Objective To explore the relevant factors influencing the prognosis of progressive cerebral infarction,in order to provide basis for clinical trentment and improve the prognosis of patients.Methods Clinical data of 163 patients admitted as progressive cerebral infarction and 355 patients admitted as non-progressive cerebral infarction were retrospectively analyzed.All patients were followed up by interview or telephone at the time of 30 and 90days,the clinical data were recorded.The relevant factors influencing the prognosis of progressive cerebral infarction were analyzed.Results Multiple linear regression analysis of patients with progressive cerebral infarction showed that total anterior circulation infarcts,respiratory infection,coronary heart disease history,imbalance of water and electrolyte,white blood cell increasing were leading influence risk factors for the higher National Institutes of Health Stroke Scale(NIHSS) in hospitalized patients.Analysis of patients with progressive cerebral infarction showed that total anterior circulation infarcts,lack of physical activity,NIHSS at admitting,the elderly and respiratory infection were leading influence risk factors of the higher Activities of Daily Living(ADL) and modify Rankin Scale(mRS) scores at 30d and 90d of following up.The scores of ADL and mRS at 30d and 90d were significantly higher in progressive cerebral infarction than those of non-progressive cerebral infarction patients (t =6.6179,P =0.000,t =5.2788,P =0.000,t =5.0608,P =0.000,t =4.0725,P =0.000,respectively).The recurrence of cerebral infarction in progressive cerebral infarction group and death events at 30d were also significantly higher than that of non-progressive cerebral infarction(x2 =8.423,P =0.004 and x2 =5.135,P =0.023,respectively).But the recurrence of progressive cerebral infarction and death events at 90d,there were no significant differences between progressive cerebral infarction and non-progressive cerebral infarction (x2 =1.938,P =0.159 and x2 =3.518,P =0.061,respectively).Conclusion The relevant factors influencing the prognosis of progressive cerebral infarction are common effect of various factors.In the treatment of progressive cerebral infarction should be actively considered as much as possible to improve the prognosis of patients.

Objective To explore the experience of diagnosis and treatment of laparoscopic abdominal inci-sion hernia repair.Methods The clinical data of 15 patients treated with laparoscopic incision hernia repair were ret-rospectively analyzed.Results All 15 cases were successful in operation by laparoscopy.The operation time was 60~180 mins,and the mean operation time was (117 ±30.46) mins,the post-operation aerofluxus time was 1~2 days and the mean time of post-operation hospital stay was (16.53 ±3.46) days.During the operation no association with serosal layer damage or massive hemorrhage occurred;no postoperative seroma infection,intestinal fistula,infec-tion of incision,patches or deaths occurred.Ten patients(66.67%) had abdominal wall nail regional pain to different degree.2~11 months′postoperative follow-up indicated no recurrent cases.Conclusion Laparoscopic adoption of stapler or stapler with sutures through abdominal wall to repair incisional hernia is safe and effective.Compared with the open surgery,laparoscopic incisional hernia repair has the advantage of minor injury,quicker recovery,and lower recurrence rate.

Objective To study the effects of butylphthalide on homocysteine (Hcy) and C-reactive protein (CRP) levels in patients with acute cerebral infarction.Methods One hundred and ten patients with acute cerebral infarction were divided into control group and treatment group by random digits table,with 55 patients in each group.Two groups were given conventional treatment for 3 weeks,and treatment group was added butylphthalide 200 mg oral application,thrice a day.Two groups were compared in the total effective rate,neurological deficit scores (NDS) and serum Hcy and CRP levels.Results The total effective rate in treatment group was significantly higher than that in control group [ 89.09％ (49/55) vs.61.82％ (34/55),x2 =11.044,P＜ 0.01 ].The NDS in two groups after treatment were significantly decreased than those before treatment [treatment group:( 11.24 ± 3.19) scores vs.(23.19 ± 4.06) scores,control group:( 18.56 ± 4.03 )scores vs. (22.31 ± 4.17) scores,P ＜ 0.01 ],and NDS in treatment group after treatment was significantly lower than that in control group (P＜ 0.01 ).The serum Hcy and CRP levels in two groups after treatment were significantly lower than those before treatment [ treatment group:( 13.12 ± 3.58 ) μ mol/L vs.(27.36 ± 6.84 )μ mol/L,( 10.33 ± 3.10) mg/L vs.( 18.96 ± 5.38) mg/L;control group:( 16.41 ± 4.76) μ mol/L vs.(28.73 ±6.32) μ mol/L,(13.16±4.02) mg/L vs. (19.17 ± 5.74) mg/L,P ＜ 0.01 ],serum Hcy and CRP levels in treatment group after treatment were significantly lower than those in control group (P ＜ 0.01 ).Conclusion Butylphthalide can reduce serum Hcy and CRP levels,reduce inflammation and improve the condition of patients with acute cerebral infarction.

