Anything in the universe can be explained by Yin-yang theory of Chinese medicine. Synaptic connections in the central nervous system also embody a balance between Yin and Yang. To discover the synaptic processes of gathering,storing and retrieving information in the brain is a hotspot field of modem neuroscience. This paper attempts to analyze the synaptic connection in both structure and function from Yin-Yang theory. The connections of axons and dendrites between neurons arc malleable and constantly changing, showing a Yin-Yang balance anatomically. Remodeling, stabilization and plasticity changes of synaptic processes also embody the relationship of contradictions, conflicts and transformation of Yin-Yang functionally. Therefore, it is possible to achieve an unexpected result to solve some modem medical problems by using the thoughts and methods of Chinese medicine.

Objective To investigate the serum and placental expressions of asymmetric dimethylarginine (ADMA) and nitric oxide(NO) in fetal growth restriction (FGR),and explore the biological role and mechanisms of ADMA in FGR.Methods Fifty patients with FGR (FGR group)and 50 normal term pregnant women (control group) were detected for the levels of ADMA in maternal sera and placentas with enzyme linked immunosorbent assay (ELISA).The level of NO in maternal sera was analyzed with nitrate reductase method,and the placental tissue sections were analyzed with pathological morphologly.Results For FGR group,the main pathological changes were growth retardation of villi,increased syncytiotrophoblast nodules,and the lack terminal villi;and the incidence rate of pathological change of placental tissue was significantly higher than that in control group [64.0％ (32/50) vs 12.0％ (6/50),x2 =7.90,P ＜ 0.01].For the placental pathological change group,the concentrations of ADMA in the placentas and sera were significantly higher than the normal group [placenta ADMA:(2.21 ± 0.72) μmol/L vs (1.69 ± 0.77) μmol/L,t =3.33,P ＜ 0.01;serum ADMA:(2.01 ± 0.70) μmoL/L vs (1.18 ± 0.54) μmol/L,t =6.66,P ＜0.01].The expression of ADMA was up-regulated in maternal sera and placentas from FGR group compared to normal pregnancy [placenta ADMA (2.24 ± 0.81) μmol/L vs (1.53 ± 0.59) μmol/L,t =5.00,P ＜0.01;serum ADMA (1.89 ±0.75) μmol/L vs (1.10 ±0.43) μ mol/L,t =6.45,P ＜ 0.O1].The NO was extremely lower expressed in maternal sera with FGR than normal pregnancy [(39.59 ± 9.15) μmol/L vs (58.02 ± 15.45) μmol/L t =-7.26,P ＜ 0.01)].For FGR group,a significant negative correlation was observed between ADMA and NO expressions in sera (r =-0.693,P ＜ 0.01).Conelusions ADMA was associated with the occurrence and development of the FGR,and its mechanism maybe inhibits NO synthesis to result in placental malperfusion.

Objective To explore the predictive values of the levels of blood lipids ,liver function and estrogen for the fetal dis‐tress in intrahepatic cholestasis of pregnancy (ICP) patients .Methods The indicators of blood lipids ,liver function and estrogen of mild IPC group ,severe ICP group and control group were detected respectively ,and the results were analyzed .Results The levels of triglycerides ,total cholesterol and low‐density lipoprotein were positively related to estradiol levels .Multivariate logistic regres‐sion analysis showed that cholyglycine (OR=8 .24 ,P=0 .01) and estradiol(OR=4 .46 ,P=0 .02) were significant for prediction of fetal distress in ICP patients .Conclusion Estradiol and cholyglycine levels may be better indicators for the prediction of fetal dis‐tress in ICP patients .

Ibuprofen/ethyl-cellulose (EC)-polyvinylpyrrolidone (PVP) sustained-release composite particles were prepared by using supercritical CO2 anti-solvent technology. With drug loading as the main evaluation index, orthogonal experimental design was used to optimize the preparation process of EC-PVP/ibuprofen composite particles. The experiments such as encapsulation efficiency, particle size distribution, electron microscope analysis, infrared spectrum (IR), differential scanning calorimetry (DSC) and in vitro dissolution were used to analyze the optimal process combination. The orthogonal experimental optimization process conditions were set as follows: crystallization temperature 40 degrees C, crystallization pressure 12 MPa, PVP concentration 4 mgmL(-1), and CO2 velocity 3.5 Lmin(-1). Under the optimal conditions, the drug loading and encapsulation efficiency of ibuprofen/EC-PVP composite particles were 12.14% and 52.21%, and the average particle size of the particles was 27.621 microm. IR and DSC analysis showed that PVP might complex with EC. The experiments of in vitro dissolution showed that ibuprofen/EC-PVP composite particles had good sustained-release effect. Experiment results showed that, ibuprofen/EC-PVP sustained-release composite particles can be prepared by supercritical CO2 anti-solvent technology.

