Objective To explore the effect of patients with acute cerebral infarction and complication of acute gastric mucosal lesions (AGML) on their short-term prognoses.Methods Two hundred and sixteen patients with acute cerebral infarction admitted to the Department of Neurology in Tianjin Nankai Hospital from January to December 2014 were enrolled, and they were divided into the control group without AGML (167 cases) and observation group with AGML (49 cases) according to whether AGML occurred or not. The digestive tract was monitored in the two groups, and the relationships between the incidence of AGML and the location of infarction, stroke classification, as well as the anti-thrombosis treatments like thrombolysis, anti-coagulation and anti-platelet, etc. were analyzed; the changes in scores of the National Institutes of Health Stroke Scale (NIHSS) on admission, 7 days and 14 days after onset and 14-day mortality of two groups were compared.Results AGML occurred in 49 of 216 patients (22.69%); the 14-day mortality of the observation group was obviously higher than that of the control group [6.12% (3/48) vs. 1.80% (3/167),P < 0.05], the incidence of infarction located in cerebellum, brainstem, multiple cerebral lobes, etc. (low density shadow > 1/3 hemispheres) in the observation group was higher than that in the control group [cerebellum: 18.37% (9/49) vs. 4.19% (7/167); brainstem: 24.49% (12/49) vs. 8.98% (15/167), multiple lobes: 16.33% (8/49) vs. 2.99% (5/167), all P < 0.05]; the incidence of cardiac cerebral embolism (CE) was significantly higher than that in the control group [55.10% (27/49) vs. 12.57% (21/167),P < 0.05]. With the extension of disease course, the NIHSS score of the observation group was increased, while the score of the control group was gradually reduced, and the NIHSS scores of the observation group were obviously higher than those of control group on the 7th and 14th day after onset (7 days: 18.12±4.20 vs. 10.93±6.73, 14 days: 19.33±3.11 vs. 9.66±9.15, bothP < 0.05). The thrombolysis, argatroban anti-coagulation and anti-platelet incidence between the two groups after treatments was of no statistically significant difference (the incidence in control group was 4.79%, 47.31%, 47.90%, and it was 4.08%, 44.90%, and 48.98% in observation group, allP < 0.05). Conclusion The occurrence of AGML complication in patients with acute cerebral infarction is closely related to their short-term prognoses, and when the cerebral embolus is cardiac in origin or the infarction is located at multiple cerebral lobes, brain stem or cerebellum, the probability of the occurrence of AGML is relatively high, suggesting a poor outcome.

[Objective]To report the polyaxial locking plate and its primary clinical results in the treatment of the tibial plateau fractures.[Method]From July 2006 to August 2007,38 patients with tibial plateau fractures,including 26 males and 12 females,were treated with surgical reduction and internal fixation with polyaxial locking plate.The mean age of the patients was 30.6 years(18-65 years).According to Schatzker classification,there were 3 of type Ⅰ,5 of type Ⅱ,5 of type Ⅲ,6 of type Ⅳ,16 of type Ⅴ,3 of type Ⅵ,of which 34 were closed fractures and 4 open fractures.The follow-up period ranged from 7 to 18 months with a mean of 13.7 months.Function of the knees were assessed according to HSS system and radiological examination.[Result]Solid arthrodesis were obtained in all patients at 3-6 months after operation.Skin flap necrosis and incision infection happened respectively in 2 cases of type Ⅴ and type Ⅵ fractures.The score of HSS system was 92.8(range 78-98) averagely half year after operation and no reduction loss was observed.[Conclusion]The polyaxial locking plate is an effective fixation technique for the surgical treatment of the tibial plateau fractures because of its convenience and stability.The locking screws can be implanted in various directions and reduction loss is avoided post-operation.

BACKGROUND:Studies have found that Wudi Dan can suppress local inflammatory response of the lesioned joints to protect the articular cartilage. OBJECTIVE:To verify the effect of Wudi Dan on chondrocyte viability and apoptosis as wel as the therapeutic effect on osteoarthritis. METHODS:Rat chondrocytes were cultured in serum medium containing Wudi Dan, and the effects of Wudi Dan on cel viability and apoptosis were observed by comparison with the control group. Rabbit model of knee osteoarthritis was constructed using modified Hulth method. Rabbit models were divided into two groups:Wudi Dan group treated with Wudi Dan and control group treated with normal saline, twice a day, consecutively for 4 weeks. Therapeutic effect of Wudi Dan on knee osteoarthritis was observed;cel viability and apoptosis were observed under microscope;the levels of interleukin-1 and matrix metal oproteinase-3 were determined using immunohistochemical method. RESULTS AND CONCLUSION:The apoptotic rate of chondrocytes was significantly lower in the Wudi Dan group than the control group. Pathological findings of the rabbit knee joints showed that the control group had more severe damage to the articular cartilage than the Wudi Dan group. Immunohistochemical staining revealed that in the Wudi Dan group, the cytoplasm and extracel ular matrix were colored light and there were a smal number of positive cel s as wel as low expression of interleukin-1 and matrix metal oproteinase-3. The results suggest that Wudi Dan can effectively protect against articular cartilage lesions, reduce inflammation, and have a good therapeutic effect on osteoarthritis. Its mechanism may be related to inhibition of chondrocyte apoptosis, reduction of cytokine production and inhibition of protein expression of matrix metal oproteinase.

