目的:研究丹参饮通过介导过氧化物酶体增殖物激活型受体γ(PPAR-γ)/肝X受体α(LXR-α)/三磷酸腺苷结合盒转运体A1(ABCA1)信号通路减轻大鼠冠状动脉粥样硬化的作用机制.方法:选取无特定病原体(SPF)级40只健康Wist-ar大鼠作为实验动物,随机分为空白组、冠状动脉粥样硬化组(对照组)、丹参饮低剂量观察组(低剂量组)和丹参饮高剂量观察组(高剂量组),比较各组大鼠的炎症介质水平、ICAM-1水平、脂代谢水平、PPAR-γ、LXR-α和ABCA1 mRNA表达和蛋白表达.结果:对照组、低剂量组和高剂量组的三酰甘油(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)均高于空白组(P<0.05),低剂量组和高剂量组的TG、TC和LDL-C均低于对照组(P<0.05),且高剂量组低于低剂量组(P<0.05),但4组的HDL-C表达差异无统计学意义(P>0.05);对照组、低剂量组和高剂量组的炎症介质和ICAM-1表达均高于空白组(P<0.05),低剂量组和高剂量组的炎症介质和ICAM-1表达均低于对照组(P<0.05),且高剂量组低于低剂量组(P<0.05);对照组、低剂量组和高剂量组的PPAR-γ、LXR-α和ABCA1 mRNA和蛋白表达均高于空白组(P<0.05),且低剂量组和高剂量组明显高于对照组(P<0.05),高剂量组明显高于低剂量组(P<0.05).结论:丹参饮可以通过对PPAR-γ-LXR-α-ABCA1信号通路的介导,发挥出抗冠状动脉粥样硬化的作用.

目的 分析康达心口服液在缺血性心肌病患者治疗中的运用.方法 选择我院于2018年2月至2019年7月收治的96例ICN(缺血性心肌病)患者为研究对象,分为对照组、干预组,给予患者常规心肌纤维化治疗,干预组增加康达心口服液治疗.结果 干预组治疗后N端B型利钠肽原(NT-proBNP)含量低于对照组(P＜0.05);干预组治疗后生活质量优于对照组.干预组总有效率高于对照组(P＜0.05).干预组治疗后心肌纤维化治疗均优于对照组(P＜0.05).结论 康达心口服液用于缺血性心肌病的治疗,疗效显著,可改善患者的心肌纤维化状况,修复心功能.

目的 探讨不同糖代谢状态下急性冠脉综合征(ACS)患者血清半胱氨酸蛋白酶抑制剂C(简称胱抑素C)与冠脉病变的相关性.方法 选择福建中医药大学附属人民医院于2017年8月至2019年8月收治的194例ACS患者,根据患者糖代谢状态的异同进行分组,分为糖尿病组(n=49)、糖尿病前期组(n=72)和正常组(n=73),测定各组糖代谢指标、血清胱抑素C水平及冠脉病变严重程度.ACS患者冠脉病变影响因素的多因素行Logistic回归分析.结果 糖尿病组患者的空腹血糖、糖化血红蛋白、血清胱抑素C和Genisi评分均高于正常组和糖尿病前期组患者,差异有统计学意义(P＜0.05);糖化血红蛋白是ACS患者冠脉病变的独立危险因素(P＜0.05).结论 ACS患者的血清胱抑素C及Genisi评分均随血糖的升高而升高,但血清胱抑素C不是ACS患者冠脉病变的独立危险因素.

目的 研究云服务平台教学对临床见习教学学生理论及实践能力的影响.方法 选取2017年9月-2019年6月进行见习的80名临床见习学生作为研究对象,将其均匀分为2组,即观察组和对照组,每组40名学生.对照组采用传统的教学方式,观察组采用云服务平台教学方式,分别观察2组学生的理论及实践能力并进行比较.结果 观察组学生的理论分和实践分数均高于对照组学生,差异具有统计学意义(P=0.001);及格率的比较中,观察组学生(85.00％)高于对照组学生(70.00％),差异具有统计学意义(P=0.003).结论 临床见习教学过程中使用云服务平台教学的方式能够提高学生理论和实践的能力,让学生可以更好地过渡到以后的实习工作中,值得推广使用.

