Objective To investigate the treatment effect of sertraline combined with psychological intervention on depression, and evaluate its application value. Methods 162 cases of patients with depression in our hospital from February 2014 to March 2017 as the research object, by double blind were randomly divided into reference group and observation group,with 81 cases in each group. All the patients were treated with sertraline treatment, on this basis,the reference group was given routine nursing intervention, the observation group added psychological intervention in nursing care on the basis of the reference group.The clinical treatment of the two groups was observed. Results The HAMD scores of the two groups were significantly improved after intervention, and the effect of the observation group was better than that of the reference group (P<0.05). The total follow-up rate and the total effective rate of the treatment group were significantly higher than the reference group, the difference was statistically significant(P<0.05). Conclusion Sertraline tablet combined with psychological intervention is effective in the treatment of depression, and can effectively improve the treatment compliance of patients, and then enhance the clinical treatment effect, the value is remarkable.

Objective: To observe the relationship among blood pressure, left ventricular hypertrophy (LVH) and sinus heart rate turbulence (HRT) in patients with essential hypertension (EH) and its clinical significance. Methods: A total of 125 EH patients received 24h ambulatory blood pressure monitoring, dynamic electrocardiogram and echocardiography examination in order to measure 24h mean blood pressure, turbulence onset (TO), turbulence slope (TS) and left ventricular mass index (LVMI). According to 24h mean blood pressure, patients were divided into hypertension stage 1 group (n=46), stage 2 group (n=41) and stage 3 group (n=38); according to LVMI, patients were divided into non- LVH group (n=74) and LVH group (n=51). TO and TS were compared among all groups. Results: TO: Compared with hypertension stage 1 and stage 2 group, there was significant increase in TO [(-2.48±1.75) % vs. (-1.86±1.19) % vs. (-0.87±1.14) %] in hypertension stage 3 group, and that of stage 2 group was significantly higher than that of stage 1 group（P<0.05～<0.01）; compared with non- LVH group, there was significant increase in TO [(-0.15±0.45) % vs. (1.08±1.19) %] in LVH group, P<0.01. TS: compared with hypertension stage 1 and stage 2 group, there was significant decrease in TS [(3.76±1.87) ms/RR interval vs. (2.33±1.48) ms/RR interval vs. (1.55±1.06) ms/RR interval] in hypertension stage 3 group, and that of stage 2 group was significantly lower than that of stage 1 group （P<0.05～<0.01）; compared with non- LVH group, there was significant decrease in TS [(4.76±1.75) ms/RR interval vs. (3.02±1.08) ms/RR interval] in LVH group, P<0.01. Conclusion: The higher the blood pressure is, the more abnormality the heart rate turbulence is; the heart rate turbulence abnormality of patients complicated with LVH is more severe than that of non- LVH patients in patients with essential hypertension, so heart rate turbulence is help to judge prognosis and guide treatment.

Background Small incision lenticule extraction (SMILE) is increasingly used for myopia.However,the size of the incision varied in different operators.The influence of 2 mm micro-incision SMILE on postoperative diopter and aberrations is not clear yet.Objective The aim of the current study was to perform a clinical analysis of the efficacy,safety,stability and predictability of 2 mm micro-incision SMILE and investigate the influence of preoperative sphere and cylinder power on postoperative aberrations.Methods A serial cases observational study was carried out under the approval of Ethic Committee of Tianjin Eye Hospital and informed consent of each patient.Fifty-five eyes of 31 subjects with myopia and myopic astigmatism were enrolled in this study in Tianjin Eye Hospital from January to April 2013 and a 2 mm micro-incision SMILE was performed on the eyes.Follow-up visits were performed at 1 week,1 month and 6 months after operation.Uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),manifest and cycloplegic refraction were examined at each postoperative time points to evaluate the efficacy,safety,stability and predictability of 2 mm micro-incision SMILE.Wave-front aberrations were measured by WaveScan aberrometer.Repeated measurement analysis of variance was used for the comparison of the differences of aberrations before and after the surgery.And the differences between various follow-up visits were compared with LSD-t test.The relationship between preoperative sphere or cylinder power and aberrations postoperatively were analyzed by Spearman rank correlation.Results At 1 week,1 month and 6 months postoperatively,the effective index was 1.2,and the safety indexes were 1.2,1.2 and 1.5 respectively.The spherical equivalent remained 0.00 D at each postoperative time point.And 96.4％ and 97.8％ of eyes were within ±0.5 D of intend correction and 100％ were within ± 1.0 D of the intend correction at 1 month and 6 months postoperatively.Vertical coma (Z7) and spherical aberration (Z12) were significantly raised at 1 week,1 month and 6 months after surgery compared with the values preoperatively (Z7:t =9.668,10.607,9.772,all at P ＜ 0.001 ;Z 12:t =-6.227,-6.923,-7.441,all at P＜0.001).The Zernike coefficients were relatively symmetrical between various time points postoperatively (all at P＞0.05).Third-order to sixth-order aberrations and higher order abberration (HOA) showed significant increase at various time points after the surgery compared with the values before surgery (all at P＜0.05),and no significant differences were seen between various follow-up visits (all at P＞0.05).Positive correlations were found between preoperative sphere and S3,S4 and HOA at 1 week,1 month and 6 months postoperatively (P＜0.05).Negative correlations were found between preoperative cylinder and S3,S4 and HOA at postoperatively various time points (all at P＜0.05).In addition,significant positive correlations were seen between Z7 and preoperative cylinder as well as between Z12 and sphere preoperatively,and negative correlations also were observed between Z7 and preoperative sphere as well as between Z12 and cylinder preoperatively at each follow-up visits(all at P＜0.05).Conclusions SMILE with 2 mm micro-incision is a safe,effective,stable and predictable procedure for myopic and myopic astigmatism eyes.The aberrations and Zernike terms remain stable after surgery until 6 months although these parameters present elevation to a certain extent.Preoperative SE and astigmatism power affect postoperative aberrations.