Objective:To compare the immediate therapeutic effect and safety between esmolol and lanatoside in con-trolling ventricular rate for patients with rapid atrial fibrillation.Methods:A total of 72 patients with rapid atrial fi-brillation (ventricular rate ≥120 beats/min)were randomly and equally divided into esmolol group and lanatoside group.Esmolol group received first dosage of 0.5 mg/kg intravenously for 1 min,then were observed for 5 min,if ventricular rate still >100 beats/min or decreased <20%,the 0.5 mg/kg esmolol was appended,meanwhile main-tained by 0.05mg·kg-1 ·min-1 via micro pump at first,maintenance dose can increase to a maximum 0.3mg· kg-1 ·min-1;lanatoside group received first dosage of 0.4mg or 0.2mg slow intravenous injection,if ventricular rate still >100 beats/min or decreased<20%,the another 0.2mg was appended.The onset time and adverse reac-tions were recorded after administration.Results:Compared with lanatoside group,there was significant reduction in mean onset time [(39.2±8.7)min vs.(5.6±3.1)min]in esmolol group,P<0.01;compared with before adminis-tration,there was significant decrease in ventricular rate in two groups after administration,P<0.05 or<0.01. On 2h af-ter administration,compared with lanatoside group,there was significant increase in decreasing range of ventricular rate (29% vs.39%)in esmolol group,P<0.05. The total effective rate and adverse reaction rate was no significant difference (P>0.05)between two groups.Conclusion:Intravenous using esmolol is efficient and safe,and it can be regarded as pre-ferred therapy to control ventricular rate in patients with rapid atrial fibrillation.

Objective To study the effects of Buyang Huangwu decoction(BHD) on serum matrix metalloproteinase-9(MMP-9),high sensitivity C-reactive protein(hs-CRP)levels and inflammatory reaction of patients with ischemic stroke accompanied by Qi deficiency and blood stasis syndrome. Methods Thirty-nine patients with acute ischemic stroke onset for 24-48 hours accompanied by Qi deficiency and blood stasis syndrome were admitted into Nankai Hospital of Tianjin City,and in accordance with the random number table,they were divided into BHD treatment group(21 cases)and conventional western treatment control group(18 cases). The patients in both groups were given conventional western medicine,such as anti-platelet,descent of blood lipid and protection of brain. In the BDH group,the patients were additionally given BHD oral administration. Before and after treatment for 72 hours and 7 days,the changes of serum levels of MMP-9 and hs-CRP were observed in both groups. In the mean time,20 subjects having taken physical healthy examinations in outpatient clinics were assigned in the healthy control group. Results Compared to the healthy control group,before treatment the levels of MMP-9 and hs-CRP in western treatment control and BHD groups were significantly higher than those in the healthy control group〔MMP-9 (μg/L):403.3±32.9,417.9±45.3 vs. 86.5±6.1;hs-CRP(mg/L):7.4±0.7,6.9±0.6 vs. 2.2±0.4,all P<0.05〕. After treatment for 72 hours,the levels of MMP-9 and hs-CRP achieved their peaks,after treatment for 7 days, the levels of MMP-9 and hs-CRP were significantly lower than those at 72 hours in both groups〔the control group:MMP-9(μg/L):190.4±58.0 vs. 528.9±65.1,hs-CRP(mg/L):5.8±0.7 vs. 11.1±0.8;the BDH group:MMP-9 (μg/L):89.5±11.4 vs. 437.6±55.2,hs-CRP(mg/L):3.1±0.9 vs. 7.3±0.6,all P<0.05〕. Conclusions In patients with acute cerebral infarction,the serum levels of MMP-9 and hs-CRP are significantly increased. After conventional treatment,the levels gradually decline,and the descent in the group with addition of BHD is more remarkable,suggesting that BHD have prominent effect for treatment of patients with acute cerebral infarction accompanied by Qi deficiency and blood stasis syndrome.

