Endovascular coil embolization has become an important way because of its advantages of less trauma and quick recovery.However,long-term follow-up studies have shown that the recurrence rate of aneurysm after coil embolization is much higher than that of the surgical clipping.It is mainly associteed with the factors such as incomplete packing coil compression and aneurysm regrowth.This article reviews the factors influencing intracranial aneurysm recurrence after endovascular coil embolization.

Increasing detection of unruptured intracranial aneurysms,catastrophic outcomes from subarachnoid hemorrhage,and risks and cost of treatment necessitate defining objective predictive parameters of aneurysm rupture risk.However,long-term follow-up have shown the risk of intracranial aneurysm rupture is associated with its morphologic characteristics,hemodynamic factors and patient's own situation.

Objective To investigate the influence of 1oganin on proliferation and differentiation of rat preadipocytes. Methods Rat preadipocytes were cultured. The proliferation of rat preadipoeytes was detected by MTT method. The expression of GPDH during the preadipoeytes differentiation was determined by using enzyme tissue chemical way, and the accumulation of cellular lipid was determined by Oil Red O staining. Results Loganin at the concentrations of 8, 16, 32 ? mol/L stimulated rat preadipocyte proliferation, inhibited GPDH increase and lipid accumulation during differentiation in a concentration-dependent manner. Conclusion Loganin can stimulate rat preadipocyte proliferation, inhibite rat preadipocyte differentiation.

Objective: To observe the effect of 17β-estradiol (17β-E2) on the calcium (Ca2) channels during the osteogenic differentiation of rat bone marrow mesenchymal stem cells (MSCs), and to elucidate the mechanism of 17β-E2 in the osteogenic differentiation of MSCs. Methods: The MSCs were separated by density gradient centrifugation and adherent screening, and passaged for 3 times continuously to induce osteoblast differentiation. The MSCs were divided into control group [cultivated in osteoblast culture medium alone (OBM)] and different doses of 17β-E2 groups (added with 0. 1, 1.0, 10. 0, and 100. 0 pmol · L-1 17β-E2 in OBM, respectively). On the 14th day of osteogenic induction, the cells in each group were stained with Fluo-3/AM, and the Ca2 levels were determinated by laser scanning confocal microscope; the mean fluorescence intensity (MFD was used to respresent the level of Ca2. Whole-cell Ca2 currents were recorded using whole-cell patch clamp technique under different conditions. Results: The MSCs with fibroblast-like cells, oval nuclei and visible nucleoli were successfully isolated by density gradient centrifugation and adherent screening. The subcultured MSCs grew vigorously and maintained the morphological characteristics of primary cells. Following the increase of 17β-E2 concentration, the Fluo-3 fluorescence staining intensity of Ca2 in each group was also gradually increased, especially in 100. 0 pmol · L-1 17β-E2 group. Compared with control group, the MFI of Ca' and the current peak values of Ca' in 10. 0 and 100. 0 pmol · L-1 17β-E2 groups were increased (P<0. 05 or P<0. 01) during osteogenic differentiation of the MSCs; the MFI of Ca2 and the current peak values of Ca2 in 0. 1 and 1. 0 pmol · L-1 17β-E2 groups showed no significant differences (P>0. 05). Conclusion: The cells isolated by density gradient and adherent screening method are the rat MScs. 17β-E2 plays a role in promoting osteogenesis by enhancing the opening of Ca' channels in the MSCs and the inward current of calcium ions in a dose-dependent manner.

Objective To study the effect of internal fixation of fibula on treatment of tibia and fibula unstable fractures. Methods 50 cases with middle and lower 1/3 fractures of tibia and fibula were treated with internal fixation of fibula and close reduction and external stabilization of tibia. Fibula was stabilized with plate and screw or intramedullary nail. Results All the 50 cases of the fracture achieved clinic union, reduction was satisfactory, and the average time of clinical union was 5 months. The functions of the joint were normal. No skin necrosis or infection occurred. Conclusion Fixation of fibula is suitable for treatment of close fracture combined with local skin injury or open fractures of tibia and fibula and lower 1/3 comminuted fracture of tibia combined with fibula fracture.

