Objective To investigate the changes of thrombomodulin (TM) and von Willebrand factor (vWf) and their clinical significance in patients with severe brain injury. Methods The study involved 62 patients with severe brain injury who were divided into diffuse axonal injury group (28 patients) and focal brain injury group (34 patients). Then, the 62 patients were divided into young group (16-30 years old, 20 patients), middle-aged group (31-65 years old, 20 patients) and elderly group ( ＞65 years old, 22 patients). The serum levels of TM and vWf were determined at days 1 and 7 after injury respectively. ELISA method was employed to determine the serum levels of TM and vWf.Results The vWf in focal brain injury group was significantly higher than that of diffuse axonal injury group at days 1-7 after injury ( P ＜ 0.05 ). Compared with the young and middle-aged groups, the TM and vWf levels in the elderly group at day 1 after injury were significantly elevated ( P ＜ 0. 05 ). The TM levels in patients with delayed traumatic intracerebral hematoma (DTICH) were significantly higher than that in patients without DTICH (P ＜ 0. 05). Conclusions In the acute stage of severe brain injury,injury severity and activation of endothelial cells varies in patients with different types of injury and at different ages. TM is one of sensitive indicators to reflect the cerebal vascular endothelial cell injury. It is very meaningful to assess the prognosis of severe brain injury by measuring serum levels of TM and vWf and take TM as a predictive indicator for DTICH.

OBJECTIVETo observe the acupoint distribution and clinical efficacy of lumbar disc herniationi (LDH) with different sensitive types.

METHODSEighty patients with LDH were randomly divided into a heat-sensitive moxibustion group (group A), a heat-sensitive acupuncture group (group B), a force-sensitive acupuncture group (group C) and a force-sensitive moxibustion group (group D), 20 cases in each one. In the group A and the group B, moxibustion and acupuncture were applied at two or three heat-sensitive acupoints separately. In the group C and the group D,acupuncture and moxibustion were used at two or three force-sensitive acupoints respectively. The treatment was given once a day, totally 10 times. The distribution law of the heat-sensitive acupoints and the force-sensitive acupoints and the change of M-JOA before and after treatment were recorded in the four groups.

RESULTSThe frequent heat-sensitive acupoints areas of LDH were at Yaoyangguan (GV 3), Dachangshu (BL 25), Zhiyang(GV 9), Guanyuanshu(BL 26) and Weizhong(BL 40). The major force-sensitive acupoints areas were at Shenshu (BL 23), Dachangshu (BL 25), Tianshu (ST 25), Guilai (ST 29) and Weizhong (BL 40). After treatment, the heat-sensitive acupoints in the group A and the group B were all reduced than those before treatment and the force-sensitive acupoints in the group C and the group D were declined as well (P < 0.01, P < 0.05). The M-JOA scores were obviously lower than those before treatment in the four groups (all P < 0.01). The score in the group A was reduced more apparently than that in the group B (P < 0.05). The score in the group C was declined more markedly than that in the group D (P < 0.05).

CONCLUSIONThere are diverse acupoints for LDH patients due to different sensitive types. All forms of stimulation can change the functional state of acupoints. Moxibustion is more suitable for heat-sensitive acupoints and acupuncture is optimal for force-sensitive acupoints.

Acupuncture Points ; Acupuncture Therapy ; methods ; Adult ; Aged ; Female ; Humans ; Intervertebral Disc Displacement ; therapy ; Male ; Middle Aged ; Moxibustion ; methods ; Treatment Outcome

