The college is an important base where high practical personnel are cultivated.In order to meet the special need in nursing for pharmacological knowledge and skills,this paper deals with the improvement of teaching method in pharmacology from the aspects of teaching materials,contents,methods as well as practical teaching.

Objective: To investigate the findings of coronary artery angiography in coronary artery disease patients with diabetes mellitus. Methods: The angiographic fingings of 153 coronary artery disease patients from 1995 to 1997 were reviewed. Among them, 33 were diabetic,23 were impaired glucose tolerance(IGT) and 97 were nondiabetic patients. Results: The age, sex, hypertension, hypercholesterolemia, smoking and the rate of myocardial infarction were the same among 3 groups. But the 2 vessel and 3 vessel disease were more frequent in diabetic group(66.7% ,30.3%) than in nondiabetic group (26.8%,19 6%). Two vessel disease were more frequent in diabetic group(66.7%) than in IGT group (13.1%). Single vessel disease were less frequent in diabetic group(3.0%) than in IGT group(52.2%)and nondiabetic group(53.6%)( P

Objective To explore the specific role of autophagy and ubiquitin-proteasome pathway in apoptosis, specific protease inhibitor and (or) macroautophagy inhibitors.Methods The stimulators were selected to work on the pheochromocytoma (PC12) cell lines transfected with human mutant α-synuclein (A53T).Cell activity and apeptosis rate were detected by MTT law and flow cytometry.NO energy, heat shock protein 70 (Hsp70) and Caspase-3 expression were determined in cell culture.Results A53T cell survival rate significantly decreased 24 hours after handling with the protease inhibitor (100 nmol/L) and (or) autophagy inhibitors 3-MA (10 mmol/L, A =0.23±0.01,0.19±0.01 and 0.17±0.01 respectively; P <0.05) compared with the control group (A =0.32±0.06).Cell survival rate was significantly higher than the other drug group after 24 hours handling with autophagy stimulators (A =0.44±0.08).Compared with the control group or autophagy stimulator of rapamycin (0.2 μg/ml) group (1.55%±1.15%), A53T cells apeptosis percentage rate was significantly higher after treated with proteasome inhibitor and macroautophagy inhibitors 24 hours (4.74%±0.91%, 4.59%±1.18% and 5.40%±1.75%respectively, P <0.05); and a slight decrease with stimulators.Protein Hsp70 and NO were significantly higher in proteasome inhibitor groups than the control group.But in antophagy inhibitor and stimulator group, NO and Hsp70 protein was similar to the control group.Conclusion The inhibition of macroautophagy and proteasome can promote apoptosis.Inhibiting or stimulating autophagy has less impact on Hsp70 and NO than proteasome pathway.

