Objective To observe the therapeutic efficacy and safety of acupuncture and epidural anesthesia during full-term labor. Method A total of 199 eligible subjects experiencing natural labor were randomized into four groups. The acupuncture group was intervened by acupuncture at acupoints; the epidural group was given epidural anesthesia;the combined analgesia group was given acupuncture at acupoints plus epidural anesthesia; the control group was not given any interventions for analgesia. The Visual Analogue Scale (VAS) was adopted to record and compare labor pain (cervix dilation 3 cm at 0 min, 30 min, and 60 min, and at full cervix dilation); meanwhile, the active period of the first stage of labor, cervix dilation speed, the second stage of labor, Caesarean section (C-section) rate, instrumental delivery rate, Apgar score, and post-labor bleeding amount (2 h) were also recorded. The contents of blood β-endorphin (β-EP) and 5-hydroxytryptamine (5-HT) were monitored during the first stage of labor. Result Compared with the control group, the VAS scores dropped in the other three groups, and the decreases were similar in the epidural group and combined analgesia group, while the decrease in the acupuncture group was the least significant. Regarding the labor-related indexes, the cervix dilation speed was higher in the acupuncture group than in the control group(P<0.05), while there was no significant difference between the acupuncture group and control group in comparing the duration of the second labor stage(P>0.05). There were no significant between-group differencesin comparing the post-labor bleeding amount and Apgar score of the new-born babies(P>0.05), but compared with the epidural group, there was no use of assisted delivery. The content of blood β-EP during the first stage of labor increased in the acupuncture group and combined analgesic group(P<0.05), but there were no significant changes in the epidural group and control group(P>0.05). Conclusion Acupuncture analgesia can reduce labor pain and shorten labor duration without affecting the second stage of labor and security-related indexes.

Objective To investigate the relationship between abnormal bone mineral density (BMD) and subclinical thyroid dysfunction. Methods Thyroid function, biochemical indicators of bone metabolism and BMD were reviewed retrospectively in the subjects who received health checkups from July 1, 2009 to January 31, 2017 in the Health Check-up Department of Peking Union Medical College Hospital. People who had thyroid dysfunction, recognized risk factors for osteoporosis, and medication history were excluded. A cross-sectional analysis of thyroid status and biochemical indicators of bone metabolism was performed by the standard methods. BMD at the lumbar spine and femoral neck was measured using dual energy X-ray absorptiometry. Results A total of 6884 subjects (3726 women and 3158 men) were enrolled in the study, with an average age of (50.74 ± 10.41) years. They were divided into three groups:subclinical hyperthyroid, subclinical hypothyroid, and euthyroidism. The alkaline phosphatase in subclinical hyperthyroid group was higher than that in the euthyroidism group[ (67.95±20.64)U/L vs. (63.88±18.99)U/L]. Calcium and phosphorus in blood were higher in both subclinical hyperthyroid and subclinical hypothyroid groups. The rate of abnormal BMD in male euthyroidism, subclinical hyperthyroid and subclinical hypothyroid groups were 36.10％(1049/2906), 29.27％(12/41) and 27.01％(57/211), respectively. The rate of abnormal BMD showed no difference between subclinical hyperthyroid group and euthyroidism group (P>0.05). The rate of abnormal BMD was lower in subclinical hypothyroid group than in euthyroidism group (χ2=7.0901, P<0.01), especially in the males aged 40-49 years (χ2=10.4618, P<0.01). The rate of abnormal BMD in female euthyroidism, subclinical hyperthyroid and subclinical hypothyroid groups was 38.81％(1286/3314), 45.83％ (33/72) and 40.88％ (139/340), respectively. The rate of abnormal BMD showed no difference among the three groups (P>0.05). Conclusion There is no significant difference in the rate of abnormal BMD between subclinical thyroid dysfunction group and euthyroidism group, possibly because abnormal serum biochemical indicators preceded the presence of low BMD. More sensitive methods used to determine the status of bone metabolism await to be developed.

Objective To investigate the correhtion between cognitive impairment and cerebral atherosclerosis in patients with acute ischemic stroke.Methods Acute ischemic stroke patients without cognitive impairment were recruited before symptom onset.The Montreal cognitive assessment (MoCA) was used to evaluate the cognitive function.Magnetic resonance imaging (MRI) was used to identify the infarct locations and sides.Magnetic resonance angiography,CT angiography and digital subtraction angiography were used to identify atherosclerotic arteries.Resul~ A total of 101 patients with acute ischemic stroke were enrolled,including 75 (74.3％) with cognitive impairment.The proportions of age (54.54 ± 12.59 years vs.64.43 ± 10.37 years;t =-3.960,P ＜0.001),years of education ≤6 years (50.7％ vs.11.5％;x2 =12.257,P ＜ 0.001),and cerebral atherosclerosis (89.3％ vs.50.0％;x2 =18.137,P ＜0.001) of the cognitive impairment group were significantly higher than those of the normal cognitive function group.Multivariate logistic regression analysis showed that cerebral atherosclerosis was an independent risk factor for cognitive impairment in patients with acute ischemic stroke (odds ratio 1.720,95％ confidence interval 1.005-2.942;P=0.048).MoCA score was negatively correlated with the offending vessels (r=-0.365,P＜ 0.001) and the most severe vessels of atherosclerotic degree (r=-0.243,P =0.014).Conclusions Most patients with acute ischemic stroke had cognitive impairment in the early stage after onset,and the MoCA scores was negatively correlated with the degree of cerebral atherosclerosis.Cerebral atherosclerosis was an independent risk factor for cognitive impairment in patientswith acute ischemic stroke.