Objective To detect different activated patterns of heavy smokers in different states as well as between smokers and non-smokers. Methods Seventeen subjects including 12 heavy smokers and 5 non-smokers (controls) were examined with functional magnetic resonance imaging (fMRI) performing smoking-related olfactory cue tasks. The data were processed with SPM2. These different patterns were compared between the two groups. Results When smokers were exposed to the smoking olfactory cue in the abstinent state, activation was found on the left superior frontal gyrus (BA8, 9, 10, 11), left middle frontal gyrus (BA8, 10, 11, 46), left inferior frontal gyrus (BA9), left medial frontal gyrus (BA6, 8, 10,11), right superior frontal gyrus (BA10), right middle frontal gyrus (BA8, 9), right inferior frontal gyrus (BA45, 47), right medial frontal gyrus (BA9, 11), left callosal gyrus (BA24, 31), right callosal gyrus (BA24, 37), right middle temporal gyrus (BA21) and both sides of the thalamus and cerebellum. When smokers were exposed to the smoking olfactory cue in the satiated state, activation could be found on both sides of the prefrontal lobe and cerebellar hemisphere, while there was no activation on the other brain regions. No activation was found on the whole brain of the nonsmokers,except for a little small volume active points appeared in individual subjects, possibly caused by the picture noise. Conclusion The Limbic system (cingulate cortex, thalamus) and the prefrontal lobe play an important role in the cue-induced smoking craving approved from the new perspective of the olfactory. It is feasible to research smoking addicts' brain activation and the role of neural mechanisms using olfactory stimulation with clinical 1.5T MRI equipment.

Objective To observe the effects of heat-sensitive moxibustion on the expression and activity of super-oxide dismutase (SOD) and the content of malondialdehyde (MDA) in focal cerebral ischemia-reperfusion injury in rats, and the mechanism thereof. Methods Thirty-six male SD rats were randomly divided into four groups, sham-operated group (n=6), ischemia-reperfusion (I/R) injury group (n=10), I/R injury with 15-minute moxibustion group (n=10) and I/R injury with 35-minute moxibustion group (n=10). The focal cerebral ischemia-reperfusion rat model was induced by middle cere-bral artery occlusion (MCAO) for 2 h followed by reperfusion. Values of SOD activity and MDA content were determined by colorimetry, and the cortical expression of SOD2 protein was detected by Western blot technique. Results Values of SOD activities were significantly higher in serum (22.78±1.31)U/mL and cortex (4 909.6±1 345.6) U/g of heat-sensitive moxibus-tion group than those of model group (20.17±1.12)U/mL and (2 602.0±1 515.5)U/g. Values of MDA contents were significant-ly decreased in serum (3.78±2.00)μmol/L and cortex (1 226.5±38.4)nmol/g in heat-sensitive moxibustion group than those of model group (16.82 ± 6.70)μmol/L and (1 905.6 ± 478.6) nmol/g. The cortical expression of SOD2 protein (0.974 ± 0.166) was higher in heat-sensitive moxibustion group than that of model group (0.702±0.040). Conclusion Heat-sensitive moxi-bustion could reduce the damage of cerebral inchemia-reperfusion, which might be through improving SOD activity, increas-ing SOD expression and decreasing MDA content.

Objective To observe the effect of moxibustion pretreatment on caspase-3 expression in cortex of rats with cerebral ischemia-reperfusion injury. Methods Twenty-one male SD rats were randomly divided into three groups, sham group (n=6), model group (n=8) and moxibustion pretreatment group (n=7). Focal cerebral ischemia-reperfusion injury rat model was induced by middle cerebral artery occlusion (MCAO) for 2 hours followed by reperfusion. Brain infarct was ex-amined by TTC staining. Brain morphology was shown by HE staining and the ultrastructure of cell was observed with elec-tron microscope. Caspase-3 expression in cortex was examined by immunofluorescence histochemistry. Results The per-centage of infarct volume [(24.9±4.7)%] in moxibustion pretreatment group was much smaller than that [(45.8±4.6)%] in mod-el group. Nerve cells in moxibustion pretreatment group experienced less morphological and structural changes than those in model group, and caspase-3 positive cells (39.17 ± 7.28) in moxibustion pretreatment group were less than those (58.17 ± 16.53) in model group. Conclusion Moxibustion pretreatment could attenuate cerebral ischemia-reperfusion injury, which might be through decreasing caspase-3 expression.

