Objective To investigate the feasibility and superiority of the lecture based learning (LBL)combined problem-based learning (PBL)for endocrinology teaching practice. Methods Totally 150 clinic medical undergraduates were randomly divided into three groups:LBL group (n=50),PBL group (n=50)and LBL+PBL group (n=50). Questionnaires,written and oral tests were employed to evaluate the teaching effect. ANOVA was used to compare the indicator scores and chi-square test was used to compare grades and passing rate. Results Teaching efficiency,mater of knowledge,capabilities of analysis,teaming and collaboration ability and medical diagnosis thinking cultivation were better in LBL and PBL group than in the other two groups. There were statistical differences in total score(F=4.69, P=0.010)and passing rate(χ2=8.94,P=0.030)among three groups. Conclusions LBL+PBL guarantee the teaching quality and cultivate the comprehensive quality of students; therefore it is superior to LBL and PBL.

Objective:To explore the incidenee of early hematoma growth in patients with intracerebral hemorrhage,and the correlation between early hematoma growth and early neurological deterioration.Methods:The evaluation of nervous system and CT scan in patients with intracerebral hemorrhage within 3 hours after the omet of symptoms were performed respectively at baseline,and 1,2,3,and 20 hours after the baseline.Results:In 106 patients,CT scan shelwed that the volume of intraparenehymal hemorrhage inereased significantly in 26% of patients at baseline and within 1 hour.CT scan showed that the bleeding volume increased in 12% of patients at 1,2,3,and 20 hours.By measuring baseline,1-hour Glasgow Coma Scale (GCS)score,and the changes of the National Institutes of Health Stroke Scale(NIHSS),it had found that the baseline status and the increased bleeding volume within 1 hour vdgre closely correlated with the clinical neurological deterioration.Conclusions:The early bleeding volume often inereases significantly in patiems with intracerebral hemorrhage,which is complicated with neurological deterioration.In order to determine whether these therapeutic measures improve the natural course of this early hematoma growth and decrease its occurrence,it is necessary to make a randomized clinical trial.

Objective To analyze the clinical characteristics of structural malformations in one of monochorionic diamnionic twins (MCDA). Methods The clinical data of 77 MCDA patients with structural malformations diagnosed by ultrasound were retrospectively reviewed from January 2012 to May 2017. The distribution of structural malformations, prenatal chromosomal karyotyping and pregnancy outcomes were analyzed. Results (1)Among the 77 MCDA patients with structural malformations, the single malformation accounted for 79％(61/77), the multiple malformations accounted for 21％(16/77). And there were a total of 94 types of malformations, the top three malformations were neurological malformations (32％, 30/94), cardiovascular malformations (29％,27/94) and twin reversed arterial perfusion sequence (TRAPS;10％,9/94). (2)Among the 77 patients with structural malformation, 64 cases (83％, 64/77) were examined for fetal chromosomes, of whom 14 cases (22％,14/64) were examined for fetal chromosomes of both twins, with 1 case (1/14) of discordant fetal chromosome. (3)Among the 77 patients, 4 cases (5％, 4/77) with severe fetal malformations terminated pregnancy. Totally 29 cases (38％, 29/77) with severe malformations were treated with selective fetal reduction, among whom 7 cases (24％, 7/29) experienced unexplained fetal death within 24 hours after the operation;2 cases (7％, 2/29) happened inevitable abortion, and 2 cases (7％, 2/29) underwent unexplained fetal death during the late pregnancy. Of the remaining 44 patients (57％,44/77) with expectant treatment, 13 cases (30％, 13/44) occurred twin transfusion syndrome (Ⅱ-Ⅳ), and were treated with fetoscopic laser occlusion. Eight patients had 2 survival twins, 4 patients delivered 1 survival twin, and 1 patient had dead twins. Conclusions The most common malformations in MCDA twins are the nervous malformations, cardiovascular malformations and TRAPS. The chromosome karyotype of MCDA twins with structural malformations are sometimes discordant, and separate samling of the twins is suggested for prenatal diagnosis. Selective fetal reduction could be given to severe structural malformation in MCDA patients safely and effectively. For non-severe structural malformation in MCDA patients with twin transfusion syndrome, fetoscopic laser occlusion is safe and effective.

