Objective To study the comprehensive quality of pre-hospital care of patients with acute coronary syndrome (ACS) in our country,and the factors affecting the efficiency of medical intervention of pre-hospital care.Methods An epidemiological investigation with target population-based cross-sectional study was carried out,and specifically designed questionnaire for determining the efficiency of pre-hospital care of patients with ACS was used to collect information of 272 patients from 13 emergency pre-hospital care centers.Results After analysis of the data from 13 majormedical centers,it could be classified into 4 patterns of pre-hospital care,namely directive pattern,pre-hospital pattern,dependent pattern and independent pattern.The results of analysis showed that the distance for ambulance driving in directive pattern was shorter than that in dependent pattern,but the call-response in directive pattern was quicker than that in pre-hospital pattern and dependent pattern,while the call-arrival time in directive pattern was longer than that in independent pattern and dependent pattern.The analysis of the on-site preliminary treatment in four patterns of pre-hospital care showed that there were differences in the establishment of intravenous access,aspirin,nitrate and ECG ( P ＜ 0.05 ).The total effective rate of pre-hospital care for ACS was 48％,while effective rate of independent pattern reached 70％.Factors affecting therapeutic effect on ACS resulting in better outcomes included pre-hospital pattern ( OR =4.097 ),directive pattern ( OR =5.158 ),and use of nitrate ( OR =3.045 ) and oral administration of medicine ( OR =8.215 ). Conclusions Independent pre-hospital pattern had the best therapeutic effect in the pre-hospital care of patients with ACS,and pre-hospital pattern had the best on-site preliminary disposal.Use of nitrate and oral administration of medicine showed the best benefit to the therapeutic effect.

Objective To investigate the inducing effects of selenium dioxide(SeO2 ) on the apoptosis in human cervical carcino-ma cell line Hela and its influence on the expression of apoptosis-related proteins caspase-3 and P53 .Methods Hela cells were trea-ted with different concentrations of SeO2 for 24 h in vitro ;the morphological changes of Hela cells were observed by the optical mi-croscope;the influence of SeO2 on the cell proliferation and vitality was examined by the MTT assay ;the flow cytometry was em-ployed to detect the cell apoptosis rate ;the expressions of caspase-3 and P53 proteins in Hela cells were determined by the Western blot analysis .Results Under the optical microscopy ,SeO2 generated the obvious influence on the cell growth morphology ,a large number of cells became rounded and shrunken ,and lost the normal form ,while the adherence cell number was evidently decreased and the proliferation was slowed down ;the MTT results showed that SeO2 markedly inhibited the cell proliferation and viability in a dose-dependent manner ,in which ,the cell apoptosis rates induced by the 0 ,1 .875 ,3 .750 ,7 .500 ,15 .000 and 30 .000 μmol/L con-centrations of SeO2 were 3 .12% ,30 .56% ,33 .42% ,37 .50% ,45 .43% and 69 .38% respectively ,which revealing the obviously in-creasing trend;the Western blot assay revealed that SeO2 could up-regulate the caspase-3 and P53 levels ,and reached the peak value at the concentration of 7 .500μmol/L .Conclusion SeO2 could induce the cervical cancer cell apoptosis possibly by up-regulating the expressions of caspase-3 and p53 in Hela cells .

Objective To investigate the risk factors for prognosis of severe acute pancreatitis (SAP).Methods The clinical data of 563 patients with acute pancreatitis (AP) treated from January 2008 to December 2014 were analyzed retrospectively.There were 334 patients with mild acute pancreatitis (MAP),and 198 patients with moderately severe acute pancreatitis (MSAP),and 31 patients with severe acute pancreatitis (SAP).Risk factors associated with MAP and MSAP + SAP group,MSAP and SAP group were determined by univariate logistic regression,and multivariate analysis was used to determine the risk factors for severity of AP.Results Univariate logistic regression analysis showed that age,WBC,serum glucose,calcium,urea nitrogen arterial partial pressure of oxygen (PaO2),SIRS,pleural effusion,peripancreatic fluid collection were associated with severity of AP in MAP and MSAP + SAP patients;age,serum calcium,PaO2,SIRS,pleural effusion,peripancreatic fluid collection were associated with severity of AP in MSAP and SAP patients.Multivariate logistic regression analysis showed that age,serum calcium,PaO2 and peripancreatic fluid collection were risk factor of MSAP and SAP;age,serum calcimm and SIRS were risk factors of SAP patients for persistent organ failure and pancreatic necrosis.Conclusions For elderly AP patients,measurement of arterial partial pressure of oxygen and serum calcium,peripancreatic fluid collection can help evaluate the severity of AP and early recognition.For SAP patients,the presence of SIRS,high serum urea nitrogen,and low serum calcium and peripancreatic fluid collection raise the concerns of persistent organ failure and pancreatic necrosis.

Objective To assess the impact of radiation on superior epigastric vessel pedicled transverse rectus abdominal myocutaneous (TRAM) for breast reconstruction.Methods Female breast cancer patients were divided into 4 groups:group A (immediate breast reconstruction + radiation therapy,123 cases),group B (immediate breast reconstruction,262 cases),group C (radiation therapy + delayed breast reconstruction,34 cases),group D (delayed breast reconstruction,53 cases) from June 2009 to June 2012 at Department of Breast Oncology,Tianjin Medical University.Patient demographics,operative details,radiation therapy details,postoperative complications,patient-centered evaluation of aesthetic and psychological outcomes were assessed.Results The average follow-up duration was 24.98 ± 6.99 months.2.5％ patients developed delayed wound healing postoperatively.Fat necrosis and flap contracture were seen in 7.0％ and 3.6％ of all patients,respectively.Irradiated patients had a significant statistical difference in cancer staging,involved lymph nodes,tissue invasion and neoadjuvant chemotherapy (P ＜ 0.05).No significant statistical differences were observed in post-operative early complications,but in advanced stage complications.There was no significantly statistical difference in breast aesthetic outcome before and after radiation therapy within four groups.Conclusions For breast reconstruction patients,those without postoperative radiotherapy were suggested immediate breast reconstruction,and those with postoperative radiotherapy were proposed to accomplish breast reconstruction after postoperative radiotherapy.

