Objective To investigate the clinical significance of observing the dynamic morphological changes of circle cistern on CT scanning in the patients with acute severe traumatic brain injtuy (TBI).Methods The CT imaging data of circle cistern of 135 patients with acute severe TBI were analyzed retrospectively.According to the morphological changes of circle cisterns on the initial CT images,135 cases were divided into 5 groups,and 135 cases carried on prognostic evaluation with Glasgow outcome score (GOS) 6 months later.The relationship between the dynamic morphological changes of circle cistern and the prognosis of patients were analyzed statistically.Results There was a significant relationship between the state of circle cistern and the prognosis of patients.The more obvious the dynamic morphological changes of circle cistern were,the worse prognosis and the higher the fatality was,especially higher mortality in patients with exacerbation of the dynamic morphological changes of circle cistern (79.5％),and the difference was statistically significant among 5 groups (P ＜ 0.01).Conclusions There was a significant relationship between the state of circle cistern and the prognosis of the patients with acute severe TBI.The dynamic morphological changes of circle cistern on CT scanning might be used as a promising marker to evaluate the severity of severe TBI,especially in the patients at earlier posttraumatic interval.It is necessary to observe the dynamic change of circle cistern.

Objective To learn quality of life of acute upper respiratory tract infection patients and their influence factors.Methods We conducted questionnaire investigation on acute upper respiratory tract infection patients from five hospitals,respectively located in Wuhan,Hefei and Jinhua.The scale we used is EQ-5D.We calculated EQ-5D score through three different integration systems,which are from China,Korea and the UK,in order to compare difference among different countries' integration systems.Then econometric model was used to carry out regression analysis on factors affected EQ-5D score.Results 659 samples was included,with 319 from Wuhan,235 from Hefei and 105 from Jinhua.Among EQ-5D five dimensions,the first three dimensions do not have problems.However,81.94％ of the patients have problems in pain/discomfort and 47.8％ of them have problems in anxiety/depression.In regression analysis,location,severity level of disease and whether accompanied by chronic diseases or not have influence on EQ-5D score.Compared with utilities of patients who are suffered from other diseases,utilities of acute upper respiratory tract infection patients are lower than that of cerebral apoplexy,hypertension,coronary heart diseaseand diabetes patients;but are higher than that of Chronic lymphatic filariasis,chronic obstructive pneumonia and rheumatoid arthritis patients.Conclusion Chinese acute upper respiratory tract infection patients mainly have problems in the dimension of pain/discomfort and anxiety/depression.Compared to British integration system,Korean's is more applicable to Chinese population.Acute upper respiratory tract infection patients' utilities are lower than that of healthy population and chronic invalids with no obvious symptoms,and higher than that of chronic invalids with obvious symptoms.

Objective To investigate the effects of edaravone on myocardial fibrosis induced by isoproterenol (ISO) in rats, and to discuss the correlation between the level of transforming growth factor-β1 (TGF-β1) and the myocardial fibrosis. Methods Forty male SD rats were randomly divided into five groups, namely control group, model group and edaravone groups (low, medium and high doses). Isoproterenol was used to establish the rat model of myocardial fibrosis. Edaravone groups were given edaravone [3, 5 and 10 mg/(kg · d)] to intervene for 14 days. The activity of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) were examined after 15-d treatment. The left ventricular mass index (LVMI) and collagen volume fraction (CVF) were examined. The expression of TGF-β1 was detected by Western blot assay and immuno-fluorescence method. Results The content of MDA and LVMI were significantly higher in model group than those of the control group (P<0.01),whereas the content of SOD was significantly lower in model group than that of the control group (P<0.01). Compared with model group, the expression level of MDA decreased with the increased intervention dose of edara-vone (P<0.05), while SOD expression level increased (P<0.05). There was no significant difference in the level of SOD be-tween middle dose edaravone group and the control group. LVMI was decreased with the increased doses of edaravone ( P<0.01). There was no significant difference in LVMI between the high dose of edaravone group and the control group. Com-pared with the control group, the expression level of TGF-β1 was significantly increased in model group (P<0.01). The ex-pression level of TGF-β1 was reduced with the increased doses of edaravone. CVF was significantly increased in model group compared with that of control group (P<0.001). CVF decreased with the increased doses of edaravone in medium and high doses of edaravone groups, but they were higher than that of control group (P<0.01). TGF-β1 was positively correlated with MDA, LVMI and CVF (r=0.931, 0.879 and 0.930, P<0.001). SOD was negatively correlated with TGF-β1 (r=-0.892, P<0.001). Conclusion Edaravone can relieve myocardial fibrosis by inhibiting oxidative stress and TGF-β1 in rats.

