This paper analyzed the procedure and organization for developing the clinical guidance by the National Institute for Health and Clinical Excellence(NICE).Focusing on the balancer role of NICE in the UK healthcare system as a statutory criteria maker,it analyzed the implementation and assurance mechanism of the clinical guidance for policy recommendations to the making and effective implantation of such a guidance in China.

EMGs were observed and analysed in 129 patients with bone-fluorosis (65 males, 64 females). It was found that muscular tissues were involved initially and the EMGs of these patients belonged to those of polymyositis. They are classified into four types: normal EMGs (25 cases), grade Ⅰ and grade Ⅱ myositis (86 eases) and cervicalis, lumber, sacral nerve root and peripheral nerve injuries (18 cases). The therapeutic effect of Fu Ning has teen affirmed in this study. There is obvious difference (p

Vaccine is expected to be a promising tool for malaria prevention and control.However, safe and effe-ctive malaria vaccine is not yet available for field use so far.They can be pre-erythrocytic stage vaccine, blood stage vac-cine and transmission-blocking vaccine.This review summarizes the progress of the vaccine development in the recent field trials.

MELAS syndrome(mitochondrial myopathy encephalophathy with lactic acidosis and stroke-like episodes),as one of the most common diseases in mitochondrial encephalomyopathies,is characterized by highly variable manifestations.So,more and more people come to realize the importance of molecular basis of MELAS.This review took the commonest mtDNA point mutation(A3243G) for example to overview its molecular biological mechanism,test strategy and recent progress of study on MELAS syndrome.

Microinjoction of thy-rotropin-releasing hormone (TRH) into par-avemricular nucleus (PVN ) obiviously increased gastric motility: frequency of gastric motility change from 3~1 times ? min-1 to 6 ~ 8 times ? min-1. intergastric pressure (IGP) rose from 0. 49 ? 0. 01kPa to 1. 9 1 ? 0. 5kPa. (P

This review summarized the current progress in the pathogenesis of leptin-mediated liver disease including fatty liver, hepatitis,fibrosis or cirrhosis. Analysis of leptin effect on activation of hepatic Kupffer cells and hepatic stellate cells was made and molecular mechanism and signal pathways were also discussed.

Objective To investigate the clinical features of stroke in young adults with infective endocarditis (IE).Methods This is a retrospective analysis of clinical data of young patients (aged between 18 and 44 years) diagnosed with IE in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2003 to March 2013.Results Three hundred IE patients (209 male and 91 female) were enrolled with mean age of (31.8 ± 7.8) years old.Fourteen of them were prosthetic valve endocarditis.All of the cases were found vegetations.The vegetations were mainly distributed in the mitral valve and/or aortic valve (262/300 patients).Congenital heart disease and rheumatic valvular disease were most frequently background diseases.Thirty-five cases (11.7％) were complicated with stroke.Among them,21 cases were with cerebral infarction (including 7 subjects with hemorrhagic transformation),9 cases with cerebral hemorrhage,3 cases with subarachnoid hemorrhage,and 2 with reasons unknown.Within the 21 cerebral infarction cases,the infarction sites were mainly distributed in internal carotid artery system with 5 cases involving bilateral internal carotid artery systems and 2 vertebro-basilar artery systems.As to the cerebral hemorrhage,lobar were the bleeding sites in all cases,and mainly distributed in internal carotid artery system.The proportions of left-sided endocarditis and rheumatic valvular disease were significantly higher in patients with stroke than those without [100.0％ (35/35) vs 86.4％ (229/265),P =0.02;22.8％ (8/35) vs 6.4％ (17/265),P =0.001,respectively].Regression analysis showed that the OR of the rheumatic valvular disease for stroke in young IE patients was 4.950 (95％ CI 1.626-15.072),and the OR of stroke for death was 8.387 (95％ CI 1.997-35.225),respectively.Conclusions Stroke is common in young patients with IE.Cerebral infarction often involves multiple vascular systems,and is prone to hemorrhagic transformation.Intracerebral hemorrhage often occurs in lobar.Rheumatic valvular disease might be a risk factor for stroke in young patients with IE,which is an independent risk factor for death of these patients.

