Epidemiological studies have shown that the incidence of patent foramen ovale (PFO) in patients with cryptogenic stroke is significantly higher than general population.The close association between cryptogenic stroke and PFO supports the hypothesis that paradoxical embolism is a cause of stroke.However,the detection of PFO alone does not establish the diagnosis of paradoxical embolism in patients with cryptogenic stroke. The risk of ischemic stroke will increase significantly when PFO and other factors coexist.Some studies tave shown that there is significant difference between the MRI lesion patterns in patients with cryptogenic stroke and PFO in those without cryptogenic stroke,particularly in multiple ischemic lesions.Therefore,it does not support the theory of paradoxical embolism as a cause of stroke in patients with PFO.The PFO detection methods include transthoracic echocardiography,transesophageal echocardiography (TEE) and transcranial Doppler (TCD).TCD and TEE have a good consistency.Accordingly,TCD should be recommended as a simple,noninvasive,and reliable technique,while TEE should be only restricted to the selected patients.The treatment options of PFO include antiplatelet drugs,anticoagulant drugs,percutaneous vascular closure,and thoracotomy.Percutaneous vascular closure should only be considered the recurrent events during the medical treatment,the contraindications of medical treatment,and PFO with some anatomical high risks for patients with cryptogenic stroke with PFO before the completion of several large randomized controlled trials.

ObjectiveTo systemically review the effects of timing of initiation of renal replacement therapy (RRT) on prognosis in septic patients with acute kidney injury (AKI).Methods A systematic search for randomized controlled trials (RCTs) and other clinical studies focused on comparing varied timing of initiation of RRT in septic AKI patients was performed in English or Chinese from PubMed, Web of Science, EMBASE, CNKI, Wanfang data, VIP from January 2000 to July 2014. Data screened were extracted with Cochrane systemically review method, and enrolled literature was collected for Meta analysis with RevMan 5.2 software. Total mortality, 28-day mortality, the total length of hospital stay and intensive care unit (ICU) stay in septic AKI patients with early or late initiation of RRT was analyzed. Funnel plots were drawn to detect publication bias.Results Five retrospective comparative studies with a total of 885 patients were enrolled. Random effect model in Meta analysis showed that there was no significant difference in total mortality between early RRT group and late RRT group [65.7% (226/344) vs. 68.7% (239/348), odds ratio (OR) = 0.71, 95% confidence interval (95%CI) = 0.38-1.31,P = 0.27]. The funnel plot demonstrated publication bias. Fixed effect model showed that there was significant difference in 28-day mortality between early RRT group and late RRT group [43.4% (66/152) vs. 55.3% (94/170),OR = 0.59, 95%CI = 0.36-0.94,P= 0.03]. The funnel plot demonstrated publication bias too. The data of total length of hospital stay and ICU stay could not be Meta-analyzed because of different data distribution, but no differences in total length of hospital stay and ICU stay between early and late RRT groups for septic AKI patients were found.ConclusionEarly RRT could reduce the 28-day mortality in patients with septic AKI compared with late RRT, but it did not lower the total mortality.

Objective:To improve the method for isolating platelet-rich plasma (PRP). Methods:Whole blood was collected from 8 healthy donors and then PRP was separated by both the tube method and the syringe method respectively. Samples were activated to get serum rich-in growth factors (SRGF).Platelets in the SRGF were counted and the level of TGF-?1 was assayed by enzyme-linked immunosorbent assay (ELISA).Results:The end product of syringe method has both a higher platelet count in PRP (P=0.003) and a higher level of TGF-?1 in SRGF(P=0.041) than that of tube method.Conclusion:The syringe method is an effective method in preparation of PRP.

