Stenosis or occlusion of vertebral artery origin is one of important reasons of posterior circulation ischemia. Vertebral artery stenting can reduce posterior circulation ischemia in patients with vertebral artery origin stenosis. Restenosis after stenting is an important reason influencing the long-term efficacy.This article reviews treatment approaches of vertebral artery origin stenosis, restenosis after stenting and the related factors.

Objective To investigate compliance rate of clinic appointments among residents contracting family doctor service and its influencing factors.Methods Total 1 442 clinic appointments among residents contracting family doctor service in Yuetan community were investigated by face to face questionnaire.Results Among 1 442 clinic appointments in Yuetan community health service center in June 2015,563 were kept with a compliance rate of 37.2％.There were significant difference in compliance rate among the residents with difference degree of education (OR =1.461,95 ％ CI:1.296-1.646,P =0.000),between those with and without chronic diseases(OR =2.009,95％ CI:1.136-3.550,P =0.016),with and without receiving first contact care at community (OR =1.360,95％ CI:1.036-1.785,P =0.027),with and without satisfying with family doctor service (OR =1.315,95 ％ CI:1.060-1.630,P =0.013),with and without recognizing clinic appointment system (OR =2.765,95％ CI:2.142-3.569,P =0.000).Among the 906 failed appointments,the reasons were forgetting the appointment in 525 (57.9％),missing the date in 124 (13.7％),time conflict in 92 (10.2％),not bring reservation form in 85 (9.4％),being hospitalized or engaging in other medical service in 41 (4.5％) andneglecting appointment system in 39 (4.3％).Conclusion Compliance rate of clinic appointments among residents contracting family doctor service is lower,and necessary measures should be taken to increase the compliance rate.

Aging ; Humans ; Presbycusis ; genetics

Objectives To investigate the effect of leptomeningeal anastomoses (LMA) compensation of anterior cerebral artery (ACA) on the size of cerebral infarction in patients with chronic middle cerebral artery occlusion (CMCAO) and to analyze the correlation between middle cerebral artery (MCA) velocity and cerebral infarction area.Methods From June 2014 to June 2016,35 consecutive patients with CMCAO from the Department of Neurology,Yanbian University Hospital and 74 with CMCAO from the Department of Neurology,Beijing Xuanwu Hospital,Capital Medical University were enrolled retrospectively.All patients were diagnosed as CMCAO on one side and MCA was normal on the other side with transcranial Doppler (TCD) or transcranial color-coded sonography (TCCS) and confirmed by digital subtraction angiography (DSA).They were divided into either a LMA group (n=49) or a non-LMA (NLMA) group (n=60) according to the DSA revealed ACA.TCCS and/or TCD were used to measure and record the peak systolic velocity (PSV) and mean flow velocity (MFV) of the contralateral and ipsilateral MCA,and the ratios of bilateral PSV were calculated.They were divided into 4 grades,including normal brain tissue,cerebral lacunar infarction,small and moderate cerebral infarction,and large cerebral infarction according to the findings of diffusion-weighted imaging (DWI).Mann-Whitney test was used to compare the differences of cerebral infarction areas between the LMA group and the NLMA group,and Spearman rank correlation analysis was used to analyze the correlation between the MCA blood flow parameters of the ipsilateral side and the cerebral infarction area.Results (1) The patients with stroke accounted for 90.0% (n=54) in the NLMA group,and it was significantly higher than 71.4% (n=35) in the LAM group.There was significant difference between the two groups (P<0.05).(2) The severity of cerebral infarction in the NLMA group was significantly higher than that in the LMA group.DWI revealed that the LMA group was mainly lacunar infarction (51.0%,n=25),the NLMA group was mainly small and moderate infarction (45.0%,n=27),the incidence of large infarction (21.7%,n=13) was higher than that in the LMA group (4.1%,n=2).The difference between the two groups was statistically significant (P<0.01).(3) The cerebral infarction area in patients of the NLMA group showed moderately negative correlation with PSV of MCA (r=-0.736,P<0.01),and increased with the increase of contralateral side of PSV/ipsilateral side of PSV,there was a high positive correlation (r=0.849,P<0.01).Conclusion The compensatory function of meningeal branches of the anterior cerebral artery in patients with CMCAO was associated with the severity of cerebral infarction.The decreased MCA blood flow velocity on the ipsilateral side had a significant correlation with cerebral infarction area.