Objective To evaluate the effect of the self-made Zishen decoction combined with conventional western medicine therapy and health education on the patients with early diabetic nephropathy. Methods The 112 patients with DN were randomly assigned to 2 groups (each group 56 patients) at a ratio of 1:1. The control group was treated with control of glucose, blood pressure, lipid, and diet therapy, and the treatment group was with self-made prescription of invigorating the kidney and health education based on the control group treatment. All patients were treated for 6 months. The SF-36 scale was used to assess the quality of life, and the clinical effect was determined based on the blood biochemical indexes. Results Total clinical effect of the treatment group was 85.7%(48/56), and the control group was 67.9%(38/56) (χ2=4.057, P=0.044). Compared with the control group after treatment for 6 months, the physical condition (72.17 ± 13.41 vs. 64.59 ± 11.83, t=3.172), social function (64.58 ± 14.54 vs. 58.94 ± 14.62, t=2.047), physical role function (55.82 ± 10.11 vs. 47.46 ± 10.18, t=4.360), emotional role function (60.43 ± 10.20 vs. 56.04 ± 11.44, t=2.143), energy (69.86 ± 11.43 vs. 62.47 ± 11.12, t=3.468), general health status (68.57 ± 11.25 vs. 62.45 ± 11.78, t=2.812) of the treatment group were significantly improved (P<0.01 or P<0.05). Conclusion The self-made Zishen decoction and health education combined with conventional western medicine can improve the clinical effect and quality of life of patients with DN.

Objective To compare the efficacy and cost of surgical clipping and endovascular embolization in the treatment of anterior and posterior communicating artery aneurysm and to conduct cost-effectiveness analysis. Methods The data of treatment outcomes and costs in patients with anterior or posterior communicating artery aneurysms admitted to Huashan hospital from 2002 to 2006 were analyzed using a retrospective cohort study. Results A total of 302 patients were included in the study. They were divided into surgical clipping group (n = 150; 65 males, age [48. 11 ±9. 94] years), interventional treatment group (n = 152;75 males, age [52. 56 ± 11. 09] year). The age of the former was lower than that of the latter (t = -3. 670, P =0. 000). There was no significant difference in preoperative clinical conditions (such as location of aneurysms and Hunt-Hess grade) between the two groups. The good outcome rate in the interventional treatment group was significantly higher than that in the surgical clipping group (84. 87% vs. 74. 67%, χ2 = 4. 875, P = 0. 027). There was no significant difference in hospital mortality (5. 33% vs. 3. 94%,χ2 =0. 328, P =0. 567) and complication rate (26.67% vs. 19. 74% , χ2 =2.036, P =0.154) between the surgical clipping group and the interventional treatment group, but the intraoperative aneurysm rupture (10. 67% vs. 3. 95%, χ2 =5.047, P =0.028) and the incidence of postoperative intracranial infection (6/144 vs. 0/152, χ2 = 6.203, P =0.014) in the surgical clipping group were higher than those in the interventional treatment group. The length of hospital stay in the interventional treatment group was significantly shorter than that in the surgical clipping group ([10. 0 ± 7. 0] dvs. [23.0 ± 11. 0] d, Z = -10. 35, P ＜0.001). The median cost of treatment was 95 327.63 %,yuan in the interventional treatment group, and the interquartile range (IQR) was 26 312. 98 yuan; it was significantly higher than the surgical clipping group (median 30 072. 01 yuan, IQR 11 178. 54 yuan) (Z = -14.449, P＜0.001). Compared with the surgical clipping group, while the mRS score improved in the interventional treatment group 0. 10, the cost was about 66 438 yuan, so that the surgical clipping was more cost-effective. Conclusions The efficacy of the intervention treatment of anterior and posterior communicating artery aneurysms is better than that of the surgical clipping The mortality and total complication rate are almost the same with the surgical clipping Thehospital stay is shorter, but the cost of treatment is higher. From an economic point of view, the surgical clipping is more cost-effective.