Genetic factors play an important role in the development of Alzheimer's disease (AD). This article mainly introduced some genes, which have been reported in recent years, predisposing to different aspects of AD. The occurrence and progress of the late onset Al-zheimer's disease (LOAD) can be better understood through further study of the susceptibility loci, especially by using the pathway analysis, and the important hub genes can be found so as to provide targets for clinical prevention, diagnosis and treatment. Due to the dispersion of genetic variant information, it needs detailed literature, online search and some bioinformatics methods to analyze the causative genes and signaling pathways related to LOAD. 3 databases were took as recourses, and they were analyzed with multi-means and multi-ways of analy-sis and data mining methods, in order to provide theoretical basis for further study and clinical treatment of AD genetics.

Background and purpose:Diffusion-weighted imaging (DWI) is a non-invasive technique of breast magnetic resonance imaging (MRI). DWI is an alternative to dynamic contrast-enhanced (DCE) MRI for differentiating malignant from benign lesions in breast screening or not. This study aimed to evaluate the potential role of DWI in differentiating malignant breast lesions from benign lesions.Methods:Seventy-four patients underwent digital mammography, DCE and DWI (49 patients’b-value of 0, 400, 600 and 800 s/mm2). The detectability, sensitivity and speciifcity of DWI and DCE were compared. Absolute apparent diffusion coefifcient (ADC) was compared with standardized ADC for quantitative analysis.Results:Sixty-four of 74 patients had positive pathologic findings (38 malignant, 26 benign). All of the malignant lesions were detected on DWI and DCE. The sensitivity of DWI was 83.33%, 90.00% and 93.33%, and the specificity was 85.91%, 76.19% and 72.72%, forb-value of 400, 600 and 800 s/mm2, respectively. The sensitivity and speciifcity of DCE were 86.61% and 90.48%. There was no signiifcant difference between absolute and standardized ADC in detecting breast cancer (P>0.05).Conclusion:DWI is an important complemented technique to DCE-MRI for differentiating malignant from benign lesions in breast MRI.

Objective To explore the influence of telephone follow-up after discharge on the re-admission rate of patients with chronic heart failure.Methods In total,161 patients were randomly divided into the observation(n=81)and control group (n=80).All participants received conventional guidance following discharge from our hospital.The patients in the observation group were subject to telephone follow-up for 6 months and individualized caring intervention.The re-admission rates after 6 months after discharge between two groups were statistically compared.Result The re-admission rate in the observation group was 30.9%, significantly lower compared with 42.5% in the control group(P<0.05).Conclusion The telephone follow-up combined with individualized caring intervention can reduce the re-admission rate among the patients with chronic heart failure.

To study thyroid hormone receptor β(THRβ)gene mutation in a pituitary-resistance to thyroid hormone syndrome family. The peripheral blood samples of the patient, his sister, parents, and 4 maternal relatives were collected. Then serum was isolated for detecting thyroid hormone levels with chemiluminescence immunoassay, and DNA was extracted for PCR, and 10 exons of THRβ gene were sequenced. The patient and his mother had the hyperthyroid symptom for many years and his mother with atrial fibrillation. The G→A heterozygous transition mutation was confirmed by exon sequencing at nucleotide 949 within exon 9 of THRβ gene in the patient and his mother, which was a missense mutation causing a substitution of Alanine to Threonine(A317T). No mutation was found in THRβ gene in other family members. This is the first Chinese family reported with pituitary thyroid hormone resistance syndrome caused by a A317T mutation in the thyroid hormone receptor β gene.

ObjectiveGeneration of human induced pluripotent stem cells from human skin fibroblasts.MethodsSox2, Klf4, Oct4, c-Myc were transfected into HSF cells with retrovirus, and then HSF cells was reprogrammed to iPS cells.Detecting cells endogenous and exogenous gene, analyzing karyotype,cells alkaline phosphatase staining and immunofluorescence staining, differentiating into teratomas in vivo and embryoid bodies in vitro were performed.ResultsiPS cell morphology was similar to embryonic stem cells (ES).The expression of Nanog, Oct4, Rex1, Sox2 in iPS cells were higher than HSF cells, and Sox2, Klf4, Oct4, c-Myc were silenced for the iPS cells.Exogenous genes were inserted into the nucleus of iPS cells, which was confirmed by 1％ agarose gel electrophoresis.iPS cell karyotype was normal, alkaline phosphatase activity increased, ES cell-specific protein expressed.iPS cells were differentiated into a teratoma in vivo and embryoid bodies in vitro.ConclusionsiPS cells were similar to ES cells, which have pluripotency.

Objective To evaluate endoscopically insertion of feeding tube via nose(EIFTN). Method Jejunal feeding tube was placed endoscopically via the nose in all 136 coma patients. Results This procedure was successful in all patients. The procedure took an average time of 5 minutes. In patients with deep coma,the procedure had no influence on HR,MAP, ECG and SaO2; In semicoma patients, HR and R increased during the procedure (t=3.902, P