05).E2 had positive correlation with HDL-C(P<0.05).Logistic regression analysis showed that IMT and FINS,IR,HbA1c,LDL-C were positively correlated(OR=2.94,72.63,27.30,98.18,all P<0.01),while nega-tively correlated with E2 levels(OR=2.94,P<0.01).Conclusion The increased level of estrogen was a protective factor of carotid artery atherosclerosis in postmenopausal women with type 2 diabetes.

Objective To retrospectively analyze the therapeutic effect of wide surgical excision combined with low-dose adjuvant interferon-alpha 2b on cutaneous malignant melanoma.Methods A total of 32 patients with cutaneous malignant melanoma received wide surgical excision after preoperative examination and staging.The excisions were performed with a margin measuring 1-2 cm from the visible lesions or biopsy scars.Surgical modalities included direct suture after excision(4 patients),dactylolysis or toe amputation(6 patients),free skin grafting(15 patients),random skin flap transfer(3 patients)and pedicle skin flap transfer(4 patients).Lymph nodes were selectively dissected in 9 patients with regional transfer of lymph nodes,and inguinal lymph nodes were cleared away in 2 patients.One week after the operation,patients received adjuvant therapy with subcutaneous injection of interferon-alpha 2b(3 million IU,thrice per week)for one to three years.Results Preoperative tumor staging revealed 21 cases of cutaneous malignant melanoma at stage Ⅱ,and 11 cases at stage Ⅲ.The excisions healed by the first stage in all the patients.Up to June 2011,2 patients had been lost to follow up,5 patients with stage Ⅲ melanoma had died.Survival was observed in all of the 4 patients receiving 1-year follow up,12 of 13 patients receiving 1-3 year follow up,5 of 7 patients receiving 3-5 year follow up,and 4 of 6 receiving 5-year follow up.Of the 25 surviving patients,regional lymph node metastasis was observed in 8 patients,which developed within 2 years after the operation in 2 patients.The adjuvant therapy with interferon-alpha 2b lasted 3 years in 8 patients,and more than 1 year in 11 patients.Side effects were mild.Conclusion Wide surgical excision plus low-dose interferon-alpha 2b is effective for the treatment of stage Ⅱ and Ⅲ cutaneous malignant melanoma with lower local recurrence and higher survival rate.

Objective To observe and compare the efficacy and safety of implantation of tissue expanders adjacent to or under keloid tissues for large keloids on anterior chest. Methods Between Mar 2006 and June 2009, a total of 17 patients with large keloid lesions on anterior chest received treatment with 21 tissue expanders,among which 12 were placed under the normal skin adjacent to keloids, and 9 were inserted under the keloid lesions. The scar size varied from 4.5 cm × 3.0 cm to 15.7 cm × 5.5 cm. The capacity was 70 to 400 ml for expanders adjacent to the keloid tissue, 80 to 500 mi for those beneath the keloid tissues. After tissue expansion for 6 to 8 weeks, the expander was removed and keloid lesions were resected followed by the repair of defect with expanded flaps. Further more, the patients received intraoperative local intradermal injection of betamethasone and postoperative superficial electron beam irradiation with divided doses of 7 Gy in 3 consecutive days within 1 week after the surgery. Follow-up varied from 12 to 50 months. Results Twenty expanders, except 1expander pocket which was removed ahead of time due to infection, were implanted successfully during the whole course of treatment. The main complication was expander exposure in 4 patients, including 1 expander adjacent to the keloids and 3 under keloid lesions, which showed no significant influence on secondary operation. Fifteen patients reported relief of symptoms and achieved satisfactory outcomes, while 2 patients, including 1 treated with expanders adjacent to the keloids and 1 with expanders under the keloid tissue, showed great suture tension and experienced delayed stitch removal followed by the recurrence of keloids after the operation.Conclusions The implantation of tissue expanders under the adjacent normal skin or keloid lesions is an ideal treatment option for large keloids on anterior chest. Regional suture tension is a direct contributor to the recurrence of keloid formation after surgical excision.

Objective To discuss the effect of H2 on osteoclast differentiation of RAW264.7 cells induced by RANKL and RANKL/TNF-α.MethodsRAW264.7 cells were treated with H2 in the presence of RANKL and RANKL/TNF-α.RAW264.7 cells viability was assessed by CCK-8.Test the Oxidative Stress of the induced RAW264.7.The number of TRAP-positive cells were counted under light microscopy.The levels of cathepsin K (CTK) and matrix metalloprotein-9(MMP-9) mRNA were analyzed by real-time PCR.ResultsH2 can not influence the RAW264.7 cell viability but can lower oxidative stress.The significant difference(P<0.05) indicated that H2 could significantly decrease the number of TRAP-positive MNCs.The significant difference among the 4 groups in CTK and MMP-9 genes (P<0.05) indicated that H2 could down-regulate their mRNA expression.ConclusionH2 can reduce the oxidative stress and inhibit differentiation of RAW264.7 cells into osteoclasts.

