The service of Traditional Chinese medical institutions consists Outpatient Care and Inpatient Care. The author summarizes the service situation of Traditional Chinese medical institutions in the last six years, by contrasting and analyzing the following quotas: the total number of treatment in the emergency door, the number of discharged patients, hospital admissions per 100 outpatient emergency treatment, rate of utilization of hospital beds, the average days of staying in hospital and doctors work efficiency, and then give some reasonable suggestions.

Objective:To analyze the independent and comprehensive effects of the sites and mechanisms of middle cerebral artery(MCA)occlusion on cerebral infarction patterns and the National Institutes of Health Stroke Scale (NIHSS)scores andto investigate the possible related mechanisms and their potential values to the selection of patieras for thrombolysis.Methods:Sixty-six patients with new cerebral infarction caused by MCA occlusion were enrolled.The sites of MCA occlusion were classified into the origin of the MCA(type Ⅰ),the MCA trunk distal to the lenticulostriate arteries(type Ⅱ)and the branches of the MCA(type Ⅲ):the mechanisms of cerebral infection were categorized as thrombotic and embolic.Cerebral infarction lesion patterns were determined according to diffusion-weighted image(DWI).NIHSS scores were evaluated within 24 hours after stroke onset.The independent and comprehensive effects of the sites and mechanisms of MCA occlusion on cerebral infarction lesion patterns and the NIHSS were analyzed.Results:Cerebral infarction involved a larger range and NIHSS scores were higher in patients with occlusion at the origin of MCA and embolic occlusion of the MCA trunk distal to the lenticulostriate arteries.The analysis of the combination of the sites and mechanisms of occlusion could conduct further stratification for patients with cerebral infarction caused by MCA occlusion compared with univariate analysis.Conclusion:The analysis of the combination of the sites and mechanisms of occlusion better stratifies patients with cerebral infarction caused by MCA occlusion.It may be help to select patients for thrombolytic therapy.

Objective To evaluate the efficacy of standard large trauma craniectomy to treat the patients with severe bump brain injury. Methods Thirty-two bump brain injured patients with cerebral hernia were treated with inside and outside decompression of standard large trauma craniectomy compared with 24 cases of routine temporoparietal craniectomy between Oct 2001 and Aug 2004.Results In standard large trauma craniectomy group,21 cases got good recovery(65.6%) and 5 were dead(15.6%).In routine temporoparietal craniectomy group,9 cases got good recovery(37.5%) and 10 were dead(41.7%).There was significant difference between the two groups in good recovery and mortality(P

Objective The relationship between hypertension ( HTN) and ischemic stroke recurrence is unclear , but there may be different effects of HTN on the risk of recurrence .This study aims to explore whether HTN contributes differently to the recur-rence among subtypes of ischemic stroke ( IS) . Methods We eventually enrolled 1114 patients with ischemic stroke from Jul 2008 to Dec 2012 registered in Nanjing Stroke Registry Program (NSRP) in this study.All the patients were classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria: 315 (28.3%) patiwnts were classified as Large-artery atheroselerosis (LAA), 212 (19.0%) as cardioembolism (CE), 266 (23.9%) as small-artery occlusion (SAO), and 321 (28.8%) as other de-termined and undetermined etiologies ( Other) .The association between HTN and stroke recurrence in patients with different IS sub-types was analyzed using multivariate Cox regression analysis . Results The average follow-up duration was (19.4 ±10.3) months. Of 1114 patients with IS, 158 (14.2%) patients experienced a recurrent stroke .Patients with HTN had a significantly higher stroke recurrence rate than those without (16.5%vs 10.5%, P<0.05).Multivariate Cox regression analysis indicated that HTN increased the risk of ischemic stroke recurrence (HR=1.722, 95%CI:1.181-2.512, P=0.005).After stratification by TOAST subtypes, analysis revealed an association between HTN and stroke recurrence in LAA( HR=3 .767, 95%CI:1.866-7.585, P=0.001) and SAO (HR=3.530, 95%CI:1.156-12.740, P=0.028), but not in the other subtypes (CE: HR=0.773, 95%CI:0.370-1.615, P=0.493;Other:HR=1.498, 95%CI:0.590-3.807, P=0.395). Conclusion HTN is an independent risk factor for recurrent ischemic stroke and is related to the recurrent ischemic stroke in patients with large-artery and small-vessel disease .

Objective Hypertension is a leading modifiable risk factor for cardiovascular disease .However , a lot of hyper-tension patients hold inactive attitudes to hypertension treatment .The purpose of this study was to investigate the relationship between previous treatment of hypertension and stroke severity in acute ischemic stroke . Methods We retrospectively analyzed the clinical data of 653 in-hospital ischemic stroke patients with hypertension between January 2011 and December 2014 .According to the National Institutes of Health Stroke Scale (NIHSS) at admission, the stroke patients were divided into a mild group (NIHSS≤3) and a severe group (NIHSS >3) and, based on their history of hypertension treatment , allocated to a regular treatment, an irregular treatment, a non-treatment , and an unawareness group .We studied the relationship of previous hypertension treatment with stroke severity by Spearman correlation analysis and identified the potential factors associated with stroke severity by multivariate logistic regression anal-ysis. Results Previous treatment of hypertension was positively correlated with stroke severity (r=0.146, P=0.000 2).Compared with the patients of the regular treatment group , those in the irregular treatment group (OR: 2.21; 95%CI:1.39 -3.52; P =0.001), non-treatment group ( OR: 2.18; 95%CI: 1.41 -3.36; P =0.0004) and unawareness group (OR:1.80;95%CI:1.12-2.88; P=0.015) tended to have more severe stroke. Conclusion Previous treatment of hypertension is closely related to the severity of ischemic stroke .

