Objective To investigate the risk factors of recurrent ischemic stroke, and evaluate the severity and short-term outcome. Methods From March, 2014 to March, 2015, 238 patients with recurrent ischemic stroke and 378 patients with initial ischemic stroke matched with gender and age were enrolled. The clinical data of two groups were compared and the non-conditional Logistic regression model was made to analysis the risk factors of recurrent ischemic stroke. The National Institute of Health Stroke Scale (NIHSS) score as ad-mission and discharge, and the neural function improvement rate of two groups were compared. Results The incidences of leukoarailsis (χ2=8.666), hypertension (χ2=8.189), smoking (χ2=6.973) and alcohol consumption (χ2=4.722) were higher in the recurrent group than in the pri-mary group (P<0.05). Logistic regression analysis showed that leukoarailsis (OR=1.690, 95%CI:1.198~2.384, P=0.003), hypertension (OR=1.715, 95%CI:1.135~2.592, P=0.010) and smoking (OR=1.896, 95%CI:1.233~2.915, P=0.004) were the independent risk factors of recur-rent ischemic stroke. The NIHSS scores as admission and discharge were significantly higher (t=-3.645, t=-4.675, P<0.001), and the neural function improvement rate was lower (t=2.643, P<0.01) in the recurrent group than in the primary group. Conclusion Hypertension, leuko-arailsis and smoking are independent risk factors for recurrent ischemic stroke. Recurrent ischemic stroke is more serious than initial isch-emic stroke, and the short-term neural function recovers more slowly.

Objective To investigate the relationship of the serum bilirubin level with acute ischemic stroke (AIS), and Chinese isch-emic stroke subclassification (CISS), stroke severity and short-term outcome of AIS patients. Methods 616 patients with AIS as well as 664 patients without stroke matched with gender and age were compared and analyzed with the non-conditional Logistic regression. The AIS pa-tients were divided based on the CISS, and their bilirubin levels were compared. The AIS patients were divided into high bilirubin group and normal bilirubin group, their scores of the National Institute of Health Stroke Scale (NIHSS) as admission and discharge, and neural func-tion improvement rate were compared. Results The levels of total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) were higher in the AIS group than in the control group (P<0.01), and the TBIL was the independent risk factors of AIS (OR=1.026, 95%CI 1.012-1.041, P<0.001). There was no significant difference of the levels of TBIL, DBIL and IBIL among the patients of CISS (P>0.05). The NIHSS score was higher in the high bilirubin group than in the normal bilirubin group as admission (P<0.05), but it was not significant as discharge (P>0.05), nor the rate of neural function improvement (P>0.05). Conclusion The serum bilirubin level elevated and correlated with the severity in the AIS patients, which might be the risk of pathogenesis and AIS. The bilirubin was not various with the CISS, and might be less involved in the short-term outcome of AIS.

This paper mainly discusses the development status in quo of field stretcher and its attachment with the history of field stretcher reviewed.The development trends of field stretcher in the future are also presented.

Objective To observe the expression of basic fibroblast growth factor(bFGF) at different stages of tooth germ development,and explore its mechanism and significance.Methods Immunohistochemical technique was used to examine the expressions of bFGF in the tooth germs at different stages of human fetus in 8-34 weeks,the suckling mice with 1-22 d,and the dog postnatal in 6 weeks-5 months.Results bFGF expressed in tooth germ at all stages.In human fetus,the positive reaction was observed in epithelium of tooth bud,dental plate,enamel organ,external and outer enamel.The ameloblasts,odontoblasts,epithelial root sheath and dental follicle showed strongly positive reaction in the unerupted human deciduous tooth,the tooth under the eruption of neonate external enamel,stratum intermedium cells,ameloblasts and odontoblasts showed strongly positive epithelium,dental papilla and dental follicle at bud stage and cap stage,while at bell stage cells in mice and 6 week postnatal canal tooth.The positive expressions of bFGF were observed in root of tooth,peridental ligament and the osteoblasts adjoin to peridental ligament in the dog succession of decideous teeth.Conclusion bFGF is one of critical regulator in the tooth development,which can regulate the differentiation and morphogenesis of tooth germ cells and control the eruption and succession of deciduous teeth at different stages.

