Strokes due to atrial fibrillation (AF) are common and frequently devastating.While oral anticoagulant agents are the mainstay in the prevention of embolic events,they have several limitations and not all patients can tolerate them long term.The left atrial appendage (LAA) has been identified as the source of thrombus formation in nonvalvular AF.Several LAA closure devices have been developed,they have been successful in stroke prevention in patients with nonvalvular AF and fewer periprocedural complications.This article reviews the application of percutaneous left atrial appendage closure for stroke prevention in patients with nonvalvular AF.

Objective Primitive neuroectodermal tumor ( PNET) is a small round cell tumor occurring mostly in children or young adults and categorized into the Ewing sarcoma family of tumors, the purpose of the study was to investigate the clinical features, treatment and prognosis of Children PNET. Methods A retrospective study was performed on clinical data of 13 children with PNET hospitalized in our hospital from March 2010 to Octorber 2014.In order to analyze the clinical effects and prognostic results, statistical analysis was made on their clinical manifestations, CT and ultrasonic results, therapeutic schemes, postoperative pathology and immu-nohistochemical staining results, along with telephone and outpaitient follow-up of average 19 months. Results Of the 13 patients, 4 cases were central nervous system PNET(CNS-PNET) and 9 cases were peripheral PNET(pPNET).The clinical manifestations of the former were headache, vomiting, convolsion, movement disorder or decreased muscle strength, while the latter mainly showed mas-ses and abdominal distention.3 cases with metastasis to lung, lymph nodes and bones respectively showed masses on surface or in cavi-ty in imaging.Homer-Wright pseudorosette textures were found in 12 patients.Immunohistochemical results showed 11 cases with CD99(+), 9 cases with VIM(+) and 8 cases Syn( +).Among 11 patients underwent chemotherapy, 2 cases were lost to follow-up, 7 cases were in stable condition without occurrence and the other 2 cases recurred 4-6 months after chemotherapy.3 of 4 cases with CNS-PNET survived with the sequelae of decreased muscle strength, convolsion and movement disorder.1 case with CNS-PNET and 1 case with pPNET died 7 months and 16 months after diagnosis respectively. Conclusion PNET in children is a very highly malignant tumor with low long-term survival rate.Immunohistochemi-cal examination including CD99 and VIM is of important diagnostic value and CNS-PNET is prone to sequelae.

Objective:To prepare sirolimus ( SRL) dropping pills to improve SRL solubility and dissolution. Methods:The base of SRL dropping pills was screened. The optimal formula and preparation process were also optimized by orthogonal design. The equi-librium solubility, hygroscopicity and drug release in vitro of SRL dropping pills were studied. Results: PEG6000 was chosen as the base. The optimal preparation conditions of SRL dropping pills were as follows: the ratio of SRL and base was 1∶10, the dropping speed was 65 drops/min, the dropping temperature was 95℃ and the temperature of cooling solvent was 5℃. The equilibrium solubili-ty of SRL dropping pills in different solvents was increased significantly compared with that of SRL. The hygroscopicity of the dropping pills was notable. The drug release in vitro of SRL dropping pills was similar to that of the marketed tablets with quick and complete re-lease. Conclusion:SRL dropping pills exhibit increased solubility and improved dissolution, which are valuable to be studied further.

Objective To explore the application value of the lower leg perforator flaps in repairing soft tissue defect on ankle.Methods From January 2007 to December 2012,62 cases of soft tissue defect on ankles have been repaired.The defects were combined with tendon and/or bone exposure for all the cases,among them 7 cases were exposure or sinus tract after achilles tendon rupture surgery,8 cases with ankle or intertarsal joint defect and exposure,24 cases with distal tibia fracture,or medial malleolus fracture,or lateral malleolus fracture,or calcaneus fracture,11 cases with different level of infection.Fifteen cases were primarily repair,and 47 cases were secondly repair or extended phase.The cases were repaired by applying different types retrograde transferred perforator pedicle flaps of lower legs,with 10 cases of posterior tibial artery perforator flaps on the medial malleolus,12 cases of front top flaps of com peroneal artery on external ankle,40 cases of back top flaps of peroneal artery on external ankle.The sizes of the flap ranged from 4.0 cm ×5.5 cm to 9.0 cm × 15.0 cm.Ten cases were applied direct suturing in donor site,and other cases were applied skin grafts to repair the defect.Results Flaps in 56 cases completely survived.Partial necrosis appeared in 3 cases of front top flaps of peroneal artery on external ankle,one perforator flap of posterior tibial artery on the medial malleolus and 2 cases of back top flaps of peroneal artery on external ankle.All these cases recovered after careful dressing changes.Sixty two cases were followed up for 3-12 months.Texture of flaps was soft with good elasticity.All of the donor skin grafts in patients survived.Conclusion Perforator flaps have the advantage of easy operation,little damage to the main blood vessels,high reliability in flap survival,less destroy to donor site.It is important that individualized flap is selected given different position of defect.

