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.

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.

Objective To research the relationship between the serum level of cystatin C (CysC),N-terminal pro brain natriuretic peptide (NT-proBNP) and the cardiovascular (CV) events in maintenance hemodialysis (MHD) patients,looking for a new and effective biological prediction method for cardiovascular disease (CVD).Methods According to the excluded criteria and included criteria,a total of 126 patients [male 67(53.2％),female 59 (46.8％)] were included in this study,screening out of 452 MHD patients from 3 blood purification centre,no secondary hyperparathyroidism,blood pressure controlled,hemoglobin standard,no lipid abnormalities,and without history of coronary heart disease,heart failure and arrhythmia.Participants adopted 3 dialysis treatment,including hemodialysis,hemoperfusion and hemodiafiltration.Every 3 months before the dialysis,the Cys-C,NT-proBNP,serum phosphorus,serum intact parathyroid hormone (iPTH),hemoglobin and electrocardiogram were detected.The heartbeat ultrasound was examined every 6 months,observed for 24 months and followed up for 3 years,recording the incidence and the inspection results.The correlation and the occurrence of CVD were analyzed by conducting a multiple factor logistic regression analysis.The forecast performance of Cys-C,NT-proBNP was evaluated by using receiver operating characteristic (ROC) curves and area under curves (AUC).Results Eighteen episodes of CV events occurred in 126 patients during the experiment and follow-up,including 8 episodes of heart failure,4 episodes of myocardial infarction,6 episodes of arrhythmia.Detection indexes had no statistically significant correlation (P ＞ 0.05),and the results of ECG and ultrasound heartbeat graph showed that no significant difference in cardiac structure and function before treatment (P ＞ 0.05).After 24 months duration,the research showed that the level of serum calcemia was lower,and the levels of phosphorus and iPTH were higher in hemodialysis group compared with that in the other 2 groups,and the differences had statistical significance (P ＜ 0.05).The median levels of Cys-C and NT-proBNP were 8.59 (9.74,7.10) mg/L and 7 739 (9 887,6 736) ng/L in the patients CV events occurred.Non conditional multivariate logistic regression analysis demonstrated that the increasing interdialytic weight,Cys-C,NT-proBNP,iPTH,dialysis hypotension were the independent risk factors of CV occurrence.AUCs to predict CVD occurrence in MHD patients was 0.64 (95％CI 0.53-0.71,P ＜ 0.05) and 0.79 (95％CI 0.72-0.89,P＜ 0.01) using Cys-C and NT-proBNP respectively.The cut-off values of serum Cys-C and NT-proBNP for CVD occurrence were 8.59 mg/L and 7 739 ng/L,with a sensitivity of 84.3％ and a specificity of 92.7％.Conclusions Cys-C,NT-proBNP can be used to predict the risk of CV events in dialysis patients.

Objective To explore biological effects of up-regulated expression of transfected FOLR1 gene on SKOV3 cell lines following action by cisplatin(DDP).Methods Three groups of cells originated from the same SKOV3 cell line were used in this research,including the SKOV3 cell line (blank control),the cell line transfected with lentiviral pWPI plasmid (no-load control) and the cell line transfected with FOLR1 gene via lentiviral pWPI plasmid (experimental group).Next,the mRNA and protein expression of FOLR1 gene in the three groups were detected by reverse transcription (RT)-PCR and western blot,respectively.Methyl thiazolyl tetrazolium (MTT) assay was used to analysis cells growth curve and identify their sensitivity to cisplatin,and their half inhibition concentration (IC5o) values were calculated.Based on the IC50 value (3.6 μg/ml) in the experimental group,different levels of cisplatin concentration (0.5 × IC50,1 × IC50,2 × IC50,respectively) were administered to the three groups of cells,and the inhibition rates,apoptosis rates as well as apoptosis proportion of each group after 24,48,72 hours were further recorded.Finally,the residual cisplatin concentrations in the three group cells acted successively by 1 × IC50 cisplatin for 48 hours were measured by high performance liquid chromatography(HPLC).P value less than 0.05 were defined as statistically significant.Results RT-PCR and western blot detection showed that stable mRNA and protein expression of the FOLR1 gene in the experimental group while the other two groups were not.MTT assay demonstrated that higher cell growth rate,sensitivity to cisplatin(IC50 =3.6 μg/ml) and inhibition rate in the experimental group compared with those in the other two groups (P ＜ 0.05),which showed no significance in intergroup comparison(P ＞ 0.05).Flow cytometry showed apoptosis rates among three groups increased with higher cisplatin concentrations and longer action duration in dosage-time dependent manner (P ＜ 0.05),and the proportion of S phase cells increased with higher cisplatin concentration in dosage-dependent manner (P ＜ 0.05) ; for the same concentration and duration,the experimental group showed significantly different apoptosis rates and S phase cells compared with the other two groups,which demonstrated no significance in intergroup comparison (P ＞ 0.05).After action by cisplatin(3.6 μg/ml) for 48 hours,HPLC showed significantly higher residual cisplatin concentration (2.60±0.21) μg/106 cell counts in experimental group than those in no-load control group (1.49 ±0.12) μg/106 cell counts and blank control group (1.54 ± 0.11)xg/106 cell counts,respectively (P ＜0.05),and the comparison within the latter two groups showed no significance (P ＞ 0.05).Conclusion Up-regulated expression of the transfected FOLR1 gene in SKOV3 cells may be associated with higher sensitivity to cisplatin,residual cisplatin concentration and higher proportion of S phase cells,and tended to inhibit cancer cells growth and induce apoptosis.

Objective To compare enhancement features of hepatic tumors on SonoVue-enhanced real-time gray-scale ultrasonography and contrast-enhanced helical CT.Methods SonoVue-enhanced real-time gray-scale ultrasonography and contrast-enhanced helical CT were performed on 49 patients with 54 focal liver lesions,including 29 primary liver carcinomas,4 metastatic liver tumors,11 hepatic carvernous hemangiomas,7 focal nodular hyperplasias,2 focal fatty sparing,1 cirrhotic.Results Contrast-enhanced ultrasonography and helical CT showed consistent results in demonstrating hemodynamics of hepatic tumors.In the differentiating of malignant tumors and benign tumors,the sensitivity,specificity and accuracy of contrast-enhanced ultrasonography were(90.9)%(30/33),(90.5)%(19/21) and(90.7)%((49/54)),respectively.Those of contrast-enhanced CT were(90.9)%(30/33),(95.2)%(20/21) and(92.6)%((50/54)),respectively.Conclusions Both of the two imaging methods are valuable for differential diagnosis of liver tumors.