Objective To investigate the main predisposing factors of hematoma enlargement in spontaneous intracerebral hemorrhage,reduce the early mortality,and improve clinical outcomes.Methods By a retrospective study of 268 patients,all patients underwent their first computed tomography (CT)scan within 24 hours of arrival and a second CT scan within 72 hours of admission.These predisposing factors were analyzed by means of univariate and multivariate logistic regression analyses.Results The patients occurred early hematoma enlargement were accounted for 27.99％ (75/268).Univariate analyses indicated that hematoma shape,midline shift,breaking into the ventricle,thrombin clotting time (TT),white blood cells,neutrophil percentage,serum creatinine,fasting plasma glucose (FPG),and Glasgow coma scale (GCS) were significantly different between the patients with or without hematoma enlargement (P ＜0.05).Furthermore,multivariate logistic regression analyses revealed that the following four factors were independently associated with hematoma enlargement:the midline shift [OR (95％ CI) =3.356 (1.251-8.999),P =0.000],the GCS score [OR (95 ％ CI) =0.745 (0.671-0.827),P =0.023],the FPG [OR (95％ CI) =3.022 (1.232-7.408),P =0.016],and the breaking into the ventricles [OR (95％ CI) =2.851(1.158-7.019),P =0.005].Conclusions The midline shift of brain CT scan,the GCS score,the FPG,and the breaking into the ventricles maybe the independent predisposing factors of hematoma enlargement.Therefore,timely review of CT scan and dynamic monitoring of peripheral blood biochemical indicators should be very important for further therapy.

Objective To observe the influence of health education on compliance of children nn-dergoing megacolon radical operation. Methods A questionnaire investigation was conducted on compli-ance of children undergoing megncolon radical operation before and after health education. ResultsCompliance of children patients and their family members increased after health education (P<0.05).Conclusions Health education could improve the compliance of children patients and their family mem-bers as well as the cognition about the disease knowledge so that the rehabilitation was facilitated.

Objective To establish a quantitative analysis of multi-components by single-marker (QAMS) for determination of four components (adenosine, uridine, guanosine, (R, S)-goitrin) in Isatidis Radix granules.Method The QAMS for Isatidis Radix granules was established and validated and adenosine was selected as the internal reference substance.The relative correction factor (RCF) of other three components were calculated.The contents of four components were determined by both external standard method and QAMS.The QAMS method was validated through comparison of the results obtained by the two different methods.Results The RCFs of uridine, guanosine and (R, S)-goitrin all showed good reproducibility within certain ranges.For Isatidis Radix granules, uridine, guanosine and (R, S)-goitrin, there was no significant difference between the quantitative results of the two methods.Conclusions The QAMS method is simple, feasible and credible to be used for comprehensive quality control of Isatidis Radix granules.

Bipolar disorder(BD)is a serious mood disorder with high prevalence,morbidity and mortality rates. Glycogen synthase kinase-3β(GSK-3β) is a multifunctional serine/threonine protein kinase that is generally located in eukaryotic cells with such functions as the adjustment of the synthe?sis of glycogen metabolism,cell proliferation and differentiation and gene expression. It is involved in multiple signaling pathways and regulates cell signaling proteins,structural proteins and transcription factors through phosphorylation,affecting the survival of the neurons and plasticity. According to gene poly?morphism and clinical studies,GSK-3β may be associated with BD. As a GSK-3β inhibitor,lithium is an effective BD therapeutic drug,and the small molecule inhibitor targeting GSK-3βis also a hotspot of BD treatment. GSK-3βmay be a potential target in the treatment of BD.

Objective To investigate the correlation of possible risk factors with acute renal injury (AKI) after coronary artery bypass surgery (CABG) and explore if the incidence of AKI could be lower by off-pump CABG for kidney protection.Methods Two hundred and nine patients who underwent coronary artery bypass surgery in Nanjing First Hospital from September 2010 to November 2013 were recruited.The patients were divided into AKI group (fifty-five cases) and non-AKI group (one hundred and fifty-four cases) according to the AKI criteria and compared the possible risk factors between two the groups by univariate analysis and multivariate analysis.Results The index of female gender,body mass index,age,hypertension,basic serum creatinine,ejection fraction,the number of coronary atherosclerosis,cardiopulmonary bypass,IABP for circulatory support,postoperative low cardiac output,lactate in AKI group were higher than that in non-AKI group by univariate analysis (P ＜ 0.05).And basic serum creatinine,ejection fraction,cardiopulmonary bypass,postoperative low cardiac output showed a significantly statistical difference between two group by multivariate analysis.Conclusions Cardiopulmonary bypass,basic serum creatinine,ejection fraction,postoperative low cardiac output were independent risk factors.Off-pump CABG could benefit for kidney protection.

Objective To optimize human acellular dermal matrix(ADM) and evaluate its biological characters. Methods Human skin was treated with hypertonic saline followed by NaOH maceration(group A), hypertonic saline followed by sodium dodecyl sulfate (SDS) detergent(group B) or Dispase Ⅱ followed by Triton X-100(group C), the resulting ADM were sectioned, and then were stained by special immunohistochemistry method. The cytotoxicity of them were evaluated by methyl thiazolyl tetrazolium (MTT) colorimetry and then cell compatibility was analyzed by cell culture;The optimized ADM resulted was choosen for use. Fibrablasts(FBs)were transfected with adenovirus vector encoding green fluorescent protein gene(Ad-GFP)and the growth of them on the optimized ADM was observed by fluorescent microscopy. Results Collagen and elastic fibers can still be observed in three kinds of ADM. The cells in dermis can be disintegrated both in group A and C, but not in group B. The cytotoxicity scores of the ADM prepared in group A and B were grade 0 or grade 1, while that of group C was more than grade 1.The ADM prepared by NaCl-NaOH maceration had good biocompatibility. There was statistical difference in adhering number of NIH3T3 cells in group A and B. NIH3T3 cells grew well in group A and the resulted ADM was optimized. FBs transfected with Ad-GFP grew well in the optimized ADM. Conclusion The ADM prepared by NaCl-NaOH maceration was a good tissue engineering biomaterial with a little cytotoxicity and rich in resouce.

