Objective: To investigate the clinical therapeutic effects on ischemic stroke by syndrome(differentiation) in traditional Chinese medicine(TCM) combined with differential diagnosis in western medicine.Methods: One hundred and thirtyeight cases suffered from ischemic stroke were randomly divided into treatment group and control group,and according to TCM(theory) the(treatment) group was subdivided into Qideficiency(气虚),phlegm(dampness)(痰湿),phlegmfire(痰火) and Yindeficiency(阴虚)(subgroups).(Different) TCM decoction was administrated respectively to the four subgroups.The clinical(symptoms) and signs,tongue picture of TCM diagnosis as well as the changes of national institutes of health stoke score(NIHSS) were observed and compared with those of the control group before and after treatment.Results: NIHSS scores were improved in all the groups(P

60 years old). 43 cases of antiepileptic drugs combination accounted for 10% and the therapeutic plasma concentration of 27 cases deviated from normal range(62.8%). CONCLUSION:Results of plasma concentration monitoring provide an important basis for clinical drug use. Monitoring data and other clinical index can promote rational use of antiepileptic drugs.

Objective The aim of this report was to study the early and mid-term outcome in hospital and follow-up mortality, predictors for late pulmonary stenosis (PAS) and insufficiency of neo-aortic valve (neo-AVI) in patients with transposition of great arteries (TGA) and Taussig-Bing malformation undergoing arterial switch operation ( ASO ). Methods Between January 2004 and December 2007, 169 patients (129 male, 40 female; mean age of [(11.71 ± 26.3 ) months] with TGA or Taussig-Bing malformation underwent ASO. The patients were divided into Group Ⅰ (n = 56 ): TGA with intact ventricular septum and Group Ⅱ ( n = 113 ): TGA with ventricular septal defect (VSD). All patients were followed up in out-patient department by ultrasonic cardiogram. The mean follow-up periods was (27.66 ± 14.6 ) months. Multiple logistic regression analysis was performed to find out the risk factors. Results The overall hospital mortality was 11.24% (19/169)and there was no significant difference between the two Groups. With the improving of perioperative management, the hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The overall actuarial survival at 1-, 3- and 5-year follow-up was 94.00%,91.33%, and 91.33%, respectively. The multivariate analysis revealed that age above 6 months was a strong predictor for poor postoperative survival. Predictors for neo-AVI were: combined with VSD, age > 6 months and postoperative neo-AVI Z-score > 1. Predictors for moderate to severe PAS were age ＜ 1 months and pulmonary artery plasty with an unstretchable patch. Conclusion ASO remains the optimal choice for treating various forms of TGA with an acceptable early and mid-term outcome regarding overall survival rate. Patients with TGA should be treated as early as possible. Age >6 months is a predictor for poor postoperative survival and neo-AVI. Mismatch between the neo-aortic root and distal aorta may induce neo-AVI. Unstretchable patch in pulmonary artery plasty may induce PAS.

Objective To investigate the signaling mechanisms underlying up-regulation of nontypeable Haemophilus influenzae(NTHi)-induced MUC5AC mucin expression. Methods The expression of MUC 5AC at mRNA level was measured by reverse transcriptase-polymerase chain reaction (RT-PCR)and real-time fluorescent quantitative PCR.Immunoprecipitation and Western blot were performed tO examine the phosphorylation of p38 mitogen-activated protein kinase(p38MAPK)and epidermal growth factor receptor(EGFR)or the effect of dominant negative mutant of EGFR on the phosphorylation of p38MAPK in HM3 cells treated with NTHi.Luciferase assay was also performed to examine the effect of p38MAPK and EGFR inhibitors or dominant negative mutant of EGFR on NTHi-induced MUC5AC expression at transcription level.Results NTHi induced MUC5AC mucin expression at both mRNA and transcription levels.Phosphorylation of p38MAPK and EGFR were observed in HM3 cells treated with NTHi.Either SB203580,a specific inhibitor for p38MAPK or AGl478,a specific inhibitor for EGFR.inhibited NTHi-induced MUC5AC up-regulation at transcription level. Furthermore,Overexpressing dominant negative mutant of EGFR also inhibited NTHi-induced MUC5AC upregulation at transcription 1evel in a dos-dependent manner.EGFR inhibitor reduced NTHi-induced p38MAPK phosphorylation in HM3 cells.Conclusion Bacterium NTHi up-regulates MUC5AC mucin transcription via EGFR-p38MAPK signaling pathway.

