Objective To investigate the role of plasma matrix metalloproteinase-9 (MMP-9) and nuclear factor kappa B (NF-κB) in the pathogenesis of obstructive sleep apnea hypopnea syndrome (OSAHS) complicated with hypertension.Methods The patients were selected in the respiratory medicine and neurology of our hospital from January 2014 to June 2014.Polysomnography(PSG) monitoring was employed to assess the patient.All patients were divided into 3 groups,including snoring group(23 cases),OSAHS group(32 cases),OSAHS with hypertension group(31 cases).And then according to the hypertension stage,OSAHS with hypertension group was divided into 3 groups,including OSAHS with stage 1 hypertension group(9 cases),OSAHS with stage 2 hypertension group(9 cases),OSAHS with stage 3 hypertension group(13 cases).The plasma MMP-9 was measured by ELISA.The mRNA expression levels of MMP-9 and NF-κB were detected by real-time quantitative PCR.Results The levels of MMP-9 and MMP-9 mRNA and NF-κB mRNA in OSAHS with hypertension group were significantly higher than those of snoring group and OSAHS group and the differences were statistically significant(P<0.05).The expression of MMP-9,the MMP-9 and NF-κB mRNA expression of monocytes in OSAHS with stage 3 hypertension group was significantly higher than those of OSAHS with stage 1 hypertension group and OSAHS with stage 2 hypertension group and the differences were statistically significant(P<0.05).The plasma MMP-9 was positively correlated with AHI and oxygen desaturation index and negatively correlated with LSaO2(P<0.05).The plasma MMP-9 was positively correlated with the MMP-9 mRNA expression(P<0.05).The MMP-9 mRNA expression was positively correlated with the NF-κB mRNA expression(P<0.05).Conclusion The plasma concentrations of MMP-9,the MMP-9 and NF-κB mRNA expression of monocytes in OSAHS with hypertension patients was significantly high,which is associated with disease severity and degree of hypoxia.The MMP-9 might play an important role in the pathogenesis of OSAHS with hypertension and be regulated by NF-κB pathway.

Objective To improve the corrected results of the nasal deformities of the hare lip nose. Methods Based on the reposition of the lower lateral cartilages and the caudal septum, the authors corrected the secondary hare lip nose with the L shaped silicon rubber graft to reinforce and model the nasal tip.Results From 1996～2000, the procedure was performed for 20 cases (15 male, 5 female ), aged from 16～21 years. Follow up was from 3 months to 4 years. All cases obtained satisfactory results. Conclusions The results of utilizing L shaped silicon rubber graft combined with reposition of the mislocated nasal cartilages are better than the latter method only, especialy for the nasal tip. The procedure is easy to learn .The material silicon rubber graft is cheap and can be trimmed very conveniently. And it can also correct the saddle nose at the same time.

Objective To evaluate the protective effect of genistein on psoralens plus ultraviolet A (PUVA)-induced photoaging in human dermal fibroblasts (HDFs) in vitro.Methods Dermal fibroblasts were isolated from the foreskin of a healthy 5-year-old boy,and subjected to primary culture.After 5-8 passages of subculture,the fibroblasts were collected and used in the following experiment.To determine the optimal concentration of genistein,methyl thiazolyl tetrazolium (MTT) assay was conducted to detect the proliferation of fibroblasts pretreated with 8-methoxypsoralen (8-MOP) and various concentrations (0-20 μg/ml) of genistein for 24 hours followed by UVA irradiation.Then,the fibroblasts were divided into 3 groups:normal control group receiving no treatment,photoaging group incubated with 8-MOP for 24 hours followed by UVA irradiation,and genistein group incubated with both 8-MOP and genistein at the optimal concentration for 24 hours followed by UVA irradiation.After additional culture,invert microscopy was carried out to observe the morphology of fibroblasts,enzyme histochemistry to assess senescent cells by using SA-β-Gal kit,flow cytometry to determine the level of reactive oxygen species (ROS),real-time fluorescence-based quantitative PCR to detect the matrix metalloproteinase-1 (MMP-1) expression.One-way analysis of variance was conducted to assess the differences in these parameters among these groups.Results At 24 hours after UVA irradiation,the percentage of fibroblasts positive for SA-β-galactosidase was (0.67 ± 0.58)％,(96.67 ± 1.53)％ and (51.67 ± 2.08)％ in the normal control group,photoaging group and genistein group respectively,with significant differences among these groups (P ＜ 0.01).The level of ROS in the photoaging group and genistein group was (0.88 ± 0.24) and (0.62 ± 0.02) fold higher than that in the control group(both P ＜ 0.01).Moreover,the MMP-1 expression level in the photoaging group and genistein group was 10 times and 6 times that in the control group,respectively,with significant differences among the 3 groups (P ＜ 0.05).Conclusion In vitro,genistein can protect against PUVA-induced photoaging in human dermal fibroblasts to some extent.

Objective To understand the practice of experiential teaching in the core midwifery curriculum. Methods Phenomenology as a qualitative research method was utilized and fifteen students participated in the non-structured interviews. Results Four themes were found: comprehension of knowledge;professional thought; teacher- student relationship;gratitude. Conclusions Experiential teaching can increase the teaching effect of core midwifery curriculum, and develop good ideological and professional qualities.

