Objective:To explore the clinical significance detecting adrenomedullin (ADM)and high sensitive C reac-tive protein (hsCRP)in patients with acute coronary syndrome (ACS).Methods:A total of 51 inpatients,which were eliminated for coronary heart disease (CHD)by coronary angiography (CAG),were enrolled as non CHD group,and 124 ACS patients diagnosed by CAG were regarded as ACS group.ADM and hsCRP concentrations were measured before and after CAG in non CHD group and before and after percutaneous coronary intervention (PCI) in ACS group,and they were compared between two groups.Results:Before CAG/PCI,compared with non CHD group,ADM [(28.7±1.6)pg/ml vs.(36.7±2.5)pg/ml]and hsCRP [(4.74±3.21)mg/L vs.(27.65±11.76) mg/L]levels significantly rose in ACS group,P<0.05 or <0.01.Compared with before PCI,there were signifi-cant increase in levels of ADM [(36.7±2.5)pg/ml vs.(47.1±5.3)pg/ml]and hsCRP [(27.65±11.76)mg/L vs.(39.53±4.83)mg/L]in ACS group after PCI,P<0.01 both,and significantly higher than those of non CHD group (P<0.05~<0.01).There were no significant difference in ADM and hsCRP levels in non CHD group be-tween before and after CAG (P>0.05 all).Conclusion:Detecting arenomedullin combined high sensitive C-reac-tive protein is gelpful to early diagnosis and evaluating lesion severity for acute coronary syndrome.

Objective To evaluate the analgesic effect of dexmedetomidine on the ultrasonic guidance brachial plexus block.Methods Sixty patients who underwent elective for one-side upper limb or forearm surgery were selected,they were received ultrasonic guidance brachial plexus block.The patients were divided into observation group and control group by random digits table method with 30 cases each.The observation group received 0.5％ ropivacaine 100 mg and dexmedetomidine 0.75 μg/kg,and the control group received 0.5％ ropivacaine 100 mg alone.The heart rate,mean arterial pressure (MAP),pulse oxygen saturation (SpO2) at the time of entering operating room,brachial plexus block completed,incision and the end of surgery were recorded.After brachial plexus block completed,the visual analogue score (VAS) at the time of incision,1 h during surgery and 1,2,6,12,24,48 h after surgery was recorded.Morphine was given the patients when VAS ＞ 4 scores,and the time to first prescription of morphine and total morphine consumption dose within 48 h after surgery were also detected.The adverse reaction was recorded.Results There were no statistical differences in heart rate and MAP at the time of entering operating room and brachial plexus block completed between the 2 groups (P ＞ 0.05).The heart rate and MAP at the time of incision and the end of surgery in observation group were significantly lower than those at the time of entering operating and the same time of control group,there were statistical differences (P ＜ 0.05).There was no statistical difference in SpO2 between the 2 groups (P ＞0.05).The VAS at the time of 6,12,24 and 48 h after surgery in observation group were significantly lower than those in control group [(3.0 ± 0.9) scores vs.(4.9 ± 0.5) scores,(3.0 ± 0.7) scores vs.(5.6 ± 1.2) scores,(2.2 ± 0.9) scores vs.(4.8 ± 1.8) scores,(1.7 ± 0.5) scores vs.(3.2 ± 1.0) scores],there were statistical differences (P ＜ 0.05).The time to first prescription of morphine in observation group was significantly longer than that in control group [(450 ± 37) min vs.(368 ± 42) min],the total morphine consumption dose was significantly lower than that in control group [(8.3 ± 2.8) mg vs.(15.5 ± 4.5) mg],there were statistical differences (P ＜ 0.05).There was no adverse reaction found.Conclusion Ropivacaine plus 0.75 μ g/kg dexmedetomidine for ultrasonic guidance brachial plexus block may prolong the duration of analgesia,thus reduce morphine consumption within 48 h after surgery without severe adverse reaction.

