Objective: To observe the clinical efficacy of Zhi Shen Tiao Sui (regulating the mind and marrow) needling in treating depression after ischemic stroke. Methods: A total of 145 patients with depression after ischemic stroke were recruited between January 2016 and January 2018 and divided into two groups using random number table method, with 72 cases in the control group and 73 cases in the observation group. The control group received conventional treatment for ischemic stroke and medication, while the observation group was given additional Zhi Shen Tiao Sui acupuncture. The two groups were treated for 4 successive weeks. Clinical efficacy was analyzed after treatment. The neurological function pertinent scores [Hamilton depression scale (HAMD), clinical neurological deficit score (CNDS), activities of daily living (ADL), Fugl-Meyer assessment scale (FMA) and Barthel index (BI) scores], as well as the levels of cortisol (CORT) and adrenocorticotropic hormone (ACTH) were recorded in the two groups. Adverse reactions that occurred during treatment were also observed. Results: The clinical total effective rate was 82.2％ in the observation group, significantly higher than 66.7％ in the control group (P<0.05). After treatment, the HAMD and CNDS scores were markedly reduced in both groups (all P<0.05), and the ADL, FMA and BI scores were markedly increased (all P<0.05). The HAMD and CNDS scores were significantly lower in the observation group than in the control group after treatment (both P<0.05), and the ADL, FMA and BI scores were significantly higher in the observation group than in the control group (all P<0.05). The levels of CORT and ACTH declined significantly after treatment in the two groups (all P<0.05), and were markedly lower in the observation group than in the control group (both P<0.05). The adverse reaction rate was 2.7％ in the observation group, versus 4.2％ in the control group, and the between-group difference was statistically insignificant (P>0.05). Conclusion: Compared with sole use of Western medication, medication combined with Zhi Shen Tiao Sui acupuncture can promote the recovery of neurological function, down-regulate the levels of CORT and ACTH and enhance the clinical efficacy in treating patients with depression after ischemic stroke, with a relatively high safety rating.

Objective To compare the myocardial protective effects of isoflurane versus sevoflurane in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods Forty ASA Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ ) of both sexes, aged 40-55 yr, weighing 55-94 kg, scheduled for elective OPCABG, were randomly divided into 2 groups ( n = 20 each): isoflurane group ( group Ⅰ) and sevoflurane group ( group S). Anesthesia was induced with midazolam, sufentanil and vecuronium. Patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with inhalation of isoflurane or sevoflurane and infusion of sufentanil and vecuronium. In group Ⅰ, the initial end-tidal concentration of isoflurane was 1.2%. In group S, the initial end-tidal concentration of sevoflurane was 1.7 %. BIS value was maintained at 40-50 by adjusting the end-tidal concentration of isoflurane or sevoflurane. The central venous blood samples were collected immediately before skin incision, at the end of surgery, 2 and 24 h after surgery for determination of plasma creatine kinase-MB (CK-MB) activity and cardiac troponin Ⅰ (cTnI) concentration. The adverse cardiovascular events were recorded. Results The incidences of ventricular premature beat, tachycardia, bradycardia, ventricular fibrillation and S-T segment elevation ( ＞0.1 mV) during surgery and the plasma CK-MB activity and cTnI concentration after surgery were significantly higher in group S than in group Ⅰ ( P ＜ 0.05). Conclusion Isoflurane has better myocardial protective effect than sevoflurane in patients undergoing OPCABG.

