Patients with nonvalvular atrial fibrillation are the high-risk population of ischemic stroke.Anticoagulation therapy is mainly used to prevent the occurrence of stroke in clinical practice.However,there are some difficulties in the conventional administration of oral anticoagulant warfarin because of some restrictions.There are a number of novel oral anticoagulants with promising data for the prevention of stroke in nonvalvular atrial fibrillation,such as direct thrombin inhibitor and coagulant factor X a inhibitor.

The vulnerable carotid atherosclerosis plaque is an important risk factor for ischemic stroke.However,there are no objective diagnostic criteria for the vulnerability of carotid atherosclerosis plaque in clinical practice now.This article reviews the progress in the diagnosis of vulnerable plaque from the aspects of ultrasound,CT,MRL cerebral angiography,and biochemical indexes.

Objective To investigate the clinical features of early postoperative inflammtory small bowel obstruction,and discuss its diagnosis,treatment and preventive measures.Methods The clinical data of 68 cases of early postoperative inflammatory small bowel obstruction were analyzed retrospectively.Results Within the 68 cases,65 cases were cured by non-operative treatment including gastrointestinal decompression,anti-inflammatory drugs,somatostatin,total parenteral nutrition(TPN) and traditional Chinese medicine.The mean time from the onset of symptoms to the recovery of bowel function was 14 days.Three cases were cured by transferring to operation.One case of them was transferred to operation for strangulated intestinal obstruction during the period of conservative treatment.One case underwent oper.ion because the patient didn t recover after 4 weeks expectant treatment.One case underwent operation for the impatience with the conservative treatment of both the doctors and the patient.Conclusion Non-operative therapy should be the first choice for the treatment of early postoperative inflammatory small bowel obstruction,and its therapeutical effect was well-accepted.

Objective To explore the relation between thyroid nodular and thyroid calcification .Methods The clinical data of 430 cases with nodular goiter admitted from January 2011 to December 2013 were reviewed.All cases were performed ultrasonography and pathologic examination .Results Of 430 cases,there was thyroid carcinoma in 49 cases(11.4%),including microcalcification in 30 cases(61.2%) and macrocalcification in 3 cases(6.1%);benign lesion in 381 cases(88.6%),including microcalcification in 24 cases(6.3%) and macrocalcification in 39 cases(10.2%).The difference was remarkable (P=0.000).There was remarkable difference in malignant calci-fied nodules ratio between the patients with microcalcification and macrocalcification (55.6%vs 7.1%,P=0.000), between the patients aged 45 years below and above(48.8%vs 22.6%,P=0.007),between the patients with solita-ry and multiple nodules(45.0%vs 16.7%,P=0.005).But there was no statistic difference in malignant calcified nodules ratio between the male and female groups (24.2% vs.39.7%,P=0.130).Conclusion Microcalcification is a highly specific sign to predict thyroid carcinoma in ultrasonography exam .Positive intervention will be performed immediately when calcification appears in thyroid nodules .

Objective To explore the effect of separate management of income and expenditure (SMIE) on standard community healthcare services. Methods Health management records of 137 community health service ( CHS) institutions in Beijing during 2006 and 2009 were retrospectively analyzed. Paired t test was used to compare annual healthcare services at urban and rural areas before or after SMIE was adopted. Results The standard community healthcare services was reduced from 1 081 965. 53 to 971 793. 98 at urban areas and from 157 492. 23 to 149 305. 25 at rural areas (P >0. 05). Urban healthcare center-based standard services was decreased from 59. 94% to 52. 14% (P < 0. 05 ); while out-hospital services were increased from 13. 50% to 18. 88% (P<0. 05). In urban areas,standard services for women healthcare, chronic disease profiling, health education and information management were significantly increased (I <0. 05). However,Temporary observation and endemic disease prevention and treatment were the main job of rural healthcare. Conclusions SMIE in CHS institutions could accommodate to the need of health management, supporting policies should be further improved.

0.05). There was statistically significant difference in morbidity rate between the groups (2.1% vs 9.3%, P=0.037). Conclusions: Percutaneous and surgical treatment of pyogenic liver abscesses are both effective, nevertheless percutaneous drainage carries lower morbidity and should be the first-line treatment.

Rheumatoid arthritis (RA), as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA.