Objeetive To investigate the risk of hemorrhagic transformation (HT) and the outcome as well as its influencing factors at 3 months after thrombolytic therapy in acute ischemic stroke patients with non-valvular atrial fibrillation (NVAF).Methods Consecutive acute ischemic stroke patients with NVAF were enrolled retrospectively.Their demography,vascular risk factors and other clinical data were collected.The modified Rankin Scale (mRS) was used to evaluate the outcome at 3 months after symptom onset.The mRS score ≤ 2 was defined as good outcome,and ＞ 2 was defined as poor outcome.Results A total of 119 acute ischemic stroke patients with NVAF were enrolled,including 63 males (52.9％) and 56 females (47.1％); their mean age was 72.1± 10.0; 45 (37.81％) were treated with recombinant tissue type plasminogen activator (rtPA),55 (46.2％) had a good outcome and 27 (22.7％) combined with HT.Compared with the poor outcome group,the mean age was younger in the good outcome group (P =0.028).The proportions of the patients with ischemic heart disease and the time from onset to treatment ＞ 4.5 h were lower (P ＜0.05).The baseline systolic blood pressure and diastolic blood pressure,as well as the National Institutes of Health Stroke Scale (NIHSS) score were lower (P ＜0.05),while the proportion of patients receiving intravenous thrombolysis with rtPA was higher (P =0.019).Multivariate logistic regression analysis showed that the patients with ischemic heart disease (odds ratio [OR] 4.572,95％ confidence interval [CI] 1.392-15.014; P =0.012),systolic blood pressure before treatment (OR 1.028,95％ CI 1.007-1.049; P =0.009),baseline NIHSS score (OR 1.058,95％ CI 1.002-1.117; P =0.042) were the independent risk factors for poor outcome,while intravenous thrombolysis with rtPA (CI 0.264,95％ CI 0.102-0.683; P =0.006) was an independent protective factor for poor outcome.The proportions of the baseline systolic blood pressure,fasting blood glucose and NIHSS score,as well as the patients with a history of previous stroke or transient ischemic attack (TIA) in the HT group were significantly higher than those in the non-HT group (all P ＜ 0.05).Multivariate logistic regression analysis showed that the baseline NIHSS score (OR 1.147,95％ CI 1.068-1.231; P＜0.001),baseline systolic blood pressure (OR 1.951,95％ CI 1.921-1.982; P =0.002),and blood glucose level (OR 1.191,95％ CI 1.095-1.294; P ＜ 0.001) were the independent risk factors for HT.Compared with the non-thrombolysis group,the mean age of the thrombolysis group was younger (P =0.021),the baseline systolic blood pressure,fasting glucose and NIHSS scores,as well as the proportions of patients with hyperlipidemia,previous stroke or TIA history,and using antihypertensive drugs before admission were higher (all P ＜ 0.05).The proportion of patients with ischemic heart disease were lower (P =0.035),but the proportion of the patients with a good outcome was higher (P =0.019).Conclusions Patients with ischemic heart disease,systolic blood pressure and higher baseline NIHSS score before treatment were the independent risk factors for poor outcome,while intravenous thrombolytic therapy with rtPA was an independent protective factor for poor outcome; the high baseline NIHSS score,baseline systolic blood pressure and glucose level were the independent risk factors for HT.For acute ischemic stroke patients with NVAF,such as no obvious contraindications for thrombolytic therapy,might benefit from intravenous thrombolytic therapy,and it could not increase the risk of HT,but the blood pressure and glucose level of the patients should be controlled appropriately.

ObjectiveToanalyzetheclinicalandimagingcharacteristicsinpatientswithcarotidsteal syndrome ( CSS ) and to investigate its compensatory pathw ays, diagnosis, and treatment. Methods The medical history and imaging data of the patients with CSS were colected. Their vascular lesions, colateral circulation, treatment, and prognosis w ere analyzed. Results A total of 11 patients w ith CSS (8 males and 3 females, mean age 66.7 ±5.1 years) were enroled in the study. Their clinical manifestations were posterior circulation transient ischemic attack (TIA) ( n=9, 81.8%), posterior circulation infarction ( n=1, 9.1%), and anterior circulation TIA ( n=1, 9.1%). A total of 19 pathological arteries w ere found:12 (63.1%) w ith occlusion, 2 (10.5%) w ith subtotal occlusion, 4 (21.0%) w ith severe stenosis and 1 (5.2%) w ith artery dissection. Seven patients (63.6%) w ere bilateral internal carotid artery lesions, 3 (27.2%) w ere unilateral bilateral internal carotid artery lesions, and 1 (9.1%) w as bilateral common carotid artery occlusion. Eleven patients had primary col ateral circulation, including posterior communicating artery patency in 10 patients (90.9%) and anterior communicating artery patency in 1 patient (9.1%). Four patients (36.3%) had secondary col ateral circulation and 1 (9.1%) had tertiary col ateral circulation. Al patients w ere treated w ith medication on the basis of the management of risk factors. Three patients w ere treated w ith stenting and tw o were treated with carotid endarterectomy. No stroke occurred in al patients during folow -up til September 2014. Conclusions The vascular lesions of patients w ith CSS often occur in the extracranial segment of internal carotid artery. Usual y the compensatory blood is through the circle of Wil is. The presentation is ischemia in the stolen arteries. Its diagnosis needs to be examined by digital subtraction angiography. On the basis of medication therapy, some patients may be treated w ith surgery or endovascular intervention.

