Objective To observe the effectiveness and safety of clopidogrel combined with fibrinolytic therapy for acute ST segment elevation myocardial infarction(STEMI).Methods From January 2004 to December 2006,a total of 158 STEMI patients in our hospital were treated with fibrinolytic agents combined with or without clopidogrel.There were 84 patients in clopidogrel group,including 66(78.6%)male,18(21.4%)female and 45(53.6%)elderly patients(aged ≥ 60 years);74 patients were in control group,including 58(78.4%)male,16 female(21.6%)and 40(54.1%)elderly patients.Clinical characteristics,patency of infarct-related artery(IRA),30 d major adverse cardiac events(MACE),recurrent angina and hemorrhage events of the two groups were retrospectively analyzed.Efficacy and safety of fibrinolytic therapy combined with clopidogrel in elderly patients(≥60 years old)subgroup were also estimated.Results Baseline clinical characteristics between the two groups were comparable.Clopidogrel therapy was associated with a higher proportion of patent IRA(69.1% vs 51.4%,P=0.035)and lower rates of cardiac death(0 vs 6.8%,P=0.047)and MACE(2.4% vs 12.2%,P=0.036).There was no significant difference in the incidence of recurrent angina(3.6% vs 2.7%,P=0.885),slight and severe hemorrhage events(7.1% vs 9.5%,P=0.811;1.2% vs 1.4%,P=0.533)between the two groups.In elderly patients,clopidogrel therapy was associated with a higher proportion of patent IRA(68.9% vs 45.0%,P=0.045),the declining tendency in MACE(2.2% vs 12.5%,P=0.155),but no significant differences in the other indexes.There were no significant differences in above-mentioned indexes between the elderly and younger patients in clopidogrel group.Conclusion Addition of clopidogrel to fibrinolytic therapy is safe and effective for both the elderly and younger STEMI patients.

BACKGROUND:Bone marrow mesenchymal stem cels can produce a variety of cytokines to provide some support for the growth and proliferation of myeloma cels.
OBJECTIVE:To investigate the effects of astragalus polysaccharides on the proliferation of bone marrow mesenchymal stem cels from patients with multiple myeloma and cytokine secretion.
METHODS:Bone marrow mesenchymal stem cels were isolated by density gradient centrifugation from the bone marrow of a healthy volunteer and a multiple myeloma patient, and were cultured and identified. Passage 3 bone marrow mesenchymal stem cels were colected, and the growth curve was depicted by the enzyme marker method. MTT method and flow cytometry were used to detect the effects of different concentrations (0.5, 1, 2, 4, 6, 8 g/L) of astragalus polysaccharides on the proliferation and cel cycle of bone marrow mesenchymal stem cels. The expression levels of interleukin-1β and interleukin-6 were detected by ELISA method.
RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cels from both the healthy control and multiple myeloma patient showed negative expression of CD34 and positive expression of CD44. The obtained cels from two sources had the characteristics of bone marrow mesenchymal stem cels. Cels from the healthy control had significantly shorter doubling time than those from the myeloma patient. After treated with 1 and 2 g/L astragalus polysaccharide, cel proliferation rate in the multiple myeloma group was significantly higher than that in the healthy control group; after treated with 6 and 8 g/L astragalus polysaccharide, the cel proliferation rate was significantly lower in the multiple myeloma group than in the healthy control group. After treated with 1 g/L astragalus polysaccharide, compared with the healthy control, the proportion of bone marrow mesenchymal stem cels from the multiple myeloma patient in G0/G1 phase was significantly decreased, while the proportions of cels in both S phase and G2/M phase from the myeloma patient were significantly increased. Interleukin-1β and interleukin-6 levels of bone marrow mesenchymal stem cels from the patient with multiple myeloma were significantly higher than those of cels from healthy control. After intervention with 0.5, 1, 2 g/L astragalus polysaccharide, the interleukin-1β and interleukin-6 levels of bone marrow mesenchymal stem cels from the patient with multiple myeloma were al significantly decreased. In conclusion, a certain concentration of astragalus polysaccharides can promote the proliferation of bone marrow mesenchymal stem cels and decrease the levels of interleukin-6 and interleukin-β in patients with multiple myeloma.

