BACKGROUND:The stimulation parameters concern directly the antiepileptic effect and safety of vagus nerve stimulation in epileptic patients, and the optimal setting of these parameters is crucial to ensure safe and effective application for antiepileptic treatment.OBJECTIVE: To observe the effect of such parameters as output current,wave width, frequency, on/off time of intermittent stimulation in electric vagus nerve stimulation for antiepileptic therapy.DESIGN: Single-sample experiment.SETTING: Department of Neurobiology, School of Basic Medical Sciences, Capital University of Medical Sciences.MATERIALS: The experiment was carried out at Electrophysiological Laboratory of Department of Neurobiology, School of Basic Medical Sciences, Capital University of Medical Sciences between September 2000and September 2002, using totally 36 healthy adult Wistar rats.METHODS: Epileptic models were established in 36 healthy adult Wistar rats by cervical subcutaneous kainic acid injection, in which various settings of vagus nerve stimulation parameters were applied and their antiepileptic effects observed in terms of changes in the behaviors, electrocardiogram (ECG), electrocorticogram (ECoG), and hippocampal neuronal discharge to identify the optimal parameter setting.rameters.nerve stimulation produced antiepileptic effect mainly within 4 hours of with wave width of 2 ms, current intensity of 3-3.5 mA, frequency of 30-35 Hz, 1-minute on/2-minute off intermittent stimulation produced remarkable antiepileptic effect presented by obviously reduced seizure duration in ECoG and epileptic severity, with lowered frequency of bursting discharge in the epileptic rat CA1 neurons (P ＜ 0.05).CONCLUSION: With normal cardiac electric activity ensured, the minimum stimulation parameters sufficient for effective epilepsy control can be considered as the optimal parameter setting in electric vagus nerve stimulation, which has no adverse effect on the heart.

BACKGROUND: Vagus nerve stimulation (VNS) is a neurophysiological therapy (NPT) of refractory epilepsy, which can control the seizure by stimulating the vagus nerve stem in cervical part.OBJECTIVE: To study the effect of intermittent left-side VNS on seizure of epileptic animals, and provide theoretic basis for the interaction of somatic information and that of internal organs.DESIGN: Observation study.SETTING: Department of Neurobiology, Capital University of Medical Science.MATERIALS: The experiment was performed in the Laboratory of Electrophysiology in Department of Neurobiology, Capital University of Medical Science from March 2000 to September 2002. Thirty-four healthy adult SD rats and 8 rabbits, weighting (220-250) g and (2.2-2.5) kg respectively were selected.METHODS: ①Ten rats were intramuscularly injected with (150 000-160 000) U of penicillin (PCN). VNS effects on epileptiform activities of rats were studied by observing the changes in electrocorticogram (ECoG)and behavior of rats before and after VNS.②(0.24-0.48) mg of PCN was injected into the hippocampus of another 8 rabbits to induce epilepsy, and VNS effects on ECoG of epileptic rats were observed. ③Seizures of 16 rats were induced by Kainic acid, and changes in discharge activity of hippocampal neuron, ECoG and behavior of epileptic rats were observed after VNS. ④Seizures of 8 rabbits were induced by cortical injection of strychnine with microinjector, and VNS effects on ECoG of rabbits with epilepsy induced by acute cortical injury were observed.MAIN OUTCOME MEASURES: ①VNS effects on seizure of rats with epilepsy induced by PCN. ②VNS effects on seizure of rats with epilepsy induced by Kainic acid. ③VNS effects on epileptiform ECoG of rabbits with epilepsy induced by strychnine.RESULTS: A total of 34 rats and 8 rabbits were involved in the analysis of results. VNS could remarkably suppress the seizure of epileptic animals,and epileptiform ECoG, epileptiform discharges of hippocampal neuron and behavior significantly changed with the total effective rate greater than 50%. The total effective rate of VNS before seizure was greater than 80%.In epilepsy group indoeed by intramuscular injection of PCN, ECoG and behavior were markedlly aneliorated respectively for 40% and 50% of rats.In epilepsy group induced by injection of PCN in hippocampus, the ECoG was siguificantly ameliorated in 50% rats. In epileptic rabbit group induced by partial injection of strychnine via cerebral cortex, the epilepti form wave iu ECoG was controlled by VNS in 50 % of animals.CONCLUSION: VNS can effectively suppress seizure of epileptic animals. The antiepileptic effect of VNS is associated with cerebral cortical aud hippcampal neurons. Somatic epileptiform activity could be effectively inhibited by the integration of visceral afferent information in cortical and hippocampal parts.

