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.

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

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 understand and to grasp the basic situation on blood donors who were ineligible by ALT dry chemistry testing before blood donation.Methods The ALT rejection ratios used in initial screening and not used in two blood collection point were compared at the same time.The relativity between the dry chemistry testing and rate method were compared.An association was explored in various influencing factors on the activity of ALT.Results The use of ALT initial screening in blood donation had a significantly lower unqualified rate than not using it in early screening (P＜0.05).Dry chemical,biological method and the results had good correlation rates (r=0.993,P＜0.05).The B MI,drinking,sleeping,sports,diabetes,liver disease were independent factors affecting ALT activity (P＜0.05).Conclusion ALT initial screening can significantly reduce the unqualified rates and disposal of blood.

BACKGROUND: Poly(lactic-co-glycolic acid) (PLGA) has been widely used as medical implants and drug vehicle. Due to various factors involved in the degradation process, it is rather difficult to simulate the mass loss properties of PLGA.OBJECTIVE: To investigate the mass loss properties of PLGA films, and observe the correlation between the stimulation and the factual measurement.DESIGN: Repeated measuring experiment. SETTING: School of Materials Science and Engineering, Dalian University of Technology.MATERIALS: PLGA 50:50, 70:30 and 75:25 with weight average molecular weight (Mw) of 63 000, 115 000 and 400 000 were purchased from Shandong Key Laboratory of Medical Polymer Materials, and 1,4-dioxane (analytically pure) was purchased from Tianjin No.1 Chemical Reagent Factory and used as solvent.METHODS: The experiments were carried out in the School of Materials Science and Engineering of Dalian University of Technology from April to July in 2006.①PLGA were dissolved in 1, 4-dioxane according to the mass ratio of 50:50, 70:30 and 75:25, and the solution were cast into 10 mm×10 mm×1 mm polymer films.②PLGA films were immersed in Hank's simulated body fluid (Ph 7.4) at 37 ℃, and then taken out every week (every 5 days for PLGA 50:50). The samples were washed and dried to measure the changes of number and Mw using gel permeation chromatography. Degradation velocity was also worked out. Meanwhile the mass loss properties of PLGA films were measured using electronic balance. Furthermore, an improved Monte Carlo method was applied to carry out the correlation analysis with experiment data. MAIN OUTCOME MEASURES: ①degradation rates of PLGA with different ratios of lactic acid and glycolic acid.②the correlation coefficient between simulation results and experiment data.RESULTS: ①The degradation rates for PLGA at 50:50, 70:30 and 75:25 were 0.058 5, 0.016 6 and 0.010 1 /d (based on Mn), or 0.061 0, 0.017 5 and 0.008 5 /d (based on Mw), respectively.②Correlation coefficients between simulation results and experiment data for PLGA 50:50, 70:30 and 75:25 were 0.973 6, 0.987 4 and 0.990 3 correspondingly. CONCLUSION:The numerical simulation results for the mass loss properties of PLGA fit the experiment data well.