Objective To compare the regulating effect of electrically stimulating different parts of the auri-cle on the cardiac vagus nerve in rats, and to explore the basic neural mechanism. Methods The tragus, concha auriculae and helix of 24 male Sprague-Dawley rats were stimulated at different intensities ( 0-16 mA) and with differ-ent durations ( 0-15 min) and any changes in the heart rate were observed. One week later, the rats were randomized into a tragus injection group, a concha auriculae injection group, a helix injection group and a control group, each of 6. The rats of the first three groups were injected with 2 μL of cholera toxin subunit B conjugate AF555 ( CTB-AF555) at the right auricle, while the control group was injected with the same amount of aseptic phosphate-buffered saline at the right tragus. Five days later, all of the rats were sacrificed and their right superior and inferior ganglia and the whole bulbus medullae were resected to observe the fluorescent labeling sites. Results The rats'heart rate declined with longer and more intense stimulation of the tragus or concha auriculae, but not with stimulation of the he-lix. With stimulation of the same duration, a significant decrease was observed in the heart rate when the tragus and concha auriculae were stimulated at 10, 12, 14 or 16 mA compared with when the helix was stimulated at the same intensities. The heart rate when the concha auriculae was stimulated at 12 mA was significantly slower than when the tragus was stimulated at the same intensity. At identical stimulus intensities, the heart rate slowed significantly more when the tragus was stimulated for 6 to 15 minutes and the concha auriculae for 4 to 15 minutes compared with stimu-lating the helix for the same length of time. And compared with stimulating the tragus for 6 to 10 minutes, the heart rate decreased significantly more when the concha auriculae was stimulated for the same length of time. All of the rats in the tragus and concha auriculae injection groups displayed nerve tracer in their superior and inferior ganglia. In the tragus injection group, CTB-AF555 was observed in the nucleus tractus solitarius ( NTS) of 3 of the 6 rats. In the concha auriculae injection group it was observed in 4 of the 6. In the helix injection group, CTB-AF555 was observed in the nucleus of the spinal tract in 5 of the 6 rats, but no nerve tracer was found in their superior or inferior ganglia or in the NTS. Conclusion Electrical stimulation of the tragus and concha auriculae can regulate the functioning of the cardiac vagus nerve, but stimulating the helix cannot. This is partly because the nerve signals in tragus or concha auriculae stimulation and the cardiac sensory nerve signal are integrated in the inferior ganglion and then analyzed and processed in the bulbar center to monitor the heart.

Objective To study the clinical characteristics and prognosis of cerebral infarction combined with metabolic syndrome.Methods From July 1,2015 to March 31,2017,250 patients with cerebral infarction combined with metabolic syndrome in four comprehensive hospital in Zhongshan city were studied.The blood pressure,blood lipid,blood sugar,waist circumference,neurological deficit and disability were analyzed before and after treatment. Meanwhile,the neurological function and disability degree of blood pressure,blood lipid,blood sugar,waist circumfer-ence and non qualified patients were compared.Results After treatment for two weeks,three months and six months, the systolic blood pressure [(132.21±11.25)mmHg,(126.37 ±10.26)mmHg,(122.29 ±11.12)mmHg], diastolic blood pressure [(90.12 ±5.21)mmHg,(84.16 ±4.11)mmHg,(82.23 ±3.10)mmHg],triglycerides [(1.81±0.24)mmol/L,(1.64 ±0.35)mmol/L,(1.51±0.25)mmol/L],high －density lipoprotein cholesterol [(1.01±0.31)mmol/L,(1.08 ±0.36 )mmol/L,(1.19 ±0.34 )mmol/L],fasting plasma glucose [(6.26 ± 0.56)mmol/L,(6.10 ±0.34)mmol/L,(5.59 ±0.34)mmol/L],two－hour postprandial blood glucose [(8.36 ± 1.12)mmol/L,(7.34 ±1.10)mmol/L,(7.05 ±0.26)mmol/L],neurological deficit scores [(31.26 ±1.16)points, (26.58 ±1.05)points,(21.10 ±0.34)points],disability scores [(3.26 ±0.34)points,(2.10 ±0.25)points, (0.59 ±0.20)points]were better than those before treatment (F＝5.10,5.23,5.45,4.89,4.21,4.20,4.26,4.58, P＝0.02,0.04,0.02,0.03,0.01,0.02,0.02,0.03).After treatment for three months and six months,the waist circ-umference [(82.21±5.10)cm,(81.23 ±4.16)cm]were less than before treatment (F＝5.26,P＝0.03).After treatment,the compliance rate of blood pressure,blood lipids,blood glucose,waist circumference was 79.20%,and the not met rate was 20.80%.The neurological deficit score [(17.25 ±1.26)points]and disability score[(0.34 ± 0.12)points]were lower than those who did not meet standard(t＝29.64,17.44,P＝0.01,0.01).Conclusion High blood pressure,high blood lipid and high blood sugar are the main clinical characteristics of patients with cerebral infarction combined with metabolic syndrome,and relieving the symptoms of＂three high＂can improve the prognosis.