Objective To investigate the risk factors of premature atherosclerotic three-vessel coronary artery dis?ease (CHD), and the association between single nucleotide polymorphism (SNP) of CD36 rs3211956, rs7755 and premature CHD. Methods Patient with premature three-vessel coronary artery disease (n=102) which were confirmed by consecutive coronary angiogram (lesion group) and patients (n=72) without CHD (control group) were enrolled in the study. Conventional CHD risk factors were compared between the two groups as well as SNPs of CD36 rs3211956 and rs7755 to disclose inde?pendent risk factor for CHD, which were measured by mass spectrometry. Results Among the conventional CHD risk fac?tors, male, HBP, high LDL-C, low HDL-C were independent risk factors of premature CHD. The GT genotype proportion of rs3211956 was significantly lower (χ2=8.042,P=0.005) in the lesion group than that in control group while the TT genotype proportion is significantly higher in lesion group compared with that in control group (χ2=6.191,P=0.014). Patients with the TT genotype have higher score of BMI than patients with GG or GT genotype (P=0.037). The G allele proportion of rs7755 in the lesion group was significantly higher than control group (χ2=3.636, P=0.047). Patients of the GG genotype have higher scores of BMI but lower level of HDL-C than those with AA or AG genotype (P<0.001). Logistic regression analysis re?vealed that after excluding a number of confounding factors, GG and TT genotype of rs3211956 and GG and GA genotype of rs7755 were respectively one of the independent risk factors for premature CHD. Conclusion The SNPs of CD36 rs7755 and rs3211956 may be the independent risk factors of premature coronary heart disease and might affect the the onset of CHD by affectting BMI and HDL-C.

Objective To evaluate the MRI value in changes of mid-urethral ligament injury offemale stress urinary incontinence (SUI).MethodsComparison of MRI changes of mid-urethral ligament on 30 healthy female volunteers and 20 female SUI patients.Chi-square test was used to compare the form of SUI patient's mid-urethral support ligaments Results The female nid-urethral support ligaments were composed of 4 groups of ligaments,including the periurethral ligament and pubourethral ligaments (1 pair),and at both sides of the urethra's paraurethral ligaments (1 pair) and suburethral ligament lying dorsal urethra,connecting the urethra and pelvic arcus tendinous fasciae.In normal MRI,ligament was a thin strip and showed low signal on both T1WI and T2WI,T2WI sagittal and cross-section scan was the best combination to show the middle urethral support ligaments changes,with tension;6 patients (20％) in the 30 patients normal control group could be seen tortuously and slack like around the urethra ligaments.Twenty SUI patients mid-urethral support ligaments were performance laxity or rupture,rates were 39％ (47/120) and 42％ (50/120) (x2 =43.191,P ＜ 0.05 ).On T2WI,the ligamentous laxity was floating,and losstension,also could performance one side extension and thinner than the other side.The ligament rupture was performance of the signal interruption,ligament contracture and one end of liganent attachment points separation.ConclusionMRIcanobjectiveeffectiveevaluatethemid-urethralsupportligaments' pathological changes in stress urinary incontinence patients.