Myocardial fibrosis is featured by excessive proliferation of cardiac fibroblast and collagen deposition. There is close relationship between myocardial fibrosis and various cardiovascular disease, and it is potential risk factor for sudden death. At present the precise mechanism remains unclear.Myocardial fibrosis has been found to relate with renin-angiotensin-aldosterone system,cell factor,oxidative stress,inflamatory factor,endothelial function obstacles,Intracellular calcium ion. These factors influences the occurrence of myocardial fibrosis by the same or different pathway.

Objective:To explore the effect of Kangfuxin solution combined with triamcinolone and Econazole cream in elderly patients with hip fracture complicated with incontinence dermatitis, and to provide reference for clinical nursing.Methods:A randomized controlled trial was conducted to select 80 elderly patients with hip fracture complicated with incontinence dermatitis who were hospitalized in the Orthopedics Department of the First Medical Center of the PLA General Hospital from February 2023 to March 2024 by convenient sampling method. They were divided into the experimental group and the control group with 40 cases in each group according to random number table method. The experimental group was treated with Kangfuxin solution combined with triamcinolone and econazole cream for incontinence dermatitis. Intervention was stopped after 2 weeks of intervention or the incontinence dermatitis reached the clinical healing standard. In the control group, 3M spray was used to care the affected area of incontinence dermatitis, intervention was stopped after 2 weeks or the incontinence dermatitis reached the clinical healing standard. Incontinence dermatitis Skin Injury Assessment Scale (IADS) and perineal skin assessment tool PAT were used to evaluate the skin status of the two groups, and the healing time and treatment effectiveness of the two groups were compared.Results:In the control group, there were 11 males and 29 females, with age of (76.53 ± 8.67)years. There were 9 males and 31 females in the experimental group, with age of (76.56 ± 8.69)years, and there was no significant differences in baseline data between the two groups (all P>0.05). After intervention, the IADS and PAT scores of the control group were (27.13±5.22) points and (5.11 ± 0.94) points respectively, which were significantly higher than those of the experimental group (25.43 ± 4.15) points and (3.73 ± 1.21) points, and the differences were statistically significant ( t=7.22, 8.21, both P<0.05). The effective treatment in the experiment group was 97.5% (39/40), which was significant higher than 72.5% (29/40) in the control group ( χ2=13.25, P<0.05). The healing time of experimental group was (4.57 ± 3.44) d, which was significantly shorter than that of control group (9.23 ± 4.19) d, with statistical significance ( t=11.61, P<0.05). Conclusions:The combined application of Kangfuxin solution and triamcinolone and Econazole cream has a significant effect on improving incontinence dermatitis and perineal health in elderly patients with hip fracture, can effectively reduce symptoms and accelerate skin healing, and has certain clinical application value.

Objective To construct lipid nanoparticles DLin-LNP for mRNA delivery. Methods DLin-LNP was prepared by thin film hydration method, and DLin-LNP/mRNA was further constructed by using EGFP-mRNA as model drug. The particle size, zeta potential, and appearance morphology were measured. Furthermore, the intracellular distribution and transfection of DLin-LNP/mRNA in RM-1 cells was investigated by laser scanning confocal microscope. Results DLin-LNP was successfully prepared. The average particle size was about (151.1±2.1) nm, the no-load potential was (23.7±0.5) mV. The cytotoxicity of DLin-LNP was far lower than that of the commercially available liposomal Lipo8000. The results of transfection experiment indicated that DLin-LNP has high transfection efficiency for mRNA delivery with low cytotoxicity and good stability. Conclusion DLin-LNP could become a potential mRNA vector for gene therapy.