Objective Meningovascular syphilis is the intima inflammation of blood vessels caused by the syphilitic infec-tion, which is associated with the occurrence of ischemic stroke.The study analyzed the clinical, imaging features and prognosis for meningovascular syphilis so as to improve its diagnosis and treatment. Methods 14 patients diagnosed with meningovascular syphilis were collected prospectively from December 2007 to March 2015 in the neurological department of Jinling Hospital.The patients were followed for a period of 21.5(range 10.2~37.9)months,and the prognosis were evaluated. Results Patients with meningovascular syphilis presented with dizziness, hemiplegia, hemidysesthesia and cognitive decline.Lesions showed multiple, scattered on MR ima-ging, intracranial vascular stenosis was seen in the CTA/MRA, and the laboratory examination had characteristic changes.With a large dose and sufficient courses of penicillin treatment, meningovascular syphilis may hopefully get predominant effects.78.57%patients got good prognosis(modified Rankin Scale ,mRS≤2)at 3 months and 85.71% patients got goodlong-term prognosis(mRS≤2). Conclusion Meningovascular syphilis was usually presented as acute onset, lacks the specific clinical and neuroimaging manifesta-tions.Most patients has favourable prognosis after treatment of syphilis with full course of penicillin.

Objective No consensus has yet been achieved on the relationship of serum albumin with the functional out-come of acute ischemic stroke.The aim of our study was to determine whether the serum albumin level was associated with the short-term functional outcome of acute ischemic stroke in well-nourished patients. Methods Totally, 113 patients with first-ever acute ischemic stroke were recruited from Nanjing Stroke Registration Program between January and June 2015.Baseline data including de-mographic and body parameters, vascular risk factors, and laboratory results were collected.The NIH Stroke Scale ( NIHSS) was used to evaluate the severity of neurological deficits and the modified Rankin Scale ( mRS ) employed to assess the short-term functional outcome.According to the mRS at discharge, the patients were divided into a good outcome group ( mRS<3 ) and a poor out-come group ( mRS≥3 ) .The independent predictors of the short-term functional outcome were evaluated by multivariate logistic regression analysis. Results Of the 113 acute ischemic stroke patients included, 52 (46.0%) were in the good outcome group, and 61 (54.0%) in the poor outcome group.Those in the former group had a significantly higher BMI, lower serum LDL-C, lower WBC count, and lower NIHSS at admission than those in the latter .Multivariate logistic regression analysis showed that low serum albumin, NIHSS at admission, and arteriole occlusion were independent predictors of the poor short-term functional outcome ( OR=0.684, 95% CI:0.490-0.956, P=0.026). Conclusion Low serum albumin is an independent predictor of poor short-term functional outcome in acute ischemic stroke patients in well-nourished status.

Objective The purpose of this study was to establish a rat model of thromboembolism for the study of hemorrhag -ic transformation after intravenous thrombolysis with the recombinant tissue plasminogen activator ( rtPA) . Methods Sixty Sprague-Dawley rats were randomly divided into a sham operation , a cerebral embolism, and an rtPA group.Thrombus was prepared in vitro with the rat femoral artery blood and injected into the internal carotid artery of the rats in the cerebral embolism and rtPA groups to es -tablish a model of embolic focal cerebral ischemia , while the animals of the sham operation group injected with BSA .Five hours later , the rats in the rtPA group received rtPA and those in the cerebral embol-ism and sham operation groups the injection of isotonic saline solu-tion.At 24 hours after embolus injection , the neurological deficit score was obtained .The rats were sacrificed after cardiac perfusion and their brains removed for triphenyltetrazolium chloride staining , assessment of the infarct volume and cerebral edema , and calculation of the hemorrhage volume by spectrophotometric hemoglobin assay . Results The hemorrhage volume was significantly higher in the rtPA than in the cerebral embolism group ([17.55 ±2.20] μL vs [3.82 ±0.86] μL, P<0.01), but there were no statistically significant differences between the two groups in the infarct volume ([29.29 ±4.204] %vs [27.89 ±3.91] %, P=0.810), cerebral edema ([12.43 ±1.66] % vs [7.13 ±2.04] %,P=0.063 2), and neurological deficit score (3.35 ±0.27 vs 2.80 ±0.28, P=0.174). Conclusion The rat model of thromboembolism, with a high stability and reproducibility , can be used for the pathogenesis-related studies of hemorrhagic transformation after thromboly-sis with rtPA.

Objective:To analyze the current development status, research hot-spots and development trends of county-level Chinese hospitals in China.Methods:By retrieving the papers of county-level Traditional Chinese Medicine (TCM) hospitals in China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodicals Full-text Database (VIP), Wanfang and China Biomedical Database (SinoMed ) with CiteSpace 5.5.R2 software to draw maps of the author, institution and keyword and make analysis.Results:A total of 598 papers are included in this study, and the trend of publications shows an upward trend and then a downward trend. Researchers conduct research in the form of forming research teams. The research institutions are mainly medical colleges and scientific research institutions. The most frequently showed keyword is "medical reform". The keyword knowledge map shows that the research content mainly involves medical reform, problem analysis and countermeasures, economic operation efficiency, TCM service capability, data envelopment analysis and so on.Conclusions:The county-level TCM hospitals generally show sound development trend in China. The research trend is dominated by county-level TCM hospitals. Scale development has been transformed into the study of hospital operation efficiency. County-level TCM hospitals need to start from their own actual conditions, strengthen cooperation in the form of teams and strengthen academic cooperation among institutions, so as to realize the basic TCM services for ordinary people.