Objective To investigate the method for the measurement of chlorpyrifos in serum by gas chromatography,and to provide a basis for emergency treatment of poisoning in clinical practice.Methods Venous blood (3.0 ml) was collected from patients.After coagulation,the blood samples were centrifuged at 4 000 r/min for 5 minutes,and 0.5 ml of serum was placed in a glass test tube with a cork;4.0 ml of ethyl acetate was then added and mixed rapidly,and this solution was subjected to extraction for 5 minutes and centrifuged at 4 000 r/min for 10 minutes.The ethyl acetate layer was placed in a conical tube and extracted twice with the same method.The extract was mixed and blow-dried with nitrogen,and the residue was dissolved with 50.0 μl ethanol.Gas chromatography was used for measurement,with a sample size of 1 μl and a retention time of 9.609 minutes.Results The linear range of this method was 0.2～20.0 μg/ml,and the regression equation was y =2 372.6x+357.2 (r=0.999 6).The detection limit of chlorpyrifos in serum was 0.05 μg/ml,and the recovery rate was 84.6％～102.4％.The relative standard deviation was 3.6％～4.8％,and the intra-day and inter-day relative standard deviations were 3.62％～5.10％ and 3.77％～4.98％,respectively.Conclusion This detection method is accurate,simple,and convenient,and can be used for the clinical diagnosis of chlorpyrifos poisoning.

Objective To investigate the method for the measurement of chlorpyrifos in serum by gas chromatography,and to provide a basis for emergency treatment of poisoning in clinical practice.Methods Venous blood (3.0 ml) was collected from patients.After coagulation,the blood samples were centrifuged at 4 000 r/min for 5 minutes,and 0.5 ml of serum was placed in a glass test tube with a cork;4.0 ml of ethyl acetate was then added and mixed rapidly,and this solution was subjected to extraction for 5 minutes and centrifuged at 4 000 r/min for 10 minutes.The ethyl acetate layer was placed in a conical tube and extracted twice with the same method.The extract was mixed and blow-dried with nitrogen,and the residue was dissolved with 50.0 μl ethanol.Gas chromatography was used for measurement,with a sample size of 1 μl and a retention time of 9.609 minutes.Results The linear range of this method was 0.2～20.0 μg/ml,and the regression equation was y =2 372.6x+357.2 (r=0.999 6).The detection limit of chlorpyrifos in serum was 0.05 μg/ml,and the recovery rate was 84.6％～102.4％.The relative standard deviation was 3.6％～4.8％,and the intra-day and inter-day relative standard deviations were 3.62％～5.10％ and 3.77％～4.98％,respectively.Conclusion This detection method is accurate,simple,and convenient,and can be used for the clinical diagnosis of chlorpyrifos poisoning.

Objective:To understand knowledge, belief, practice level of insulin injection and influencing factors of behavior of clinical nurses in tertiary general hospitals, so as to provide the basis for formulating targeted training programs for insulin injection.Methods:Using the convenient sampling method, a total of 169 clinical nurses in the adult ward of a tertiary general hospital were selected as the research objects in May 2020. The self-made basic information questionnaire and Insulin Injection Knowledge, Belief and Practice Questionnaire were used for investigation. Binary Logistic regression analysis was used to investigate the influencing factors of insulin injection behavior of clinical nurses.Results:Among 169 clinical nurses, the awareness rate of guidelines was 82.84% (140/169) , 95.86% (162/169) of nurses had patient education experience, the incidence rate of insulin injection needle stab injury was 14.79% (25/169) , and 90.53% (153/169) of nurses had the need to receive insulin injection system training. The total scores of knowledge, belief and practice dimensions of the Insulin Injection Knowledge, Belief and Practice Questionnaire for clinical nurses were respectively 60.00 (45.00, 70.00) , 50.00 (49.00, 50.00) and 85.00 (82.00, 85.00) , and the total score of the questionnaire was 189.00 (178.50, 200.50) . The results of binary Logistic regression analysis showed that knowing the guidelines, receiving insulin injection operation training and insulin injection needle stick experience were the influencing factors of insulin injection behavior ( P<0.05) . Conclusions:Clinical nurses in tertiary general hospitals have a high level of insulin injection beliefs and behaviors and there are still deficiencies in insulin injection knowledge. In the training work related to clinical insulin injection, attention should be paid to strengthening and maintaining the belief and behavior of standardized insulin injection, emphasizing the safety of insulin injection, and combining with the technical guidelines and specifications of insulin injection, improving the knowledge reserve and application ability of insulin injection of clinical nurses.

