Objective:To investigate the impact of " staging" hybrid coronary artery revascularization (HCR) on the short-and long-term efficacy of patients with multiple coronary artery lesions.Methods:A retrospective case-control study was conducted. Eighty patients with multiple coronary artery lesions admitted to the Baoding Second Central Hospital from January 2017 to October 2018 were selected and divided into two groups according to different surgical methods. Forty patients were treated with " staging" HCR and were designated as the HCR group, and 40 patients were treated with off-pump coronary artery bypass grafting (OPCAB) and were designated as the OPCAB group. The perioperative related indicators and perioperative serious complications were compared between the two groups. The serum myocardial injury marker levels were detected preoperatively and 48 hours postoperatively, including heart-type fatty acid binding protein (H-FABP) and troponin I (cTnI). All subjects were followed up for at least 3 years to calculate the incidence of major adverse cardiovascular and cerebrovascular events (MACCE).Results:The bypass surgery time, mechanical ventilation time, ICU stay time, and total hospital stay time in the HCR group were all less than those in the OPCAB group (all P<0.05), and the incision length in the HCR group was shorter than that in the OPCAB group ( P<0.05). The intraoperative bleeding volume, postoperative 24-hour drainage volume, red blood cell transfusion volume, and plasma transfusion volume in the HCR group were all less than those in the OPCAB group (all P<0.05). Forty-eight hours after surgery, the serum H-FABP and cTnI levels in both groups were significantly higher than those preoperatively (all P<0.05), but the increase was more significant in the OPCAB group (all P<0.05). The perioperative serious complication rate in the HCR group was 2.50%(1/40), which was significantly lower than that in the OPCAB group [20.00%(8/40)] ( P<0.05). During the 3-year follow-up after surgery, the MACCE incidence in the HCR group was 12.50%(5/40), and that in the OPCAB group was 22.50%(9/40). There was no significant difference in the long-term MACCE incidence between the two groups ( P>0.05). Conclusions:" Staging" HCR treatment for multiple coronary artery lesions can achieve ideal surgical results. Compared with OPCAB, its short-term efficacy is more significant, and long-term efficacy is equivalent.

Objective:To compare the efficacy and safety of ticagrelor and clopidogrel in antiplatelet aggregation after 2-staged hybrid coronary revascularization (HCR).Methods:A prospective randomized controlled trial was conducted. According to the postoperative antiplatelet therapy scheme, the patients with coronary artery multivessel disease who underwent 2-staged HCR operation in our hospital were divided into ticagrelor group (after the operation, the patients were given aspirin enteric coated tablets 100 mg orally once daily and ticagrelor tablets 90 mg orally twice daily for 1 year) and clopidogrel group (after the operation, the patients were given aspirin enteric coated tablets 100 mg orally once daily and ticagrelor tablets 75 mg orally once daily for 1 year). The general condition, platelet aggregation funtion [maximum platelet aggregation rate (MPAR) and P2Y12 reaction unit (PRU) ] at different time points before and after operation, and platelet inhibition rate [aspirin resistance (AA), ticagrelor or clopidogrel resistance (ADP)], major adverse cardiovascular events (MACE), bleeding events, and adverse reactions after operation were analyzed and compared between the 2 groups.Results:A total of 124 patients were enrolled in the study, 62 patients each in the ticagrelor group and clopidogrel group. There were no statistically significant differences in baseline data (gender, age, New York Heart Association cardiac function classification, concomitant diseases, etc.) between the 2 groups (all P>0.05). The MPARs at 24 h, 7 d, and 1 month after operation in the ticagrelor group and clopidogrel group were lower than those before operation [(50±9)%, (36±8)%, (29±6)% vs. (65±11)% and (59±10)%, (47±9)%, (38±7)% vs. (65±12)%, all P<0.001]. The MPARs at 24 h, 7 d, and 1 month after operation in the ticagrelor group were lower than those in the clopidogrel group[(50±9)% vs. (59±10)%, (36±8)% vs. (47±9)%, (29±6)% vs. (38±7)%, all P<0.001]. The PRUs at 24 h, 7 d, and 1 month after operation in the 2 groups were lower than those before operation (all P<0.001). The PRUs at 24 h, 7 d, and 1 month after operation in the ticagrelor group were lower than those in the clopidogrel group(all P<0.001). There was no significant difference in the incidence of AA 24 hours after operation between the 2 groups ( P>0.05); the inhibition rate of ADP in the ticagrelor group was higher than that in the clopidogrel group ( P<0.001). At the 24th month of follow-up, the incidence of MACE in the ticagrelor group was lower than that in the clopidogrel group (11.3% vs. 27.4%, P<0.05). At the 12th month of follow-up, there was no statistically significant difference in incidence of bleeding events between the 2 groups (3.2% vs. 8.1%, P>0.05) . There was no statistically significant difference in the incidence of adverse reactions between the 2 groups (16.1% vs. 11.3%, P>0.05) . Conclusions:Compared with clopidogrel+aspirin regimen, ticagrelor+aspirin regimen is more effective in inhibiting platelet aggregation and reducing postoperative MACE after 2-staged HCR. Both antiplatelet aggregation regimens do not increase the risk of bleeding and have no serious adverse reactions. Both regimens have good safety.

