Objective To study the relationship between ambulatory arterial stiffness index and extent of coronary atherosclerosis.Methods All subjects were underwent coronary CT angiography.Ambulatory arterial stiffness index(AASI) was measured before coronary CT angiography.AASI value between different periods in each group were calculated and compared.Results AASI between different periods in the normal control group and coronary heart disease group existed statistical difference (P ＜ 0.05).The extent of coronary sclerosis and AASI between different periods in different coronary artery lesions groups were statistically different(P ＜0.05),AASI was proportional to the degree of coronary sclerosis,24 h AASI,DAASI,NAA SI were related to extent of coronary atherosclerosis lesions,the correlation coefficient between NAASI and extent of coronary atherosclerosis was the largest.Conclusion AASI night is related to coronary atherosclerosis most closely,namely the higher the value of the nighttime AASI,the greater the degree of coronary atherosclerosis.

Objective To investigte the inhibit effects of drug combination of Kanglaite injection(KLT) and TXT on human pulmonary epithelial cells(95D) in vitro,and to find the best time of combination.Method 95D cell growth inhibition was measured with MTT assay.Results Various concentration of KLT and TXT could inhibit the proliferation of 95D cell,and KLT could enchance the sensiti vity of 95D cell to TXT(P

Objective:With the development of digital technology, network technology and mobile technology, new media aided-teaching has become a hot topic in medical teaching. However, the studies about the application of new media aided-teaching in training for professional postgraduates of neurosurgery are still less studied.Methods:In this study, 24 Batch 2015-2016 professional postgraduates of neurosurgery from Neurosurgery Department of Affiliated Hospital of Southwest Medical University were divided into the test group and control group, with 12 students in each group. From September 2016 to August 2018, students in the test group were taught with conventional teaching and various new media such as WeChat official accounts, professional video sharing websites and so on. The control group adopted conventional teaching methods. Students' theoretical knowledge, operation ability and clinical research ability were assessed between the two groups. SPSS 22.0 software was used for t test and descriptive statistics on the data.Results:The results of t test analysis showed that the scores of theoretical knowledge and general ability in test group were higher than those in control group, with significant differences ( P < 0.05). Meanwhile, the scores of teaching satisfaction, professional interest, teaching participation, knowledge mastery and scientific research ability in the test group were higher than those in the control group, with significant differences ( P<0.05). Conclusion:Conventional teaching combined with new media aided-teaching is a good new training model for professional postgraduates of neurosurgery, which has improved students' participation and motivation of study and contributed to the training of medical students' comprehensive abilities.

Objective To evaluate the efficacy of low-dose levothyroxine sodium in treatment of severe pulmonary tuberculosis with euthyroid sick syndrome(ESS). Methods One hundred and twenty inpatients with severe pulmonary tuberculosis and ESS were randomly divided into treatment group and control group by gender, age, disease duration and severity. Both groups were given anti- tuberculosis, antiinfection treatment and nutritional support for 2 weeks; patients in treatment group were given low-dose levothyroxine sodium additionally. Thyroid function, clinical improvements, increase of albumin, reduction of acid-fast bacilli, improvements on images and the mortality rates were compared between the groups.Results After 2 weeks of treatment, symptoms including fever, cough and night sweats were improved in both groups. Marked improvements were observed in 19 patients(31.7%)of treatment group and 8 patients (13.3%)of control group(χ2 = 5. 73, P ＜ 0.05). Clearance rate of acid-fast bacilli in treatment group was 25.0%(15/60), but that in the control was only 6.7%(4/60)(χ2 = 7. 50, P ＜ 0.01). Serum albumin in the treatment group was increased to(34.2 ±0.4)g/L after the treatment, and that in the control group was(29.1 ±0.6)g/L(t =2.42, P＜0.05). T3 and FT3 were significantly increased in both groups, but more significant difference was observed in the treatment group(t = 59. 42 and 50. 66, P ＜ 0. 01). No empty closed after treatment in both groups, but the effective rate in treatment group was significantly higher than that in the control group(93.3% vs. 76.7%, χ2 =6. 54, P＜0.05). Two patients in control group died(2/60, 3. 3%), while no death was reported in treatment group. Conclusions Low-dose levothyroxine sodium treatment is effective for ESS in patients with severe pulmonary tuberculosis.Improvement on low T3 syndrome may be an important indicator for the overall improvement or recovery.