The molecular targeted therapy method using microRNAs(miRNAs)is gradually stepping into people′s vision. miRNAs affect colorectal cancer progress via abnormal expression in tumor cells or micro-environment. The high or low expressions of miRNAs in specific tissues probably have an impact on the expressions of oncogenes,tumor suppressor genes or other aspects including the surrounding environments,the metastases and the drug tolerance of tumors,thus contributing to curing the colorectal cancer. Nowadays, miRNA has entered the stage of animal experiments.

Purpose To explore the value of ultrasound contrast time-intensity curves in hepatic tumor qualitative diagnosis and evaluation of tumor ablation effect. Materials and Methods Forty-two patients who were clinically diagnosed as hepatic cancer or cirrhosis underwent contrast enhanced ultrasound for the tumor lesions within the liver, dynamic analysis of the lesions were executed with software SonoLiver CAP, the nature of the tumors were determined and the results were compared with those of the enhanced MRI. Ultrasound guided biopsy was followed with radiofrequency ablation treatment, two-dimensional and contrast enhanced ultrasound were executed two weeks after the ablation, and the results were compared with enhanced MRI findings during corresponding period. Results 52 tumor nodules were found with two-dimensional and color Doppler ultrasound, 65 (33 hyperplastic nodules, 32 malignant lesions) with CEUS, 65 (21 hyperplastic nodules, 44 malignant lesions) with ultrasound contrast time-intensity curves, and 61 (20 hyperplastic nodules, 41malignant lesions) with contrast enhanced MRI; pathological examination revealed that 26 of the lesions were benign and 39 were malignant;there was statistically significant difference (χ2=4.561, P<0.05) between the results of ultrasound contrast time-intensity curves and simple contrast enhanced ultrasound for the assessment of the nature of tumor;no statistically significant difference (χ2=0.003, P>0.05) was found between ultrasound contrast time-intensity curves and enhanced MRI for the assessment of the nature of tumor;there was statistically significant difference (χ2=5.298, P<0.05) between ultrasound contrast time-intensity curves and simple contrast enhanced ultrasound for the assessment of whether the tumor was malignant or benign, when taking biopsy results as the reference standard. Conclusion With ultrasound contrast time-intensity curves, dynamical, intuitive, and quantitative evaluation can be obtained for the perfusion differences between the lesion and the surrounding liver parenchyma, which provides more accurate information for qualitative diagnosis of hepatic tumors thus contains great application value in the evaluation of the effects of radiofrequency ablation for hepatic tumors.

Objective To study the immunophenotype and chromosome karyotype of 57 adult patients with newly?diagnostic acute lymphoblastic leukemia(ALL). Methods The immunophenotype and chromosome karyotype of 57 adult patients with newly?diagnostic ALL were determined by using flow cytometer and karyotyping,and then the clinical characteristics and significance were analyzed. Results In patients with B cell acute lymphoblastic leukemia(B?ALL),the expression of CD19 and CD22 were significantly higher than CD10 and CD20(P<0.05). The expression of CD7 and CD3 were much higher in patients with T cell acute lymphoblastic leukemia(T?ALL). As for the early antigen,patients of all subtypes of ALL showed high expression rate of CD34 and CD38. In addition,the HLA?DR was only detected in B?ALL. There was no difference in comparison with clinical characteristics,total rate of CR and rate of relapse between ALL with and without myeloid antigen expression. The expression rate of CD34 and HLA?DR was higher in My+?ALL(P<0.05). The relapse rate was much higher in these patients with abnormal karyotype than other pa?tients(P<0.05). Patients with high?risk karyotype showed higher expression rates of CD20 and CD3 than those with standard?risk. Conclusion The immunophenotypes and chromosome karyotypes show obviously heterogeneous features,and the patients with abnormal karyotypes have higher relapse rate. These above mentioned methods are applicable for the diagnosis and individualized treatment of ALL patients.

