The mechanism of thrombus formation in living vessel wall is complex and involves a combination of blood and vessel wall properties and local flow conditions.The significance，theory and experimental tech-niques of thrombus formation in vivo were comprehensively reviewed.Particularly,the important role of signa-ling pathway and hemodynamic in thrombus formation in vivo was pointed out.The difficulty ic in vivo animal models was analyzed.Some recent new phenomena as welt as new approaches and directions worthy of in-vestigation also were summarized.

This paper reviewed recent advances in clinical and basic researches of scalp acupuncture based on evoked potentials (EPs).The role and significance of various EPs in scalp acupuncture were analyzed and compared.Eventrelated potentials (ERPs) which occupied leading position in EPs application nowadays and the latest advances in the related components of its action were combined to make a prospect of the scientific research methods of scalp acupuncture in the treatment of cerebral apoplexy and other diseases.

Objective To compare the application,safety and theraputic effect of local resection of early rectal tumours by transanal endoscopic microsurgery(TEM) and the conventional transanal excision(TAE).Methods The data of seventy-six patients who were treated by conventional transanal excision from January 2003 to July 2006 and fifty-three patients who were treated by transanal endoscopic microsurgery from September 2006 to February 2010 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were reviewed.Results Age,sex,tumour size,blood loss,postoperative hospital stay were similar in the two groups(P＞0.05).The median distance from the anal verge was significantly higher in the TEM group ( TEM/TAE =7.0/5.0 cm,P ＜ 0.01 ).The operation time was significantly longer in the TEM group (TEM/TAE =70.00/30.00 min,P ＜ 0.01 ).There was no operation-related mortality in both groups (P ＞ 0.05 ).Two patients in the TEM group developed postoperative haemorrhage,and one patient developed pulmonary infection and retention of urine respectively.There were two secondary haemorrhage cases in the TAE group.On median follow-up of 30 months,there was 7.8％ recurrence rate in the TEM group,compared with 23.2％ the in TAE group.Conclusions Transanal endoscopic microsurgery is a safe and effective mininally invasive surgical technique for the treatment of early rectal neoplasm.It has broader indication,and better theraputic effect than the conventional transanal excision.

This study was aimed to explore the immediate effect mechanism of the middle 2/5 of the vertex-temporal anterior oblique line in the treatment of stroke by scalp acupuncture using event-related brain potential (ERP).A total of 30 stroke cases who met the inclusion criteria and 25 healthy subjects were selected.Patients in both groups were treated by scalp acupuncture,with stimulation on the middle 2/5 of the vertex-temporal anterior oblique line on the right side.ERP was detected before acupuncture and 10 min after acupuncture in both groups.The muscle strength and neurological deficit score of the stroke group were also detected.At the end of the experiment,the movement-related cortical potentials (MRCPs) of both the left and right hand were extracted from the ERP.The results showed that after 10 min scalp acupuncture stimulation,the neurological deficit score of the stroke group was lower than that of the pretreatment (P ＜ 0.05);the muscle strength rating was higher than before (P ＜ 0.05).Before and after acupuncture,the amplitude of MRCPs on the diseased side of the stroke group was significantly decreased compared to before (P ＜ 0.05).It was concluded that the immediate effect of scalp acupuncture treatment of hemiplegia patients with stroke was definite.Its mechanism may be that acupuncture stimulates the motor cortex through the vertex-temporal anterior oblique line,reduces the energy loss of brain motion planning,activates the damaged brain movement related area cortex neurons,improves the processing efficiency of movement in the brain,so as to promote the improvement of hemiplegic limb motor function immediately.And we also observed that the healthy side brain has a compensatory effect,which suggested that in our clinical scalp acupuncture,bilateral stimulation may be more effective.

Objective To analysis the short-term quality of life and clinical outcome of early enteral immunonutrition(EIN)used after operation in patients with totally endoscopic esophagectomy.Methods This randomized controlled trial enrolled 110 patients receiving totally endoscopic esophagectomy in department of thoracic surgery of the fourth hospital of Hebei medical university between May 2015 and November 2016.The patients were randomly divided into enteral immunonutrition group (EIN group,n =56) and parenteral nutrition group (PN group,n=54).The scale scores of quality of life,the time of first postoperative anal exhaust,the time of removal of drainage tube,the number of postoperative infections and the length of hospitalization were compared between the two groups before operation and after operation.Results (1) There were no significant differences in age,gender,education,marital status,tumor location,clinical stage,intraoperative bleeding between the two groups (P＞0.05).(2) There were no significant differences in the quality of life before operation (P＞0.05);All functional scale scores of EIN group were significantly higher than PN group (P＜0.05),while the symptom scale score were significantly lower than PN group(P＜0.05).(3) There were significant differences in the time of first postoperative anal exhaust,the time of removal of drainage tube,the number of postoperative pneumonia compliCations and the length ofhospitalization in the two groups (P＜ 0.05).There was no significant difference in the incidence of anastomotic fistula between the two groups(x2=0.621,P=0.431 4) The scale scores of quality of life (the overall health status as the representative) had a negatively linear relationship with the clinical outcome(P =0.000),the absolute value of correlation coefficient in EIN group was higher than that in PN group.The higher score of the quality of life,the shorter time of the postoperative anal exhaust,removal of drainage tube and the length of hospitalization.Conclusion Enteral immunonutrition can improve the quality of life,improve the prognosis and promote the rapid recovery of patients with totally endoscopic esophagectomy.

Acute necrotizing encephalopathy (ANE) is a rare but deadly complication with an unclear pathogenesis. We aimed to elucidate the immune characteristics of H1N1 influenza virusassociated ANE (IANE) and provide a potential therapeutic approach for IANE. Seven pediatric cases from a concentrated outbreak of H1N1 influenza were included in this study. The patients’ CD4+T cells from peripheral blood decreased sharply in number but highly expressed Eomesodermin (Eomes), CD69 and PD-1, companied with extremely high levels of IL-6, IL-8 in the cerebrospinal fluid and plasma. Patient 2, who showed high fever and seizures and was admitted to the hospital very early in the disease course, received intravenous tocilizumab and subsequently showed a reduction in temperature and a stable conscious state 24 h later. In conclusion, a proinflammatory cytokine storm associated with activated CD4+T cells may cause severe brain pathology in IANE. Tocilizumab may be helpful in treating IANE.