OBJECTIVE:To investigate the effects of glutamine on neurological and gastrointestinal function of severe organo-phosphate poisoning patients. METHODS:46 patients with severe organic phosphorus poisoning in our hospital were enrolled and ran-domly divided into control group and observation group,with 23 cases in each group. Control group was given antidote atropine,en-ergy recovery agent pralidoxime chloride,blood perfusion and other symptomatic treatment. Observation group was additionally given Glutamine dipeptide injection 0.5 g/kg,ivgtt,qd,on the basis of control group. Both groups received the treatment for consecutive 3 d. The time of poisoning symptom disappearance,the time of blood cholinesterase recovery,hospitalization time,neurological and gastrointestinal function indexes were compared between 2 groups. RESULTS:The time of poisoning symptom disappearance,the time of blood cholinesterase recovery and hospitalization time of observation group were significantly shorter than those of control group,with statistical significance (P<0.05). After treatment,serum diamine oxidase and lactulose/mannitol of observation group were significantly lower than those of control group,while the serum content of citrulline was higher than in control group,with sta-tistical significance (P<0.05). After treatment,MCV and SCV of observation group were significantly higher than those of control group,while F wave latency was significantly shorter than control group,with statistical significance(P<0.05). CONCLUSIONS:Glutamine dipeptide is helpful to promote remission,improve gastrointestinal and neurological function.

Objective To investigate the characteristic and its clinical value of tumor necrosis factor (TNF)-α and its receptor, interleukin (IL)-1β and its receptor in serum and bronchoalveolar lavage fluid(BALF) in patients with pulmonary tuberculosis and to determine the role of them in the immunopathogenesis of tuberculosis. Methods The concentrations of TNF-α,soluble TNF receptor (sTNF-R) Ⅰ, IL-1β and IL-1 receptor were measured using sandwish ABC-enzyme-linked immunosorbent assay (ELISA) method in serum and BALF of 46 patients with active tuberculosis and 21 patients with inactive tuberculosis, and in the serum of 20 cases of healthy control. Meanwhile the above-mentioned cytokine levels in serum and BALF of 19 patients with active tuberculosis were followed up. Differences between groups were assessed for significance by t test. Results The TNF-α,sTNF-R Ⅰ, IL-1β and IL-1 receptor levels and TNF-α/sTNF-R Ⅰ ratios in BALF of active tuberculosis group were (286.2±96.3) pg/L,(2 431.5±1 124.6) pg/L,(58.6±3.2) pg/L,(162.4±17.1) pg/L and 0.06±0.01, respectively, which were all significantly higher than those with inactive tuberculosis group (t=3.36,3.25,2.95,2.27 and 3.12 respectively; P<0.05). The TNF-α,sTNF-R Ⅰ,IL-1β and IL-1 receptor levels and TNF-α/sTNF-R Ⅰ ratios in BALF of cavernous tuberculosis group were (381.4±106.4) pg/L,(2 824.7±1 318.5) pg/L,(66.4±4.6) pg/L,(176.4±18.7) pg/L and 0.07±0.01, respectively,which were all significantly higher than those of non-cavernous tuberculosis group (t= 3.46,2.37, 3.19, 2.99 and 3.22, respectively; P<0.05). After 2-month' antituberculosis treatments, among 19 cases, the TNF-α,sTNF-R Ⅰ,IL-1β and IL-1 receptor levels and TNF-α/sTNF-R Ⅰ ratios in BALF of 16 cases were significantly lower than those at the beginning of treatments (t= 3.26,3.17, 3.28, 2.92 and 3.12 respectively; P<0.01). Meanwhile, their clinical symptoms improved, sputum smear negative, lesions on chest X-ray resolved and the cavity shrinked or closed. Conclusions TNF-α, sTNF-R Ⅰ, IL-1β and IL-1 receptor are likely to be involved in the immunopathogenesis of tuberculosis. Detection of TNF-α, sTNF-R Ⅰ, IL-1β and IL-1 receptor levels in the serum and BALF is helpful to understand the activity of disease, determine the clinical pattern of disease,assess the prognosis of disease and monitor the therapeutic effect in patients with pulmonary tuberculosis.

