Abtract: Acute coronary syndrome is a common clinical and frequently occurring disease, belonging to the chest discomfort, heartache, and true heart pain of TCM category. The clinical observation shows that the heat and blood stasis, and poison damage heart nutrient is one of the important mechanisms of triggering coronary syndrome. Therefore, the method of promoting blood circulation to remove meridian obstruction and the Qing Ying detoxication was established as the basic treatment, and Danshen Tongluo Jiedu Decoction is applied as the main formula. According to the different types of disease and syndrome differentiation, flexible modification can achieve good efficacy. It is expected that these will provide new ideas and methods for clinical treatment of acute coronary syndrome.

Objective To discuss the relationship between serum folic acid (Fa),homocysteine (Hcy),Vitamin B12 (VB12) in pregnent women as well as neonatal umbilical cord blood and fetal growth restriction.Methods We selected 44 delivery mothers and their infants inpatient from February to November in 2010.Serum Hcy,Fa,VB12 were measured by enzyme-linked immunosorbent assay.According to the birth weight neonates were classified into fetal growth restriction (FGR),appropriate for gestational age (AGA),large for gestational age (LGA).We recorded fetal birth weight,height,head circumference,abdomen circumference,placenta weight,body mass index (BMI),Rohrer index,delivery method,gender and evaluated neonatal growth state.Results ( 1 ) Serum Fa,VB12 of pregnant women in FGR group were less than those in AGA and LGA group (P ＜0.05).Hcy of pregnant women in FGR group was higher than that in AGA,LGA group (P ＜0.05).Serum VB12 of umbilical cord blood in FGR group was less than that in AGA,LGA group.Hcy in FGR group was higher than that in AGA,LGA group ( P ＜ 0.05).Serum Fa in pregnant women was correlated positively with Fa,VB12 in umbilical cord blood ( P ＜0.01 ),as well as serum VB12 in pregnant women was correlated positively with that in umbilical cord blood ( P ＜ 0.01 ).( 2 ) Serum Hey in pregnant women and umbilical cord blood was negatively correlated with neonatal growth parameters (P ＜0.01 ).Serum Fa in pregnant women was positively correlated with birth weight ( P ＜ 0.05 ).Serum VB12 in pregnant women was positively correlated with neonatal head circumference and abdomen circumference ( P ＜0.05).(3) Placenta weight in FGR group was less than that in AGA,LGA group (P ＜0.01).There wasn't correlation between placenta weight and birth weight,height,head circumference,abdomen circumference,BMI in FGR group (P ＞ 0.05 ).There is a significant positively correlation between placenta weight and birth weight,height,head circumference,abdomen circumference,BMI in AGA,LGA group (P ＜0.01 ).(4)Rohrer's body index: In FGR group the index was less than 2.00 at the gestational age of ≤37.The index was less than 2.20 at the gestational age of ＞ 37.The ratio of height and head circumference was more than 1.36 in three groups.Conclusion Lack of the Fa and VB12 may induce hyperhomocysteinemia in period of pregnancy.FGR may be corelated with the increasing Hcy level.Serum Fa,VB12 and Hcy had important influence on the fetal physical condition at the later period of pregnancy.Placenta weight may play an important role in the fetal growth and development.

