Microglia can be activated immediately after acute cerebral ischemia and play a role of double-edged sword of nerve repair and neurotoxicity.Studies in recent years have suggested that this dual role of microglia can be achieved by a Toll-like receptor 2 (TLR2) signal transduction pathway.Therefore,reasonable regulation of TLR2 expression of microglia may improve the therapeutic effect of cerebral ischemia to a certain extent.This article reviews the mechanisms of TLR2 in cerebral ischemia and the possible interventions.

Objective To observe the clinical efficacy ofToutongning Formula in the treatment of migraine. Methods Totally 100 cases of migraine patients (wind disturbance, blood stasis syndrome) were randomly divided into two groups. Patients in the experimental group were treated withToutongning Formula orally, and patients in the control group were treated with flunarizine capsules 5 mg orally, for 30 d. The scores of number, degree, duration and accompanying symptoms of episodes before and after treatment were observed, the total scores were calculated, and adverse reactions were recorded, to evaluate the clinical efficacy and safety.Results Clinical total efficiency was 92.0% (46/50) in experimental group and 64.0% (32/50) in the control group; the incidence rate of adverse reactions was 20.0% (10/50) in experimental group and 80.0% (40/50) in the control group; there was statistical significant differences in efficacy and adverse reactions between the two groups (P<0.05). After the treatment, the differences in the scores of number, degree, duration and accompanying symptoms of episodes, and in the total scores between the two groups was statistically significant (P<0.05). There was statistical significance in the different value of above indexes before and after treatment between the two groups (P<0.05).ConclusionToutongning Formula can not only improve symptoms significantly in patients with migraine (wind disturbance, blood stasis syndrome), but also reduce adverse reactions, with more safety and efficacy than flunarizine capsules.

Objective To investigate the causes of hearing loss for people over 60 years old. Methods People more than 60 years old in 14 provinces, 22 districts were investigated with a self-designed questionnaire, and a hearing test was also done for every subject. Results Among all the subjects, the etiological factors of hearing loss were otitis media (10.5%), hereditary deafness (2.9%), noise-induced hearing loss (3%), ototoxic deafness (6.4%), traumatic deafness (2%), presbycusis (33.8%), sudden deafness (1%) and other reasons (36.2%), respec-tively, with 11.3%unknown. Conclusion Presbycusis is the main reason of hearing loss for old people, and otitis media is the second. The cause of hearing loss is different with ages, districts, and whether in rural areas.

Objective To discuss the practical application effect of the work process oriented teaching model that based on flipped classroom in the teaching of higher vocational Chinese medicines.Method We chose 97 students from Grade 2012 higher vocational Chinese traditional medicine,set them into experimental group (47 students) and comparison group (50 students).The experimental group was applied with the flipped classroom teaching,combined with the teaching mode of working process and the comparison group was applied with the traditional teaching mode from September 2014 to July 2015.At the end of the experiment,through the questionnaire survey,the differences of the experimental group students' autonomous learning ability and problem solving ability were compared between before the experiment teaching and after the teaching.The difference of post adaptation ability of the experimental group and the control group was also compared,and besides,the students' satisfaction degree to flipped classroom combined with working process teaching mode was investigated and analyzed.SPSS 16.0 software was used for statistical analysis,and t test was used to compare two groups' measurement information and count data with chi-square test.Result The score of independent learning ability after teaching in the experimental group was significantly higher than before [(77.50 ± 7.10) vs.(88.51 ± 9.30);t=6.451,P=0.000].However,there was no statistically significant difference in problem-solving capability before and after the teaching[(83.70 ± 2.32) vs.(84.30 ± 2.11);t=1.312,P=0.193].The score of five aspects of the adaptability to work in the experimental group and total score were higher than the comparison group and the difference was statistically significant [work attitude (18.72 ± 2.01) vs.(16.78 ± 3.33),t=3.447,P=0.001;service ability (17.99 ± 1.98) vs.(16.05 ± 2.15),t=4.614,P=0.000;professional ability (18.19 ± 2.46) vs.(15.37 ± 2.79),t=5.267,P=0.000;completion of work (19.01 ± 1.75) vs.(16.88 ± 1.83),t=5.851,P=0.000;strain capacity:(18.33 ± 2.09) vs.(17.01 ± 2.46),t=2.839,P=0.006;the total score of job adaptability (92.24 ± 3.89) vs.(82.09 ± 4.05),t=12.574,P=0.000].Experimental group's satisfaction showed that 91.48％ of students liked the teaching model,87.23％ thought that it improved their learning interest,82.98％ believed that it was beneficial to improving their communication skills.Conclusion Teaching mode of flipped classroom combined with working process helps to improve teaching quality.

OBJECTIVE:To provide reference for clinical rational use and management of anti-HIV drugs,and to provide ref-erence basis for occupational exposure to develop free drug policy. METHODS:Using retrospective study method,according to DDD calculation method recommended by WHO,consumption sum,DDDs,DDC and B/A of anti-HIV drugs in our center during 2011-2014 were analyzed and evaluated. RESULTS:The consumption sum of anti-HIV drugs increased firstly and decreased later, increasing from 512112 yuan in 2011 to 650854 yuan in 2012,decreasing to 496473 yuan in 2014. DDDs of anti-HIV drugs in our center during 2011-2014 decreased from 35932 in 2011,to 16363 in 2014,showing decreasing tendency. The consumption sum of nucleotide reverse transcriptase inhibitors during 2012-2014 took up the first place,and DDDs of nucleotide reverse tran-scriptase inhibitors took up the first place in 2011,2013,2014. DDDs of Zidovudine tablets took up the first place in 2013,2014, and that of Tangcao tablets took up top 3 places during 2011-2014. DDC of Tenofour disoproxil fumarate tablets,Zidovudine and la-mivudine tablets,Emtricitabine and tenofovir tablets,Lopinavir and ritonavir tablets were in high level,being more than 46 yuan. DDC of Zidovudine tablets,Stavadine tablets and Nevirapine tablets were in low level,being lower than 6 yuan. B/A of Tenofovir disoproxil fumarate tablets,Stavudine tablets and Efavirenz tablets ranged 0.5-1.5 in 4 years and B/A of Tangcao tablets was equal to 1,showing good synchronism of social and economical benefits. CONCLUSIONS:Clinical application of anti-HIV drugs in our center is rational basically,and the use of drug is basically consistent with the occupational exposure prevention. The use of TCM preparation is basically in line with the requirements of drug use in the clinic.

