OBJECTIVE: Controversy over the presence of neuronal apoptosis in acute brain injuries has not been resolved due to the lack of direct evidence. In this article, the authors briefly review the current research progress of apoptosis and discuss the relationship between acute brain injuries and neuronal apoptosis.DATA SOURCES: A computer-based retrieval for relevant papers with abstracts indexed in Medline database published in English full text between January 1995 and February 2005 was conducted using the key words of "acute brain injuries" and "Neuronal apoptosis". Related articles in Chinese full text published between January 2000 and December 2004 were also searched in Chinese periodical full text database, Wanfang databases with key words of "acute traumatic brain injury, neuronal apoptosis".STUDY SELECTION: The retrieved articles were first examined to exclude review articles and repetitions, and only randomized and non-randomized controlled experiments or clinical trials on acute traumatic brain injury and neuronal apoptosis were included.DATA EXTRACTION: Altogether 136 articles directly related to acute traumatic brain injury and neuronal apoptosis were collected, among which 19 met the inclusion criteria with the other 117 removed for repetition or irrelevancy.DATA SYNTHESIS: The valid articles were reviewed to identify the factors related to neuronal apoptosis, apoptotic network theory, detection methods of apoptosis, and the relationship between acute traumatic brain injury and neuronal apoptosis as well as the possible mechanisms.CONCLUSION: Neuronal apoptosis occurs after acute traumatic brain injury, which induces intrinsic and extrinsic neuronal environment changes including increased extracellular excitatory amino acid content, massive free radical production and abnormal gene expression. These factors interact with each other and modulate neuronal apoptosis through multiple pathways.

ObjectiveTo explore the efficacy of large trauma craniotomy with bilateral frontal coronal incision in treating contusion and laceration of bilateral frontal lobes.MethodsThe clinical data of 68 patients with contusion and laceration of bilateral frontal lobes who were treated with bilateral decompressive craniectomy were analyzed retrospectively.There were 36 cases(observation group) treated with large trauma craniotomy with bilateral frontal coronal incision and 32 cases (control group) given bilateral decompressive craniectomy by stages.The prognosis of two groups were observed and compared.The prognosis was evaluated at 6 months after surgery by Glasgow outcome scale (GOS) score.ResultsThere were 23 cases (63.89％,23/36) who got good recovery,8 cases(22.22％,8/36) with poor prognosis and 5 dead cases (13.89％,5/36) in observation group.There were 11 cases (34.38％,11/32) who got good recovery,9 cases (28.12％,9/32) with poor prognosis and 12 dead cases (37.50％,12/32) in control group.The rate of good recovery and mortality between two groups had significant differences (P ＜ 0.05).ConclusionsThe large trauma craniotomy with bilateral frontal coronal incision can significantly relieve or ease intracranial hypertension of patients with contusion and laceration of bilateral frontal lobes.And it can improve the prognosis and decrease the mortality.

Objective To evaluate the value of digital subtraction angiography(DSA) in diagnosis and planning endovascular treatment of cerebrovascular diseases. Methods Thirty-one children suspected with ischemic cerebrovascular diseases were treated by urokinase and dextran after they underwent DSA.Results Twenty-four cases (77%) had cerebrovascular abnormalities. Two cases had arteriovenous malformations, 1 case had posterior communicating artery aneurysm,21 cases had cerebrovascular stenosis or occlusions. Shortly after intervention therapy using urokinase,muscle strength increased by one level in 13 cases,two levels in 3 cases,3 levels in 2 cases and no effect in 4 cases. The total effective rate reached 86%. Seven patients with ischemic stroke achieved 100% recanalization. Conclusion DSA is very important in diagnosis of cerebrovascular stenosis and occlusion.

Currently,as various liver cancer-related treatments in China become developed,doctors also become super-subspecialized.This results in the doctors having more specialized skills and knowledge but a narrower vision.There is a tendency for these super-subspecialists to think and to make decisions based on a narrow perspective.As a consequence,interdisciplinary collaboration is becoming difficult.This hinders further improvement of treatment of liver cancer which has reached a plateau for many years.The present paper proposes a systematic perspective in decisionmaking for treatment of liver cancer.There are seven aspects which include the basic nature of medical care,the history of development of treatment,liver anatomical and functional characteristics,multicentric tumour occurrence,pathology,tumor immunology and biology.We aim to broaden the doctors’ vision and optimize their clinical thinking process.

Increases in diagnostic frequency of breast ductal carcinoma in situ(DCIS) have followed the introduction of mammographic screening in past years.It is very important to distinguish the clinical syndrome of DCIS.The management of surgery for DCIS includes mastectomy,lumpectomy plus radiotherapy and lumpectomy alone; axillary lymph node dissection(ALND) in DCIS has not been recommended and sentinel lymph node biopsy(SLNB) is still controversial; adjuvant radiotherapy for ipsilateral whole breast and endocrine treatment can reduce local recurrence,prevent second primary breast tumor,preclude regional and distant metastasis.But whatever we take towards the DCIS above,there is little disturbance to DCIS' s inherent prognosis.Doctors must pay enough attention to this point.