Objective To explore the diagnosis and treatment of the congenital membrane atresia of duodenum(CMAD). Methods The clinical data of 32 cases of CMAD admitted from 1980 to 1996 were analysed retrospectively.Results Of the 32 cases,28 cases had single membrane in the duodenum,4 two membranes;and 6 accompanied with intestinal malrotation, 2 circular pancrease and 1 anal atresia. 24 patients were treated with membrane resection only,2 underwent membrane resection and gastrojejunostomy,6 underwent membrane resection plus Ladd's operation.28 cases were cured,4 cases died.Among the 28 cases discharged,20 cases were followed-up for the period from five months to three years,their sympotoms disappeared, nutrition and development were good.Conclusions Patients with CMAD have vomit, and containing bile in most cases;abdominal erect plain film shows "double bubble sign",and gastrointestinal series can help make the diagnosis.Membrane resection is the best way of therapy,but we should pay attention to correct the double membranes and other deformity,and should strengthen perioperative period management.

The present study shows that mushroom juice exhibits a significanteffect on growth of L. acidophilus in reconstituted skim milk. When 5% - 10% mushroom juice was added in skim milk, they shorten generation time and the rate of lactic acid production was accelerated. After 10h incubation at 37℃ cell counts of L. acidophilus in test groups were much more than in control group, were up to 108/mL.

Objective To explore the effect of treadmill training on inspiratory function and its association with improvement of exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Methods The 12 moderate to severe COPD patients were allocated to lower-limb exercise training for 12weeks. The routine tests of pulmonary ventilation function, diffusion function,lung volume, peak inspiratory flow (PIF), maximal inspiratory pressure (MIP), symptom-limited progressive cycle ergometer exercise tests and constant work rate exercise tests were administered before and after the training program. During the constant work rate exercise tests, tidal breathing flow volume (TBFV) curves were recorded every 1 mir. Results After treadmill training, the exercise duration (T) (t=7. 357, P＜0. 001), peak work rate (WRpeak) (t=3. 614, P＜0.05), MIP (t=4.754, P＜0. 001) and PIF (t=2. 440, P＜0. 05) increased significantly. The tidal PIF (t=- 2.747, P＜0.05) and peak expiratory flow (PEF) (t = - 4.487, P＜ 0.05 ) decreased significantly at isotime. Maxium inspiratory flow reserve (△FLOWinsp) (t = 2. 755, P ＜ 0. 05 ) increased significantly at isotime, and maxium expiratory flow reserve (△FLOWexp) (t = 1. 326, P ＞ 0.05)showed no significant changes; The△T were positively correlated with △MIP (r=0. 613, P＜0. 05),△PIF (r=0.497, P＜0.05) and △FLOWinsp (r=0.592, P＜0.05). Conclusions Lower limb exercise training improves inspiratory function of COPD patients. The improvement of exercise endurance in moderate to severe COPD patients after lower limb exercise training is due to increases of inspiratory muscle strength, maxium PIF and inspiratory flow reserve.

Objective To investigate whether antiseptic central venous catheters (CVC) modified with chlorhexidine acetate and silver sulfadiazine can be beneficial in reducing bacterial colonization and catheter-related infection. Methods Prospective controlled non-blinded randomized clinical trial was conducted. Seventy adult inpatients with CVC from intensive care unit of General Hospital of Chinese People's Armed Police Force during June 2007-June 2009 were enrolled. Their baseline characteristics, APACHE Ⅱ score and therapeutic interventions were comparable. Patients were randomly received either an antiseptic CVC ( antiseptic group, n = 28) or a standard two-lumen CVC ( control group, n = 42 ). Microbiological evaluation was done after CVC removal. A catheter bacterial colonization ( CBC) was considered if bacterial growth of > 15 CFU was found by semi-quantitative roll-plate technique from a proximal or distal catheter segment. A catheter-related infection ( CRI) was defined as a colonized catheter with local signs of inflammation. A catheter-related bloodstream infection ( CR-BSI) was defined as a colonized catheter with isolation of the same organism from the patient' s blood with accompanying clinical signs of infection. SPSS 11.5 software was used for statistical analysis. Kaplan Meier curve was used to evaluate the association between CVC retention time and bacterial colonization or infection, and Log-rank test was performed to compare between the groups. Results CVC was removed from 3.6% (1/28) patients of antiseptic group and 21.4% (9/42) patients of control group because of infection (x2 = 5. 143, P <0. 05). Colonization of CVC was observed in 7. 1% (2/28) patients from antiseptic group and 35. 7% ( 15/42) from control group (x2 =7.458, P<0.01). CBC or CRI was not observed in antiseptic group until day 19, while CRI occurred at day 6 in the control group. CVC colonization and infection were developed in 31.4% and 14. 3% patients of antiseptic group during day 14-day 28 respectively, while the rates in the control group were 90% and 70% ( u = 27.5 and 14.31, P < 0.01). Conclusions Antiseptic CVC modified with chlorhexidine acetate and silver sulfadiazine can significantly lower the risks of CBC and CRI. But more than 50% patients would develop infection when colonization occured, no matter patients receive standard or antiseptic CVC. After CVCs have been inserted for > 2 weeks, the colonization and infection will increase significantly in both standard or antiseptic CVC, so to shorten the insertion time is an effective measure to decrease the CVC-related infection.