Objective:To compare the efficacy and safety of ticagrelor and clopidogrel in antiplatelet aggregation after 2-staged hybrid coronary revascularization (HCR).Methods:A prospective randomized controlled trial was conducted. According to the postoperative antiplatelet therapy scheme, the patients with coronary artery multivessel disease who underwent 2-staged HCR operation in our hospital were divided into ticagrelor group (after the operation, the patients were given aspirin enteric coated tablets 100 mg orally once daily and ticagrelor tablets 90 mg orally twice daily for 1 year) and clopidogrel group (after the operation, the patients were given aspirin enteric coated tablets 100 mg orally once daily and ticagrelor tablets 75 mg orally once daily for 1 year). The general condition, platelet aggregation funtion [maximum platelet aggregation rate (MPAR) and P2Y12 reaction unit (PRU) ] at different time points before and after operation, and platelet inhibition rate [aspirin resistance (AA), ticagrelor or clopidogrel resistance (ADP)], major adverse cardiovascular events (MACE), bleeding events, and adverse reactions after operation were analyzed and compared between the 2 groups.Results:A total of 124 patients were enrolled in the study, 62 patients each in the ticagrelor group and clopidogrel group. There were no statistically significant differences in baseline data (gender, age, New York Heart Association cardiac function classification, concomitant diseases, etc.) between the 2 groups (all P>0.05). The MPARs at 24 h, 7 d, and 1 month after operation in the ticagrelor group and clopidogrel group were lower than those before operation [(50±9)%, (36±8)%, (29±6)% vs. (65±11)% and (59±10)%, (47±9)%, (38±7)% vs. (65±12)%, all P<0.001]. The MPARs at 24 h, 7 d, and 1 month after operation in the ticagrelor group were lower than those in the clopidogrel group[(50±9)% vs. (59±10)%, (36±8)% vs. (47±9)%, (29±6)% vs. (38±7)%, all P<0.001]. The PRUs at 24 h, 7 d, and 1 month after operation in the 2 groups were lower than those before operation (all P<0.001). The PRUs at 24 h, 7 d, and 1 month after operation in the ticagrelor group were lower than those in the clopidogrel group(all P<0.001). There was no significant difference in the incidence of AA 24 hours after operation between the 2 groups ( P>0.05); the inhibition rate of ADP in the ticagrelor group was higher than that in the clopidogrel group ( P<0.001). At the 24th month of follow-up, the incidence of MACE in the ticagrelor group was lower than that in the clopidogrel group (11.3% vs. 27.4%, P<0.05). At the 12th month of follow-up, there was no statistically significant difference in incidence of bleeding events between the 2 groups (3.2% vs. 8.1%, P>0.05) . There was no statistically significant difference in the incidence of adverse reactions between the 2 groups (16.1% vs. 11.3%, P>0.05) . Conclusions:Compared with clopidogrel+aspirin regimen, ticagrelor+aspirin regimen is more effective in inhibiting platelet aggregation and reducing postoperative MACE after 2-staged HCR. Both antiplatelet aggregation regimens do not increase the risk of bleeding and have no serious adverse reactions. Both regimens have good safety.