Objective To investigate the efficacy of Madopar on vascular parkinsonism with paroxysmal atrial fibrillation(VPD+ PAF)in elderly patients and its effect on the autonomic nervous system. Methods We recruited 50 patients aged over 60 with VPD + PAF into this randomized controlled trial.Based on sinus rhythm recorded by 24 hour ambulatory electrocardiogram ,individuals with an average heart rate below 60 times per minute were assigned into a sinus bradycardia group (n＝15)and those with a normal average heart rate were randomly assigned into a normal rate group (n＝20)or a control group (n＝ 15)by drawing lots.The control group was given routine care for 12 weeks ,while the other two groups were treated with Madopar plus routine care for 12 weeks. The three groups were examined using UPDRS-3 ,dynamic electrocardiogram ,heart rate variability , echocardiography ,and plasma acetylcholine(ACH)levels 1 day before treatment ,4 weeks and 12 weeks after treatment ,and atrial fibrillation frequency 2 weeks after treatment. Results UPDRS-3 scores decreased significantly in the sinus bradycardia group and the normal rate group after treatment for 4 weeks and 12 weeks ,compared with those before treatment (P＜0.05) ;UPDRS-3 scores in the control group did not show statistically significant changes at week 4 after treatment but decreased significantly at week 12(P＜0.05).UPDRS-3 scores in the sinus bradycardia group and the normal rate group were lower than those in the control group after treatment for 4 weeks and 12 weeks(P＜0.05). The total effectiveness rates in the sinus bradycardia group (86.7%,n＝13)and the normal rate group(85.0%,n＝17)were higher than the rate in the control group(53.3%,n＝8)(P＜0.05).Ach levels in the sinus bradycardia group and the normal rate group significantly decreased after treatment for 4 weeks and 12 weeks ,compared with before-treatment levels ,but no significant difference was observed between before-and after-treatment levels in the control group. Frequencies of AF in the sinus bradycardia group(5.6 ± 3.5)and the normal rate group(5.2 ± 4.1)were significantly lower than in the control group(8.4 ± 5.2)(P＜0.05). Conclusions Madopar can depress vagus nerve activity ,relieve VPD+ PAF symptoms ,and reduce the frequency of AF ;Heart rate variability and ACH level are potential predictors of clinical efficacy of Madopar in VPD patients.

