Objective To study the effect of melatonin on ultrastructural changes of aorta endothelium of insulin-resistant (IR) rats. Methods Insulin-resistant rat model was established with SD rats (n=20) aged 6-8 weeks by high-glucose diet (70% calories from glucose) for 6 weeks. All the IR rats were divided into 2 groups: with melatonin (MEL group, n=10) and without melatonin (control group, n=10). Rats in MEL group were filled with melatonin (10mg? kg -1?d -1) for 6 weeks. The ultrastructure of aorta endothelium was observed with transmission electron microscope (TEM). Results Systolic blood pressure (SBP), serum triglyceride (TG), low-density lipoprotein (LDL-c), insulin (Ins), and malondialdehyde (MDA) declined while the Serum high-density lipoprotein(HDL-c), superoxide dismutase (SOD) and insulin sensitive index (ISI) elevated in the rats of MEL group than that in control group (P

Objective To evaluate the prognostic role of bispectral index (BIS) monitoring in patients after cardiopulmonary resuscitation (CPR) in the intensive care unit (ICU).Methods Thirtythree adult patients after CPR were enrolled and divided into survived group and non - survived group as per 7-day survival.During their stay in the ICU,BIS and SaO2 (saturation of artery oxygen) levels of all the patients were continuously monitored.The neurological status of the patients was measured with Glasgow coma scale (GCS).Acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) was used to evaluate the patient condition. SjO2 (saturation of jugular bulb venous oxygen ) levels of 23 patients were continuously monitored and then the difference in values between SaO2 and SjO2 was calculated to show oxygen metabolism in the brain. The studied variables were compared between the two groups. The correlations between BIS values and GCS scores,and between BIS and APACHE Ⅱ scores were respectively analyzed. Results The BIS values and difference in values between the SaO2 and SjO2 were significantly higher in the patients of survived group than those in the patients of non-survived group (P ＜0.01 ).There were positive correlation between BIS and GCS (r =0.821,P ＜ 0.01 ) and as well as positive correlation between BIS and APACHE- Ⅱ ( r =0.434,P ＜ 0.05 ).Conclusions The BIS may be useful to predict the post - resuscitative outcome of patients after cardiopulmonary resuscitation.

Causal inference research is a causal test designed to assess the impact of exposures on outcomes.Both experimental and observational studies can be used to examine causal associations between exposure factors and outcomes. Experimental studies are sometimes limited by factors such as ethics or experimental conditions. Observational studies account for a large proportion in clinical studies, but the effectiveness and research value of observational studies will be affected if the design of observational studies is not rigorous and the confounding factors are not well controlled.The Guidelines for controlling confounding factors and reporting results in causal inference studie formulated by a special group of 47 editors from 35 journals from all over the world provide good guidance to researchers. This article interprets the guidelines and hopes to provide help for clinical researchers.

Objective To observe the clinical efficacy of Ziyin Yikang Recipe plus hexadecadrol on anti-HCG antibody positive secondary sterility and the influence on anti-HCG antibody titers. Methods Sixty patients with anti-HCG antibody positive secondary sterility were randomly divided into treatment group (TG) and control group (CG), 30 cases in each. Patients in the TG were treated with Ziyin Yikang Recipe plus hexadecadrol, while patients in the CG were given hexadecadrol only. The Chinese medicine symptom scores and changes of anti-HCG antibody titers were evaluated and compared between the two groups.Results The Chinese medicine symptom scores in the two groups decreased compared with those before treatment (P<0.05), and the TG showed a more significant decrease than the CG (P<0.05). The anti-HCG antibody titers in both groups dropped compared with those before treatment (P<0.05, P<0.01). There was no statistically difference between the two group after treatment (P>0.05). The total effective rate in the TG was higher that that in the CG (P<0.05), with 63.33% (19/30) in the TG and 47.66% (14/30) in the CG.Conclusion The treatment of Ziyin Yikang Recipe plus hexadecadrol on anti-HCG positive secondary sterility can obviously improve the clinical syndrome of yin deficiency and fire hyperactivity, and promote pregnancy success.

