Objective To study the risk factors for cognitive impaurment in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with ischemic stroke.Methods Three hundred and twenty-eight OSAHS patients with ischemic stroke were divided into cognitive impairment group (n=158) and cognitive impairment-free group (n=170) according to their MMSE score.The risk factors for their cognitive impairment were analyzed by multivariate logistic regression analysis and stratification analysis respectively.Results The blood glucose and lipid,AHI,LSaO2,infarction size and site,HIF-1 and Ngb level were significantly different between the two groups (P＜0.01).Multivariate logistic regression analysis showed that blood glucose and lipid,AHI,infarction site and Ngb level were the independent risk factors for cognitive impairment (OR=3.527,95％CI:1.559-7.983,P=0.002;OR=6.413,95 ％CI:2.766-14.865,P=0.000;OR=4.099,95％CI:1.694-9.918,P=0.002;OR=4.484,95％CI:1.950-10.310,P=0.000;OR=3.891,95 ％CI:1.759-8.606,P=0.001).Stratification analysis showed that high HIF-1 and Ngb levels were positively related with cognitive impairment in patients with AHI＞20 times/h,frontotemporal infarction,hyperglycosemia or hypoglycosemia,and dyslipidemia.Conclusion High HIF-1 and Ngb levels are independently related with cognitive impairment in OSAHS patients with ischemic stroke.

At present, mesenchymal stem cell treatment mainly applies in local and systematic transplantation, gene therapy combining stem cells, as well as tissue engineering. Based on mesenchymal stem cells are easily separated, cultured, have potentials of fast proliferation, easy exogenous gene's induction and expression, and can maintain multi-differentiation potential throughout long-term culture in vitro, and the quite stable genetic background. Mesenchymal stem cells have widely application prospect in tissue engineering of ophthalmology. At present, domestic and foreign researches have had massive evidences that mesenchymal stem cells can differentiate into cornea and retina cells. The application of mesenchymal stem cells in the anterior eye is usually by dint of a kind of carrier, such as amniotic membrane, fibrin gel membrane and so on. Moreover, the temperature sensitive culture dish has made the non-carrier transplantation of ocular surface stem cells. The application of mesenchymal stem cells in the posterior eye mostly concentrates in seeking for the feasible treatment of retinitis pigmentosa. Researches are mature on mesenchymal stem cells as seed cells acting on damaged tissue in ocular repairs and regeneration. But its oncogenicity and the security are waiting for further solving.

Medical ethics is a set of behavioural principles which regularized medical workers' relationships to patients and society and that between themselves under social ethics and the development of medical science.It is an essential constituent of the social ethical system and plays an important role in medical activity.By studying the current situation of the ethics-oriented education on medical students,the author re-analyzed the current state of medical ethics and proposed some creative and feasible methods on improving the quality of medical ethics of the students.

Objective To explore the application effect of sufentanil or dexmedetomidine on blind intubation in 88 patients with difficult airway .Methods Eighty eight cases of patients with difficult airways in our hospital were divided into treatment group and control group depending on different preoperative sedation .There were 44 cases in each group .Patients in the treatment group were treated with dexmedetomidine anesthesia treatment ,and patients in the control group were treated in clinical routine application of sufentanil anesthesia ,both groups were taken blind intubation after anesthesia treatment .The heart rate ,systolic arterial pressure , diastolic arterial pressure and respiratory rate of patients before anesthesia ,after anesthesia ,when the intubation tube reached uvu‐la ,epiglottis ,when the intubation finished and 5 minutes after the intubation were recorded .Cases of nausea ,dysphoria ,bucking and respiratory depression during the intubation were also recorded .Results From the induction of anesthesia to 5 min after intubation , the respiratory rate of the treatment group was higher than the control group (P<0 .05);the systolic blood pressure ,diastolic blood pressure and heart rate of treatment group were significantly lower than the control group since intubation tube arrive uvula until the completion of systolic (P<0 .05);The arterial oxygen pressure was (98 .52 ± 9 .18) mm Hg in the treatment group 5 min after intubation ,which was significantly higher than the control group which was (93 .46 ± 10 .81) mm Hg (P<0 .05);cases of nausea , dysphoria ,bucking and respiratory depression in the treatment group were significantly lower than that of control group(P<0 .05) , and the average intubation time of the treatment group were significantly shorter than that of control group (P<0 .05) .Conclusion Dexmedetomidine could effectively improve the condition of the patients with difficult airways ,achieve effective anesthesia ,reduce cardiovascular reactivity in patients ,and ensure the smooth progress of intubation for the difficult airway patients .