In view of the characteristics of the learning curve for medical students,the ' three phases and seven steps' case-based learning model was designed and implemented by Changzheng Hospital,the Second Military Medical University.This model was carried out in the theoretical study stage,the first round of internship and the second round of internship.Cases of single diseases,multiple diseases involving variant systems and a variety of diseases involving different department were enrolled for analysis and discussion.Implementation of each case study was divided in seven procedures:determining learning objective and choosing typical case,studying case and raising questions,panel discussions and establishment of common problems,looking up for information to answer questions and preparing report slide,large group discussions,summary and evaluation.'Three phases and seven steps' case based learning model ensure the width and depth of basic medical knowledge learned by the students.With the practice of this model,the basic medical knowledge was constructed systemically and comprehensively by medical students.Students' abilities of problem-analyzing and problem-solving as well as clinical research were developed.This model was effective according to our practice and was worth spreading out.

Anastomotic leakage is one of the most serious complications following colorectal surgery. Occurrence of anastomotic leakage is concealed and numerous risk factors might relate to anastomotic leakage, which greatly affect the postoperative outcomes and life quality of patients. Therefore, it is necessary to recognize risk factors to predict anastomotic leakage in advance and adopt available treatments to reduce the incidence. This review summarized the risk factors of postoperative anastomotic leakage base on two aspects, and so on. Perioperative related factors and biological markers, aiming to provide a theory for predicting anastomotic leakage then improving the treatment outcomes of colorectal cancer patients .

Objective To clone and characterize Profilin encoding genes in Amaranthus spinosus and to analyze the contribution of different amino acids in isoallergens to allergen antigenicity and tertiary structure. Methods The primers were designed according to the core sequences which were obtained by bioinformatic analysis of the known Profilin amino acid sequences, followed by gene cloning from the Ama- ranthus spinosus cDNA pool and subsequent confirmation by double-digestion, colony PCR and DNA sequen- cing. Antigenicity evaluation and tertiary structural modeling of the encoded protein were accomplished by online software MULTIPRED and SWISS-MODEL, respectively. Results Two panallergenic genes, named as PRF7 and PRF23, were acquired from Amaranthus spinosus. Sequence and structure analysis demonstra- ted that there was some discrepancy in tertiary structures of the encoded proteins, besides distinct difference in their amino acid sequences. PRF7 exhibited high homology with panallergen Profilins Q64LH0, with the identities 98%, whereas the homology of PRF23 and Q9XF42 (apple allergen) was 81%. Q64LH0 and PRF23 were modeled as 3nulA (Q42449) and lg5uB (Q9LE18), respectively. PRF23 exhibited distinct0 three dimensional structural difference in certain fragments compared with Q64LH0 and other Profilins. Though the average values of antigenicity displayed no difference between Q64LH0 and PRF23 on whole se- quences, the antigenicity of PRF23 on certain fragments was obviously lower than that of Q64LHO because of the alteration of some amino acids with different characters, implying the cause of lower incidence of hay fe- ver in South China than in North China. Conclusion Based on sequence analysis, antigenicity evaluation and tertiary structural modeling for Q64LH0 and PRF23, we obtained lots of useful information about the contribution of different amino acids to antigenicity and protein structures, thus would facilitate allergen ge- netic improvement by amino acid replacement.

Objective Study and analyze the benefits and risks of unilateral thyroidectomy for 1 to 4 cm thyroid cancer in primary surgery.Methods The patients who underwent thyroidectomy for 1 to 4 centimeters WDTC (May 2014 to June 2015) were retrospectively reviewed,and the patients with preoperatively known high-risk characteristics were excluded.One hundred and seventy-one patients would have been eligible for lobectomy as the initial operation based on current American Thyroid Association guidelines.The proportion of patients who need secondary surgery was estimated basing on pathological characteristics.Result In this group,49％ patients would have to undergo a secondary surgery if they took lobectomy as the initial operation.Conclusions Patients with 1 to 4 centimeters WDTC who accept unilateral thyroidectomy may take the risk of secondary surgery.Surgeons and patients need to balance the relative benefits and risks of initial TT versus lobectomy before the operation.

Objective To investigate the application of intraoperative neuromonitoring (IONM) during thyroidectomy for non-recurrent laryngeal nerve (NRLN).Methods From Oct.2013 to Apr.2016,2846 patients underwent thyroidectomy with the application of IONM,and 11 patients with non-recurrent laryngeal nerve were analyzed.Results 11 cases of NRLN were all accurately identified by IONM,and no injury of NRLN occurred during thyroid surgery.Conclusions NRLN is uncommon in clinical and it is difficult to be predicted before surgery and easy to be injured.The application of IONM can reduce the possibility of NRLN injury remarkably.