培养可以适应临床快速发展需要的医学人才，是临床医学教学的最终目的。而只有提升医学人才的创新思维、创新能力，才能满足人们对健康和医疗服务水平不断增长的需要。因此，对于加强创新型医学人才培养的重要性不言而喻，通过日常临床教学过程中的发现，只有在日常的临床教学中不断增强带教老师整体创新教学理念，调动学生的临床学习创新性，辅以生活的临床实践活动平台及成熟的临床教学考评体系才能保证以临床为导向的创新型医学人才培养的教学工作有序稳定有力的开展。

培养适应临床需要的实用型合格医学人才，是临床医学教学的根本目的。因此对于加强医学生临床实际技能的培养的重要性不言而喻，通过发现实际工作中存在的问题，不断完善临床技能理论课程体系，培养优良的临床技能师资队伍，创建校内外临床技能培训中心，并构建临床理论与实践综合考评体系，以保障临床医学生临床技能培养的顺利进行。

目的：探讨血浆降钙素原联合内毒素检测在重症患者革兰阴性菌感染早期诊疗中的临床意义。方法：以体检中心健康人为对照组，比较感染组患者血浆降钙素原及内毒素定量水平的治疗前后差异情况。结果：治疗前感染组患者血浆中的降钙素原定量水平（61.80±23.25）ng/ml明显高于对照组（21.12±11.32）ng/ml，同时血浆中的内毒素定量水平（87.54±25.75）pg/ml明显高于对照组（17.23±4.25）pg/ml，具有统计学差异（P＜0.05）。而治疗后，感染组血浆降钙素原及内毒素定量水平与对照组无明显差异。结论：血浆降钙素原及内毒素定量测定具有快速、敏感的特点，对重症患者革兰阴性菌感染的早期诊断具有重要的临床应用价值。

Aim To investigate the effects of different dosage of atorvastatin postconditioning and its mechanisms on myocardial ischemia-reperfusion injury in GK rat.Methods Seventy GK rats were randomly divided into seven groups(n=10 each): sham group,ischemia-reperfusion injury(I/R) group,different dosage of atorvastatin(0.1,0.5,1 and 2 mg/kg) postconditioning group,atorvastatin+LY294002.Myocardial infarct size(IS),ultrastructural change and myocardial expression of phosphorylated Akt/totalAkt were determined.Results Myocardial infarct size and ultrastructural damages were all reduced,myocardial Akt phosphorylation was significantly increased,and Akt was significantly activated in atorvastatin postconditioning group compared with I/R group.The effects were significant at 1 mg/kg and 2 mg/kg atorvastatin postconditioning group,and were significantly attenuated by PI3K inhibitor LY294002.Conclusion Atorvastatin postconditioning could dose-dependently alleviate myocardial ischemia-reperfusion injury in this type 2 diabetic model,which may probably be associated with the increase of the activating PI3K/Akt signaling pathway in the myocardium.

Objective To investigate the association of high mobility group box-1(HMGB-1) level with the left ventricular ejection fraction(LVEF) in patients with acute coronary syndrome(ACS).Methods A total of 121 patients with ACS and 42 healthy controls were compared serum HMGB-1 level,LVEF,left ventricular end diastolic diameter(LVDD),left ventricular end systolic diameter(LVDS) and mitral valve E/A.Results Serum HMGB-1 level was significantly higher in ACS group than that in control group(P0.01).LVEF and mitral valve E/A were significantly lower,and LVDS was significantly longer in ACS group compared with control group(P0.05).HMGB-1 level was significantly and negatively correlated with LVEF(P0.01).Conclusion Serum HMGB-1 level can reflect the LVEF value,which helps to evaluate cardiac systolic function in patients with ACS.

Background and Objectives Myocardial ischemia-reperfusion injury (MIRI) can be alleviated by ischemia post-conditioning (IPC) and/or statin post-conditioning (SPC), and their combination. However, it is unclear how the cardio-protection works in impaired glucose tolerance (IGT) state since IGT significantly abolishes intrinsic myocardial self-protection, and if it does so, what mechanisms are involved in the process. This study aims to investigate the cardio-protective effects and possible mechanisms by combination of SPC and IPC in the IGT rats. Methods An IGT model was successfully created in 72 out of 117 male Wistar rats by injecting STZ, which were randomly allocated into six groups (n=12 per group): Sham group, treated with open chest operation but without myocardial ischemia as controls; I/R group, with ischemia 30 min and reperfusion 2 h in LAD territory but without other interventions; IPC group, treated with initial ischemia 30 min, then 3 consecutive runs of 10 s reperfusion/10s ischemia, and final reperfusion 2 h; SPC group, with initial ischemia 30 min, then pitavastatin (0.1 mg/kg) intravenously 3 min before reperfusion, and final reperfusion 2 h; ISPC group, with initial ischemia 30 min, then combination of three consecutive runs of 10 s reperfusion/10 s ischemia and pitavastatin 3 min before reperfusion, and final reperfusion 2 h; ISPC+LY294002 group, with initial ischemia 30 min, then combination of 3 consecutive runs of 10 s reperfusion/10 s ischemia, pitavastatin and PI3-K inhibitor LY294002 (0.3 mg/kg, intravenously) 3 and 15 mins before reperfusion, respectively. Results Compared with sham group, I/R group had larger infarct size (70.1±3.1% vs 0±0%, p<0.05), and higher mitochondria score (3.24±0.74 vs 0.00±0.00, p<0.05). Compared with I/R group, IPC group, SPC group, and ISPC group all reduced myocardial infarct size (p<0.05, each) and CK-MB level (p<0.05, each), alleviated mitochondria injuries (p<0.05, each), and enhanced PI3K activation by up-regulated expression of phosphorylate Akt (p<0.05, each) and phosphorylate eNOS (p<0.05, each). Compared with IPC and SPC groups, ISPC group further reduced myocardial infarct size (33.4±6.5% vs 45.3±4.6%, p<0.05; vs 43.2±4.1%, p<0.05), CK-MB level (p<0.05, each) and mitochondria score (1.23±0.68 vs 2.28±0.77, p<0.05; vs 2.33±0.79, p<0.05) with more activation of PI3K evidenced by higher expression of phosphorylate Akt (p<0.05, each) and eNOS (p<0.05, each). However, compared with IPC, SPC and ISPC groups, phosphorylated Akt expression and phosphorylation levels of eNOS was significantly lower or undetectable in ISPC+LY294002 group (p<0.05, each), indicating that PI3K inhibiter LY294002 could completely block the PI3K-Akt-eNOS signaling pathway, resulting in abolishment of cardio-protection induced by IPC, SPC and their combination. Conclusions The combination of pitavastain and ischemic postconditioning enhances the cardioprotection against myocardial ischaemia-reperfusion injury in impaired glucose tolerance rats, and PI3K-Akt-eNOS may be a major signaling pathway mediated this cardioprotection.