ObjectiveTo evaluate the therapeutic effect ofZishen decoction combined with standard treatment of western medicine for for stage IV diabetic nephropathy with Qi and Yin deficiency.MethodsA total of 112 patients with stage IV diabetic nephropathy and Qi and Yin deficiency were randomized to thestandard treatment and the combined treatment groups, 56 in each. The standard treatment group received conventional treatment, including blood glucose controlling, antihypertensive, blood lipid regulating and diet controlling. The combined treatment group receivedZishen decoction on the basis of conventional treatment. All the patients were treated for 3 months. The blood urea nitrogen (BUN), serum creatinine (SCr), total cholesterol (TG), triacylglycerol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and glycated hemoglobin (HbA1c) were measured by an automatic chemistry analyzer. The urinary albumin excretion rate (UAER) was measured by the enzyme-linked immunosorbent assay.ResultsCompared with the standard treatment group, the SCr (53.51 ± 18.12μmol/Lvs. 62.66 ± 21.14μmol/L;t=2.459,P<0.05), UAER(100.73±84.24μg/minvs. 156.24 ± 96.38μg/min;t=3.245,P<0.05), TG(1.73±0.22 mmol/Lvs. 2.06 ± 0.21 mmol/L;t=8.112,P<0.01), TC(4.56 ± 0.62 mmol/Lvs. 5.10 ±0.31 mmol/L;t=5.830, P<0.01), LDL-C (2.42 ± 1.05 mmol/Lvs. 3.31 ± 0.81 mmol/L;t=5.022,P<0.01) in the combined treatment group decreased significantly, and the HDL-C (1.67 ± 0.33 mmol/Lvs. 1.36 ± 0.41 mmol/L;t=4.460,P<0.01) increased significantly. ConclusionZishen decoction on the basis of conventional treatment can improve the SCr and UAER, and regulate the blood lipid in the patients with stage IV diabetic nephropathy and Qi-Yin deficiency.

Objective To investigate the characteristics and risk factors of occupationai exposure to bloodborne pathogens among health care workers (HCWs),and evaluate prevention and treatment countermeasures.Methods Record Form for Occupational Exposure to Bloodborne Pathogens Among Health Care Workers was used for retrospective survey on the occurrence of occupational exposure to bloodborne pathogens in a hospital between January 1,2013 and December 31,2015.Results A total of 246 cases of blood/body fluid occupational exposure occurred.The main occupational exposure population were nurses (n =95,38.62％);occupational exposure mainly occurred in wards(n =148,60.16％);the main mode of occupational exposure was sharp injury(n =219,89.02 ％);the main opportunity of occupational exposure of HCWs was surgical accident(n =69,28.05 ％);the main exposure source was hepatitis B virus(n =123,50.00 ％);none of HCWs developed infection after local treatment and prophylactic medication.Conclusion Medical institutions should strengthen the training for HCWs about occupational exposure to bloodborne pathogens,enhance protection awareness,standardize operation procedures,and improve working environment,so as to minimize the occurrence of occupational exposure.

Objective To evaluate the clinical results of Willis covered stent implantation and coil embolization in the treatment of cranial internal carotid artery (CICA) aneurysm. Methods Eighty-nine patients with CICA aneurysms were selected for treatment with Willis covered stents (n = 43, group A) or coil embolization (n =46, group B) according to the patients'will. Data on the technical success, initial procedure time and in-hospital interval, initial and final angiographic results, mortality, morbidity, and final clinical outcomes were collected and analyzed for the two groups at 6 months post-procedure. Results Endovascular covered stent placement and coil embolization were technically successful in all patients,except for one patient in group A. The initial angiographic results showed complete occlusion in 34 patients of group A (81%, 95% CI: 69%, 93% ) and 24 patients of group B (52%, 95% CI: 37%, 67% ) ( P ＜0. 05). The final angiographic results indicated complete occlusion in 39 patients of group A (39/41,95%,95% CI: 88%, 102% ) and 22 patients of group B (22/45,49%, 95% CI: 34%, 64% ,P ＜0. 01 ). The average procedure time was(103 ± 13)min in group A and (143 + 39) min in group B (P＜0. 01). No significant differences were seen between the two groups in technique success, mortality, morbidity, or final clinical outcomes. Conclusion In this nonrandomized, prospective trial, CICA aneurysm treatment with covered stents yielded midterm angiographic results that were superior to those of coil embolization.