Objective To investigate the changes in the surface-associated protein expression of streptococcus rnutans (Sm) isolated from clinical samples at pH7.0 and pH5.0. Methods The proteins were extracted from cells at pH7.0 and pH5.0 by Homer method. The proteins were separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and two-dimensional gel electrophoresis followed by image analysis. Proteins were identified by matrix-assisted la?ser desorption ionization time of flight mass spectrometry and computer-assisted protein sequence analysis. Results Image analysis revealed that four high expression levels of protein loci and two specific protein loci were existed in two strains at pH7.0. Two high expression levels of protein loci and two specific protein loci were existed in two strains at pH 5.0. Three high expression levels of protein loci and six specific protein loci were existed in Sm593 at pH5.0. Two-component system histidine kinases Lyts and glyceraldehyde-3-phosphate dehydrogenase were highly modulated, and NADH oxidase were modulated specifically. Conclusion The two clinical isolations in acid have high expression of some special proteins, which are presumed to be the resemblance of acid reaction.The difference of protein expression of two clinical isolations in acid may represent their distinct acid resistance.

Objective To analyze the clinical and pathological characteristics of thyroid nodules.Methods A retrospective analysis of the clinical data of 2843 Han patients with thyroid nodules from January 2009 to June 2011 in Henan province was performed.Results The most high-risk of thyroid nodule resided in the group aged 45-54.The main pathological manifestation was simple nodular goiter.The rate of preoperative misdiagnosis was 2.4％.22.1％ of the patients with thyroid nodules showed abnormal thyroid function,which was mainly as subclinical thyroid dysfunction.The positive rate of thyroid peroxidase antibody (TPOAb) in patients with thyroid nodule was 19.8％ while that of thyroid globulin antibody (TgAb) was 20.0％.Among all 2843 subjects,the prevalence of differentiated thyroid carcinoma (DTC) was 28.8％,and the incidence of DTC was accompanied by raised TSH levels.The prevalence of DTC exceeded 40％ in patients aged between 25 to 34 as well as more than 74 years old.The prevalence of DTC was up to 33.8％ in TgAb positive patients.There was no difference in TPOAb levels between DTC patients and non DTC patients (P =0.406),but the TgAb level in patients with DTC was significantly higher than that of non DTC patients (P =0.033).Conclusion Thyroid nodule patients aged 25-34 or older than 74 formed high-risk groups of DTC.The serum TSH level and TgAb level were positively correlated with the risk of DTC.

Objective To investigate the present situation of elective course,find out the problems,explain the causes and offer some suggestions.Methods Using the information collected from self-made questionnaires,and analysis data.Results The survey shows that there are the problems of elective courses in the installation,time,management,contents,teachers,exam,and so on.Conclusion The system of elective course should be made perfect in construction,management and operation.

Objective To preliminarily explore the delineation of clinical target volume in intensity-modulated radiotherapy for para-aortic lymph node metastases in patients with gynecological malignancies.Methods A retrospective analysis was performed on 56 gynecological tumor patients with para-aortic lymph node metastases who were admitted to our department from January 2010 to September 2016.The number and distribution of metastatic para-aortic lymph nodes were determined by imaging method.Results A total of 108 positive para-aortic lymph nodes were found in the 56 patients,with 1-4(mean,2) positive para-aortic lymph nodes per patient.The mean diameter of positive para-aortic lymph nodes was 2.3 cm (1.2-4.0 cm).A total of 20 metastatic lymph nodes (19%) were located at the L4 level,38(35%) at the L3 level,44(41%) at the L2 level,and 6(5%) at the L1 level.There were 71 metastatic lymph nodes (66%) at the left side of the para-aortic region,20 metastatic lymph nodes (19%) between the abdominal aorta and the vena cava,and 17 metastatic lymph nodes (15%) at the right side of the inferior vena cava.Conclusions For patients with gynecological malignancies,nodal contouring for the para-aortic region should not be defined by a fixed circumferential margin around the vessels.The left side of the para-aortic region should be covered adequately;the upper target should be extended up to the renal artery,and needs to be further extended for patients who have nodal involvement near the renal arteries and veins.