Percheron artery infarct (PAI) is uncommon clinically.One case had an acute onset of coma,impaired left limb activities,verbal incoherence,drinking cough and vertical gaze palsy after regaining consciousness.Magnetic resonance imaging (MRI) showed symmetrical high signal intensity on diffusion-weighted imaging (DWI) in bilateral paramedian thalami and a distinct pattern of V-shaped midbrain hyperintensity on DWI.Magnetic resonance angiography (MRA) showed left-sided embryonal posterior cerebral artery (PCA) from ipsilateral internal carotid artery (ICA).Systemic treatment yielded a poor prognosis.

Competency-based medical education and personnel training isbecoming a global trend, and the United States has developed a set of competence evaluation system to evaluate a pack-age of emergency, orthopedics, thoracic surgery physicians etc. in 26 specialties. This paper introduces the development background of the evaluation system, the structure of specialist competency evaluation form, content and methodologies , and uses emergency physicians for further evaluation to illustrate this. American physician competency evaluation system provides a unified framework for the country's medical graduates after graduating from medical education training. It helps tocombine process control withthe results ofthe evaluation, self-evaluation with the evaluation of others to makethe evaluation more objective and comprehensive . It can provide new reference to the evaluation and training of physicians in our country.

Objective To construct and assess the competency scale for emergency physicians in our country. Methods Learning from the milestone project in America, we developed the scale through Delphi method . The application effect was evaluated among 81 emergency physicians by questionnaire survey. Excel was used to do data entry. SPSS 20.0 was adopted to do data analysis. Factor analysis method was employed to verify the structure validity of the scale. Results The competency scale comprises six dimensions and 13 items. The scale of total Cronbach's alpha coefficient was 0.98 and the split half reliability was 0.95. Two factors were extracted by principal component analysis with cumulative contribution rate of 86.5%. The differ-ences of competency score on six aspects of different ages, titles, working years and training situation were tested and all had statistically significant differ-ence (P<0.01). Conclusion The scale developed in our study can reflect the growth stage of the emergency physicians and serve the purpose as an evaluation tool for the competency of emergency physicians in our country.

Twenty cDNA differential fragments were isolated from the hippocampus of rats in epileptic state using mRNA differential display technique. Four fragments were sequenced and compared with the known sequences in the Genebank, which showed that ERG8, ERG11, ERG12had no significant identity to any known sequences; ERG14 had 64%-69% identity to microtubulin-associated protein of the rat. Because the differential expression of these genes was caused by epilepsy inducer coriaria lactone (CL) and anti-epilepsy drug MK-801 and ERG8 might be a novel candidate epilepsy gene; ERG11 and ERG12 might be novel candidate anti-epilepsy genes.Since the microtubulin-associated protein is closely associated with the collateral sprouting of mossy fibers in the hippocampus of seizured rat, the high expression of ERG14 in the early stage of epilepsy might predict the growth of axon and formation of synapse.

Twenty cDNA differential fragments were isolated from the hippocampus of rats in epileptic state using mRNA differential display technique. Four fragments were sequenced and compared with the known sequences in the Genebank, which showed that ERG8, ERG11, ERG12had no significant identity to any known sequences; ERG14 had 64%-69% identity to microtubulin-associated protein of the rat. Because the differential expression of these genes was caused by epilepsy inducer coriaria lactone (CL) and anti-epilepsy drug MK-801 and ERG8 might be a novel candidate epilepsy gene; ERG11 and ERG12 might be novel candidate anti-epilepsy genes.Since the microtubulin-associated protein is closely associated with the collateral sprouting of mossy fibers in the hippocampus of seizured rat, the high expression of ERG14 in the early stage of epilepsy might predict the growth of axon and formation of synapse.

OBJECTIVE: To investigate the information acquired through the four diagnostic methods of traditional Chinese medicine in patients with bronchial asthma, and to classify the syndrome types. METHODS: Four hundred and thirty patients with bronchial asthma were randomly investigated. The information acquired through the four diagnostic methods was recorded and the database was established by Amos software, and then the data were analyzed by confirmatory factor analysis (CFA). RESULTS: After analyzing the data with 4 factors, 5 factors and 6 factors, we found that the results of CFA with 6 factors were in accordance with clinical practical experience. CONCLUSION: According to the results of CFA with 6 factors and with the standard regression coefficient 0.4 as primary and secondary critical points, the syndromes in patients with bronchial asthma can be classified into 5 types, which are syndromes of cold fluid retained in lung, phlegm-heat obstructing lung, wind-phlegm blocking lung, qi deficiency of lung and kidney and qi deficiency of spleen.

