Objective To investigate the clinical advantages and safety profile of the combinational treatment of acute progressive cerebral infarction with aspirin,clopedogrel and atorvastatin.Methods 170 cases with acute progressive cerebral infarction were randomly divided into the treatment group and control group,85 patients in each group.Both two groups were initially treated with aspirin and atorvastatin.After excluding the possibility of hemorrhage, the treatment group additionally received clopedogrel,while the control group was treated with aspirin and atorvastatin. The difference in clinical efficacy was evaluated between before treatment and 7 days,14 days or 28 days after treatment by using the NIH Stroke Scale (NIHSS)and Barthel Index (BI).Results The NIHSS scores of the treatment group after 7d,14d and 28d were (12.52 ±3.25)points,(9.10 ±3.21)points and (6.87 ±2.85)points, which of the control group were (13.65 ±2.93)points,(10.73 ±3.41)points and (9.07 ±2.96)points respectively, the differences between the two groups were statistically significant(t =2.340,3.170,4.877,all P <0.05).The BI scores of the treatment group after 7d,14d and 28d were (35.26 ±11.18),(53.73 ±13.74)and (74.61 ±17.35), which of the control group were (31.98 ±9.12),(46.65 ±11.79 )and (63.87 ±15.73 )respectively,the differences between the two groups were statistically significant(t =2.131,3.752,4.456,all P <0.05).The overall effective rates of the treatment group after 7d,14d and 28d were 62.7%,79.5% and 94.0%,which of the control group were 51.2%,68.3% and 84.1% respectively.The differences of overall effective rates were statistically significant after 14d and 28d(χ2 =4.711,8.531,all P <0.05).Few reverse reactions were observed in both two groups.Conclusion Compared with the aspirin and atorvastatin therapy,combinational treatment of acute progressive cerebral infarction together with clopedogrel has a better efficacy,safety profile and significant promotion on neurological recovery.

Objective:To investigate the effect of recombinant Elafin on A549 apoptosis induced by paraquat and the underlying mechanism.Methods:pEGFP-C1-Elafin was transformed into A549 competent cells by electroporation.Transformed A549 was cultured for additional 24 h before Elafin mRNA was detected by RT-PCR and cocultured with or without various concentration of paraquat( PQ ) for different duration.A549 apoptosis percentage and reactive oxygen species ( ROS ) content were tested by flow cytometry .Nuclear factor erythroid like-2(Nrf2) heme oxygenase-1(HO-1) were examed by Western blot .Results:Elafin expressed successfully in A549 after transformation.PQ caused A549 apoptosis in a concentration dependent manner and leaded to ROS content increasing and Nrf2 and HO-1 decreasing.However,elafin could inhibit ROS production and A549 apoptosis,upregulate Nrf2 and HO-1.Conclusion:Elafin could restrict A549 apoptosis to some extent and the possible mechanism lied in its ability to upregulate Nrf2 ex-pression.

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 changes of serum troponin I (cTnI) in children with severe pneumonia in the early time and its significance in the diagnosis of myocardial damage.Method cTnI was measured by automatic chemo-immuno-analyzer in 47 patients with severe pneumonia during acute stage and 25 patients during recovery stage.Results The levels cTnI in blood of 33 patients with severe pneumonia during the acute stage were obviously higher,with the abnormal rate 70.2%.There was a remarkable difference compared with control group(P

