As a kind of mature non-invasive brain stimulation technology, transcranial direct current stimulation (tDCS) has shown sig-nificance in clinic. Recently, DCS has been applied over the scalp to the spinal cord, named transcutaneous spinal direct current stimulation (tsDCS), that may modulate the spinal cord tracts and spinal cord loop electrical activity at segmental level, and may benefit in the treatment of chronic pain and motor dysfunction after injury of nervous system. This paper reviewed physiological effects, safety considerations and potential clinical applications of tsDCS.

Objective To explore the operative methods of open reduction and fixation for the old trimalleolus fractures. Methods Fifty-eight patients of the old trimalleolus fractures were treated from January 2000 to January 2004. There are 41 males and 17 females with an average age of 43 years (ranged from 19 to 61 years). The average time of postinjury was 48 days (ranged from 29-76 days). The fractures were classified by Lauge-Hansen system. Supination-external rotation type in 37 cases. Pronation-external rotation type in 21 cases. The anterior-medial approach and anterior-lateral approach were chosen. Explore the original fracture line of medial and lateral malleolus sharply, resect scar tissue at the fagment and ankle mortise, make the ankle joint valgus, expose the posterior malleolus fragment directly and explore the original fracture line. Reducted and fixed the posterior malleolus. According to the fibular crest, the normal length and alignment were recovered. The fracture was fixed with 1/3 tubular plate or ordinary plate. Medial malleolus was fixed with screw or tention band. The time of partial weight bearing was 10-12 weeks. Results The mean duration of follow up was 37 months (range from 18-65 months). Superficial skin necrosis was in 2 cases. The wound delayed union in 4 cases. The average time of fracture healing was 25 weeks(range from 21-29 weeks). The fibula malalignment in 2 cases. 6 cases developed arthrosis. 2 cases in this 6 patients had a good reduction of fractures. The average time of the operation in this 6 patients was 58.5 d after injury. According to the AOFAS scoring system, excellent in 31 cases, good in 22 cases, fair in 5 cases. The total rate of good results was 91.4%. The pain score was up to 20 in 5 cases. 9 cases had restriction of dorsiflexion with less than 10?. Conclusion The excellent reduction and clinical results were obtained by explore the original fracture line sharply, reduct posterior malleolus fragment directly and maintain normal length of the fibula, rotation and alignment for the old trimaleolus fractures which injuried within 76 days.

Objective To evaluate the early and middle outcome of deep circumflex iliac arterial vascularized iliac bone grafting to delayed femoral neck fractures in young patients. Methods Thirty-one delayed femoral neck fractures were treated from January 1997 to December 2003. Complete data were available in 26 cases (19 males and 7 females). The patients' age ranged from 15 to 38 years old with the average of 25 years old. 17 cases suffered from traffic accidents and 9 cases from falling injury. There were 11 cases in Garden type Ⅲ and 15 cases in type Ⅳ. 11 cases exhibited nonunion after conservative treatment and another 15 nonunion cases had previous surgery history. The initial operation included closed reduction and steinmann pin fixation or open reduction and threaded pin or steinmann pin fixation. The average duration from injury to the second operation was 8.5 months (range from 6 to 17 months). Most of the patients presented shorten limbs and limited hip function in difference degree. Open reduction, deep circumflex iliac artery vascularized iliac bone grafting and cannulate screw fixation were performend. Partial weight bearing started on 6 to 8 months postoperatively and full weight bearing on 11 months postoperatively. Results The mean duration of follow up was forty-one months (range from 28 to 69 months). Fracture healed successfully in 26 cases. The average time of fracture healing was 12.5 months (range from 11 to 15 months). Two femoral head necroses were noted during the follow-up period. The 5 cases of obvious shortened limbs stop progressing after surgery. Harris hip joint function score was on average 82.8. Conclusion Deep circumflex iliac artery vascularized iliac bone grafting can improve the blood supply to fractured femoral head. As a result, it's an effective way to enhance delayed femoral neck fracture.

The retrospective analysis of data of snail status in Baofeng harbor,Yingcheng City from 1975 to 2009 suggests that the snail surveillance in schistosomiasis transmission-interrupted areas is a long term work,which should be strengthened continuously.

Objective To search for an effective acupuncture-moxibustion therapy for high fever in common cold. Methods According to the randomized and multi-central trial principle, 276 cases enrolled were randomly assigned to observation group of 138 cases and control group of 138 cases. The observation group were treated by electroacupuncture at Dazhui and the control group were treated by Antondinie injection coordinating pathogeny therapy to observe the prompt effects in 24 hours. Results After treatment, the temperature of every time point of the observation group was lower than that of the control group (P 0.05). Conclusion The method of electroacupuncturing at Dazhui has a definite therapeutic effect on high fever in common cold.