Objective To investigate the role of insulin resistance in patients with prostate cancer who received surgical castration. Methods Sixty-seven patients with advanced prostate cancer who received with surgical castration were divided into obesity group [30 cases, BMI (26.85±1.22) kg/m2] and non-obesity group[37 cases, BMI(22.72±1.28) kg/m2]. The fasting blood glucose (FBG) and the fasting serum insulin, while evaluated the insulin resistance index(IRI) were determined before treatment, 6 months after treatment and 12 months after treatment. Results The levels of fasting serum insulin were significantly higher 6 months[(23.21±5.78 )mU/L] and 12 months [(24.34±5.37) mU/L] after treatment than that be-fore treatment[(20.01±4.82) mU/L] in obesity group, but 12 months after treatment [(22.19±6.14) mU/L ]was higher than that before treatment [(17.36±6.01) mU/L] in non-obesity group (P<0.01). The IRI were significantly higher 6 months (2.94±0.79) and 12 months (3.10±0.73) after treatment than that be-fore treatment (2.53±0.64) in obesity group, but 12 months after treatment (2.79±0.75) was higher than that before treatmeat(2.17±0.73) in non-obesity group(P<0.01). Conclusion The current data suggests that the patients with prostate cancer who received surgical castration is at risk for developing insulin resistance, thus leading to increasing risk of cardiovascular disease and type 2 diabetes mellitus.

Objective To evaluate the application of echocardiography in guiding percutaneous balloon pulmonary valvuloplasty in children and to summarize the key echocardiographic planes used in the procedure Methods From February 2013 to September 201 5 38 isolated congenital pulmonary valve stenosis patients were recruited Case inclusion criteria age ≥3 years old purely congenital pulmonary valve stenosis and pulmonary transvalvular pressure gradient ≥40 mmHg Echocardiography was used to assess the severity of pulmonary valve disease and to measure pulmonary transvalvular pressure gradient before procedure Intraoperative transthoracic or transesophageal echocardiography was used to monitor the whole process of percutaneous balloon pulmonary valvuloplasty and to evaluate immediate postoperative efficacy of the procedure All patients were followed up by echocardiography after a month post-discharge Results Thrity eight cases were successfully treated by echocardiography-guided percutaneous balloon pulmonary valvuloplasty The average age of children was 7 1 ±2 5 years mean body weight was 25 3 ±7 1 kg Before the procedure pulmonary transvalvular pressure gradient was 65 9 ± 8 9 mmHg pulmonary annular diameter was 14 6±1 1 mm Immediate postoperative pulmonary transvalvular pressure gradient was 1 5 5 ± 3 4 mmHg All children survived and had no significant complications After a month pulmonary transvalvular pressure was 16 1 ± 3 3 mmHg Conclusions Echocardiography plays an important role in percutaneous balloon pulmonary valvuloplasty for children with congenital pulmonary valve stenosis As a non-x ray guided way it has advantages in preoperative screening of patients intraoperative real-time monitoring and postoperative assessment of efficacy The key sections of echocardiography for intraoperative monitoring are four-chamber and aortic short axis view.

Objective To investigate the clinical efficacy of combination treatment of Ambroxol,Ipratropium and Budesonide during perioperative period in elderly patients with cardiac adenocarcinoma and chronic obstructive pulmonary disease(COPD).Methods A total of 126 elderly patients aged over 65 years diagnosed as cardiac adenocarcinoma and COPD were selected,and no chemotherapy was given to them before operation.Patients were randomly divided into experimental group(n＝ 62)and control group(n＝ 64).Intravenous infusion of Ambroxol hydrochloride and atomizing inhalation of Ipratropium were given in both groups,and the experimental group received budesonide additionally.The pulmonary function,postoperative pulmonary atelectasis,pulmonary infection,antibiotics application and hospitalization after operation were compared between the two groups.Results The forced expiratory volume at the first second(FEV1),forced vital capacity(FVC)and FEV1/FVC were higher in experimental group than in control group [(1.79 ± 0.52)1 vs.(1.33 ± 0.38)L,(2.44 ±0.43)Lvs.(1.93 ± 0.36)L and(73.91 ± 8.17)％ vs.(62.87 ± 7.23)％,respectively,allP＜0.05].The postoperative pulmonary atelectasis and pulmonary infection were lower in experimental group than in control group(4.8％ vs.15.6％,6.5％ vs.18.8％,respectively,both P＜0.05).The time for antibiotics application after operation had no difference between the two groups[(4.81±1.20) days vs.(5.98 ± 1.17)days,P ＞ 0.05].There was a significant difference in postoperative hospitalization between the two groups [(8.37 ± 0.27) days vs.(11.80 ± 0.33) days,P ＜ 0.05].Conclusions The combination treatment of Ambroxol hydrochloride,Ipratropium and Budesonide during perioperative period achieves better therapeutic effects than does the combination treatment of ambroxol hydrochloride and ipratropium in elderly patients with cardiac adenocarcinoma and COPD.