Objective: To study the mechanism of Gengnianle Water-paste Pills in resisting climacteric aging. Methods: Rats were randomly divided into blank group, model group, high and low dosage groups of Gengnianle, positive control group. The climacteric rat model were established by ectomizing the bilateral ovaries. The E2, follicle-stimulating hormone (FSH), luteinizing hormone (LH), triiodothyronine (T3), thyroid hormone (T4), thyroid-stimulating hormone (TSH) were detected. Results: Compared with model group, in high dose of Gengnianle group, the levels of E2, T3, T4 increased and the levels of FSH, LH, TSH reduced. The effect of high dose of Gengnianle in improving the adjustment function of the thalamus-hypophysis-ovary axis and the thalamus- hypophysis-thyroid gland axis is better than that of positive control group (P

Objective:To analyze the clinical features, imaging findings and gene test of patients with type Ⅱ Alexander disease.Methods:All the clinical data of three cases with type Ⅱ Alexander disease from August 2018 to June 2020 in the Department of Neurology, Qilu Hospital of Shandong University (Qingdao) and Qilu Hospital of Shandong University were collected, and their clinical and imaging findings were analyzed retrospectively.Results:All the three patients were middle aged and old men with a chronic progressive course, beginning with weakness of one or both lower limbs, followed by dizziness, dysarthria, dysphagia, sphincteral disturbances, constipation and orthostatic hypotension. Three patients all experienced misdiagnosis (hydrarthrosis, cerebral vascular disease, alcoholism, respectively) at early stage of the disease. Cranial magnetic resonance imaging (MRI) showed mild supratentorial periventricular leukodystrophy, which was not specific. Sagittal cranial MRI demonstrated medulla oblongata and upper cervical cord atrophy called “tadpole atrophy”, which had high suggestive value. The results of gene analysis showed heterozygous mutation of glial fibrillary acidic protein gene, which had been reported as pathogenic gene; c.1091C>T (p.A364V) in exon 6, c.722C>T (p.R258C) in exon 4 and c.197G>A (p.R66Q) in exon 1, respectively.Conclusions:Type Ⅱ Alexander disease is an autosomal dominant disease, most with point mutations, rarely with deletion mutations. Type Ⅱ Alexander disease should be suspected when a patient had signs of lower brainstem involvement such as dizziness, ataxia, pyramidal sign, autonomic dysfunction, especially when cranial MRI showed mild supratentorial leukodystrophy, and medulla oblongata and upper cervical cord atrophy.

Objective To evaluate the prognestic effect of thrombus aspiration combined tirofiban in patients of acute myocardial infarction. Methods 372 patients with acute ST segment elevation myocardial infarction were randomly divided into the observation group (n=183) and the control group (n=189). Patients in the observation group received thrombus aspiration combined tirofiban additional to conventional treatment, and cases in the control group received routine treatment. The curative effect, postoperative complications and adverse reactions were compared between the 2 groups. Results The postoperative TIMI classⅢperfusion was achieved in 152 cases (83.1%) in the observation group and 140 cases (74.1%) in the control group (P < 0.05). The left heart ejection fraction of the observation group on 7 and 30 days after surgery was (60.4±6.1)%and (64.3±5.6)%respectively which was higher than the control group with (52.4±5.9)% and (55.4±5.7)% on 7 and 30 days respectively (P < 0.05). Bleeding events were recorded in 36 cases(19.7%) in the observation group rensus 26 versus (13.8%) in the control group (P>0.05). MACE reorded within 30 d post operation was 10 cases(5.5%) in the observation group and 22 cases (11.6%) in the control group (P < 0.05). No thrombocytopenia recorded in both groups. Conclusions Thrombus aspiration combined tirofiban for patients with acute myocardial infarction during PCI can improve the postoperative coronary artery perfusion, left ventricular ejection function and reduce the incidence of MACE within 30 days.

