Objective To investigate the relationship between retinal vascular lesions and cerebral microbleeds ( CMBs) . Methods One hundred twenty-three consecutive patients with cerebral infarction who could sit and finish fundus photography at the Department of Neurology, General Hospital of Beijing Military Command from August 2013 to August 2014 were enrolled prospectively. After informed consent, the patients underwent head MRI examination and bilateral eye fundus photography. They were divided into either a cerebral microbleed group ( CMB group, n =52 ) or a non-cerebral microbleed group ( nCMB group,n=71) according to whether they had CMBs or not. The general clinical data and retinal vascular lesions ( microaneurysms,hard exudates,cotton wool spots,bleeding spots,focal retinal arteriolar narrowing, arteriovenous cross sign,and silver thread-like changes) of both groups were compared. Results (1)There were significant differences in age,hypertension,diabetes,systolic blood pressure,diastolic blood pressure, fasting blood-glucose,triglyceride,and C reaction protein between the CMB group and the non-CMB group (all P<0. 05). (2) The incidences of hard exudates,focal retinal arteriolar narrowing,and arteriovenous cross sign of patients with CMB were higher than those with non-CMB,and there were significant differences (χ2 =6.233,7.675,and9.544,respectively;P=0.040,0.031,and0.019,respectively).(3)There were significant differences in the incidences of hard exudates,focal retinal arteriolar narrowing,and arteriovenous cross sign in patients with different severity of CMBs (Z= -2. 317,-2. 294 and -2. 157,respectively;P=0. 029,0. 033,and 0. 039,respectively). In patients with severe CMB,there were more patients with hard exudates,focal retinal arteriolar narrowing,and arteriovenous cross sign. (4) The age (OR,3. 623, 95%CI 2. 631-7. 866),hypertension (OR,4. 348,95%CI 3. 734-10. 563),diabetes (OR,3. 831,95%CI 2.126-9. 245),fasting blood-glucose (OR,3. 329,95%CI 2. 631-11. 012),arteriovenous cross sign (OR,5. 437,95%CI 3. 441-13. 606),and hard exudates (OR,4. 054,95%CI 3. 137-13. 252) were the independent risk factors for the occurrence of CMBs. Conclusion The arteriovenous cross sign, focal retinal artery narrowing,and hard exudates in retinal vascular lesions are associated with the CMBs and different degree of CMBs classification. Both the arteriovenous cross sign and hard exudates are the independent risk factors for CMBs.

Objective To investigate the risk factors for occurring cerebral microbleeds( CMBs)in patients with ischemic stroke Methods A total of 184 consecutive patients with ischemic stroke admitted from January 2012 to January 2014 in General Hospital of Beijing Military Command were enrolled prospec-tively. They were divided into either a CMB group( n=60 )or a non-CMB group( n=124 )according to whether head MRI magnetic sensitive weighted imaging( SWI)revealed CMBs or not. The general clinical data and serum biochemical results of the patients in both groups were collected. Renal creatinine clearance ( Ccr)was calculated,and the data of both groups were analyzed by the univariate and multivariate analyses. Results (1)The results of univariate analysis showed that there were significant differences in age(63 ± 10 vt. 58 ± 10 ),male( 65. 0%[ 39/60 ]vs. 49. 2%[ 61/124 ]),the incidence of leukoaraiosis( LA ) (73. 3%[44 cases]vs. 47. 6%[59 cases]),and serum homocysteine(Hcy)levels(20 ± 8 vs. 16 ± 6μmol/L)between the CMB group and the non-CMB group(P<0. 05). The Ccr level(89 ± 10 mL/(min·1.73m2)of the CMB group was lower than(106 ±6mL/(min·1.73m2)of the non-CMB group. There was significant difference(P <0. 05).(2)Multivariate logistic regression analysis showed that age(OR,1. 103,95%CI1. 024—1. 989,P =0. 028),LA(OR,3. 121,95%CI 1. 310—7. 436;P <0. 05)and impaired kidney function(OR,1. 890,95%CI 1. 358—3. 076;P<0. 01)were the independent risk factors for the occurrence of CMBs in patients with ischemic stroke. Conclusion Age,LA and impaired kidney function are the independent risk factors for occurring CMBs in patients with ischemic stroke.

Objective To measure the equity of resources allocation in obstetric healthcare in Zhejiang Province, and provide evidence for decision making by healthcare departments of the government. Methods Lorenz curve and Gini coefficient were used to measure the equity of obstetric healthcare resources. Results The investigation found such allocation as equitable as measured by the layout of the number of live births, as the Gini coefficient of the distribution of obstetric doctors, nurses and beds was 0.1697,0.1971 and 0.1497 respectively by total birth, failing within the equitable range. However, when measured by geographic distribution, such coefficient were 0.2701, 0.3216 and 0.3341 respectively in cities, which were less equitable yet still within equitable range. Conclusions The government and health bureaus are recommended to scientifically predict the number of immigrants and rationally deploy healthcare resources according to the service radius of healthcare resources;moreover, more gynecologic doctors and nurses should be trained to improve the human resource structure in gynecologic departments. These effort can cater to the growing healthcare demands of the society resulting from a growing population of immigrants.

