Objective To investigate the efficacy and safety of long guidewire exchange technique in performing cerebral angiography via radial artery approach.Methods The clinical data of 257 patients,who received cerebral angiography during the period from June 2014 to May 2016 at Daxing Hospital of Capital Medical University,Beijing,China,were retrospectively analyzed.Among the 257 patients,186 had type Ⅱ or type Ⅲ aortic arch.According to the different looping technologies for Simmons-2 catheter used in the performance of cerebral angiography,these 186 patients were divided into the study group (n=90) and the routine group (n=96).The success rate of radial artery puncturing,the success rate of Simmons-2 catheter looping formation,the success rate of supra-arch arterial catheterization,the time spent for angiography,the radiation exposure time,complications,etc.were recorded.Results The success rate of radial artery puncturing was 100％ in both groups.The success rate of Simmons-2 catheter looping formation in the study group was 97.8％,which was significantly higher than 72.9％ in the routine group (P＜0.05).The success rates of catheterization for the left subclavian artery,left common carotid artery and right carotid artery in the study group were 97.8％,97.8％ and 97.8％ respectively,which were remarkably higher than 72.9％,72.9％ and 72.9％ respectively in the routine group (P＜0.05).No statistically significant difference in the success rates of catheterization for right subclavian artery and for right vertebral artery existed between the two groups (P＞ 0.05).The time spent for angiography in the study group and the routine group was (22.5±9.4) min and (28.3±8.3) min respectively.The radiation exposure time in the study group was (8.9±4.5) min,which was obviously lower than (12.6±6.5) min in the routine group (P=0.017 and P=0.035,respectively).The incidences of complications in the study group and the routine group were 4.4％ and 5.2％ respectively,the difference was not statistically significant (P＞0.05).No severe complications,such as intracranial arterial embolie events,puncture bleeding,arterial occlusion,etc.,occurred in all patients of both groups.Conclusion The use of long guidewire exchange technology can improve the success rate of Simmon-2 catheter looping formation and the success rate of supra-arch arterial catheterization,it can also shorten the time for angiography procedure and reduce the radiation exposure time.This technique is very effective with higher safety.Therefore,this long guidewire exchange technique should be used as a common method for cerebral angiopraphy via radial artery approach in patients with type Ⅱ or type Ⅲ aortic arch.

A century ago the Flexner Report facilitated the process of modern medical education reform.Half a century ago,Problem-based learning initiated the student-centered medical education model.At present training medical students' competency will usher in the third reform in medical education.Over 100 years' development and in the global context of current medical education reform,China's medical education has become an important part of the world medical education.Harbin Medical University conducted an all-around reform through international cooperation and received the accreditation referenced according to global standards in medical education,which is an epitome of the medical education reform in China.

Objective To investigate the safety and clinical effect of combined anterior and posterior surgeries approach for the treatment of lumbosacral tuberculosis .Methods There were 31 cases of low lumbar and sacrum spinal tuberculosis in this se‐ries .All cases that anti‐tuberculosis treatment lasted 3 weeks before the operation received posterior transpedicular screw system in‐ternal fixation ,anterior radical focus debridement and auto‐grafting with iliac bone .Bed rest was for 6-12 weeks after surgery and no brace was needed .Anti‐tuberculosis treatment lasted 12 -18 months .Results The period follow‐up was 12 -43 months and there was one case of the formation of the sinus and bilateral abscess after surgical resection of re‐healing ,and there was no cases of bone block displacement .All tuberculosis lesions were healing .13 cases with neurological symptoms had recovery .There was no spondylolisthesis postoperative follow‐up;The heigh ,kyphosis correction and restore stability of vertebral body were satisfied .The patients had solid bony fusion without internal fixation loosening and rupture after 5-9 months .Conclusion It is a safe and effec‐tive method to treat lumbosacral tuberculosis by posterior transpedicular screw system internal fixation and anterior radical focus debridement with interbody autografting .which can thoroughly clear focus of spinal tuberculosis ,decompress sufficiently spinal cord ,correct effectively the kyphosis deformity and achieve the stability of a strong three‐column .

Objective A preliminary study was conducted on the measuring tool for teachers' attitude in the medical schools towards curriculum integration of medical program.Methods Literature review and expert interview were conducted to design a questionnaire which comprised 56 items to investigate teachers' attitude towards medical curriculum integration.The method of factor analysis and Pearson correlation coefficient were used to evaluate structure validity,the content validity index I-CVI and S-CVI were used to evaluate the content validity and Cronbach's alpha coefficient and split-half reliability were used to evaluate the reliability of the questionnaire.Results Three principal components were extracted by factor analysis,which explained 59.219％ of the total variance.After rotation,the factors 1-3 were respectively defined as value recognition,participation initiative and emotional tendency.Cronbach's alpha coefficient of the three factors and all the items is 0.922,0.903,0.728 and 0.862 respectively.Conclusion The reliability and validity of the measurement tool is acceptable,and can be used as a reference for similar domestic survey

