OBJECTIVE:To establish the quality standard for Chaige ganmao mixture. METHODS:TLC was conducted to iden-tify the Scutellaria baicalensis and Paeonia lactiflora;HPLC was conducted to determine the content of puerarin. The column was Zorbax Eclipse XDB-C18 with mobile phase of methanol-water(25:75,V/V)at flow rate of 1.0 ml/min,detection wavelength was 250 nm,and column temperature was 25℃,and the injection volume was 5μl. RESULTS:TLC showed clear spots and good sepa-ration. The linear range of puerarin was 18-198 μg/ml(r=0.999 9);RSDs of precision,stability and reproducibility tests were low-er than 2%,recovery was 99.04%-99.75%(RSD=0.28%,n=6). CONCLUSIONS:The standard can be used for the quality con-trol of Chaige ganmao mixture.

Objective To observe the effect of Tongqiaohuoxue decoction on cognitive impairment in rats with traumatic brain injury and explore the mechanisms. Methods 70 Sprague-Dawley rats were randomized into normal group (n=10), sham operated group (n=20), untreated group (n=20) and treatment group (n=20). Controlled cortical impact device was utilized to establish traumatic brain injury model. The treatment group received Tongqiaohuoxue decoction 5 ml/d, and other groups received distilled water. The cognitive function of rats was evaluated with Morris water maze 1, 2, 3, 4 weeks post operation. And the rats were sampled to test the expression of brain-derived neu-rotrophic factor (BDNF) and synaptophysin (Syn) I in hippocampus through immunohistochemistry. Results The escape latency was longer in the untreated group than in the normal group in all the time points (P<0.05), and was longer in the treatment group than in the normal group 1 and 2 weeks after injury (P<0.05), with no significant difference 3 and 4 weeks after injury (P>0.05). And it was shorter in the treat-ment group than in the untreated group 3 and 4 weeks after injury (P<0.05). The percentage of swimming time was lower in the untreated group than in the normal group in all the time points (P<0.05), and was lower in the treatment group than in the normal group 1, 2, and 3 weeks after injury (P<0.05), with no significant difference 4 weeks after injury (P>0.05). And it was higher in the treatment group than in the untreated group weeks after injury (P<0.05). The BDNF expression was lower in the untreated group than in the normal group 1 and 2 weeks after injury (P<0.05), with no significant difference 3 and 4 weeks after injury (P>0.05). It was higher in the treatment group than in the normal group 4 weeks after injury (P<0.01), and was higher in the treatment group than in the untreated group 2, 3 and 4 weeks after in-jury (P<0.05). The Syn I expression was lower in the untreated group than in the normal group in all the time points (P<0.001), and was low-er in the treatment group than in the normal group 1, 2 and 3 weeks after treatment (P<0.01). And it was higher in the treatment group than in the untreated group 3 and 4 weeks after injury (P<0.01). Conclusion Tongqiaohuoxue decoction could improve the cognitive function in rats with traumatic brain injury. The change in expression of BDNF and Syn I might be associated with the improvements.

Objective To explore the ability of advanced oxidation protein products (AOPP)in predicting the progression of diabetic retinopathy (DR)in patients with type 2 diabetes mellitus (T2DM). Methods 363 T2DM patients were enrolled in this prospective cohort study. According to the quartile points of baseline AOPP level,patients were divided into four groups (Q1,Q2,Q3 and Q4 ). The progression rate of DR was calculated according to the changes of non-mydriatic fundus photography after a 5-year follow-up. Results With the increase of baseline AOPP level,the rate of progression of DR increased (19.51% vs 28.42% vs 37.36% vs 47.37%,P <0.01). Logistic regression analysis showed that baseline level of AOPP was an independent risk factor for the progression of DR (OR=1.833,95%CI:1.573~1.982,P<0.05).Area under the curve of AOPP in predicting DR is 0.883 (95% CI:0.842~0.924)with the sensitivity 86.1% and specificity 91.9%. Conclusion AOPP may be one of the biomarkers for the prediction of type 2 diabetic retinopathy progression.