Objective:To investigate the relationship between the left ventricular morphology, systolic function and the severity of the coronary artery lesions. Methods:A total of 589 consecutively admitted patients were studied retrospectively. All patients suspected of coronary artery disease underwent a selective coronary angiography and a survey of left ventricular ejection fraction (EF) during the hospitalization. Results:A significant correlation between the severity of the coronary artery lesions and the EF, FS, LADD, LADS, LVDS and LVDD was found through the Bivariate Correlation analysis ( P

BACKGROUNDAutophagy has been found to be involved in animal and cell models of atherosclerosis, but to date, it lacks general observation in human atherosclerotic plaques. Here, we investigated autophagy in smooth muscle cells (SMCs), endothelial cells (ECs), and macrophages in human atherosclerotic plaques via transmission electron microscopy (TEM), western blotting, and immunohistochemistry analysis.

METHODSThe histopathologic morphology of these plaques was observed via hematoxylin and eosin staining. The ultrastructural morphology of the SMCs, ECs, and macrophages in these plaques was observed via TEM. The localization of microtubule-associated protein 1 light chain 3 (MAP1-LC3), a relatively special maker of autophagy, in plaques was observed by double fluorescent immunochemistry and western blotting.

RESULTSAll of these human atherosclerotic plaques were considered advanced and unstable in histologically observation. By double fluorescent immunochemistry, the expression of LC3-II increased in the SMCs of the fibrous cap, the macrophages, and the microvascular ECs of the plaque shoulders. The protein level of LC3-II by western blotting significantly increased in plaques compared with normal controls. In addition, TEM observation of plaques revealed certain features of autophagy in SMCs, ECs, and macrophages including the formation of myelin figures, vacuolization, and the accumulation of inclusions in the cytosol. These results indicate that autophagy is activated in SMCs, ECs, and macrophages in human advanced atherosclerotic plaques.

CONCLUSIONSOur study is to demonstrate the existence of autophagy in human atherosclerotic plaques by different methods, which may contribute to the development of pharmacological approaches to stabilize vulnerable and rupture-prone lesions.

Atherosclerosis ; metabolism ; physiopathology ; Autophagy ; physiology ; Endothelial Cells ; pathology ; Humans ; In Vitro Techniques ; Microscopy, Electron, Transmission ; Microtubule-Associated Proteins ; metabolism ; Myocytes, Smooth Muscle ; pathology ; Plaque, Atherosclerotic ; metabolism ; physiopathology ; ultrastructure

Objective:To understand the infection and distribution of syphilis in hospitalized patients, thus to provide reference for syphilis prevention and control.Methods:TP-ELISA test was used to examine early syphilis antibody, and adopted the TPPA test to validation syphilis antibody, and TRUST was used to determine the titer of syphilis antibody in 80 478 hospitalized patients from January 2015 to November 2017, then the results were retrospectively analyzed.Results:Among 80 478 inpatients, 1 326 cases were positive by TP-ELISA test(1 223 cases positive, 101 cases weak positive and 2 cases negative by TPPA confirmed). The positive rates of TP-ELISA in different years were 1.62%(445/27 394), 1.72%(490/28 412) and 1.58%(389/24 672), respectively, and the difference was not statistically significant( P>0.05). The positive rates of male and female patients were 2.02%(689/33 985) and 1.37%(635/46 479), and the difference was statistically significant(χ 2=52.91, P=0.00). The positive rates of ≤18 years old, >18-59 years old, >59-79 years old and>79 years old were 0.32%(7/2 161), 1.44%(765/53 001), 2.31%(488/21 163) and 1.50%(62/4 153), respectively.The highest proportion of syphilis patients was in the group of >59-79 years old, and the differences were statistically significant compared with the other groups(χ 2=37.08, 67.05, 10.80, all P<0.01). Among the TP-ELISA positive patients, 54.90%(728/1 326) had TRUST titer negative, 36.50%(484/1 326) had titer less than 1∶8, and the others had 8.44%(112/1 326). Conclusion:The incidence of syphilis was higher in males than in females in 80 478 hospitalized patients.The highest positive rate was found in >59-79 years old group, and the number of elderly cases increased rapidly.Therefore, the effective interventions should be developed to control the transmission of syphilis according to the epidemiological features.

