Objective To explore optimal puncture route and method for advance pierce accuracy when perform percutaneous vertebroplasty. Methods 248 cases (365 vertebrae )with osteoporotic vertebral body fractures in thoracic vertebral and lumbar vertebral were treated by percutaneous vertebroplasty. Total injured vertebraes were examined and measured puncture routes under CT before operation. Then according to measure route pierce and perform percutaneous vertebroplasty, when the pricker arrived preconceive place, take some radiographs obverse and side, after operation,scan injured vertebraes with CT again. Pierce accuracy was evaluated. Results 365 vertebrae were pierced successfully,the pierce successful rate was 100%. 324 vertebra piercing route were coincident with CT measure routes,coincident rate 88.8%. 41 vertebra piercing route weren' t coincident with CT measure routes, deflective rate was 11.2%. Conclusion CT measure puncture route and directing pierce was effective means when percutaneous vertebroplasty.

The paper introduces an overview of Shanghai medical security system, analyzes its effectiveness and challenges, and put forward overall goals and key tasks in the future. Shanghai has formed a multiple, medical security system and basically achieved the short-term goal of medical security system establishment which was requested to put forward in national health system reform. Shanghai medical insurance system has played a positive role in promoting economic and social development and reducing the burden of medical expenses. To further implement requirements of national health system reform, Shanghai will be conducting the integration of different schemes , narrow down the gap of benefit packages, improvement of health care management and the initiatives of nursing care insurance to further improve the medical security system, and strive to cover 98% of household population and 90% resident population in 2012.

Objective To systematically evaluate the clinical efficacy and safety of the traditional Chinese medicine(TCM) therapy on perimenopausal insomnia from the standpoint of regulating liver and kidney.Methods Randomized controlled trials(RCT) on PubMed, EMbase, CNKI, Wanfang Database and VIP database from their inception to April 2016 were searched.Two researchers separately screened the literature, extracted data and evaluated the literature bias risk according to inclusive criteria and exclusive criteria.Then the Meta-analysis was operated using Rev Man 5.3 software.Results Altogether nine RCT with 678 patients were eligible.The result of Meta-analysis showed: the clinical effectiveness of experimental group (TCM therapy group) was superior to that of control group(RR=1.30,95%CI[1.11,1.52],P<0.05);the PSQI scores showed significant differences between the two groups (SMD=-1.16,95%CI[-2.12,-0.20],P<0.05),but SPIEGEL score did not.Although adverse reactions were appeared in five studies, the adverse reaction rate of the experimental group was lower significantly (RR=0.09,95%CI[0.04,0.22],P<0.05).Conclusion The experimental group achieved obvious clinical efficacy with less adverse effect.

Objective: To investigate the correlations of serum uric acid with outcomes and symptomatic intracranial hemorrhage (sICH) after intravascular mechanical thrombectomy bridged with intravenous thrombolysis in patients with ischemic stroke. Methods: From January 2015 to January 2019, patients with acute ischemic stroke admitted to Nanjing First Hospital, Nanjing Medical University and underwent intravascular mechanical thrombectomy bridged with intravenous thrombolysis were analyzed retrospectively. Demographic characteristics, vascular risk factors, laboratory findings, National Institutes of Health Stroke Scale (NIHSS) scores, onset to treatment time, and whether sICH occurred were recorded. The modified Rankin Scale was used to evaluate the outcomes at 90 d after onset, and 0 to 2 was defined as good outcome. Multivariate logistic regression models were used to determine the independent factors for outcomes and sICH. Results: A total of 144 patients were included, 54 (37.5%) had a good outcome, 90 (62.5%) had a poor outcome (including 28 deaths), and 29 (20.1%) had sICH. Serum uric acid was significantly higher in the good outcome group than in the poor outcome group (P<0.05). Serum uric acid was significantly higher in the non-sICH group than in the sICH group (P<0.05). Multivariate logistic regression analysis showed that higher serum uric acid were the independent protective factors of good outcome (odds ratio 0.82, 95% confidence interval 0.66-0.93; P<0.001) and sICH (odds ratio 0.97, 95% confidence interval 0.93-0.99; P=0.004). Conclusion High serum uric acid level is independently associated with good outcome after intravascular mechanical thrombectomybridged with intravenous thrombolysis in patients with acute ischemic stroke.

Objective:To prepare the virus-like particle (VLP) of the GII.3[P12] human norovirus (HuNoV) strain GZ2013-L20 in Guangzhou and its polyclonal antibody, and systematically characterize its immunogenicity and receptor binding ability, which would provide data for prevention and control of HuNoV.Methods:ORF2 gene was amplified from the genome of the GZ2013-L20 strain to construct the recombinant transposon vector, which was further transformed into Escherichia coli DH10 Bac to develop the recombinant baculovirus Bacmid-L20-ORF2. VLP was expressed in the sf9 insect cells and then purified. Transmission electron microscopy, SDS-PAGE, Western blot (WB), and receptor binding experiments were performed to characterize the purified VLP. In addition, the polyclonal antibody from the immunized mice was evaluated by indirect enzyme-linked immunosorbent assay (ELISA) and the blocking test of receptor binding. Results:The recombinant baculovirus plasmid Bacmid-L20-ORF2 was constructed, and the target VLP was successfully obtained. The result by the transmission electron microscope demonstrated that the VLP were about 30 nm in diameter. SDS-PAGE and WB analyses showed that the protein’s relative molecular mass (Mr. ×10 3) was about 58. The result of receptor binding experiments showed that the VLP could bind to the secretory salivary receptors (types of A, B, AB and O), non-secretory salivary receptors (O type) and the porcine gastric mucin. The polyclonal antibody with a titer of 2 × 10 5 was detected in the immunized mice, which showed strong cross-immunoreactivity with capsid proteins of 20 (20/28) HuNoV genotypes. In addition, the result of blocking tests of receptor binding showed that the VLP polyclonal antibody only blocked the viral VLP of the same genotype, but had no neutralizing effects on the VLPs of GII.2, GII.4, GII.8 and GII.17. Conclusions:The VLP of GII.3[P12] HuNoV Guangzhou strain showed strong binding ability to both secretory and non-secretory salivary receptors, and its polyclonal antibody showed a broad spectrum of immunobinding, but its neutralization blocking feature was effective only against the virus of the same genotype. The result provide basic data for rational design of vaccine development.