Objective To discuss the relationship between diabetic macular edema(DME) and visual field defects and evaluatethe therapeutic effect of micro-pulse laser.Methods A total of 117 patients (149 eyes) with diabetic retinopathy(DR) were enrolled in this study and divided into two groups according to early treatment diabetic retinopathy study(ETDRS) DME diagnostic criteria:DME group(n=50,70 eyes) and N-DME group(n=67,79 eyes).Healthy subjects(n=40,80 eyes)were selected as NC group in thisstudy.The clinical data and biochemical index were collectedand visual fields were examined in all the subjects.Then the DME group was further divided into two subgroups:micro-pulse laser subgroup(35 eyes) and conventional laser subgroup(35 eyes).The vision recovery after treatment was evaluated on different time points.Results Diabetes duration,FPG,HbA1c and HOMA-IR were significantly higher in DME group than in N-DME group (P<0.05).RF value was less than 15% in each group,suggestingreliable test results.The levels of MD index[(7.81±0.75) vs (4.32±0.67) vs (1.14±0.22) dB],LV[(20.17±4.85) vs (15.34±3.19) vs (4.72±1.11) dB] and sLV[(10.71±1.37) vs (7.22±1.12) vs (2.35±0.41) dB] were significantly higher in DME group and N-DME group than in NC group,and those in DME group were higher than in N-DME group(P<0.01).After three month's treatment,the levels of MD index,LV and sLV were lower in micro-pulse laser subgroup than in conventional laser subgroup(P<0.05).There were no statistically significant difference in MD index,LV and sLV in conventional laser subgroup on different time points(P>0.05).Multiple logistic regression analysis showed that DM duration,FPG,HbA1c and HOMA-IR were riskfactors for DME(all P<0.01).Conclusion Patients with DME have severe vision loss.Micro-pulse laser therapy is helpful invision recovery,while conventional laser therapy have no obvious effect on it.Longer duration of DM,higher level of FPG,HbA1c,and IR severity may increase the risk of DME.

The change of pitutary hormones can occur in any time after traumatic brain injury, the main cause is primary or secondary impairment of hypothalamus as well as pituitary after brain injury. It is important to further research when to test hormone and to carry on the hormone replacement therapy.

ObjectiveTo study the effect of a course of regular rehabilitation treatment on patients with different traumatic brain injury(TBI) course, explore the costs of one rehabilitation course in patients with different TBI course, and study the timing and focus of rehabilitation on patiens with different stages.Methods250 TBI patients were distributed to five groups by different TBI courses: <3 months, 3～6 months, 6 months～1 year, 1～2 years and >2 years. The clinical data and initial function evaluation were done at the admission. All of them received at least one regular rehabilitation treatment, then another function evaluation was done. Effects and costs of one rehabilitation course in patients with different TBI course were investigated.ResultsThe longer the duration of illness, the higher the cost-effectiveness ratio. The cost-effectiveness ratio of the second treatment course was higher than the first one. The patients within 12 months should receive a comprehensive rehabilitation treatment, and should be prevented and treated hydrocephalus and other complications; for patients within 1～2 years, there would be no significant improvement in balance and lower limb function, should enhance the training of activity of daily living (ADL) and upper extremity function; for the patients more than two years just improved ADL using of residual function.ConclusionTBI patients should accept rehabilitation as soon as possible, and should be conducted corresponding trainings according to different disease course.

ObjectiveTo observe the changes of thyroid hormone and reproductive hormone in post-acute traumatic brain injury(TBI).Methods70 post-acute TBI patients were selected from Beijing Charity Hospital from September 2009 to March 2010. The levels of thyroid stimulating hormone(TSH), triiodothyronine(T3), thyroxine(T4), free triiodothyronine(FT3), free thyroxine (FT4), follicie stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (P), and testosterone (T) were measured at 7 a.m. to 8 a.m. on the second day of admisson. According to the reference ranges, the total abnormal rate and the single hormone abnormal rate were calculated. According to the level of hormone, the subjects were divided into the normal group and the abnormal group. The two groups were compared in gender, age, course of disease, duration of coma, basal fracture and scores of Disability Rating Scale (DRS).ResultsThe total abnormal incidence of anterior pituitary hormone was 77.1% in post-acute TBI. The abnormality of reproductive hormones was higher. The duration of coma was related to the reproductive hormone.ConclusionThe abnormal incidence of anterior pituitary hormone occurs frequently in post-acute TBI. The duration of coma is related to the reproductive hormone.