Objective To research the relationship between the expression of PAI-1 and the clinical characteristics of the endometrial carcinoma.Methods We detected the level of the serum PAI-1 by ELISA in the patients with endometrial carcinoma,the patients with endometrial hyperplasia and the patients with normal endometrium.The expression of PAI-1 in endometrial carcinoma and normal endometrial tissues was observed by immunohistochemistry.Results The concentration of serum PAI-1 in patients with endometrial carcinoma was 18.64 ± 6.22 μtg/L,significantly higher than those of patients with endometrial hyperplasia (6.94 ± 2.87) μg/L and patients with normal endometrium (6.68 ± 2.13)μg/L (P=0.00).The expression rate of PAI-1 was 68.2％ (15/22) in endometrial carcinoma tissue,and 8.3％ (2/24) in normal endometrial tissue (P=0.00).Compared with the early endometrial carcinoma,the expression rate of PAI-1 in the advanced endometrial carcinoma was significantly higher (6/6 w 9/16,P=0.03).Conclusions The expression level of PAI-1 may be related to the stage of the endometrial carcinoma.

Objective To compare the precision and correlation of test parameters betwee the two types of automatic blood ana-lyzer,Sysmex XT-2000i and Mindray BC-5800.Methods We selected 60 cases of EDTA-K2 anticoagulant whole blood samples, correlation analysis was carried out on the two instrument parameters,and high,medium and low value samples were chosen for 10 times′precision analysis in the two instrument s respectively.Results The variation coefficient(CV)values of blood count parame-ters of Sysmex XT-2000i were 0.02%-5.70%,while the CV values of white blood cell classification parameters were 0.06%-1. 66%.The CV values of blood count parameters of Mindray BC-5800 were 0.02%-5.3%,white the CV values of white blood cell classification parameters were 0.09%-1.17%.The determination coefficient(r2 )of each parameter of the two instruments were 0. 185-0.995.Conclusion the correlation between the two instruments is good,and the two instruments′precisions were consistent with the design range.

ObjectiveTo assess gene chip application value in detecting pathogenic bacteria in intracranial infection cases.MethodsPrimers and probes aiming at the specific DNA sequences of 4 kinds of common pathogenic bacteria and 6 kinds of common drug resistance genes (DRGs) were designed and used to identify the bacteria and DRGs among 30 cerebrospinal fluid (CSF) specimens (12 positive,18negative in CSF culture) from patients with intracranial infection using multiplex polymerase chain reaction (mPCR) and gene chip.The results of gene detection were compared with those of CSF culture and drug sensitivity testing.ResultsBacteria were identified and DRGs were detected in 15 specimens; DRGs and 16S gene were detected in 8 specimens; neither bacterium nor DRG was detected in 7 specimens.ConclusionGene chip technique is characterized by its relative sensitivity and rapidity of detecting the pathogenic bacteria in CSF of intraeranial infection cases.

Objective The study was to determine the relationship between acquired admission and/or pre-operative Rotterdam CT scores and TBI prognosis after standard decompressive craniectomy. Methods We chose 1 108 cases simple TBI patients with unilateral decompressive craniectomy(DC) from January 2011 to May 2016 in our hospital as the research object,and 212 patients which were reached standard were included in our retro-spective study. According to general data analysis,GOS 3 month after injury,the subject were divided into poor prognosis group and good prognosis group.Multiple factors logistic regression analysis was used to determine the re-lationship between acquired admission or preoperative Rotterdam CT scores and mortality or GOS in 3 month after injury. Results A total of 85 patients(40.1%) had a good prognosis and 127(59.9%) had a poor prognosis.A comparative analysis of different admission and preoperative Rotterdam CT scores groups showed the mortality and poor prognosis rates were statistically significant(P=0.00) in 4-6 groups of patients after injury 3 months.Multi-ple factors logistic regression analysis showed admission and preoperative Rotterdam CT scores were significantly as-sociated with mortality and poor prognosis(P<0.05).Conclusions Rotterdam CT scores provide important prog-nostic information of TBI patients with DC. Combined admission Rotterdam CT scores and preoperative Rotterdam CT scores may forecast the early mortality and long-term outcome for TBI patients.

On the basis of analysis of the current status and future tendency of development of the health services industry in Shanghai,the authors identified key problems and bottlenecks.Thus they made clear the target positioning and principles of the industry,and proposed the basic ideas and pattern of the industry in the 13 th five-year plan period,focusing on such fields as private and high-end healthcare services,traditional Chinese medicine services,public health services,commercial health insurance,and other related industries.In the end,corresponding supporting polices were proposed.