Objective To explore using evidence-based medicine to establish infection control process of hospital supply room. Methods We determined problems in the practice through collecting relevant materials on infection control of hospital supply room. Then we searched the related literatures from the evidencebased medicine(EBM) websites(MEDLINE database, ere) and undertook comprehensive evaluation, established all the infection control processes of hospital supply department by applying a systematic method. Results All the monitoring indexes were compared between the control group and the observation group :disinfection and sterilization of instruments (P<0.01), management of aseptic materials (P<0.05), environmental hygiene monitoring (P<0.05) and handwashing compliance of medical staff met standard requirements(P<0.05).All the items were statistically different between the two groups. Conclusions The method of EBM applied in establishing of infection control process of hospital supply room provides scientific and systematic working method.

There are significant correlations between cerebral embolism and thyrotoxic atrial fibrillation in patients with hyperthyroidism. The incidence of thyrotoxic atrial fibrillation increases significantly in patients with subclinical hyperthyroidism with serum thyroid-stimula-ting hormone levels ＜ 0. 1 mU/L. Hyperthyroidism may result in cerebral venous thrombosis,moyamoya disease and giant cell arteritis; while hypothyroidism is closely associated with the risk factors of arteriosclerosis, especially hypertension, hyperlipidemia, and hyperhomocysteine-mia. However, this association remains uncertain in subclinical hyperthyroidism.

Hyperplastic disease of the breast (HDB) is caused by a hormone imbalance experienced among women at a certain age. Slight breast pain is common in women before menstruation without need of treatment; however, if the pain becomes severe, it can cause physical and mental suffering. Therefore, it is of great clinical significance to control this disease.

Objective To investigate the significance of procalcitonin(PCT),C-reactive protein (CRP)and WBC counts in predicting the postoperative jnfections in patients with bone fractures.Methods Clinical data of 49 patients with open fractures were retrospectively analyzed,and the patients were grouped into the infeeted(n=24)and non.infected(n=25).PCT,CRP and WBC values were detected 1,4,7and 10 days after the operations,and the results were compared with those taken from the healthy controls.Areas under the receiver operating characteristic(ROC)curves were used to determine the value in predicting postoperative infections.Results PCT,CRP and WBC values in the infected group and the noninfected group were higher than those in health controls(F=19.84,57.71 and 35.44,P＜0.01).PCT,CRP and WBC values in the infected group were higher than those in the non-infected group 4.7 and 10 days after the operations(tPCT=7.31,7.74 and 4.59;tCRP=2.23,5.75 and 8.01;tWBC=2.34,2.51 and 4.07,P＜0.05).ROC curves suggested that PCT value was more sensitive and had higher specificity than CRP and WBC values in the diagnosis of postoperative infections.Conclusions PCT,CRP and WBC values arise in bone fracture patients with postoperative infections.Detection of PCT has higher sensitivity and specificity.which can be used in early diagnosis of postoperative infections.

OBJECTIVETo observe the difference in the clinical efficacy on peripheral facial palsy between electro-acupuncture (EA) assisted with surface electromyography (sEMG) and conventional EA.

METHODSSixty cases of peripheral facial palsy were randomized into an observation group and a control group, 30 cases in each one. EA was applied during the first 15 days of sickness in the two groups, at Xiaguan (ST 7), Jiache (ST 6), Dicang (ST 4), Yangbai (GB 14), Taiyang (EX-HN 5), Quanliao (SI 18) and Hegu (LI 4), once a day. In the observation, group, 15 days after sickness, according to the situation in sEMG, on the basis of the acupoints in the previous treatment, the corresponding acupoints were reselected for EA. In the control group, the conventional EA was kept on. The treatment was given once every two days till the 35th day of sickness. Separately, on the 5th, 15th and 35th days of sickness, according to the detection of sEMG in the patients of two groups, the means ratios of: root mean square (RMS) of musculi buccinators, orbicularis oris, frontalis and nasalis on the healthy and affected sides were recorded and analyzed.

RESULTSThe differences of ratio in RMS of musculi buccinators, orbicularis oris, frontalis and nasalis on the healthy and affected sides were significant statistically in comparison between the, 15th day and the 5th day, and between the 35th day and the 15th day of sickness within each group (all P<0. 01). The differences of ratio in RMS of the muscles on the healthy and affected sides were significant statistically on the 15th and 35th days between the two groups (all P<0. 05).

CONCLUSIONEA assisted with sEMG achieves the significant efficacy on peripheral facial palsy, better than the conventional EA.

Acupuncture Points ; Adolescent ; Adult ; Aged ; Electroacupuncture ; Electromyography ; Facial Muscles ; physiopathology ; Facial Paralysis ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult