Embolic stroke of undetermined source ( ESUS ) refers to non-lacunar brain infarcts without definite proximal arterialstenosis or major cardioembolic sources.Paroxysmal atrial fibrillation may be the most important cause of ESUS, thus anticoagulation may be more effective than antiplatelet therapy for secondary stroke prevention to this group of patients.This paper reviews the latest progress on the definition, epidemiology, diagnostic approach, relation to atrial fibrillation and management of ESUS.

Acrylonitrile ; toxicity ; Carcinogens ; toxicity ; Humans ; Mutagens ; toxicity ; Occupational Exposure

Objective To analyse the key influential factors for research performance of medical colleges and provide evidenes for further research management. Methods A questionnaire suvery was carried out in Shanghai Jiaotong University School of Medicine.Through stratified cluster sampling,those who assumed all ranks of projects from 2001 to 2006 in Basic Medical College and some affiliated hospitals were investigated.Two hundred and sixty questionnaires were sent out and 211(81.2%) were reclaimed.Delphi and comprehensive analysis were used to measure the research performance,and multi-Logistic regression was employed to analyze the influential factors for research performance.Results The key influential factors for research performance included research team,research investment,age of researchers,international exchanges and communications,and extra working hours for research.Conclusion To improve the research performance of medical colleges,it is most important to strengthen research team development,expand research investment,promote acedemic exchanges and communications,and initiate dedicated spirit for research work.

Objective To provide basis for the formulation of policies and measures that will reduce the work pressure on nurses and to provide them with a better working environment. Methods An investigation was made via questionnaires into 942 nurses working in designated SARS hospitals and a comprehensive analysis was conducted by means of multivariant stepwise regression. Results The major factors affecting the pressure on nurses include: lack of support from and communications with families, arduousness of tasks to an unbearable point, extreme strictness in management, and unsoundness of treatment and living conditions. Conclusion Good communications with families are of great significance to nurses working in isolated areas. It is imperative to rationally allocate the human resources of nurses, show more concern for them, encourage them to participate in management, and strengthen scientific prevention so as to create a better working environment.

Skillful in the treatment of gouty arthritis (GA) by integrated therapies of Chinese and Western medicine,chief physician Zhang Tang-fa proposes to ‘deal with the exterior with the needles,and attack the interior with the drugs,by integrated application of acupuncture and herbal medicine',in combination with comprehensive intervention of dietetic therapy and health education.In the treatment of GA,he adopts the syndrome differentiation based upon the pathogenic factors,in combination of syndrome differentiation based upon the six meridians,to reinforce and benefit the spleen and kidney,clear away heat and remove dampness as the therapeutic principle.By acupuncture mainly at the acupoints of the Spleen and Liver Meridians,he also proposes to select the acupoints by the theory of Na Zi Fa (earthly branch method) of Zi Wu Liu Zhu (midnight-noon ebb-flow),and to puncture the surrounding area of the involved joints shallowly by multiple needles as the major needling method,simultaneously with the reinforcing and reducing manipulations based upon the respiration.In the treatment,acupuncture and acupoint-injection are often used.In diet,low purine diet is often suggested.In health education,the patients are often instructed to understand the disease correctly,eliminate fears and cooperate with doctor's treatment positively.

Dao-di Herbs is specificity and locality, and its unique phenotypic features is closely related to the growth and development of medicinal plants. In addition to traditional genetic, epigenetic play an important role in formation of Dao-di herbs. This paper introduces the concept of epigenetic and the role of DNA methylation in the gene expression regulation. We further prospects epigenetic mechanism in study of Dao-di herbs formation from specific phenotype and regional analysis. And study on the relationship of epigenetic and Dao-di herbs will provide a basis for quality assessment and identification of Chinese drugs.
DNA Methylation ; Drugs, Chinese Herbal ; standards ; Epigenesis, Genetic ; Gene Expression Regulation, Plant ; Plants, Medicinal ; genetics

OBJECTIVETo provide quantitative foundation for the diagnosis of atlanto-axial rotatory subluxation by analyzing the various imaging features of normal atlanto-axial joints in neutral position and rotary functional position on the MSCT images.

