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 investigate the variance of antimicrobial resistance of Klebsiella.spp isolated in our hospital during the recent 5 years.METHODS:Disk diffusion test was used to study the anti microbial resistance.The results were evaluated based on the criteria recommended by American Clinical and Laboratory Standards Institute.The data analysis was performed using WHONET-5software.RESULTS:Atotal of 840 strains of Klebsiella.spp were collected fromour hospital during2003～2007,of which,59.3% were fromrespiratory secretion speci men,12.0%fromblood speci men,and10.1% from secretions.The detection rate of ESBLs-producing Klebsiella.spp was from51.0% to65.1%.No I mipenem-and Meropenem-resistant Klebsiella.spp strain was detected.Susceptibility test showed that Klebsiella.spp-producing ESBLs was multiple resistant,and the anti microbial resistance of Klebsiella.spp has increased year on year.CONCLUSION:Monitoring of the drug resistance of Klebsiella.spp should be strengthened.The variation of the anti microbial resistance of Klebsiella.spp should be noted so as to direct rational drug use in the clinic and prevent spreading of drug resistant strains.

Bioactive natural products are the material bases of Chinese materia medica resources. With successful applications of synthetic biology strategies to the researches and productions of taxol, artemisinin and tanshinone, etc, the potential ability of synthetic biology in the sustainable utilization of Chinese materia medica resources has been attracted by many researchers. This paper reviews the development of synthetic biology, the opportunities of sustainable utilization of Chinese materia medica resources, and the progress of synthetic biology applied to the researches of bioactive natural products. Furthermore, this paper also analyzes how to apply synthetic biology to sustainable utilization of Chinese materia medica resources and what the crucial factors are. Production of bioactive natural products with synthetic biology strategies will become a significant approach for the sustainable utilization of Chinese materia medica resources.
Artemisinins ; metabolism ; Biosynthetic Pathways ; Biotechnology ; Diterpenes, Abietane ; genetics ; metabolism ; Drugs, Chinese Herbal ; metabolism ; Escherichia coli ; metabolism ; Ginsenosides ; genetics ; metabolism ; Metabolic Engineering ; methods ; Paclitaxel ; metabolism ; Saccharomyces cerevisiae ; genetics ; metabolism ; Salvia miltiorrhiza ; genetics ; metabolism ; Synthetic Biology

ZENG Tian-zhi, as one of the disciples of Mr. CHENG Dan-an, is considered as one of the major successors of the Chengjiang acupuncture school in the South of the Five Ridges. By collecting Mr. ZENG's works and papers as well as the interviews with his followers, his life and achievements are verified and his existing representative works are introduced. It is found out that following CHENG Dan-an's steps, ZENG Tian-zhi has practiced the medicine and performed great deeds, established schools and taught students. Also he established the first educational institution of acupuncture in Hong Kong, namely College of Scientific Acupuncture. He has traveled to many places to promote the acupuncture and cultivate a large number of acupuncturists. His works are characterized by organized edition, bringing in modern medical theory and focusing on clinic applicability.
Acupuncture ; education ; history ; methods ; Acupuncture Therapy ; Books ; China ; History, 20th Century ; Humans ; Male