Objective:To explore the application value of humanistic literacy and clinical practice ability training in postgraduate courses of geriatrics.Methods:Postgraduates in Zhejiang University School of Medicine were taken as research objects. The teaching curriculum combining humanistic literacy and clinical practice ability training was set as the course of experimental group, and the teacher-led teaching course was set as the course of control group. The questionnaire survey was conducted to the evaluate the teaching effect among the postgraduates from three aspects: classroom situation, knowledge application and ability training. SPSS 17.0 was used for t-test. Results:The teaching of combining humanistic literacy and clinical practice ability training in classroom atmosphere, participation, teacher-student communication, helping memory, knowledge comprehension, knowledge application, collaboration ability, expression ability, organizational ability, knowledge acquisition ability, and autonomous learning ability scores of the experimental group were (3.96±0.20), (3.92±0.28), (3.75±0.44), (3.92±0.28), (3.96±0.20), (3.96±0.20), (3.83±0.38), (3.92±0.28), (3.79±0.41), (3.88±0.34), and (3.83±0.38), which were better than those of the control group, especially in classroom atmosphere, participation, knowledge application, expression ability, and autonomous learning ability.Conclusion:The combination of humanistic literacy and clinical practice ability training can significantly improve the classroom atmosphere of geriatric postgraduate courses, enhance students' medical humanistic literacy, familiarize students with the core skills of geriatrics, and improve students' ability to express and learn independently.

Objective To promote the Institutional Review Board(IRB) construction and development via paying more attention to the detail management and providing better protection of subjects' rights and interests in ethical review of clinical trials and scientific research projects.Methods Assessment criteria were established according to the domestic and international laws and regulations on the management of ethical and scientific research project.Ethical site visit was performed on the 37 clinical trials/scientific research projects approved by IRB during the year 2012-2015.Results Clinical trials/scientific research projects were divided into tree types:the registered clinical trials,the post-marketing clinical trials and the researcher initiated scientific research project.All the types met with the following assessment criteria:satisfy the requirement of equipment,facilities and qualifications of drug preservation required for conducting clinical research;subjects were given compensation according to the protocol;informed consent were obtained.Among them,the registered clinical trials meet more criteria than other research types.Regarding to the standard of informed consent implementation,all types met with the following assessment criteria:all the subjects enrolled signed informed consent forms,informed consent forms are well documented;investigators and subjects/ the guardian signed the forms.However,during the site visit,some other criteria were also neglected more or less.Particularly,only few project recorded the consent process and time spots singed the forms.Conclusions Investigators should pay more attention to the activities and behaviors taken place during the research implementation process.Researchers and management staffs should pay attention to ethical detail management to guarantee better protection of subjects' rights and interests.

Objective To evaluate the auxiliary diagnostic value of viral load test for samples with indeterminate HIV antibody detection results.Methods Thirty-two samples with indeterminate HIV antibody detection results collected from MSM were used for two viral load tests in Tianjin in 2015.Follow up was conducted for this population to confirm their HIV infection status.Results Virus loads were detected in the 2 viral load tests.In the follow-up survey,the results of HIV antibody test of all the samples were positive.The results of viral load test were completely consistent with those of HIIV antibody confirmation test.Conclusion The viral load test was effective in the auxiliary diagnosis of HIV infection in window phase,which can be used for the samples with indeterminate HIV antibody detection results.