Objective To investigate the effects of Ethephon on spermatogenic cells and sex hormones levels of adolescent male rats.Methods The male SD rats of 25-day old were randomly (from the random number table) divided into high dose group (2 000 mg/kg),middle dose group (1 000 mg/kg),low dose group (500 mg/kg) and control group (the same amount of physiological saline).They were given Ethephon through stomach for 14 d.The pathological changes in testis tissues were observed by HE staining.The apoptosis of germ cells were detected by terminal transferase labeling (TUNEL).The automatic chemical luminescence immunoassay analyzer was used to test the serum sex hormone levels.Results After ethephon and saline lavage for 14 days in the dose of 2 000 mg/kg,1 000mg/kg,500 mg/kg concentrations respectively,body weight growth was significantly decreased (F =3.58,P =0.03).Testis mass growth [(0.91 ± 0.17) g,(1.13 ± 0.15) g,(1.21 ± 0.11) g,(1.29 ± 0.28) g] was significantly decreased (F =4.31,P =0.02).Experimental group spermatogenic cell apoptosis,the apoptosis index increased (F =156.00,P =0.00),high dose group[(2.40 ±0.18)％] and middle dose group[(1.72 ±0.14)％] was significandy increased (P ＜ 0.01).The levels of testosterone and estrogen in serum showed a decreasing trend along with the increase of the doses,and there was a statistical significance (F =11.85,38.93,all P =0.00).Compared with the control group [(0.86 ± 0.10) μg/L],the testosterone levels in high dose group [(0.31 ± 0.08) μg/L],middle dose group [(0.36± 0.05) μg/L] decreased significantly (P ＜ 0.01).Compared with the control group,low dose group,middle dose group [(36.43 ± 3.57) ng/L,(38.62 ± 2.24) ng/L,(31.87 ± 5.78) ng/L],the estrogen level in high dose group[(27.39 ± 2.11) ng/L] was significantly reduced (P ＜ 0.01).Conclusion Ethephon has reproductive toxicity,and can cause the serum level of testosterone and estradiol decreased,resulting in spermatogenic cell apoptosis index increased and the spermatogenic capability decreased.

Objective To investigate the correlation between the CD40 gene( - 1 C/T)single nucleotide polymorphism(SNP) and acute coronary syndromes(ACS), and the expression of CD40 on platelets. Method A total of 562 patients with ACS canfirmed by coronary angiography were divided into 3 groups according to the clinical characteristics, namely ACS patients( n = 210), stable angina(SA) patients( n = 189) and control group( n = 163).ACS was defined as ischemic chest pain at rest resulting in admission to hospital and > 50% stenosis in a major coronary artery with or without a rise in troponin Ⅰ. SA was defined as stable effort-related angina without change in angina pattern in 3 months. Patients with infection, tumor, or liver or kidney disease were excluded The gene polymorphism was measured by the polymerase chain reaction and restriction fragment length polymorphism(PCR-RFIP) and identiffed by sequencing. The expression of CD40 on platelets was detected by flow cytometry. The frequency, distribution of genotypes was compared using cross-tabulation and standard X~2 test. Result The CC genotype(31% ) and C allele of frequency(57.9%)of CD40 gene in ACS patients were significantly higher than those in SA(15.9%, 43.1% ) and control groups( 16.1%, 42.6% ). No significant difference of the genotypes or allele frequencies was found between SA and control group(X~2 = 0.053, P = 0.974;X~2 = 0.017, P = 0.897). 1he expression of CD40 on platelets in patients with C alleles carries was significandy higher than that of T allele carries in each group( P <0.0001). Conclusions CD40- 1C/T polymorphism was associated with ACS in Chinese Han nationallity.

Objective To evaluate the anti-HBV effect of hypericin from the cellular level and to preliminarily explore its po-tential drug target point.Methods Liver cell line HepG2.2.15 cells secreting HBV particles were selected as the experimental ob-jects.Hypericin served as the HY group,lamivudine was taken as 3TC group and deionized water as the blank control group.The cells were grouped and administrated.The HBV-DNA copy level was measured at72 h after medication by Southern blot and fluo-rescent quantitative PCR;the inhibition rate of HBsAg and HBeAg was detected by using ELISA assay;the pgRNA expression level was tested by using Northern blot and fluorescent quantitative PCR;Western blot and fluorescent quantitative PCR were adopted to detect the expression of regulatory factors including HNF3β,HNF4α,PPARαand RXRα.Results Compared to the blank control group,both hypericin and lamivudine had significant inhibiting effect on HBV DNA and expression level of HBsAg and HBeAg in HepG2.2.15 cells (P <0.05).Hypericin could significantly decrease the pgRNA expression compared with the blank control group (P <0.05),while lamivudine had no obvious change (P <0.05).Moreover,hypericin exhibited significant effects on the expression of HNF3βand regulatory factor HNF4αcompared with the blank control group and 3TC group(P <0.05).Conclusion Hypericin represents a strong anti-HBV effect,moreover could increase the negative regulatory factor HNF3βn expression and decreases the positive factor HNF4αexpression,prompting that its drug target point could be pgRNA.

Principles of medical equipment course were explored of formative evaluation as the center examination,constructed an examination reform scheme as” One center (formative evaluation as the center),three systems (content system,operation system,monitoring system).” Made students to learn from the center of focus scores change to autonomous learning and culture analysis,solves the question ability and practical ability.At the same time,strengthen the teaching process of teaching and learning to communicate and exchange,Get the students learning feedback information to improve teaching and learning in time,Strengthen the students′ ability of autonomous learning and lifelong learning ability.