Objective: To explore age of menarche and associated factors of Han nationality, Zhuang nationality and Yao nationality girl in Guangxi, and to provide reference for the development of adolescent health education in schools. Methods: The 7-, 10- and 13-year-old girls of Han, Zhuang, Yao nationality were chosed from three counties of Guangxi, and height, weight and other physical indicators were measured for three consecutive years, and age of menarche was inquired. 448 cases of with compete data in the three consecutive years of monitoring. The influencing factors were investigated through questionnaire. Results: Age of menarche of the whole sample was 11.83(95%CI=11.69-11.96)years old, and that of the Han, Zhuang,Yao nationality was 11.87(95%CI=11.64-12.09), 11.44(95%CI=11.25-11.64)and 12.42(95%CI=12.14-12.70)years old respectively, the difference was statistically significant(P<0.05). Height, sitting height, weight of menarche group in 12 and 13 years old were significantly higher those of the group without menarche(P<0.05). Logistic regression analysis primary sitting height,the chest circumference,intake of seafood,duration of sleep in the night and school exercise time were the primary factors for age at menarche(P<0.01). Conclusion There are ethnic differences in age of menarche among girls in Guangxi, and it is related to sleep,physical activity and dietary structure. Puberty recated health education for girls might start at the fourth grade of primary school, focusing on the education of health life patten, balanced dietary habits, regularly routine, with the goal of growth and development promotion.

OBJECTIVETo investigate the mechanisms of DelCD11-279 of factor XIII subunit A mRNA in the pathogenesis of hereditary factor XIII deficiency.

METHODSThe recombinant plasmids containing pET-22b(+)/FXIIIA of normal subject and proband's mother and pET-22b(+)/FXIIIA-Del of the proband were constructed and transformed into E. coli BL21. Expressing protein was analyzed by the SDS-PAGE and purified by Ni-NTA resin. Purified proteins were detected by the Western-blot. The activity of purified protein was detected by the incorporation test with EZ-LinkTM5-(Biotinamido) Pentylamine.

RESULTSThe recombinant plasmids containing pET-22b(+)/FXIIIA and pET-22b(+)/FXIIIA-Del which constructed and identified successfully by enzyme digestion and PCR, were transformed into E. coli BL21 and efficiently expressed by IPTG induction. The molecular weights of expressing proteins are 83 200 and 51 900 by the SDS-PAGE. Expressing proteins were purified by Ni-NTA resin, and were proved to be human FXIIIA proteins by Western-blot. Purified protein activity of proband's mother and proband was 95.87% and 0 of the purified FXIIIA protein activity from the normal subject, respectively.

CONCLUSIONDelCD11-279 of FXIIIA mRNA which encoding a 464 amino acids of inactive FXIIIA protein is one of the molecular mechanisms resulting in FXIII deficiency in the patient.

Objective To investigate the clinical features and prognosis risk factors of the elderly and youth patients with acute severe poisoning.Methods Adult patients with acute severe poisoning in the emergency intensive care unit (EICU) of Nanjing Drum Tower Hospital from January 2008 to December 2017 were enrolled. The patients were divided into the elderly group (age ≥ 60 years) and the youth group (16 years≤age < 60 years), the clinical data of the two groups were analyzed. The patients were divided into survival group and death group according to the prognosis of 28-day, binary multivariate Logistic regression was used to analyze the risk factors of mortality of the elderly and youth patients; receiver operating characteristic curve (ROC) was used to assess the predictive value of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) in mortality of youth patients.Results A total of 343 patients with acute severe poisoning were included, 89 in the elderly group and 254 in the youth group. ① Clinical features: compared with the youth group, the elderly group had higher proportion of basic diseases included hypertension, type 2 diabetes and coronary heart disease, higher the initial APACHEⅡ scores at admission, higher the proportion of invasive mechanical ventilation and respiratory failure, and longer the length of EICU stay and the length of hospital stay. The main poisoning causes of elderly and youth patients were suicide (58.43％, 83.86％) and accidents (38.20％, 13.39％). The most common poisoning types of elderly patients were sedative hypnotics (23.60％) and organophosphorus pesticides (22.47％); the youth patients were mainly paraquat (42.52％) and organophosphorus pesticide (17.32％). There were 28 patients died (31.46％) in the elderly group and the cause of death were respiratory failure (53.57％), circulatory failure (32.14％) and multiple organ dysfunction syndrome (MODS, 14.29％). There were 67 patients died (26.38％) in the youth group and the cause of death were respiratory failure (59.70％), MODS (20.90％) and circulatory failure (19.40％). ② Risk factors of deaths: the APACHEⅡ score, incidence of acute kidney injury (AKI) and MODS in the elderly death group were significantly higher than those in the elderly survival group. Logistic regression analysis showed that AKI was the independent risk factor for death in elderly patients [odds ratio (OR) = 8.449, 95％ confidence interval (95％CI) =2.347-30.410,P = 0.001]. The proportion of female, APACHE Ⅱ score, and the incidence of AKI, respiratory failure and MODS in the youth death group were significantly higher than those in the youth survival group. Logistic regression analysis showed that APACHE Ⅱ score (OR = 1.175, 95％CI = 1.081-1.277,P = 0.001), AKI (OR = 34.470, 95％CI =11.681-101.722,P = 0.001) and MODS (OR = 3.834, 95％CI = 1.264-11.636,P = 0.018) were the independent factors for death in the youth patients. ③ Predictive value: the initial APACHEⅡscore was useful for predicting prognosis of youth patients with acute severe poisoning. The APACHE Ⅱ score to predict the death of the area under the ROC curve (AUC) was 0.744 (95％CI = 0.681-0.806,P = 0.001); the cut-off was 5, the sensitivity was 92.54％, the specificity was 51.34％, the positive predictive value was 65.53％, the negative predictive value was 87.31％, the positive likelihood ratio was 1.902, and the negative likelihood ratio was 0.145.Conclusions Patients with acute severe poisoning have their own clinical characteristics. To reduce the morbidity and improve the prognosis, we should strengthen the pre-hospital management and optimize the clinical treatment process.

