AIM: To investigate the protective effect of ischemic-preconditioning under the mild hypothermia against small intestine ischemia-reperfusion injury in rats and its mechanism. METHODS: Thirty-two rats were randomized into 4 groups (8 rats in each group): sham operated group (Sham), ischemia-reperfusion (I/R) group, ischemic-preconditioning (IP) group, mild hypothermia ischemic-preconditioning (MHIP) group. The wet/dry ratio, Ca 2+ -Mg 2+ -ATPase activity in intestine tissue, the malondialdehyde (MDA) content, activities of lactate dehydrogenase (LDH), superoxide dismutase (SOD) and total antioxdase (TAX) in blood were determined. Ultrastructure, Bcl-2 and Bax expression in intestinal mucosa tissue were also observed. RESULTS: After I/R, the intestinal tissue wet/dry ratio, the content of MDA, LDH activity, the optic density of Bcl-2 and Bax proteins were significantly higher in I/R group than those in sham group (P

Objective To judge the effect by understanding the change of the blood related indexes before and after the applica-tion of lamivudine combined with silibinin treatment for treating E antigen positive chronic hepatitis B to provide the basis for the individualized therapy.Methods 226 cases of E antigen positive chronic hepatitis B were selected and divided into the mild group (55 cases),moderate group (94 cases)and severe group(77 cases)according to the degree of liver function injury.The 3 groups were given oral lamivudine 100 mg once daily and oral silybinin 70mg,3 times a day.The course of treatment was 6 months;the re-lated blood indexes before and after treatment were analyzed.Results After 6 months of treatment,the recovery rate of ALT,E an-tigen negative conversion rate and HBV-DNA negative conversion rate in the mild group and the moderate group were improved in different degrees,and those in the severe group were significantly increased(P <0.05).Conclusion Lamivudine combined with sili-binin treatment can inhibit the replication of HBV-DNA more effectively,promote the recovery rate of serum ALT significantly,im-prove the E antigen negative conversion rate,especially for the patients with severe liver function injury;which improve the curative effect in the treatment of chronic hepatitis B in some extent.

Objective To investigate the clinical features of subarachnoid hemorrhagic moyamoya disease and the therapeutic effect of encephalo-duro-arterio-synangiosis (EDAS). Methods The clinical and imaging data of 38 patients with subarachnoid hemorrhagic moyamoya disease admitted to the Department of Neurosurgery,the 307th Hospital of PLA from January 2002 to April 2013 were analyzed retrospectively. Thirty-five patients underwent unilateral or bilateral EDAS (64-sides underwent EDAS,4 patients with aneurysms underwent endovascular embolization first),and 3 patients did not undergo any surgery. Results (1)Subarachnoid hemorrhagic moyamoya disease accounted for 10. 8%(38/353)of all the hemorrhagic moyamoya disease admitted in hospital over the same period,including 37 adults and 1 child. The male to female ratio was 1∶3. 22 (9/29),and the age of onset was 12 to 59 years. The mean age of patients was 39 ± 11 years. Four patients were combined with aneurysms. There were no significant differences in the distribution of Suzuki stage,anterior choroidal artery dilatation and posterior communicating artery dilatation in the remaining 34 patients without aneurysms between the bleeding sides and non-bleeding sides (P>0.05). (2 ) The patients were followed up for 13 -125 months (mean 51 ± 27 months ),two patients had rebleeding,one of them was intraventricular hemorrhage,the other was parenchymal hemorrhage. The postoperative modified Rankin score (mRS)was significantly lower in 35 patients whom were treated with EDAS. Compared with before surgery,there was significant difference (P<0. 05). The re-examination of positron emission tomography (PET)for 16 patients at 3 to 19 months after surgery showed that among the 23 surgically treated hemispheres,the cerebral metabolisms of 17 hemispheres were improved after surgery, and 6 did not have any change after surgery. The re-examination of whole brain digital subtraction angiography (DSA)at 5 to 30 months after surgery in 13 patients showed that revascularizations in 19 of 23 surgical hemispheres were effective. Conclusion Subarachnoid hemorrhagic moyamoya disease often occurs in adults,and women are more common. EDAS can achieve good revascularization effect and improve brain metabolism of patients,and thus relieve the symptoms of cerebral ischemia.

Objective Based on Chinese guidelines for the management of ischemic stroke, a standardized stroke management program was performed to provide intensive education and training for medical physicians, aiming to enhance their knowledge and ability for ischemic stroke prevention and treatment, thereby reducing patients′ in-hospital cost and length of stay, and improving patients′ clinical prognosis. Methods This study was conducted in 20 general hospitals throughout Hainan province. A total of 163 physicians from 20 hospitals involved in the management of stroke patients were trained by highly experienced physicians based on the Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2014 and the Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack 2014. Prior to and post the standardized stroke management training, the data of 3218 and 3367 patients with ischemic stroke were respectively collected. Quality of life assessments including the Barthel index (BI) and the modified Rankin Scale (mRS) score of all patients were recorded at baseline and after discharge. The length of stay and in-hospital cost were directly collected from the hospital information system. Results Physicians′ knowledge and ability manifested as testing scores were significantly improved after training (78.2 ± 15.5 vs 55.6 ± 10.7, t=69.1, P<0.01). The average length of stay of post-training patients was significantly shorter than that of pre-training patients ((8.7 ± 0.9) vs (11.7 ± 1.5) days, t=97.9, P<0.01). The average in-hospital cost of post-training patients was significantly less than that of pre-training patients ((7681.7 ± 1397.7) vs (11846.2 ± 2514.6) Yuan, t=82.5, P<0.01). Both BI (68.2 ± 3.2 vs 43.5 ± 5.3, t=227.7, P<0.01) and mRS score (2.74±0.51 vs 3.65±0.71, t=59.5, P<0.01) were significantly improved for post-training patients. Multivariate linear regression analysis illustrated that standardized stroke management was negatively associated with in-hospital cost (r=-0.461, P<0.01), length of stay (r=-0.357, P<0.01) and mRS score (r=-0.298, P<0.01), and was positively associated with levels of BI (r=0.376, P<0.01). Conclusion Standardized stroke management program might be a cost-effective choice for the management of ischemic stroke as it reduces the in-hospital cost and improves patients′BI and mRS levels.