Objective To investigate the effects of S100B on the expressions of dopamine receptors and the synthesis,metabolism of neurotransmitters dopamine,5-hydroxytryptamine which are related to the abnormal motor coordination of Parkinson's disease (PD).Methods The hS100B transgenic mice were established.The mice were divided into S100B transgenic group (TG,n =14),S100B knockout group (KG,n =14) and the non-transgenic control group (CG,n =14).The motor coordination ability of mice was measured by the Rota-rod test.The expressions of dopamine D1 receptor (D1DR),dopamine D2 receptor (D2DR),tyrosine hydroxylase (TH) and phosphorylated TH at Ser19,Ser31,Ser40 in brain tissue were detected by reverse transcription polymerase chain reaction and Western blotting.The levels of Tyr,levodopa,dopamine,homovanillic acid,Trp,5-hydroxytryptamine and 5-hydroxyindoleacetic acid in mesencephalon were measured by high performance liquid chromatography with fluorescence detection.Results Compared with CG,the motor coordination ability of mice (s) showed progressive decline in TG (3 months:4.60±0.30vs4.25±0.21,q =5.194;6 months:4.52±0.31 vs4.07±0.22,q =6.139;9 months:4.43 ± 0.25 vs 3.60 ± 0.18,q =13.484;all P ＜ 0.05),the expressions of D2DR mRNA and protein decreased (1.34 ± 0.13 vs 0.48 ± 0.07,q =21.578;1.05 ± 0.15 vs 0.69 ± 0.10,q =8.063,both P＜0.05) and phosphorylated TH at Serl9 and Ser40 increased (0.95 ±0.10 vs 1.14-0.13,q =4.972;0.94 ± 0.12 vs 1.17 ± 0.14,q=5.382,both P＜ 0.05),the levels of levodopa,dopamine and homovanillic acid were elevated (87.04 ± 11.77 vs 115.28 ± 16.80,q =4.764;56.66 ± 9.87 vs 72.96 ± 11.02,q=3.923;26.58 ± 8.11 vs 38.65 ± 6.67,q=3.981,all P＜ 0.05),the leve1 of 5-hydroxytryptamine was reduced (925.50 ± 74.26 vs 637.87 ± 56.76,q =11.084,P ＜ 0.05),the ratios of homovanillic acid/dopamine and 5-hydroxyindoleacetic acid/5-hydroxytryptamine increased (0.45 ± 0.05 vs 0.54±0.08,q =3.325;0.94±0.07 vs 1.42±0.12,q =12.367,both P＜0.05) in the brain of TG at the age of 9 months old.There was no significant difference of detection indexes between KG and CG.Conclusions S100B plays an important role in the development of PD and the brain-specific S100B transgenic mice can be used to investigate the function of S100B gene on the development of PD.

Objective To investigate the expression of Circulating tumor cells ( CTCs ) in peripheral blood cells of patients with different stages of Small-Cell Lung Cancer ( SCLC) ,and to evaluate its significance in early diagnosis of lung cancer metastasis.Methods Thirty-five patients with SCLC ( 12 in limited stage and 23 in extensive stage ) and 25 patients with benign lung disease were recruited at the Shanghai Changhai Hospital from April 2011 to April 2013.Samples were prepared from 7.5 ml peripheral venous blood and collected in CellSave tubes.The CTC counts were determined using CellTracks AutoPrep fluorescence scanning system according to the manufacturers′instructions.The expression of CTCs in peripheral blood of SCLC patients and benign lung disease patients were analyzed.The expression of CTCs in different stages of SCLC was measured and compared.Furthermore, samples were prepared from 2 ml peripheral venous blood by centrifugation.The serum levels of NSE Neuron specific enolase were measured.The relationship between the expression of CTC and NSE was analyzed.Results CTCs positive rates in SCLC were significantly higher than in benign lung disease controls [ Positive rates of CTC≥1 were 80.0%and 12.0%(χ2 =27.003,P<0.000 1),CTC≥5 were 51.4%and 0 (χ2 =18.367,P<0.000 1), CTC≥10 were 34.3%and 0(χ2 =10.714,P<0.001),CTC≥50 were 17.1 and 0(P=0.036,P<0.05), respectively ].CTCs positive rates in SCLC extensive stage were significantly higher than limited-stage [Positive rates of CTC≥1 were 58.3% and 91.3%(P=0.033,P<0.05), CTC≥5 were 65.2% and 25.0%(P=0.035,P<0.05), respectively].The expression of CTCs was significantly correlated with NSE (r=0.743 7, P<0.000 1).Conclusion The expression of CTC in SCLC patients is significantly higher than those in control group , and is closely related to clinical stages , which may provide new clues to early predicting of SCLC metastasis and deterioration.

