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 .

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.

Trauma and infection may cause a stress reaction to the body,which leads to the metabolic imbalance of organs and tissues,but some treatment methods can effectively reduce the negative effects of undesirable stress on body metabolism.This article focuses on the effects of trauma and infection stress on the protein metabolism,furthermore,introduces some related treatment methods.

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.

Objective To analyze the expression and the role of Toll-like receptor 4 (TLR4) and the effect of N-acetylcysteine (NAC) on hepatic ischemia- reperfusion (I/R) injury.Methods The rat model of 45 min hepatic ischemia followed by 24 h reperfusion was used. Animals were divided into 3 groups: the pseudoperated control group (P), I/R group and treated group with NAC at a dose of 300 mg/kg at 5 min before reperfusion (I/R-NAC). Plasma concentrations of ALT, AST and lipopolysaccharide (LPS) at various time points were measured. The expression of TLR4 protein and mRNA was detected in liver tissue by using immunohistochemistry and RT-PCR.Results The TLR4 expression, plasma ALT, AST and LPS levels were markedly increased during 45 min hepatic ischemia and 24 h reperfusion, but they were lower in I/R-NAC group and no alteration almost in group P. The plasma concentrations showed a significant correlation between ALT, AST and LPS at different time points in I/R group and I/R-NAC group.Conclusion LPS and TLR4 play a prominent role in the pathophysiological processes of I/R and NAC can be of therapeutic potential for reducing the expression of TLR4 mRNA and alleviating endotoxemia derived from gut.

Objective To analyse the clinical characteristics of drug-fever caused by ?-lactams antibiotics and provide the basic information for diagnosis of patients with drug-fever,and profile the drug fever due to antimicrobil agent.Methods In this study,64 hospitalized cases between 2000 and 2006 were enrolled who had drug-fever during antiinfective treatment.Results Most medications can cause fever,so as ?-lactams Antibiotics,with or without concomitant clinical manifestations.The fever could arise from the drug's pharmacologic action,its effects on thermoregulation,a local complication following parenteral administration,or an idiosyncratic response.Patients with drug-fever caused by ?-lactams,their temperature droped to normal level while ?-lactams discontinued for about 24h~48h,and without any linger effect.Conclusions Drug-fever is mainly caused by ?-lactams antibiotics like piperacillin sodium.It is important that doctors should bear the drug-fever in mind to avoid misdiagnosis.

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.

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.

Objective To analyze the influence of total thyroidectomy (TT) on quality of life of patients with nodular goiter with iodine deficiency.Methods 70 patients who received TT in the hospital from June 2014 to July 2015 were randomly divided into two groups, 35 cases in each.Control group received subtotal thyroidectomy and observation group received total thyroidectomy.The situation of operation, thyroid function, therapeutic effects and quality of life in two groups were compared.Results Operation time and hospital stays of observation group were significantly longer than that of control group (P<0.05);There was no significant difference in intraoperative bleeding volume and curative effective rate between the two groups;Before surgery, there was no significant difference in thyroid function between the two groups;After surgery, thyroid function of both two groups decreased compared with pre-operation, but there was no significant difference;There was significant difference in VAS and health description system scores between the two groups.Conclusion TT in treatment of patients with nodular goiter with iodine deficiency has significant clinical efficacy with high cure rate and less complication, and it can improve quality of life of patients, which is beneficial to postoperative recovery and worthy of generalization in clinical application.

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.