Objective:To investigate the effect of Ginkgo leaf extract and dipyridamole injection on serum tumor necrosis factor-α, procalcitonin, lipopolysaccharide and 28-day mortality in patients with sepsis.Methods:Ninety patients with sepsis who received treatment in Ningbo Yinzhou People's Hospital from February 2018 to February 2019 were included in this study. They were randomly assigned to receive routine treatment (control group, n = 45) or Ginkgo leaf extract and dipyridamole injection treatment combined with routine treatment (treatment group, n = 45). Clinical efficacy, preoperative and postoperative Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, serum tumor necrosis factor-α, procalcitonin, bacterial lipopolysaccharide levels as well as 28-day mortality were compared between the control and treatment groups. Results:There was significant difference in total effective rate between the treatment and control groups [91.11% (41/45) vs. 75.56% (34/45), χ 2 = 6.690, P = 0.039]. After treatment, Acute Physiology and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score in the treatment group were (15.93 ± 1.01) points and (6.25 ± 1.83) points, respectively, which were significantly lower than those in the control group [(18.62 ± 1.75) points, (8.54 ± 2.19) points, t = 8.931, 5.383, all P < 0.001]. After treatment, serum tumor necrosis factor-α, procalcitonin and lipopolysaccharide levels in the treatment group were (43.62 ± 3.39) ng/L, (1.46 ± 0.79) μg/L, (23.62 ± 7.19) ng/L, respectively, which were significantly lower than those in the control group [(56.28 ± 4.54) ng/L, (2.12 ± 1.03) ng/L, (33.75 ± 8.67) ng/L, t = 14.989, 3.411, 6.033, P < 0.001, P = 0.001, P < 0.001]. The 28-day mortality in the treatment group was significantly lower than that in the control group [6.67%(3/45) vs. 22.22%(10/45), χ 2 = 8.160, P = 0.017]. Conclusion:Based on routine treatment, Ginkgo leaf extract and dipyridamole injection can improve the clinical symptoms of patients with sepsis, reduce inflammatory reaction and decrease mortality.

Objective To evaluate the value of cranial MRI on diagnosing nonalcoholic Wernickes encephalopathy (WE). Methods The clinical characters, cranial MRI features, and outcomes materials in six cases of nonalcoholic Wernickes encephalopathy were analyzed.Results Cranial MR and Flair imaging of the patients exhibited areas of increased T 2W and flair signals symmetrically surrounding the aqueduct and third ventricle and within the medial thalamus. One patient who became persistent vegetative state coexistenced increased T 2W and flair signal of the cortex. According to the follow-up results, the alterations of four patients in T 2W and Flair signals showed to resolve being consistent with the clinical recovery. One patient with persistent vegetative state had no change within two years of the follow-up.Conclusions Cranial MRI is of great value in diagnosing nonalcoholic Wernickes encephalopathy and reflects appropriately the pathological evolution of this disease.

OBJECTIVE:To observe the efficacy and safety of Guizhi fuling capsule combined with mifepristone in treatment of uterine fibroids. METHODS:116 patients with uterine fibroids were randomly divided into control group and observation group. Control group was orally given Mifepristone tablet 25 mg,2 h before meal in the first day of menstrual period,once a day,for con-tinuous 10 d;observation group was additionally given Guizhi fuling capsule 3 pills in non-menstrual period,3 times a day. 3 months was regarded as a treatment course,it lasted 2 courses. Clinical efficacy,and E2,FSH,SHBG,uterine volume,menstrual blood volume,uterine fibroid volume and incidence of adverse reactions in 2 groups before and after treatment were observed. RE-SULTS:Total effective rate in observation group was significantly higher than control group,the difference was statistically signifi-cant(P<0.05). After treatment,the FSH,E2,uterine volume,menstrual blood volume and uterine fibroid volume in 2 groups were significantly lower than before,and observation group was lower than control group,the differences were statistically signifi-cant(P<0.05);but there were no significant difference in the SHBG and adverse reactions between 2 groups(P>0.05). CONCLU-SIONS:The clinical efficacy of Guizhi fuling capsule combined with mifepristone in treatment of uterine fibroids is more signifi-cant than mifepristone alone,with good safety.

