Irisin is one of the myokines, that widely expresses in vavious tissues. Irisin may play a role in metabolism of glucide, lipoid, etc., as well as the insulin resistance, that may be focused in the researches of exercise therapy for diabetes.

Diabetes mellitus is an independent predictor of high platelet reactivity after antiplatelet therapy in patients with ischemic stroke,and the latter is closely related to the increased risk of recurrence of stroke.The mechanisms of high platelet reactivity in patients with diabetes or insulin resistance are associated with a variety of factors.Some circulating molecules can be used as markers for predicting the reactivity of platelets.Monitoring of platelet reactivity after treatment with new antiplatelet agents may provide basis for individualized antithrombotic therapy in ischemic stroke patients with diabetes or insulin resistance.

Clopidogrel can inhibit platelet aggregation and reduce the risk of recurrent stroke.However,it is a great difference in antiplatelet inhibition in different populations.This article reviews the mechanism of clopidogel resistance and its countermeasures in the prevention of ischemic stroke.

Objective To investigate the relationship between biomarkers of renal function and cerebral microbleeds (CMBs) in cerebral hemorrhage patients.Methods This is a cross-sectional study including a total of 129 patients with cerebral hemorrhage.All patients underwent susceptibility weighted 3.0 T MRI.The presence and number of CMBs on susceptibility weighted MRI were independently interpreted.We calculated the urinary albumin/creatinine ratio (UACR) from morning spot urine and the estimated glomerular filtration rate (eGFR) in serum samples.Serum cystatin C (CysC) was measured using the automated particle-enhanced turbidimetric immunoassay.Results Among 129 patients with cerebral hemorrhage,86 (66.7％) had CMBs on susceptibility-weighted imaging.UACR (mg/g;20.47 ± 9.03 vs 35.24±14.83,t=3.823,P＜0.01)andCysC (mg/L;0.98±0.09vs 1.31 ±0.13,t=4.739,P＜0.01) levels were higher in the patients with CMBs than those without,and the eGFR (ml · min-1 · 1.73 m 2) was lower in the patients with CMBs than those without (78.07 ± 18.69 vs 61.59 ± 17.08,t =3.672,P ＜0.01).A Logistic regression analysis indicated that the levels of kidney impairment biomarkers were significantly associated with the prevalence of CMBs in cerebral hemorrhage patients after an adjustment for age,sex and other risk factors.The odds ratio (OR) and 95％ CI of each kidney biomarkers (eGFR,UACR,and CysC) for the CMBs status were 2.573 (1.172-5.315),2.735 (1.247-6.246)and 2.976 (1.764-6.968),respectively.CysC exhibited fair diagnostic value for CMBs,with an area under the curve of 0.835 (95％ CI 0.791-0.878).Furthermore,there were negative correlations between eGFR and the the number of CMBs (P =0.038,R2 total =0.216).There was a positive correlation between UACR,CysC and number of CMBs (P =0.024,R2 total =0.312;P =0.013,R2 total =0.375).Conclusions Elevated levels of kidney biomarkers are associated with the presence of CMBs in cerebral hemorrhage patients,independent of conventional risk factors.CysC may be a potential diagnostic biomarker for CMBs in cerebral hemorrhage patients.

Sleep disorder is a common complication after is chemicstroke.If it is nottimely diagnosed and treated, it may affect the rehabilitation of stroke and recurrence. The manifestations of sleep disorders have various forms according to the different locations of infarction. For the treatment of sleep disorder after stroke, the method of the combination of drugs and physical therapy is used in clinical practice at present. In recent years, w ith the w idely use of the polysomnography, poststroke sleep disorders can be diagnosed clearly and carefuly. The treatment for sleep disorders after stroke may significantly improve the prognosis of patients.

ObjectiveTo evaluate the therapeutic effect and toxicities of gemcitabine combined with cisplatin in the treatment of advanced or metastatic transitional cell carcinoma (TCC) of urinary tract. Methods Eighteen patients with advanced or metastatic TCC of urinary tract (15 cases of bladder TCC,2 of renal pelvic TCC,and 1 of ureteral TCC),who were pathologically confirmed,were treated with GC regimen (gemcitabine 1000 mg/m 2,iv infusion on day 1 and day 8;cisplatin 30 mg/m 2,iv infusion on day 2,day 8 and day 9).Before treatment, Karnofsy score for each patient was evaluated with a result of ≥60;liver and renal functions and blood routine test were normal.GC regimen was repeated for 2-3 cycles every 3-4 weeks and the response rate was evaluated.ResultsThree patients (16.7%) had complete response; 7(38.9%), partial response;5(27.8%),no response;and 3(16.7%) had progression.The overall response rate was 55.6%. The main toxic effects included decrease in white cell count (10 cases),anemia (7),nausea and vomiting (10) and constipation (8),which were mild or moderate and disappeared after stopping treatment.No chemotherapy-associated death occurred.ConclusionsGemcitabine combined with cisplatin in the treatment of advanced or metastatic transitional cell carcinoma of urinary tract is effective,and the toxicity is mild and tolerated. It is suggested that GC regimen can be used as the first line chemotherapy.