Objective To compare the effects on neurobiological factors of attributional retraining group therapy (ARGT) or selective serotonin reuptake inhibitors (SSRI) for major depressive disorder (MDD),anxiety disorder (AD) and obsessive-compulsive disorder (OCD).Methods Outpatients with MDD,AD and OCD were divided into ARGT group (n =63) and SSRI group (n =66) according to the sequence of entering the study.MDD,AD and OCD patients were respectively measured with Hamilton Depression Scale (HAMD),Hamilton Anxiety Scale (HAMA),and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and after 8 weeks treatment.All subjects were detected of plasma serotonin,norepinephrine,cortisol and adrenocorticotropic hormone by radioimmunoassay before and after treatment.Results After treatment,HAMD scores of MDD patients were reduced significantly in both ARGT group (t =18.411,P =0.000) and SSRI group (t =20.092,P =0.000) ; HAMA scores of GAD patients were reduced significantly in both ARGT group (t =13.989,P=0.000) and SSRI group (t=15.815,P=0.000) ;Y-BOCS scores of OCD patients were reduced significantly in both ARGT group (t =5.465,P =0.000)and SSRI group (t =4.792,P =0.000).In ARGT group,MDD (t =3.145,P =0.006),AD (t =2.785,P =0.012) and OCD patients (t =2.877,P =0.011) decreased plasma cortisol concentrations significantly.In SSRI group,MDD (t =-2.923,P =0.010) and OCD patients (t =-2.301,P =0.035) improved plasma serotonin significantly and MDD patients (t =-2.333,P =0.033) improved plasma norepinephrine significantly.Conclusion ARGT can modulate plasma cortisol level.SSRI can up-modulate plasma serotonin level.The two therapies take effect by different biological ways.

Objective To evaluate the role of AMP-activated protein kinase (AMPK)-dependent autophagic signaling pathway in ketamine-induced reduction of diabetic neuropathic pain (DNP) in rats.Methods Sixty male Wistar rats,aged 3 months,weighing 200-250 g,were equally randomized into 5 groups using a random number table:control group (C group),normal saline group (NS group),ketamine group (K group),ketamine + Compound C group (KC group),and ketamine + 3-methyladenine (3-MA) group (KM group).DNP model was established by intraperitoneal injection of streptozocin (STZ)65 mg/kg in anesthetized rats.Four weeks later,the equal volume of normal saline,ketamine 10 mg/kg,ketamine 10 mg/kg + Compound C1 mg/kg,and ketamine + 3-MA 2 μl were injected intraperitoneally once a day for 7 consecutive days in NS,K,KC and KM groups,respectively.The mechanical paw withdrawal threshold (MWT) was measured on 8th day.The rats were then sacrificed,and the lunbar segment (L1-5) of the spinal cord was removed for determination of the expression of AMPKαt,Beclin-1,microtubule-associated protein 1 light chain (LC) 3B (by Western blot) and dendritic spine density in the dorsal root ganglia.Results Compared with group C,the MWT,expression of AMPKα,Beclin-1,and LC3B,and dendritic spine density were significantly decreased in group NS (P＜0.05).Compared with group NS,the MWT,expression of AMPKαt,Beclin-1,and LC3B,and dendritic spine density were significantly increased in group K (P＜0.05).Compared with group K,the MWT,expression of AMPKα,Beclin-1,and LC3B,and dendritic spine density were significantly decreased in KC and KM groups (P＜0.05).Conclusion Activation of AMPK-dependent autophagic pathway is involved in ketamine-induced reduction of DNP in rats.

Objective To evaluate the validity of GP proceptors in mini-CEX workshop.Methods Three mini-cex workshops for GP proceptors of standardized training of general practitioners in Shanghai were held during November 2009 to September 2012.In the workshops 82 GP proceptors gave the complete rating scores for the training videotapes and the assessment accuracy was analyzed.Results The accurate rates of all items including history taking,physical examination,communication,clinical judgement,consulting skills,organisation and overall clinical perfomance were lower than 50％ in 9-point scale and the completely accurate rate and completely error rate were 1.2％ and 30.5％,respectively.The accurate rates of 5 items were more than 50％ in 3-rank system and the completely accurate rate and completely error rate were 3.7％ and 9.8％,respectively.The accurate rates of 4 items were more than 50％ in standard score ± 1 system and the completely accurate rate and completely error rate were 8.5％ and 2.4％,respectively.Comparing with 9-point scale,3-rank system had higher accurate rate in 5 items (P ＜ 0.05) and standard score ± 1 system had higher accurate rate in all 7 items(P ＜ 0.05).Abnomal rating scores were found more common in medical interview (41,50.0％),clinical judgement (32,39.0％) and physical examination (13,20.7％).GP proceptors with more than five years teaching experience were more likely to give error scores than those with five or less years teaching experience in 9-point scale(OR =6.993) and 3-rank system (OR =4.902).Leniency and halo effects occurred in 11 (13.4％) and 8 (9.8％) GP proceptors,respectively; and 14 (17.1％) GP proceptors gave written feedback.Conclusions The rater accuracy of GP proceptors in mini-CEX workshop should be improved further.

