As an effective therapeutic approach for acute ischemic stroke,endovascular interventional therapy has received increasing attention.However,a large number of revascularization clinical trials have shown that its mortality rate and the incidence of complications are higher than intravenous thrombolysis.This article reviews the perioperative complications of endovascular interventional therapy of acute ischemic stroke and thek treatment.

Endovascular interventional therapy can signifantly improve the clinical outcomes in patients with acute ischemic stroke.It has become the important therapeutic means and research focus for acute ischemic stroke.However,there are many factors affecting its efficacy.This article reviews the factors affecting the treatment effect of endovascular interventional therapy of acute ischemic stroke.

Objective To assess the value of whole cerebral perfusion weighted map (PWM) and whole cerebral perfusion blood volume (PBV) integrating in scan protocol about CT perfusion (CTP) combined with CT angiography (CTA) in acute cerebral infarction. Methods Twenty-three patients with acute cerebral infarction proved clinically underwent CTP examination combined with CTA. The color-coded images of PWM and PBV were attained using workstation, and the raw data of contract CTA images and subtractive images between contract CTA and non-contract CTA were processed. The diagnostic sensitivity and the value of CTP and PWM, PBV integrating CTP in acute cerebral infraction were evaluated. Results Seven of 9 patients with negative results on CTP images had positive expressions on PWM and PBV images. The sensitivity of CTP was 60.87% and the sensitivity of PWM and PBV integrating CTP was 91.30%. Conclusion The scan protocol of PWM, PBV integrating CTP not only increases detection rate of acute cerebral infraction, but also has ability to predict the clinical prognosis of patients with cerebral infraction.

Objective To provide the effective references for reasonable arrangement of nursing post by comparison on the core competence level and characteristics between the upgraded and the fulltime bachelor nurses.Methods Questionnaire survey based on the basic demographic data and the Competency Inventory for Chinese Registered Nurse for 391 clinical nurses from 13 three level of firstclass hospitals.Results The core competence score of the upgraded and the full-time bachelor nurses showed a moderate degree of satisfaction; the full-time bachelor nurses' total scores were higher than those of the upgraded nurses,and there were statistically significant differences among 6 dimensions included critical thinking and scientific research ability; there was no significant difference in clinical nursing dimension.Conclusions The full-time bachelor nurses' core competence is higher than that of the upgraded nurses in general,but no significant difference exists in clinical nursing dimension.

Objective To assess the short-time economics of various glutamine dipeptide-enriched parenteral nutrition (PN) for patients undergoing elective surgery for gastrointestinal tumors, with an attempt to provide evidence for decision makers on clinical nutrition support.Methods A prospective cohort study was designed.From payer/disburser''s perspective, a cost-effectiveness decision-tree model was developed to assess the clinical outcomes and short-time economic effects of glutamine dipeptide-enriched PN that used in different time points (early postoperative or perioperative).Cost-effectiveness analysis, cost-utility analysis, and incremental cost-effectiveness analysis were adopted in the decision-tree model.One-way sensitivity analysis was performed to determine the robustness of the results.Results Totally 107 patients were included.There was no significant difference between the perioperative alanine(Ala) glutamine(Gln) nutrition support (group A) and early postoperative Ala-Gln nutrition support (group B) in the ratio of 5％ weight declines on the 8th day after surgery and infection-related postoperative complications (72.1％ vs.78.1％, χ2=0.509, P=0.498 and 2.32％ vs.4.69％, χ2=0.060, P=0.806).The levels of prealbumin (PA) and albumin(Alb) and the level of total lymphocyte count(TLC) also the time of recovering gastrointestinal function, length of stay nutritional discharge index(LOSNDI), and direct costs were significantly different [PA:(208.19±56.92)mg/L vs.(187.97±62.05)mg/L, t=2.283,P=0.039;Alb:(33.82±3.91)×109 vs.(31.96±4.57)×109, t=2.184, P=0.036;TLC:(1.19±0.55)×109 vs.(0.89±0.66)×109, t=2.461, P=0.015;the time of recovering gastrointestinal function(3.06±0.28)d vs.(3.39 ± 0.34)d, t=-3.675, P=0.000;LOSNDI:(16.84±2.92)d vs.(18.52 ±3.47)d, t=-2.613, P=0.011;direct costs:￥(17 029.05±317.28) vs.￥(15 610.64±292.56), t=23.764, P=0.000].When LOSNDI and quality-adjusted life years (QALYs) were estimated as indicators of effectiveness, the incremental cost-effectiveness ratios and incremental cost-utility ratios of group A were ￥844.3 and ￥70 920.5, respectively.Net monetary benefit of group B was more than that of group A.One-way sensitivity analysis showed that parameters had no significant effect on the model.Conclusion When using local per capita gross domestic product as threshold, early postoperative Ala-Gln PN was more economical than perioperative Ala-Gln PN strategy evaluation.