Objective To investigate the point prevalence rate of social anxiety disorder (SAD) in Chengdu primary school, and analyze the influencing factors. Methods Data came from a large representative sample of Chengdu 1441 primary school students, who were selected by stratified cluster sampling methods. They then finished self-compiled questionnaire, strengths and difficulties questionnaire, Eysenck Personality Inventory (EPI) (age 7 ～ 15 ), Egma Minnen ay Bardndosnauppforstran (EMBU) respectively. And then they had the face to face interviews with the trained psychiatrists, according to development and well - being assessment ( DAWBA,Chinese Version). Results Among 1441 Chengdu primary students, 37 of them were diagnosed SAD,with a point prevalence of 2.6% totally. The point prevalence was different in each grades, for 2.7% in grade 3,4. 1% in grade 4,4.1% in grade 5,3.5% in grade 6( z= -2.3, P=0. 023 ). Compared with the normal counterparts ,the SAD students had statistically significance different in pro-socialization ( z = -2. 1, P = 0.035 ), affection(z=- 5.2, P = 0. 001 ) , moral conduct ( z = - 2.8, P = 0. 004 ), peer( z = - 3.1, P = 0.002 ), excessive interference of maternal education ( z = - 3.1, P = 0.002 ), introversion-extroversion ( z = - 2. 0, P = 0. 046 ), neuroticism ( z =- 3.5, P= 0. 000), concealing tendency ( z= - 2.3, P= 0.018 ). Logistic regression analysis showed that: grade,family location, habitual lifestyle over the past years more emotional problem and excessive interference of maternal education were related with SAD occurrence. Conclusion The point prevalence rate of social anxiety disorder among Chengdu primary students is 2.6% ,and it was influenced by a number of factors .

Objective To explore the effects ofDanshen Tongluo Detoxication Decoction on the inflammatory response of rats with bone marrow stem cell (BMSC) transplantation in acute myocardial infarction (AMI); To discuss its mechanism of action.Methods The whole bone marrow adherent method was adopted for BMSCs separation and culture. The AMI model was established by closing the left anterior descending coronary artery of SD rats. After the modeling, SD rats were randomly divided into sham-operation group, model group and BMSCs group (BMSCs transplantation group),Danshen Tongluo Detoxication Decoction group, Danshen Tongluo Detoxication Decoction + BMSCs group, 10 rats in each group. BMSCs cell suspension was injected directly into the edge of the myocardial tissue infarction area; Chinese medicine or normal saline were administered for gavage. 4 weeks later, the contents of MCP-1 and sICAM-1 in each group were detected by ELISA. TLR-4 expression was measured by Western blot method, and HE staining was used to observe the myocardial tissue pathological changes.Results Compared with the model group, the contents of MCP-1 and sICAM-1 and the protein expression of TLR-4 in BMSCs group,Danshen Tongluo Detoxication Decoction group, andDanshen Tongluo Detoxication Decoction + BMSCs group decreased, Danshen Tongluo Detoxication Decoction group was better than BMSCs group (P<0.05,P<0.01), andDanshen Tongluo Detoxication Decoction + BMSCs group was better than BMSCs group andDanshen Tongluo Detoxication Decoction group(P<0.05,P<0.01).Conclusion BMSCs transplantation combined withDanshen Tongluo Detoxication Decoction can restrain the inflammatory response of AMI model rats and repair ischemic myocardium issue, which mechanism may be related to regulating TLR-4 induced inflammatory response.

Objective To study application of Chinese general practice assessment questionnaire (GPAQ)consultation version 2.0 in evaluating patients' satisfaction with community health-care service (CHS).Methods First,origihal GPAQ consultation version 2.0 in English was translated into Chinese language by three experts in general practice/family medicine field,then translated it back into English,finally a Chinese version of GPAQ was formed.Ten medical doctors who were on duty on 25 April,2008 at each out-patient clinic from CHS of Daxing,Nancaiyuan,Yongning and Hancunhe were selected randomly as targets for evaluation of service satisfaction.A sample of the first 30 patients(1200 in total)aged more than 16 years who visited the clinic on that day were selected to fill out the Chinese GPAQ consultation version 2.0 to express their satisfaction with the medical doctors they visited,and reliability and validity of the questionnaire was then evaluated.Results Cronbach's alpha ranged 0.734 to 0.813 for each domain of the Chinese version of GPAQ2.0.and cumulated contribution of three common factors with the eigen-value more than one reached 58.722%.Scores of patients' satisfaction withreceptionists,access,continuity,doctor's communication skills andpatient enablement were significantly lower,as compared to those of national bench-mark in the United Kingdom,with t-values of -6.397,-11.729,-6.328,-59.871 and -2.210,and all P＜0.05.respectively.Conclusions The Chinese version of GPAO 2.0 achieves good reliability and modcrate validity,and can be used as an instrument for evaluating patient's satisfaction with quality of CHS in China as further revision in the future studies.

