Objective To observe the correlation between lipoprotein-associated phospholipase A2(Lp-PLA2) levels and coronary artery disease (CAD), extent of angiographic coronary artery lesions and risk factors of CAD in the elderly. Methods Plasma levels of Lp-PLA2, triglyceride (TG), total cholesterol(TC), low density lipoprotein(LDL-C), high density lipoprotein cholesterol (HDL-C) and high sensitivity C-reactive protein(hs-CRP) were measured in 67 elderly patients with angiographic CAD meanwhile in 23 normal controls without angiographic coronary artery lesions. The extent of coronary artery lesions was evaluated according to the number of vessel lesions (divided into single, double and triple-vessel lesions) and Gensini scoring system. Then the relationship between Lp-PLA2 and CAD was assessed. Results The plasma levels of Lp-PLA2 were significantly higher in the CAD group than in the controls [(352.7 ± 129.0) vs. (204.0 ± 59. 7) μg/L, P < 0. 01]. Lp-PLA2 levels increased with the number of coronary artery lesions and Gensini score, then were positively correlated with age(r= 0. 25, P<0. 05) ,TC(r=0. 33, P<0. 01) ,LDL-C(r=0.27, P< 0. 05),apoB(r=0. 36, P<0. 01). The levels of LP-PLA2 and LP(a) were associated with CAD by using stepwise regression analysis. Conclusions In the eldly, the levels of LP-PLA2 are much higher in angiographic CAD, and these may reflect the severity of CAD. LP-PLA2 is a risk factor for CAD.

Objective: To explore the effects of ramipril, trimetazidine and the combination of ramipril and trimetazidine on renal cell apoptosis index (AI) and cytochrome C (Cyt-C) expression in experimental rats with chronic heart failure (CHF).
Methods: CHF model was established by partially banding of abdominal aorta superior to renal artery in experimental rats. A total of 50 male Wistar rats were randomly divided into 5 groups: Sham operation group, Model group, Ramipril group, Trimetazidine group and Combination (ramipril and trimetazidine) group.n=10 in each group. Renal tubular cell AI was examined by TUNEL method, mRNA and protein expressions of Cyt-C were detected by RT-PCR and Western Blot analysis in each group respectively.
Results: Compared with Sham operation group, Model group had increased AI of renal tubular cells, increased mRNA and protein expressions of Cyt-C,P<0.01. Compared with Model group, Ramipril group, Trimetazidine group and Combination group showed decreased AI of renal tubular cells (20.02 ± 1.14) %, (20.10 ± 1.2) % and (14.27 ± 1.40) % vs ( 40.82 ± 1.31) %; reduced Cyt-C mRNA expression (0.54 ± 0.06), ( 0.56 ± 0.05) and (0.44 ± 0.04) vs (0.89 ± 0.03); reduced Cyt-C protein expression (1.50 ± 0.11), (1.58 ± 0.12) and (0.75 ± 0.06) vs (2.53 ± 0.10); the most reduction was obtain by Combination group, allP<0.01.
Conclusion: Ramipril and trimetazidine can inhibit renal cell apoptosis and effectively improve the renal function in CHF rats. Combined medication is better than either of them alone.

Objective To investigate the impact of thyrotropic hormone (TSH) on recurrence rate of common bile duct stone (CBDS).Methods The clinical data of 268 cases of primary or recurrent CBDS undergoing surgery was analyzed.According to whether screening preoperative TSH level routinely,we assigned the patients into two groups,unchecked group with 171 cases and screened group with 97 cases.The postoperative recurrence rates in 36 months between two groups were compared.Results The recurrence rates of unchecked group and screened group were 3.5％,12.9％,16.9％ and 0.0％,5.2％,8.2％ respectively in 12-,24-,36-months,there was statistically significant difference between two groups (x2 =4.029,P ＜ 0.05).In unchecked group,patients ≥ 60 years had a significant higher recurrence rate than ＜ 60 years patients (x2 =6.485,P ＜ 0.05).In screened group,there was no statistically significant difference between ≥60 and ＜ 60 patients (x2 =0.142,P ＞ 0.05).In those 34 patients with a high TSH level in the screened group,normalizing the level from (6.23 ± 1.44) μIU/ml to (2.91 ±0.74) μIU/ml by oral intake of thyroid hormone postoperatively,led to the recurrence rates of 0％,5.9％,8.8％ in 12-,24-,36-months,which was not significantly different from those with normal TSH (x2 =0.022,P ＞ 0.05).And that,there was not statistically different between the young and elder patients in those 34 cases for the 12-,24-,36-month recurrence rates (x2 =0.086,P ＞ 0.05).Conclusions Some CBDS patients may be with high level of TSH.Normalizing TSH level may be conducive to a reduced postoperative recurrence rate of CBDS.

