Subarachnoid hemorrhage (SAH) is a common cerebrovascular disease.Its morbidity and mortality are higher.Cerebral vasospasm (CVS) and early brain injury (EBI) are the major pathophysiological mechanisms of neurological deficits and death after SAH.Both CVS and EBI are associated with a variety of factors,including nitric oxide,endothelin,thrombin and its receptor,hemoglobin and proinflammatory cytokines.Animal experiments have shown that thrombin is an important causative factor.This article reviews the role of thrombin in SAH.

AIM: To study the interaction effects of Astragalus polysaccharide(APS) and total glucosides of paeony(TGP) with various dosage on the platelet aggregation. METHODS: Platelet aggregation was estimated by the turbidimetric method. The best interaction effects were determined by uniform design method. RESULTS: APS showed apparent anti-platelet effects and better combination with TGP,and the ratio of 121 was the best one. CONCLUSION: APS concerted with TGP inhibits platelet aggregation.

Objective To study the effects of the numbers of the canalith repositioning procedure on the treatment of benign paroxysmal positional vertigo(BPPV).Methods A clinical study was conducted on 68 BPPV patients using randomized controlled methods.The canalith repositioning procedure was performed on 34 patients in the treatment group only a day for 3 consecutive days,whereas it was performed on 34 patients in the control group once only,patients in both groups took betahistine mesylate tablets and flunarizine hydrochloride on the basis of ma-nipulative reduction.After one week and three months,the efficacy was evaluated,and the recovery situation was observed.ResuIts After 1 week of treatment,the cure rate was 82.4% in the treatment group,and 58.8% in the control group.The difference was statistically significant (P<0.05).After 3 months,the cure rate was 91.2% in the treatment group,and 85.3% in the control group,showing no significant difference (P>0.05 ).ConcIusion Based on the classifications of BPPV ,several times of manipulative reduction combined with drug treatment can im-prove short-term cure rates of BPPV and shorten healing time.

Objective To compared the effect of combined teaching method of lecture,case analysis and GasMan@software (LAG) and traditional teaching method (LBL) in inhalation anesthesia practice course.Method 78 anesthesiological undergraduates were randomly assigned to G group (n=39) or Control group (n=39).According to the requirements of clinical anesthesiology in the syllabus,G group used classroom lectures,case analysis and GasMan@software (LAG) teaching method,while Control group used lecture based learning (LBL) teaching method.The students took anonymous quiz and filled teaching effect evaluation form after practice course.Then the exam results were compared between groups to evaluate the teaching effect.SPSS 19.0 was applied to do statistical analysis and t test and x2 test were used.Results Compared to the Control group,G group got better results in objective questions like choosing,judgment,case analysis and average ranks (P=0.000),and there was no significant difference in the identification section (P=0.087),while G group also got better results in subjective questions like learning interests,study efficiency,memorize,logical thoughts,ability of analysis,solving problems and cooperation (P＜0.05).Conclusion Compared to traditional teaching method,the combined use of lecture,case analysis and GasMan@software make students immersive,develop their clinical thinking ability,and improve the teaching effect of inhalation anesthesia practice course significantly.

Objective:To identify HLA-A2-restricted CTL epitope of breast cancer differentiation antigen NY-BR-1.Methods:The HLA-A2-restricted CTL epitope of breast cancer differentiation antigen NY-BR-1 is predicted by combination quantitative motif method and the molecular dynamics.The three epitope were assayed their affinity to HLA-A2.Results:The affinity to HLA-A2 of NY-BR-1_ 1043-1051 is a best.Conclusion:NY-BR-1_ 1043-1051 is a HLA-A2 restricted epitope.

Objective To investigate clinicopathological features,diagnosis and treatment of progressive osseous heteroplasia (POH).Methods Clinicopathological data were collected from 3 cases of POH,and analyzed retrospectively.Related literature was also reviewed.Results All the 3 patients were female,and developed POH within a few days to months after birth.POH clinically manifested as light pink or skin-colored indurated papules,nodules or plaques scattered over the scalp,trunk and extremities without subjective symptoms.Histopathological examination showed that there were flaky bone or bone-like tissues in the middle and lower dermis.Serum levels of calcium,phosphate and parathyroid hormone were normal in the 3 children.Case 1 was treated with oral sodium bicarbonate tablets and surgical resection of skin lesions on the right lower abdomen.During the follow-up for about 7 months,the skin lesions on the right lower abdomen did not recur,while other skin lesions became more bulging,larger and harder,and new skin lesions occurred.Case 2 was treated with topical adapalene gel,and these skin lesions did not increase in number,but became larger and harder.Case 3 received no treatment,and was lost to follow-up.Conclusion POH clinically manifests as indurated maculopapules and plaques progressively affecting deeper skin tissues,and there are no effective therapies or prevention approaches at present.