Based on the conservation of nucleotides at splice sites, the characteristics of base composition and base correlation in the adjacent segment sequences, the distance between alternative donor or acceptor splice sites and the content of GC and TC near splice sites, the donor and acceptor splice sites for alternative and constitutive introns are predicted by use of the method of diversity measure combined with quadratic discriminant analysis. For alternative splice sites the total prediction accuracies are 87.9% and 89.9% for donors and acceptors respectively (with the chosen threshold -2). For constitutive splice sites the total accuracy are 92.8% and 94.3% for donors and acceptors respectively (with the chosen threshold -1).

Objective To investigate the effects of sevoflurane pretreatment on renal ischemia-reperfusion (I/R)-induced apoptosis in kidney in rats. Methods Thirty pathogen-free male SD rats weighing 220-260 g were randomized into 3 groups (n=10 each):group control (group C);group I/R and group sevoflurane(group S). Renal I/R was induced by clamping the left renal pedicle for 45 min in I/R and S groups. In group S inhalation of 2.2% sevoflurane in O2 was started at 30 min before operation and maintained throughout the experiment.Venous blood samples were taken at 3 h of reperfusion for determination of serum BUN and Cr concentrations. The animals were then sacrificed and the left kidneys were removed for microscopic examination, detection of apoptosis(by TUNEL)and determination of heme oxygenase-1(HO-1) mRNA and protein expression (by RT-PCR and Western blot).Results Renal I/R significantly increased serum BUN and Cr concentrations, apoptotic index(percentage of apoptotic cells) and the severity of necrosis of renal proximal convoluted tubules (0=normal,4=necrosis of whole segment of proximal convoluted tubules).Sevoflurane inhalation attenuated the I/R-induced changes mentioned above.HO-1 mRNA and protein expression was up-regulated by I/R and HO-1 mRNA expression was further up-regulated by sevoflurane inhalation.Conclusion Sevoflurane pretreatment can protect kidney against I/R injury by attenuating cell apoptosis.Up-regulation of HO-1 mRNA expression may be involved in the mechanism.

Objective To observe the effects of early rehabilitation on the motor function of post-stroke hemiplegic patients treated with intravenous thrombolysis.Methods Thirty-six post-stroke hemiplegic patients after intravenous thrombolysis with rtPA were recruited in this study.They were randomly divided into the early rehabilitation group (with the course less than three days) and the control group (with the course between three and seven days),18 cases in each group.Both group received a two-week rehabilitation programme.They were assessed using the Fugl-Meyer assessment (FMA) of up extremity,FMA of lower extremity and ADL score (modified Barthel index,MBI) before and after treatment,as well as at the 3rd month after treatment (during the following-up).Results After treatment and at the following-up,FMA scores of up extremity,FMA scores of lower extremity and MBI scores had improved significantly compared with before treatment in both groups.Furthermore,after treatment,in the early rehabilitation group the average FMA score of lower extremity and MBI score reached (23.33 ± 4.37) and (56.11 ± 22.27) respectively,significantly higher than those of the control group [(17.06 ± 4.70) and (40.00 ± 15.81) respectively].Conclusion Early rehabilitation contributes to short-term recovery of lower extremity motor function and ability in the activities of daily living in post-stroke hemiplegic patients after intravenous thrombolysis.

