Objective To observe the effects of restrain stress on the phosphorylation of p38 mitogen-activated protein kinase ~MAPK) in rat hypothalamus and the regulation effects of electroacupuncture on the phosphorylated-p38 MAPK. Methods Twenty-eight rats were randomly divided into a control group, a restrain stress group and a restrain stress plus electroacupuncture group. The Western blot was employed to observe the changes of phosphorylated-p38MAPK in the three groups. Results Western blot analysis demonstrated a higher level of phosphorylation of p38 MAPK in the hypothalamus from restrain stress group than that from control. The higher level of phosphorylated-p38 MAPK could last for 3 hours after stress was relieved. The level of phosphorylated-p38MAPK could be decreased to some extent when the Zusanli acupoint of the restrained rat was acupunctured. The effects of electroacupuncture of Zusanli on phosphorylated-p38MAPK in hypothalamus could still be retained although the electroacupuncture was ended for 3 hours. Conclusion The results suggested that restrain stress can lead to a higher level of phosphorylation of p38 MAPK in hypothalamus, which might be an important event in the response of hypothalamic-pitutary-adrenal ~HPA) axis. The mechanism underlying the regulation of HPA by electroacupuncture might be (related) to the regulation of phosphorylated-p38 MAPK in hypothalamus.

The research outputs from 2010 to 2014 in clinical medicine of the top 10 universities announced by the Academic Degrees Center under Education Ministry of China in 2012 were analyzed and assessed according to the index system for assessment of research outputs in clinical medicine we established on the basis of bibliometrics.

Objective:To observe the imprinting effects of prenatal overexposure to glucocorticoids on 11?-hydroxysteroid dehydrogenase type 1(11?-HSD1) expression in the rat offspring liver. Methods: Pregnancy was determined by examining vaginal smear. Eight pregnant rats were divided into dexamethasone(DEX) group and normal saline(NS) group at random with each group containing 4 rats.DEX group was given subcutaneous injection of DEX [0.05 mg/(kg?d)] and NS group was given injection of NS.Western blot was adopted to determine 11?-HSD1 protein in the liver of the offspring at the age of 4 months;RT-PCR was used to determine 11?-HSD1 mRNA and hepatic phosphoenolpyruvate carboxykinase(PEPCK) mRNA;and glucose oxidase method was used to measure the blood glucose concentration. Results: Western blot and RT-PCR showed that prenatal overexposure to DEX increased the expression of 11?-HSD1 protein and mRNA in the liver of the female offsprings at 4 months old, but not in male offsprings.Prenatal overexposure to DEX also increased the expression of PEPCK mRNA and blood glucose level in the female offsprings at 4 months old.Conclusion:Our study suggests that prenatal overexposure to glucocorticoids throughout gestation can imprint the expression of 11?-HSD1 in rat offsprings liver, which may lead to the PEPCK overexpression and blood glucose elevation.Development of diabetes may be induced in individuals overexposed to glucocorticoids during fetal period.

This paper summed up the medical professionalism as taking patients'interests first , reshaping the medical good faith , improving business ability and promoting social justice .Also proposed that in order to have rea-sonable human resource allocation , ensure the construction of rural health personnel team and stability , the follow-ings are necessary:medical staff at villages and towns setting up the medical ethics , strengthening the altruism spir-it;changing the traditional model of the doctor -patient relationship , adhering to the principle of patient autonomy;cultivating professional sense of responsibility , building moral education;intensive training and striving to improve the level of medical technology;increasing the doctor -patient communication , restoring patients'interests first , re-shaping medical doctor -patient trust integrity , improving business ability and promoting social justice as well as fully exerting the social , moral and cultural supporting factors etc .

Objective To evaluate the efficacy and safety of percutaneous balloon aortic valvuloplasty (PBAV) in retrograde,antegrade way or right ventricular pacing in children.Methods This was retrospective clinical study included 32 children who were treated with PBAV for congenital aortic stenosis from January 2008 to June 2017 in Guangdong Cardiovascular Institute.The general clinical data including residual stenosis and aortic stenosis again,and degree of artery injury,aortic regurgitation were particularly assessed.Results A total of 32 patients consisting of 27 boys and 5 girls underwent the procedure,with age of (55.8 ± 52.0) months (ranging from 20 days to 15 years) and body weight (18.2 ± 14.0) kg (ranging from 3.5 kg to 59.0 kg).Two infants accepted left cardiac catheterization through femoral vein and one with interventional indication then accepted PBAV through the patent foramen ovale.The others underwent the retrograde way,including 24 cases with rapid right ventricular pacing.The catheter-measured peak systolic the aortic valve gradient decreased from (81.6 ± 28.0) mmHg(1 mmHg =0.133 kPa) to (41.4 ± 19.0) mmHg immediately after percutaneous interventional treatment,and the difference was statistically significant (t =9.543,P =0.000).The peak systolic valve gradient mea-sured pre-PBAV and on the second day after PBAV measured by Doppler echocardiography decreased from (82.7 ±23.0) mmHg to (44.6 ± 18.0) mmHg,and the difference was statistically significant (t =11.732,P =0.000).The diameters of the aortic valve were (13.8 ± 3.0) mm(ranging from 6.5 mm to 21.0 mm) and the balloons were (14.1 ±4.0) mm(ranging from 6 mm to 23 mm).The follow-up period was 1 to 72 months.The peak systolic valve gradient measured by Doppler echocardiography increased from (44.6 ±18.0) mmHg to (58.6 ± 30.0) mmHg,and the difference was statistically significant (t =-2.549,P =0.016).During the procedure,5 children (14.7％) accepted surgery for restenosis or regurgitation.Seven had regurgitation,one had femoral artery embolism and one died on the second day after the procedure.Conclusions With the diversification of procedures and the continuous improvement of interventional devices,PBAV can play a very good role in alleviating congenital aortic stenosis in children,and the safety has been continuously improved.