Objective To investigate the effects of selective cyclooxygease-2 inhibitor on pulmonary surfactant protein(SP-B) and transforming growth factor(TGF-β1) of hyperoxic lung injury in newborn rats.Methods One hundred and five SD rats were randomly divided into 3 groups (35 cases in each group):air group (group Ⅰ),in which the rats were exposed to room air;hyperoxia group(group Ⅱ),in which the rats were exposed to hyperoxia(850 mL/L oxy gen);Celecoxib group(group Ⅲ),in which the rats were exposed to heyperoxia(850 mL/L oxygen) and intraperitoneally injected with 5 mg/kg Celecoxib.The lungs of rats were removed on 3 d,7 d,14 d after birth and the following indices were measured:lung section from the lower right lung were stained with HE,and the histological changes was examined;the contents of SP-B and TGF-β1 in the bronchoalveolar lavage fluid of left lung was determinated by using enzyme-linked immunosorbent assay (ELISA);right upper lung was immunohistochemically stained to measure the contents of SP-B and TGF-β1,quantitative real-time PCR(RT-PCR) was used to detect the mRNA expression of SP-B and TGF-β1.Results There were no inflammatory cells and exudation in the lung in group Ⅰ;in group Ⅱ,the structure disorder,pulmonary edema,and inflammatory infiltrates were found;but the damage was obviously alleviated in group Ⅲ.Protein expression could be better detected by ELISA,at the time of 14 day,SP-B was expressed at different levels in3 groups:(29.93±6.40) ng/L in group Ⅰ,(18.20 ±3.70) ng/L in group Ⅱ and (19.63 ±10.20) ng/L in group Ⅲ,SP-B level in group Ⅱ was significantly lower than that in group Ⅰ (t =13.152,P ＜ 0.01),and the expres sion in group Ⅲ was significantly higher than that in group Ⅱ (t =5.190,P ＜ 0.01).TGF-β1 was expressed at different levels in 3 groups:(34.73 ±2.30) μg/L in group Ⅰ,(41.66 ± 1.80) μg/L in group Ⅱ and (38.03 ±0.20) μg/L in group Ⅲ,and the level of TGF-β1 was significantly higher in group Ⅱ than that in group Ⅰ (t =6.584,P ＜ 0.01),but the expression of group Ⅲ was significantly lower than that in group Ⅱ (t =5.609,P ＜ 0.01).The expression of mRNA was detected by RT-PCR,and at the time of 14 day,SP-B mRNA was expressed at different levels in 3 groups:3.14 ±0.10 in group Ⅰ,0.81 ±0.06 in group Ⅱ and 1.12 ±0.06 in group Ⅲ,and SP-B level in group Ⅱ was significantly lower than that in the group Ⅰ (t =55.050,P ＜0.01),and the expression in group Ⅲ was significantly higher than that in group Ⅱ (t =10.305,P ＜ 0.01).TGF-β1 mRNA was expressed at different levels in the 3 groups:1.94 ±0.03 in group Ⅰ,13.26 ±0.43 in group Ⅱ and 6.49 ±0.26 in group Ⅲ,the level of TGF-β1 was significantly higher in group Ⅱ than that in group Ⅰ (t =75.471,P ＜ 0.01),while the expression of group Ⅲ was significantly lower than that in group Ⅱ (t =38.470,P ＜ 0.01).Conclusions Cyclooxygenase-2 inhibitor can attenuate hyperoxic lung injury in rats,and the mechanism might be related to the reduction of prostaglandin.