Peroxisome proliferator-activated receptors (PPARs) are a family of nuclear hormone receptors belonging to the steroid receptor superfamily. Three PPAR isoforms, PPAR?, PPAR? (also known as PPAR?) and PPAR? have been found in the mouse. They can activate expression of many genes, including those involved in lipidmetabolism. PPAR? is ubiquitously expressed, but the level of expression differs markedly between different cell types. PPAR? is expressed in skeletal muscle at 10- and 50-fold higher levels compared with PPAR? and PPAR?, respectively. A role for PPAR? in skeletal muscle is to increase the genes expression with relation to oxidative metabolism. In order to determine the molecular mechanisms governing PPAR? gene expression in muscle, a 2 kb 5′ flanking region was cloned and analyzed. The DNA fragment is able to transcribe GFP in COS7 cells. Dual luciferase assay is used to quantify promoter activity. Deletion analysis of the 2 kb PPAR? promoter fragment in COS7 and NIH 3T3 cells shows that the proximal promoter sequence, nt -197 to +120, confers basal transcriptional activity of the mouse PPAR? gene. Computational analysis of putative cis-acting elements located within the ～2.0 kb mouse PPAR? 5′-flanking sequence was performed using the TRANSFAC database and MatInspector software and 4 potential MEF2A binding sites were found. And there is a potential binding site sharing 100% identity with positive element of MEF2A in the proximal promoter (nt -261). Co-transfection experiments of the PPAR? promoter reporter and pMEF2A expression plasmid (pMEF2A) showed that MEF2A significantly enhanced transcription activity of PPAR? promoter in NIH 3T3. Moreover, the enhancive effect depended on the concentration of plasmid pMEF2A transfected into cells. The results suggested that MEF2A may enhance transcription activity of the PPAR promoter in muscle cells.

Objective To compare the laboratory and clinical results between unstimulated in vitro maturation (IVM) and IVM converted from in vitro fertilization (IVF) in polycystic ovarian syndrome (PCOS) and non-PCOS patients.Methods We divided 591 IVM cycles in the First Affiliated Hospital of Wenzhou Medical Univesity from Jan.2008 to Dec.2013 into 4 groups:group A1B1,PCOS patients underwent unstimulated IVM protocol,240 cycles; group A1B2,PCOS patients underwent IVM converted from conventional stimulated IVF protocol,153 cycles; group A2B1,non-PCOS patients underwent unstimutlated IVM protocol,103 cycles; group A2B2,non-PCOS patient underwent IVM converted from conventional stimulated IVF protocol,95 cycles.Multiple linear regression method and binary logistic regression method were used to assess the influence of PCOS and protocols for IVM on laboratory and clinical outcomes.Results The mean number of oocytes retrieved was positively related with PCOS [partial regression coefficient (B)=3.37,P＜0.01].The maturation rate of oocytes was positively related with hCG-prime prior to oocyte aspiration (B=0.05,P=0.010).High-quality embryo rate was positively related with PCOS and IVM converted from IVF (B=0.08,P=0.010; B=0.09,P=0.001),as well as implantation rate related with them (B=0.07,P=0.010; B=0.10,P＜0.01).PCOS and IVM converted from IVF improved hCG positive (hCG＞10 U/L) rate (OR=1.636,95％CI:1.113-2.204,P＜0.05; OR=1.861,95％CI:1.307-2.649,P＜0.05) and the clinical pregnancy rate (OR=1.507,95％CI:1.041-2.240,P＜0.05; OR=1.881,95％CI:1.312-2.696,P＜0.05).IVM converted from IVF protocol decreased the spontaneous abortion rate (OR=0.490,95％CI:0.245-0.978,P＜0.05).Multiple gestation rate and ectopic pregnancy rate were not affected by PCOS condition and protocol used (P＞0.05).Conclusions PCOS and IVM converted from IVF protocol improved the high-quality embryo rate,implantation rate,hCG positive rate and clinical pregnancy rate.IVM converted from IVF protocol reduced the spontaneous abortion rate.PCOS patients may be more suitable for the IVM treatment.No matter PCOS or non-PCOS patients,IVM converted from IVF protocol had better pregnancy outcome than that of unstimulated cycle.