Objective To introduce a method using hydroxyapatite methylmethacylate cement implanted in the femoral head for the treatment of patients suffering from avascular necrosis of the femoral head due to different causes and to review the medium term follow up results. Methods From January 1990 to December 1995, eight hips in seven patients(male 4, female 3) with femoral head necrosis at Ficat stage Ⅲ were treated with the hydroxyapatite methylmethacylate cement implantation in the involved femoral head. Four osteonecrosis were secondary to femoral neck fracture, two were due to corticosteroid intake and one had alcohol abuse history. All patients complained pain and limited joint activity. The operation consisted of the removal of necrotic bone under weight loading cartilage with curet and the implantation of the hydroxyapatite methylmethacylate cement. The function of hip joint were well evaluated and X ray films were taken pre and postoperatively. The average postoperative follow up was 7.9 years, ranging from 5.1 to 11 years. Results Merle d Aubign? method was used to assess and compare the pre and post operative function of hip joint. The average score for unilateral cases increased from 8.66 to 15.5 at final examination. On radiography, the improvement of the contours of the femoral head was seen in all patients and most of them could preserve their initial postoperative contours during the follow up. No sign of expansion of the bone necrosis appeared in most of the patients, although certain patients presented various joint degeneration such as narrowing of joint space,sclerosis and osteophyte. Subjective evaluation was satisfactory except two suffering from painless limited activity of hip joint. Conclusion This method is relatively simple with less invasion and rapid postoperative recovery. It may be a choice of surgery for the treatment of certain femoral head necrosis at Ficat stage Ⅲ, especially for young patients.

In this paper, the hardware and software designs of a portable CPR device are introduced. The system, with a DSP chip and a single chip microcomputer composing the control system, can perform CPR and monitoring at the same time. This paper expatiates on such contents as the signal acquisition and process, the drive of the touch screen, closed cardiac massage and the control of the respiration part.

Objective To study the expression of CDK4 andβ-Catenin and their relevance in glioma. Methods We used immunohistochemistry to detect the expression of CDK4 andβ-Catenin in forty-five glio-ma tissues and eight normal tissues.According to the classification standard of WHO in 2000 classify and grade the tissues.Results There were significant differences of CDK4 andβ-Catenin expressions between normal tis-sues and glioma tissues(P<0.01).The expression of CDK4 and β-Catenin had positive correlation with the pathological grades of glioma and histological type and increased(P <0.05).Furthermore,the expression of CDK4 was positively correlated with the expression ofβ-Catenin in glioma(r=0.52,P<0.01).Conclusion The increased expression of CDK4 andβ-Catenin may have correlation with malignant change of glioma and oc-curance of glioblastoma,and their combination is expected to become an important indicator in assessing malignant glioma.

Objective To evaluate the effects of nicotine or electric vagal stimulation on injury to transplanted lungs in rats.Methods Twenty-four male Wistar rats with transplanted lung,weighing 250-300 g,were randomly divided into 3 groups (n =8 each) using a random number table:control group (group C),nicotine group (group NI) and electric vagal stimulation group (group VS).Nicotine 2 mg/kgwas injected intraperitoneally at 15 min after lung transplantation in group NI.Right cervical vagus nerve trank was stimulated for 20 min with continuous electric rectangular pulses (5 V,2 ms,1 Hz) at 10 min interval twice in total starting from 15 min after lung transplantation in group VS.Arterial blood samples were then collected for blood gas analysis at 15,30,45,75,105 and 135 min after lung transplantation.Arterial blood samples were then collected at 135 min after lung transplantation for determination of the plasma concentration of interleukin-6 (IL-6),IL-8 and tumor necrosis factor-α (TNF-α) by ELISA.The rats were sacrificed at 135 min after lung transplantation and the tissue of transplanted lung was removed for determination of lung injury score (LIS) according to the pathological changes obtained with light microscope,and of wet/dry lung weight ratio (W/D ratio).Results Compared with group C,PaO2 and pH value were significantly increased,and LIS,W/D ratio,and the concentrations of plasma IL-6,IL-8 and TNF-α were decreased in NI and VS groups.Conclusion Nicotine or electric vagal stimulation can attenuate injury to transplanted lungs in rats.