Objective To investigate the effects of troglitazone on cholesterol homeostasis and secretion of 3T3-L1 cells by sirolimus and the underlying mechanisms. Methods In vitro cultured 3T3-L1 cells were divided into control group,sirolimus (100 nmol/L) group,sirolimus(100nmol/L)+ troglitazone (10 μmol/L) group and troglitazone (10 μmol/L) group.High performance liquid chromatography (HPLC) was used to measure intracellular cholesterol accumulation.ELISA was used to measure leptin excretion.Quantitative real-time PCR and Western blotting were used to examine mRNA and protein expression of PPARγ. Results Free cholesterol of sirolimus +troglitazone group was 1.19 times of sirolimus group (P＜0.05).The leptin secretion levels of control group,sirolimus group,sirolimus+troglitazone group and troglitazone group were (19.02±0.52) μg/L,(15.62±0.47) μg/L,(16.45±0.51) μg/L,(18.07±0.66) μg/L,respectively.And the leptin secretion level of sirolimus+ troglitazone group was 1.05 times of sirolimus group (P＜0.05).The PPARγmRNA expressions of sirolinus group,sirolimus + troglitazone group and troglitazone group were 0.60±0.14,1.12±0.27,1.30±:0.14 folds of control,and the PPARγ mRNA expression of sirolimus + troglitazone group was higher than that of sirolimus group (P＜0.05).PPARγ protein expression had the same tendency. Conclusion Troglitazone reduces the inhibitory effect of sirolimus on PPARγ transactivation and the inhibitory effect of sirolimus on 3T3-L1 cells differentiation and adipogenesis.

Objective To investigate the application effect of anterior clinoid process drilled off via epidural approach in posterior communicating artery aneurysm ( PCoAA) clipping. Methods The clinical data of 42 patients with PCoAA who underwent craniotomy from January 2012 to January 2014 were analyzed retrospectively,including 22 patients performed anterior clinoid process drilled off and 20 did not. The difficult or easy degree of intraoperative aneurysm clipping and postoperative efficacy were analyzed. Results The aneurysms in 22 patients underwent anterior clinoid process were clipped satisfactorily. The brain retractor was not used during the procedure. Only one patient had cerebral infarction after procedure. No patients had oculomotor nerve paralysis and incomplete clipping of aneurysms. Of the 20 patients without the anterior clinoid process drilled off,3 aneurysms were clipped incompletely because it was difficult to implant aneurysm clips, 2 had cerebral infarction, and 1 had oculomotor nerve paralysis. Conclusion Removing the anterior clinoid process drilled off via extradural approach may bring convenience for PCoAA clipping. It can effectively avoid the difficulty of implanting aneurysm clips during the procedure. Its application is safe and can reduce postoperative complications.

This article analyzes the current characteristic of cardiology teaching.In light of advantages of network education,it discusses the prospect of network-based education and some problems.

Objective To assess the relationship between diffusion-weighted imaging-perfusionweighted imaging (DWI-PWI) mismatch and the prognosis of patients with acute anterior circulation ischemic stroke receiving intravenous thrombolysis.Methods Patients with acute anterior circulation ischemic stroke who finished multimode MRI (T1 WI,T2 WI,DWI,PWI) within 4.5 hours after disease onset were recruited in this study.They were divided into DWI-PWI mismatched and matched groups.All patients received intravenous thrombolysis using recombinant tissue type plasminogen activator (rt-PA).Head CT was performed 24 hours later to exclude cerebral hemorrhage,and the patients were followed up for 3 months.The improvement of neurological function,the rate of death and symptomatic intracranial hemorrhage (sICH) were recorded.Results A total of 63 patients were recruited in this study,of which 41 patients presented DWI-PWI mismatch while 22 patients presented DWI-PWI match.Three months later,the rate of the improvement of neurological function in the DWI-PWI mismatched group was significantly higher than that in the DWI-PWI matched group (70.7％ vs 40.9％,x2 =5.32,P =0.021).Of note,no significant difference in the rate of death and sICH was found between DWI-PWI mismatched and matched groups (9.8％ vs 13.6％,x2 =0.22,P =0.640).Conclusions Compared with DWI-PWI matched group,the DWI-PWI mismatched group has better prognosis after receiving intravenous tbrombolysis.The results provide more direct evidence supporting the application of intravenous thrombolysis under the guidance of multimode MRI in acute anterior circulation ischemic stroke.