Objective To analyze the influence of medical insurance paying proportion to hierarchical diagnosis and treatment, and to provide basis for the improvement of hierarchical diagnosis and treatment. Methods Data about average number of visits of insured residents in 2015 were obtained from Hangzhou medical insurance service database. Differences between visits to Community Health Service Centers (CHSC) of residents having Medical Insurance of Urban and Rural Residents (MIURR) and residents having Urban Employees' Basic Medical Insurance (UEBMI) were compared. And differences stratified by signed contracted services offered by General Practitioners (GPs) or not were further analyzed. Results Proportion of visits to CHSCs in all visits to medical institutions in residents with MIURR was 77.22%, which was significantly higher than the proportion in residents with UEBMI was 51.26%. In the residents with UEBMI, and the proportion of visits to CHSCs in all visits to medical institutions of the group sighed contracted services offered by GPs was significantly higher than the group non-sighed. Conclusion Increasing the gap between reimbursement ratio of CHSCs and higher medical institutions plays an important role in guiding health-seeking behavior of residents. Reformation of medical insurance payment and contracted services will guide residents to seek medical treatment and effective referral.

Hematopoietic stem cell ( HSCs) injury induced by ionizing radiation ( IR) is the primary cause of death after exposure to ionizing radiation .The mechanisms of inducing HSCs damage include induction of HSCs apoptosis via the P53-Puma pathway;promotion of HSCs differentiation via the activation of the G-CSF/Stat3/BATF-depend-ent differentiation checkpoint;induction of HSCs senescence via the ROS-P38 pathway; and damage to the HSCs niche.Recent researches provide a basis for the prevention and treatment of bone marrow suppression caused by ionizing radiation .

Objective The survey aimed to investigate the self-efficacy of permanent colostomy patients at different stages,and explore its impact factors.Methods A total of 267 cases of permanent colostomy patients at different stages (postoperative hospital stay,postoperative chemotherapy and home rehabilitation),coming from many domestic top three hospitals were investigated using the general information questionnaire,C-COH,the Stoma Self-Efficacy Scale,and Perceived Social Support Scale (PSSS).Results The total score of self-efficacy of 267 colostomy patients was (75.97 ± 23.92),ranked in the middle level,and it showed a rising tendency at postoperative hospitalization,postoperative chemotherapy and home rehabilitation.The influencing factors of self-efficacy of the patients at postoperative hospitalization included psychological well-being,BMI and age the regression coefficients were 7.126,1.512 and-0.281.the influencing factors of self-efficacy of the patients at postoperative chemotherapy included psychological well-being,age,the proportion of medical insurance,living state and caregiver,the regression coefficients were 5.182,-0.726,0.238,7.993 and 6.083; the influencing factors of self-efficacy of the patients at home rehabilitation included spiritual well-being,social support,self-care degree,gender and the monthly cost of ostomy supplies,the regression coefficients were 7.215,-7.820,-9.616 and-4.762.Conclusions The influencing factors of self-efficacy of permanent colostomy patients at different stages was different,the medical staff should assess and screen the high-risk factors of self-efficacy positively,according to the individual circumstance and stage,to formulate the individualized intervention measures,so as to enhance the patients' self-confidence to deal with and manage the disease,thereby increasing the level of self-efficacy.

Objective We aimed to construct the handbook of self-management for patients with permanent colostomy by using the Delphi method.Methods Based on htemture review,23 experts were consulted twice by using the Delphi method about the related problems of constructing the handbook of self-management for patients with permanent colostomy,and the consulting results were analyzed later.Results The valid response rates of two rounds of expert consultation were 91.3％ and 100.0％,respectively.The authority coefficient of the experts (Cr) was 0.879,and coordination coefficients of the experts' opinion (W) were 0.387 and 0.307,respectively.Finally,the handbook of self-management for patients with permanent colostomy was determined by two rounds of expert consultation.Conclusions The handbook of self-management for patients with permanent colostomy,consmucted by using the Delphi method,provides a practical and effective tool for the patients with permanent colostomy to manage themselves,so as to provide a guidance and supervision role on self-management,such as stoma management,role management and emotion management,fither more,it provides references for the clinical and community nursing of the patients with permanent colostomy.