Objective To investigate the effect of has-miR-663 on proliferation and apoptosis of human adrenal cortical cell line SW-13.Methods Based on the first stage study,in adrenocorticotropinindependent macronodular adrenal hyperplasia (AIMAH),hsa-miR-663 was up-regulated.The synthetic hsa-miR-663 mimics and inhibitors were transfected the SW-13 cell line.Real-time quantitative PCR (RT-PCR) tested the effect of the transfection.According to the results of RT-PCR,cell line was divided into five groups,including blank group,mimics NC group,inhibitor NC group,mimics group,inhibitor group.Then proliferating of the cell was tested by MTT and the apoptosis by Annexin V-FITC/PI.Result By RT-PCR,mimics group showed that has-miR-663 was over-expressed,and inhibitor group were knocked down.MTTshowed that,compared with NC group and Blank group,SW-13 cell line proliferated faster in mimics group and slower in inhibitor group.Annexin V-FITC/PI showed that apoptosis of SW-13 cell line was not different in all the five groups.Conclusion Up-regulating has-miR-663 could accelerate proliferation of adrenal cortical cells.The microRNA might play some role in the pathogenesis of AIMAH.

Based on the high solubility of azodicarbonamide (ADC) in hot solution and its electrostatic interaction with Nafion film,a new electroanalytical method was developed for the determination of ADC by using Nafion film electrode.The effect of temperature on the solubility of ADC and the mechanism of the reduction reaction of ADC on Nafion film electrode were investigated.Under the experimental conditions such as water bath at a constant temperature of 80 ℃,pH 6.0 and optimal test parameters,the differential pulse voltammetric response was proportional to the concentration of ADC in the range of 0.93-10.5 μg/L,and the detection limit was estimated to 0.58 μg/L.The relative standard deviation was less than 5.86 ％ and the recovery was 95.8％-104.0％ for the determination of the ADC in flour samples.The semicarbazide and nitrofurazone did not interfere with the determination of ADC.

Recently,the new term lamellar hole-associated epiretinal proliferation was introduced to describe a specific epiretinal proliferation.Different from conventional epimacular retinal membrane,lamellar hole-associated epiretinal proliferation (LHEP) can be found around the edge of lamellar macular holes and part of full thickness macular holes.It is defined as a thick homogenous layer of yellowish material without any contractive properties on the epiretinal surface with medium reflectivity on optical coherence tomography images.Immunocytochemical analysis showed the presence of glial cells,fibroblasts,hyalocytes and collagen type Ⅱ.Electron microscopy revealed fibroblasts and hyalocytes as predominant cell types,densely packed in cell agglomerations.LHEP is a secondary event in lamellar macular hole formation and may represent a repair process after large and deep retinal defect.Further studies on its clinical features and clinical significance are still required.