Objective To investigate the influence of parental compliance on the therapeutic effect of children with epilepsy.Methods Two hundred and sixty children with epilepsy and their parents admitted to the First People's Hospital of Wenling from December 2013 to June 2016 were enrolled,and the classical Morisky medication adherence questionnaire (MMAS-8) was applied to evaluate the compliance of parents for treatment of their children with epilepsy;after the patient taking drug for 3 days,fasting venous blood was collected in the morning,the concentration of the blood drug was tested and the influence of parent compliance on the blood drug concentration of the child with epilepsy was evaluated.Results In 260 patients,122 cases took karma form,and 138 cases took valproate orally.There were parents with good medication compliance in 130 cases (50％),medium medication compliance 80 cases (30.76％) and poor adherence to the doctor order in 50 cases (19.23％).In cases using medication irregularly,there were 26 cases sometimes without taking any drug (10.0％),17 patients' medication being interrupted (6.54％) and 10 cases having excessive medication (3.85％);no relationships were found between parental compliance and each of the following items,family role,occupation and age (all P ＞ 0.05);and the compliance was related to gender,indicating that women's good compliance level was higher than that of males';the education level was positively proportional to the compliance,and the compliance of parents with senior high school or above degree was higher than those with primary school and junior secondary school levels (83 cases vs.9 cases,38 cases,both P ＜ 0.01).Under situation of parents with poor compliance,their children had blood drug concentration higher or lower than proper range of drug level (high in 22 cases,low in 41 cases,higher than the result in good compliance 0 cases and 17 cases respectively),thus seriously affected the safety and efficacy of the treatment;the patients' frequency of irregular medication in parents' good compliance group was significantly lower than that in parents' poor compliance group [3.08％ (4/130) vs.72.0％ (36/50),P ＜ 0.05].Conclusion To improve the therapeutic effect of epileptic children,their parental good cooperation is necessary.

Objective To investigate whether metabolic pathway-related gene polymorphisms are associated with arterial plaque stability and their gene-gene interactions increase the risk of cerebral infarctions.Methods Totally 294 patients with atherothrombosis stroke admitted to the Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University from September 2010 to December 2012 were divided into a carotid vulnerable plaque group ( n=69 ) and a stable plaque group ( n=225 ) according to the results of carotid B-mode ultrasonography.A total of 282 healthy volunteers excluded carotid plaque and stroke were enrolled as well.Genetic polymorphisms of ALOX5AP and CYP3A5, CYP2C9*2, CYP2C9*3 and EPHX2 were genotyped using polymerase chain reaction and mass spectrometry analysis.The SPSS16.0 software was used to compare genotype frequencies and the generalized multifactor dimensionality reduction ( GMDR ) method was applied for gene-gene interaction analyses.Results The results showed that EPHX2 GG genotype might protect against stroke ( OR =0.520, 95% CI 0.288 -0.940, P=0.030).The distribution of CYP3A5 genotypes showed statistically significant differences (χ2 =7.284, P=0.026) between the vulnerable plaque ( AA: 5 cases, AG: 36 cases, GG: 28 cases) and stable plaque ( AA: 26 cases, AG: 77 cases, GG: 122 cases ) groups.Multivariate Logistic regression analysis showed that the GG genotype of CYP3A5 was protective factor for unstable plaques ( OR=0.405, 95%CI 0.178 -0.920, P =0.031 ).Differences in other SNPs did not reach statistical significance between the two groups.The GMDR analysis showed a significant gene-gene interaction between SG13S114 and A6986G, with scores of 10 for cross-validation consistency and 9 for the sign test (P=0.011).The best model for ischemic stroke was found to be SG13S114 AA and A6986G AA.Adjusting for age, hypertension and diabetes, the certain gene-gene interaction predicted a significantly higher risk of cerebral infarction (OR=1.804, 95%CI 1.180-2.759, P=0.006).Conclusions The EPHX2 G860A gene might be linked with the incidence of cerebral infarctions.Only a CYP3A5 gene polymorphism might be associated with carotid plaque instability in patients with stroke.The gene-gene interaction predicts a significantly higher risk of cerebral infarction.There is a 1.804-fold increased risk for ischemic stroke in individuals with these combined genetic factors.

