Objective To study the clinical efficacy and safety of clopidogrel combined with aspirin in doub-le loading dosage and ordinary dosage in the treatment of acute non -cardiac cerebral infarction.Methods A total of 110 patients with acute non -cardiac infarction were equally assigned into two groups,each group had 55 patients.The patients in group A were treated with clopidogrel 300mg and aspirin 300mg on the 1st day,and followed by clopidogrel 75mg and aspirin 100mg every day.Patients in group B were treated with clopdogrel 75mg and aspirin 100mg every day.Clinical efficacy and safety were evaluated in one week,NIHSS scores were evaluated,and adverse effects were recorded during treatment.Results After one week treatment,the deteriorate rates of group A and B were 12.7%, 18.2%.Compared with group B,group A had lower cerebral infarction deteriorate rate,but there was no statistically significant difference(P =0.429).After seven days treatment,the NIHSS score of A group had improved[(4.42 ± 3.34)points vs.(3.15 ±2.58)points],the difference was statistically significant(t =3.713,P <0.01 ),which in group B had no significant improvement[(4.16 ±2.76)points vs.(3.80 ±3.15)points,t =1.209,P =0.232].After seven days treatment,the NIHSS score improvement of group A was (1.27 ±2.54)points,which of group B was (0.36 ±2.23)points,the difference was statistically significant(t =1.994,P =0.049).No severe adverse effects occurred in both two groups.Conclusion Using clopidogrel combined with aspirin in double loading dosage may effectively attenuate stroke process and improve prognosis than ordinary dosage.Using clopidogrel combined with aspirin had no severe adverse effects in short -term treatment of acute non -cardiac cerebral infarction.

Clinical practice is quite important transition phase for medical students to become qualified doctors,and development of surgerical skills is the diffficult and key point in the clinical practice.Intensive training of surgerical skills before clinical practice can enhance the confidence and efficiency of medicine students during the course of clinical practice.Whihin limited time,the key of intensive training of surgerical skills is the training of aseptic technique and basic skills of surgery,and during the course of training,attention should be paid to both principle and details.

BACKGROUND:Simvastatin enhanced the expression of bone morphogenetic protein-2(BMP-2),which plays an anabolic role in bone metabolism and osteoblastic lineage differentiation.However,little is known about the molecular mechanism of simvastatin on regulation of bone marrow stromal cells differentiation.OBJECTIVE:To investigated the effect of simvastatin on osteoblastic differentiation of bone marrow stromal cells based on genetics level.METHODS:Bone marrow stromal cells derived from femur and tibia were cultured in different mediums with simvastatin or Vehicle for 7 days Following extraction and purification,mRNA was reverse-transcripted into cDNA.Fluorescence labelina was employed and the samples were then hybridized with oligonucleotide chip to screen the different genes,which were utillzed to analyze osteogenesis-related factors.Alkaline phosphatase and Von Kossa staining were performed at days 14 and 21,respectively.RESULTS AND CONCLUSIONS:At day 14,alkaline phosphatase-positive cells were more in the experimental group than control group.Von Kossa staining demonstrated that simvastatin could promote BMSCs osteoblastic differentiation and mineralization.Comparative analysis showed that 103 genes out of 22 575 rat genes had differential expression (≥2 fold or≤ 0.5 fold),and some genes were related to cell proliferation and ostoeblastic differentiation,including C/EBP δ,Cited,Ascl2,Ptpnl6,Wisp2,Tieg,etc.Simvastatin could induce osteoblastic differentiation of bone marrow stromal cells,involving in many osteogenetic-related genes.

Objective To evaluate the significance of AFP-IgM, this is one of new tumor markers, in the diagnosis of primary hepatocellular carcinoma (PHC). Methods The contents of AFP-IgM and AFP in serum of 103 healthy subjects, 74 patients suffered primary hepatic carcinoma, 27 patients affected by liver cirrhosis and 63 patients affected by chronic hepatitis were detected by means of enzyme linked immunosorbent assay and electrochemiluminescence. No-PHC is comprised of liver cirrhosis,chronic hepatitis and health subjects as control group. Results The area under ROC curve of AFP was larger than that of AFP-IgM (0.85 vs 0.72, Z=3.21) and the best cut-off value of AFP-IgM and AFP was 3×105-AU/L and 10 ug/L respectively, which was determined by ROC curve. Under the cut-off value, the sensitivity of AFP- lgM and AFP for PHC were 64.9% and 79.7%, and the specificity were 75.6% and 80.3%, yet their efficacies were similar. However, for early diagnosis of liver cancer (stage Ⅰ and Ⅱ), the area under ROC curve of AFP-IgM was larger than that of AFP (0.91 vs 0.82,Z=1.73). The sensitivity of AFP-IgM andAFP were 94.4% and 72. 2%, and the specificity were 81.9% and 79.9%. The differences of AFP-IgMand AFP for early diagnosis of liver cancer were statistically significant. When both of the test results combined AFP-IgM with AFP are positive, it can be diagnosed as liver cancer. The specificity of combineddetermination of the two forms was 89.1%, and the efficacy was 79. 0%. Conclusions Both of thesensitivity and specificity of the AFP-IgM test were higher than that of the AFP for early diagnosis of livercancer. We also found that combined determination of the two forms significantly increased the specificityand the positive predictive value for the diagnosis of PHC, thus AFP-IgM was of especially significance forearly diagnosis of liver cancer.