Objective To investigate the signal mechanism of protein kinase C alpha(PKC-α)participated in enhanced expression of type Ⅰ inositol 1,4,5-trisphophate receptors (IP3 RI) induced by tumor necrosis factor alpha(TNFα),in order to delineate the mechanisms of decreased glomerular filtration rate (GFR) in hepatorenal syndrome caused by TNFα.Methods The glomerular mesangial cells (GMCs)line from rats was chosen as experimental material.GMCs were divided into control (D),TNFα-2 h,TNFα-4 h,TNFα-8 h,and TNFα-24 h groups.Moreover,another two groups were sanflngol-8h (S),TNFα + Sanfingol-8h(TS)groups.The effect of TNFα on the expression of IP3RI was detected by immunocytochemical staining,Western blotting,teal time-polymerase chain reaction (PCR) assays.Results Immunocytochemical staining demonstrated that IP3 RI was mainly distributed in cytoplasm of GMCs.Enhanced positive staining was determined in all TNFα-treated groups,especially in TNFα-8 h group.Western blotting demonstrated that the expression of IP3RI protein was significantly higher in TNFα-4 h,TNFα-8h and TNFα-24 h groups than control group(4 h:1.82 ± 0.63 ; 8 h:2.95 ± 0.66 ; 24 h:2.48 ± 0.72 ; D:1 ±0.02 ; F =9.24,P ＜ 0.05).The expression of IP3 RI protein was the highest in TNFα-8 h and TNFα-24 h groups(P ＜0.05).No difference was found among S,TS,and control groups(S:1.39 ±0.65; TS:1.35± 0.37 ; P ＞ 0.05).Real time-PCR found the expression of IP3 RImRNA was significantly higher in all TNFα-treated groups than control group(2 h:3.35 ± 1.97; 4 h:3.16 ± 1.35; 8 h:3.70 ± 1.76; 24 h:4.49±1.70; D:1 ±0.01; F =6.167,P ＜0.05).No difference was found among all TNFα-treated groups(P ＞0.05).No difference was found among S,TS,and control groups(S:1.53 ±0.79; TS:1.32 ± 0.38 ; P ＞ 0.05).Conclusions IP3 RI was mainly distributed in cytoplasm of GMCs.TNFa could enhance the expression of IP3 RI protein and IP3 RI mRNA,which could be blocked by sanfingol,a PKCα inhibitor.It might be an important signal in the mechanisms of GFR decrease caused by TNFα in hepatorenal syndrome.

This paper expounds the connotation of doctor-patient communication and its importance in medical prac-tice, and points out the problems existing in the doctor-patient communication in practice. Based on this, advances the ESP teaching ideas, reform mainly from the following several aspects: first, the increase in oral English course arrange-ment class, small class teaching;secondly, on the oral English teaching mode reform, with school, learning, is unified. Once again, to reform on English spoken language teaching material use, both medical professional knowledge and English language skills. Finally, the reform on oral English teaching staff, improve English teachers' team.