Objective To investigate the protective mechanisms of Atorvastatin against high glucose environment-induced injuries of myocardial microvascular endothelial cells. Methods Myocardial microvascular endothelial cells(MMECs)in SD rat were cultured and divided into groups of control group ,hyperglycemia group ,atorvastatin group ,and atorvastatin + high glucose group. The level of reactive oxygen species (ROS)was assayed using Superoxide Assay Kit. Apoptosis of cells was detected by terminal deoxynucleotidyl transferase(TdT)-mediated dUTP nick end labeling(TUNEL) . The expression levels of Akt1 and β1-Integrin were assayed by short-interfering RNA (siRNA ) technique ,and the levels of small GTP-binding protein dissociation stimulator (SmgGDS) expression were measured using Western blot. Results (1)The level of ROS was higher in the high glucose group than in the control group(t=4.154 ,P <0.01) ,and lower in both Atorvastatin group and the Atorvastatin + high glucose group than in the high glucose group (t= 4.233 and 2.893 ,both P <0.05). (2)The proportion of apoptotic cells was higher in the high glucose group than in the control group(t= 4.058 ,P < 0.01) ,and lower in both Atorvastatin group and the Atorvastatin + high glucose group than in the high glucose group(t=4.157 and 2.601 ,both P<0.05).(3)The expression level of Akt1 was lower in the high glucose group and the high glucose + Atorvastatin group than in the mock control group after transfection of Akt1-siRNA(t=4.058 and 4.167 ,both P<0.01).The expression level of β1-integrin was lower in the high glucose group and the high glucose + atorvastatin group than in the mock control group after transfection of β1-integrin-siRNA (t=4.073 and 4.215 , both P<0.01). (4)Western blot analysis showed the following results. First ,the relative expression levels of SmgGDS in both the low dose(1 μmol/L)and high dose(10 μmol/L)of atorvastatin group were higher than in the control group (t= 2.671 and 2.832 ,both P < 0.05).Second ,the relative expression level of SmgGDS in the high dose group were higher than in the low dose group (t=2.612 , P< 0.05 ). Third ,after transfection of Akt1-siRNA ,the expression level of SmgGDS in the high glucose + Atorvastatin group and the high glucose group was decreased ;and the level was higher in the high glucose + atorvastatin + mock group than in the high glucose + mock group(t=4.051 ,P<0.01).Fourth ,after transfection of β1-integrin-siRNA ,the expression level of SmgGDS was lower in high glucose + Atorvastatin group and the high glucose group than in the high glucose +Atorvastatin + mock group ;the level was higher in the high glucose + Atorvastatin + mock group than in the high glucose + mock group(t= 4.068 ,P < 0.01).Fifth ,the expression level of Akt phosphorylation in the high glucose group and the high glucose + Atorvastatin group was higher at 10 minutes than at five minutes(t=2.608 ,P<0.05) ,and higher at 15 minutes than at 10 minutes(t=3.127 ,P <0.05). After transfection of β1-integrin-siRNA ,the expression level of p-Akt /t-Akt was lower in the high glucose group than in the high glucose + mock group(t= 3.371 ,P < 0.05). Conclusions Atorvastatin treatment protects myocardial microvascular endothelial cells possibly by up-regulating SmgGDS through β1-integrin/Akt1 against high glucose environment-induced oxidative stress and apoptosis injuries.

Objective To investigate the significance of fibroblast growth factor 23 in metabolic bone disease of prematuriy.Methods 60 patients who had been treated in our hospital from March 2016 to March 2017 were included in this study.Blood biochemistry was examined two weeks after birth,and values of blood phosphorus, serum calcium and alkaline phosphatase were recorded. Serum levels of 25 hydroxyvitamin D3,parathyroid hormone and fibroblast growth factor 23 were detected two weeks after birth. 20 premature infants with metabolic bone disease were selected as a study group. 40 infants without metabolic bone disease were treated as a control group. Two weeks after treatment,the above indicators were measured and compared in the study group. Results Serum levels of 25 hydroxyvitamin D3,parathyroid hormone and fibroblast growth factor 23 were compared between the two groups 2 weeks after birth,the difference was statistically significant(P<0.05).Levels of serum parathyroid hormone and fibroblast growth factor 23 in the study group were not statistically significant after treat-ment(P > 0.05). Levels of 25 hydroxy vitamin D3 in the study group had statistically significant after treatment (P<0.05).Conclusions Early detection of fibroblast growth factor 23 can reflect metabolic bone disease in pre-term infants.It suggests that vitamin D should be adequately supplemented in early.

Objective To investigate the role of mylin basic protein,S100B and arterial blood gas analysis's levels in early diagnosis of brain injury in premature infant.Methods A total of 95 premature infants treated in our hospital were enrolled in the study.Experimental group was 45 premature infants with brain injury.Control group was 50 premature infants without brain injury were the.All patients were detected with arterial blood gas analysis,MBP and S100B on the 1st day and 7th day after birth.Results The pH,PCO2,BE,lactic acid,MBP and S100B's levels in experimental group were significantly different between the 1st day and 7th day after birth.In the 1st day after birth,compared with the control group,the pH,PCO2,BE,lactic acid,MBP and S100B in the experimental group were obviously high than that of control group.Conclusion On the 1st day after birth,monitoring arterial blood gas analysis,S100B protein and MBP's levels could be useful in early diagnosis of brain injury in preterm infants.

Objective To investigate the early diagnosis value of arterial blood gas analysis , neuron specific enolase and serum glial fibrillary acidic protein in brain injury of premature infant. Methods In the study, 95 premature infants admitted in our hospital were enrolled. 45 premature infants with brain injury were selected as experimental group. 50 premature infants without brain injury were selected as control group. All patients received arterial blood gas analysis , NSE and GFAP on the 1st day and 7th day after birth. Results There is statistically significant difference between the experimental group and the control group on the 1st day after birth in terms of pCO2, pH, BE and lactic acid (P<0.05). In experimental group, there is statistically significant difference between the 1st day and 7th day after birth in terms of pCO2, pH, BE and lactic acid (P < 0.05). The NSE and GFAP levels had statistically significant difference between the experimental group and the control group on the 1st day and 7th day after birth(P < 0.01); the NSE levels of experimental group had statistically significant difference between the 1st day and 7th day after birth (P < 0.05); The GFAP levels of experimental group had statistically significant difference between the 1st day and 7th day after birth (P < 0.01). Conclusion pCO2, NSE and GFAP levels are correlated with brain damage in premature infants in early stage. This could provide evidence of early diagnosis for brain injury in preterm infants.