Objective:To conduct a position evaluation of functional departments directors by means of Hay guide-chart profile (Hay) and international position evaluation (IPE) for heads of public hospital departments, and a comparative analysis of the results, for reference in reforming the performance-related pay system of the functional departments.Methods:From July to August of 2021, positions of ten functional department directors of a public tertiary general hospital were selected, and expert groups within and out of the hospital were invited for a position evaluation using both Hay and IPE. Cronbach α and intraclass correlation coefficient were used in the reliability and consistency evaluation. Technique for order preference by similarity to ideal solution (TOPSIS) was conducted to compare the differences between results of both methods, with the position value ranked by quartiles. Results:22 position evaluation forms were issued and 20 were recovered (12 for in-hospital experts and 8 for extramural experts). In Hay evaluation, the scores of medical affairs department and hospital head office were higher, averaging 757.30 and 727.21 respectively, and those of logistics management department were the lowest, being 279.94. In-hospital experts scored lower than those extramural experts on the posts of directors of scientific research management department, Party committee office and medical insurance department, while the scores of the directors of the hospital head office were higher than those extramural experts. In IPE evaluation, the position values of hospital head office and medical affairs department were the highest, averaging 680.25 and 621.00 respectively, and the score of the logistics management department was the lowest, being 365.05. In-hospital experts scored lower than those extramural experts on the posts of directors of Party committee office, scientific research management department and logistics management department, while the scores of the directors of the hospital head office were higher than those of extramural experts. The Cronbach α coefficients of position value scoring of functional department heads evaluated by two evaluation methods were 0.943 (Hay) and 0.800 (IPE) respectively. The hospital head office and medical affairs department ranked the first quartile, the Party committee office and nursing department ranked the second, while the medical insurance department and logistics department ranked the third and fourth respectively. In addition, the ranking differences of the information technology department, human resource department, financial department and scientific research management department were within one quartile. Conclusions:The position evaluation results of Hay and IPE are consistent, but the former is more sensitive. Ranking of position values by quartiles via TOPSIS can support the reform of performance-related pay system of functional departments of public hospitals.

Yeast autolysis under solid-state fermentation can effectively promote the release of various active substances, thereby improving the quality of yeast products. The optimal process for yeast autolysis under solid-state fermentation was obtained by optimizing the autolysis temperature, autolysis time and the zinc ion concentration. We analyzed the indexes of free amino acid, soluble protein and α-amino nitrogen in the fermentation material, as well as A₂₆₀/A₂₈₀ ratio to determine yeast autolysis process conditions in the solid-state fermentation. On the basis of the obtained data, L₉ (3³) orthogonal test was designed to optimize the solid-state fermentation parameters for yeast autolysis: temperature at 40, 50 and 55 °C; time 12, 18 and 24 h; zinc ion concentration 2, 4 and 8 mg/kg. The optimum process conditions for yeast autolysis were: autolysis temperature 55 °C, time 18 h, zinc ion concentration 2 mg/kg, and soluble protein content reached 9.31 mg/g, free amino acid 14.36 mg/g, α-amino nitrogen 10.16 μg/g and A₂₆₀/A₂₈₀ 1.73. After optimization of the process, the soluble protein, free amino acid and α-amino nitrogen contents of the yeast autolysis production can be significantly increased, thereby obviously improving the quality of the composite culture.
Amino Acids ; Autolysis ; Fermentation ; Humans ; Hydrogen-Ion Concentration ; Nitrogen ; Saccharomyces cerevisiae ; Temperature

OBJECTIVE： To systematically evaluate the efficacy and safety of cyclosporin combined with glucocorticoid versus cyclophosphamide combined with glucocorticoid in the treatment of membranous nephropathy （MN）. METHODS： Retrieved from Embase， Medline， CNKI， VIP and Wanfang database， RCTs about cyclosporin combined with glucocorticoid （trial group） versus cyclophosphamide combined with glucocorticoid （control group） in the treatment of MN were collected. Meta-analysis was conducted by using Rev Man 5.3 statistical software after literature screening， data extraction and quality evaluation with Jadad scale. RESULTS： Totally 6 RCTs were included， involving 312 patients in total. Results of Meta-analysis showed that remission rate 3 months after treatment [OR＝3.42，95％CI（2.05，5.71），P＜0.000 01] and relapse rate [OR＝3.12，95％CI（1.45，6.70），P＝0.004]， leukocyte count 12 months after treatment [MD＝1.77，95％CI（0.96，2.58），P＜0.000 1] in trial group were significantly higher than control group. There was no statistical significance in remission rate 6 months after treatment [OR＝2.06，95％CI（0.80，5.30），P＝0.13] and remission rate 12 months after treatment [OR＝1.30，95％CI（0.68，2.48），P＝0.42]， blood creatinine level 3 months after treatment [MD＝－1.55，95％CI（－6.72，3.62），P＝0.56] and blood creatinine level 6 months after treatment [MD＝－1.21，95％CI（－5.96，3.54），P＝0.62]， cholesterol level 12 months after treatment [MD＝－0.77，   95％CI（－1.81，0.28），P＝0.15] or ALT level[MD＝－0.40，95％CI（－4.38，3.58），P＝0.98] between 2 groups. ADR were reported in 5 RCTs， but their results were different. CONCLUSIONS： Long-term efficacy of cyclosporine combined with corticosteroid is similar to that of cyclophosphamide combined with corticosteroid in the treatment of MN. Cyclosporin combined with glucocorticoid has a faster effect， but a higher relapse rate.