To examine the effects of ischemia and anoxia on cell activation and cell cycle of astrocytes in vitro, the cell cycles and the proliferation of astrocytes in different time points after ischemia and anoxia were studied by flow cytometry and BrdU labeling and the expression of GFAP and cyclin D1 was detected by the fluorescence immunochemistry. After ischemia and anoxia in vitro, the astrocytes in S phase were significantly increased as compared with those in the normal group and the proliferating ability of the astrocytes was highest 6 h after the treatment as revealed by BrdU pulse labeling, but the astrocytes in S phase and proliferating ability were decreased after 6 h. At the early stages of ischemia and anoxia, the positive staining intensity of GFAP was increased, peaked at 6th h, while 12 h after the ischemia and anoxia, the positive staining intensity of GFAP became weak, and the expression of cyclin D1 was gradually increased after the ischemic and anoxic damage. It is concluded that astrocytes are activated to proliferate and enter new cycle events by ischemia and anoxia, and cyclin D1 is implicated in the proliferation and repair of astrocytes. The cell cycle events are closely associated with the proliferation and activation of astrocytes.
Animals, Newborn ; Astrocytes/*cytology ; Cell Cycle ; Cell Hypoxia ; Cell Proliferation ; Cells, Cultured ; Cyclin D1/biosynthesis ; Cyclin D1/genetics ; Glial Fibrillary Acidic Protein/*biosynthesis ; Glial Fibrillary Acidic Protein/genetics ; Rats, Wistar

Objective The correlation and agreement of mycophenolic acid (MPA) plasma concentrations that detected by enzyme extended immunoassay (EMIT) and high performance liquid chromatography (HPLC) were studied using Pearson's correlation and Bland-Altman plots.METHODS 435 plasma samples were collected from 95 renal transplant patients who were treated with MPA from October 2014 to December 2015.The MPA plasma concentrations were simultaneously measured by EMIT and HPLC respectively,and the results were divided into two levels.Paired t test and Pearson's correlation were performed using SPSS13.0 to evaluate the relationships between the results in each level.The Bland-Altman plot was used to assess the agreement of the results of two methods.Results Higher concentrations were obtained with EMIT,there was a significant positive bias of EMIT for MPA(20.94％ ±14.42 ％,P＜0.001).Pearson's correlation analysis and Bland-Altman analysis showed that the results from different methods presented good correlation (r＞0.98) and agreement.Conclusion The results of EMIT were higher than that of HPLC.There were good correlation and agreement between the two methods.The differences between EMIT and HPLC suggest that different therapeutic window should be set up when the two methods are used for MPA therapeutic drug monitoring.

Objectiye To observe the prevalence of prolonged seizures and the changes of biochemical markers of myocardial injury in patients with prolonged seizures after modified electroconvulsive therapy(MECT).Methods Patients treated with MECT or simulated ECT were divided into three groups.Group Ⅰ , 26 patients,experienced at least one prolonged seizure after MECT;group Ⅱ,41 selected patients, had not prolonged seizures at all during a course of MECT treatments and group Ⅲ, 31 patients, received simulated ECT.Biochemical markers of myocardial injury, including phosphocreatine kinase (CK), MR isoenzyme of phosphocreatine kinase (CK-MB), lactate dehydrogenase ( LDH ), α-hydroxybutyrate dehydrogenase ( α-HBDH ) and cardiac troponin (cTnT) ,were measured immediately, 3 hours later and on the following day after the first prolonged seizure for group Ⅰ ,the same time points as group Ⅰ after the first treatment of MECT for group Ⅱ , immediately after simulated ECT for group Ⅲ.These indexes were compared between the patients of three groups.Results The positive rate ofcTnT was 30.8%(8/26) and 17.1% (7/41)in group Ⅰ and Ⅱ respectively, but no difference was found(P＞0.05 ).CK measured immediately after MECT in patients of group Ⅰ was significantly higher than that of group Ⅲ(P ＜ 0.05 ).CK-MB (immediately), LDH ( immediately and 3 hours later) and α-HBDH ( immediately, 3 hours later and on the following day) in patients of group Ⅰ were significantly higher than those of group Ⅱ and Ⅲ measured after MECT or simulated ECT(P＜0.05 ).Conclusion More attention should be paid that absolute or relative hypoxemia may lead to minor myocardial injury.