【Objective】To explore the relationship of pathological changes,clinical manifestations and results of laboratory examination with TCM syndromes in patients with IgA nephropathy.【Methods】With parameters in Memphis renal biopsy accessing system and principle syndromes and complicated syndromes in differentiation criteria of chronic nephritis as reference,pathological changes and clinical manifestations of IgA nephropathy were classified by principle component analysis and factor analysis.The regression equations of different syndromes were established after a regression analysis of the principle components of pathological changes and clinical manifestations with the standard syndromes.【Results】(1)With the parameters in Memphis renal biopsy accessing system as reference,the principle components(reflecting over 85% information of glomerular changes)of pathological changes in 123 IgA nephropathy patients were glomerulosclerosis,crescent,stroma,immunofluorescence IgA and complement 3(C_3).With principle syndromes and complicated syndromes in differentiation criteria of chronic nephritis as reference,the principle components(reflecting over 90% information of syndrome manifestations)were lassitude and weakness for deficiency syndrome,cold limbs,white tongue and slippery fur and deep-thready pulse for yang-deficiency syndrome,and dry mouth and throat,red tongue and thready pulse for yin-deficiency syndrome.For liver-stagnation syndrome,the principle components were impatience and irritability,bitterness in mouth,frequent sighing and wiry pulse;for bloodstasis syndrome,the principle components was purple tongue with ecchymosis;for phlegm-damp syndrome,the principle components were heaviness of limbs,greasy fur,abdominal distension and impaired appetite;for heat-toxic syndrome,the principle components were sore throat,purulent sore and yellowish tongue with dry fur;for damp-heat syndrome,the principle components were bitterness and stickiness in mouth,and yellowish greasy fur.(2)The regression equations of syndromes of yin deficiency,yang deficiency,yin-yang deficiency,blood stasis,phlegm damp and liver stagnation were obtained.(3)The results of non-conditional Logistic regression analysis showed that yang-deficiency syndrome was correlated with edema,the incidence of yang deficiency in edema patients being 1.6 times of that in patients without edema;yin-deficiency syndrome was positively correlated with gross hematuria,the incidence of yin deficiency in patients with gross hematuria being 1.5 times of that in patients without gross hematuria;pain in waist and back was the common signs in patients with yin deficiency,yang deficiency and yin-yang deficiency.【Conclusion】Parameters of glomerulosclerosis,crescent,stroma,immunofluorescence IgA and C_3 reflect over 85% information of glomerular changes in IgA nephropathy patients;there exists a relationship of TCM syndrome with pathological changes and clinical manifestations;yang-deficiency syndrome is correlated with edema and yin-deficiency syndrome is correlated with gross hematuria.

ObjectiveTo explore the efficacy and safety of infliximab combined withdiseasemodifying antirheumatic drugs (DMARDs) in the treatment of psoriatic arthritis.MethodsThis was an openlabeled trial.All subjects fulfilled the Moll and Wright criteria for definite PsA and-had poor response to DMARDs.The patients received combined infliximab and DMARDs.Infliximab 3 mg/kg was infused at weeks 0,2,6,14.After week 14,patients received infliximab 3 mg/kg every 8 weeks.The primary end point was the improvement of psoriatic arthritis response criteria(PsARC) response.The secondary end point was the percentage of patients who had 20％ improvement of modified American College of Rheumatology (ACR20)response.Parameters for efficacy for psoriatic rash was defined as the proportion of modified 50％ and 75％improvement of psoriasis area and severity index scores (PASI).All adverse reactions in the whole observation period were recorded.Chi-square test and repeated measurement data analysis of variance were used for the statistical analysis.ResultsTwenty-one patients completed the 14 weeks treatment.Five patients completed 26-104 weeks treatment,including 2 cases for 104 weeks.At week 14,the percentage of patients achieving PsARC was 84％,the percentage of patients achieving ACR20 was 77％,and the percentage of patients achieving PASI 50 was 76％.At week 14,tender joint counts,swollen joint counts,patient's assessment of pain,patient's global assessment(PGA),physician's global assessment,dermatology life quality index (DLQI),health assessment questionnaire(HAQ) were significantly improved compared with base-line(P＜0.05).Five patients received 26-104 weeks follow-up,including 2 cases for 104 weeks,four patients was stable,the rash and joint symptoms of 1 patient recurred at 104 weeks.The most frequently occurred adverse reactions were upper respiratory tract infection and skin as well as appendage damages.The second most common adverse effect was elevation of liver enzymes.ConclusionThe infliximab combined with DMARDs is effective and safe for the treatment of psoriatic arthritis.