Objective To investigate awareness about tuberculosis (TB) prevention and treatment and influence of professional training on TB detection among health-care workers (HCWs) in general hospitals.Methods In total,750 HCWs were trained for TB-related knowledge for eight class-hours in a two-day course in three general hospitals,and 20 HCWs from each of the three hospitals classified as grade 3A and grade 2A in urban Beijing and grade B at suburban Beijing,respectively,were interviewed with questionnaire designed to understand their awareness about TB prevention policy,epidemiology,diagnosis and treatment,and to evaluate effectiveness of the training,respectively.All the trainees responded before and after the training,with a hundred percent of response rate.TB diagnosis and reporting one year before training in the three hospitals were compared to those one year after it.Results Scores of knowledge about TB diagnosis and treatment averaged 64-80 for HCWs before training,with statistically significant difference among three hospital (F = 5.984,P ＜ 0.01).Scores increased after training,but without significant difference from those before it (P ＞ 0.05).Awareness of TB prevention policy,regulations and epidemiology was insufficient in most HCWs of those hospitals,with lowest and highest average scores of 38.3 and 71.7 before training,respectively,but scores increased significantly after training (P ＜ 0.01).Proportion of TB diagnosis with chest roentgenograph at grades 3A and 2A hospitals was significantly higher one month,three months and six months after training,as compared to that at suburban hospitals (P ＜0.01).There was significant decrease (P ＜ 0.01) in proportion of chest roentgenograph at respiratory departments in hospitals grade 3A and grade 2A after training.There was no significant difference in reporting of pulmonary TB and positive sputum smear (P ＞ 0.05) before and after training.Conclusions HCWs in general hospitals had experience and capacity in diagnosis and treatment of pulmonary TB,but their knowledge of TB prevention policy and epidemiology was insufficient.Their ability in finding and reporting TB can not been improved with short-term training.

Objective To study the gene expressions of nestin and stem cell factor(SCF)in neurons after ischemia-reperfusion injury in rat brain. Methods Thirty-six adult female rats were subject to left middle cerebral artery occlusion for 1.5h and different hours of reperfusion. In site hybridization was used to examine the expression of nestin and SCF mRNA in the rats subjected to 2h, 6h, 12h, 24h, 2d, 3d, 7d, 14d of reperfusion and sham-operation group (n=4). Results (1) Nestin expression in cortex, striatum and extraventricular zone was weak in the sham-operation group, and increased markedly in the ischemic hemisphere compared with sham-operation group except of reperfusion 2h in cortex, 2h, 6h in striatum, 2h, 6h and 14d in extraventricular zone. (2)SCF expression in cortex, striatum and extraventricular zone was weak in the sham-operation group, and increased markedly in the ischemic hemisphere compared with sham-operation group except of reperfusion 2h, 6h, 12h in cortex, 2h, 6h in striatum, 2h and 14d in extraventricular zone. Conclusion It is suggested that SCF expression might enhance the proliferation of neural stem cells following ischemia-reperfusion in rats.

Objective To explore the insertion of the teaching contents of nursing in rural doctors'higher education,so as to increase their understanding of medical knowledge and improve their medical skills.Method 90 rural doctors of Grade 2014 were chosen as the research object,and according to their willingness to participate,they were divided into control group and observation group.The students in the control group were mainly taught by the relevant knowledge of clinical medicine,while nursing teaching content was inserted in the teaching of observation group.In the teaching process,firstly,the teaching contents of nursing were reorganized,and then the teaching content of clinical medicine was taken as the main line,according to the development of teaching content,flexibly inserting nursing teaching part.The results of the final examination of the internal medicine of the two groups were compared and the specific learning experience of rural doctors was investigated.SPSS 20.0 was used to analyze the data,the count data was expressed as percentage,and chi square test was performed.Results The number of students in the control group and the observation group whose subjective score was more than 40 was 17.65％ and 48.72％ respectively.The number of students scoring ＜30 points accounted for 23.53％ and 5.13％ of the total number of students,and there was a statistically significant difference between the two groups(P＜0.05).The observation group had a better learning experience,and had little influence on the learning of clinical medical knowledge.Conclusion In the stage of education for rural doctors,inserting the teaching contents of nursing can improve the teaching effect.

