Objective To observe the efficacy and effect on cerebral vascular reserve and serum hs-CRP of Xueshuantong combined with butylphthalide in patients with acute cerebral infarction.Methods A total of 140 cases with ACI in Huzhou Central Hospital from August 2015 to July 2016 were divided into the observation group and the control group with 70 cases in each group, according to the order of single and double number.The control group was treated with routine western medicine while giving butylphthalide , and the observation group was given Xueshuantong on the basis of the control group.After two weeks of treatment, the efficacy and CVR, BHI and hs-CRP levels were observed.Results After treatment, the total effective rate of the observation group was 92.86%, and the control group was 81.43%, the difference was statistically significant (χ2 =4.080, P<0.05), there was significant differences of CVR, BHI between two groups (Fgroup =5.534, 4.608, P<0.05), the CVR and BHI increased gradually with time (Ftime =11.325, 9.432, P<0.05), the rised amplitude in observation group was higher than the control group (Finteraction =5.742, 5.016, P<0.05), there were significant differences in the levels of hs-CRP between two groups (Fgroup =7.421, P<0.05), and hs-CRP decreased gradually with time (Ftime =10.185, P<0.05), the decrease of observation group was larger than that of control group(Finteraction =4.824, P<0.05).Conclusion Xueshitong combined with butylphthalide in the treatment of ACI is effective , can better improve cerebral vascular reserve capacity and inhibition of inflammatory response, better than the single use of butylphthalide.

Objective To establish quality improvement project through theσ value and quality goal index ,then determine the effect of quality improvement by comparing the changes of uncertainty ,provide the laboratory basis for the effective improving of the quality of clinical laboratory .Methods The quality control data of blood cell analysis items were analyzed ,and the σ values , quality goal index (GQI) and measurement uncertainty [u(Rw)] were calculated and the performance was estimated .The quality improvement project was designed and had run for one year .The effect of quality improvement project was determined according to u(Rw) changes .Results The excellent rate (σvalue >4σ) of process performance evaluation in 2012 was up to 62 .5% ,the items withσvalue>6σamounted to 37 .5% ,about 62 .5% of the items needed to be improved .Comparing the u(Rw) in 2013 with 2012 , the improvement rate was 50% .The laboratory quality had been improved .Conclusion The performance analysis of σvalue ,GQI combined uncertainty evaluation is a good management method to improve the efficiency and reduce the cost .

Objective:To explore the histogenesis and differentiation of dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP). Methods: Clinical information and microscopic characteristics of 26 cases of DF and 26 cases of DFSP were investigated. The immunohistochemical study was performed on microarray sections by a panel of antibodies including FactorⅩⅢa, HLA-DR, CD34, CD14, S-100, MSA, and Ki67. Probe was labeled by in vitro transcription. The mRNA expression levels of TGF-? and bFGF were investigated by in situ hybridization. Results: All cases showed positive for Factor ⅩⅢa,HLA-DR and CD34 to different extent. The medians of positive rates in DF were FactorⅩⅢa 90%, HLA-DR 70%, and CD34 5%, and in DFSP were FactorⅩⅢa 10%, HLA-DR 5%, and CD34 80%. CD14 was positive in 3 cases of DF and 1 case of DFSP. S-100 was positive in 6 cases of DFSP and 2 cases of DF. MSA was positive in 5 cases of DFSP and 3 cases of DF. In all cases, positive rate of Ki67 was less than 5%. The mRNA expression levels of TGF-? was elevated in DF in comparison with DFSP. Conclusion: Both DF and DFSP can differentiate to dendritic cells (DC) in different degree. Considering the character of microscopic features and immunohistochemical phenotype, cells of DF are much similar to mature DC, while those of DFSP much similar to immature dermal reserve cell (DRC). The differences of cell differentiation between DF and DFSP result in different prognosis. DF is a benign tumor, while DFSP a low grade malignant tumor. The different expression of FactorⅩⅢa and CD34 may be helpful to differential diagnosis of DF and DFSP.