Objective To explore the change of glyoxalase I in type 2 diabetic ocular muscles palsy (DOMP) and its associations with advanced oxidation protein products (AOPP) and oxidative stress. Methods 58 DOMP patients, 50 T2DM and 30 normal controls were enrolled in this study. Levels of blood lipids, fasting blood glucose, hemoglobin A1c, insulin, serum glyoxalase I, AOPP, malondialdehyde (MDA), superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) were measured. Homeostasis model assessment was performed to evaluate the status of insulin resistance (IR). Results Levels of high-density lipoprotein cholesterol, SOD and T-AOC were positively correlated with glyoxalase I and inversely associated to AOPP. Levels of triglycerides , low-density lipoprotein cholesterol , fasting blood glucose , hemoglobin A1c , IR and MDA were negatively correlated with glyoxalase I and positively related to AOPP. AOPP had an inverse association with glyoxalase I (r = -0.823, P < 0.001). Multivariate regression analysis showed that serum levels of glyoxalase I (Sβ = 0.554) and AOPP (Sβ= -0.469) were influencing factors of groups. Conclusion Serum glyoxalase I levels were significantly decreased in DOMP and correlated with AOPP and levels of oxidative stress , which suggest that glyoxalase I could play crucial roles on the development of DOMP.

Objective To investigate the effects of advanced oxidation protein products (AOPP) in type 2 diabetic ocular muscles palsy (DOMP). Methods 58 DOMP patients and 50 type 2 diabetes patients were included in the research. Hemoglobin A1c (HbA1c), blood glucose (FPG), fasting insulin (FINS) and triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) were measured and recorded. Homeostasis model assessment was performed to evaluate the status of insulin resistance (HOMA-IR), basal insulin secretion (HOMA-β) and the insulin sensitivity index (ISI). Serum AOPP was measured by enzyme linked immunosorbent assay. Unconditional logistic regression model was used to evaluate the influencing factors of DOMP. Results The DOMP group showed higher levels of plasma AOPP, TG, LDL, FPG, FINS, HbA1c and HOMA-IR, but lower levels of HDL, HOMA-β and ISI than those of the T2DM group. Unconditional logistic regression analysis revealed that AOPP was an independent risk factors for DOMP (OR =3.01, P = 0.002). Conclusion AOPP may be involved in the pathogenesis of DOMP. AOPP could be a useful indicator for monitoring the development of DOMP and for evaluating its severity.

Objective:To explore the relationship between tissue factor (TF),tissue factor pathway inhibitor (TFPI) and the severity in patients with diabetic cerebral infarction.Methods: 226 patients with diabetic cerebral infarction were included into the study,National Institute of Health Stroke Scale ( NIHSS) was used to evaluate the severity of CIS.The single factor analysis and multiple regression analysis were used to explore the relationship between TF , TFPI and the severity.Results: The concentrations of TF,TFPI,TF/TFPI,cholesterol and triglyceride in the NIHSS≤12 group were significantly lower than that in the NIHSS>12 group ( P<0.05);the NIHSS was significantly positive correlate with TF (r=0.354,P=0.012),TFPI (r=0.302,P=0.027),TF/TFPI (r=0.410,P=0.000),cholesterol (r=0.364,P=0.006) and triglycerides (r=0.334,P=0.018);Multiple linear regression analysis showed that the TF , TFPI, TF/TFPI, cholesterol were independent risk factors of the severity in patients with diabetic cerebral infarction.Conclusion:The level of TF and TFPI could reflect the severity in patients with diabetic cerebral infarction according to the NIHSS.