Objective To investigate the inhibitory effect of RNA interference on the expression of Aurora A in U251 cells, and the influence on proliferation and apoptosis of U251 cells. Methods The siRNA specific for Aurora A was synthesized and transfected into U251 cells in vitro. Aurora A mRNA expression and protein content were detected by RT-PCR and Western blotting respectively. The cell proliferation and apoptosis were observed by methyl thiazolyl tetrazolium(MTT) and flow cytometry(FCM). Transmission electron microscope was used to observe the ultrastructural changes of U251 cells. Results After transfection, the expression level of Aurora A mRNA was significantly decreased(P<0.01), and the protein content of Aurora A was also obviously reduced. The inhibitory rate of cell proliferation reached up to 67.57% 72 hours after transfection, which was significantly higer than that of normal control group(P<0.01). The apoptosis rate of U251 cells was significantly increased from (3.69±0.87)% to (15.34±2.16)% (P<0.01). Under the transmission electron microscope, it was observed that the U251 cells showed typical morphologic changes of apoptosis after transfection, such as karyopyknosis, chromatin condensation and margination, intracytoplasmic vacuoles formed, and apoptotic bodies formed. Conclusion The expression of Aurora A gene can be inhibited by siRNA successfully, and it results in the suppression of cell growth and induce apoptosis of human glioma cells in vitro. Aurora A may become a new target for the gene therapy of gliomas.

Objective To study the CT perfusion features of various lymph nodes in the neck.Methods Dynamic perfusion CT scanning was performed in 83 neck lymph nodes proved by pathology,including tuberculosis lymph nodes, lymphoma and metastatic lymph nodes. The shapes, blood flow modes,and perfusion parameters of these lymph nodes were compared among 3 groups. Statistical analysis of L/T and CT perfusion parameters was performed by one-way ANOVA and LSD test. Results The values of MTT of tuberculosis lymph nodes, lymphoma and metastatic lymph nodes were (28. 13 ±5.08), (31.08 ±5.82),and ( 11.24 ±5.31 ) s,respectively. The MTT of metastatic lymph nodes was statistically lower than that of tuberculosis lymph nodes and lymphoma (P ＜ 0. 05). Their frequencies of marginal blood flow were 5/9,4/19, and 39/55 (70. 9% ), respectively. The frequency of marginal blood flow in the tuberculosis lymph nodes and metastatic lymph nodes was statistically higher than that of lymphoma ( P ＜ 0. 05 ). Their frequencies of central blood flow were 2/9, 11/19, and 9/55 (16.4%), respectively. The frequency of central blood flow in the lymphoma was statistically higher than that of tuberculosis lymph nodes and metastatic lymph nodes ( P ＜ 0. 05 ). Their values of L/T were 1.82 ± 0. 32, 1. 80 ± 0. 39, and 1.84 ± 0. 36,(40. 98 ±6. 62) s,respectively. There were no significant differences in L/T, BF, BV and TTP among tuberculosis lymph nodes, lymphoma and metastatic lymph nodes( P ＞ 0. 05 ). Conclusion CT perfusion,especially combination functional imaging with perfusion images may be helpful in judging the nature of neck lymph nodes.

Antineoplastic Protocols ; Child ; Humans ; Neoplasm, Residual ; therapy ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; therapy