Objective To evaluate value of multi-indexes of real-time myocardial contrast echocardiography (RT-MCE) for the detection of coronary artery disease(CAD). Methods A total of 35 patients scheduled for coronary angiography underwent RT-MCE, and were undergone gated single photon emission computed tomography(gated-SPECT) after RT-MCE shortly. Coronary angiography was performed within one week of RT-MCE in all patients. All patients were divided CAD and no-CAD group. The observing indexes included: (1)The images of RT-MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion by using the Qlab software; A,β and A×β were compared between two groups. The sensitivity and specificity of RT-MCE for detection of CAD were performance by ROC curves Gensini score were calculated in 22 patients. Then the correlation analysis was used for comparing the value of A,β and A×β with Gensini score. (2) The sensitivity and specificity of gated-SPECT and RT-MCE for assessment of CAD were calculated by 4 score method. (3) RT-MCE for the detection of coronary artery stenosis with multi-indexes. Results (1) A,β and A×β were significant difference between two groups. The cutoff of A,β and A×β was 4. 58,0. 64 and 2. 73,then the sensitivity and specificity of RT-MCE for detection of CAD were 86. 0% , 80. 2% , 88. 9% and 84.1 % , 64. 6% , 79. 9 % , respectively. The correlation index was - 0. 79, - 0. 51 and - 0. 76 comparing the results of A, β and A ×β with Gensini. (2) The sensitivity and specificity of gated-SPECT for assessment of CAD were 84. 8 % and 82. 7% ,respectively. (3) The sensitivity of multi-indexes RT-MCE increased, the sensitivity was 89. l%,90. 4% and 96.3% when combinated A and β,A and A×β,and β and A×β, respectively. Conclusions RT-MCE with multi-indexes has a valuable application for assessment of CAD. The severity of CAD could be evaluated by RT-MCE.

Aim To observe the effect of endomorphin-1 (EM-1 )on TLR2 and TLR4 expressions of dendritic cells (DC)from human peripheral blood.Methods Monocytes isolated from human peripheral blood mono-nuclear cells were cultured in medium containing re-combinant human interleukin-4 and recombinant hu-man granulocyte macrophage colony stimulating factor. After six days of culture,the immature dendritic cells (imDC ) were divided into four groups,the control group (BLA group),EM-1 group,LPS group and LPS+EM-1 group.After 2 days of culture,the expres-sions of TLR2 and TLR4 were determined by fluores-cence activated cell sorter(FACS).The expressions of TLR2 and TLR4 at mRNA level in DC were detected by RT-PCR.Results The FACS results showed that the expressions of TLR2 and TLR4 in imDC were high-er,and their expressions were decreased with the mat-uration of DC.Compared with BLA group,the expres-sions of TLR2 and TLR4 in DC were down-regulated in EM-1 group (P<0.05 ).Compared with LPS group, TLR2,TLR4 on DC surface were significantly lower in LPS +EM-1 group (P <0.01 ). RT-PCR results showed that compared with BLA group,EM-1 interven-tion induced TLR2 mRNA expression was down-regula-ted significantly (P<0.01),there were no significant changes of TLR4 mRNA expression (P>0.05 ).mR-NA expressions of TLR2 and TLR4 on DC in LPS +EM-1 group were lower than those in LPS group (P<0.05 ).Conclusions EM-1 enables the down-regula-tion of the expressions of TLR2 and TLR4 on DC sur-face,the effects of EM-1 on immune function may be associated with TLR2 and TLR4 expressions on DC surface.

Objective To compare the efficacy and safety of intravenous thrombolysis on cardiogenic cerebral infarction and noncardiac infarction by recombinant tissue plasminogen activator (rt-PA). Methods Comparations of NIHSS, mRS and adverse events before and after treatment were made between the cardiogenic group and the noncardiac group. Results No significant differences in the NIHSS and mRS were found between the two groups. The incidence of brain hernia and dermatorrhagia in the cardiogenic group was higher than that in the noncardiac group. Conclusion Rt-PA therapy in cardiogenic cerebral infarction was effective and safe in spite of higher incidence of hemorrhage and brain hernia.