The paper analyzed legally the following predicaments of legitimization of rural doctors in China:no legitimacy protection for their practice,vague criteria for practicing medicine,conflicts between legal regulations for medical practice and rural realities,and lack of a liability insurance system.The authors,based on an exploration of the legislative framework for rural doctors,made four corresponding legislative proposals as follows:to clearly define the legal scope and identity of rural doctors,to establish a qualification and employment system for rural doctors,to develop practicing norms applicable for rural doctors,and to set standards for their income.

Objective To observe the effects of dexmedetomidine hydrochloride on the cisatracurium-induced neuromuscular blockade in geriatric, young and middle-aged patients. Methods Forty elderly patients and forty young and middle-aged patients undergoing elective abdominal surgery under general anesthesia were randomly divided into 4 groups ( n=20 each):elderly dexmedetomidine hydrochloride group (group DE),elderly control group (group CE),young and middle-aged dexmedetomidine group (group DY) and young and middle-aged control group (group CY).In groups DE and DY,a loading dose of 0.5 μg?kg-1 dexmedetomidine was intravenously infused over 10 min before induction of anesthesia,respectively,followed by infusion at a rate of 0.4μg?kg-1?h-1 until the end of surgery.Equal volume of 0.9% sodium chloride was given in groups CE and CY.Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium 0.15 mg?kg-1.Four groups were maintained with infusion of propofol and remifentanil. Neuromuscular blockade was maintained with continuous cisatracurium infusion in the four groups and was monitored with TOF-Watch SX acceleromyography at the adductor pollicis.The onset time,TOF no reaction period,duration of action,the amount of cisatracurium consumption,and the spontaneous recovery index ( T1 25% to 75%) were recorded. Results The four groups were comparable in the demographic data.Intubation conditions,the onset time and recovery index were not significantly different among the four groups. The duration of blockade action in groups DE and DY was ( 61. 1 ± 8.9) min and (53.6±9.3) min,which was significantly longer than that in group CE [(49.9±5.8) min] and group CY [(44.8± 6.4) min] (P<0.01).The duration of blockade action was significantly longer in groups DE and CE than in groups DY and CY (P<0.05).The amount of cisatracurium consumption in groups CE and CY was significantly higher than that in groups DE and DY (P<0.05). Conclusion The neuromuscular blockade is longer and the requirement of cisatracurium is less in elderly patients than in young and middle-aged patients.Continuous infusion of dexmedetomidine hydrochloride can't accelerate the onset time of cisatracurium.But duration of action is prolonged and the amount of cisatracurium consumption is lower in patients with infusion of dexmedetomidine hydrochloride.

Objective:To explore the role CD4+CD45RO+memory T cells in the pathogenesis of Hashimoto's thyroiditis (HT) by detecting the percentages of CD4+CD45RO+ memory T cells in peripheral blood mononuclear cells in peripheral blood of newly diagnosed HT patients. Methods:53HT patients and 43 matched healthy controls (HC) were included in this study. According to the thyroid functions,HT patients were divided into euthyroid subset(HT-A,n =15) ,subclinical hypothyroidism(HT-B,n=14) and overt hypothyroidism subset (HT-C,n=24). The percentages of CD4+CD45RO+memory T cells in PBMCs,as well as the level of serum IFN-γ and IL-17,and thyroid functions,and the titers of thyroid-specific autoantibodies (TPOAb,TgAb) were respectively detected by flow cytometry,ELISA,and ECLIA. Results:The percentages of CD4+CD45RO+ memory T cells in PBMCs,as well as the level of serum IFN-γ and IL-17,the titers of TPOAb,TgAb were all significantly higher than that in HC(P<0. 01). Bivariate correlation revealed that the percentages of CD4+CD45RO+ memory T cells positively correlated with the level of serum IFN-γ,TPOAb and TgAb(P<0. 01,P=0. 015,P<0. 01) in HT patients. Conclusion:The significant increase of CD4+CD45RO+memory T cells in peripheral blood of patients with HT suggested a role of CD4+CD45RO+ memory T cells in the pathogenesis of this disease.