Objective To investigate the optimal operative time interval from the combined application of endoscopic sphincteropapillotomy ( EST) and endoscopic nasobiliary drainage ( ENBD) to laparoscopic cholecystecto-my ( LC) in the treatment of concurrent cholecystolithiasis and choledocholith.Methods Retrospective analysis was made in the 180 patients who had received sequential treatment of concurrent cholecystolithiasis and choledocholith with the combined application of EFS+ENBD+LC.Patients in group A received LC 3 days after EST +ENBD;patients in group B received LC 7 days after EST +ENBD;patients in group C received LC 30 days after EST +ENBD.Comparative analysis was made in the duration of LC,the intraoperative blood loss,the number of conversion to laparotomy and the total hospital expenses among patients in the three groups.Results Operation time in group A,B and C was separately (34.70 ±2.24)min,(51.00 ±2.31)min and (34.43 ±2.51)min.Patients in group B suffered significantly-extended surgical duration ( F=6.15,P<0.01);Intraoperative blood loss in the three groups was separately (28.86 ±3.35)mL,(50.43 ±3.90)mL,(28.57 ±3.40)mL.Significant increase was observed in group B(F=7.23,P<0.01).There were 1,6 and 1 patients who underwent conversion to laparotomy in the three groups. Slight increase was found in group B(χ2 =6.54,P<0.05).Total hospitalization expenses was separately (10 093.29 ± 496.05)yuan,(10 845.86 ±744.27)yuan and (15 250.57 ±1 006.67)yuan.Patients in group C had incurred a significant increase(F=6.62,P<0.01).Statistical difference was equally found.Conclusion 3 days after EST+ENBD is the optimal operative time for LC.

Clinical practice is an important part of cultivating the master of nursing specialist,this paper analyzed characteristics of clinical practice in domestic and foreign nursing students and revealed the problem in cultivation of master of nursing specialist in China,in order to provide references for the future construction and perfection of clinical practice of master of nursing specialist in China.

BACKGROUND:An increase in activity of muscle contraction can induce transcription of a variety of signaling molecules to activate a large number of gene expression within the nucleus through proprietary signaling pathway OBJECTIVE:To review studies related the peroxisome proliferator-activated receptor-gamma coactivator 1(PGC-1)and exercise induced skeletal muscle adaptations.METHODS:A computer-based online search of Pubmed was performed for relevant English articles published from January 1995 to January 2009 with the keywords of"PGC1,skeletal muscle,exercise,adaptations"The relevant articles about PGC-1 and exercise induced skeletaI muscle adaptations were included.and repetitive contents were excluded.PGC1 and mitochondrial oxidative metabolism,and exercise-induced skeletal muscle adaptation and PGC1s changed served as the evaluation indicators.RESULTS AND CONCLUSION:Of 57 collected articles,34 were classified and sorted according to the criteria.Endurance training results in profound adaptations for skeletal muscle,including mitochondrial biogenesis,capillary density,and fiber composition.Transcription factors are highly dependent on coactivator molecules to regulate training physiologic adaptation processes.The majority of transcription factors target genes are involved in mitochondrial biogenesis and metabolism.These transcriptional patterns may provide a basic framework for understanding the integration of mitochondrial biogenesis and function with signaling events that exercise induced energetic properties Post-transcription of PGC-1 alpha protein,there are a variety of protein modifications,with a variety of biological processes closely related to the possible adaptive mechanism of exercise-induced skeletal muscle.

Objective To explore the effect of Mycobacterium tuberculosis antigen (Mtb-Ag) on neutrophils apoptosis.Methods The fresh isolated neutrophils from healthy adults blood were cultured with Mtb-Ag for 24 h,with or without pretreatment of nuclear factor -?B (NF-?B) inhibitor N-tosyl-L-phenylanyl chloromethyl ketone (TPCK) for 30 minutes.Annexin V staining and Flow cytometry were used to measure cell apoptosis of neutrophils.NF-?B DNA binding was measured by gelelectrophorestic mobility shift assay (EMSA) in neutrophils after incubated with Mtb-Ag for 0,1,2,4,6,24 hours.Results Comparing to the spontaneous apoptosis (55%?6%) of neutrophils after culture in vitro for 24 h,treatment of Mtb-Ag (1.125 mg/ml) decreased the cell apoptosis of neutrophils (32%?3%).The NF-?B shift bands were detected at 1 h in neutrophils after stimulated by Mtb-Ag,and reached maximum peak at 2 hours,and then returned to basal levels within 24 h.Pretreatment of TPCK inhibited the anti-apoptosis role of Mtb-Ag in neutrophils.Conclusion Mtb-Ag prevents neutrophils apoptosis and its inhibitory role concerns NF-?B pathway.

Objective To evaluate the effects of focal vibration on the physical properties and surface electroyograms of persons with neck-shoulder pain.Methods Thirty-four patients with neck-shoulder pain received 3 to 5 applications of vibratory stimulation of the inner side of the trapezius and scapula for 30 s each time.They reported their pain level using a visual analogue scale.Muscle tone and the elasticity and stiffness of the trapezius muscle were measured bilaterally using a MyotonPRO Muscular Function Evaluation System.Surface electromyography (sEMG) was performed bilaterally during arm extension while standing.The testing was repeated four times:before treatment (baseline),immediately after treatment (IAT),2 hours after treatment (2AT) and 6 hours after treatment (6AT).Results There was a significant reduction in reported pain at IAT and 2AT compared to baseline,but no significant difference was found between the perceived pain at baseline and at 6AT.The values of oscillation frequency,logarithmic decrement and dynamic stiffness had decreased significantly at IAT and 2AT compared to baseline.The average AEMG during upper-arm flexion of the trapezius on the painful side had increased significantly at IAT comparcd to that before the treatment,while the average IEMG and MF were both significantly higher than before the treatment.At 2AT the average AEMG and IEMG were both still significantly higher than at the baseline,but there was no longer a significant difference in the average MF.By 6AT none of the three indicators differed significantly from those before the treatment.Conclusions A single session of focal vibration can relieve pain,increase muscle activation as well as decrease muscle stiffness for people with neck-shoulder pain within 2 hours.

