Objective To assess the association of vascular endothelial growth factor (VEGF) gene-460C/T and-634C/G polymorphism with diabetic retinopathy (DR) among patients in Asia and European by meta-analysis.Methods A systematic search of electronic databases (PubMed,Cochrane Library,EMBASE,VIP,Wanfang technological,CNKI,etc.) was carried out until Jun,2014.Case-control studies on the relationship between genetic polymorphism of VEGF-460C/T and VEGF-634C/G with diabetic retinopathy were included in this analysis.The data were quantitatively analyzed by RevMan 5.0 software after assessing the quality of included studies.The pooled odds ratios (OR) and their corresponding 95％ confidence intervals (CI) were used to assess the strength of the association.Results VEGF-460C/T (7 studies:899 cases and 786 controls) and VEGF-634C/G (10 studies:1615 cases and 1861 controls) were inclued in this meta-analysis.Significant association was found for-460C/T polymorphism in Aisa (C versus T:OR=1.52,95％CI was [1.22,1.90],Z=3.72,P=0.0002;CC versus CT+TT:OR=1.61,95％CI was [1.19,2.19],Z=3.05,P=0.002;TT versus CT+CC:OR=0.64,95％CI was [0.41,0.98],Z=2.07,P=0.04),and VEGF-634CC gene type was associated with DR in European (OR=1.56,95％CI [1.08,2.25],Z=2.37,P=0.02).No significant publication bias was found.Conclusions The metaanalysis demonstrated that DR was associated with VEGF-460C/T polymorphism in Asia,and C alleles and CC gene type was the risk polymorphism;VEGF-634C/G polymorphism was not associated with DR,but its CC genotype maybe the risk factor in European.Further case-control studies based on larger sample size are still needed,especially for-634C/G polymorphism.

Background Studies showed that vascular endothelial growth factor (VEGF) plays an important role in the development and progress of diabetic retinopathy (DR),and the association between VEGF-2578C/A polymorphism(SNPs) and risk for DR is a hotspot.Objective This Meta analysis aimed to investigate the comprehensive and reliable conclusion in the association of VEGF-2578C/A SNPs and risk for DR in different races.Methods A systematic search of electronic databases including PubMed,Cochrane Library,EMbase,VIP,Wanfang technological,CNKI and reference lists of relevant articles was carried out until April,2014.Case-control studies on the relationship between VEGF-2578C/A SNPs and DR were selected based on inclusion and exclusion criteria,and the relevance of VEGF-2578C allele to DR,the relevance of VEGF-2578C/A SNPs to DR and the relevance of VEGF-2578A allele to Caucasian DR were quantitatively analyzed.Begger funnel plot of publication biases on the relationships of VEGF SNPs with the risk of DR under the allele and dominant models was drown.RevMan 5.0 software was used for the statistical analysis.The pooled odds ratio (OR) and corresponding 95％ confidence interval (CI) were used to assess the strength of the association.Results A total of 1 228 DR cases and 1 224 diabetes controls without retinopathy(DWR) were included from 8 independent studies (9 groups of data).A significant relationships between VEGF-2578A allelic gene and VEGF-2578AA gene type with DR were found in all samples,and the A allelic gene and AA gene type were the risk genes of DR (A versus C:OR=1.39,95％ CI=1.08-1.80,Z=2.52,P=0.01;AA versus CC+C/A:OR=1.53,95％ CI=1.05-2.24,Z=2.20,P=0.03;CC versus AA+C/A:OR=0.70,95％ CI=0.50-0.98,Z =2.10,P =0.04).When the other two studies which did not meet the HardyWeinberg Equilibrium were incorporated in a sensitivity analysis,the results were not materially altered.VEGF-2578 A allelic gene was the risk gene to Europeans with DR (OR =1.50,95％ CI=1.02-2.21,Z =2.07,P =0.04),but not among Asians in subgroup analysis (P＞0.05).No significant publication bias was found.Conclusions The Meta analysis demonstrates that VEGF-2578C/A is associated with DR in Europeans but not in Asians.Further case-control studies based on larger sample size are still needed,especially in Asians.