Objective To investigate the effect of salidroside on brain edema and neurological function in global cerebral ischemia-reperfusion injury in rats.Methods A total of 100 Sprague Dawley rats were randomly divided into sham operation,ischemia-reperfusion and salidroside 12,24 and 48 mg/kg groups (n =20 in each group),and than redivided into 6 h,24 h,72 h and 7 dsubgroups (n =5 in each subgroup).A rat model of global cerebral ischemia was established using the four-vessel occlusion method.Immediately after modeling,all groups were administered intragastrically for 7 days.The brain water content was quantitated by the wet-dry weight method.The neurological evaluation was performed using a neurological deficit score (NDS).Results After modeling both the ischemia-reperfusion group and all the salidroside groups had significant neurological deficit,and as time went by,it was improved gradually.Compared to the ischemia-reperfusion group at the corresponding time points,neurological deficit in all the salidroside groups was improved significantly (all P ＜ 0.05),and showing a dose-dependent trend.Compared to the salidroside 12 mg/kg and 24 mg/kg groups,neurological deficit in the salidroside 48 mg/kg group was improved significantly at 72 hours and 7 days (all P ＜ 0.05).The brain water contents began to increase at 6 hours after modeling in the the ischemia-reperfusion group and all the salidroside group.They reached the peak at 72 hours,and significantly higher than that in the sham operation group (all P ＜ 0.05).The brain water contents in all the salidroside group were significantly lower than those in the ischemiareperfusion group at 24 and 72 hours after modeling (all P ＜ 0.05) and showing a dosedependent trend.The brain water content in the salidroside 48 mg/kg group was close to that in the sham operation group at 7 days after modeling.Conclusions Salidroside may significantlydecrease brain edema and improve neurological function in global cerebral ischemia-reperfusion injury in rats,and it has a neuroprotective effect.

The article introduced the content of medical genetics in USMLE,and compared it with Chinese official teaching material. Medical genetics is an important part of USMLE and the USMLE questions come from real clinical cases and pay more attention to clinical experience. To adapt to the international trend,Chinese teaching material can clarify the genetic-related illness in detail. Clinical case is a good guide for PBL(Problem-Based learning)teaching. The medical genetics were called for in Chinese Practicing Physician Qualifications Test.

Background and purpose:As a tumor suppressor gene, ribosomal S6 kinase 4 (RSK4) plays important roles in inhibiting cell proliferation, migration and inducing cell apoptosis. However, the proteins interacting with RSK4 are still unknown. This study aimed to screen proteins interacting with RSK4 in breast cancer cell line MDA-MB-231 by lfag-tag affnity puriifcation and LC-MS/MS (liquid chromatography/mass spectrometry).Methods:The pcDNA3.1/EGFP-RSK4-Flag eukaryotic expression vector was constructed by inserting full lengthRSK4 gene into vector pcDNA3.1/EGFP-Flag. And then the recombinant plasmids were transferred into MDA-MB-231 cells. Real-timelfuorescent quantitative polymerase chain reaction (RTFQ-PCR) and Western blot were used to detect the expression of RSK4 in MDA-MB-231 cells. Affnity puriifcation and LC-MS/MS were applied to screen proteins interacting with RSK4, and the related action mechanism of RSK4 with its interacted proteins was detected based on bioinformatics gene ontology (GO) and ingenuity pathway analysis (IPA).Results:Twenty-four proteins, such as serine/threonine-pro-tein kinase 38 (STK38)/serine/threonine-protein kinase 38-like (STK38L), MOB kinase activator 2 (MOB2) and protein arginineN-methyltransferase 5 (PRMT5), were successfully identiifed by Flag-tag affnity puriifcation followed by LC-MS/MS analysis, which probably interacted with RSK4. Bioinformatics analysis of the identiifed proteins suggested the proteins interacting with RSK4 were involved in diverse biological pathways, such as apoptosis and cell migration. Conclusion:According to bioinformatics results of proteins interacting with RSK4 identiifed by affnity puriifcation and LC-MS/MS, biological networks of RSK4 are involved in apoptosis and migration in breast cancer cells.

Objective To investigate the significance of glomerular deposition of C4d in accessing the severity and prognosis of IgA nephropathy. Methods A total of 131 patients were recruited for the study. Immunofluorescence was used to detect the deposition of C4d in renal tissue of pa?tients with IgA nephropathy,and the relationship between C4d deposition and clinical and pathological parameters and renal remission was ana?lyzed. Results Totally 30 patients had glomerular deposition of C4d. Compared with the patients without C4d deposition,the patients with C4d deposition had significantly higher levels of serum creatinine,urinary protein excretion and C4d and higher prevalence of hypertension,but had sig?nificantly decreased levels of glomerular filtration rates. With the histopathological phenotypes segregated by Lee 's classification,the ratios of C4d deposition presented an increase(P=0.005). The patients with C4d deposition had more severe mesangial proliferation,endocapillary hypercellu?larity,segmental glomerulosclerosis and tubular?interstitial injury. The rates of renal remission were significantly lower in IgA nephropathy patients with C4d deposition than those without C4d deposition(P<0.001). Conclusion IgA nephropathy patients with C4d deposition have more se?vere clinical and pathological manifestations and lower rate of renal remission. Glomerular C4d deposition is expected to be an important pathologi?cal prognostic factor for predicting the prognosis of IgA nephropathy.