Objective To explore the application value of uric indicant monitoring on patients with impaired glucose tolerance. Methods 9 6 health examination people were selected who with glucose tolerance impairment diagnosis standard population in Jan to Feb 2015 in LaiZhou,There were no significant differences in age and sex composition between the two groups in 48 cases of experimental group and 48 cases in control group.There were no other diseases,and no drugs were taken to con-trol blood glucose.IGT patients in the experimental group using uric indican monitoring to establish personal diet guide, while the control group used normal health education guidance,the two groups respectively before experiment and at the end of detecting urinary indican,fasting blood glucose,2h glucose tolerance levels,and were compared.Results According to the findings of the two groups follow up and the experimental data collected during one year,at the end of the experiment the IGT patients in the experimental group levels of urinary indicant was (50.7±6.2 mg/L vs 78.5±7.9 mg/L),fasting blood glucose was (6.34±0.11 mmol/L vs 6.91±0.29 mmol/L),2h glucose tolerance was (7.81 ± 0.52 mmol/L vs 9.57 ± 1.13 mmol/L)which was lower than the control group.There was significant difference between two groups (t=2.0,2.6, 3.06,P<0.05).Compared with IGT in the experimental group at the end of the experiment,the level of uric indican was (50.7±6.2 mg/L vs 78.3±8.1 mg/L),fasting glucose was (6.34±0.11 mmol/L vs 6.78±0.19 mmol/L),2h glucose tol-erance was (7.81±0.52 mmol/L vs 9.33±0.93 mmol/L)was lower than before the start of the level (t=2.01,2.28, 2.83,P<0.05),and the difference was statistically significant.In terms of the outcome of the various stages of diabetes, IGT patients in the experimental group was significantly better than the control group (χ2=10.85,P<0.05),the difference was statistically significant.Conclusion Through the determination of uric indican to guide the glucose tolerance decrease in patients with a reasonable diet,is conducive to glucose tolerance in the patients with impaired on blood glucose control,can effectively reduce the glucose tolerance decrease (IGT)conversion to diabetes mellitus (DM),change to a positive direction.

This study was aimed to optimize the vacuumextraction technology of alkaloids fromSophora alopecuroides. The orthogonal test and comprehensive evaluation were used to optimize the vacuumextraction technology. Contents of total alkali and oxymatrinewere used as index components for optimizing the effect of three factors, which were the adding amount of water, extraction time, and extraction frequency. Comparison was made among optimal conventional extraction process, decoction extraction and vacuumextraction. The results showed that the optimum extraction process was to add 12 times amount of water, and to extract for 3 times under the temperature of 60℃, 1h for each time. It was concluded that the optimized extraction vacuum technologyof alkaloids fromS. alopecuroidsdecompression total alkali content and oxymatrine process was better than that of optimal conventional extraction process and decoction extraction. The vacuumextraction technology was stable and practical.

Objective　To explore the clinical superiority of two kinds of chopping nucleus methods in phacoemulsification——etch and turn technique, stop and chop technique.Methods　Three hundred and sixty-five eyes were performed with phacoemulsification, among which 85 eyes were performed with turn technique and 280 eyes were performed with chop technique.The results of the two kinds of chopping nucleus were analyzed.Results　(1)Time of chopping nucleus:time of turn technique averaged 81.26 seconds while chop technique averaged 40.71 seconds; (2)Visual acuity in the first week after operation:turn technique:vision of 76 of 85 eyes were 0.5 of better, 7 eyes were 0.2～0.5(8.2%) and 2 eyes were 0.2 or worse; chop technique: vision of 253 of 280 eyes were 0.5 or better (90.4%), 21 eyes were 0.2～0.5(7.5%) and 6 eyes were 0.2 or worse (2.1%);(3)Reaction of corneal endothelial cells after the operation: central endothelium rugosity appeared in 4 eyes (4.7%) with turn techinque and in 7 eyes (2.5%) with chop technique. Conclusion　The operation of the former is less difficult and the chopping nucleus time is longer. The time of the operation on the latter is shorter and it is appriate for hard nucleus and should be applied and spreaded. There are no marked differences as for the vision after the operation and the microcorneal injury between them.

ObjectiveTo explore the application of evidence-based nursing in ulcer pressure prevention of patients in cardiovascular surgery department and effect evaluation. MethodsEvidence-based nursing was applied to 342 patients in our department from January 2008 to October 2010,and the nursing effect was evaluated. ResultsNon of the 342 patients suffered ulcer pressure,the course of disease was shortened and the treatment effect was increased. ConclusionsApplication of evidence- based nursing in cardiovascular surgery patients can significantly reduce the occurrence of pressure ulcers,greatly improve the patients' quality of life,and also can increase the observation,analysis and problem solving ability of nursing staff.