Objective To explore the correlation between the psychological resilience levelwith the emotional regulation modeand personality characteristicin the patientwith gastricarcinomto provide the theoretical reference fothe intervention measure.MethodOne hundred and forty-seven patientwith gastricancewere selected athe research subject(gastricancegroup) and contemporaneou150 individualwith healthy physical examination in the outpatiendepartmenwere selected athe control group .The Connoand Davidson Resilience Scale(CD-RISC) ,Eysenck Personality Questionnaire(EPQ) and Emotion Regu-lation Scale were adopted to perform the investigation .The correlation between the psychological resilience levelwith the emotional regulation modeand personality characteristicwaanalyzed .ResultThe overall CD-RISscore in the gastricancegroup wa(59 .12 ± 9 .19) point,which belonged to the poorescope ;the personality characteristic,emotional regulation modeand psycho-logical resilience had statistical differencebetween the gastricancegroup and the control group (P＜0 .05);the multivariate Lo-gistiregression analysiresultshowed thathe introversion ,extroversion ,neuroticism ,catharsiregulation and depression regula-tion had largeinfluence on the lowepsychological resilience level in the patientwith gastricance(P＜0 .05);the psychological resilience in the patientwith gastricancewapositively correlated with the catharsiregulation and the depression regulation (r=0 .287 ,0 .136 ,P＜0 .05) and negatively correlated with the introversion ,extroversion and neuroticism (r= -0 .232 ,-0 .789 , P＜0 .05) .Conclusion The introversion ,extroversion ,neuroticism ,catharsiregulation and depression regulation are the importanfactorinfluencing the psychological resilience level .The multi-angle interventional measureshould be taken to improve the psy-chological resilience level in the patientwith gastricance.

Objective To evaluate the academic level of Chinese Journal of Internal Medicine by analyzing its citation status by using bibliometrics method.Methods The distribution of articles published in Chinese Journal of Internal Medicine from January,2005 to December,2011 indexed by Chinese Science Citation Database (CSCD) was analyzed.Results A total of 2809 articles were published in Chinese Journal of Internal Medicine between January,2005 and December,2011.Among them,832 (29.62％) articles were cited for totally 1993 times.There were 14 authors whose total citation number in 2005-2011 was ≥ 10 times.Authors of the cited articles came from 25 provinces,autonomous regions and municipalities.The regions from where the articles had the highest citation were Beijing (341 articles),Shanghai (87 articles),Guangdong (64 articles),Jiangsu (45 articles) and Zhejiang (43 articles).The medical institutions with the highest citation were Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences (205 times),Peking University People's Hospital (77 times),and Chinese PLA General Hospital (76 times).Conclusions Quite a few high level academic papers had been published in Chinese Journal of Internal Medicine in recent years.Chinese Journal of Internal Medicine plays a good role in enhancing academic exchange.

Objective To analyze the articles and citation published in the Chinese Journal of Internal Medicine from 2008 to 2010,in order to investigate the influence factors of impact factor (IF).Methods All articles published in the Chinese Journal of Internal Medicine covered by Chinese Medical Citation Index(CMCI) from 2008 to 2010 were searched and downloaded.Some article related attributions were manual added and their influences to IF were analyzed.Results A total of 1164 academic papers were published in the journal in 3 years,with 9.95 references per paper.The total citation was 1029 times,with 0.93 time per paper and 0.31 time per page.Among them,736 articles were not cited,accounting for 63.2％.Original articles,pure clinical articles had good citation output.For fund supporting,the citation of articles without fund was higher than those with fund.The articles on hematology,cardiology and gastroenterology accounted the most,while ICU,emergency and nephrology were the least internal medicine reported specialties.Although there exists citation difference among different subjects,for considering the absolute values,neurology/psychiatry (0.73 time per paper),cardiology (0.65 time per paper) and gastroenterology (0.54 time per paper) had better citation output,while hematology,basic research and rheumatology had no good performance to IF.Conclusion We should further strengthen acquisition and dissemination of excellent articles,reduce the number of non-cited paper,expand periodical visibility,and provide a quick and convenient way of literature reading.