Objective:To explore therapeutic effect and safety of endovascular stenting on transient ischemic attack (TIA) caused by atherosclerotic vascular stenosis .Methods:A total of 100 patients with TIA caused by vascular ste-nosis in our hospital from Jan 2011 to Feb 2013 were enrolled ,and equally divided into combined treatment group (received endovascular stenting combined medication ) and routine treatment group (received medication treat-ment) .After 12-month treatment ,recurrence rate of TIA ,incidence rate of stroke and vascular stenosis rate before and after treatment were compared between two groups .Results:Compared with before treatment ,there was no significant change in all above-stated indexes after treatment in routine treatment group;were significant reduction in vascular restenosis rate [ (73.31 ± 12.76)% vs .(25.01 ± 5.73)% ] in combined treatment group ,and it signifi-cantly reduced than that of routine treatment group (74.33 ± 12.96)% ,P<0.01 both ;during the 12-month follow-up ,compared with routine treatment group , there were significant reductions in percentages of recurrent TIA (16.0% vs .2.0% ) and cerebral stroke (12.0% vs .0) in combined treatment group ,P<0.05 both Conclusion:En-dovascular stenting can significantly improve clinical therapeutic effect and prognosis in patients with atherosclerotic vascular stenosis ,and is worth clinical extension in some condition .

Objective To study the characteristics of the transcranial electric stimulation(TES)-elicited motor evoked potentials(MEP)recorded from different points of the diaphragm,and to determine the optimal record- ing site in the diaphragm.Methods One EEG electrode was placed subcutaneously in the midline of the skull as stimulation electrode and another EEG electrode was inserted into hard palate submucously as cathode in 30 male rats.And single square wave electrical pulse was used for stimulation.The stimulation intensity was 15 mA,the du- ration of the pulse was 0.2 ms,and the stimulating interval was 200 ms.The concentric needle electrode were insert- ed into the following eight sites:the medial,intermediate,lateral crura of the diaphragm,the junction of the posterior axilla line and the inferior border of the eleventh rib,the junction of the anterior axilla line and the inferior border of the ninth rib,the junction of the intermediate line of the clavicle and the inferior border of the eighth rib,the junction of the para-sternal line and the inferior border of the seventh rib,the pars sternalis.The MEP was recorded from each point,respectively.The optimal sites of the diaphragm MEP were found and recorded.Results The MEPs were re- corded from each of the 8 sites of the diaphragm in all the rats after TES.There was no statistically significant differ- ence among the latencies of every site.But the amplitude varied from 6.08?0.46 mV in maximum along the inferior border of the ninth rib at the anterior line of the axilla to the minimum of O.91?0.03 mV at the pars sternalis. Conclusion It is safer to insert the needle along the inferior border of the ninth rib at the anterior line of the axilla, because there was certain distant from the folding part of the pleura and the amplitude of the recorded wave at this point is maximal.

Objective To explore the technique of massive facial scar revision. Methods All 12 patients in the group were treated with expanded deltopectoral skin flap. In the primary surgery, expander was implanted underneath deltopectoral flap region through an incision inferior to the clavi-cle. The skin perforators of transverse cervical artery and thoracoacromial artery were ligated during surgery, and the internal thoracic artery was carefully preserved. After the deltopectoral skin flap was fully expanded, the second surgery was performed and the facial scar was released and the normal ana-tomic position of eyes, nose and month was restored. The deltopectoral skin flap was planed according to the size of the defect. The excised facial scar was converted to the flap pedicle and a hinge-like con-nection was formed. The flap was delayed and three weeks after the second surgery, the pedicle was divided. The flap from the pedicle was applied for the mental region scar revision. Results Unilateral or bilateral dehopectoral skin flaps were employed for the repair of extensive facial scar in 12 patients. Satisfactory results were achieved in all these patients. Conclusion Expanded deltopectoral skin flap is a good technique for the repair of extensive facial scar.

