Objective To investigate the expression of C/EBP homology protein(CHOP) in rat brain tissue after focal cerebral ischemia-reperfusion,as well as to observe the influence of the shenxiong injection on the expression of CHOP.Methods One hundred forty four male rats were randomly divided into three groups:the sham-operation group,operation group,shenxiong group.Focal cerebral ischemia and reperfusion rat models were established by using suture.Zea Longa method was introduced to evaluate neurologic behavioral changes.The levels of mRNA and protein of CHOP were measured with methods of immunohistochemistry and reverse transcription polymerase chain reaction.The neuronal apoptosis was detected by the method of terminal deoxynucleotidy1 transferase-mediated dUTP-biotin nick end labeling.Results The expression of CHOP was up-regulated in per-infarction after cerebral ischemia-reperfusion in rats.CHOP mRNA and protein levels peaked at the 12th h and 24th h after reperfusion,respectively.The apoptosis cell counting increased gradually after cerebral ischemia-reperfusion and peaked at the 24th h after reperfusion.Compared with the saline control group,treatment with shenxiong injection could reduce the neuronal apoptosis at the 6th,12th,24th,and 72nd h after reperfusion (P ＜0.01).Compared with the saline control group,treatment with shenxiong injection could decrease CHOP mRNA and protein expression at the 6th,12th,24th,and 72nd h after reperfusion (P ＜0.01).Conclusions Shenxiong Injection may prevent neurocyte from apoptosis by inhibition of the expression of CHOP induced by endoplasmic reticulum stress.

Objective To investigate clinical effects of cutaneous branch flaps of the low medial leg for the repair of soft tissue defects on the foot and ankle.Methods A flap with pedical of cutaneous branches of the low medial leg was used for the repair of 7 cases of skin and soft tissue defects on the feet and ankle from March 2003 to October 2005.The cutaneous branches of the posterior tibial artery were identified along the medial border of the tibia and between the soleus muscle and the flexor digitorum longus muscle.The flap was mobilized according to the site and length of the cutaneous branches,and was transferred to soft tissue defects for skin grafting. Results The operating time was 3~5 hours(mean,4.2 hours).The flaps survived completely in all the 7 cases.Follow-up checkups were carried out for 5~18 months(mean,10 months).The appearance and functions of the foot were satisfactory and met the requirements for daily activities.Conclusions The procedure can effectively repair soft tissue defects on the foot and ankle and does not sacrifice the major arteries.This flap is easy to be prepared.

Objective To investigate chemokine receptor CX3CR1 gene T280M polymorphism in patients with ischemic cerebrovascular disease(ICVD) and its frequency.Methods 165 patients with ICVD(cerebral infarction 85 cases,lacunar infarction 40 cases,transient ischemic attack 40 cases) and 150 age- and sex-matched healthy controls(normal control group) were involved in this study.The polymorphism of T280M was analyzed by multiplex polymerase chain reaction-restriction fragment length based(PCR-RFLB),the gene frequency was compared between two groups and each ICVD subgroups.Results There were TT and TM genotypes in normal control group,and TT,TM and MM genotypes in ICVD group.The genotype were significant differences between the two groups(P0.05).Conclusions There is MM genotype in the chemokine receptor CX3CR1 gene T280M in the patients with ICVD,and their M allele frequency obviously increase.It suggests that CX3CR1 gene T280M polymorphism may be associated with ICVD.

Objective To observe the effect of Shenxiong injection on the changes of brain X-box binding protein 1 (XBP1) gene expression following cerebral ischemia-reperfusion in rats and to investigate its neuroprotective effect and mechanisms. Methods One hundred forty-four male SD rats were randomly assigned to sham-operation, saline control and Shenxiong groups. A rat model of middle cerebral artery occlusion was induced using the suture method. Shenxiong injection 33.3 ml/kg was injected intraperitoneally during the reperfusion in the Shenxiong group. The same volume of saline was injected intraperitoneally in the saline control group. The animals were sacrificed at 6, 12, 24, and 72 hours after the reperfusion.Meanwhile, immunohistochemical staining and reverse transcription-polymerase chain reaction (RT-PCR) were used respectively to detect the expressions of XBP1 protein and mRNA in the cerebral ischemic areas. TUNEL was used to detect neuronal apoptosis. Results The levels of XBP1 protein and mRNA increased after the reperfusion, and it reached the peak at 12 hours; both the numbers of apoptotic cells and neurological scores in the Shenxiong group were lower than those in the saline control group at 6, 12, 24, and 72 hours after the reperfusion (all P ＜0.01); the levels of XBP1 and mRNA at 6, 12, and 24 hours after the reperfusion were alsosignificantly lower than those in the saline control group (all P ＜ 0.01). Conclusions Shenxiong injection may have certain inhibition on the endoplasmic reticulum stress activated XBP1 pathway induced by cerebral ischemia-reperfusion.