AIM:To investigate the effect of hydrogen sulfide (H2S) on the expression of MAPKs and ileal epithelial cell apoptosis in the rats with intestinal ischemia-reperfusion ( I/R) injury.METHODS:Healthy female Wistar rats were randomly divided into sham operation group, I/R group, I/R+sodium hydrosulfide ( NaHS) group .The animal model of intestinal ischemia reperfusion was established.Apoptosis index ( AI) of ileal epithelial cell was measured by TUNEL assay.H2 S was detected by sensitive sulfide electrode.The mRNA expression of ERK, JNK and p38MAPK was detected by RT-PCR.The protein levels of phosphorylation( p)-ERK, p-JNK, p-NF-κB P65 and p38MAPK were deter-mined by Western blot.RESULTS:H2 S, ERK mRNA and p-ERK in I/R group were significantly higher than those in I/R+NaHS group and sham group while JNK mRNA, p38MAPK mRNA, p-JNK, p-p38MAPK, p-NF-κB P65 and AI were predominantly higher than those in I/R+NaHS group and sham group (P<0.01).CONCLUSION:H2S attenuates ileal epithelial cell apoptosis in the rats with intestinal I/R injury by down-regulating ERK mRNA p-ERk and up-regulating JNK mRNA, p38MAPK mRNA and phosphorylation of JNK, p38MAPK and NF-κB P65.

Objective To study the change in endogenous hydrogen sulfide (H2S) in patients with acute pancreatitis and its relationship to coagulation function. Methods A prospective case control study was conducted. Forty patients with mild acute pancreatitis (MAP group) and 40 with severe acute pancreatitis (SAP group) admitted to Yiwu Central Hospital in Zhejiang Province from December 2002 to March 2015 were enrolled. Forty healthy persons served as control (healthy control group). Blood was collected to determine the levels of H2S, blood coagulation factor Ⅷ (FⅧ), von Willebrand factor (vWF), plasminogen (PLG), antithrombin (AT), platelet count (PLT), tissue factor (TF), tumor necrosis factor-α (TNF-α), and protease activated receptor-1 (PAR-1). The correlations among the above parameters were analyzed. Results There was no statistical significance in sex, age, body weight and time of disease among three groups, indicating it was comparable among the groups. Compared with healthy control group, the levels of H2S, FⅧ, vWF, TF, TNF-α, and PAR-1 in MAP and SAP groups were significantly elevated [H2S (μmol/L): 67.42±6.34, 112.47±12.69 vs. 42.57±4.18, FⅧ: (67.5±5.8)%, (82.3±4.7)% vs. (57.2±6.4)%, vWF: (112.6±9.7)%, (142.5±12.5)% vs. (76.4±8.2)%, TF (ng/L): 45.27±4.34, 64.76±6.25 vs. 18.15±1.89, TNF-α (ng/L): 197.67±13.62, 324.72±25.54 vs. 20.08±2.57, PAR-1 (fluorescence intensity): 32.16±4.43, 56.12±7.07 vs. 12.27±2.12, all P < 0.01], and PLG and AT activity were significantly decreased [PLG: (52.4±4.7)%, (36.7±3.2)% vs. (62.1±5.6)%, AT: (43.2±6.9)%, (35.5±5.4)% vs. (53.6±6.1)%, all P < 0.01]. The changes in the parameters in SAP group were more remarkable than those in MAP group (all P < 0.01). PLT in SAP group was significantly lower than that in healthy control and MAP groups (×109/L: 8.5±1.1 vs. 15.7±2.8, 12.4±1.9, both P < 0.01). H2S was positively correlated with FⅧ, vWF, TF, TNF-α, and PAR-1 (r value was 0.56, 0.61, 0.72, 0.66, 0.64, respectively, all P < 0.01), and it was negatively correlated with PLG and AT (r value was -0.64, -0.57, both P < 0.01). Conclusion As an inflammatory factor, endogenous H2S deteriorates coagulation function in patients with acute pancreatitis by up-regulating TF, TNF-α, and PAR-1.