Objective To investigate the clinical results of minimally invasive fixation of the sacroiliac triangle for vertically unstable pelvic posterior ring injury. Methods A retrospective study was conducted of 20 patients who had been treated for vertically unstable pelvic posterior ring from January 2014 to August 2016. They were 12 males and 8 females, aged from 20 to 58 years ( average, 35 years ) . According to Tile classification for pelvic fractures, there were 4 cases of type C1. 1, 6 cases of type C1. 2, 7 cases of type C1. 3 and 3 cases of type C2. Their posterior rings were treated by fixation through posterior paraspinal approach with S1-iliac pedicle screws plus percutaneous sacroiliac screws, and their anterior rings by closed reduction and internal fixation with cannulated screws, Infix or plate following open reduction. The incision length, operation time and intraoperative blood loss were recorded. Postoperative reduction quality was assessed by Matta radio-logical criteria and pelvic function by Majeed criteria at the final follow-ups. Results Altogether 20 fixation systems of S1-iliac pedicle screws and 37 sacroiliac joint screws were inserted in this series. The length of incision ranged from 5. 5 to 7. 6 cm ( average, 6. 2 cm ) , the operation time from 89 to 130 minutes ( average, 98 minutes) and the intraoperative blood loss from 110 to 320 mL (average, 195 mL). According to Matta ra-diological criteria, reduction was excellent in 13, good in 5 and fair in 2 cases, with an excellent and good rate of 90％. The follow-up time for the 20 patients ranged from 6 to 15 months ( average, 9 months ) . The healing time ranged from 10 to 14 weeks ( average, 12. 5 weeks ) . At the final follow-ups, X-ray and CT three-dimensional reconstruction showed fine fracture union. By the Majeed criteria, the pelvic function was excellent in 11 cases, good in 5, fair in 3, and poor in one, with an excellent and good rate of 80％. No loosening, breakage or pull-out of pedicle screws or sacroiliac screws happened. Conclusion Minimally invasive fixation of the sacroiliac triangle for vertically unstable pelvic posterior ring injury can lead to precise placement, quick recovery, small incision and good functional outcome.

Objective Explore the reversibility and potential molecular mechanisms of pulmonary hypertension in pa-tients with complete transposition of the great arteries (cTGA) combined with ventricular septal defect (VSD) in comparison with those with simple VSD. Methods Twenty-four patients with pulmonary hypertension (mean pulmonary arterial pressure was greater than 30 mmHg) were enrolled in our study, in which 10 patients suffered from cTGA with VSD, and the rest 14 pa-tients suffered from simple VSD. Lung specimens were taken from the right middle lobe of lung before cardiopulmonary bypass. The extent of pulmonary hypertension was then graded according to the Heath-Edwards classification. ELISA was used to exam-ine the expression of eNOS, iNOS, ET-1, ET-AR, ET-BR, MMP-2, MMP-9 and TIMP in all the specimens. Results No statistically significant differences in age, height, weight, the size of VSD, and the pulmonary artery pressure before operation were found between the groups. The level of hemoglobin, aortic and pulmonary arterial oxygen saturation, and the reduction value of pulmonary arterial pressure after surgery were significantly higher in the cTGA patients than that in the simple VSD pa-tients (P < 0.05). All patients had grade 0 - Ⅱ Heath-Edwards changes in their lung biopsy samples. The expression of eNOS and MMP-2 was significantly lower in the TGA group than that in the simple VSD group [eNOS: (280.13 ± 101.92) ng/mg vs. (488.41±249.6) ng/mg, P<0.05; MMP-2:(31.68±15.36)ng/mg vs. (69.28±49.12)ng/mg, P<0.05]. There were no statistically significant differences between the two groups regarding the expression of iNOS, ET-1, ET-AR, ET-BR,MMP-9 or TIMP. Conclusion The imbalance of the NOS/ET system and the MMP/TIMP system involves in the development of pulmonary hypertension in patients with TGA combined with VCD. In patients with cTGA, the high oxygenation state in pul-monary circulation may decrease the expression of MMP2 and eNOS, and may affect the progress of pulmonary hypertension to a certain extent.