METHODSForty-one normal volunteers were examined by CT on the atlanto-axial joint in neutral position and rotary functional position. By the observation and measurement of atlanto-dental interval (ADI), lateral atlanta-dental space (LADS), VBLADS and rotating angle of atlas on dentate (RAAD), the imaging manifestations and anatomical characteristics were analyzed and compared. In order to compare VBLADS and RAAD and make a correlation analysis between different age groups, 51 normal volunteers were divided into two groups: age younger than 45 years old group and age older than or equal to 45 years old group.

RESULTSThe dens in neutral position deviated in an angle range of (3.22±0.89)°. The articular facets of lateral atlantoaxial joint in rotary functional position had rotatory displacement and the range of the relative rotation angle was (33.85± 2.79)°. Through the correlation analysis of matching data, it could be concluded that there was no correlation between atlantoaxial relative rotation angle and VBLADS within a certain range. There were statistically differences of atlantoaxial relative rotation angle in rotary functional position between two groups.

CONCLUSIONMSCT imaging in rotary functional position can clearly show the anatomical structure and rotation function of a normal atlanto-axial joint, so as to provide a theoretical basis for the diagnosis of atlanto axial rotatory subluxation.

Adult ; Aged ; Atlanto-Axial Joint ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; methods ; Rotation

Interventional management was performed in 10 patients with hemorrhage following hepatic biliary and pancreatic surgery.The super-selection arterial embolization was performed in 9 patients using gelfoam pledgets (n =6 ) or metal coils (n =3 ),the procedure was combined with local infusion of reptilase; 1 case was managed by local infusion of reptilase alone.Selective angiography revealed the pseudoaneurysm in 3 cases,contrast media extravasation in 6 cases; in 1 case no obvious bleeding site was found The interventional treatment was successful and hemorrhage stopped in all patients,including one case with reptilase alone with a successful rate of 10/10.The results indicate that interventional treatment is a safe and effective method for hemorrhage following hepatic biliary and pancreatic surgery.

Objective To investigate the clinical features of moyamoya disease complicated with Graves′disease and the efficacy of extra-and intra-cranial revascularization. Methods The clinical data of 4 patients with moyamoya disease complicated with Graves′disease were analyzed retrospectively. Among them,three were females and one was a male. Their mean age was 32 ± 7 years. After medical treatment, their thyroid function was normal. The patients were treated with superficial temporal artery-middle cerebral artery bypass grafting. Results (1) Three patients showed cerebral infarction and one showed frequent transient ischemic attack. DSA confirmed that 2 patients had unilateral moyamoya disease and 2 had bilateral moyamoya disease. Head MRI revealed brain infarcts. (2) The thyroid function was normal after drug treat-ment,the symptoms of moyamoya disease were stable in 3 cases. One patient had high metabolic symptoms, such as high fever and accelerated heart rate within one week after procedure. The patients were followedup for 6 to 18 months,one was good,3 were excellent,and there was no recurrence of Graves′disease. Postoperative head MRI revealed that the 4 patients did not have new brain infarcts. MRA showed that the arterial filling in cerebral sulci in the ischemic lesion areas was obviously improved compared with that before procedure. Retrograde filling of the ipsilateral middle cerebral artery M2-M3 segment was observed in 2 patients. Postoperative single photon emission computed tomography perfusion imaging revealed that the ischemic perfusion lesions on the operated sides were obviously improved compared with those before procedure. Conclusion When complicated with Graves′ disease,the symptoms of moyamoya disease will aggravate. It manifests as acute and chronic cerebral ischemia. After controlling the symptoms of hyperthyroidism,most cerebral ischemic symptoms can be alleviated. Superficial temporal artery-middle cerebral artery bypass grafting may establish an effective collateral circulation and improve the clinical symptoms.