Objective:To explore therapeutic effect of ticagrelor on patients with acute ST elevation myocardial in‐farction (STEMI) and its influence on short‐term prognosis .Methods :A total of 180 STEMI patients undergoing e‐mergency percutaneous coronary intervention (PCI) were selected ,randomly divided into clopidogrel group (n=90) and ticagrelor group (n=90) .Clinical therapeutic effect was compared between two groups ;platelet function ,inci‐dence of major adverse cardiovascular events (MACE) ,adverse reactions and bleeding events were observed in two groups .Results:Total effective rate of ticagrelor group was significantly higher than that of clopidogrel group (93.4% vs .87.8% ,P=0.036);compared with clopidogrel group on 24h and 7d after operation ,there were signif‐icant reductions in platelet aggregation rate [24h :(62.1 ± 5.2)% vs . (56.5 ± 5.4)% ,7d:(47.3 ± 6.1)% vs . (38.7 ± 5.2)% ] and P2Y12 reaction unit [24h:(218.1 ± 12.3) U vs . (201.3 ± 11.1) U ,7d:(173.4 ± 11.8) U vs . (152.6 ± 12.6) U] in ticagrelor , P< 0.05 all;there were no significant difference in incidence rates of MACE ,adverse reactions and bleeding events between two groups , P>0. 05 all .Conclusion:Compared with clopi‐dogrel ,ticagrelor can better reduce platelet aggregation rate and improve clinical therapeutic effect without increas‐ing incidence of adverse reactions and bleeding events .

Objective To investigate the curative effect of Candesartan on chronic systolic heart failure in Tibetan pla?teau. Methods A total of 526 patients with chronic systolic heart failure were divided into two groups randomly (Treatment group N=252;Control group N=274). Regular medicines, such as cardiac, diuretic and vasodilator drugs , are given to pa?tients in both groups according to their primary underlined diseases. Additionally, enalapril is added in control group, while candesartan is added in treatment group. Improvement of cardiac function, LVEF, LVEDD and blood pressure were compared between these two groups after 8 weeks. Results There was no significant difference in effective rate (i.e., 45.2%in treat?ment group and 44.9% in control group, respectively), efficiency rate (i.e. 54.8% in treatment group and 55.1% in control group, respectively) and inefficiency rate (i.e. 2.0%in treatment group and 2.2%in control group, respectively) between treat?ment and control groups . After treatment, LVEF in the two groups are all improved, while LVEDD and blood pressure both de?creased with statistical significance. However, the difference between the two groups is not significant. Conclusion No sta?tistical difference was found in curative effect on chronic systolic heart failure in Tibetan Plateau between two groups.

Objective To investigate the calcium dobesilate tablets combined with mecobalamin injection in treatment of diabetic peripheral neuropathy and effects on oxidative stress and neurotrophic factor.Methods 82 cases of diabetic peripheral neuropathy(DPN) patients from February 2015 to October 2016 in our hospital were selected and randomly divided into observation group and control group with 41 cases in each group.The control group was treated with mecobalamin injection, the observation group were treated with calcium dobesilate tablets.The course of treatment was two weeks in two groups.Results The total efficiency of the observation group (90.24%) was higher than the control group (68.29%) , the difference was statistically significant ( P<0.05 ) , patients in the observation group after the treatment of common peroneal nerve and median nerve SCV and MCV higher than the control group, the difference was statistically significant (P <0.05), the level of serum malondialdehyde (MDA) in the observation group was lower than that in the control group and the level of superoxide dismutase ( SOD) in the observation group was higher than that in the control group, the difference was statistically significant (P<0.05), the levels of serum NGF and BDNF in the observation group were higher than those in the control group, the difference was statistically significant (P<0.05), the two groups were no obvious adverse reactions.Conclusion Calcium dobesilate tablets and mecobalamin injection curative effect in the treatment of diabetic peripheral neuropathy , and patients could improve oxidative stress and neurotrophic factors, and the safety is good, has the important research significance.

Objective To discuss the significance of region Ⅵ lymph nodes dissection in treatment of patients with clinical cervical nodes negative(cN0)papillary thyroid carcinoma(PTC).Methods Clinical data of 38 cases of cN0 PTC treated with region Ⅵ lymph nodes dissection were retrospectively analyzed.The related literature was reviewed.The cervical nodes dissection scope and the key operation points in treatment of cN0 PTC were discussed.Results No permanent recurrent laryngeal nerve injury or parathyroid damage happened.14 cases(36.84％)had occult lymph node metastasis to region Ⅵ lymph nodes.After more than 5 years of follow-up,all the cases had excellent life quality.3 cases(7.89％)were found lymph node metastasis to lateral cervical region and they were given functional neck dissection.No recurrence or metastasis occurred to the 3 cases during more than 2 years of follow-up.Conclusion Region Ⅵ lymph node dissection in treatment of cN0 PTC is safe,reliable,and with less complications.