Objective: To explore the clinical value of plasma copeptin level on major adverse cardiovascular event (MACE) occurrence in patients with acute ST-segment elevation myocardial infarction (STEMI) during hospitalization.
Methods: Our research included 2 groups:STEMI group, n=80 and Control group, n=80 patients with stable coronary artery disease (CAD). All patients were treated in our hospital from 2012-06 to 2014-06. Plasma level of copeptin was detected by ELISA, other relevant examinations were conducted to study the MACE occurrence in STEMI patients.
Results: Plasma copeptin level in STEMI group (523.26 ± 142.69) pg/ml was higher than that in Control group (345.25 ± 89.36) pg/ml, P<0.05. In STEMI group, there were 28/80 (35%) patients suffered from MACE, compared with non-MACE patients, they had increased plasma copeptin, cardiac muscle protein I (cTnI), kinase isoenzyme (CK-MB) and left ventricular ejection fraction (LVEF), P<0.05. Multivariate regression analysis indicated that plasma copeptin, cTnI and LVEF were the independent risk factors for MACE occurrence. According to occurred area under the curve, compared with cTnI and CK-MB, plasma copeptin level had the higher predictive value to judge the ROC, positive/negative possibility, sensitivity and speciifcity for MACE occurrence in STEAMI patients, P<0.05.
Conclusion: Plasma copeptin level could effectively predict MACE occurrence in patients with acute STEMI during
hospitalization, it may predict their prognosis at certain point.

Objective To investigate the efficacy of the oxygen uptake efficiency slope (OUES), obtained from submaximal exercise, as an index of cardiopulmonary functional reserve in adults. Methods Exercise tests, following a symptom-limited standard Bruce protocol with simultaneous respiratory gas measurement, were performed on a treadmill in 33 healthy adults free of clinically recognized cardiovascular disease and 31 patients with heart disease. The OUES was derived from the relation between oxygen uptake (VO2) and minute ventilation (VE) during incremental exercise and was determined by VO2=alog10VE+b, where a=OUES. The OUES was calculated from data of the first 75%, 90% and 100% of exercise duration (as 75%OUES，90%OUES and 100%OUES). Results The 100%OUES，90%OUES and 75%OUES were not significantly different from each other（F=0.212，P=0.809）. The 75%OUES was slightly lower (1.9%) than the 100%OUES. The 100%OUES, the 90%OUES and the 75%OUES correlated with the peak VO2 （r=0.836,r=0.824 and r=0.777, P<0.001, respectively）. The VAT correlated with the peak VO2 （r=0.878，P<0.001），and the VE/VCO2 at VAT correlated with the peak VO2 （r=-0.584，P<0.001）. The 100%OUES correlated with the 90%OUES and the 75%OUES （r=0.991 and r =0.945, P<0.001, respectively）. Conclusion The OUES is an index of exercise performance and cardiopulmonary functional reserve on healthy adults and patients with cardiac disease. The 75%OUES from submaximal exercise can be an index of cardiopulmonary functional reserve for patients with cardiac disease.