Objective To establish a rat model of middle cerebral artery occlusion (MCAO)by blockage or obstruction of middle cerebral artery. NO precursor L-Arginine (L-ARG) and NO donator Nitroglycerine (NG)are administrated from intraearotid arteries. DWI and PWI are applied to evaluate blood circulation and brain damage of the effected region to elucidate the piotective function of L-ARG and NG in the early stage of brain ischemia. Methods The middle cerebral artery was occluded by insertion of a suture through the internal carotid artery of SD male rats to duplicate ischemia-reperfusion model. Reperfusion was established by suture withdrawal. After 2 hours of blockage, reperfusion and administrate L-ARG,NG by interventional therapy through the internal carotid artery simultaneously. Image indexes such as T1WI, T2WI, DWI and PWI are utilized to assess the changes in different time points. These indexes, Longa score and TTC stain were compared. Results There were obvious decrease in DWI high signal region and Trc pale region in drugs groups, compared with MCAO group(P＜0.01).ADC and rADC values in DWI high signal region increased gradually from 2 hours after ischemia to 24 hours after reperfusion in each group. ADC and rADC values in DWI high signal region of the drugs groups increased obviously(P＜0.01).Conclusion Interventional therapy with NO precursor/donator showed significant protective function in the early stage of brain ischemia.

Objective:To understand the current situation of physicians′ competency in China and statistically analyze its influencing factors, hence providing referential evidences for promoting their competency.Methods:The evaluation scale for Chinese physicians′ competency was developed by referring to sophisticated overseas evaluation frameworks. Based on the electronic platform of the medical alliance, stratified sampling was conducted at 39 hospitals in 13 provinces, from which 2 156 physicians were surveyed, and statistical analysis was made on the current situation and influential factor of their competency in 6 dimensions(medical knowledge, diagnosis and treatment, scientific research and teaching, interpersonal communication, spirit of professionalism, population health)Results:The score range in multiple dimensions of physicians′ competency was between 2.85 and 3.89(5 in total), among which spirit of professionalism dimension scores the highest, and teaching and research dimension scores the lowest. Logistic regression analysis shows that their competency level in 6 dimensions is correlated to a range of factors, including gender, degree, title, supervisor qualifications, standardized training program of specialist physicians, and affiliation or not to teaching hospitals( P<0.05). Conclusions:Their overall competency is expected to be elevated. To name a few, they are lack of teaching and research abilities, and need to conduct clinical-oriented scientific research; they are expected to enrich knowledge structure, and need to embrace a wider concept of health; they need to improve their non-technical service abilities, and should further emphasize their humanistic quality; physicians′ practice competency depends upon their extent of medical education, and ensuring the quality of standardized training becomes the key measure.

Objective To explore the feasibility and validity of laparoscopic choledochotomy and choledochoscopy for treament of patients with acute pancreatitis accompanying commom bile duct stones. Methods A total of 102 patients acute pancreatitis accompanying common bile duct gall stones were treated in our institution between January 2007 and November 2009. Among them, 43 patients underwent laparoscopic choledochotomy and choledochoscopy within 72h after admission entered our study group. They all had a laparscopic cholecystectomy and choleldochotomy and choledochoscopy to retrieve common bile duct stones. Of these, 13 patients undergoing pancreatic capsule incision and peritoneal lavage. Fifty-nine patients undergoing traditional conservative treatment firstly were used as a control group. Of these, 46 were performed laparscopic surgery and choledochotomy after smoothly recovery from pancreatitis. 13 underwent emergency open operation due to complications of pancreatitis. Results In the gastrointestinal function recovery time, amylase recovery time, length of stay and hospitalization cost, there was a significant difference between study group and the control group (P<0.05). Conclusions Our study provides evidence for the good clinical efficacy of early implementation of laparoscopic choledochotomy and choledochoscope for treatment of choledocholithiasis and acute pancreatitis.

Objective To study the changes of trans-diaphragmatic pressure (Ptra) and its correlation with esophageal pressure (Peso) through ARDS piglet model.Methods Five piglets were enrolled in the study.Peso,gastric pressure (Pgas) and intra-thoracic pressure (Pint) was monitored through balloon inserted.The data before ARDS serve as control.ARDS was produced in the piglets through saline lavage.The pressure were observed and the Ptra were calculated.The pressure changes and correlation between Ptra and Peso were analyzed as well.Linear regression with the coefficient of determination and t-test were used as appropriate.Significance was assumed for P ＜ 0.05.Results Peso,Pgas and Pint before ARDS were 7.3 ± 1.9,25.5 ± 2.4,- 1.23 ± 0.21 cmH2O,Ptra was 18.2 ± 1.6 cmH2O.While after ARDS,the data were 4.7 ± 1.4,31.1 ± 3.1 and - 1.79 ± 0.28 cmH2O,and Ptra was 26.4 ± 2.1 cmH2 O,and all these changes were obviously ( P ＜ 0.05 ).The correlation between Pint and Peso,Pint and Ptra (A) and Ptra ( B ) were 0.93 ± 0.025,0.88 ± 0.023 and 0.87 ± 0.37 before ARDS.After ARDS,the correlation changed to be 0.82 ±0.21,0.81 ±0.20 and 0.78 ±0.31.Although a bit decreased,the correlation was still positive (P ＜ 0.01 ).Conclusions There existed good correlations between Peso and Ptra as well as between Pint and Peso before or after ARDS.Ptra was increased obviously after ARDS,which could lead to respiratory muscle fatigue.