BACKGROUND: The locking plates are often used for internal fixation of closed tibial fractures. The use of a locking plate as an external fixator is still controversial, particularly for closed fractures. The purpose of this study is to evaluate the results of external fixation using the femoral less invasive stabilization system (LISS) plate in proximal metaphyseal fractures of the tibia. METHODS: We prospectively evaluated 35 patients (26 males and 9 females) with a mean age of 42 years (range, 21 to 62 years) who presented with fresh tibial proximal metaphyseal fractures. According to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, the fractures were identified as type 41-A2 in 18 cases and type 41-A3 in 17 cases, including 25 closed fractures and 10 open fractures. The femoral LISS plate was used to fix these fractures, which was placed on the anteromedial aspect of the tibia as an external fixator. The mean follow-up period was 18 months (range, 13 to 22 months). RESULTS: All fractures healed in a mean time of 14 weeks (range, 10 to 20 weeks). There was no case of nonunion, deep infection, and loosening of screws and plates. One month after the appearance of cortical bridging on biplanar radiographs, the locking plate was removed within 3 minutes in the clinic without any difficulty. According to the Hospital for Special Surgery (HSS) knee scoring system and American Orthopaedic Foot & Ankle Society (AOFAS) ankle scoring system, the mean HSS score was 91 (range, 85 to 100) and 98 (range, 93 to 100), and the mean AOFAS score was 94 (range, 90 to 100) and 98 (range, 95 to 100) at 4 weeks postoperatively and final follow-up, respectively. CONCLUSIONS: For proximal metaphyseal fracture of the tibia, external fixation using the femoral LISS plate is a safe and reliable technique with minimal complications and excellent outcomes. Its advantages include ease of performing the surgery, use of a less invasive technique, and convenience of plate removal after fracture healing.
Adult ; *Bone Plates ; External Fixators ; Female ; Fracture Fixation/*instrumentation/methods ; Humans ; Male ; Middle Aged ; Prospective Studies ; Tibial Fractures/radiography/*surgery ; Young Adult

Objective:To correlate homocysteine (Hcy) and blood lipid levels with neurological function in patients with progressive ischemic stroke.Methods:A total of 400 patients with ischemic stroke who received treatment between June 2018 and June 2020 in Linhai Second People's Hospital were included in this study. Progressive ischemic stroke ( n = 126) and non-progressive ischemic stroke ( n = 274) groups were designated. Hcy level was determined by enzyme-linked immunosorbent assay. High-density lipoprotein cholesterol, triacylglycerol, low-density lipoprotein cholesterol and cholesterol levels were measured using a biochemical analyzer. Hcy and blood lipid levels as well as National Institute Health of Stroke Scale (NIHSS) score were determined in each group. Hcy and blood lipid levels were correlated with NIHSS score. Results:Hcy level in the progressive ischemic stroke group was significantly higher than that in the non-progressive ischemic stroke group [(28.39 ± 4.36) μmol/L vs. (20.17 ± 3.24) μmol/L, t = 18.894, P < 0.05]. Low-density lipoprotein cholesterol , triacylglycerol and TC levels in the progressive ischemic stroke group were (3.29 ± 0.45) mmol/L, (2.08 ± 0.34) mmol/L and (4.82 ± 0.79) mmol/L, respectively, which were significantly higher than those in the non-progressive ischemic stroke group [(2.48 ± 0.37) mmol/L, (1.56 ± 0.29) mmol/L and (4.08 ± 0.43) mmol/L, t = 17.644, 14.859, 9.860, P < 0.05]. High-density lipoprotein cholesterol level in the progressive ischemic stroke group was significantly lower than that in the non-progressive ischemic stroke group [(1.03 ± 0.13) mmol/L vs. (1.19 ± 0.14) mmol/L, t =11.158, P < 0.05]. NIHSS score in the progressive ischemic stroke group was significantly higher than that in the non-progressive ischemic stroke group [(21.72 ± 4.35) points vs. (15.52 ± 2.89) points, t = 14.582, P < 0.05]. Hcy, low-density lipoprotein cholesterol, cholesterol and triacylglycerol levels were linearly and positively correlated with NIHSS score ( r = 0.846, 0.724, 0.718, 0.765, all P < 0.05), while igh-density lipoprotein cholesterol level was linearly and negatively correlated with NIHSS score ( r = -0.710, P < 0.05). Conclusion:In patients with progressive ischemic stroke, Hcy level is increased and blood lipid level is obviously abnormal. Hcy and blood lipid levels are greatly correlated with neurological function.