Objective To investigate the causes of success or failure of natural orifice translumenal endoscopic surgery(NOTES)in animals.Methods Data were collected from animal studies of NOTES carried out between August 2007 and September 2009.The studies were divided into acute phase and survival phase.In the studies,simple NOTES and laparoscopic-assisted NOTES were performed on female miniswines or adult mongrel dogs.Diagnostic abdominal exploration,liver biopsy,cholecystectomy,tubal ligation,oophorectomy,gastrojejunal anastomosis,and splenectomy were made in the animals.The intra-and post-operative complications and technical difficulties were recorded during the procedures.Results Totally 37 miniswines and 16 mongrel dogs were enrolled in the studies of NOTES procedures(91 procedures),including 22 acute experiments and 31 survival experiments.Simple NOTES was conducted through the transgastric route in 25 cases,transcolonic route in 8 cases,and combinations of transgastric and transcolonic routes in 16 cases,and combinations of transgastric and transvaginal routes in 6.In Laparoscopic-assisted cases,36 animals were treated via the transgastric route by traditional(26 cases)or single-port transumbilical laparoscopy(10 cases).Diagnostic exploration was carried out in 33 cases,liver biopsy was done in 11 cases,tubal ligation was made in 11,and oophorectomy was performed on 6;the procedures were all completed in these cases showing a success rate of 100%.Cholecystectomy was completed in 27 cases with a success rate of 44.4%(12/27).One case of splenectomy,and two cases of gastrojejunal anastomosis failed.The totally complication rate in the studies were 39.6%(21/53).The complications included perforation(8 cases),organ injury(5 cases),bleeding(4 cases),infection(3 cases)and pneumoperitoneum with hypertonia(1 case).Conclusions NOTES is feasible,safe and effective in diagnostic abdominal exploration and simple abdominal surgeries,but does not suit difficult abdominal surgeries.By using laparoscopy,the technique may be further developed and used in the future.

Purpose To evaluate 1H proton magnetic resonance spectroscopy (1H-MRS) in detecting traumatic brain injury (TBI) and its metabolic changes during the initial two weeks after trauma using rabbit modes. Materials and Methods Fifteen Chinese rabbits were randomly divided into sham control group (n=5) and TBI group (n=10), 1H-MRS was performed 1 hour, 6 hours, 24 hours and 2 days, 7 days, 14 days after trauma, the concentration of N-acetylaspartate (NAA), creatine (Cr), choline-compound (Cho), NAA/Cr and Cho/Cr in each group was evaluated. At 6 hours, 24 hours and 168 hours after injury, 1 rabbit was slaughtered after abdominal anesthesia at each time point, the sample was ifxed with left heart catheterization perfusion after death, brain tissue was obtained, blocked, dehydrated into frozen section, HE staining was used for observation. Results Compared with the control group, NAA/Cr ratio in the trauma region decreased by 29%1 hour after trauma, with maximal reduction of 40% (at 24 hours) before increasing slightly, the NAA/Cr ratio returned to control level gradually until 168 hours later. The Cho/Cr ratio decreased by 16% 1 hour after trauma, with maximal reduction of 30%(at 6 hours) and increased gradually until finally su rpassed control level (168 hours) for 20% and then became stable. NAA/Cr ratio and Cho/Cr ratio showed statistically significant changes between each observing time point (P<0.05). Conclusion 1H-MRS can be used for dynamic detection of cerebral metabolism without injury, and is superior to MRI in detecting early abnormality of the brain, with NAA/Cr as the most sensitive parameter. Detecting the changes of NAA/Cr, Cho/Cr ratios in the trauma region can be used as a guide for assessment of the clinical treatment effectiveness of TBI.

Objective To probe into the clinical effect of acupuncture combined with herbal medicine with the functions of detoxication and purging fu-organ on patients with constipation of phlegm-heat and bowel-repletion type in acute cerebral infarction.Methods The enrolled cases were randomly assigned to an observation group of 35 cases and a control grouD of 35 cases.Besides both groups were treated with routine neurological treatment and acupuncture with the flinchon of brain activating,the observation group was treated by acupuncture combined with herbal medicine with the functions of detoxication and purging fu-organ and the control group was treated with Dilute Glycerol.Such indexes of patients in both groups were observed 7 days and 21 days before and after the treatment as clinical effect of constipation,scores of related symptoms,and scores of traditional Chinese medical category and clinical effect.Results The effective rates of eonstipation 7 davs and 21 days after treatment were 93.7% and96.9% in the observation group,and 61.8% and79.4% in the control group,with significant differences between the two groups(P＜0.01).After the treatment for 7 days and 21 days,the symptoms of constipation.dark tongue,yellow and greasy fur were improved significantly in the observation group than those in the control group(P＜0.05);The observation group also showed a definite therapeutic effect than the control group on treating the svmptoms of upset minded,constipation,red or dark tongue,yellow and greasy fur(P＜0.01).The scores of traditional Chinese medical category of the observation group were lower than that of the control group(P＜0.01)after treatment for21 days.The total improvement rate was 97.0% in the observation group comparing 55.8%in the control group,showing significant difference(P＜0.01).Conclusion The method of acupuncture combined with herbal medicine with the functions of detoxication and purging fu-organ has a definite therapeutic effect on treating constipation of phlegm-heat and bowel-repletion in acute cerebral infarction.It can also improve clinical effects of these patients,which is worth generalizing in the clinical practice.