Objective To explore the clinical methodology and comparative analysis of both autogenous septum cartilagineum nasi or Medpor surgical implant in secondary unilateral cleft lip rhinoplasty.Methods Thirty-six patients with varied secondary nasal deformities of unilateral cleft lip were treated,autogenous septum cartilagineum nasi or Medpor surgical implant were implanted to supply the powerful supporting strength for nasal constructions.An anthropometry method based on the quantitative analysis of the characteristics of nasal deformity was used to evaluate and compare the preoperative and postoperative measure of the patients.Results After 6 to 24 months follow-up,all 36 cases received satisfactory results.20 of them used autologous septum cartilagineum nasi to supply the powerful supporting strength for nasal construcions,and other used Medpor surgical implant.No rejection and exposure of implants were found.The postoperative quantitative measurement results supported that both of the implants could effectively correct nasal deformities.Conclusions Both of the implants could effectively correct nasal deformities of unilateral cleft lip in secondary rhinoplasties.The quantitative measurement is a scientific approach to evaluate the outcome.

Objective To explore the methodology for correction of nasal and ocular fracture syndrome to decrease surgical incisions and times as much as possible. Methods Depending upon the characteristics of neighbour anatomy of nose and orbit, a series of nasal and ocular interrelated deformities caused by late naso-orbital fractures were corrected simultaneously through the same surgical incision, in 18 patients with interruption of medial canthal ligament, dislocation and deformity of medial canthal angle, obstruction of nasal-lacrimal duct, epiphora, depression of nasal bridge and deviation of nose. A total of 18 cases with late naso-orbital fracture syndrome were treated since 1997, including 11 male and 7 female cases from 5 to 38 years old. Results After 6 months to 4 years follow-up, 2 child patients were still with epiphora and another one with medial canthal angle was reposited, the rest were achieved satisfactory effects. Conclusion Surgeons, cooperated with other specialists, are able to correct the disease simultaneously. It is worth to be recommended to other hospitals.

Objective To discuss the effect of transplanting autogenous rib cartilage in correction of short and upwardly rotated nose.Methods A piece of autogenous rib cartilage was transplanted into the front of nasal septa to lengthen it,leading to the nasal tip moving forwards and correcting the short and upwardly rotated nose.For low nose cases,simultaneous implants was used into the nasal back.Results The nasal tips were prolonged 0.75 cm on average after operation in 56 patients with short and upturned noses.The nasolabial angle and extent of nostril exposure were normal after operation.The operational consequences were fine in 54 patients,while 2 case were not satisfactory.Efficacy was stable during one year follow-up.Conclusions This method is reliable,and it can be recommended in rhinoplasty of patients with short and upwardly rotated nose.

Objective To evaluate the role of autologous septal cartilage in the rhinoplasty of the wide and bulbous nasal tip. Methods A big piece of autologous nasal septal cartilage was removed and transplanted to the front of nasal septum, acting as a septal extender to fix the nasal alar cartilage,and then the shape of nasal tip was reconstructed by middle crus suture technique, excessive soft tissue under skin of tip and a part of lateral crura cartilage were removed to stand out the shape of the nasal tip. Results After one year follow-up, 118 of 126 cases achieved satisfied effects, but 8 cases dissatisfied because of their undue thick skin. Conclusions This method is reliable in the correction of the wide and bulbous nasal tip.

Background Constipation is a common complication after stroke, and the results investigated overseas showed the incidence was about 30% ～60%. The difference of results is so significant because the time investigated and the diagnosis criterion used are different. There are less relative report about risk factors of constipation and no report about the impact of constipation on pragnosis. The study is to investigate the incidence and risk factors of new-onset constipation after stroke in the patients with acute stroke and to evaluate the impact of new-onset constipation occurrence on the prognosis in the patients.Methods A prospective cohort study of new-onset constipation was performed to investigate 154 cases of acute stroke patients who were hospitalized from December 2003 to October 2004 in the department of neurology, the first Affiliated Hospital of Sun Yat-sen University. We recorded the demographics, medical history,stroke severity and medication used. National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI)and Modified Rankin Scale (MRS) were evaluated in the 1st week and 4th week after stroke to evaluate the neurological function and ability of an independent life. BI and MRS were recorded at the 12th week after stroke.Patients were then followed for the development of stroke, the event such as recurrence or death. Constipation was defined by Rome Ⅱ criteria.Results The incidence of new-onset constipation after stroke within 4 weeks was 55. 31%, and the highest risk was within seven days after onset of stroke. Cox regression showed that the incidence of constipation occurrence was strongly related to neurological functional status of patients in the 1st week assessed by BI and the transform of surrounding for defecation. In the 4th week and 12th week after stroke, the rates of poor prognosis in patients with constipation in middling state were both higher than patients without constipation, and the difference was statistically significant respectively(P ＜ 0. 01 ;P = 0. 012).Conclusions The new-onset constipation occurrence in acute stroke is very common and its main risk factor is functional status assessed by Barthel Index at the 1st week after onset and the transform of surrounding for defecation. The results indicate that the new-onset constipation occurrence after stroke has negative effects on the outcome of partial stroke patients.

Objective To evaluate the incidence and epidemiologic characteristics of Kawasaki disease (KD)in Nanjing.Methods We reviewed the medical records and reports of all patients admitted to Nanjing Chil-dren′Hospital with KD diagnosed during 3 -year periods from 2012 to 2014.Results We studied 1 446 inpatients diagnosed with KD from 2012 to 2014.There were 1 135 cases(78.5%)with complete KD.The ratio of male to female was 1.7241.The disease occurred in all of the seasons,but the peak was from spring to summer.Age at onset ranged from 1 month to 14 years old,and the peak age group was 1 year old.Fever(99.45%)was the most common clinical symptom,followed by conjunctive congestion(93.15%),rash(73.32%),oral changes(51.76%), extremities desquamate(75.08%)and lymphadenopathy(45.89%).There were 131(9.05%)patients with coronary aneurysm,the ratio of male to female was 3.02  1.14 patients (0.97%)developed recurrent KD.Conclusion Patients with KD has become more and more in Nanjing,and clinical doctors should improve the understanding of KD. Early diagnosis and treatment is very important to reduce the sequelae and reduce the mortality of KD.