Objective To evaluate value of narrow band imaging(NBI) endoscopy for children with abdominal Henoch?Schonlein purpura ( HSP ) . Methods A total of 46 patients with abdominal HSP were enrolled into the observation group(NBI intervention) from November 2010 to February 2016.Diagnostic rates of white light and NBI endoscopy in abdominal HSP patients, IgA positive rates of targeted biopsies and severe complications were retrospectively analyzed. A total of 25 abdominal HSP patients with no NBI intervention admitted from 2007 to 2009 were randomly enrolled into control group. Data of the control group were compared with those of observation group. Results In observation group, the diagnostic rate under NBI was significantly higher than that under white?light endoscopy[91. 3%(42/46)VS 67. 4%(31/46),χ2=8. 02,P<0. 05]. IgA positive rates of targeted biopsies under NBI was significantly higher than that under white?light endoscopy [ 95. 7%( 88/92 ) VS 69. 6%( 64/92 ) ,χ2 = 21. 79, P<0. 05 ] . Three patients developed such serious complications as digestive hemorrhage as predicted. Compared with control group, abdominal pain and blood stool relief time (10. 96±5. 32 d VS 19. 68±4. 29 d,t=7. 50,P<0. 01), fasting time(10. 37±5. 42 d VS 8. 80± 3. 71 d,t=7. 73,P<0. 01), hospital stay (18. 80±7. 11 d VS 23. 12±4. 36 d, t=3. 16,P<0. 01), time of stool occult blood negative ( 11. 41 ± 6. 30 d VS 19. 12 ± 4. 09 d, t=6. 22, P<0. 01 ) in observation group were significantly shortened. Conclusion NBI endoscopy is valuable for improving the diagnostic accuracy and biopsy accuracy and complication prediction of abdominal Henoch?Schonlein purpura in children.

Objective To explore the mechanism of rapamycin-eluted stent in vascular endothelial injury. Meth?ods (1)Rapamycin (rapamycin group) was injected to rabbit dorsum muscle to simulate rapamycin-eluted stent implanta?tion into muscles. Control group and acetone control group were established at the same time. Morphological change in mus?cle was observed and serum calcium levels were measured after rapamycin injection.(2)HUVECs were incubated with 0.1, 1, 10 and 100μg/L rapamycin for 48 h respectively or with 1μg/L rapamycin for 6, 12, 24 and 48 h respectively.Cell via?bility was examined by MTT and its relationship with drug concentration and treatment time were analyzed.(3)HUVECs were divided into control group and 1μg/L rapamycin group. After 48 h,morphological changes of HUVECs were assessed by HE staining,the production of nitric oxide was examined by Nitric Oxide Assay Kit and the intracellular calcium ion con?centration was tagged with Fluo-3/AM. Results (1) Organizational morphology in local muscle with rapamycin injection represent stent implantation of rabbit,and calcium content in local muscle increased significantly in rapamycin group com?pared with nomal control group and acetone control group(P<0.05). (2) Cell survival rate decreased significantly upon ad?ministration of rapamycin in both concentration and time dependent manner(P<0.01). (3) In rapamycin group, cytoplasm vacuoles, nucleus pycnosis and nuclear fragmentation were observed;compared with control group,the levels of intracellular free Ca2+increased while the levels of nitric oxide was reduced. Conclusion Rapamycin treatment lead of injury to vascular endothelial cells which might through up-regulating intracellular Ca2+level.

Objective To summarize the effectiveness and security of endoscopic removal of foreign bodies of battery in the gastrointestinal tract in children.Methods We analyzed retrospectively the clinical data of 13 patients who swallowed foreign bodies including button cell and cylindrical battery.The 13 patients were treated in our hospital between July 2011 and April 2015,aged 19 months to 12 years.Results A total of 9 cases of foreign bodies in esophagus,including embedded in the first the esophageal stenosis in 4 cases,the second the esophageal stenosis in 3 cases,cardia in 1 case,and 4 cases of foreign body in stomach.We successfully removed 16 foreign bodies of the battery in endoscopy.No serious complications such as perforation,hemorrhaging happened during and after operation.Conclusion It is one relatively safe and effective method of diagnosis and treatment of endoscopic removal of foreign bodies of battery in gastrointestinal tract in children.

Objective To evaluate the value of endoscopy with narrow-band imaging(NBI)for tar-geting biopsy of lesions in children with allergic colitis. Methods The colorectal lesions under the model of traditional white light imaging and NBI in children with allergic colitis were observed and recorded. The re-sults of biopsy under white light imaging and NBI were compared with postoperative pathological diagnosis. Results A total of 60 patients completed the study. Under NBI,47(78. 3%)rectal lesions,52(86. 7%) sigmoid colon lesions and 19(31. 7%)descending colon lesions were found. There were 21(35. 0%),25 (41. 7%),and 8(13. 3%)lesions in the transverse colon,ascending colon and iloececus,respectively. For the lesions in transverse colon and ascending colon,the detection rate under NBI was significantly higher than that under white light endoscopy[35. 0% VS 16. 7%(10/ 60),P<0. 05;41. 7% VS 18. 3%(11/ 60),P<0. 05]. No significant difference was found between two methods for the sigmoid and rectal lesion[86. 7% VS 83. 3%(50/ 60),P>0. 05;78. 3% VS 76. 7%(46/ 60),P>0. 05].There was no significant difference in ileo-cecus and descending colon[13. 3% VS 5. 0%(3/ 60),P>0. 05;31. 7% VS 28. 3%(17/ 60),P>0. 05]. The targeted biopsy results by NBI indicated that the ratio of EOS≥6/ HP was significantly higher than the biopsy results by white light imaging. Conclusion NBI is easy to operate and can discern the microcosmic structure which cannot be observed by the traditional endoscopy. It can provide higher diagnostic accuracy of allergic colitis. After suspicious lesions were found under conventional endoscopic check,NBI could be used to guide the targeted biopsy.