ObjectiveTo assess the clinical value of procalcitonin (PCT) in the diagnosis of sepsis in adults.Methods An extensive search for related literature from the Wanfang data, CNKI, VIP, Medline/PubMed, Embase/OvidSP and the Cochrane Library up to December 2014 was performed. The articles, including prospective observational studies or randomized controlled trials, regarding PCT for the diagnosing of sepsis were enrolled. Only patients older than 18 years were included. Patients with sepsis, severe sepsis, or septic shock served as the experimental group, and those with a systemic inflammatory response syndrome (SIRS) of non-infectious origin as control group. The language of literature included was English or Chinese. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC) and subgroup analysis were analyzed with the software of Metadisc 1.4.Results A total of 6 385 published reports were collected, and among them 24 met the inclusion criteria, including a total of 3 107 patients. The studies showed substantial heterogeneity (I2 = 69.4%), and random effect model was used for Meta analysis, showing that the pooledDOR was 10.37 [95% confidence interval (95%CI) = 7.10-15.17]. No evidence of a threshold effect was found (Spearman correlation coefficient = 0.27, calculated by logarithm of sensitivity and logarithm of 1-specificity,P = 0.20). TheDOR values of pooled and each study were not distributed along the same line in forest plots, and Cochran-Q = 78.33,P = 0.000 0, showing that there was heterogeneity in result from non threshold effect. Except for partial heterogeneity caused by non threshold effect, the result of Meta regression analysis including PCT detection method, categories of disease, research location and so on showedP values were all higher than 0.05. Thus, the heterogeneity could not be explained by Meta regression analysis. The pooled sensitivity was 74% (95%CI = 72%-76%), the pooled specificity was 70% (95%CI = 67%-72%), the pooled positive likelihood ratio was 2.79 (95%CI = 2.31-3.38), the pooled negative likelihood ratio was 0.34 (95%CI = 0.28-0.41), and the pooled AUC was 0.83 (95%CI = 0.79-0.87). AUC in medical patients was 0.80 (95%CI = 0.75-0.85), which was higher than that in surgical patients [0.71 (95%CI = 0.65-0.81)].Conclusions Our results indicate a moderate degree of value of PCT for diagnosis of sepsis in adult patients. The diagnostic accuracy in medical patients is higher than that in surgical patients. PCT is a good auxiliary biomarker for diagnosis of sepsis.

Objective:To imestigate the effect of Shenxiong injection on neuronal aooptosis and Fasassociated death dormin protein(FADD)and its mRNA expression after ischernia-reperfusion in rats.Methods:Atotal of 100 SD rats wgre randomly allocated into normal(n=10),sham-operation(n=10),cerebral ischemia-reperfusion(n=40),and Shenxiong injection(n=40)groups.A model of middle cerebral wtery occlusion was induced by suture method.The neuronal apoptosis was detected by the TUNEL assay.The expressions of FADD protein and mRNA were detected by inmmnohistochemical staining and reverse tramcription-polymerase chain reaction(RT-PCR),respectively.Results:As compared with the normal and sham-operation groups.the numbers of apoptotic cell in the cerebral ischemia-reperfusion group were increased significantly(P＜0.01),and the expressions of FADD protein and mRNA were enhanced significantly(all P＜0.01).As compared with the ceretral ischemia-reperfusion group,the numbers of apoptotic cell were decreased significantly (P＜0.05,P＜0.001),and the expressiom of FADD protein and mRNA were reduced significantly in the Shenxiong group(P＜0.05,P＜o.001).Convlusions:Shertxiong injection may inhibit the neuronal apoptosis after ischemia-reprfusion in r-cas by down-regulaftng the expression of FADD.

Identifying the goals of outstanding doctor tralning and orienting medical students' competency, we conducted rational integration and construction of curriculum system for graduate students of clinical medicine and implemented 5 modes of module teaching including professional course, foreign language course, practical skill course, scientific research course and comprehensive ability course . According to the different characters of courses and professional development , we adopted multi-dimensional teaching methods and input the quality education throughout the whole teaching process. These efforts promoted the reform of graduate course evaluation system and provided effective security for improving teaching contents, teaching methods, teaching means and evaluating methods.