Objective:To study the predictive value of the systemic immune inflammation index (SII) on the overall survival rate of patients after Whipple surgery for pancreatic ductal adenocarcinoma (PDAC).Methods:The clinical data of patients with PDAC who underwent Whipple surgery at the First Affiliated Hospital of Zhengzhou University from January 1, 2010 to December 31, 2017 were retrospectively analyzed, and the SII value was calculated. The best cut-off value of SII was 900, and all patients were divided into the low SII group (SII≤900) and the high SII group (SII>900) using 900 as the dividing point. The Kaplan-Meier method was used to draw survival curves and the log-rank test was used. The overall survival of the two groups of patients were analyzed. The Cox risk regression model was used to perform univariate analysis of the various clinicopathological parameters, and multivariate analysis for the statistically significant indicators.Results:Of 135 patients enrolled into this study, there were 78 males and 57 females, aged 28.0-76.0 (56.6±8.8) years. There were 92 patients in the low SII group, aged (56.9±9.2) years with 53 males and 39 females; and 43 patients in the high SII group, aged (56.1±7.9) years, with 25 males and 18 females. The median survival of the low SII group and the high SII group were 32.7 months (95% CI: 28.4-37.0) and 24.4 months (95% CI: 21.4-27.4), respectively. The survival of patients with PDAC in the low SII group was significantly higher than that in the high SII group ( P<0.05). On univariate survival analysis, postoperative overall survival of patients with PDAC was significantly associated with high SII ( HR=2.047, 95% CI: 1.354-3.096), R 1 margin ( HR=2.595, 95% CI: 1.663-4.048), a positive rate of lymph node>20% ( HR=3.244, 95% CI: 1.888-5.573), and positive regional lymph node (N1) ( HR=3.061, 95% CI: 1.993-4.702), all P<0.05. Multivariate Cox regression analysis showed that high SII ( HR=1.672, 95% CI: 1.094-2.555), R 1 resection margin ( HR=2.167, 95% CI: 1.274-3.685), and a positive rate of lymph node>20% ( HR=2.631, 95% CI: 1.309-5.285) to be independent risk factors affecting overall survival ( P<0.05). Conclusion:SII was an independent prognostic factor available before surgery for patients with PDAC. It has some guiding significance in predicting overall survival in patients after Whipple surgery for PDAC.

[ABSTRACT]OBJECTIVETo study the mRNA expression of glucocorticoid receptor(GR) in peripheral blood mononuclear cells in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) and its clinical significance. METHODSReal-time fluorescent quantitative PCR was used to detect GRα mRNA and GRβ mRNA exprssion in PBMC of 30 male patients with moderate to severe OSAHS and 27 healthy male subjects. The relationships between the expression of glucocorticoid receptor mRNA and the apnea hypopnea index, body mass index, neck circumference, waist circumference, the lowest oxygen saturation, the average oxygen saturation, the Epworth sleepiness scale(ESS) score, fasting blood glucose, heart rate and blood pressure were analyzed.RESULTSCompared with the control group, the expression level of GRα mRNA was lower in the OSAHS group(t=2.25,P<0.05) and the expression level of GRβmRNA had no difference between the two groups(t=1.43, P>0.05). We had not found the significant correlation between the expression of GRα mRNA and the clinical parameters above in OSAHS patients.CONCLUSIONThe expression of GRα mRNA in PBMC in moderate to severe OSAHS male patients have a downward trend compared with healthy group, but the mechanism remains unclear.

Objective To survey the basic situation of trainees, the career awareness, the requirement for training, the problems in training, and the selection to the training institutions for the health management specialist trainees. Method Using the cluster sampling method, the trainees from two health management specialist training institutions in Hunan Province were randomly selected from Oct. 2012 to Jun. 2014, a total of 543 trainees were recruited from tertiary health management specialist trainees of 12 periods training a questionnaire survey was conducted. Result Totally 474 valid questionnaires were received, the effective rate was 87.3%. The trainees were mainly from college or undergraduate settings (366, 77.2%), medical professionals (430, 90.7%). The main purpose of the training was to improve their knowledge and technique. Students' demands in the theory content for health management training mainly included the health monitoring (396, 83.5%), health education and health promotion (384, 81.0%), health risk assessment and risk management (382, 80.6%), health intervention plan formulation, implementation and evaluation (360, 75.9%). Demand for practical skills was mainly for health monitoring (426, 89.9%), health risk assessment (424, 89.5%), health interventions (410, 86.5%), health plan formulation, implementation and evaluation (402, 84.8%), health management in the application of specific people (398, 84.0%), etc. At the same time, most of the students considered that for teaching arrangement equal attention to theory and practice should be paid (320, 67.5%). Conclusion Health management specialist training is still in its infancy in China;establishment and improvement of the relevant policies about health management system and forming a complete standard set of health management specialist training system are imminent.