Objective To evaluate the effect of mitochondrial permeability transition pore (mPTP) in lipid emulsion-induced inversion of bupivacaine myocardiotoxicity in rats.Methods H9c2 cells were inoculated in 6-well plates at a density of 105 cells/ml, and were randomly divided into 4 groups (6 wells in each group, 2 ml/well) using a random number table: control group (group C) , bupivacaine group (group B) , lipid emusion + bupivacaine group (group LB) , and lipid emusion + bupivacaine + atractyloside group (group LBA).Phosphate buffer solution 100 μl was added to the culture medium in group C.In group B, bupivacaine was added to the culture medium with the final concentration of 1 mmol/L.In group LB, lipid emusion and bupivacaine were added to the culture medium with the final concentrations of 1％ and 1 mmol/L, respectively.In group LBA, lipid emusion, bupivacaine and atractyloside (an mPTP opener) were added to the culture medium with the final concentrations of 1％, 1 mmol/L and 30 μmol/L, respectively.All the cells were incubated for 24 h.After the end of incubation, the expression of Bcl-2, Bax, phosphorylated Bad (p-Bad) , caspase-3, activated caspase-3, caspase-9,activated caspase-9 and cytochrome c (Cyt c) was detected using Western blot.The expression of Bcl-2 mRNA, Bax mRNA, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was detected using real-time reverse transcriptase polymerase chain reaction.The ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/Bcl-2 mRNA were calculated.Results Compared with group C,the ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/ Bcl-2 mRNA were significantly increased, the expression of p-Bad was down-regulated, and the expression of Cyt c, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was up-regulated in group B (P＜0.05) , and no significant change was found in the parameters mentioned above in group LB (P＞0.05).Compared with group B, the ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/Bcl-2 mRNA were significantly decreased, the expression of p-Bad was up-regulated, and the expression of Cyt c, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was down-regulated in LB and LBA groups (P＜ 0.05).Compared with group LB, the ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/Bcl-2 mRNA were significantly increased, the expression of p-Bad was down-regulated, and the expression of Cyt c, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was up-regulated in group LBA (P ＜ 0.05).Conclusion The mechanism underlying lipid emulsioninduced inversion of bupivacaine myocardiotoxicity is related to inhibited mPTP opening in rats.

Objective:To probe the therapeutic effects of Butylphthalide Injection in the elderly patients with acute cerebral infarction (ACI) and its influence in cerebral hemodynamics and cerebral vascular reserve (CVR),and to clarify the pharmacological action mechanism of butylphthalide in treatment of ACI.Methods:A total of 100 cases of elderly patients with ACI were selected as the subjects and divided into observation group and control group according to the serial number on admission.Fifty cases were included in each group.The patients in control group were treated with the conventional treatment, while the patients in observation group were treated with Butylphthalide Injection on the basis of the conventional treatment.The National Institute of Health Stroke Scale (NIHSS) score, the brain hemodynamics indexes of the peak velocity (Vp), the mean velocity (Vm) and the differences of the velocity (DVp, DVm) as well as pulsatility index (PI), CVR of bilateral middle cerebral artery (MCA)of the patients in two groups were observed and compared.The therapeutic effects of the patients in two groups were evaluated and compared.Results:The NIHSS score of the patients in observation group after treatment was significantly lower than that in control group (t=15.420, P<0.05).The therapeutic effects and the clinical efficiency of the patients in observation group were significantly better than those in control group (U=2.225, χ2=5.005, P<0.05).The Vp and Vm of the patients in observation group after treatment were significantly higher than those in control group(t=10.819,t=7.259, P<0.05)and the DVp and DVm were significantly lower than those in control group (t=16.438,t=19.055, P<0.05).The CVR of the patients in observation group after treatment was significantly higher than that in control group(t=6.884, P<0.05)and the PI was significantly lower than that in control group (t=4.979, P<0.05).Conclusion:Butylphthalide Injection can effectively correct the abnormality of brain hemodynamics in the ACI patients, enhance the ability of body in maintaining the stability of cerebral vascular perfusion, improve the neurological symptoms in the patients with ACI, and improve the therapeutic effects.

Objective To explore the relationship and clinical significance between the serum levels of oxidized low density lipoprotein (Ox-LDL) and soluble P-selectin (SP-S),and carotid atherosclerosis (CA) in metabolic syndrome (MS) patients.Methods In 103 cases of MS patients and 44 healthy subjects (control group),in MS patients with 3 MS diagnostic criteria for the low risk group (51 cases),with ≥ 4 MS diagnostic criteria for high risk group (52 cases).Carotid artery intima-media thickness (IMT) and plaque was measured by color Doppler ultrasound,serum Ox-LDL,SP-S was determined by enzyme linked immunosorbent assay,and pearson regression analysis of linear correlation and classification of two non condition Logistic was performed.Results The serum levels of Ox-LDL,SP-S,carotid artery IMT in low risk group and high risk group were higher than those in control group [(36.42 ±7.17) μg/L and (54.44± 8.10) μg/Lvs.(30.08±7.15) μg/L,(71.46± 12.52) μ g/Land (89.33±20.28) μg/Lvs.(49.95 ± 12.49) μ g/L,(0.86 ± 0.11) mm and (1.00 ± 0.10) mm vs.(0.69 ± 0.11) mm],the difference was statistically significant (P ＜ 0.01).The incidence of plaque in high-risk group and low-risk group was significantly higher than that in control group [55.8％ (29/52) and 45.1％ (23/51) vs.15.9％ (7/44)],the difference was statistically significant (P ＜ 0.01).Linear correlation analysis results of Pearson display,Ox-LDL was positively correlated with SP-S (P ＜0.01).Conclusion Serum Ox-LDL and SP-S are independent risk factor for carotid atherosclerosis in MS patients,they can evaluate progression of carotid atherosclerosis in patients with MS.