Objective To evaluate the efficacy and safety of different bismuth-based quadruple therapies for Helicobacter pylori (H.pylori) eradication.Methods From December 2012 to October 2013,240 patients with H.pylori infection were collected and evenly divided into clarithromycin group,levofloxacin group,furanzolidone group and metronidazole group.Each group received bismuth potassium citrate 220 mg,esomeprazole 20 mg and amoxicillin 1 000 mg twice daily.In addition,each group received clarithromycin 500 mg,levofloxacin 200 mg,furanzolidone 100 mg,and metronidazole 400 mg,respectively.The course of treatment was 10 days.At least four weeks after the end of therapy and withdrawal the medicine,patients underwent fasting 13C-urea breath test or 14C-urea breath test.The negative result indicated as successful H.pylori eradication.The adverse effects were observed and recorded during treatment.The rate of H.pylori eradication was analyzed by the intention to treat (ITT) analysis and per protocol (PP) analysis.Chi-square test was performed for eradication rate comparison among groups.Results According to ITT analysis,the eradication rate of clarithromycin group,levofloxacin group,furanzolidone group and metronidazole group was 81.67％ (49/60),88.33％ (53/60),93.33％ (56/60) and 73.33％ (44/60),respectively,and according to PP analysis which was 85.96％ (49/57),89.83％ (53/59),94.92％ (56/59) and 75.86％ (44/58),respectively.The differences among four groups were statistically significant (x2 ＝10.13 and 9.89,both P＜0.05).The differences between furanzolidone group and metronidazole group were statistically significant (x2 =8.64 and 8.55,both P＜0.01).There were no statisticaly significant differences in adverse effects among the four groups (x2 =0.47,P＞0.05).Conclusion The H.pylori eradication rate is high in furanzolidone contained bismuth based quadruple therapy and with good safety,which could be the first line treatment for H.pylori eradication.

A 70-year-old female patient presented with several cutaneous masses on the left neck and trunk for 40 years. Some masses were removed by surgical operation more than 10 years prior to the presentation, but recurred subsequently along with an increase in lesion number. Persistent dull pain emerged at the lesion sites 2 months prior to the presentation and the masses on the left neck ulcerated 10 days prior to the presentation. Histopathology showed tumor cell clumps in the dermis with benign eccrine spiradenoma components in the centre region and carcinomatous components in the periphery. The carcinomatous components included slightly atypical cells and hyaline degeneration. Immunohistochemically, carcinoembryonic antigen and epithelial membrane antigen were observed in the tumor tissues. The case was diagnosed as eccrine spiradenocarcinoma. The masses were surgically removed, but recurred 1 month later, increased in size and number and ulcerated 3 months later, and the patient died 6 months after the surgery.

Objective To investigate the distribution of cytotoxin-associated gene A (cagA) of Helicobacter pylori (Hp) and the polymorphism of EPIYA motifs in patients with upper gastrointestinal diseases in Changchun area of China and to evaluate the association between EPYIA motifs patterns and gastrointestinal diseases.Methods Hp strains were isolated from clinical samples.Their cagA gene was analyzed by PCR and sequencing analysis.Nucleotide sequence of cagA gene was translated into amino acid sequence by using DNAMAN software,and then the amino acid sequence was imported into software MEGA6.0 for multiple comparisons and construction of a phylogenetic tree.Results A total of 60 Hp strains were isolated and identified from gastric mucosa specimens collected from 298 patients.Hp infection was not correlated with patient's age or sex (P>0.05).The isolation rate of Hp in peptic ulcer disease (PUD) group was higher than that in non-peptic ulcer dyspepsia (NUD) group (P<0.05).Of the 60 Hp strains,90% (54/60) carried cagA gene.Twenty-three out of 26 successfully sequenced strains (88.4%) were East Asian-type including 22 containing EPIYA-ABD motif and one containing EPIYA-ABBD motif.The other three strains (11.6%) were Western type including two carrying EPIYA-ABC motif and one carrying EPIYA-BC motif.Results of the phylogenetic tree showed that the sequences of cagA gene were clustered into two groups,East Asian-type and Western-type groups.East Asian-type strains caused no disease cluster of statistical significance.All Western-type Hp strains were isolated from patients with peptic ulcer disease (PUD).Four mutant Hp strains were detected in the PUD group and the amino acid mutations preferentially occurred in the EPIYA-B segment.Conclusion The positive rate of Hp cagA gene is 90% in this region.Its distribution is not related to the type of gastrointestinal diseases.EPIYA-ABD (84.6%,22/26) is the predominant EPIYA motif.The amino acid mutation of EPIYA-B segment is closely related to peptic ulcer disease.Neither significant change in the sequence of 3' region of Hp cagA gene nor regional difference is observed in those Hp strains circulating in Changchun area of China.