Objective To analyze the basal conditions of 5 patients with cerebrovascular fibromuscular dysplasia (FMD),and explore the clinical presentation,imaging features,therapies and outcomes of cerebrovascular FMD.Methods Five patients with cerebrovascular FMD,admitted to our hospital from January 2012 to April 2013,were chosen in our study; their medical history and imaging features were collected,and their clinical presentation,imaging features,therapies and outcomes were retrospectively analyzed when combining with literature review.Results Five patients all presented with stroke,including four having hemiplegia as the initial symptom,and one having headache with nausea and vomiting as the main performance.One was diagnosed as having subarachnoid hemorrhage by CT scan,and four had different infarction lesions in lobes and basal ganglia on MRI.Artery dissection was discovered in all patients by cerebral digital substraction angiography,including two with right internal carotid artery dissection,one with right vertebral artery dissection combined with aneurysm in anterior communicating artery associated with "string-of-beads" appearance on C1 segment of right internal carotid artery and left vertebral artery,one with bilateral vertebral artery dissection,and the last one with bilateral internal carotid artery dissection and moyamoya disease-like vessels.No abnormality was discovered in two patients by renal artery angiography.The patient with anterior communicating artery aneurysm was treated with endovascular aneurysm embolization,having poor prognosis.In the remaining 4 patients with cerebral infarction,two were treated with carotid artery stenting,and the other 2 were only given antiplatelet therapy.No patient suffered cerebrovascular accidents during the 12-month follow-up.Conclusions Cerebrovascular FMD is a rare cause of young stroke,and patients with cerebrovascular FMD often manifest headache,neck bruit,carotid artery dissection and stroke.It is particularly important to make definitive diagnosis by performing cerebrovascular imaging examinations and give treatment accordingly.The long term outcome of FMD is not clear now.

Objective To evaluate the changes of adenosine metabolism pathway related molecules and their contribution to inflammatory injury in primary biliary cholangitis (PBC).Methods The consecutive samples of 49 subjects with PBC from The First People's Hospital of Taicang and The Second People's Hospital of Changshu were recruited from October 2016 to October 2017,and 36 healthy controls were involved in this study.The expression of CD39 and CD73 on CD4+T cells and Foxp3 + regulatory T cells were assayed by flow cytometry and the concentration of adenosine triphosphate (ATP) in serum was analyzed by ultraperformance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF/MS).The correlations between Tregs,ATP and liver function were analyzed,i.e.,alanine aminotransferase (ALT),aspartate aminotransferase (AST),gamma-glutamyltransferase (GGT),alkaline phosphatase (ALP) and Mayo scores.Results In the patients with PBC,low proportions of CD4+CD39+T cells were noted compared with healthy controls [(5.28 ± 1.92) ％ vs (11.0l ± 3.19) ％,t =10.25,P ＜ 0.01].The patients with PBC also had significantly low proportion of CD4+CD25 + Foxp3+ CD39+ T cells compared with healthy controls [(23.75 ± 9.48) ％ vs (54.68 ± 5.18) ％,t =13.79,P ＜0.01].No significant difference of the proportion of CD4+CD73+T or CD4+CD25+ Foxp3+CD39+T cells was found between PBC and control groups (t values were 2.235 and 1.083,P ＞ 0.05).The level of serum ATP was higher in the patients with PBC than that of healthy controls [(200.28 ± 79.41) μg/L vs (89.20 ± 33.76) μg/L,t =8.367,P ＜ 0.01].A significant correlation was demonstrated between the proportion of CD39 + Treg in total Treg cells and the levels of ATP (r =-0.413,P =0.003),GGT (r=-0.378,P=0.007) and Mayo score (r=-0.382,P=0.007).Conclusion The low proportion of CD39+ Treg cells may contribute to the down-regulation of ATP hydrolysis in the patients with PBC.No significant change of CD73 + Treg cells was found in PBC patients.