Objective To investigate the level and value of serum IgE, anti-IgE, FcεRⅠα, anti-FcεRⅠin autoimmune liver disease ( AILD) .Methods In this case-control study, the serum samples and clinical data of 77 patients with hepatosis were collected between May and November 2014 from the department of gastroenterology of Shanghai First People′s Hospital.These patients had positive results about the liver-related autoimmune antibodies, including 33 cases of AILD, 44 cases of other chronic liver disease. 64 healthy persons were collected as control group.Serum mast cell-associated anti-IgE, FcεRⅠα, anti-FcεRⅠwere detected by Enzyme-linked Immuno sorbent Assay ( ELISA) .Serum IgE, IgM and IgG were detected by rate scatter nephelometry.Differences among AILD, other chronic liver disease and healthy control were assessed.Results were compared using Mann-Whitney U test.Results Mast cell-associated anti-IgE, FcεRⅠα, anti-FcεRⅠin liver-related autoimmune antibodies positive patients were significantly higher than healthy control [1.74(1.16 -2.88)mg/L, 14.86(4.39 -26.23)mg/L, 47.22(36.89 -55.29)mg/L and 1.23(0.95-1.58)mg/L, 1.87(1.52-2.33)mg/L, 35.40(24.74-44.89)mg/L, respectively;U=1614,556.5,1319.5, P<0.01].FcεRⅠαwas significantly higher in other chronic liver disease patients than AILD patients [18.40(7.35-30.64)mg/L and 6.25(2.49-22.29), respectively;U=445, P<0.01] .Conclusion Mast cell-associated anti-IgE, FcεRⅠα, anti-FcεRⅠwere increased in liver-related autoimmune antibodies positive hepatosis patients.However, FcεRⅠαwas lower in AILD than other chronic liver disease.Mast cell-associated anti-IgE、FcεRⅠαand anti-FcεRⅠ molecules involved in the inflammatory lesion of liver disease.

Objective To study the role of manganese-enhanced MRI(MEMRI) in the depiction of cortical architecture of rat brain after systemic administration of Mn~(2+) through caudal vein and compare the effects of normal or opened blood-brain barrier on the manganese-enhanced MRI. Methods Fifteen SD rats were randomly divided into three groups according to ranked list of random. Blood-brain barrier was opened in short time by the injection of 30% mannitol via the right internal carotid artery, in group A, then 100 mmol/L MnCl_2 physiologic saline solution was delivered through vena caudalis, and MRI was performed 12 hours later. In group B, 100 mmol/L MnCl_2 physiologic saline solutions was administrated through vena caudalis, following normal saline injection into the right internal carotid artery, and MRI was performed 12 hours later. The group C served as normal control group. All images were acquired with a 7.0 T microMR scanner. Signal-to-noise ratios (SNR) in regions of interest were measured by Paravision 4.0 and the differences of three groups were compared by using one-way ANOVA. The differences of SNR on both sides of hemispheres were compared by using paired t test. Results MEMRI could show the gray matter and white matter of rat brain and the anatomy borders between somatosensory cortex and motor cortex clearly. Periventricular structures such as hippocampus, dentate gyms, habenula united, and olfactory bulb could also be showed clearly. Symmetrical enhancement on both sides of the cortex and banded structures was shown clearly in group B. The SNR increased and the differences were significant in right cerebral cortex, both sides of cerebellar cortex, hippocampus and pituitary, among three groups (right cerebral cortex 35.2±7.0,30.1±2.4,26.6±2.8,F =4.36,P=0.038;left cerebellar cortex 27.1±5.2,29.4±3.8,19.4±4.5, F=6.66, P=0.011;right cerebellar cortex 27.8±3.8,28.5±4.2,20.4±4.8, F=5.84, P=0.017; left hippocampus 34.5±4.9,38.1±5.3,24.5±3.6, F=11.38, P=0.002; right hippocampus 35.3±5.5, 37.6±4.7,25.6±3.0,F=9.93,P=0.003;pituitary 39.5±3.8,52.6±9.1,26.2±4.2,F=22.80, P=0.001) after systemic administration of Mn~(2+). Asymmetric enhancement on two sides of cortex was shown in group A. The mannitol-infused side was enhanced obviously but displayed blurring banded structures. However,the SNR differences of both sides of hemispheres in group A and B were not significant (P >0.05). Conclusions After systemic administration of MnCl_2 through vena caudalis, MEMRI could map the laminar architectures and the anatomy border of functional zone of somatosensory cortex specifically. High concentration of mannitol could open blood brain barrier(BBB) effectively and have distinct impacts on the architectures displayed in MEMRI. Opening or maintaining BBB in MEMRI had respective characteristics, and it should be selected according to practical needs.

OBJECTIVE To compare the effects of post-aural injection of methylprednisolone and dexamethasone in flat-type sudden hearing loss.METHODS 142 patients with flat-type sudden hearing lossin our hospital were selected and divided into methylprednisolone group and dexamethasone group randomly.All patients in these two groups received local injection of glucocorticoidsoncein mastoid periosteum.Patients in methylprednisolone group were injected methylprednisolone solution;Patients in dexamethasone group were injected dexamethasone solution.The efficacy,hearing improvement of two groups were compared.RESULTS After the treatment,the recovery rate of methylprednisolone and dexamethasone group were 25.35％ and 16.90％,the total effective rate was 88.73％ and 63.38％,respectively;Each clinical index between two groups had statistically significant difference (P＜0.05);Moreover,the hearing improvement in methylprednisolone group was much better than dexamethasone group,withan averagedincrease of (26.5 ±4.3) dB in 125-250 Hz in methylprednisolone group while only (18.5 ± 6.2) dB in 125-250 Hz in dexamethasone group,which demonstrated statistical significantly difference(P＜0.05).CONCLUSION The clinical efficacy of local injection with methylprednisolone was better than dexamethasone,and demostrated mild adverse reactions,which could be widely applied in clinical therapy.