BACKGROUND:Angiographic coronary lesion complexity has been reported to predict plaque vulnerability. It is important to develop a noninvasive blood biomarker for accurate prognostication of angiographically complex lesions in patients with coronary artery disease (CAD).HYPOTHESIS:Serum soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) levels may be correlated with coronary lesion complexity in patients with CAD.METHODS:We measured serum sLOX-1 levels in 180 consecutive patients undergoing coronary angiography for the evaluation of CAD. Coronary lesions were classified as simple or complex lesions based on coronary plaque morphology.RESULTS:Stable CAD patients with complex lesions (n=50) had significantly higher serum sLOX-1 levels than those with simple lesions (n=72), at 0.914 ng/mL (range, 0.489-1.296 ng/mL) vs 0.426 ng/mL (range, 0.195-1.075 ng/mL), respectively, P<0.01. Multivariate logistic regression analysis revealed that sLOX-1 levels were independently associated with the presence of complex lesions in patients with stable CAD (odds ratio [OR]: 1.964, 95% confidence interval [CI]: 1.149-3.356, P<0.05). Among patients with acute coronary syndrome (n=58), who had significantly higher circulating sLOX-1 levels than stable CAD patients (n=122) at 1.610 ng/mL (range, 0.941-2.264 ng/mL) vs 0.579 ng/mL (range, 0.265-1.172 ng/mL), respectively, P<0.01, sLOX-1 levels were independently associated with the presence of multiple complex coronary lesions (OR: 1.967, 95% CI: 1.075-3.600, P < 0.05).CONCLUSIONS:Serum sLOX-1 levels were associated with complex lesions that might predict vulnerable plaques. This study suggested sLOX-1 might be a useful biomarker of coronary plaque vulnerability in patients with CAD.

Aim To assess whether levels of serum soluble lectin-like oxidized low-density lipoprotein receptor-1(sLOX-1) are correlated with angiographic coronary lesion complexity in patients with stable angina pectoris(SAP),and evaluate the value of sLOX-1 in early prediction of the vulnerable coronary atherosclerotic plaque. Methods Levels of sLOX-1 were measured in 108 stable angina pectoris patients(46 with simple coronary lesions and 62 with complex coronary lesions).Coronary lesions were classified as of simple or complex appearance.Gensini score system was used to measure the severity of coronary artery disease;Enzyme-linked immunosorbent assay(ELISA)was used to measure sLOX-1 levels. Results sLOX-1 levels were significantly higher in stable angina pectoris patients with complex coronary lesions1.12(0.34～1.68) μg/L,n=62] than those with simple lesions 0.28(0.14～0.64) μg/L,n=46](P<0.05).Polytomous Logistic regression analysis demonstrated that serum sLOX-1 level was independently associated with complex lesions(odds ratio 2.99,95%confidence interval 1.47 to 6.08,P=0.003).Pearman correlation analysis showed a positive correlation between log(sLOX-1) and log(Gensini Score)(correlation coefficient=0.458,P<0.05).1.10 μg/L is the critical value of serum sLOX-1 in the diagnosis of stable angina with sensitivity of 54.8% and specificity of 93.5%(P<0.05). Conclusion Serum sLOX-1 level is related to coronary lesion complexity in patients with stable angina pectoris which may be an independent risk factor for prediction of coronary plaque vulnerability and rupture.