BACKGROUND: Puerarin, the main effective component of Chinese herb, Radix puerariae, is isoflavone monomer, which can counteract learning and memory impairment induced by scopolamine or D-galactose etc.OBJECTIVE: To investigate the protective effects of puerarin on β-amYloid peptide-induced learning and memory impairment of model mouse of dementia and the changes of superoxide dismutase activity and malondialdhehyde content in brain and blood.DESIGN: Randomized controlled trailSETTING: Department of Pharmacology, Capital University of MedicalSciencesMATERIALS: The experiment was conducted in Departmentof Pharmacology of Capital University of Medical Sciences from March to June 2002.A total of 40 ICR mice were selected and randomly divided into 4 groups:pseudooperation group, dementia model group, puerarin 25 mg/kg group and puerarin 50 mg/kg group, with 10 in each group.METHODS: ①Model preparation: After anaesthesia with pentobarbital sodium, single intraventricular injection of 3 μL β-amyloid peptide was conducted from right side on each mouse in dementia model group, puerarin 25 mg/kg group and puerarin 50 mg/kg group under aseptic manipulation. The same operation was carried out on the mouse in pseudooperation group but without injection of β-amyloid peptide. ②Giving medicine:10 mL/kg physiological saline was intraperitoneally injected into the mouse in pseudooperation group and model group; 25 mL/kg puerarin was intraperitoneally injected to the mouse in 25 mg/kg puerarin group; 50 mL/kg puerarin was intraperitoneally injected to the mouse in 50 mg/kg puerarin group.The medicines were given to each group from the day of model preparation on and behavioral test was carried out 12 days later. ③ Morris water maze examination was used to detect learning and memory ability of the mice.Time for finding the platform (escape latency) in 2 minutes, swimming distance, original angle and search strategy were recorded as learning results.④When the above experiment was finished, anaesthesia with ether was applied to the mice and blood was collected from the orbit to prepare serum.After that, the mice were put to death by decapitation and the tissue of right-brain of the mice were rapidly took out to prepare cerebral homogenate in ice bath, then superoxide dismutase activity and malondialdhehyde content were determined in brain and serum.MAIN OUTCOME MEASURES: ①Escape latency, swimming distance,search strategy and original angle for the mouse in each group to reach the latform. ②Superoxide dismutase activity and malondialdhehyde content in brain and blood of the mouse in each group.RESULTS: All the 40 mice were involved in result analysis. ① Escape latency and swimming distance were shortened in puerarin 25 mg/kg and 50 mg/kg groups (P ＜ 0.05-0.01). The results of search strategy and original angle indicated that as the number of training days increased, the frequency of randomization+magin strategy gradually decreased; The decreasing rates and extents in pseudooperation group and puerarin 25 mg/kg and 50 mg/kg puerarin were more rapid than that in dementia model group,meanwhile, the increasing rates and extents of frequency of tendency+directness strategy in these groups were more rapid than that in dementia model group. There was no significant difference in original angle between groups (P ＞ 0.05). ② The content of superoxide dismutase increased and that of malondialdhehyde decreased in brain and blood of the model mouse in puerarin 25 mg/kg group andpuerarin 50mg/kg group (P ＜ 0.05 -0.01).CONCLUSION: Puerarin can counteract the neurotoxicity of β-amyloid peptide, which improves learning and memory of model mouse. It is not relevant to the dosage but probably related with elimination of cerebral free radical and improvement of antioxidation activity.

OBJECTIVE:To provide reference for promoting the development of medical and health care in China.METHO-DS:The development process of national essential drug system was reviewed and analyzed and the experience of WHO was drawn on to design the future of national essential drug system in China.RESULTS & CONCLUSION:WHO proposed the concept of national essential drugs and recommended medical institutions to establish drug and therapeutics committee and to prepare "Standard Treatment Guidelines" and "National Formulary" for management of rational use of national essential drug.While essential drug system and basic medical security system have been worked out in China,their impacts of them are not satisfactory because of weak enforcement. "National Essential Drugs List ? The Part for Primary Health Care and Health Institutions" (2009 version) and National Formulary Indicate.The Part of Chemicals and Bidogical Products were published,and they are symbols of the re-beginning of national essential drug system.