Objective To compare inter-hospital transport and clinical outcome in severe acute respiratory distress syndrome(ARDS)patients whom were transported either on extracorporeal membrane oxygenation(ECMO) or on conventional ventilation,and to investigate the optimal means of inter-hospital transport. Methods Eleven patients with severe ARDS who were invalid under conventional ventilation and were transported from other hospitals to Tianjin Third Central Hospital from November 2009 to January 2014 were analyzed. Five patients were transported on ECMO(observation group)and 6 on conventional ventilation(control group). The clinical characteristics,outcomes, transportation,vital signs before and after transportation,respiratory parameters,and Murray score between two groups were compared. Results Patients in observation group were significantly older than those in control group〔years:73(46,77)vs. 34(23,46),Z=-2.293,P=0.022〕. There was no significant difference between observation group and control group in acute pathologic and chronic health evaluationⅡ(APACHEⅡ)score,Murray score,oxygenation index(PaO2/FiO2)before transportation,transit time,and transit distance〔APACHEⅡscore:36(33,39)vs. 27(23,35),Z=-1.830,P=0.067;Murray score:3.5±0.3 vs. 3.4±0.2,t=0.667,P=0.524;PaO2/FiO2(mmHg, 1 mmHg=0.133 kPa):61±14 vs. 63±14,t=-0.249,P=0.809;transit time(minutes):24(18,74)vs. 79(41, 86),Z=-1.654,P=0.098;transit distance(km):12.9(8.3,71.8)vs. 72.4(39.5,86.8),Z=-1.651,P=0.099〕. There was no significant difference between two groups in vital signs and respiratory parameters before transportation. When arrived in ECMO centre,heart rate,respiratory rate,fractional inspired oxygen,inspiratory pressure and Murray score in observation group were significantly lower than those in control group〔heart rate(beat/min):102±16 vs. 136±8, t=-4.374, P=0.002;respiratory rate(beat/min):23±3 vs. 37±2,t=-7.967,P=0.000;fractional inspired oxygen:0.40±0.05 vs. 0.96±0.09,t=-12.152,P=0.000;inspiratory pressure(cmH2O, 1 cmH2O=0.098 kPa):21±1 vs. 34±4,t=-6.887,P=0.000;Murray score:2.7±0.2 vs. 3.8±0.2,t=-8.573, P=0.000〕,but PaO2/FiO2 was higher than that of control group(mmHg:278±65 vs. 41±5 ,t=8.075,P=0.001). Four patients were survived in observation group,and one died from the shortage of oxygen induced lung injury deterioration during transportation. Three patients died in control group,which was directly associated with lung injury deterioration. Conclusion For patients with severe ARDS who need the support of ECMO,ECMO-assisted transfer is safer than conventional ventilation,but transfer should be implemented by experienced team.

Objective To investigate the relationship between cathepsin L and apoptosis cell in rats after cerebral ischemia reperfusion.Methods Sixty healthy male Sprague-Dawley Rats (10-12 weeks old,260-300 g) were chosen.Based on the random number table method,the rats were randomly divided into sham-operated control group (Sham group,n =10),ischemia-reperfusion group (model group,n =25),and Z-FY-DMK intervention group (CLI group,n =25).Rats were randomly divided into 6 h,12 h,24 h,and 48 h four subgroups in model group and CLI group,respectively.Modified transient middle cerebral artery occlusion was made as Longa described,the intervention groups were injected intracerebroventricularly Z-FY-DMK (20 μg / 1μ1 ×5 μl) preoperative 30 min prior to surgery,Sham group and schemia reperfusion injury (IRI) group were injected intracerebroventricularly dimethyl sulfoxide (DMSO) 5 μ1 (10ml/L) at the same time.Cell apoptosis was detected by terminal dexynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) straining.Western blotting was used to detect the expression of cathepsin L and caspase-3.Results In the cortical area of ischemic brain,apoptosis cells of sham operation group were rare,while apoptosis of nerve cells of model group with 6 hours reperfusion were visible,and were gradually increased in the order of 12 hours,24 hours and 48 hours.At the same time point,the apoptosis cells of CL intervention group (6 h,12 h,24 h,48 h) were obviously less than model group (P ＜0.05).Western blotting found little visible cathepsin L protein expression in ischemic cerebral cortex preoptic in the sham group.For model group,the cathepsin L expression initially increased in sub groups with 6 hours reperfusion,reached to a peak in sub groups with 12 hours and 24 hours,and remained a high level in sub groups with 48 hours reperfusion.Compared to model group,the cathepsin L expressions of CL intervention group were obviously decreased at all time points (P ＜ O.05).Conclusions Cathepsin L may be involved in neuronal apoptosis by means of caspases 3 pathway.

Objective To observe the therapeutic effect of Wenwei Zhitong Granules ( WZG) combined with acupoint moxibustion for spleen-stomach deficiency-cold ulcer disease. Methods A total of 120 cases of spleen-stomach deficiency-cold ulcer disease were evenly randomized into treatment group and control group. Both groups were given conventional treatment with western medicine plus oral use of WZG, and the treatment group was given acupoint moxibustion additionally. The treatment lasted for 8 weeks. The therapeutic effect on gastroscopy and on relieving stomachache, and the adverse reaction were observed. Results ( 1) The total effective rate showed by gastroscopy was 95.00% in the treatment group and was 85.00% in the control group, the difference being significant (P<0.05). (2) Total effective rate for relieving stomachache was 98.33% in the treatment group and was 88.33% in the control group, the difference being significant ( P<0.05). ( 3) During the treatment, both groups had 2 cases of adverse reaction of nausea, poor appetite and loose stool after oral use of Clarithromycin and Amoxicillin, and then the adverse reaction disappeared after two weeks. No other reverse action was found. Conclusion WZG combined with acupoint moxibustion is effective, convenient and safe for the treatment of spleen-stomach deficiency-cold ulcer disease by promoting the healing of ulcer and relieving stomachache.