Objective To investigate the association between serum level of secretory type Ⅱ phospholipase A2 (sPLA2 Ⅱ a) and carotid intima-media thickness (CIMT) in elderly patients with metabolic syndrome (MS).Methods A total of 124 consecutive MS patients aged over 65 years were enrolled and another 90 elderly non-MS subjects were served as controls.The serum concentration of sPLA2 Ⅱ a was measured by enzyme-linked immunosorbent assay.Blood pressure,blood lipids and blood glucose levels etc.were also measured.The carotid intima-media thickness was examined by color Doppler ultrasonography.Results Serum level of sPLA2 Ⅱ a was significantly higher in elderly MS patients than in control group [(4.41±1.55)μg/L vs.(2.39±0.97)μg/L,P＜ 0.05].Compared with the control group,elderly MS patients showed CIMT was significantly increased [(1.17±0.24) mm vs.(0.89±0.24)mm,P＜0.05].Serum level of sPLA2 Ⅱ a were higher in elderly obesity patients than in normal BMI subjects [(4.76±0.99)μg/L vs.(2.84±0.54)μg/L,P＜0.05].Multiple regression analysis indicated that sPLA2 Ⅱ a level was an independent risk factor for CIMT in elderly MS patients after adjusting for the effects of BMI,IL-6 and high sensitive C-reactive protein (hs CRP) on CIMT(r=0.38,P＜0.01).Conclusions Serum level of sPLA2 Ⅱ a is increased in elderly MS patients and is independently correlated with CIMT,which has a predictive value for atherosclerosis,sPLA2 Ⅱ a may be involved in the process of vascular endothelial injury.

Temporomandibular joint disorder (TMD) is one of the common diseases in stomatology caused by a variety of factors, with a high incidence rate, especially among the young people with great pressure, and difficult to treat this disease. it was easy to relapse directly affects the physical and mental health and quality of life of the patients. Psychological factors had been proved to be one of the causes of temporomandibular joint disorder, and cognitive behavioral therapy was a form of psychological therapy that has been applied to a variety of problems, including mental illnesses such as depression, anxiety, and physical symptoms like pain. Cognitive behavioral therapy (CBT) was also used in stomatology department. This paper reviewed the origin, concept formation, theory formation, characteristics and application of CBT in TMJ disorders, in order to provide more evidence for clinical practice and reduce pain for patients.

Objective To investigate the relationship between plasma homocysteine on admission and the outcome at discharge of acute ischemic stroke.Methods A non-concurrent cohort study was performed and a total of 1 3 1 9 patients with acute is-chemic stroke were continuously included in this study.According to tertile range of plasma homocysteine,patients were di-vided into three group.Logistic regression analysis was used to assess the independent association between plasma homocys-teine on admission and poor outcome at discharge of acute ischemic stroke.Results The difference of plasma homocysteine on admission between the poor outcome and those with good outcome had statistical significance (P<0.000 1).Without the adj ustment of multiple factors,when comparing to the first group,the second and third tertile seemed to have a tendency of increasing the risk of poor outcome at discharge,the OR (95%CI)was 2.111 (1.297~3.437,P<0.05),2.113 (1.361~3.279,P<0.05).After adjustment for multivariate,the second and third tertile also seemed to have a tendency of increasing the risk of poor outcome at discharge,the OR (95%CI)was 1.876 (1.160~3.036,P<0.05),2.396 (1.414~4.062,P<0.05).Conclusion The current study indicated that higher plasma homocysteine level was an independent risk factor for poor outcome at discharge in ischemic stroke patients.It would increase the risk of the outcome at discharge in patients with acute ischemic stroke,and suggests that there is a dose-response relationship between plasma homocysteine level on admis-sion and the poor outcome at discharge.

Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a specific subtype of the stiff-person syndrome, which is rare and difficult to diagnose clinically. A case of PERM in a 66-year-old female with a fluctuating progressive course was reported in this article. She had increased facial muscle tone, pruritus and sensory hypersensitivity mainly in the head and neck, medullary involvement syndrome and bilateral lower limb rigidity as the main clinical manifestations, and a previous history of pulmonary malignancy, thymoma, typeⅠ diabetes and Hashimoto′s thyroiditis. The patient′s serum and cerebrospinal fluid were positive for anti-glutamic acid decarboxylase antibody. The electromyogram showed a large number of motor unit potentials in the trunk and proximal extremities in the quiet state, which were significantly enhanced during spastic episodes, consistent with the electromyographic manifestations of stiff-person syndrome. The final diagnosis was PERM, and immunotherapy including gamma globulin and hormone responded well. PERM is a rare neurological autoimmune disease with atypical early symptoms, which can be easily misdiagnosed, and it requires attention to avoid delaying the diagnosis.