Objective To explore the effect of the transcutaneous tracheostomy tube in patients with pneumothorax and its clinical value. Methods A prospective randomized controlled trial was conducted. Thirty-two patients with pneumothorax admitted to Department of Critical Care Medicine of Harrison International Peace Hospital of Hebei Medical University from June 2010 to June 2014 were enrolled. The patients were divided into control group and observation group,with 16 cases in each group. Beside the treatment for primary disease,the patients in control group received thoracic close drainage with traditional silica gel tube as performed by thoracic surgeons,and those in observation group received thoracic close drainage with transcutaneous tracheostomy tube by intensive care doctors. The curative effect and complications of the two groups were observed. Results Compared with control group,the time from diagnosis to operation(minutes:8.00±1.36 vs. 23.06±3.83,t=14.790,P=0.000)and the operation time were significantly shortened(days:5.37±1.02 vs. 7.31±1.70,t=7.286,P=0.000),the frequency of drainage tube replacement(times:0.18±0.40 vs. 3.87±1.14,t=12.128,P=0.000)and the times of repeated chest radiography(times:1.12±0.34 vs. 2.93±0.77,t=8.589,P=0.000)in observation group were significantly reduced,the length of hospital day was significantly shortened(days:8.30±1.37 vs. 24.56±5.62,t=17.289, P=0.000),the rates of dislocation of drainage tube(0 vs. 3 cases),obstruction of the tube(0 vs. 5 cases),and subcutaneous emphysema(3 vs. 16 cases)were reduced obviously,but there was no difference in incidence of incision infection(1 vs. 3 cases)and infection of thoracic cavity(0 vs. 2 cases). Conclusions The usage of transcutaneous tracheostomy tube in patients with pneumothorax is safe and simple. Doctors in ICU can independently do this procedure,and its effect is positive.

Objective:To explore the clinical pathological characteristics and initial 131I curative responses of familial differentiated thyroid cancer (FDTC) and sporadic differentiated thyroid cancer (SDTC). Methods:A total of 66 FDTC patients (19 males, 47 females, age (39.8±11.7) years) and 1 701 SDTC patients (442 males, 1 259 females, age (40.9±11.3) years) who underwent 131I therapy in Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2010 and August 2018 were retrospectively enrolled. The clinical pathological characteristics, preablative stimulated thyroglobulin (ps-Tg), preablative stimulated thyroglobulin antibody (ps-TgAb) and response to initial therapy (excellent response, indeterminate response, biochemical incomplete response, structural incomplete response) of two groups were analyzed and compared. The clinical pathological parameters included age, gender, pathological type, tumour maximum diameter, bilateral, multifoci, nodules goiter, thyroiditis, thyroid membrane invasion, lymph node metastasis (LNM), invasion of the surrounding soft tissues, distant metastasis, TNM staging and American Thyroid Association (ATA) risk stratification (low-risk, intermediate-risk, high-risk). χ2 test or Fisher exact test and independent-sample t test were used to compare the data between two groups. Results:Comparing with SDTC group, FDTC group showed higher proportion of bilateral foci (45.5%(30/66) vs 31.2%(530/1 701); χ2=5.999, P=0.010), thyroid membrane invasion (43.9%(29/66) vs 26.6%(452/1 701); χ2=9.672, P=0.002) and distant metastasis (15.2%(10/66) vs 6.2%(105/1 701); χ2=8.418, P=0.004). There was a statistical difference in risk stratification between two groups (high-risk: 18.2%(12/66) vs 9.2%(156/1 701); intermediate-risk: 68.2%(45/66) vs 72.7%(1 237/1 701); low-risk: 13.6%(9/66) vs 18.1%(308/1 701); χ2=6.898, P=0.030). But the tumor maximum diameter of FDTC group was smaller than that of SDTC group ((1.24±0.74) vs (1.50±0.92) cm; t=-2.275, P=0.020). There were no significant differences in other clinical pathological parameters between FDTC group and SDTC group ( t=-0.804, χ2 values: 0.101-5.359, all P>0.05). There were no significant differences between two groups in the postoperation ps-Tg, ps-TgAb levels and the response to initial therapy after 131I treatment ( χ2 values: 0.059-1.915, all P>0.05). Conclusions:The FDTC group displays distinct characteristics as increased aggressiveness at diagnosis. But after accurately treatment, there is no significant difference in the response to therapy between two groups.