Objective To retrospectively explore the incidence and causes of apnea after operation for retinopathy of prematurity(ROP). Methods The clinical data of 17 premature infants with operation for ROP(ROP group)and the other 23 premature infants without ROP(control group)were collected.The occurrence of apnea(time of onset and remission and original diseases) was recorded after operation in ROP group and at adjusted 37 weeks of gestational age in control group.Follow-up was conducted for 4 weeks,and the prevalences of apnea were compared between these two groups.Results There was significant difference in prevalenees of apnea between ROP group and control group ( 52.9%vs 21.7%,P<0.05).In ROP group,time of occurrence of apnea was (38±40)h after operation,and time of remission was (126±145)h after onset.Among the infants with apnea,there were 3 cases of pneumonia(33.3%),1 case of hypoglycemia(11.1%)and 5 cases with unexplained causes(55.5%). Conclusion Infants after operation for ROP are more prone to apnea,and pediatricians and ophthalmologists are required to collaborate in the perioperative care.

Objective To investigate the operative methods and their efficacy of the modified decompressive craniectomy in combination with indirect revascularization for the treatment of massive cerebral infarction. Methods The clinical data of 15 patients with massive cerebral infarction who underwent modified decompressive craniectomy in combination with encephaloduroarteriomyosynangiosis were analyzed retrospectively. The clinical efficacy was assessed according to the mortality, Barthel Index and modified Rankin scale. Results All the patients were followed up, and 12 patients survived 3 months after operation, of those, 4 had a good functional outcome; 11 patients survived 6 month after operation, of those, 7 had a good functional outcome. Conclusions The modified decompressive craniectomy in combination with indirect revascularization for the treatment of massive cerebral infarction could effectively treat massive cerebral infarction and increase the survival rate and life quality of patients, however, the surgical timing, surgical indications and surgical skills are needed to master accurately.

Objective:To study the best opportunity for minimal invasive puncture in the treatment of hypertensive intracerebral hemorrhage.Methods:Forty-one patients with hypertensive intracerebral hemorrhage were randomly divided into four groups:<6 h,6-12 h,12-18 h and 18-24 h from the onset of symptoms.The comparison among groups in outcome measures were performed,including the rebleeding rate,short-term efficacy,long-term efficacy,mortality,and excellent and good rate.Results:The incidence of complication such as rebleeding etc had no significantly difference in the four groups.The excellent and good rates of clinical outcomes at 3 months were the<6 h group>6-12 h group,and 12-18 h group>18-24 h group(P<0.05).The 18-24 h group had the highest mortality(30%,3/10).Conclusions:Within 6 h after the onset of hypertensive intracerebral hemorrhage was the best opportunity for the minimal invasive puncture.

Objectives To detect the carotid artery intima-media thickness (CIMT)with color Doppler ultrasound and to investigate the relationship between CIMT and new ischemic cerebrovascular disease. Methods From May 2012 to October 2013,the cluster random sampling method was used to consecutively enroll 4 412 60 -70 year old residences in Reqiu City for prospective study,including face to face health questionnaire survey,human body measurement,laboratory test,and neck vascular color Doppler ultrasonography. According to whether having new ischemic cerebrovascular disease,the patients who had ischemic cerebrovascular disease in 2013 were divided into either a case group (n = 251)or a control group (n =4 161). The single factor analysis,such as baseline data and CIMT levels in both groups were compared, and the related risk factors for ischemic cerebrovascular disease were analyzed. Results (1)The detection rates of hypertension,cerebrovascular disease,taking antiplatelet agents,carotid artery plaque of the case group were higher than those of the control group (62. 2% [n = 156]vs. 44. 2% [n = 1 838],45. 0%[n = 113]vs. 14. 9% [n = 622],55. 0% [n = 138]vs. 40. 0% [n = 1 663],and 65. 7% [n = 165]vs. 54. 5% [n = 2 266],all P < 0. 05). The systolic blood pressure,insulin,and CIMT levels were higher than those of the control group (158 [141,177]mmHg vs. 152 [137,169]mmHg,8. 07 [4. 77,12. 48]μU/ L vs. 6. 93 [4. 27,11. 60]μU/ L,0. 950 [0. 900,1. 000]mm vs. 0. 925 [0. 900,1. 000]mm,all P <0. 05). The cholesterol level was lower than that of the control group (4. 59 [4. 17,5. 26]mmol/ L vs. 4. 78 [4. 20,5. 36]mmol/ L,P < 0. 05). There were significant differences between the 2 groups. (2)Multivari-ate logistic regression analysis showed that histories of hypertension and cerebral vascular disease and CIMT thickening were the independent risk factors for new ischemic cerebrovascular disease (hypertension:OR, 1. 534,95% CI 1. 166 -2. 017,P = 0. 002;history of cerebral vascular disease:OR,3. 940,95% CI 2. 997 -5.180,P =0.000;and CIMT thickening:OR,12.122,95%CI 2. 327 -63. 163,P =0. 003). Conclusion CIMT, hypertension,and cerebrovascular disease are the independent risk factors for ischemic cerebrovascular disease in Renqiu City,and the monitoring of CIMT is very important.