Objective Previous study showed that the histopathological basis of visual function damage caused by optical nerve injury is apoptosis of retinal ganglion cells(RGCs). This procedure is regulated by P53, bax and caspase 3 genes. Present study aimed to observe the expression of bax, P53 and caspase 3 mRNA in RGCs after traumatic optic nerve damage in the rats by SYBR green I fluorescence quantitative PCR method. Methods The animal model of optic nerve injury was established in the right eyes of 56 adult Wistar rats by a fluid percussion brain injury device (FPI) . Animal were killed on days 1, 3, 5, 7, 9, 14, 28 days separately after injury. Other 16 Wistar rats were divided into normal control group and sham operation group. The total RNA was isolated from rat fresh retina tissue by Trizol method and was treated by reverse transcription to cDNA using 01igo(dt) 18 as primer and then amplified. The target fragments of bax, P53 and caspase 3 cDNA were linked with carrier pTZ57 R/T to construct recombined plasmids which were transformated to E. Coli DH5α by T/A clone method. Recombined plasmids were extracted with alkaline lysis method and the plasmids were selected in white colonies by ampicillin screening, EcoR I restrictive enzyme analysis, and their specificity was evaluated using DNA sequencing. The standard curves were created by plasmid DNA and the precise expression level of target genes in samples were determined using software. The results were expressed as the ratios of target gene mRNA to GAPDH mRNA. Results The standard curve drawn by pTZ57R/T and target gene presented a good linear tendency with the higher sensitivity and specificity. The expression of P53 and bax mRNA began to increase on the third day after the injury of optic nerve and peaked on the fifth day and started to decline on the seventh day. The expression of caspase 3 mRNA increased from the fifth day through the ninth days after injury and declined on the fourteenth day. The significant differences were found in the expression of P53, bax and caspase 3 between model group and control group (P ＜ 0. 05) . Conclusion The pro-apoptotic protein P53, bax and caspase 3 play an important role in RGCs apoptosis.

Objective To investigate the effect of nano-?-linolenic acid on the expression of cathepsin B(CB) in mice with viral myocarditis(VM).Methods Eighty male Balb/c mice were randomly divided into 4 groups:control group,myocarditis group,low-dose intervention group and high-dose intervention group,each group had 20 mice.Mice in control group were inoculated introperitoneally with eagle′s solution,every mouse in the last 3 groups was treated with 0.1 mL Coxsackie B3 virus(CVB3) intraperitoneally.Then,mice in low-dose intervention group and high-dose intervention group were treated with 60 mg?kg-1and 180 mg?kg-1 nano-?-linolenic acid solution for 7 days,respectively.Mice in control group and myocarditis group were treated with 9 g?L-1 saline for 7 days.All mice were killed on the 15th day,and the specimens of hearts and serum were conserved.Myocardial histopathology was determined with hematoxylin and eosin stain.The expression levels of myocardial CB mRNA were detected by reverse transcription polymerase chain reaction.Serum CB concentration was examined by enzyme-linked immunosorbent assay.Results The mortality rate was 0,45%,30% and 20% in control group,myocarditis group,low-dose intervention group and high-dose intervention group,respectively;the mortality rate was significantly lower in high-dose intervention group compared with myocarditis group(P0.05).The expression level of CB mRNA and serum CB concentration were markedly higher in myocarditis group than those in control group(Pa

AIM: To study the protection of extract of Radix Atragali composite against acute hepatic injury. METHODS: Fed with the extract of Radix Atragali composite, m ice were injected with D-galactosamine intraperitoneally (800 mg/kg) and rats were i njected with carbon tetrachloride hypodermically (5 mL/kg) to induce acute hepat ic injury on the 8th day. ALT, AST and bilirubin in serum were examined. Patholo gical changes of liver tissue were observed. RESULTS: Compared with model group, activities of ALT and AST, c oncentrations of bilirubin were markedly decreased and pathological scores also showed that degeneration and necrosis of hepatic cell were lighter in the the ex tract of Radix Atragali composite treatment group. CONCLUSION: The extract of Radix Atragali composite attenuat es hepatic injury induced by D-galactosamine or carbon tetrachloride.