Objective To investigate the causes and treatment of familial neurohypophyseal diabetes insipidus with hydronephrosis.Methods A retrospective analysis was conducted in 6 cases (5 males and 1 female,aged 11 to 53 years) of familial neurohypophyseal diabetes insipidus with hydronephrosis treated in our institute from June 2009 to December 2010.All cases had polydipsia and polyuria since their childhood.The daily output of urine ranged from 5,290 to 15,040 ml.The urine specific gravity was less than 1.005.The water deprivation and vasopressin injection test showed positive results,and MRI showed that the shape and size of pituitary gland were in normal range.Ultrasound and IVU showed that all cases had hydronephrosis.Five adult cases were administered with Desmopressin 0.2 mg three times a day,and 1 juvenile patient given half dosage of Desmopressin as in adult.The case No.1 underwent percutaneous nephrostomy and bilateral ureteral reimplantation.Case No.2 received urethral catheterization for 5 days and Tamsulosin.Three cases with urinary tract infection were given antibiotics on the base of urine culture and antibiotic sensitivity test results.Follow-up was undertaken every 3 mon for the duration of 18-36 mon.Results In 6 cases,polydipsia and polyuria were significantly improved after the treatment.Daily urine output dropped to 6000 ml in 5 adult cases and decreased to 2000 ml in the juvenile case.The flank sore of case No.1 was relieved after percutaneous nephrostomy,and hydronephrosis improved 6 mon after bilateral ureteral reimplantation.The residual urine volume of case No.2 was reduced to 40 ml,and no recurrence was observed after anti-infection therapy.During the follow-up,6 cases showed relieved hydronephrosis and no recurrent infection.Conclusions It is of important to reduce the urine volume for the treatment of familial neurohypophyseal diabetes insipidus with hydronephrosis.Early diagnosis and treatment of the diseases is crucial for the improvement of renal function.

Objective To detect mutations of the ADAR1 gene in three Chinese families with dyschromatosis symmetrica hereditaria (DSH).Methods DNA was extracted from the blood samples of seven patients with DSH and their 33 relatives in three families with DSH as well as from 50 unrelated healthy controls.PCR and direct sequencing were performed to detect mutations in the ADAR1 gene.Results All the patients carried mutations in the ADAR1 gene.Three mutations were identified,including one frameshift mutation c.2433-2434delAG in family 2 and two missense mutations,i.e.,c.1760A ＞ G (p.Y587C) in family 1 and c.3620G ＞ T (p.G1207V) in family 3.No mutations were found in the ADAR1 gene in unaffected individuals in these families or the healthy controls.Conclusion Two novel missense mutations are found in the ADAR1 gene of two Chinese families,which may represent a molecular mechanism underlying the development of DSH.

Objective To investigate the correlation between plasma cystatin C (CysC) level and carotid atherosclerotic plaque in patients with ischemic stroke.Methods The clinical data in patients with acute ischemic stroke were analyzed retrospectively.According to the results of carotid artery ultrasound,the patients were divided into either a non-plaque group or a plaque group.Then the plaque group was redivided into a stable plaque subgroup and a vulnerable plaque subgroup.Multivariate logistic regression analysis and Pearson correlation analysis were used to explore the risk factors for carotid atherosclerotic plaque.Results A total of 226 patients with acute ischemic stroke were enrolled,172 of them had carotid plaque,and 54 had no plaque.Of the patients with carotid plaque,94 were stable plaque and 78 were vulnerable plaque.The age (71.82 ± 9.94 years vs.60.74 ± 13.81 years; t =6.160,P =0.014),proportion of patients with ischemic heart disease (11.6％ vs.1.9％; x2=6.169,P=0.020),systolic blood pressure (148.770± 21.007 mm Hg vs.142.240 ± 19.404 mm Hg; t =2.029,t =0.044),plasma CysC concentration (1.046 ± 0.438 mg/L vs.0.860 ±0.214 mg/L; t =3.006,P =0.003),and carotid IMT (1.122 ±0.278 mm vs.0.878 ±0.250 mm; t =5.762,P=0.000) in the plaque group were significantly higher than those in the non-plaque group.Multivariate logistic regression analysis showed that the age (odds ratio [OR] 1.079,95％ confidence interval [CI] 1.044-1.116; P=0.000) and IMT (OR 31.450,95％ CI 6.233-158.692; P=0.000) was the independent risk factor for carotid plaque,while there was no significant independent correlation between the plasma CysC level and carotid plaque (P =0.217).Only IMT in the stable plaque subgroup was significantly higher than the vulnerable plaque group (1.176 ±0.285 mm vs.1.058 ±0.258 mm; t =-2.824,P =0.005),and it was the independent protective factor for the carotid plaque stability (OR 0.195,95％ CI 0.059-0.064; P =0.007).Pearson correlation analysis showed that the plasma CysC level was positively correlated with the age (r =0.375,P =0.000) and serum creatinine level (r =0.462,P =0.000),but it was not significantly correlated with carotid IMT (r =0.075,P =0.264).Conclusions In patients with ischemic stroke,no correlations were found between the plasma CysC level and carotid atherosclerotic plaque,plaque stability,and IMT.