Objective To evaluate the effect of tranexamic acid (TXA ) in medical treatment of chronic subdural hematoma (CSDH) .Methods A total of 19 patients with CT-confirmed CSDH in our department from Mar 2014 to Aug 2015 received an in-travenous dose of 1g TXA in the first week ,and followed by a maintenance oral dose of 250 mg TXA three times a day for 1 - 5 months (2 .73 ± 1 .05) months .These patients received a follow-up period of 6 - 10 months .Hematoma volume and neurological functions were compared before and after treatment .Results The therapeutic outcome was divided into effectiveness and ineffec-tiveness .Thirteen cases (68 .4% ) were effective ;six cases (31 .6% ) were ineffective .Among them ,three patients (15 .8% ) whose neurological functions deteriorated underwent surgery ,one patient (5 .3% ) who did not show any improvement with initial one month of TXA underwent surgery ,one patient (5 .3% ) stopped the treatment due to the side-effect of drug ,one patient (5 .3% ) lost .Conclusion Results of this preliminary study show that the administration of TXA is effective and safe in treating CSDH .

Severe acute pancreatitis (SAP) is a common gastrointestinal disease, often accompanied by systemic inflammatory reactions and organ dysfunction. SAP has an acute onset, severe condition, rapid progression, and poor prognosis. The development of SAP is closely related to the excessive release of inflammatory factors. In the comprehensive treatment of SAP, continuous blood purification (CBP) can clear inflammatory mediators, improve the stability of Internal environment, improve organ function, reduce blood lipids, regulate immunity, and significantly improve the condition of SAP patients. It is an important means of treating SAP. This article reviews the research progress of CBP in the treatment of SAP.

Objective To investigate the effect of Galangin on migration and invasion in gliomas and explore the possible mechanism.Methods (1) After treating the glioma lines U87 and U251 with 0,10,20 and 40 μmol/L galangin for 24 h,CCK-8 was performed to detect the cell viability;wound healing assay and Transwell assay were used to detect the cell migration and invasion,respectively;protein expression of transforming growth factor (TGF) β was detected by Western blotting.(2) The second experiment was divided into control group,20 μmol/L galangin treatment group,TGFβ over-expression group and 20 μmol/L galangin+TGFβ over-expression group;the cells in the control group and 20 μmol/L galangin treatment group were transfected with empty-vector plasmids;cells in the TGFβ over-expression group and 20 μmol/L galangin+TGFβ over-expression group were transfected with TGFβ plasmids,and 24 h after the transfection,the cells in the 20 μmol/L galangin treatment group and 20 μ mol/L galangin+TGFβ over-expression group were added 20 μmol/L galangin;24 h after that,wound healing assay and Transwell assay were used to detect the cell migration and invasion,respectively;TGF β protein expression was detected by Western blotting.Results (1) As compared with cells from the 0,10 and 20 μmol/L galangin group,the cells from 40 μmol/L galangin group had significantly lower cell viability (P＜0.05).Cells from the 0,10 and 20 μmol/L galangin group had significantly decreased wound healing percentage,significantly decreased cell number reaching to the lower chamber,and statistically decreased TGFβ protein expression in sequence (P＜0.05).(2) U87 and U251 cells from the TGFβ over-expression group,control group,20 μmol/L galangin+TGFβ over-expression group and 20 μmoll/L galangin treatment group had successively decreased wound healing percentage,decreased cell number reaching to the lower chamber,and decreased TGFβ protein expression (U87 cells:1.63±0.21,1.00±0.00,0.78±0.05 and 0.43±0.08;U251 cells:1.98±0.20,1.00± 0.00,0.86±0.06 and 0.29±0.04),with significant differences (P＜0.05).Conclusion Galangin inhibits the glioma migration and invasion through TGFbβ down-regulation.

Objective To evaluate the clinical application and effect of computerized digital sur -gical assisted design and manufacture for reconstruction of mandibular defect with vascularied iliac crest flap graft .Methods CT was used to scan the craniofacial and maxillofacial region of mandibular ameloblastoma patient ,and then the 3D model of the maxillofacial skeleton was reconstructed using the computerized digital surgical aid design to simulate the focal resection and the mandibular defect reconstruction with the iliac crest flap .Surgical guides were prepared by 3D printing to assist focal re-section and bone reshaping .Postoperatively ,clinical and CT examinations were performed to observe the restoration of the patient's facial appearance and occlusal relationship ,as well as wound healing and graft survival .Results Postoperative review results showed that the bone graft survived well ,and the anastomosed bone was formed .The wound in the surgery area healed .No recurrence of the tumor was found after clinical and CT examination .The maxillofacial appearance was well restored ,and the re-sidual occlusal relationship recovered well .Conclusions The use of computerized digital surgical aided design combined with 3D printing technology can effectively simplify the mandibular segmental defect repair and reconstruction and optimize the postoperative repair effect .

