There is evidence to show that the treatment in a stroke unit reduces mortality in patients with stroke and improves neurological functional recoxery.Early mobilization is benefit to improve the prognosis in patients stroke,however,there is a lack of high-quality evidence.The term of"early mobilization"after stroke is not well defined now.A number of medical workers lack enough understanding of the early mobilization.How to perform the early mobilization to get the best benefit is unclear.This article reviews the related studies about the early mobilization after stroke.

Ascites is an important indicator of poor prognosis of liver cirrhosis.Although several guidelines and consensus statements on the management of ascites have been published in the past years,there are still a lot of controversial problems in this regard.The current contro-versial problems and difficulties in the management of ascites,such as the timing of sodium supplementation or sodium restriction,the selec-tion of diuretics,the application value of aquaretics,the strategy of albumin administration after large-volume paracentesis,and the indica-tions and efficacy of transjugular intrahepatic portosystemic shunt,are reviewed.It is pointed out that further studies on these problems with evidence-based medicine means will enhance the diagnosis and treatment of cirrhotic ascites and improve patients'prognosis.

Objective To investigate the causes of intra-abdominal hernia and improve the level of early (diagnosis) and therapy of intra-abdominal hernia. Methods A retrospective analysis of the clinical data of 68 cases of intra-abdominal hernia was made. Results The postoperative confirmed diagnosis was para-occal hernia in 1 patient;herniation of efferent jejunal loop through the space between the afferent jejunal loop and the mesocolon after Billroth II gastrectomy in 6 patients,one of which had bowel necrosis,all of the 6 patients were cured after reduction of the hernia or enterectomy after and enteroanastomsis;internal henia though (ruptured) pelvic (peritoneum) after Miles operation in 4 patients;internal hernia though the space between the (descending) colon and the lateral abdominal wall after colostomy of descending colon in 6 patients;internal (hernia) caused by (adhesion) of omentum to the intestinal wall of sigmoidostomy in 1 patient;internal hernia through hiatuses caused by postoperative or post-peritonitis adhesions to the peritoneum,ovaries,urinary (bladder),uterus,(intestinal) wall or between loops of intestine in 50 patients(73.5%),including 3 cases of bowel (necrosis).All of those patients were cured after reduction of the hernias,repair of the hiatuses,release of (adhesions) or enterectomy and enteroanastomosis. Conclusions Preoperative diagnosis of internal abdominal hernia is difficult.The possibility of internal abdominal hernia should be cansidered in patients with a history of operation,and who complain of frequent abdominal pain or bowel obstruction.Early diagnosis and prompt (operation) is necessary to prevent the occurrence of bowel strangulation and bowel necrosis.

OBJECTIVE:To discuss the characteristics and regularities of adverse drug reactions (ADR) in our hospital. METHODS:ADR reports of 618 cases collected via ADR network system and submitted to state ADR database from 2005 to 2006 were analyzed statistically in respect of patients' age and sex,rating of correlated factors and outcome,clinical manifestations,routes of administration,and the involved drugs etc. RESULTS:Anti-infective drugs dominated the first place on the list of ADR incidence rate,followed by antineoplastic agent and Chinese patent medicines. The main symptoms of ADR were drug eruption,allergic,athma,followed by gastrointestinal reaction. There were fewer incidences of serious ADR such as bone marrow depression,hypoleukemia and shock. CONCLUSION:The ADR monitoring in Fuzhou General Hospital is lack and should be strengthened,and knowledge of ADR must be publicized for guiding the rational,safe and effective drug use in clinic.

Objective To constitute a database of chronic wounds for characterizing the patients with chronic wounds.Methods Based on the guideline of chronic wounds defined by international wound healing society,86 outpatients with chronic wounds were selected between January and October in 2013 to set up a wound database using the wound information management system.The parameters including etiology,age distribution,mean time of fracture healing and wound healing time posterior to different treatments were analyzed.Results (1) Statistical difference existed for cause distribution (P ＜0.05).Top three causes were trauma (29％),varicosity (26％) and pressure sore (19％).(2) Age distribution varied significantly among the patients with various causes of chronic wounds (P ＜ 0.05).(3) Statistical difference was observed in healing time of various types of chronic wounds (P ＜ 0.05).Diabetic wound and varicose ulcer took the longest healing time,with average 116.36 days and 88.48 days respectively.(4) Patients treated with novel dressings had shorter healing time than those managed with traditional dressings (P ＜ 0.05).Conclusions Trauma,varicosity and pressure ulcer are relatively common among the outpatients.Etiology of chronic wounds is strongly related to age and novel dressings contributed to a shortened cause of the disorder.