The proportion of laparoscopic surgeries is continuously increasing in general surgeries. Along with the development and application, new image sensor and digital image processing technology accelerated the emergence of novel laparoscope in recent years. Stereoscopic laparoscope (3D) appearing make the space orientation more accurate. new imaging methods and new structure design satisfy more clinical requirements; combination with optical technology (NBI technique, PDD technique, ICG technique) make intraoperative diagnosis possible.
Image Processing, Computer-Assisted ; Laparoscopes ; Laparoscopy

Messenger RNA(mRNA) CCT6A can encode chaperone proteins and plays an important role in malignant tumors such as colorectal cancer, lung cancer and breast cancer. CCT6A is highly expressed in malignant tumors, which can be used as a biomarker to assess patients' prognosis, and promote malignant biological behaviors such as tumor proliferation and metastasis by regulating transforming growth factor β signals, cell cycles, and other pathways. CCT6A can also modulate immune cell infiltration in the tumor microenvironment and may be a potential target for tumor immunotherapy. The paper reviews the expression and function of CCT6A in malignancies.

Objective:To comprehensively evaluate the utilization of some essential medicines among elderly people in clinic settings in China, in order to provide a reference for the selection of fully reimbursed medicines for the elderly.Methods:Expert consultations were conducted to evaluate the utilization of 58 essential medicines related to eight major therapeutic areas, including neurology, psychiatry, cardiovascular diseases, respiratory diseases, among elderly people.The evaluation indexes included safety, efficacy, compliance by medical staff, compliance by patients, clinical value, and pharmaceutical economics.Results:Except for psychiatry, authority coefficients for drugs related to the other therapeutic areas were greater than 0.7, indicating that experts were familiar with the indications of the medications.According to the comprehensive evaluation scores, 10 medicines, i.e., nitroglycerin, metoprolol tartrate, isosorbide dinitrate, omeprazole, metformin, amlodipine, aspirin, acarbose, valsartan, and clopidogrel, could be considered as the first choices for guaranteed essential drugs for the elderly.Meanwhile, another 10 medicines, including nifedipine, estazolam, tamsulosin, simvastatin, alfacalcidol, enalapril, bisoprolol, beclomethasone dipropionate, ipratropium, and salbutamol, could be considered as the second choices for guaranteed essential drugs for elderly people.Conclusions:The first choices recommended by experts as guaranteed essential drugs for the elderly are mainly cardiovascular, endocrine and respiratory medicines, in line with the disease spectrum of the elderly.The selection of essential medications with full cost reimbursement for elderly patients should be those frequently used and with a burden of high medicine costs.

Objective To investigate the role of Notch signaling pathway to maintain the stem cell-like characteristics of osteosarcoma and its underlying mechanism.Methods Lentiviral NICD1 or Numb-shRNA was transduced into MG63 osteosarcoma cells to activate Notch activity in vitro.The impact of Notch on osteosarcoma stem cells were assessed by the tumor sphere formation assay and flow cytometry analysis of cell surface markers STRO-1/CD117.The expression of stem cell related genes (Sox2,Oct4) were evaluated by Western blot and qPCR.The nude mice were randomly divided into 3 groups:the NICD1 overexpression (NICD-OE) group,the DAPT group and the control (CON) group.The tumor growth was monitored for 8 weeks and the tumor volume and weight were recorded weekly.To investigate whether Notch regulates Eph pathway,Eph pathway related protein EphB,pEphB was measured by Western blot.The impact of ephrinB 1 on NICD overexpression cell were assessed by tumor sphere formation assay.The expression of Sox2 and Oct4 was evaluated by Western blot.Results NICD1 overexpression or Numb-shRNA increased the activity of Notch pathway.The Notch-activated osteosarcoma showed enhanced in vitro tumor spheroid formation capacity,increased Stro-1/CD117double positive ratio,and upregulated expression of Sox2 and Oct4 in vitro.In animal experiments,it was found that activation of Notch pathway promoted tumor formation in vivo and Notch inhibition decreased it.The primary osteosarcoma cells were obtained from mice xenograft treated with DAPT and its tumor sphere formation capacity was significantly reduced.Finally,The Notch pathway inhibits the phosphorylation of EphB,as well as the downstream signal pathway of EphB,but there is no significant change in total EphB.The activation of Eph pathway inhibited Notch induced up-regulation of tumor sphere formation and Sox2 and Oct4 expression.Conclusion Notch signaling pathway maintains the stem cell-like characteristics of osteosarcoma probably by inhibiting the Eph pathway.