OBJECTIVE:To study the anti-tussive and anti-inflammatory effects of aqueous extract of Pegaeophyti Radix Et Rhizoma(P. Radix Et Rhizoma). METHODS:In the experiment,there were a model group,a positive control group [30 mg/kg co-deine for mice,18.38 mg/kg codeine for guinea pigs,20 mg/kg indometacin for mice and 15 mg/kg indometacin for rats] and P. Ra-dix Et Rhizoma low-dose,medium-dose and high-dose groups [2.0,4.0 and 8.0 g(medicinal materials)/kg for mice;1.2,2.4 and 4.8 g (medicinal materials)/kg for guinea pigs;1.4,2.8 and 5.6 g (medicinal materials)/kg for rats],with 10 animals in each group. The above-mentioned animals were given corresponding drug ig for 4 consecutive days,and then strong ammonia spraying method and sulfur dioxide stimulation method were employed to induce cough in mice and citric acid spraying method to induce cough in guinea pigs to observe the incubation period and times of cough,auricular swelling method to observe xylene-induced au-ricular swelling in mice and pedal swelling method to observe carrageenin-induced pedal swelling in rats. RESULTS:Compared to the model group,Aqueous extract of P. Radix Et Rhizoma could prolong the incubation period and reduce times of cough induced by strong ammonia spraying and sulfur dioxide stimulation in mice of positive control group and P. Radix Et Rhizoma medium-dose and high-dose groups;it could prolong the incubation period of and reduce times of cough induced by citric acid spraying in guinea pigs of positive control group and P. Radix Et Rhizoma medium-dose and high-dose groups;it could alleviate xylene-induced auricu-lar swelling in mice of positive control group and P. Radix Et Rhizoma medium-dose and high-dose groups;it could alleviate carra-geenin-induced pedal swelling in rats of positive control group and P. Radix Et Rhizoma medium-dose and high-dose groups. There were statistically significances (P<0.01 or P<0.05). CONCLUSIONS:Aqueous extract of P. Radix Et Rhizoma has anti-tussive and anti-inflammatory effects on the experimental animals.

For investigating the epidemiology and genetic characteristics of enterovirus 71 (EV71) in Fujian from 2010 to 2015,we analyzed the surveillance data of EV71 and sequenced VP1 genes of 72 EV71 strains randomly picked from the past 6 years.The overall infection rate was gradually down and one incidence peak (from May to July) was observed each year.Major infectious population were focused on Xiamen,Fuzhou,Nanping and Quanzhou,the ages ranged from one to three years old.Scattered children were the most infected ones.The proportion of EV71 in the severe case was higher than in the HMFD(χ2 =732.064 5,P＜0.000 1).EV71 circulated from 2010 to 2015 in Fujian Province was belonged to subgenotype C4a in consistent with vaccine strain (H07).Compared with the VP1 of vaccine strains,the divergence of complete VP1 nucleotide sequence was gradually expanding as time distance increased,but the sequence of amino acid was not found obvious difference.Variations in 4 key immune epitopes of amino acid had not appeared a regular pattern in year and not consistent with the trend of proportion of EV71 in HMFD.As a result,we considered the epidemiology characteristics of EV71 in Fujian was obvious,72 strains still belonged to C4a subgenotype and had no outstanding antigenic drift or mutation.Extensive epidemiology surveillance and genetic characteristic are needed for the application of EV71 vaccine.