Objective:To establish the quality control method for compound Jieyu granules. Methods:Liquorice was identified by TLC. saikosaponin a, Saikosaponin d and rutin were determined by HPLC. Results:The spots on TLC plates were clear without any in-terference. The linearity was achieved within the range of 0. 508-16. 200 μg (r=0. 999 8) for saikosaponin a, 0. 503-16. 100 μg(r=0.999 7) for saikosaponin d, and 0.130-4.250 μg(r =0.999 9) for rutin. The average recovery was 99.7%(RSD =2.03%), 99. 8%(RSD=1. 44%) and 102. 6%(RSD=1. 40%), respectively. Conclusion:The method is simple, reliable and accurate, and can be applied as the quality control method for compound Jieyu granules.

Objective:To analyze the clinical efficacy of different intervention regimens combined with Sintilimab and Lenvatinib in the treatment of liver cancer.Methods:Using a case-control study method, a retrospective analysis was conducted on 72 patients with advanced liver cancer admitted to Huangshi Central Hospital from January 2020 to January 2023. They were divided into two groups according to the treatment plan. The TACE group (36 cases) received transcatheter hepatic artery embolization chemotherapy (TACE)+ Sintilimab+ Lenvatinib, while the HAIC group (36 cases) received hepatic artery infusion chemotherapy (HAIC)+ Sintilimab+ Lenvatinib. The research data and clinical efficacy of two groups were analyzed, liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil)], and tumor between the two groups. Markers [serum alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199)]and drug safety. Telephone and outpatient follow-up were conducted on patients after treatment, calculate the disease progression rate and mortality rate of two groups of patients, and follow up until the patient′s condition progresses or until March 1, 2024. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), t-test was used between the two groups. Chi-square test was used between the two groups of count data. Results:The objective response rate of TACE group was 27.78%, while that of HAIC group was 52.78%. The objective response rate of HAIC group was higher, and the difference between the two groups was statistically significant ( P<0.05); Before treatment, the levels of AST, ALT, and TBil in the two groups were compared, with P>0.05; After treatment, the AST of the TACE group was (36.65±4.80) U/L, ALT was (55.40±5.90) U/L, and TBil was (19.65±2.25) μmol/L, while the HAIC group was (25.95± 4.92) U/L, (41.15±6.15) U/L, and (14.40±2.13) μmol/L, respectively. The levels of various indicators in the HAIC group were lower, and the difference between the two groups was statistically significant ( P<0.05); Before treatment, there was no statistically significant difference in the levels of AFP, CEA, and CA199 between the two groups ( P>0.05); Before treatment, there was no statistically significant difference in the levels of alpha fetoprotein, carcinoembryonic antigen, and CA199 between the two groups ( P>0.05); After treatment, the levels of alpha fetoprotein, carcinoembryonic antigen, and CA199 in the TACE group were (152.50±20.10) ng/mL, (3.93±1.42) ng/mL, and (20.35±3.50) IU/mL, respectively, while those in the HAIC group were (102.35±18.10) ng/mL, (2.85±1.26) ng/mL, and (21.48±3.31) IU/mL, respectively. The levels of alpha fetoprotein and carcinoembryonic antigen in the HAIC group decreased more significantly ( P<0.05); The incidence of adverse reactions in the TACE group was 33.33%, while in the HAIC group it was 25.00%. There was no statistically significant difference in the incidence of adverse reactions between the two groups ( P>0.05). All patients completed treatment. In the TACE group, there were 4 cases of disease progression and 1 case of death, with an incidence of adverse prognosis of 13.89%. In the HAIC group, there was 1 case of disease progression and no death, with an incidence of adverse prognosis of 2.78%. There was no statistical significance between the two groups( P=0.088). Conclusion:For liver cancer patients, the combination of HAIC+ Sintilimab+ Lenvatinib is more effective in improving liver function and tumor marker levels compared to the combination of HAIC+ Sintilimab+ Lenvatinib.

Fentanyl and fentanyl-related substances are a series of synthetic and powerful anesthetics represented by fentanyl. In recent years,the abuse and trafficking of these substances in many countries around the world are serious which poses a great threat to people"s health and social stability. This paper focuses on the abuse,pharmacological and toxicological action,detection methods and control of fentanyl and fentanyl-related substances and aims to enhance people"s understanding of their basic properties,current research and control so as to provide references for future research.