OBJECTIVE：To investigate the effects of Shenfu yixin decoction on the utilization of fatty acid in primary hypoxic cardiomyocytes and its potential mechanism. METHODS ：The apical tissue of neonatal SD rats with 1-3 days old were collected ， and the primary cardiomyocytes were isolated ，cultured and identified. The cardiomyocytes were randomly divided into normal group，model group ，coenzyme Q 10 group（positive control ，1×10－4 mol/L），Shenfu yixin decoction low-dose and high-dose groups（0.25，0.5 mg/mL）. Except for normal group ，cells in other groups were cultured under 5％O2，5％CO2 and 90％N2 for 6 hours to induce hypoxic injury model. After 6 hours of hypoxia ，the content of ATP was detected by luciferase luminescence assay. Western blotting assay was adopted to detect the expression of FAT/CD 36，PPARα and PPARβ/δ. RESULTS：Compared with normal group ，the content of ATP and relative expression of FAT/CD 36 protein were decreased significantly in model group （P＜ 0.05）. Compared with model group ，the content of ATP was increased significantly in coenzyme Q 10 group and Shenfu yixin decoction high-dose group ，while the relative expression of FAT/CD 36 and PPARα protein in coenzyme Q10 group，the relative expression of FAT/CD 36 protein in Shenfu yixin decoction high-dose group as well as the relative expression of PPARα and PPARβ/δ protein in Shenfu yixin decoction groups were decreased significantly （P＜0.05）. CONCLUSIONS ：Shenfu yixin decoction can inhibit the utilization of fatty acid of primary hypoxic cardiomyocytes and improve their energy metabolism by inhibiting the expression of FAT/CD 36，PPARα and PPARβ/δ protein.

ObjectiveTo investigate the current status of secondary prevention of stable angina in patients with coronary heart disease in three regions of China， namely Henan Province， Xinjiang Uygur Autonomous Region， and Tianjin City， and analyze the the influencing factors. MethodsA cross-sectional study was conducted to include patients with stable angina with coronary heart disease in Henan， Tianjin and Xinjiang from August 10， 2020 to March 14， 2021. General information， traditional Chinese medicine （TCM） syndrome elements， prescriptions and other data of patients were collected， and clinical characteristics， blood pressure， blood lipid and blood glucose of patients were analyzed； the patients were divided into groups according to whether their blood pressure， blood lipid and blood glucose were up to standard. With the most common syndrome element as the main variable， region， age and gender as covariables， Logistic regression equation was incorporated to analyze the influencing factors for the patients' blood pressure， blood lipid and blood glucose being up to standard. ResultsA total of 1061 coronary heart disease patients with stable angina were included， including 658 in Henan， 210 in Xinjiang， and 193 in Tianjin. The clinical characteristics of patients in the three regions showed statistical different in age， sex， disease course， complication， blood pressure， blood lipid， blood glucose， smoking， drinking， living habits， and medication treatment （P＜0.05 or P＜0.01）. For the included patients， qi deficiency （79.55%， 844/1061） and blood stasis （39.96%， 424/1061） were the main syndrome elements. The overall compliance rate of blood pressure was 48.89% （506/1035）， blood lipids 12.68% （133/1049） and blood glucose 48.18% （504/1046）. Qi deficiency was the independent factor affecting the blood pressure of coronary heart disease patients with stable angina combined with hypertension （P = 0.029，95%CI ［1.048， 2.369］）， and the independent factors influencing the blood lipid standard of coronary heart disease patients with stable angina （P = 0.011， 95%CI ［1.133， 2.646］）， but not the independent factors affecting blood glucose standard in coronary heart disease patients with diabetes （P＞0.05）. ConclusionCoronary artery disease patients with stable angina have geographical variability in clinical characteristics and distribution of TCM syndrome elements， and the overall control of blood pressure， blood lipids， and blood glucose is poor， and qi deficiency syndrome is an independent risk factor affecting the control of blood pressure and blood lipids.