Objective To investigate the prevalence of orthostatic hypotension in hypertensive patients aged 80 or over and associated risk factors at level A tertiary hospitals.Methods A multicenter cross-sectional study was conducted among very old hypertensive patients (≥ 80 years) at 28level A tertiary hospitals by using questionnaire-based surveys.A total of 1298 hypertensive subjects aged between 80 and 101 years were enrolled in this study.Blood pressures was measured in the supine position and the upright position within three minutes of standing,and 316 patients were assigned to the orthostatic hypotension(OH) group and the other 982 patients to the non-orthostatic hypotension(NOH) group.Additional information was acquired through patients' medical records and the questionnaire.Results The prevalence of OH was 24.3％ (316 cases) There were no significan different betueen OH patienl with NOHones in gender and age.OH patients had higher supine systolic and diastolic blood pressure(P=0.003 and 0.000,respectively),lower standing systolic and diastolic blood pressure(P=0.000 and 0.000,respectively),and higher rates of past coronary heart disease,stroke and renal abnormalities (P =0.037,0.001 and 0.014,respectively) than NOH patients.Logistic regression analysis showed that the prevalence of OH in the patients was positively correlated with supine systolic blood pressure(OR=1.196,CI:1.153-1.242,P=0.000) and supine diastolic blood pressure (OR =1.740,CI:1.602-1.885,P =0.000) and was negatively correlated with standing systolic blood pressure(OR =0.824,CI:0.795-0.855,P=0.000) and standing diastolic blood pressure (OR =0.584,CI:0.539-0.634,P =0.000).Conclusions The prevalence of orthostatic hypotension is high in hypertensive patients aged 80 years or over at level A tertiary hospitals.Poor blood pressure control may increase the risk of orthostatic hypotension.

Objective To observe the effects of baicalin on forms of hepatic tissue, liver apoptosis, mRNA expressions of iNOS, NF-κB and protein expression of Caspase-3 in rats with ischemia reperfusion injury; To discuss its mechanism of action.Methods The rat models of liver ischemia reperfusion were performed according to the Pringle's method. Rats were randomly divided into sham-operation group, model group and baicalin group. Sham-operation group and model group were given normal saline for gavage, while baicalin group was given baicalin for gavage. Morphological characteristic was observed by HE staining. Hepatocyte apoptosis was determined by TUNEL. The mRNA expressions of iNOS and NF-κB were determined by RT-PCR. The protein expression of Caspase-3 was determined by Western blot.Results Compared with the sham-operation group, mRNA expressions of iNOS and NF-κB and the protein expression of Caspase-3 in the model group increased, as well as liver apoptosis rate (P<0.05,P<0.01); compared with the model group, mRNA expressions of iNOS and NF-κB and the protein expression of Caspase-3 in the baicalin group decreased, as well as liver apoptosis rate (P<0.05), and the hepatic lesion significantly improved in the baicalin group.Conclusion Baicalin can restrain Caspase-3 induced apoptosis by reducing the expressions of iNOS and NF-κB, with a purpose to realize the hepatoprotective effect for liver of rats with ischemia reperfusion injury.

Objective:To understand the current situation of physicians′ competency in China and statistically analyze its influencing factors, hence providing referential evidences for promoting their competency.Methods:The evaluation scale for Chinese physicians′ competency was developed by referring to sophisticated overseas evaluation frameworks. Based on the electronic platform of the medical alliance, stratified sampling was conducted at 39 hospitals in 13 provinces, from which 2 156 physicians were surveyed, and statistical analysis was made on the current situation and influential factor of their competency in 6 dimensions(medical knowledge, diagnosis and treatment, scientific research and teaching, interpersonal communication, spirit of professionalism, population health)Results:The score range in multiple dimensions of physicians′ competency was between 2.85 and 3.89(5 in total), among which spirit of professionalism dimension scores the highest, and teaching and research dimension scores the lowest. Logistic regression analysis shows that their competency level in 6 dimensions is correlated to a range of factors, including gender, degree, title, supervisor qualifications, standardized training program of specialist physicians, and affiliation or not to teaching hospitals( P<0.05). Conclusions:Their overall competency is expected to be elevated. To name a few, they are lack of teaching and research abilities, and need to conduct clinical-oriented scientific research; they are expected to enrich knowledge structure, and need to embrace a wider concept of health; they need to improve their non-technical service abilities, and should further emphasize their humanistic quality; physicians′ practice competency depends upon their extent of medical education, and ensuring the quality of standardized training becomes the key measure.

OBJECTIVEThis study aimed to investigate the effects of different tooth preparations on the fracture strength and pattern of failure of teeth with severe wedge-shaped defect restored with post and core crowns.

METHODSAccording to whether the teeth above the wedge-shaped defect was removed (represented by B) or not (represented by A), the ferrule next to the wedge-shaped defect was prepared (represented by D) or not (represented by C), the cast post-and-core was chosen (represented by E) or glass-fiber post and resin core was chosen (represented by F). A total of 64 human mandibular premolar teeth were randomly divided into 8 groups: A1-1 (A + C + E), A1-2 (A + C + F), A2-1 (A + D + E), A2-2 (A + D + F), B1-1 (B + C + E), B1-2 (B + C + F), B2-1 (B + D + E), B2-2 (B + D + F), each group 8 teeth. All the teeth were prepared and restored accordingly and then mounted on an electronic pressure universal testing machine. The maximum fracture strength and the patterns of failure were recorded.

RESULTS1) The fracture strength of Group A1-1 > that of Group B1-1, Group A1-2 > Group B1-2, Group B2-1 > Group B1-1, and Group B2-1 > Group B2-2 with significant differences (P < 0.05). 2) The patterns of repairable fracture in Group A1-2 and B1-2 were both 37.5%, and that of the other groups were 0. Furthermore, the difference was significant, and Group A1-2 and B1-2 were higher than other groups.

CONCLUSIONThe maintenance of the overhang above the severe wedge-shaped defect aid in the improvement of the fracture strength of the tooth restored with post and core crown. The ferrule of the wedge-shaped defect is not recommended to be prepared. Furthermore, the glass-fiber post and resin core is favorable for the re-repair of the teeth than the cast post and core.