Objective:Since malignant fibrous histiocytoma (MFH) may be taken as an undifferentia-ted pleomorphic sarcoma (UPS), this study was conducted to reassess 33 previously diagnosed MFH cases in the past 10 years based on the latest WHO concept. And then to search for the clinicopathological features, probably tumorigenesis, and the line of differentiation of the remaining MFH/UPS cases.Methods: Thirty-three cases in tissue microarray were studied by immunohistochemistry with panels of neurogenic, myogenic, and lipogenic antibodies. Three expertise pathologists reevaluated the slides separately. Results: Among the 33 cases, 17 cases (51.5%) of MFH had their diagnoses changed, including 5 leiomyosarcomas, 3 malignant peripheral nerve sheath tumors, 1 fibrosarcoma, 1 inflammatory myofibrosarcoma, 1 giant cell tumor and 1 angiomatoid fibrous histiocytoma. The remaining 16 cases (48.5%) were finally diagnosed as MFH/UPS, among which patients were mainly old adults (median age: 63 years; range: 38 to 76 years). The median tumor size was 6.0 cm (range: 3.0 to 14.0 cm), 8 cases (50%) located in lower limb and 5 cases (31.3%) located in thigh. These tumors had marked cytological and nuclear pleomorphism. Immunohistochemistry showed that Vimentin was strongly positive in all 16 MFH/UPS (100%), Muscle-specific actin was variously positive in 8 cases (50%) and 1 case focally expressed Desmin. Eleven cases (68.8%) variously expressed CD68 (KP1) and 7 cases (43.8%) expressed CD68 (PG-M1), which were much higher than leiomyosarcoma, malignant peripheral nerve sheath tumor and liposarcoma with significant difference. Moreover, Ki67 expression rates were from 10% to 100%, including 14 cases more than 50% and 11 cases more than 70%. However, only 2 cases (12.5%) showed P53 positive. Conclusion: MFH/UPS often show marked histological pleomorphism, and the diagnosis must be made by exclusion of other definitive sarcomas, especially myogenic and neurogenic sarcoma. Only Vimentin was always expressed in MFH/UPS, while some of the tumors were positive for myogenic antigen and CD68. It was suggested that MFH/UPS might arise from primary mesenchymal cells, and some cases exhibited fibroblastic and/or myofibroblastic features. In addition, histiocytic phenotypic marker did have more expression in MFH/UPS than in other sarcomas. MFH/UPS still had certain clinicopathological characteristics.

Objective To assess the association of three polymorphisms in Megsin (rs1055901,rs1055902 and rs2689399) and susceptibility of IgA nephropathy in Asian population.Methods We conducted a comprehensive search of electronic CNKI,VIP,WangFang Data,CBM,Pubmed,Web of Science and Google Scholar database on the association between Megsin rs1055901,rs1055902 and rs2689399 polymorphism and susceptibility of IgA nephrology in Asian population (last search update on 2 May 2016).Stata 12.0 software was used to calculate the odds ratio (OR) and 95 ％ CI (confidence interval),as well as sensitivity and publication bias analyses.Results Six publications encompassing mine case-control studies were finally included,including 2 179 cases and 1 769 controls.Finally,no significant association between Megsin rs1055901 and rs1055902 polymorphism and IgA nephrology in Asian population was identified,while a significantly decreased risk of IgA nephrology for rs2689399 polymorphism,was identified in Asian population (G and C:OR=0.754,95％CI 0.592-0.961,P=0.022;GG and CC:OR=0.506,95％CI 0.287-0.892,P=0.019;GG and GC+CC:OR=0.551,95％CI 0.316-0.961,P=0.036).Conclusion Rs2689399 G allele and GG genotype of Megsin may be the protective factors for IgA nephropathy in Asian population.

BACKGROUND: Biomechanical mechanisms are complex, and previous studiers focus on the stress conduction in the carpus. However, the stress distribution and characteristics of trabecula in the carpus are rarely reported.OBJECTIVE: To investigate the stress distribution and deformation characteristics of the normal lunate through a two-dimensional sagittal finite element model.METHODS: A normal cadaveric lunate sample was scanned with Micro-CT and the central sagittal image was chosen for further finite element analysis (FEA). The chosen image was processed and imported into the finite element analysis software (Ansys 14.0). A two-dimensional sagittal finite element model of the lunate bone was established. Axial pressure was applied to the model with the wrist held in different positions, and nine regions of interests (ROIs) were identified, for which stress and displacement nephograms were created. These included the first principal stress (S1, the maximum stress in a principal plane), the third principal stress (S3, the minimal stress in a principal plane), shear stress (SXY, the component of stress coplanar with a material cross section), von Mises stress (SEQV, yielding begins when the elastic energy of distortion reaches a critical value)and displacement of each ROI (UY, displacement on the vertical plane of the lunate) which were calculated and compared.RESULTS AND CONCLUSION: (1) The stresses on ROIs located in the proximal and volar cortices of the lunate bone were much higher than those in the distal and dorsal cortices. At the proximal lunate, S1 was less than S3; however at the distal lunate, S1 was greater than S3. The ROIs of the distal and proximal ends of the lunate bone received much higher stress than the ROIs of the middle part. As for axial trabecular displacement,both distal and proximal ROIs were compressed by axial pressure. However, the dorsal and the volar parts of the proximal lunate moved in different directions at different wrist postures. Besides, the stress values and magnitudes of displacement were elevated in wrist flexion and extension compared to neutral position.Furthermore, the stress concentration zones (the proximal volar ROI, the proximal dorsal ROI, the distal volar ROI, and the distal dorsal ROI) had different directions of shear stress and displacement in different wrist postures. (2) These results suggest that when stress is loaded on a normal lunate model, four stress concentration zones, the proximal volar ROI, the proximal dorsal ROI, the distal volar ROI, and the distal dorsal ROI are found. The wrist postures can significantly affect the value and distribution of axial stress on the sagittal lunate.