Steroid-induced avascular necrosis of the femoral head (SANFH) is the death of the femoral head caused by long-term use of glucocorticoid (GC). Its pathological manifestations are mainly trabecular bone collapse and increased empty bone lacunas, osteocyte apoptosis rate and autophagy rate. Its pathogenesis is complicated, and the exact pathogenesis is still unclear. MicroRNAs (miRNAs) are a group of endogenous, non-coding small RNAs with an average length of 23 nucleotides. They are responsible for negatively regulating gene expression after transcription by inhibiting target messenger RNAs (mRNAs). MiRNAs play an important role in physiological processes, including cell development, proliferation, differentiation, metabolism, migration and apoptosis. According to bioinformatics analysis, MiRNAs play an important role in regulating gene expression, and it is estimated that more than one-third of human genes are regulated by them. In the past few years, more and more miRNAs have been found to be related to osteonecrosis, such as regulating the proliferation and differentiation of mesenchymal stem cells and osteoblasts. This article aims to review the relationship between steroid-induced femoral head necrosis and miRNAs.

Ferroptosis is an iron-dependent, apoptotic cell death caused by massive lipid peroxidation-mediated cell membrane damage. Recent evidence suggests that exosomes, as a 30-100 nm diameter follicular body, contain a variety of active ingredients such as proteins, various RNAs and lipids that can have a great impact on the diagnosis and treatment of related diseases by regulating cellular iron death. To this end, this paper elaborates the research significance of exosomes in the regulation of cell ferroptosis, analyzes their role in disease treatment, and reviews the relevant reports and studies on exosomes regulating cell ferroptosis in recent years.

ObjectiveThe heightened expression of local immunoglobulins is a significant pathological characteristic of chronic rhinosinusitis with nasal polyps （CRSwNP）， particularly in the Asian population. This study is centered on exploring the association between MZB1 and the localized aggregation of immunoglobulins in Asian individuals with CRSwNP. MethodsNasal polyp tissues obtained from 40 CRSwNP patients and inferior turbinates from 6 healthy controls underwent examination for both mRNA and protein levels. The assessments were conducted using polymerase chain reaction， luminex， and immunohistochemical staining. Statistical analyses， including one-way Anova （ANOVA）， independent samples t-test， and Pearson's correlation analysis， were employed for comprehensive data evaluation. ResultsThe mRNA expression levels of MZB1（P < 0.01） and HSP90B1 （P < 0.01） were significantly higher in type 2 CRSwNP patients compared with those in healthy controls. Immunohistochemical staining revealed a significant increase in MZB1 protein expression in type 2 CRSwNP. MZB1 demonstrated correlation with the expression of immunoglobulin E in nasal polyp tissues （P < 0.01， r = 0.52）. Additionally，MZB1correlated with the expression ofIL-5（P < 0.05， r = 0.4） and IL-13 （P < 0.05， r = 0.44） in nasal polyp tissues. Furthermore，MZB1showed correlation with the number of eosinophils in nasal polyp tissues （P < 0.05， r = 0.72）. ConclusionThe expression of MZB1 is notably elevated in Asian CRSwNP， particularly in type 2 CRSwNP， when compared with controls.MZB1expression correlates significantly with high IgE expression and disease severity in nasal polyp tissues.

Objective: To conduct a comprehensive and systematic review of the efficacy and safety of Wenxin Keli (WXKL) in the treatment of atrial fibrillation (AF) . Methods: Seven databases (PubMed, The Cochrane Library, Web ofScience, CNKI, Wanfang Database, VIP and SinoMed) were searched to identify relevant randomized controlled trials (RCTs) from inceptions to 1 October, 2018. Two review authors independently assessed the methodological quality andanalyzed data by Cochrane handbook and the Rev Man 5.3 software. Begg.s test was conducted to assess publication biasvia Stata 14 software. Results: Twenty-four RCTs with 2246 patients were included in this review. Compared with blankcontrol, placebo or western medicine alone, WXKL alone or combined with western medicine could effectively reducerapid ventricular rate (MD=-7.14, 95％CI:-8.42——5.87), the frequency and duration of AF. It could also shorten thesinus rhythm conversion time (MD=-3.04, 95％CI:-3.47——2.61), increase the sinus rhythm conversion rate (RR=1.19, 95％ CI: 1.09～1.29) and decrease recurrence rate of AF (RR=0.28, 95％ CI: 0.13-0.59) . Besides, WXKL alone orcombined with western medicine was beneficial for improving the left ventricular ejection fraction (LVEF) (MD=3.44, 95％ CI: 0.87-6.01), left ventricular end diastolic diameter (LVEDD) (MD=-2.47, 95％ CI:-2.86——2.08), left atrialdiameter (LAd) (MD=-0.91, 95％CI:-1.58——0.25) and P wave dispersion (Pd) (MD=-4.04, 95％CI:-4.15——3.93) .WXKL combined with low-dose amiodarone was superior to conventional-dose amiodarone alone in improving themaximum P wave (Pmax) (MD=-8.25, 95％ CI:-10.33——6.17), and WXKL combined with conventional-doseamiodarone is more effective (MD=-13.10, 95％CI:-13.65——12.55) . Compared with the control group, the treatmentgroup had fewer adverse reactions, and the Begg.s test did not find any publication bias. Conclusion: WXKL alone orcombined with western medicine exhibited better therapeutic effects in the treatment of AF, but these results still needhigh-quality evidence to verify.