Objective:To investigate the effect and mechanism of exosomes derived from human umbilical cord mesenchymal stem cells (hUC-MSC) in repair of tendon injury in rats.Methods:The hUC-MSC were cultured and the surface markers were identified by flow cytometry. The cells were induced to differentiate into osteoblasts, chondroblasts and adipocytes using a specific media. Meanwhile, the exosomes were isolated from the cell supernatant using exosome separation columns, and were identified by transmission electron microscopy, PKH67 staining and Western blot. A total of 40 Wistar rats were used to establish the Achilles tendon injury model by surgical resection. The rats were divided into hUC-MSC group (Group A) (with 100 μg exosome injected at the injured site) and control group (Group B) (with 250 μl normal saline injected at the injured site) according to the random number table, with 20 rats per group. The expressions of transforming growth factor β (TGF-β), bone morphogenetic protein (BMP-2), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF-2), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the tendon tissues of both groups were detected using q-PCR, Western blot and immunofluorescence assay at 4 weeks following injection. The expression of collagen III in the injured tissues of both groups was detected by immunohiestochemistry.Results:The isolated and cultured hUC-MSC presented fusiform under an inverted microscope. After osteogenic differentiation, the cells exhibited a cube nodular structure, and the Alizarin red staining was positive. After adipogenic differentiation, the fat was observed inside the cells, which was red by oil red O staining. After chondroblast differentiation, the cells secreted a large amount of glycosaminoglycans, and a strong positive was revealed by Alisin blue staining. The hUC-MSC-derived exosomes showed round disc shape with a depressed internal structure under a transmission electron microscope, which was verified via PKH67 staining. The Western blot analysis showed high expressions of motility-related protein-1 (CD9) and lysosomal associated membrane protein 3 (CD63). The q-PCR test revealed that the mRNA expressions of TGF-β (4.887±0.767), BMP-2 (3.079±0.150), VEGF (3.108±0.508) and FGF-2 (4.211±0.522) in Group A were markedly higher than those in Group B (1.000±0.062, 0.918±0.129, 1.004±0.103, 1.010±0.169, respectively) ( P<0.01), and that the mRNA expression of IL-1β (0.697±0.037) and TNF-α (0.793±0.021) in Group A was markedly lower than those in Group B (1.004±0.089 and 1.006±0.015, respectively) ( P<0.01). The Western blot analysis revealed that the protein expressions of TGF-β (1.434±0.041), BMP-2 (1.798±0.177), VEGF (1.552±0.113) and FGF-2 (1.357±0.039) in Group A were markedly higher than those in Group B (1.002±0.032, 0.992±0.068, 1.007±0.070, 0.994±0.051) ( P<0.01), and that the protein expressions of IL-1β (0.705±0.016) and TNF-α (0.840±0.045) in Group A was markedly lower than those in Group B (1.000±0.016, 1.003±0.040) ( P<0.01). The immunofluorescence revealed that the positive expression rates of TGF-β and VEGF in Group A were not significantly different from those in Group B ( P>0.05). However, the positive expression rates of BMP-2 (2.278±0.208) and FGF-2 (4.656±0.106) in Group A were markedly higher than those in Group B (0.315±0.101, 1.661±0.110) ( P<0.05 or 0.01), and the positive expression rates of IL-1β (1.677±0.947) and TNF-α (1.520±0.088) in Group A were greatly lower than those in Group B (4.296±0.291, 2.373±0.273, respectively) ( P<0.01). In Group A, the tendon collagen fibers were arranged regularly and tightly, with relatively significant expression of collagen III; while the tendon collagen fibers in Group B were distributed loosely, accompanying broken scarlike healing. Conclusion:The hUC-MSC-derived exosomes can prompt the repair of the injured tendon tissues, which may be associated with the function in up-regulating the expressions of growth factors including TGF-β, BMP-2, VEGF and FGF-2, enhancing the expression of collagen III and inhibiting the expression of the inflammatory cytokines including IL-1β and TNF-α.

Tuberculous meningitis is the most common and serious type of central nervous system tuberculosis, with high mortality and disability rate, which has attracted extensive attention of global public health. The high mortality rate and disability rate of tuberculosis meningitis may be related to its lack of specific clinical and imaging characteristics, insufficient attention from clinicians, lack of early sensitive and specific diagnostic testing techniques, delay in treatment, and restricted penetration of anti-TB drugs into the blood-brain barrier or/and MDR-TB, etc. This article reviews the disease burden of TBM, chemotherapy drugs and regimens, anti-inflammatory agents, aspirin, interventional and surgical treatment to provide reference for clinical management of this disease.