Liver resection is the most effective treatment for hepatocellular carcinoma (HCC). The Barcelona Clinic Liver Cancer (BCLC) staging system is commonly accepted as a guideline for HCC treatment, but it only recommends liver resection for the patients with HCC at stage 0 to A1. The surgical indications of the BCLC staging system need to be re-evaluated. 120 HCC patients undergoing curative liver resection were retrospectively stratified to the BCLC staging system, and the survival of the patients at stages A, B and C was analyzed. The justification of the BCLC staging system was re-evaluated. Fifty-two patients were classified at stage A, 51 at stage B and 17 at stage C respectively. The hospital mortality of this cohort was zero and the morbidity was 24.1%. The 1-, 2-, 3-year overall survival rate of this cohort was 81.6%, 68.3%, and 57.5% respectively. There was no significant difference in the survival rate between the patients at stage A and B (P>0.05). If the treatment guidelines of BCLC staging system were followed, the majority of the patients at stages A and B (77.7%, 80/103) would not have been treated surgically. Our data suggest that the surgical indications of the BCLC staging system are not justified for HCC treatment. More studies may be needed as for how to further broaden the surgical indications of the BCLC staging system in the future.

Objective To explore the relationship of the ratio of plasma adrenomedullin(AM)and endothelin-1(ET-1)with serum concentration of neuron-specific enolase(NSE)in full-term neonates with hypoxic-ischemic encephalopathy(HIE).Methods Plasma concentrations of AM,ET-1 and serum NSE from 32 full-term neonates with HIE were detected by radioimmunoassay(RIA)on the 1,3 and 7 d after parturition,30 neonates in the corresponding periods in our hospital were employed as controls.The infants with HIE were divided into mild,moderate or severe group in terms of diagnostic standard of HIE.Results 1.Plasma concentrations of AM and ET-1 in newborns with mild,moderate or severe HIE were significantly higher than that of control group at 1 d after life with a decline from 3-7 d(Pa

Objective To explore the effect of exogenous adrenomedullin(ADM) on expressions of glutathion in plasma and brain tissue inneonatal rats with hypoxic-ischemia reperfusion brain damage(HIRBD) and the mechanism of action.Methods Fifty-six cases of 7 d SD rats were randomly divided into 4 groups including normal control group(without any treatment),HIRBD group(the model with hypoxia for 2 h and ischemia for 1 h),primed group(abdomen infusion of ADM at 0.5 h before making model,the other was same to the HIRBD group)and treatment group(abdomen infusion of ADM at onces after making model,the other was same to the HIRBD group).The neonatal rats in 4 groups were derived blood and brain tissue after decapitation at either 4 h or 24 h after reperfusion.The levels of gtutathion(GSH) in plasma and brain tissue were determined by using chromatometry.Results In HIRBD group,the affection areas at 24 h after reperfusion enlarged compared with those at 4 h after reperfusion.Meanwhile,the affection of punctiform degeneration or necrosis at 4 h after reperfusion transformed into the affection of lamellar or diffuse degeneration or necrosis at 24 h after reperfusion.The levels of GSH in plasma and brain tissue in HIRBD group at either 4 h or 24 h after reperfusion were significantly lower than that in normal control group(Pa0.05).Meanwhile the pathology score of brain section in primed group and treatment group were significantly lower than that in HIRBD group at either 4 h or 24 h after reperfusion(Pa0.05).Conclusion Exogenous ADM can induce the neuroprotection in HIRBD by adjusting the expression of GSH.

Objective To assess the efficacy and safety of ketogenic diet(KD) on refractory epilepsy in children.Methods KD treatment was designed to observe the effects for 12 weeks.Totally 22 children with 16 boys and 6 girls were enrolled in the study.The epileptic syndromes included infantile spasms(13 cases),Lennox-Gastaut syndrome(4 cases),Dravet syndrome(2 cases),and the unclassified(3 cases).The KD was prepared according to the modified Johns Hopkins regimen.Urinary ketones were measured every day to ensure that ketosis state and parents′ diaries were kept to find out when it started to work and the change of seizure frequency.Effects of KD was evaluated by Engel standard.Blood chemistry was done at baseline,4 weeks and 12 weeks to analyze the effects of KD on metabolism.Side effects were monitored and treated.Results All cases completed the KD regimen for at least 2 weeks,19 cases for at least 4 weeks,and 10 cases for at least 12 weeks.Sixteen out of 22 children experienced the seizure reduction within 3 weeks(1-15 d),especially in the first week,and seizure free appeared within 5 weeks(1-32 d) in 8 cases.Overall,the diet achieved the seizure-free in 36.4%(8/22 cases) and an over 90% of seizure frequency reduction in 22.7%(5/22 cases).The efficacy of KD seemed not correlated with the sex,age,etiopathogenisis,and syndromes and so on.Blood chemistry suggested a normal range of glucose level at 4 weeks,though higher than that at the baseline.The blood triglyceride and total cholesterol level at 12 weeks increased strikingly,even beyond the normal range compared with the baseline.The side effects mainly including transient gastrointestinal symptoms and metabolic disturbances were mostly tolerable.Conclusions KD is probably a feasible therapy on refractory epilepsy in children,with quick and high efficacy and few side effects.