Objective To study the application of modified two-hole laparoscopic cholecystectomy ( LC) for exploring new minimal invasive LC approach. Methods 176 patients with calculous cholecystitis and polypus of cholecyst underwent LC through two abdominal holes. Results 174 gallbladders were removed successfully by modified two-hole LC. The average time of operation was 27.8±7.1minute. The average hospitalized stays of post operation were 2.7±0.8 day. There were two patients whose operation had to be converted to tradition three-hole LC. There were no complication and conversion of open cholecystectomy in all patients. During an average follow-up time of 6 monthw, ranged from 3 to 10month, there were no abdominal pain and jaundice happened to patients. Conclusions The application of modified two-hole LC is a safe and effective LC approach on the basis of skillful perform of traditional three-hole LC. It can reduce the injury to patients and advance the technique of ninimal invasive surgery further.

OBJECTIVETo measure the root anatomic topography of mandibular first molar using cone beam CT (CBCT), calculate the proper space for dowel preparation.

METHODSThe roots of 121 mandibular first molars from 71 patients were scanned by CBCT, the images from cross section, sagittal plane, and coronal plane were got respectively. The dowel preparation spaces according to established three dimensional images and dowel preparation requirements were analyzed.

RESULTSThree dowels could be prepared. The dowel length for distal-root was (7.19 +/- 0.91) mm, dowel diameter was (0.80 +/- 0.12) mm on the level of 4mm above root apex. The dowel length for mesio-root was (6.92 +/- 1.02) mm, and dowel diameter was (0.71 +/- 0.08) mm on the lever of 4 mm above root apex for buccal side and (0.71 +/- 0.07) mm for lingual side. Dowel should be prepared cone-shaped.

CONCLUSIONMany factors affect dowel preparation, individualized design is needed. CBCT can provide reliable radiographic evidence.

BACKGROUND:Previous studies concerning neuromechanism of acupuncture for regulating gastric function mainly focused on peripheral nerve, involving in central nervous system. In particular, there are few studies addressing higher central nervous system.
OBJECTIVE:To explore the effects of acupuncture at Neiguan (PC6) and Zusanli (ST36) on gastric-related neurons in the hypothalamic paraventricular nucleus.
METHODS:Using microelectrode extracellular recording technique, gastric related neurons in the paraventricular nucleus were found in gastric distension rats. Stimulation was conducted for 30 seconds by hand acupuncture at Neiguan and Zusanli. The effects of acupuncture on gastric-related neurons in the paraventricular nucleus were observed.
RESULTS AND CONCLUSION:The discharge of 109 neurons in the hypothalamic paraventricular nucleus of 60 rats was recorded. A total of 56 gastric-related neurons of the 109 neurons were observed. The number of neurons response to acupunctures at Zusanli, Neiguan, Pishu (BL20) and Weishu (BL21) were respectively 44, 47, 29, and 33, with the reaction proportion of 78.57%, 83.47%, 51.79%and 58.93%. Results suggested that there exist gastric distension stimulation and acupuncture stimulations from neurons soma to visceral reaction in the hypothalamic paraventricular nucleus, which simultaneously participates in the regulation of acupuncture on the gastric function.

BACKGROUND:Preliminary studies of our research group mainly focus on the role of nucleus of solitary tract in gastric noxious stimulation and acupuncture point, while dorsal nucleus of vagus nerve, nucleus of solitary tract and area postrema are the necessary component for vagus nerve complex, and dorsal nucleus of vagus nerve plays a crucial role in the regulation of gastric functions. OBJECTIVE:To observe the effect of acupuncture at Zusanli, Neiguan, Pishu and Shenshu acupoints on the gastric-related neurons in dorsal motor nucleus of the vagus nerve. METHODS:The gastric related neurons in dorsal motor nucleus of the vagus nerve of gastric distension rats were identified using extracellular recording technique, according to neuroelectrophysiology method. Acupuncture stimulation was given to Zusanli, Neiguan, Pishu and Shenshu for 15 seconds. The effect of body stimulation on the gastric distension related neurons in dorsal motor nucleus of the vagus nerve of rats was recorded. RESULTS AND CONCLUSION:Among the involved 24 rats, 90 neurons at paraventricular hypothalamic necleus exhibited discharge. Among the discharged neurons, 54 neurons were related to gastric distension. After acupuncture stimulation at Zusanli, Neiguan, Pishu and Shenshu, there were 44, 39, 38, 27 neurons giving a response, the reaction rate was 82%, 72%, 70%and 50%, respectively. Acupunture at different nerve segment acupoints can activate the dorsal motor nucleus of the vagus nerve to different degrees, which is involved in the regulation of gastric motility.