Objective This study was aimed to analysis the relationship of BK polyomavirus ( BKV) and hemorrhagic cystitis ( HC ) in patients who received hematopoietic stem cell transplantation (HSCT).Methods Data of 80 patients who received HSCT and took regular urine test every week from June 2015 to April 2018 in the Third Xiangya Hospital of Central South University was retrospectively analyzed, they were 35 females and 45 males (aged 20-40 years, median age 30 years), and 31 cases with acute myeloid leukemia ( AML) , 24 cases with acute lymphoblastic leukemia ( ALL) , 15 cases with aplastic anemia ( AA ) , 4 cases with chronic myeloid leukemia ( CML ) , 6 cases with other diseases such as myelodysplastic syndrome ( MDS) in the study population.The positive rate and incidence of HC were analyzed.Patients who infected with the BK virus were divided into HC group and non -HC group according to occurrence of HC.BK viral load were compared in two groups .Urine BK viral load were analyzed after logarithmic transformation.Data that conforms to a normal distribution is expressed as mean ± standard deviation.t test, ANOVA and ROC curve were used to statistical analysis .Skewed data is expressed in median ( interquartile range ) , non-normal distribution parameters were compared by Wilcoxon test .Results Among 80 patients, 43 recipients (53.75％) became urinary BK positive, with 19 patients developed HC (23.75％), all of the 19 HC patients have urinary BK positive , and none of 37 BK-negative patients developed HC;the urine BKV level of the initial time and the peak time in HC group were (7.59 ±2.46) lg copy/ml, (10.56 ±1.71) lg copy/ml, the urine BKV level of the initial time and the peak time in non-HC group were (5.75 ±2.10) lg copy/ml,(7.31 ±2.29) lg copy /ml.The urine BKV level of the initial time and the peak time in HC group was higher than in non-HC group ( t=2.642, P=0.012 and t=5.147, P=0.000 respectively), when analyzing the urine BKV level of the initial time in HC group and non-HC group, the best threshold is 5.23 lg copy/ml(1.68 ×105 copy/ml),with a sensitivity of 84.20％and specificity of 54.17％, when analyzing the urine BKV level of the peak time in HC group and non-HC group, the best threshold is 9.75 lg copy/ml(5.62 ×109 copy/ml),with a sensitivity of 84.20％and specificity of 83.33％, area under curve of each other were 0.728 (95％ CI 0.575-0.881) and 0.875 (95％ CI 0.769-0.981) respectively.Conclusions The BK viral load is closely related with HC in HSCT patients .The cut-off level of 1.68 ×105 copy/ml when analyzing the urine BKV level of the initial time , and the cut-off level of 5.62 × 109 when analyzing the urine BKV level of the peak time , help to forecast or auxiliary diagnose HC .

Objective To propose a new suggestion for the clinical downstaging of nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT) without changing the current T,N,and M staging system.Methods We reviewed the records of 536 NPC patients treated in Sun Yat-Sen University Cancer Center from January 2002 to December 2006.The Kaplan-Meier method was used to calculate the disease-specific survival (DSS) rate,and the log-rank test was used for survival difference analysis.The Cox regression model was used to calculate the hazard ratio (HR) of each subset.ResultsAccording to the 7th edition of UICC/AJCC staging system,the 5-year DSS rates of stage Ⅰ-Ⅲ patients (except T3N2M0) were all more than 85%(P>0.05),those of stage ⅣA and ⅣB patients were 71.8% and 46.2%,respectively (P=0.171),and that of stage ⅠVC patients was only 24.0%.In stage Ⅲ,the 5-year DSS rate of non-T3N2M0 patients (91.5%) was significantly higher than that of T3N2M0 patients (78.6%)(P=0.042),but there was no significant difference in DSS between T3N2M0 patients and stage ⅣA and ⅣB patients.Based on the above results,new stage Ⅰ included T1-3N0-1M0 and T1-2N2M0,new stage Ⅱ included T3N2M0,T4N0-2M0,and TxN3M0,and new stage Ⅲ included TxNxM1.The 5-year DSS rates of new stage Ⅰ,Ⅱ,and Ⅲ patients were 93.3%,72.7%,and 24.0%,respectively (P=0.000).Compared with new stage Ⅰ patients,new stage Ⅱ and Ⅲ patients had HRs of 4.01 and 16.76,respectively,for 5-year DSS.Conclusions In the era of IMRT,the new clinical staging system (stages Ⅰ,Ⅱ,and Ⅲ) helps with prognostic evaluation and clinical treatment.