Objective To investigate the electrocardiographic(ECG) characteristics and assess the safety of radiofrequency catheter ablation (RFCA) of ventricular tachyeardia (VT), and frequent ventricular premature con- tractious(VPCs) originating from left ventricular outflow tract(LVOT). Methods Twelve-lead ECG analysis and RFCA were performed in 9 patient with VT or VPCs originating from LVOT. Results The sites to be successfully ablated were in left valsalva sinus in 6 patients,and subaortic valve in 3 patient. ECG revealed tall R wave in leads Ⅱ, Ⅲ ,aVF, V5 and V6. QS morphology in both leads aVR and aVL,QS morphology in lead Ⅰ in most cases. R wave in lead Ⅰ was relative tall, the R/S wave amplitude in lead V1 was over 0.62 ,and precordia R wave transition was irregular. All 9 patients were successfully ablated. No death or recurrenced case during follow-up. Conclusion Ventricular taehycardia and frequent ventricular premature rcontractions originating from left ventricutar outflow tract could be known by some specific ECG characteristics and could be radically treated safely by RFCA.

Objective To analyze the risk factors leading to prolonged mechanical ventilation following valve replacement surgery with the purpose of improving the management of these patients.Methods The risk factors of prolonged mechanical ventilation at preoperative,operative and postoperative clinical data of 307 patients who underwent valve replacement surgery were retrospectively analyzed.Binary Logistic regression model was used to assess the factors.Results The time of mechanical ventilation after valve replacement surgery was (15 ± 35) h,and 31.6％ (97/307) of these patients underwent prolonged mechanical ventilation (＞ 8 h).Age ≥ 65 years (P =0.003),smoker (P =0.024),left ventricular ejection fraction (LVEF) preoperative (P =0.002),duration of operation (P =0.000),aortic block time (P =0.046),cardiopulmonary bypass time (P =0.030),number of replaced valve (P =0.001),volume of postoperative chest drainage (P =0.000) and postoperative complications (P =0.010) were risk factors of prolonged mechanical ventilation.Logistic regression analysis showed that LVEF (P =0.026),duration of operation(P =0.037),aortic block time (P =0.001),cardiopulmonary bypass time (P =0.013),number of replaced valve (P =0.017),volume of postoperative chest drainage (P =0.020) and postoperative complications (P =0.014) had extremely affection.Conclusions Greater importance should be attached to healthcare education,early treatment to avoid multivalvular involvement,preoperative heart function regulation,lower duration of operation especially aortic block time and cardiopulmonary bypass time,lower postoperative chest drainage and better preservation of organs during operation to decrease the rate of prolonged mechanical ventilation and optimize the clinical quality.

AIM:To investigate the effects and mechanisms of sphingosine-1-phosphate receptor-2 (S1P2R) on lipopolysaccharide (LPS)-induced acute lung injury (ALI).METHODS:ALI model was induced by intratracheal ad-ministration of LPS in both wild-type mice and S1P2R-deficient mice.The pathological changes in the lung tissues were ob-served, and the protein concentration , total cell number, neutrophil ratio, TNF-αlevel and IL-6 level were determined in the bronchoalveolar lavage fluid (BALF) 24 h after LPS injection.In order to investigate the mechanisms of S1P2R in LPS-induced ALI, 10 min before LPS injection, both wild-type mice and S1P2R-deficient mice were injected with nitric oxide synthase inhibitor by tail vein injection , the pathological changes of the lung tissues were observed , and the protein concen-tration and total cell number in BALF were determined 12 h after LPS injection .RESULTS: Compared with wild-type mice, S1P2R-deficient mice showed more severe LPS-induced ALI, and the protein concentration , neutrophils and inflam-matory cytokines in BALF were significantly increased in S1P2R-deficient mice.Administration of nitric oxide synthase in-hibitor Nω-L-nitro-arginine methyl ester protected S1P2R-deficient mice from aggravation of ALI .CONCLUSION:S1P2R mediates the protection from LPS-induced ALI possibly through inhibiting nitric oxide synthase .

Diabetic retinopathy is a major cause of blindness all over the world, and it is one of the most serious and common microvascular complications of diabetes. Breakdown of the endothelial blood - retinal barrier ( BRB ) , as occurs in diabetic retinopathy, result in vasogenic edema and neural tissue damage, causing loss of vision. The inner BRB is created by complex tight juctions of retinal capillary endothelial cells, this barrier prevents the free diffusion of substances between the circulating blood and the neural retinal, the inner BRB efficiently supplies nutrients to the retinal and removes endobiotics and xenobiotics from the retina to maintain a constant milieu in the neural retina. The central mechanism of altered inner BRB function is a change in the permeability characteristics of retinal endothelial cells caused by elevated levels of cytokines, growth factors, advanced glycation end products, inflammation, hyperglycema and loss of pericytes. This article reviews the relationship between diabetes and the ultrastructure changes of BRB.