Objective To study the potential mechanism of recovery from dysphagia after surface electrical stimulation. Methods 3 cases recovery from dysphagia caused by lower brainstem infarction after surface electrical stimulation of lower mandible and trigeminal nerves were analyzed. Results After 3～16 weeks surface electrical stimulation, the swallow assessment scores reached from 0 to 6 in all the 3 patients. Conclusion Surface electrical stimulation can facilitate the recovery of swallow function, which may be involved with the sensory input, especially the integration of nucleus of the solitary tract (NTS).

Objective:To explore the changes in the diffusion tensor imaging (DTI) parameters of the pontocerebellar tract 3 months and one year after ischemic stroke and analyze the data′s potential for predicting long-term motor outcomes.Methods:Thirty patients with middle cerebral artery infarction were prospectively studied using DTI within 3 months and 1 year after the onset. A region of interest-based analysis was performed for the fractional anisotropy (FA) of the middle cerebellar peduncles (MCP) in the pontocerebellar fibers (PCF). Neurological functioning was evaluated using the National Institutes of Health Stroke Scale and the degree of paresis was assessed at the same time using paresis grading. At one year after the onset, balance function, functional prognosis and self-care ability were evaluated using the Brunel Balance Scale, the modified Rankine Scale and the Functional Independence Scale respectively.Results:The average FA on the healthy side 3 months and 1 year after onset was significantly less than on the affected side at each time point. The ratio of the FA of the affected side to that of the unaffected side (rFA) in the PCF correlated significantly with the average paresis scores of the lower and upper extremity and the total paresis score at each time point. Moreover, the rFA of the PCF was significantly correlated with the average functional independence score, the prognosis for the upper and lower extremities as well as motor functioning. The area ratio under the ROC curve of the PCF for predicting lower extremity motor outcome was 0.84, and the optimal threshold was 0.92 (sensitivity 71.4%, specificity 73.9%). The area ratio under the ROC curve was not a significant predictor of upper extremity motor outcome.Conclusion:The DTI parameter rFA of the PCF in patients with subacute middle cerebral artery infarction can help to predict the long-term recovery of motor ability. It can serve as an important reference index for predicting the long-term motor ability of the lower limbs.

Adult ; Antiphospholipid Syndrome ; complications ; Humans ; Male ; Myocardial Infarction ; complications

Objective To learn the clinicians'attitude towards the “Drug and Medical Service Separation” reform in Beijing.Methods A number of pilot hospitals of “Drug and Medical Service Separation” reform in Beijing were pinpointed,for a random questionnaires survey among 800 clinicians,to learn their awareness,evaluation and attitudes to the reform.Results The clinicians were found with good awareness and understanding of the reform,with an awareness rate of 99.5％ ; 72.0％ of them hold that the pricing of “medical service charge” of the reform as reasonable; most of them believe that the reform plays a positive role in relieving the difficulties of seeing doctors and affordability of medical treatment; their approval rate for the reform pilot project is 97.3％; their satisfaction for the reform implementation is 90.8％,and their support for full implementation of the reform is 94.0％.Conclusion The clinicians from those pilot hospitals are sufficiently aware of and understand this policy,and are supportive of the pilot with useful suggestions.The recommended strengthened publicity and training,higher medical service charges,better pay for medical workers,improved incentive mechanism and evaluation mechanism,and better clinicians' satisfaction.

Objective To evaluate the clinical efficacy of local intra-arterial thrombolysis (LIT) with urokinase in patients with acute ischemic stroke.Methods One hundred and sixty two patients with acute ischemic stroke were treated with LIT by using urokinase and relationship of reconalization for different occluded arteries with the Glasgow outcome scale (GOS) scores three months later was analyzed. Results Angiography showed occlusion of the cerebral artery in 162 patients, among which 119(73.5%) patients showed the sites in the internal carotid artery system, with 27 occlusions in the internal carotid artery (ICA)trunk, 63(38.89%) in the middle cerebral artery (MCA)and 29(17.9%) in the anterior cerebral artery (ACA), and the remaining 43(26.5%)patients of vertebrobasilar artery (VBA); successful recanalization was achieved in 103 (63.58%)patients, including 11 (40.7%), 49(77.8%), 20(69.0%) and 23(53.3%), respectively, after intraarterial infusion of urokinase. Unsuccessful recanalization occurred in 59patients (36.42%). Followed up for 90 days, 90 (55.6%) patients obtained a good outcome; 72(44.44%) had poor prognosis including 20(12.35%) deaths. 8 patients associated with hemorrhage (4.9%) 73 with reperfusion injury (45.1%) and 5 arterial re-occlusion (3.1%). Based on statistic analysis, ICA trunk and VBA had low ratio of successful recanalization with poor clinic prognosis MCA and ACA possessed high ratio of successful recanalization and good clinic outcomes. There was a significant relationship between arterial recanalization rate and clinic prognosis (r=0.86).Conclusions Successful recanalization of cerebral occlusive artery by using intra-arterial thrombolysis could improve clinic prognosis in patients with acute ischemic stroke. Clinical prognosis has a significant relationship with both initial treatment time and arterial recanalization rate.