Objective To adopt the network meta analysis method to compare the incidence difference of cutaneous squamous-cell carcinoma(SCC)and rash in 5 kinds of targeted drugs regimen for treating malignant melanoma.Methods PubMed and Cochrane Library databases were retrieved by computer.The retrieval range was from their establishment to November 2015.The network meta analysis pooled the evidences of direct and indirect comparison for evaluating the pooled odds ratio(OR)and cumulative probability of cutaneous complications occurrence difference in 5 kinds of targeted drugs regimen for treating malignant melanoma.Results Six randomized controlled trials(RCTs)conforming to the inclusion criteria were included.The meta analysis results revealed that compared with Dabrafenib+Trametinib,the cutaneous SCC occurrence rate of Vemurafenib was higher(OR=9.20,95％CI=1.26-52.53),while the rash occurrence rate of Vemurafenib+Cobimetinib was higher(OR=6.81,95％CI=1.01-41.87).The surface under the cumulative ranking curves(SUCRA)value showed that adopting Trametinib had the lowest occurrence rate for SCC,and adopting Dabrafenib+Trametinib had the lowest occurrence rate of rash.Conclusion Dabrafenib+Trametinibis generate the lowest complication incidence rate of malignant melanoma.

Objective:To study the effect of Fragmin in treatment of unstable angina (UA).Methods:100 patients with UA were randomized into treatment group and control group.In the control group,the subjects were given routine drugs such as sorbitrate,nifedipine and aspirin,while those in the treatment group given fragmine in addition to the routine drugs.Results:The response rates in the treatment and control groups were 82.1% and 54.5%,respectively (P＜0.01).The total effective rates in the treatment and control groups were 92.9% and 63.6%,respectively (P＜0.01).The total effective rate of EKG improvement in the treatment and control groups were 80.4% and 50.0%,respectively (P＜0.01).Conclusion:Fragmin is effective in the treatment of UA.

Observe and study the morphological changes and effects on yoleperoxidase (MPO) of traditional Chinese medical complex Intestine-clearing Suppository (ICS) in preventing and treating ulcerative colitis (UC).Method.. Divide the experimental rats randomly into 6 groups, i.e., blank, salicylazosulfapyridine (SASP), model, high, middle and low dosage of ICS, except the blank group, makeother rats experimental UC model with albumen immunologic method of rabbit colon mucosa, further divide them randomly into 2 experimental groups, i. e. , prevention and treatment, afterwards at 2nd~21st day, give prevention group the medicine, 22nd~35th day, treatment group, then decapitate them and take the colon tissue, and observe it morphologically under optical microscope, measure active MPO, analyse statastic results. Result: Through general morphological observation ,we found there were serious congestion ,edema, mucosa erosion, many large ulcers in the rats of model group; less serious mucosa erosion and quantity of ulcers in SASP and low-dosage ICS groups: small ulcers, not serious mucosa erosion, low degree of congestion and edema in high-and middle-dosage ICS groups; the scores of inflammatory injury of ICS groups were markedly lower than that of model (P＜0. 01), meanwhile, the preventive and reating effectiveness of high-and middle-dosage groups was better than that of SASP (P＜0.05). Under the optical microscope, there were large area of mucosa coloboma in the rats of model group, the ulcer penetrated to muscular layer and serous coat; in SASP group and low-dosage ICS group, there were erosive mucosa and inflammatory cell infiltration, granulation on the base; in middle-and high-dosage groups, large part of colon mucosa recovered, granulation formed on the base, ulcers were obviously less than that in model group (P <＜0.01); there had marked difference compared with that in SASP group (P＜0.05). The MPO active values of high-and middle-dosage groups were markedly lower than that of model group (P ＜ 0.01). Conclusion: Traditional Chinese complex ICS had good prevention and treatment to rats UC, itseffectiveness was positively correlated with dosage and better than that of SASP suppository.

The essence of training for clinical postgraduates is comprehensive capacity,including clinical and scientific research capacity,and the demand for the former is relatively higher than the latter. By means of discussion on the source and the educational system for postgraduates,we try to train clinical anesthesiology postgraduates with high diathesis and meet the needs of clinical anesthesia.

Clinical practice is an important teaching stage for interns of anesthesiology in medical universities.We discuss advantages and disadvantages for different teaching modes in the course of clinical practice,aiming at choosing a better one to optimize practice quality and bringing up graduates with high diathesis.