Objective To investigate the diagnostic value of multi‐slice spiral CTA on the SAH patients ,and serum S‐100B pro‐tein in the evaluation of brain damage and cerebral vasospasm in SAH patients .Methods One hundred and sixty six patients with SAH were selected ,and all underwent CTA examination ,the serum S‐100B protein level were detected 1 d ,2 d ,3 d and 7 d after ad‐mission .Results In the 166 patients ,CTA showed 119 aneurysms .With the treatment ,on day 1 S‐100B protein level of Ⅰ - ⅡHunt‐Hess grade patients was (0 .71 ± 0 .11)μg/L ,on day 7 the level was (0 .62 ± 0 .09)μg/L ;S‐100B level of Hunt‐Hess Ⅳ stage patients on day 1 and 7 were (2 .12 ± 0 .23)μg/L and (1 .97 ± 0 .06)μg/L .After treatment ,S‐100B level was proportional to Hunt‐Hess grade .S‐100B protein level of GCS(3-8) score patients were (1 .87 ± 0 .23)μg/L on day 1 and (1 .87 ± 0 .23)μg/L on day 7 .S‐100B protein level of GCS(13-15) score patients were(0 .63 ± 0 .17)μg/L on day 1 ,(0 .44 ± 0 .15)μg/L on day 7 .After treat‐ment ,the S‐100B level was inversely proportional to GCS score .Conclusion CTA could display three‐dimensional structure and the surrounding relations ,and could contribute to the choice of treatment and assessment of the degree of difficulty .Serum and cerebro‐spinal fluid concentration of S‐100B protein level could be used to assess the gravity of the secondary brain damage and the possibili‐ty of cerebral vasospasm .

Objective To summarize the clinical experience of laparoseopie chdeeystectomy(LC).Methods Clinical records of 276 cases treated by LC were retrospectively reviewed.Results LC Was successfully accomplished in 265 cases and conversion to open surgery was required in 11 eases;The success rate of operation was 96%;and conversion rate of opening surgery was 4%;In the study,no severe complications occurred.Conclusion selecting fitable inpatients;With perfect technique and highly responsibility,LC could be performed safely.

Objective To investigate the value of pathological examination in the diag-nosis of lethal cases due to acute poisoning.Methods The macroscopic and microscopic find-ings in 28 autopsy cases (10 cases of toxic gas,7 cases of pesticide,6 cases of drug,3 cases of alcohol and 2 cases of chinese herbal medicine) died of acute poisoning during the period from October,2001 to June,2012 were retrospectively reviewed.Results Gross Changes were found on gross examination in 22 of the 28 cases studied.Of them,7 cases died of acute carbon mono-xide poisoning had showed cherry red of Shiban,muscle,visceral organs and blood.In addition,11 and 8 cases had been found gastric mucosa hemorrhage and epicardium petechial hemorrhage respectively.Histologically,myocardial interstitial hemorrhage was observed in 9 cases,pulmonary hemorrhage in 18 cases,bronchospasm in 12 cases,cerebral hemorrhage in 4 cases,hepato-cyte necrosis in 11 cases,renal tubular necrosis in 7 cases and gastric mucosa hemorrhage in 11 cases.In 6 cases of oral pesticides poisoning,besides they had all gastric mucosa hemorrhage,the change of character of gastric contents was found in 3 cases and pesticide odor from stomach in 3 cases.In addition,acute inflammatory and necrosis of gastric wall in 6 cases of oral pesticides poisoning were observed under the light microscope.Drug addicts often suffered from chronic lesions in multiple organs,such as chronic liver disease,fatty infiltration of the myocardium with myocardial atrophy,interstitial lung disease and pulmonary foreign body granuloma.Conclusions Pathology examination is helpful in the diagnosis of some lethal cases due to acute ooisoning,and it can provide pathological basis to study on treatment of acute poisoning.

Objective To summarize the effect of tension-free hernioplasty for inguinal hernia .Methods Retrospective analysis of 619 cases of adult inguinal hernia underwent tension-free hernioplasty clinical data , curative effect and complications were observed .Results Patients could all get up 1 day after operation .Incisional pain was disappeared within 1-2days.Postoperative scrotal hematoma was found with 3 cases,no postoperative incision infec-tion,rejection.574 cases were followed up for 3 months to 4 years, there was no recurrence .Conclusion Adopting the method of Tension-free herniorrhaphy in treatment for inguinal hernia has the advantages of less trauma , faster postoperative recovery ,less complications and low recurrence rate etc .