Objective To explore and analyze the clinical characteristics and treatment strategy of severe complications caused by childrenˊs foreign bodies in esophagus.Methods The clinical data of 71 ca-ses of esophageal foreign bodies in children with ENT admitted to our hospital were analyzed retrospectively from Jan 2009 to Dec 2014.Results Esophageal foreign bodies in children with 71 cases,of whom 42 males and 29 females;aged from 2 months to 14 years old,highest incidence of 1 to 3 years old.Foreign bodies in esophagus lasted 2 h to 15 d.Ingestion of metallic foreign bodies in 43 cases,12 cases of plant-based foreign body,9 cases of animal foreign bodies,7 cases of chemical foreign bodies.Foreign bodies located in the upper esophageal was 51 cases,9 cases of the middle and 7 cases of the under section,3 cases of esophageal en-trance,1 case of falling into the stomach.In children with 71 cases,9 cases had complications,69 cases were cured,improved in two cases,and the cure rate was 97.2%,the average healing time was 4 d.Conclusion Early diagnosis and treatment,avoid esophageal perforation are the key to avoid the emergence of the compli-cations in children with esophageal foreign bodies,timely and accurate treatment of esophageal perforation and other complications are the effective measures to improve the cure rate.

Objective To observe the clinical effects of different doses of Xuebijing injection in the treatment of sepsis. Methods Eighty patients with sepsis from First Center Clinical College of Tianjin Medical University were selected and randomly divided into four groups:the control group,Xuebijing small,middle and large dose groups(each, 20 patients). All patients in the four groups were given Western medicine conventional treatment,whereas in the Xuebijing small,middle and large dose groups,additionally they were intravenously dripped with Xuebijing injection 50 mL, 2 times a day,100 mL,2 times a day and 100 mL,4 times daily respectively. The patients' vital signs,blood routine, interleukin-18(IL-18),procalcitonin(PCT)and C- reactive protein(CRP)were detected before treatment(0 d)and 3,7 and 14 days after Xuebijing injection,28-day and 60-day death rate were observed. Results With prolonged treatment,the body temperature,heart rate(HR),respiratory rate(RR),white blood cell count(WBC),IL-18,PCT, CRP levels were all decreased in each group(all P<0.05),and on 14 days they reached the valley;when compared with middle,small dose Xuebijing groups and control group,in the Xuebijing large dose group they were decreased the most significantly over the same period〔temperature (℃):36.22±0.55 vs. 36.55±0.99, 36.87±1.05, 36.93±1.07,HR(beats/min):82.11±8.99 vs. 93.45±10.02,109.02±11.44,113.13±10.34,RR(breaths/min):15.48±6.45 vs. 17.33±6.94,20.35±7.19,22.34±6.67,WBC(×109/L):5.35±1.37 vs. 8.35±2.98,10.54±3.22, 13.33±4.78,IL-18(ng/L):107.36±55.89 vs. 136.55±80.19,177.78±102.32,193.93±98.07,PCT(μg/L):0.33±0.19 vs. 0.66±0.22,1.62±0.44,2.78±0.34,CRP(mg/L):15.40±1.37 vs. 48.34±8.98,100.45±30.67, 131.92±49.53〕,the differences all being statistically significant(all P<0.05). The 28-day and 60-day death rate in Xuebijing large dose group were significantly lower than those in control group,Xuebijing small,middle dose groups (28-day:25% vs. 40%,40%,45%;60-day:30% vs. 45%,40%,50%). Conclusion The time for onset of therapeutic effect in large dose Xuebijing group is short,and reduce the levels of inflammatory mediators significantly, and improve the prognosis of patients with sepsis,therefore it can be used clinically.

Acute coronary syndrome(ACS) belongs to “thoracic obstruction” and “heartache” in traditional Chinese medicine.Although many ancient physicians has discussed this disease,while due to the impact of “Yang Wei Yin Xian” in Zhang Zhong-jing's theory,the disease caused little attention by far.In the clinical practice,the author found that most ACS patients belong to heat syndrome.Based on TCM constitution theory,the author put forward the ACS was mainly caused by heat accumulation and blood stasis due to the changes of living environment,lifestyle,and diet,etc.According to traditional Chinese medicine theory,emotional disorder,spicy and hot food can burn body fluid,leading to blood stasis.Long term of blood stasis turns to heat,which further consumes heart blood and aggravates blood stasis.Therefore heat accumulation and blood stasis should be paid attention in the treatment of ACS.