OBJECTIVE: To study the expression of Survivin, Caspase-3 and p53 in surgical margin of laryngeal squamous cell carcinoma (LSCC), and their clinical significance and relationship. METHOD: Immunohistochemistry method was used to detect the expression of Survivin, Caspase-3 and p53 in 116 cases of surgical margin of LSCC. RESULT: According to the recurrence, the patients were divided into four group, recurrence within one year, between one year to three years, between three to five years, more than 5 years (include no recurrence). The expression rate of survivin were 92.9%, 85.0%, 50.0% and 21.1% (P < 0.01) in four groups, respectively. The expression rate of Caspase-3 were 50.0%, 50.0%, 66.7% and 89.5% (P < 0.01). The expression rate of p53 were 57.1%, 37.5%, 45.8% and 18.4% (P < 0.05). The expression rate of survivin, caspase-3 and p53 in four groups, respectively, there were significant differences (P < 0.05). CONCLUSION Expression of Survivin, Caspase-3 and p53 in surgical margin of LSCC may play an important role in the tumorigenesis and development of laryngeal carcinoma. They are feasible for early diagnosis and prognosis estimation.
Aged ; Carcinoma, Squamous Cell ; metabolism ; pathology ; surgery ; Caspase 3 ; metabolism ; Female ; Humans ; Inhibitor of Apoptosis Proteins ; metabolism ; Laryngeal Neoplasms ; metabolism ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Survivin ; Tumor Suppressor Protein p53 ; metabolism

Objective:To analyze the clinical characteristics of fulminant type 1 diabetes (FT1DM) in China.Methods:Clinical data of 279 cases related to FT1DM in Chinese Database from January 2005 to December 2018 were collected, and other 20 patients from our hospital were included in the present study.Results:(1) There has been a progressive increasing in the number of reported cases every year in China, and the number in the southern region were significantly more than that in the northern region. (2) The median age of the onset of FT1DM patients in China was 32.5 years old, without significant gender difference. Moreover, 36.5% (54/148) of the female patients caught the disease during their prenatal period, most of them were onset in the second or third trimesters of pregnancy and 2 weeks after delivery (37/40), and the prognosis of the fetus was extremely poor. (3) Compared with new-onset type 1 diabetes, FT1DM patients were younger, and with higher blood glucose [(39.7±15.3) vs (21.2 ± 9.9) mmol/L], higher serum creatinine [(188.4±115.9) vs (51.8 ±23.1) μmol/L], and higher amylase levels [245.5 (26.0-5 137.0) vs 54.7 (14.0-404.9) U/L]. FT1DM patients were with more severe acidosis, and lower HbA 1C level [(6.6 ±0.8)% vs (12.9 ± 2.5)%, P<0.01]. (4) FT1DM patients may combine with multiple organ dysfunction or severe metabolic disorders, electrolyte disorders, as well as liver and kidney dysfunctions, and elevation of amylase and muscle enzymes. Conclusion:FT1DM are with some clinical characteristics different from classic new-onset type 1 diabetes, including adult-onset, frequent in the southern China. Pregnancy may be a predisposing factor for female patients. Significant metabolic disorders and multiple organ involvements are common in the patients with FT1DM.

Primary hemifacial spasm is a motor disorder of facial muscles related to facial nerve. During the attack, the facial muscles present irregular and involuntary clonus, which can be induced or aggravated by emotional excitement, mental tension and random facial movement, seriously affecting daily work and life. The pathogenesis, diagnosis, differential diagnosis and treatment of the primary hemifacial spasm have been studied extensively in recent years. This article reviews the progress in these aspects.