Objective To establish diagnostic criteria for dampness syndrome through scientific and normative research methods.Methods The basis for syndrome differentiation of dampness syndrome was comprehensively integrated through literature research and structured tools,and in-depth investigation was carried out on the connotation and extension of dampness syndrome,judgment basis and criteria construction through questionnaire surveys and consensus conference method.Results Thirty-six items for syndrome differentiation of dampness syndrome were obtained through literature research.Through the questionnaire surveys,some experts suggested that the diagnosis mode of dampness syndrome should be in line with the clinical practice requirements.Accordingly,we were deep in thought about the key issue of"how to establish accurate diagnostic criteria".After in-depth investigation,we found that the dampness syndrome had specific and sensitive indicators.And 11 specific and 19 sensitive indicators were determined.Furthermore,according to the experts'suggestions,the specific indicators were classified into three categories based on dampness characteristics.Meanwhile,we investigated the diagnosis attributes of Chinese medicine syndromes and summarized them into four corresponding modes.Based on this,specificity mode and similarity/consistency mode should be adopted for diagnostic criteria for dampness syndrome.In addition,the judgment form in accord with the diagnostic attributes of dampness syndrome was determined.Conclusion This diagnostic criteria can provide a basis for the clinical diagnosis of dampness syndrome.Besides,this study explored the diagnostic attributes of Chinese medicine syndromes,which could provide reference for the development of other Chinese medicine syndrome criteria.

Objective: To analyze the susceptibility and distribution of β-lactamase encoding and efflux pump genes as well as the inhibitory effect of efflux pump inhibitors on the carbapenem resistance of the carbapenem resistant Klebsiella pneumoniae without producing carbapenemase (CRKPPC). Methods: One hundred and eight strains of carbapenem non-susceptible Klebsiella pneumoniae were collected from our hospital during 2012-2014. The strains producing carbapenemase were screened by Mastdiscs combi Carba plus disc system. For CRKPPC strains, the susceptibilities to antimicrobial agents were determined by micro-dilution broth methods. PCR and DNA sequencing technology were used to analyze the prevalence of β-lactamase encoding extended-spectrum β-lactamase (ESBL) and plasmid mediated AmpC genes as well as efflux genes including acrAB-tolC, kexD, kdeA, kpnEF and kpnGH. The inhibitory experiments were implemented by using carbonylcyanide-m-chlorophenylhydrazone (CCCP) and Reserpine to observe the role of efflux pumps on the carbapenem resistance. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) was performed to analyze the expression of outer membrane proteins OmpK35 and OmpK36. Results: Twenty-six strains out of the 108 carbapenem non-susceptible Klebsiella pneumoniae were identified to be CRKPPC strains which displayed quite high resistance to β-lactam and high resistance to amikacin, gentamicin, levofloxacin and ciprofloxacin. Very good sensitivities were observed to tigecycline, polymyxin, ceftazidime/avibatan and aztreonam/avibatan. The high prevalence of bla CTX-M and bla SHV were also displayed with the prevalent rates being 76.9% and 57.7%, respectively. The loss of outer membrane proteins OmpK35 and OmpK36 with varying degrees was observed, among which 57.7% strains lost ompK35 and 19.2% strains lost OmpK36. More than 80% strains contained efflux genes including acrAB-tolC, kexD, kdeA, kpnEF and kpnGH. The results of inhibitory experiments showed that CCCP displayed quite obviously inhibitory effects on the carbepenem resistance whereas no inhibitory effect was observed for Reserpine. Conclusion Tigecycline and polymyxin could be used as the basis of combined drug for CRKPPC. The prevalence of AmpC, ESBLs and loss of OmpK35 and OmpK36 with varying degrees among these strains were observed, but the over-expression of efflux pumps should be the main mechanism of the carbapenem resistance in the Klebsiella pneumoniae strains, and efflux inhibitors may have potential value in treating the infections caused by these bacteria.