Heart failure is a serious and terminal stage of various cardiovascular diseases,is one of the most important heart diseases,and it also the most common reason for hospitalization.In recent years,studies on new markers in the diagnosis,treatment and prognosis of heart failure have made great progress,such as B-type brain natriuretic peptide can partially reflect hemodynamic imbalance,troponin can indicate cardiomyocyte injury,soluble ST2 and galectin-3 indicate myocardium remodeling and fibrosis,C-reactive protein,cystatin C and procalcitonin,and copeptin have significant prognostic value for outcomes,microRNA in the regulation of gene expression influence heart failure.

In the undergraduate teaching assessment,"eaching quality control" is the core content of their inspection.This paper explained the quality control of the content,analyzed the challenge of improving the teaching quality and put forward the idea of constructing the perfect teaching quality control system from five aspects such as raising awareness and unifying thinking,establishing a sound teaching system,strengthening the organizational functions and responsibilities,grasping the key points and implementing the whole process of the quality control.

ObjectiveUsing the single cell fluid to establish a kind of practical experimental method,to detect the HER-2 gene and protein of breast cancer,and to provide reliable basis for pathology diagnosis.MethodsThe single cell fluid of breast cancer was preparaed by Medimachine system.Sucking a little of the single cell fluid spreaded on the slide and to be examined by immunohistochemistry using antibodies to HER-2 and fluorescence in situ hybridization.ResultsThe cell membrane of breast cancer was positive for HER-2 by immunohistochemistry according to American society of clinical oncology of American pathologists guideline recommendations for HER-2 testing in breast cancer and the HER-2 gene of the single cell amplified obviously by fluorescence in situ hybridization which the ratio of the average of HER-2 and the average of CEP17 exceeded 2.2.ConclusionThe single cell fluid could be used as positive control when we detected the HER-2 gene or protein of breast cancer,which guaranteed the correction of the results of the sample to be detected.

Objective:To explore dynamic change of heart rate variability (HRV) before and after circumferential pulmonary vein ablation (CPVA ) in patients with paroxysmal atrial fibrillation (PAF) and its relationship with postoperative recur‐rence .Methods:A total of 108 PAF patients undergoing left atrial circumferential pulmonary vein electrically isolated ra‐diofrequency ablation were selected .According to 12‐lead DCG on 3d and three months after operation ,patients were di‐vided into early recurrence group (n=10) ,late recurrence group (n=21) and no recurrence group (n=77) .HRV changes were followed up and compared among all groups .Results:Compared with before ablation ,on 3d after ablation ,there were significant reductions in standard deviation of normal to normal RR intervals calculated over the 24 h period (SDNN) , standard deviation of normal to normal RR intervals in all 5 min segments of the entire recording (SDANN) ,root‐mean square of differences betweensuccessive normal to normal intervals (rMSSD) ,low frequency (LF) ,high frequency (HF) in no recurrence group ;significant rise in mean heart rate ,and significant reductions in SDNN ,LF and LF/HF in early recur‐rence group ( P< 0.05 or <0.01);compared with no recurrence group ,there were significant rise in mean heart rate [(69.3 ± 11.2) beats/min vs .(75.4 ± 14.0) beats/min] ,SDANN[(66.9 ± 25.7)ms vs .(137.5 ± 92.3)ms] ,rMSSD [(22.1 ± 10.6)ms vs .(46.2 ± 19.2)ms] ,LF [(233.1 ± 31.4)ms vs .(251.7 ± 17.3)]and HF[(228.0 ± 82.4) ms2 vs . (508.0 ± 13.5) ms2 ] ,and significant reduction in LF/HF[(1.13 ± 0.53) ms2 vs .(0.41 ± 0.13) ms2 ]in early recurrence group (P<0.05 or < 0.01);significant rise in rMSSD [(23.9 ± 11.10) ms2 vs .(52.0 ± 28.7) ms2 ]and HF[(344.4 ± 103.2) ms2 vs .(482.1 ± 100.6) ms2 ] ,and significant reduction in LF/HF[(1.16 ± 0.41) vs .(0.85 ± 0.43)]in late recur‐rence group , P<0. 05 or <0. 01. Conclusion:Vagal tone reduction may reduce recurrence after CPVA in PAF patients .

Carcinoma of pancreas is the most common primar y pancreatic malignancy. Symptoms usually are nonspecific and include abdominal pain, jaundice, loss of appetite, weight loss, nausea, and vomiting. CT usually demonstrates a mass with ill-defined margins but also solid components and dil atation of the main pancreatic duct. This tumor is usually smaller and virtuall y never contains calcification. Following contrast material administration,all masses were enhanced less than the surrounding pancreas. Tumors were oval, rou nd or lobular,and is almost always locally invasive. These features can be used to differentiate carcinoma of pancreas from other pancreatic tumors.