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.

Objective To investigate the changes in small-diameter sensory neuron (SNS)/ peripheral nerve type 3(PN3) Na+ channel transcript and in tetrodotoxin-resistant (TTX-R) Na+ current in dorsal root ganglion (DRG) neurons in a chronic constriction injury (CCI) model of neuropathic pain. Methods Eighteen rats were divided into 6 groups of 3 animals each. Chronic constriction injury model was established after Dib-Hajj et al. Pain threshold was significantly lowered after CCI as compared with that in control group. The animals were deeply anesthetized and rapidly decapitated 14 days after surgery. The L4-5 DRG of the operated side was removed and crushed and total RNA was extracted with trizol reagent. The DRG of the contralateral side was used as control. The change in SNS/PN3 Na + channel expression was determined by semi-reverse transcriptase-PCR. The DRG neurons were isolated enzymatically and the change in voltage-gated TTX-R Na+ current was recorded using whole-cell patch clamp technique. Results Sensory neuron specific TTX-R Na+ channel transcript SNS/PN3 was down-regulated by 60% 14 days after CCI as compared with that in control group. TTX-R Na+ current density was significantly reduced but its activation and steady state inactivation were unchanged. Conclusions Na+ channel SNS/PN3 is involved in the hyperextability of the primary sensory neurons after CCI.

Objective To evaluate the preoperative nutritional status of patients with colorectal carcinoma by using the nutritional risk screening 2002 (NRS2002) score and its prediction for postoperative outcomes.Methods Retrospectively evaluated the nutritional risk of 259 colorectal cancer patients with NRS2002 score in terms of different sexes,ages,tumor location,pathology and differentiation,Dukes stages.The relationship between different NRS2002 score and postoperative complications and hospital stay were also observed.Results NRS2002 score was applicable in 243 cases,≥ 3 scores of 80 cases,＜ 3 scores of 163 cases.Gender,histological differentiation and before surgery NRS2002 score unrelated (P ＞ 0.05).Ages,tumor location,and Dukes stages related NRS2002 score (P ＜ 0.01).No case of perioperative death,hospital stay 10-101 (21.6 ± 9.7) d.The incidence of complications in ≥ 3 scores patients was significantly higher than that in ＜ 3 scores patients [30.0％ (24/80) vs.17.2 ％ (28/163),P ＜ 0.05],hospital stay in ≥ 3 scores patients was significantly shorter than that in ＜ 3 scores patients[(20.5 ± 8.2) d vs.(23.9 ± 11.9) d,P＜ 0.05].Multiple Logistic regression analysis showed that gender,age,tumor location,histological differentiation,Dukes stages,surgical and colorectal cancer complications unrelated (P ＞ 0.05),NRS2002 score associated with colorectal cancer complications (P ＜ 0.05).Pearson correlation analysis showed that hospital stay correlated with NRS2002 score (P ＜ 0.01).Conclusions NRS2002 score is applicable in Chinese colorectal cancer patients.The youth and the elderly,the proximal part of colon,and Dukes D stage patients are more liable to develop preoperative nutritional risk than those of middle age,the distal part of colon,or other Dukes stages.≥ 3 scores predicts higher postoperative complications and longer hospital stay.Preoperative nutritional support is necessary in patients with ≥ 3 scores.

Objective　To investigate the pattern of human neutrophil degranulation mediated by Fc alpha receptors. Methods　IgA immune complexes (IgA IC) and specific monoclonal antibody were used to stimulate neutrophil degranulation. Lactoferrin released by stimulated neutrophils was quantitatively determined. Results　Monoclonal antibody and IgA IC could both induce neutrophil lactoferrin release. However, monoclonal antibody induced rapid and strong degranulation whilst the effect of IgA IC was much weaker. Conclusion　The pattern of neutrophil degranulation induced by IgA IC and monoclonal antibody is different.