Thirty patients with ulcerative rectitis were treated by lavement of balsalazide sodium solution combined with Xileisan (test group).The results were compared with those treated by salazosulfapyridine (SASP) suppository (control Ⅰ group, n = 25 ) and those treated by lavement of prednisolone and tinidazole (control Ⅱ group, n =28).The complete remission rate and effective rate were 67% (20/30)and 90% (27/30), 36% (9/25) and 60% (15/25), 68% (19/28) and 86% (24/28) for test group, control Ⅰ group and control Ⅱ group, respectively.The efficacy of test group and control Ⅱ group was better than that of control Ⅰ group (P ＜ 0.05).The least side effects occurred in test group ( P ＜0.05).The recurrence rates of 3 groups were 20% (4/20), 2/9 and 5/19, respectively.Lavement of balsalazide sodium solution combined with Xileisan is effective for ulcerative rectitis with less side effects.

OBJECTIVE:To investigate the effects of clinical pharmacists participating in the implementation of clinical path-way under the condition of disease diagnosis related groups-prospective payment system(DRGs-PPS),and to provide reference for promoting rational drug use in the clinic. METHODS:Patients with femoral neck fracture in the clinical pathway were collected from our hospital as research objects. The patient collected during Jan.-Dec. 2015 were included in control group(52 patients includ-ed,41 patients completed)and those collected during Jan.-Dec. 2016 were included in observation group(58 patients included,46 patients completed). Clinical pharmacists participated in the implementation of clinical pathway in observation group,and provided technological intervention and administrative intervention. No intervention was performed in control group. Hospitalization time, hospitalization cost,drug cost and ADR were observed in 2 groups. The rationality of antibiotics for prophylactic use,analgesic drugs,adjuvant drugs,anti-osteoporosis drugs and anticoagulant were compared between 2 groups. RESULTS:After clinical pharma-cists participating in the implementation of clinical pathway in observation group,there was no statistical significance in hospitalization time or the incidence of ADR between 2 groups(P>0.05); hospitalization cost and drug cost of observation group were significantly lower than those of control group,with statistical significance(P<0.05). Medication time and cost of antibiotics for prophylactic use,cost of analgesic drugs,medication time of adjuvant drugs in observation group were significantly shorter/lower than control group;type of anti-osteoporosis drugs was significantly more than control group,with statistical significance(P<0.05). CONCLUSIONS:Under DRGs-PPS,the participation of linical pharmacists participating in the implementation of femoral neck fracture clinical pathway can play an important role in regulating the clinical rational use of 5 kinds of drugs and ensuring the safety,effectiveness and econom-ics of drug use.

Objective To explore possible role of cellular repressor of E1A-stimulated genes(CREG) in the process of phenotypic switching of adventitial fibroblasts(AFs). Methods Immunofluorescent staining was performed with tissue sections from mouse carotid arteries to evaluate the relationship between the expression of CREG and smooth muscle actin-α(α-SMA) in injured arteries, especially in the adventitia. Tissue block pasted culture method was used to isolate and culture AFs. RT-PCR and Western-blot were used to detect the change of CREG andα-SMA mRNA and protein expression in AFs in the presence of different concentrations of AngⅡfor 12 h/24 h or in the presence of 100 nmol/L Ang Ⅱ for different times. Results Normal mouse carotid arteries had little α-SMA expression throughout the tunica adventitia. Arteries at day 1 and day 3 post-injury exhibited significantly higher immunofluorescence of α-SMA compared with non-injured arteries. Alpha-SMA expression began to decrease on day 7 and progressively declined on day 14. In contrast, immunofluorescent staining revealed that CREG was expressed in the adventitia of normal arteries. Expression of CREG in the adventitia of injured arteries was decreased on the 1st day, reached its lowest value on the 3rd day, and increased gradually from the 7th day, and was higher compared with that in non-injured arteries on the 14th day after injury. Similarly, the expression of CREG in AFs was very high, and AngⅡremarkably decreased mRNA and protein expression levels of CREG in a dose-dependent and time-dependent manner. Conclusions The changes in CREG expression correlate with AF phenotypic modulation, and CREG down-regulation may facilitate AF phenotypic switching into myofibroblasts (MFs).

Objective To study the effect of Chinese Herb of Yigan Granules in different dosages on bile secretion in rats.Methods The rats were randomly divided into 5 groups: blank control group,positive control group and high,mod erate,low dosages of Yigan Granules groups.The medicines were administered thr ough duodenal intubation for the rats.Then the volume of bile were gathered by common bile duct intubations in different time,and the volume of bile and the contents of bilirubin in bile were tested before and after given drugs.Results Yigan Granules increased the bile secretion in a dose-dependent manner and promote the secretion of bilirubin.Conclusion Chinese Herb of Yigan granules has a choleretic effect.