Objective To summarize the characteristics of neurological symptoms in patients with aortic dissection.Methods The clinical data including symptoms,signs,and imaging of 865 consecutive patients with aortic dissection were analyzed retrospectively.Results Neurological symptoms occurred in 225 cases (26.0％) with aortic dissection.The most common symptom was dizziness (56 cases,6.5％),followed by syncope (49,5.7％),single lower limb sensory disturbances(47,5.4％),single lower extremity weakness(27,3.1％),coma (22,2.5％),paraplegia (19,2.2％),headache (13,1.5％)and hemiplegia (9,1.0％).The first manifestation of five cases was the neurological symptoms,including syncope (2),dizziness(1)and headache (2).Patients with type A aortic dissection were more vulnerable to the neurological symptoms than those with type B aortic dissection (34.6％ vs 14.7％),and the symptoms with significantly higher occurrence were syncope,coma,hemiplegia,paraplegia and lower limb sensory disturbances.Conclusion Neurological symptoms are common in patients with aortic dissection,especially in those with type A aortic dissection.

Objective To investigate the clinical characteristics of stroke in young patients with cardiac myxoma.Methods Medical records of young patients (aged between 18-44 years) diagnosed with cardiac myxoma in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2005 to March 2016 were retrospective reviewed.Results A total of 117 cases were included (85 female and 32 male)with the average age (36 ±7)years old.Most myxomas (83.8％) were located in the left atrium,7.7％ were in the right atrium,3.5％ were in the both atriums,2.6％ were in the left ventricle,and a few were in the left atrium plus left ventricle and in the right ventricle.Of all the patients,24 (20.5％) (16 women and 8 men) were complicated with cerebral infarction.Among them,3 patients were with lower extremity arterial embolisms.Two patients were with cerebral hemorrhage.The cerebral infarction mainly involved in the distribution area of the internal carotid artery.Infarctions involving 2 or more cerebral vessels were found in 4 cases.Most subjects (58.3％) manifested with hemiplegia,and some (18.2％) with syncope.The proportion of the left atrial myxoma in patients with cerebral infarction (100.0％) was significantly higher than those in patients without cerebral infarction (85.1％,P =0.044).Subjects with tumor diameter less than 3 cm were more frequently complicated with cerebral infarction (37.5％ vs 13.8％,P =0.009).A logistic analysis showed that the odds ratio of myxoma with tumor diameter less than 3 cm for cerebral infarction was 3.750 (95％ CI 1.343-10.470).Conclusions Cardiac myxoma is more common in young women,and often complicated with cerebral infarction.The infarctions are mainly distributed in internal carotid artery system,and some are involved in multiple vascular systems.The incidence of stroke is associated with the position of the myxoma.Smail-size myxoma cannot be ignored for its risk of stroke.

BACKGROUND: Ginsenoside Rb1 has been extensively used in the protection and treatment of heart, encephalon, lung, kidney and liver damage. However, its application in skin flap is rare.OBJECTIVE: To investigate the effects of intraperitoneal injection of ginsenoside Rb1 on the survival of the dorsal random-pattern skin flap with large length-to-width ratio in rats.METHODS: Healthy adult SD rats were randomly divided into experimental and control groups. A caudally based dorsal random pattern skin flap, 80 mmx20 mm (length: width = 4:1), was symmetrically made. Ginsenoside Rb1 (2 mg/kg) was intraperitoneally injected into the experimental group rats, and the same volume of normal saline was injected into the control group. Malonyl dialdehyde (MDA) and nitric oxide (NO) level of the flaps were tested 1 day after operation; the amount of viable tissues of the flaps were examined by planimetry 10 days after operation. Specimens from the proximal, middle and distal flaps were harvested for HE staining to examine the microstructure.RESULTS AND CONCLUSION: At the first day after operation, NO level was higher in the experimental group than the control group (P< 0.01), while MDA level was lower than the control group (P< 0.01). At the 10th day after operation, the survival rate of the flap was significantly greater in the experimental group than the control group (P < 0.001). Histological observation showed that compared with the control group, the edema and inflammatory cells infiltration were less, while the fiber hyperplasia and the microvascular growth were more obvious in the experimental group. Results show that intraperitoneal injection of ginsenoside Rb1 can enhance the blood supply of the flaps and improve the survival of the random-pattern skin flaps with large length-to-width ratio in rats. This may involve its effects of improving NO activity, decreasing lipid peroxidation, and promoting angiogenesis of skin flaps.