Objective To report the clinical outcome of dual plating in treating humeral intercondylar fractures. Methods From February 2002 to June 2003, 22 cases of humeral intercondylar fractures were treated with dual plating. It involved 15 males and 7 females, whose average age was 42.2 years with a range from 19 to 67 years. According to the AO classification, 5 cases were of type C1, 11 of C2 and 6 of C3. The posterior midline approach was selected, and the intercondylar fracture ends were exposed through the trans-olecranon osteotomy. The intercondylar fragments were fixed first, in 6 cases with C3 type fractures, the auto-grafting from the iliac bone was performed because of comminution, then the supracondylar fracture was fixed with dual plating. The semi-tubular plates was applied on the medial epicondylar crest of the humerus; and the reconstruction plate was implanted on the postero-lateral side, the two plates were kept in 90? with each other. The osteotomized ends were fixed with tension band. Results All the 22 patients were followed up for 13-29 months ( mean, 20.2 months ). By the end of the first postoperative month, the elbow flexion averaged 86.2?( range, 80?-105?), and the loss of extension averaged 40.7?(range, 30?-45?). But at the 12th month, the flexion improved to 117?(range, 95?-135?), and the extension loss decreased to 23.2?( range, 10?-35?). The averaged union time was 15.7 weeks with a range of 12 to 20 weeks. Assessed by the Jupiter scoring system, 3 cases were rated as excellent, 15 as good and 4 as fair. Complications included 4 cases of incision exudation, 3 K-wires withdrawal, 1 ulnar neuropathy and 3 heterotopic ossification. But no incision necrosis, deep infection, loosening or breakage of the internal fixators occurred. Conclusion The dual plating is able to provide stable and durable fixation for the humeral intercondylar fractures. In addition, it can prevent malunion or nonunion effectively, and decrease the related complications significantly. This method is helpful to improve the functional recovery of the elbow joint satisfactorily.

Bile acid can not only emulsify fat and facilitate the absorption of fat soluble substances,but also it is an important signaling molecules that plays an important physiological role by activating specific bile acid receptors.Takeda G proteincoupled receptor 5 (TGRS) is a membrane receptor of the bile acid,it can activate G-protein effectors and promote the expression of the second messenger and activate a variety of signal transduction pathways to exert physiological functions.The obstructive jaundice bile acid can cause a series of pathophysiological reactions through activating TGR5,which plays a significant role in the obstructive jaundice.In this article,the latest researches about the function and molecular mechanism of TGR5 in obstructive jaundice were reviewed in order to provide a new idea for exploring the new method and strategy to cure the disease.

Though lack of definite evidences,closed suction drainage after arthroplasty is routinely employed by the majority of orthopaedic surgeons with the aim of preventing the formation of wound haematoma,reducing delayed wound healing and the risk of deep infection.But the optimal time to remove drains is controversial.The usual time to remove drains is 48~72 h after operation when the volume of drains is less than 50ml within 24 h.But some scholars find that the time of draining more than 24 h increases the risk of wound infection.This paper reviews the literature of draining time,and concludes that the optimal time to remove drains is 24 h after the primary arthroplasty.

Cao reported that melagenine extracted from human placenta was effective in the clinical treatment of vitiligo, to elucidate the possible mechanism involved, melagenine and placenta peptide were added to melanocytes in the culture, and the culture without melagenine as control. The results obtained by MTT showed that melagenine can stimulate melanoeyte proliferation, its promoting rate was 42.5%, while placenta peptide got a promoting rate of 5.9%, the difference was significant (P

Benzene ; toxicity ; Gene Expression Profiling ; Oligonucleotide Array Sequence Analysis

Objective To investigate the pharmacodynamic interactions between remifentanil and sevoflurane during general anesthesia for laparoscopic operation.Methods Sixty-five ASA I patients undergoing selective laparoscopic operations at the Department of Gynecology and the Department of General Surgery in People's Hospital were enrolled in this study.Sevoflurane was used for anesthesia induction with its expired concentration being kept stable,and different dosages of remifentanil(0,1,2,4,6,and 8 ng/ml)being added during the operation.When the expired concentration of sevoflurane reached an expected level(pseuto-state),the block somatic and cardiovascular responses to electrical tetanus stimuli(ETS;100 Hz,60 mA,5 s)were measured.The data were analyzed using NONMEM software to establish concentration-effect curves.Logistic regression was used to calculate the minimal alveolar concentration of sevoflurane under ETS(MACETS).Results In the cases received sevoflurane only,the somatic response was inhibited when MACETS reached 1.52%;while the cardiovascular response was inhibited when MACETS reached 2.24%.The MACETS was decreased significantly by adding low-dosage remifentanil.When the target-controlled concentration of remifentanil was 8 ng/ml,the MACETS for the inhibition of somatic and cardiovascular responses decreased by 70.0% and 76.3%,respectively.Conclusions There is a synergic effect between remifentanil and sevoflurane on the suppression of somatic and cardiovascular responses to ETS.Remifentanil produces a dose-dependent decrease of MACETS of sevoflurane.The effect is especially strong in low-dosage remifentanil group,but shows ceiling effect characteristics.