OBJECTIVE:To optimize the parameters of the extraction and purification technologies of total flavonoids from Di-ospyros kaki Thunb. leaves,and then to compare the contents of flavonoids in fresh and dried D. kaki Thunb. leaves. METHODS:Taking the yield of total flavonoids as the investigated index,the influences of liquid-solid ratio,the volume fraction of ethanol and ultrasonic extraction time on the extraction effect were discussed by single-factor and orthogonal test. With the purity of total flavo-noids as the investigated index,the purification effects of such three kinds of methods as ethyl acetate extraction method,alcohol deposition method and macroreticular resin purification method combined with petroleum ether degreasing on the extracted solution were compared. The optimal extraction technology was adopted to extract the total flavonoids from fresh and dried D. kaki Thunb. leaves and their contents were compared. RESULTS:The optimal extraction technology was as follows as liquid-solid ratio of 25∶1 (ml/g),volume fraction of ethanol of 70%,ultrasonic extraction time of 30 min,extraction temperature of 30 ℃. The results of the verification tests showed the average content of total flavonoids was 1.75%(RSD=2.00%,n=3). The total flavonoids in the extracted solution purified by the above-mentioned three purification methods had a purity of 24.92%,15.94% and 35.52% respec-tively,in which the macroreticular resin purification method with petroleum ether degreasing combined with AB-8 resin purification was optimal. The content of flavonoids in fresh D. kaki Thunb. leaves(1.75%) was about twice as much as that in dried leaves (0.87%). CONCLUSIONS:The optimal extraction and purification technologies are simple with good effect,and suitable for large-scale production. Fresh D. kaki Thunb. leaves should be used as raw materials for extracting flavonoids.

Objective To explore the effect of Acorus gramimeus and its major components ?-asarone on N-methyl-D-asperate recepter 1 (NMDAR1) mRNA levels of hippocamp neurons in epileptic animal models induced by pentylenetetrazol (PTZ). Methods PTZ 60 mg/kg was injected to the abdominal cavity of three weeks Wistar rats to prepare epileptic animal models. The animal models were randomly divided into three groups: epilepsy control, A. gramimeus and ?-asarone as well as the normal control. Each group was administered through intraperitoneal injection. Both of two control groups were injected physiologic saline 1.0 mL/d, and the rest groups were injected A. gramimeus 2 350 mg/(kg?d) or ?-asarone 29 mg/(kg?d) for 7 d, respectively. All rats were treated by PTZ 60 mg/kg through intraperitoneal injection next day. After their behaviors were observed for 24 h, animals were sacrificed. The expressions of NMDAR1 mRNA in hippocamp CA1 and CA3 of all rats were detected by in situ hybridization and semiquantitative RT-PCR. Results The results of in situ hybridization showed that positive staining granules were located in the cyptoplasm of hippocamp neurons. The number of positive cells and average absorbance of A. gramimeus group or ?-asarone group was markedly less than that of epilepsy control (P

Objective To investigate the expression of connexin CX43 using hybridization techniques after GABA restraining receptor gene was transferred into the supramammillary of hypothalamus in Kainic acid(KA) induced epileptic rats.Methods Twenty-four male Wistar rats were divided into four groups: control group(n=2),surgery group(n=2),KA group(n=10) and GABA restraining receptor gene transferred group(GABA group)(n=10).No treatment was given to the control group.Physiological saline(1 ?L) was injected into right amygdala of rat in surgery group.In KA group,KA(1 ?L,1 ?g) was injected into the amygdala of rat to build epileptic model.In GABA group,the GABA restraining receptor gene(400 nL,40 ng) was transferred into the supramammillary of hypothalamus by HVJ-liposome 48 h before KA was injected into amygdala.The expressions of CX43 mRNA and morphological changes different time(3 h,6 h,24 h,3d,7d) were observed by in situ hybridization in each group.Results In control group and surgery group,the morphological manifestations were normal,and the hippocampus structures were complete.In KA group,swell and degenerative hippocampus neurons were showed and deteriorated with time.In GABA group,the degeneration and necroses of hippocampus neurons were relatively alleviated.The positive expression of CX43 mRNA was few in control group and surgery group.And in KA group it increased with time.In GABA group,the positive expression of CX43 mRNA was fewer than that of KA group at every period.Conclusion The expression of CX43 mRNA in hippocampus can be decreased by transferring GABA receptor gene into hypothalamus.