Objective To study the effects of diet and exercise intervention on prognosis of nonalcoholic fatty liver disease (NAFLD).Methods Fifty two patients with NAFLD received diet and exercise intervention.The treatment effects before and after intervention were analyzed.Result The body mass index(BMI),triglyceride(TG),cholesterol(TC)were significantly lower than those in control group after three-month intervention(all P<0.05).Conclusions Diet and exercise intervention can effectively improve liver function and promote the prognosis of nonalcoholic fatty liver,thus promote their quality of life.

Objective:To analyze bone strength index, osteoporosis and fracture in ankylosing spondylitis (AS) patients with radiologic hip involvement and explore the characteristics of bone strength in these patients.Methods:According to bath ankylosing spondylitis radiology hip index (BASRI-hip) score, 339 AS patients were divided into two groups. The differences of bone strength in each group were analyzed by t-test, Mann-Whitney U test and χ2 test. Logistic regression was used to analyze the risk factors of bone strength index. The correlation between quantitative ultrasound and dualenergy X-ray absorptiometry (DXA) (total hip, g/cm 2) was analyzed. Pearson correlation analysis was used. Results:①Bone strength index of quantitative ultrasound was positively correlated with bone mineral density of DXA (total hip, g/cm 2), r=0.553, P<0.01. ② The age of 27(23, 37) years old in radiographic hip involvement was lower than 37(28, 48) years old in non-radiographic hip involvement, and the difference was statistically significant ( Z=-5.986, P<0.01). There were no differences in gender and course of disease between the two groups ( P>0.05).③ The radiographic hip involvement in AS patients whose ages were younger than 50, when compared with non-radiographic hip involvement patients, the bone strength index was lower (78±18 vs 84±16), while bone strength was lower than patients at the same age (41.0% vs 18.4%), however, the incidences of osteoporosis (42.7% vs 28.8%) and fragility fracture (3.7% vs 0%) were significantly higher ( t=3.028, P<0.01; χ2=16.758, P<0.01; χ2=5.886, P=0.019; χ2=4.67, P=0.038). For AS patients whose ages were ≥50, there were no significant differences between the two groups ( P>0.05). ④ Multivariate analysis showed that radiographic hip involvement [ OR (95% CI)=1.912(1.05, 3.48)], age [ OR (95% CI)=0.94(0.911, 0.97)] and body mass index (BMI) (kg/m 2) [ OR (95% CI) =0.875(0.807, 0.948)] were associated with lower bone strength. Conclusion:There is positive correlation between the bone strength index of quantitative ultrasound and bone mineral density of DXA. AS patients with radiographic hip involvement are characterized by decreased bone strength and are more likely to develop osteoporosis and fragile fractures. The risk factors of low bone strength are radiographic hip involvement, age and BMI.

Objective To assess the value of plasma level of cystatin C(Cyst-C)and carotid artery plaque score(PS)in predicting significant coronary artery disease(SCAD)in patients with chest pain. Methods A total of 192 patients with chest pain were involved retrospectively. According to the coronary angiography results ,the patients were divided into groups of SCAD (n = 128) and non-significant coronary artery disease (NSCAD , n = 64). Analyses were done to discuss the association of Cyst-C and PS with SCAD and the predictive value of Cyst-C and PS for SCAD. Results Logistic regression analysis demonstrated that Cyst-C and PS were independent predictors of SCAD. The odds ratios(OR)associated with the Cyst-C(each 1 mg/L)and PS(each 1 mm)for prediction of SCAD were 1.329 and 1.197,respectively. The areas under the receiver-operating characteristic curves(AUC)for the Cyst-C and the PS to predict the SCAD were 0.654 and 0.688,respectively. The combination of Cyst-C and PS increased the AUC to 0.742. The optimal cut-off value of Cyst-C was 0.95 mg/L and had a sensitivity of 72.3% for SCAD. Similarly,the optimal cut-off level of PS was 3mm which presented a sensitivity of 70.7%. A Cyst-C ≥ 0.95 mg/L and a PS ≥ 3 mm had negative predictive values of 46.3% and 48.3%,respectively,for SCAD. By combining Cyst-C with PS ,the sensitivity and negative predictive value increased to 83.6%and 62.5%, respectively. Conclusions Cyst-C and PS are both correlated with SCAD. They are independent predictive factors for SCAD in patients with chest pain. Combination of Cyst-C and PS can improve the predictability ,which may increase the reliability of screening SCAD before cardiac catheterization.