Objective To observe the clinical efficacy and safety of high-frequency diathermic therapy and intra-thoracic chemotherapy with recombinant endostar combined with cisplatin in treatment of malignant pleural effusion. Methods A total of 48 patients with malignant pleural effusion diagnosed in the First People ' s Hospital of Guiyang from September 2014 to September 2016 were randomly divided into observation group and control group with envelope method. Twenty-four patients in observation group were received high-frequency diathermic therapy and cisplation 60 mg/m2 combined with endostar 25-30 mg/m2 intra-thoracic chemotherapy. Twenty-four patients in control group were treated with high-frequency diathermic therapy and single cisplation 60 mg/m2 intra-thoracic chemotherapy. The patients were karnofsky performance scores ≥70, cooperate with intravenous systemic chemotherapy, every 21 days for a total of two or three cycles. High frequency diathermic therapy was administered twice a week for 3 weeks 30 minutes after intra-thoracic chemotherapy,treatment time of 60 minutes every time. Chi-squared test were selected to evaluate the clinical efficacy and quality of life and adverse and toxic responses, respectively. The paired samplest test were selected to evaluate the variation of tumor markers in hydrothorax of the two groups pretherapy and post-treatment. Results In 24 patients of observation group, 2 patients were complete remission (CR), 17 patients were partial remission (PR), 4 patients were disease stable (SD), 1 patient was disease progression (PD), and the objective response rate (ORR) (CR+PR) was 79.2 ％. In 24 patients of control group, 0 patient was CR, 12 patients were PR, 7 patients were SD, 5 patients were PD, and the ORR was 50.0％, there was significant difference in ORR between the two groups (χ 2 = 4.463, P = 0.035). Karnofsky performance scores in observation group was higher than that in control group after treatment, patients with clinical benefit rate was 79.2 ％ vs. 54.2 ％, but the difference in life quality between the two groups was no statistically significant (χ2=3.375, P=0.066). There was no significant difference in adverse reactions between the two groups (P>0.05). The tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA-125), carbohydrate antigen 199 (CA-199), cytokeratin 19 fragments (CYFRA21-1) and neuron-specific enolase (NSE) in hydrothorax of the two groups were reduced by the treatment, except for the difference of CYFRA21-1 between the two group was not statistically significant (P= 0.161), the changes of the other 3 indicators in the observation group before and after treatment were greater than those in the control group (all P< 0.05). Conclusions High-frequency diathermic therapy and intra-thoracic chemotherapy with single cisplatin are effective in treating patients with malignant pleural effusion, and is more superior when combined with endostar. Additionally, the combination of the above two drugs has synergistic action and better safety, deserves to be further promoted in clinic.

The article takes the experiment teaching combining Chaoxing Network Teaching Platform with BOPPPS model of obstetrics and gynecology in Chongqing Medical University as an example, and introduces the six teaching modules in detail that are followed in the mixed teaching mode: bridge in, objective, pre-assessment, participatory learning, post-assessment, and summary. Using the three-in-one assessment method of "process evaluation + incentive evaluation + summative evaluation", the learning effect of students was comprehensively evaluated. The practice proved that this mode can improve students' learning autonomy, exercise communication skills, cultivate teamwork spirit, promote the construction of clinical thinking, and improve teaching effect and classroom teaching quality.