OBJECTIVE： To observe the effects of Shenfu yixin decoction on reactive oxygen species （ROS） and energy metabolism in primary hypoxic cardiomyocytes. METHODS： After isolation， culture and identification， primary cardiomyocytes of neonatal SD rats were randomly divided into normal group， model group， positive control group （coenzyme Q10， 0.1 mmol/L） and Shenfu yixin decoction low-dose and high-dose groups （0.25， 0.5 mg/mL）. Except for normal group， other groups were cultured with 5％O2， 5％CO2 and 90％N2 for 6 h to induce hypoxic injury model. After 6 hours of hypoxia， ROS contents in cardiomyocytes and mitochondria of each group were detected by ROS probe and flow cytometry. Luciferase luminescence and Western blotting were used to detect ATP content and CK protein expression of each group. Transmission electron microscope was used to observe ultrastructure of cardiomyocytes in each group. RESULTS： Compared with normal group， the expression of ROS in primary hypoxic cardiomyocytes and mitochondria as well as the content of ROS were increased significantly， while the content of ATP and expression levels of CK protein were decreased significantly （P＜0.05）； there were swelling of endoplasmic reticulum and mitochondria， dissolution or even disappearance of mitochondrial ridge， obvious cardiomyocytes injury. Compared with model group， the expression of ROS in primary hypoxic cardiomyocytes and mitochondria of administration groups， the contents of ROS in primary hypoxic cardiomyocytes of positive control group and Shenfu yixin decoction high-dose group as well as the content of ROS in primary hypoxic cardiomyocytes mitochondria of administration groups were all decreased significantly， while ATP contents in primary hypoxic cardiomyocytes of positive control group and Shenfu yixin decoction high-dose group as well as expression levels of CK protein in primary hypoxic cardiomyocytes of administration groups were all increased significantly （P＜0.05）. The primary hypoxic cardiomyocytes injury was relieved significantly in positive control group and Shenfu yixin decoction high-dose group. CONCLUSIONS： Shenfu yixin decoction can improve primary hypoxic cardiomyocytes， down-regulate the expression of ROS in cardiomyocytes and mitochondria and also improve its energy metabolism.

OBJECTIVE To explore the mechanism of Tingli dazao xiefei decoction on ventricular remodeling in model rats with heart failure after myocardial infarction. METHODS The rat model of heart failure after myocardial infarction was established by ligation of anterior descending branch of left coronary artery， which was divided into 8 groups： sham operation group， model group， A779 group （1 mg/kg）， A779 （1 mg/kg）+Tingli dazao xiefei decoction equivalent-dose group （0.8 g/kg）， A779 （1 mg/kg） +Tingli dazao xiefei decoction high-dose group （1.6 g/kg）， Tingli dazao xiefei decoction equivalent-dose group （0.8 g/kg）， Tingli dazao xiefei decoction high-dose group （1.6 g/kg） and losartan potassium group （10 mg/kg）. Each group was given equal volume of distilled water or corresponding drugs intragastrically for 4 weeks. Masson staining was used to determine the distribution of collagen fibers in rat myocardium. The content of hydroxyproline （Hyp） in myocardium was determined by alkaline hydrolyzation. The expressions of type Ⅰ and Ⅲ collagen （COLⅠ， COLⅢ）in myocardium were detected by immunohisto-chemistry. Myocardial fibrosis-related indexes such as matrix metalloproteinase-2 （MMP-2）， MMP-9， tissue inhibitor of metalloproteinase-1 （TIMP-1） and soluble suppression of tumorigenicity-2 （sST-2） were detected by ELISA. The protein expressions of angiotensin converting enzyme 2-angiotensin-（1-7）-Mas [ACE2-Ang-（1-7）-Mas] axis were detected by Western blot. RESULTS Compared with sham operation group， myocardial cells in model group and A779 group were disordered， collagen fiber deposition was significantly increased and myocardial fibrosis was obvious； the Hyp content and MMP-2， MMP-9， sST-2 levels were increased， and COL Ⅰ and COL Ⅲ positive expressions were significantly enhanced； TIMP-1 level， protein expressions of ACE2， Ang-（1-7） and Mas were significantly decreased （P＜0.05）. Compared with model group， above indexes of Tingli dazao xiefei decoction equivalent-dose and high-dose groups were improved to different extents. Compared with A779 group， A779+Tingli dazao xiefei decoction equivalent-dose and A779+high-dose groups could improve myocardial arrangement and collagen distribution， reduce the Hyp content and MMP-2， MMP-9 levels， reduce positive expressions of COL Ⅰ and COL Ⅲ （P＜0.05）， but couldn’t improve Ang-（1-7） and Mas protein expression. CONCLUSIONS Tingli dazao xiefei decoction can improve ventricular remodeling in myocardial failure model rats after myocardial infarction by improving the expression of ACE2- Ang（- 1-7）-Mas axis proteins.