Objective To explore the effect of toll-like receptor 4 (TLR4), myeloid differentiation protein-2 (MD2), and stromal interaction molecular 1 (STIM1) for regulating human vascular endothelial calcium overload injury and inflammatory reaction induced by bacterial endotoxin (LPS).Methods Human umbilical vein endothelial cells (HUVECs) were cultured in Dulbecco's modification of Eagle's medium (DMEM). ① The levels of TLR4, MD2 and nuclear factor-κB (NF-κB) were detected by reverse transcriotion-polymerase chain reaction (RT-PCR) before and 0.5, 1, 6, 12, 24 hours after LPS stimulation. ② Intracellular calcium peak level was detected by confocal following probe fluo-3 AM loading in HUVEC cells induced with LPS and transfected by psiSTIM or psiTLR. ③ MD2, STIM1 or NF-κB protein level was detected by immunoprecipitation (IP) and immuno-blotting in HUVEC cells which were transfected by TLR4 inhibited expression (psiTLR) for 12 hours and followed by LPS stimulation for 6 hours. ④ HUVEC cells were randomly divided into 6 groups: control group, LPS group, PDTC 0.1 mg/L group, PDTC 1 mg/L group, psiTLR 1 h group and psiTLR 12 h group. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected by enzyme linked immunosorbent assay (ELISA) in supernatant. The mRNA levels of STIM1 and NF-κB were detected by RT-PCR.Results ① The mRNA levels of TLR4, MD2, and NF-κB gradually increased after LPS induction and peaked at 6 hours (2-ΔΔCt: 23.52±2.88, 17.43±3.43, 18.13±2.99, respectively), which were statistically significant before the stimulation with LPS (2-ΔΔCt: 7.02±2.81, 5.19±3.22, 8.11±1.42, allP < 0.05). ② Extracellular calcium influx in LPS group was increased significantly higher than control group (nmol/L: 108.13±22.33 vs. 41.57±13.19, P < 0.01). Extracellular calcium influx in psiSTIM+LPS group (nmol/L: 62.61±14.12 vs. 108.13±22.33,P < 0.05) and psiTLR+LPS group (nmol/L: 50.78±8.05 vs. 109.43±20.21,P < 0.01) were both suppressed as compared with LPS group. While extracellular calcium peak level in psiTLR+psiSTIM+LPS group further decreased (nmol/L: 39.31±6.42 vs. 109.43±20.21,P < 0.01). ③ MD2 protein but not STIM1 or NF-κB can be detected in anti-TLR4 precipitates in control (ctrl-) by immunoprecipitation. MD2 protein level increased in anti-TLR4 precipitates in LPS group (ctrl+) and was suppressed in TLR4 inhibiting group (psiTLR). ④ The levels of TNF-α in PDTC 1mg/L group were significantly lower than those of LPS group (ng/L: 0.60±0.24 vs. 1.77±0.66,P < 0.01). The levels of IL-6 in PDTC 0.1 mg/L, 1 mg/L group and psiTLR 12 h group decreased significantly lower than that of LPS group (ng/L: 232.10±63.54, 134.32±37.23, 284.23±56.14 vs. 510.22±89.23, allP < 0.05). Compared to LPS group, the mRNA levels of NF-κB and STIM1 were obviously inhibited in PDTC1 mg/L group and psiTLR 12 h group [NF-κB mRNA (2-ΔΔCt): 17.22±2.35, 13.24±3.54 vs. 30.16±2.06; STIM1 mRNA (2-ΔΔCt): 12.57±2.43, 12.21±2.46 vs. 25.12±2.02, allP < 0.05]. Conclusions TLR4, MD2, NF-κB signal and SOC calcium channel STIM1 mediate LPS induced-calcium influx and inflammatory mediators level in HUVEC cells. Extracellular calcium overload and inflammatory response by endotoxin induction can be effectively inhibited by down-regulation of TLR4, NF-κB and/or STIM1.

【Objective】 To explore the effect of different extraction methods on the content of total flavones from propolis.【Methods】With rutin as the control,spectrophotometry was used to investigate the content of total flavones extracted from propolis.【Results】The content of total flavones extracted by pharmacopoeia extraction method was 0.1982mg/g and 0.1978mg/g by methanol Soxhlet extraction method,the difference being insignificant.【Conclusion】Methanol Soxhlet extraction method is simple,effective and practical,and can be used to replace pharmacopoeia extraction method for the determination of total flavones from propolis when necessary.