Objective Through the application of recombinant human Ⅱ tumor necrosis factor-Fc function protein (rhTNFR:Fc) in the treatment of juvenile idiopathic arthritis (JIA) with randomized control study,clinical characteristic and clinical effect were summarized.Methods According to the randomized controlled principle,124 patients with JIA were divided into control group and treatment group.The basic treatment in two groups were one antirheumatic slow-acting drug,nonsteroidal drug,adrenal cortical hormone.There were no significant differences between clinical type and basic treatment in two groups (P ＞ 0.05).Sixty-two patients of JIA treated with rhTNFR:Fc by subcutaneous injection.The doses was 0.8mg /kg per week.There were 17 cases of oligoarthritis,15 cases of polyarthritis,30 cases of systemic arthritis in the treatment group and control group respectively.The basic antirheumatic drugs,nonsteroidal anti-inflamatory drugs ( NSAIDs),adrenal cortex hormone were allowed to continued.Clinical evaluation index included ACR Pedi 30,ACR Pedi 50 and ACR Pedi 70.The adverse drug reactions were recorded.Results The remission rate of ACR Pedi 30,50,70 in 2 weeks,one month,three monthes and six monthes were different in types of JIA patients in the treatment group ( P ＜ 0.05 ).The remission rate of systemic arthritis was lower than the other two groups of arthritis ( P ＜ 0.05 ).Only 44％ ACR Pedi 50 remission was achieved after three monthes medication in systemic arthritis and 41.7％ ACR Pedi 50,29.2％ ACR Pedi 70 were achieved after six monthes.The remission rate in the types of oligoarthritis and polyarthritis at different time points (2 weeks,one month,three monthes,six monthes) of ACR Pedi 30,50,70 were similar.After six monthes,more than 80％ reached ACR Pedi 50 remission,more than half of patients reached ACR Pedi 70 remission.Three cases of macrophage activation syndrome in systemic arthritis group was effective treated with rhTNFR:Fc.In the treatment group,2 cases of systemic arthritis appeared ache and discomfort after one week treatment,3 cases appeared repeated mild upper respiratory tract infection and diarrhea during treatment,including one varicella infection.The incidence of adverse reactions in the treatment group of systemic arthritis were 16.7％,Other 2 types of patients did not show adverse reaction during rhTNFR:Fc treatment.Conclusion rhTNFR:Fc has good effect on oligoarthritis and polyarthritis of JIA.The adverse reactions of six monthes were rare.The cases of systemic arthritis could reach some clinical remission,but need to guard against infection and the occurrence of adverse reactions.To whom did not respond to conventional therapy in systemic arthritis or systemic arthritis combined with macrophage activation syndrome,it could be considered with rhTNFR:Fc.

To investigate the protective effect of L-carnitine on myocardial ischemia-reperfusion injury in rat heart,all harvested isolated hearts were perfused on Langendorff apparatus with oxygenized K-H solution for 20 min. The hearts were then exposed to ischemia for 30 min. Following the ischemia the hearts were re-perfused with K-H solution for 120 min to serve as the control group A. Either 5 or 10 mmol/L of L-carnitine was added into the K-H solution for 20 min at the beginning of reperfusion to generate group B and group C, respectively. The derivatives of the intraventricular pressure curve (DP/DT), left ventricular developed pressure (LVDP), and coronary flux were monitored during the entire experiment. The levels of ATP, hepatin, malondialdehyde (MDA), and superoxide dismutase (SOD) in tissue, and lactic dehydrogenase (LDH), creatine phosphate kinase (CPK), malondialdehyde (MDA), and superoxide dismutase (SOD) concentration in the coronary efflux were all measured. Compared with the control group, the treatment with L-carnitine resulted in better results, i. e., higher DP/DTmax and LVDP. At the same time, ventricular fibrillation was reduced, and the levels of ATP, hepatin and SOD were all elevated. However, the concentrations of MDA, CPK and LDH were all reduced. In conclusion, L-carnitine has a protective effect on ischemia-reperfusion injury, which is partly due to its prevention of energy loss and its antioxidant activity.

To adapt to the rapid development of medicine and law and the impact of globalization of crime,it is necessary to reinforce the forensic pathology postgraduate general competence.According to the teaching experience of America and Europe for reference,we need to adopt multi-means to enhance forensic pathology postgraduate comprehensive competence.

Portal hypertension is a common complication of chronic liver diseases and is responsible for most of the clinical consequences of cirrhosis.Accurate assessment of portal venous pressure is essential for the designing of treatment strategy and judging of prognosis.Measurement of hepatic venous pressure gradient (HVPG) is the gold standard for evaluating portal venous pressure, however, it is an invasive procedure and is hard to be performed routinely in clinical practice.Therefore, it is urgent to explore a noninvasive method for assessing portal venous pressure.Recent evidence highlights that biochemical parameters, transient elastography, CT, MRI and the conjoint analysis model of multiple parameters have the potential diagnostic value.This article reviewed the advances in study on noninvasive assessment of portal venous pressure.

Vitamin D participates in a variety of biological processes. 1,25-dihydroxyvitamin D [1,25-(OH)2D]is the active form of vitamin D. Besides its classical role in bone and calcium homeostasis, 1,25-(OH)2D has many non-classical functions such as regulating proliferation and differentiation of cells in various tissues, including tumor cells as well. However, the role of 1,25-(OH)2D in thyroid cancer is not clear yet. There are three integral components of the vitamin D pathway in thyroid cells. These components are the vitamin D receptor, 1α-hydroxylase (CYP27B1), and 24-hydroxylase (CYP24A1). Differences in the expression levels of these components in normal thyroid tissue and thyroid cancer tissue may offer clues and lay the foundation for study of the inhibitory function in the pathogenesis of thyroid cancer.This review focuses on the insights gained in the elucidation of the role of 1,25-(OH)2D pathway in thyroid cancer, one of the most common endocrine malignancies.