Objective To investigate the effect of tumor necrosis factor-α (TNF-α) on intracellular calcium concentration ([Ca2 +] i) and the contraction of glomerular mesangial cells (GMCs),and prove that hypercontractility of GMCs induced by TNF-α in hepatorenal syndrome(HRS) was connected with inositol 1,4,5-trisphophate receptors (IP3Rs).Methods GMCs were divided into TNF-α-treated 0 h,4h,and 24 h groups.Another 3 groups were blocked by 2-APB.The effect of TNF-α on [Ca2 +] i was identified and observed whether it could be blocked by 2-APB.Contraction of GMCs was determined by accessing the surface area of cells before and after contraction.Results TNF-α significantly increased ET-induced calcium release,in that we found higher [Ca2 +] i after stimulated by ET in TNF-α-treated 4 h group and 24 h group[4 h:(648.08 ±267.11) nmol/L; 24 h:(879.30 ±-260.29) nmol/L; 0 h:(619.93 ±258.94)nmol/L,F =5.486,4 h vs 0 h:P ＜ 0.05 ; 24 h vs 0 h:P ＜ 0.05 ;24 h vs 4 h:P ＞ 0.05].This phenomenon can be totally blocked by 2-APB in all groups.The change in planar surface area in response to ET was slightly in control cells but significantly enhanced in TNF-α-treated cells [4 h:(2198 ± 340)μm2; 24h:(2260±553)μm2; 0 h:(2436±474)μm2,F =4.001,4 h vs0 h:P ＜0.05; 24 h vs0 h:P ＜0.05;24 h vs 4 h:P ＞ 0.05].Conclusion TNF-α can enhance ET-induced sarcoplasmic reticulum Ca2 + release and increase the contractile responses of GMCs to ET,which is associated with IP3Rs.TNF-α is responsible for hyperconstractility of glomeruli in HRS.

Objective To investigate the current status of self-management action of patients with chronic kidney disease (CKD) during early-mid stage and its influencing factors. Methods 80 patients were recruited in a tertiary hospital in Beijing from March to June 2011.They were surveyed with a self-designed self-management action questionnaire of patients with CKD. Results The total score of self-management action in patients with CKD was(69.10±5.63 ).1.25％ patients with CKD had bad self-management ability and 88.75％ patients had moderate self-management ability,only 10.00％ patients had good self-management ability.Patients of younger age,with higher education level,ever attending lectures or having inpatient experience had better self-management ability.And the methods of payment also had significant influence on the self-management of patients with CKD. Conclusions When taking care of patients with CKD,health care providers should be more individual case-based,especially paying more attention to those who are older,with low education degree,never have attended health education lectures and do not have inpatient experience,in order to increase patients' self-management ability and help them improve their health status.

Objective To investigate the status of second trimester maternal serum screening for Down's syndrome from 2006 to 2009 to evaluate the screening quality in Beijing.Methods Birth defect data (birth defect register) from 2006 to 2009 and screening data reported by certificated screening hospitals from 2008 to 2009 in Beijing were retrospectively analyzed by descriptive statistic method.Results Three hundred and thirty Down' syndrome babies were delivered from 2006 to 2009 in Beijing,among which 166 mothers accepted Down' syndrome serum screening and 85(51.2％) were diagnosed finally according to the screening results;among the 85 mothers,35 were≥35 years old with the detection rate of 62.5％ (35/56),and 50 cases were ＜35 with the detection rate of 45.5％ (50/110).The prenatal diagnostic rate of Down's syndrome babies increased from 26.8％(11/41) in 2006 to 47.4％(46/97) in 2009.The detection rate of Down's syndrome with serum screening increased from 23.1％(3/13) in 2006 to 62.9％(22/35) in 2009.One hundred and fifty-eight 21-trisomy cases accepted mid-term ultrasound screening,among which 62 cases (39.2％) were found abnormal.Conclusions Quality control for second trimester maternal serum screening for Down's syndrome should be improved in Beijing.Second trimester maternal serum screening for Down's syndrome in elderly primipara is not suggested.More attention should be paid on prenatal ultrasound screening.

Objective To explore the contamination of water samples from centralized air conditioning system and other domestic environment by legionella. Methods One hundred and eighty-six samples were collected from 75 sampling sites located among centralized air conditioning system, shower bath and humidifiers. The serology identification and semi-nested PCR were used to identify legionella in water samples. Results The positive rate was 8.60% (16/186) for legionella and 8.06%(15/186) for Legionella pneumophila among water samples respectively. Legionella and Legionella pneumophila were found in cooling water and condensate of centralized air conditioning system and water from shower bath in different degree. Water samples from cooling tower of centralized air conditioning system showed the highest positive rate for legionella and Legionella pneumophila. Conclusion Cooling water and condensate of centralized air conditioning system and water from shower bath present the risk of contamination by legionella. It should be paid more attention to prevent legionnaires' disease.