Objective To explore the expression of heat shock protein (HSP) 90α in outside of different metastatic hepatocellular carcinoma (HCC) cell lines and its role in the cells migration and invasion.Methods The expression of HSP90α was detected by Western blot analysis in conditioned media of MHCC97L and MHCC97H with low and high metastatic HCC cell lines.A small molecule cell-impermeant HSP90 inhibitor DMAG-N-oxide was used to inhibit extracellular HSP90α.Changes of the cells migratory and invasive capability were assessed by in vitro motility and invasion assay.The endogenous matrix metalloproteinase 2 (MMP-2) was demonstrated by Zymography.The expression of extracellular co-chaperone HSP70 and MMP-2 were tested by Western blots and the association between HSP90α,HSP70 and MMP-2 was analyzed by immunoprecipitation.The effects of HSP70 knockdown by siRNA,with or without MMP-2 inhibitor Batimastat,on the level of active MMP-2 and cell migration and invasion were also evaluated.Results HSP90α can express both inside and outside of different metastatic HCC cell lines,and the level of expression was consistent with metastasis potentials.After MHCC97-H cells were treated with a special HSP90α inhibitor DMAG-N-oxide for 24 h,the average migratory cell numbers (28.11 ±3.56) had a significantly reduction,compared with those without treatment group (80.12±4.16) and empty control group (82.24±4.12),respectively (P ＜ 0.01).In vitro invasion assay showed the average invaded cell numbers in treatment group (36.54±4.12) were more fewer than without treatment group (95.12±3.48) and empty control group (101.1 1±3.36),respectively (P =0.017),and accompanying with decreasing of the extracellular MMP-2 activity.HSP70 and MMP-2 could express outside of MHCC97-H cells and interact with HSP90α.Small molecular interfere RNA (siRNA) dramatically inhibited HSP70 expression and reduced the interaction HSP90α with MMP-2 and MMP-2 activity outside MHCC97-H cells,and also suppressed MHCC97-H cells migration and invasion.In addition,combining MMP-2 inhibitor had additive inhibition effects.Conclusion Extracellular HSP90α and HSP70 form chaperone complex to assist in MMP-2 activation and increases HCC cells migration and invasion,which maybe a novel therapeutic target against metastatic HCC.

OBJECTIVETo discuss the mechanism of the traditional Chinese medicine Keyouling oral liquid in the treatment of condyloma acuminatum(CA) and the adjustment of cellular immunity function.

METHODSThe IL-18 and TNF-alpha levels of peripheral serum and wart tissue of patterned rats and CA patients exposed to Keyouling were determined by means of double-antibody sandwich ELISA, and the NK cellular activity of the spleen of the patterned rats and that of the peripheral blood of the CA patients exposed to Keyouling were determined by means of 3H-TdR isotype release.

RESULTSThe IL-18 and TNF-alpha levels, the NK cellular activity of the high-dosage group showed significant difference from those of the pattern group and low-dosage group in animal experiment(P < 0.05); the IL-18 and TNF-alpha levels of peripheral serum and wart tissues, and the NK cellular activity of the peripheral blood of the treatment group showed significant difference from those of the control group after treatment(P < 0.01, P < 0.05).

CONCLUSIONSKeyouling oral liquid has significant positive adjusting effect, which can markedly ameliorate the cellular immunadeficiency of the patterned animals and reinforce the cellular immunocompetence of CA patients.

Adolescent ; Adult ; Animals ; Condylomata Acuminata ; drug therapy ; immunology ; Female ; Humans ; Interleukin-18 ; blood ; Killer Cells, Natural ; drug effects ; immunology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; analysis

Interleukin-8 (IL-8) is an important activator and chemoattratant of neutrophils and has been implicated in airway inflammatory diseases. To explore the new gene therapeutic strategies for airway inflammation, plasmid expressing dominant negative myeloid differentiation protein (MyD88 DN) was constructed and transfected into human airway epithelial cell lines A549 and SPC-A-I. The cells were challenged with M. tuberculosis, P. aeruginosa or K. pneumoniae and the release of IL-8 was measured using ELISA. The results showed that the supernatants of M. tuberculosis and R. aeruginosa enhanced IL-8 release from the epithelial cells; and transfection of MyD88 DN diminished this effect. MyD88 DN also reduced IL-8 release from cells induced by live bacteria of P. aeruginosa or K. pneumoniae. These data suggest that MyD88 could be used as a target gene in the gene therapy of airway inflammation.
Cells, Cultured ; Epithelial Cells ; microbiology ; secretion ; Humans ; Interleukin-8 ; secretion ; Mycobacterium tuberculosis ; Myeloid Differentiation Factor 88 ; genetics ; Pseudomonas aeruginosa ; Transfection

Objective:To explore the application of endoscopic narrow-band imaging(NBI) in the early diagnosis of throat malignant tumors.Methods:From January 2014 to December 2019, 512 patients with suspected benign or malignant diseases of the throat in the First People's Hospital of Wenling were selected, and all patients were performed white light endoscopy and NBI endoscopy.The biopsies were taken for pathological examination.The histopathological results were seemed as gold standard for diagnosis.Results:NBI endoscopy was superior to white light endoscope in terms of microvascular morphology and lesion outline(χ 2=457.497, 293.209, all P<0.05). The diagnostic coincidence rate, sensitivity and negative coincidence rate of NBI endoscope for malignant tumors were higher than those of white light endoscope(χ 2=10.131, 6.197, 4.084, all P<0.05). The sensitivity of NBI endoscope type Ⅰ-Ⅱ in the diagnosis of benign lesions was 90.65%, and the specificity was 96.88%.The sensitivity and specificity of NBI endoscope type Ⅲ-Ⅳ in the diagnosis of mild-moderate dysplasia were 80.99% and 97.52%, respectively.The sensitivity and specificity of NBI endoscopy type Va in the diagnosis of severe atypical hyperplasia were 15.18% and 98.54%, respectively.The sensitivity and specificity of NBI endoscope Va-c in the diagnosis of invasive cancer were 93.24% and 96.93%, respectively. Conclusion:Compared with white light endoscope, NBI endoscope can more clearly show the outline of lesions and submucosal blood vessels, and can more accurately diagnose malignant tumors in the throat, especially can more recognized the pre-cancerous lesions and early malignant tumors.It has important clinical application value in early diagnosis of malignant tumor in the throat.