Objective To study the application and significance of constructivism theory in pathological experiment teaching.Methods Six classes in total of 198 students majoring in clinical medicine were selected from grade 2009 of Guangdong medical college for research and were divided into experimental group (n=99) and control group (n=99) using random number table.Various teaching methods based on constructivism theory were used in experimental group while conventional teaching methods were applied in control group.The observing ability for specimen and slices,theoretical level and learning behavior of students were assessed with the same standard and anonymous homemade questionnaire survey was executed for students.SPSS 13.0 statistical software was used to analyze the results.The examination results of the two groups were compared using independent samples t-test.The questionnaire survey results of the two groups were compared using Wilcoxon rank-sum test.P＜0.05 represented the difference having statistical significance.Results The observing capability for specimen and slices,theoretical level and learning behavior of students in experimental group were significantly improved (P＜0.01)and the questionnaire survey results demonstrated that there were statistical difference in feedbacks between the two groups and the satisfaction rate was significantly improved in experiment group (P＜0.01).Conclusions Applying comprehensive teaching methods based on constructivism theory can stimulate students' interest and initiative in learning,improve students' learning behavior and learning strategies,and significantly improve the teaching quality.

OBJECTIVE:To determine the median effective dose (ED50) of propofol with single intravenous injection in alcohol dependence or withdrawal model rats,and to observe the anaesthetic effect of 2-fold ED50 propofol. METHODS:Fifty SD rats were divided into drinking group(n＝23)and control group(n＝27)based on whether the consumption of alcohol was greater than 3.0 g/(kg·d). Drinking group continued to drink freely and intermittently to establish alcohol dependence model. Control group was only given drinking water for ethanol elution 16 rats were randomly selected from each group to determine ED50 of propofol with single intravenous injection by sequential method,and initial dose was 6.02 mg/kg. After eluting for a week,alcohol dependence rats stopped drinking for 24 hours and had alcohol withdrawal symptoms to establish alcohol withdrawal model. ED50 of propofol in alcohol withdrawal group and control group were determined with same method. After eluting for a week,anaesthetic effect [disappearance time and reappearance time of forepaw righting reflex(FRR),time of activity complete recovery] of 2-fold ED50 propofol with single intravenous injection were observed in alcohol dependence group,alcohol withdrawal group and control group,and corresponding time point and the frequency of respiration before administration were also observed. Changes of liver function indexes(serum albumin,alanine transaminase,total bilirubin,γ glutamyl transaminopeptidase)and liver histomorphology were observed 48 h after medication,10 in each group. RESULTS:ED50 of propofol in alcohol dependence model rats was 9.563 mg/kg,which was higher than 5.623 mg/kg of control group. ED50 of propofol in alcohol withdrawal model rats was 4.086 mg/kg,which was lower than 5.297 mg/kg of control group. Compared with control group,reappearance time of FRR was prolonged significantly in alcohol dependence group and alcohol withdrawal group (P＜0.05). There was no statistical significance in disappearance time of FRR or activity complete recovery time (P＞0.05). The frequency of respiration during FRR disappearance was lower than before propofol injection,FRR reappearance and activity complete recovery (P＜0.01). After intravenous injection of 2-fold ED50 propofol,reappearance time of FRR in alcohol dependence group and alcohol withdrawal group were longer than control group(P＜0.05)；the alcohol dependence group was longer than the alcohol withdrawal group(P＜0.05).The time of activity complete recovery in alcohol dependence group was longer than control group and alcohol withdrawal group (P＜0.05). The frequency of respiration in 3 groups during FRR disappearance were all lower than before propofol injection,FRR reappearance and activity complete recovery(P＜0.01). There was no significant difference in the change of liver function indexes or liver histomorphology. CONCLUSIONS:ED50 of propofol is increased in alcohol dependence rats,while ED50 of propofol is decreased in alcohol withdrawal rats. 2-fold ED50 of propofol has no significant toxicity to liver function.

Objective To investigate the microembolic signal (MES) in patients with carotid artery stenosis by transracial Doppler (TCD) diasonograph,and explore the influence of intervention treatment in MES of patients with carotid artery stenosis.Methods One hundred and fifty-eight patients with carotid artery stenosis,admitted to our hospital from March 2009 to November 2014,were enrolled as carotid artery stenosis group;and 158 workers from our hospital without carotid artery stenosis were used as control group.TCD was used to monitor the MES at the initiative internal carotid artery in the two groups;and then,10 d after aspirin enteric coated tablets (100 mg/d) on platelet aggregation and torvastatin (20 mg/d) treatment,MES was monitored again;the MES positive rate between the two groups or in carotid artery stenosis group between before and after medication was compared.Results As compared with the control group (1.9％),the carotid artery stenosis group (36.1％) had significantly increased MES positive rate (P＜0.05).In the carotid artery stenosis group,MES positive rate before treatment (36.1％) was significantly higher than that after treatment (7.6％,P＜0.05).Conclusion MES positive rate in the cerebral blood flow in patients with carotid artery stenosis is increased;treatment by drugs can reduce the microemboli positive rate.