Objective To analyze the correlative factors and cause of death within short-term in initially lucid patients with intracerebral hemorrhage (ICH).Methods 441 patients with spontaneous ICH admitted within 24 hours of onset and with Glasgow Coma Scale (GCS) score more than 9 on admission were enrolled. The demographic characteristics, clinical features at onset, CT, electrocardiograph (ECG) and laboratory findings, medical complications and 27 days outcome were recorded. Univariate and multivariate analysis were performed.Results 24 (5.4%) patients died winthin 27 days after onset, 14 (58.3%) died of brain herniation and central respiratory failure, another 10 (41.7%) of systemic complications. Multivariate analysis demonstrated that age was 75 years old or more, urinary incontinence at onset, peripheral white blood cell count more than 10.0?10 9/L on admission, blood glucose more than 7.0 mmol/L and abnormal ECG were independent correlative factors of death.Conclusions The short-term outcome of initially lucid patients with ICH is favorable in general, albeit with a relatively low mortality. Brain herniation and central respiratory failure were main cause of death, and they have independent correlative risk factors.

Objective To evaluate the role of gamma-aminobutyric acid A (GABAA) receptor in isoflurane-induced cognitive dysfunction in neonatal rats.Methods Twenty-eight 7-day-old Sprague Dawley rats,weighing 16-18 g,were randomly divided into 4 groups (n =7 each):control group (group Con),securinine group (group See),isoflurane group (group Iso) and securinine + isoflurane group (group Sec + Iso).Normal saline 0.2 ml was injected intraperitoneally in group Con.Specific GABAA receptor antagonist securinine 30 mg/kg was injected intraperitoneally at the corresponding time points in group Sec.Normal saline 0.2 ml was injected intraperitoneally and 1.4％ isoflurane was inhaled for 6 h in group Iso.Securinine 30 mg/kg was injected intraperitoneally at 30 min before isoflurane inhalation and 3 h of inhalation,and 1.4％ isoflurane was inhaled for 6 h in group Sec + Iso.The rats were then sacrificed at 3 weeks after administration,their brains were immediately removed and hippocampal slices were prepared for electrophysiological experiments.The value of population spike amplitude (PSA) and long-term potentiation (LTP) were measured every 5 min.The successful LTP induction was recorded.Results Compared with group Con,the values of PSA and rates of successful LTP induction were significantly decreased in group Iso (P ＜ 0.01),and no significant change was found in the parameters mentioned above in groups Sec and Sec + Iso (P ＞ 0.05).The values of PSA and rates of successful LTP induction were significantly higher in group Sec + Iso than in group Iso (P ＜ 0.01).Conclusion GABAA receptor is involved in isoflurane-induced cognitive dysfunction in the neonatal rats.

Objective To evaluate the efficacy and safety ofGuipi Decoction vs. antidepressants for depression. Methods Articles about the randomized controlled trials (RCTs) ofGuipi Decoction for depression were searched in the databases of CNKI, VIP, Wanfang Data, CMB, Embase, PubMed, and Cochrane Library. Two researchers independently screened the articles, extracted the data, and evaluated the methodological quality. Meta-analyses were performed by using RevMan 5.2 software.Results A total of 9 RCTs articles involving 893 cases were included. Meta-analysis results suggested that as compared with antidepressants only,Guipi Decoction together with antidepressants was associated with a significantly greater reduction in HAMD scores (MD=-4.63, 95%CI [-5.95, -3.32];P<0.001). There was no significant difference in HAMD scores betweenGuipi Decoction used alone and antidepressants (MD=-0.30, 95%CI [-4.22, 3.62];P=0.88). As compared with antidepressants,Guipi Decoction together with antidepressants increased in the rates of total effective events (RR=1.26, 95%CI [1.14, 1.38];P<0.001). No serious adverse reactions were reported. Meta-analysis results suggested that the incidence of adverse reactions of Guipi Decoction(RR=0.48, 95%CI [0.40, 0.58];P<0.001) andGuipi Decoction together with antidepressants (RR=0.51, 95%CI [0.30, 0.85];P=0.010) were lower than that of antidepressants alone.Conclusion The present evidence suggests thatGuipi Decoction is effective and relatively safe for patients with depression. However, because the quality of included research was low, more large-scale RCTs with multicenter and high quality are needed for further verification.

The forkhead box O (FoxO) transcription factor family plays an important role in cell functions, including metabo-lism, apoptosis, cellular proliferation, stress reactions, DNA repair, and immune response. As a member of this family, forkhead box O3a (FoxO3a) regulates its target genes by modulating histone modifications, including phosphorylation, acetylation, and methylation. FoxO3a expression is abnormally downregulated in urologic neoplasm. Protein modifications and FoxO3a activity are mainly con-trolled by PI3K/Akt signal pathway and other signaling pathways. FoxO3a is also involved in the initiation, progression, and prognosis of urologic neoplasm. This review focuses on the function of FoxO3a in urologic neoplasm and elucidates the regulatory mechanisms involved. This article will provide novel strategies to clinical diagnosis and drug therapy of urologic neoplasms.

Dietary fiber contents in 34 common foods perchased in Beijing markets have been determined with detergent method, including neutral detergent fiber, acid detergent fiber, cellulose, hemicellulose and lignin. On dry basis, the dietary fiber contents of vegetables varied with kinds of food: the dietary fiber contents were higher in tender stems, leaves, stalks and flowers; lower in starchy tubers and roots; medium in non-starchy tubers and roots. The propotions of dietary fiber components were different in various categories of foods. Cellulose was the major component in vegetables and legumes, but in most cereals, hemicellulose content was higher than cellulose. All foods had the lowest lignin content with the exception of garlic bolt.

Objective To retrospectively investigate the endoprosthetic survival and complications after custom-made tumor prosthesis replacement of knee joint.Methods From April 1996 to April 2007,85 patients with bone tumors around knee joints undergoing custom-prosthetic replacement were respectively analyzed,including 54 males and 31 females with an average of 31.33±15.3 years(range,11-72).The diagnoses were osteosarcoma(43 patients),giant cell tumor(31),chondrosarcoma(4),metastatic tumor(3),malignant fibrohistiocytoma(2),Ewing sarcoma(1),and fibrosarcoma(1).The distal femar was affected in 43 patients and the proximal tibia in 42.All patients in this group underwent wide resection and domestic custommade cemented endoprosthetic reconstruction.Results Mean following was 45.8 months.The overall complication rate was 27.1%(23/85),which was 25.6% in distal femar and 28.6% in proximal tibia.Thirteen complications occurred within 3 years after definite surgery,3 in 3-5 years,and 7 over 5 years.All of 6 operation-relation complications(wound dehiscence,periprosthetic infection,peroneal nerve injury,etc) occurred within 3 years.Seven prosthetic-related complications(prosthetic loosening or breaking,dislocation,periprosthetic fracture,etc)occurred within 3 years,3 occurred in 3-5 years,and 7 over 5 years after definite surgery.The overall endoprosthetic cumulative survival rate was 79.4%,67.7%and 62.3% after 3,5 and 7 years,respectively;which was 86.6%,79.2% and 73.5% in distal femur;66.1%,53.7% and 48.8% in proximal tibia.Conclusion All operation-related complications occurred within 3 years,prosthesis-related complications occurred mainly within 3 years and over 5 years postoperatively.Prosthesis-related complications could occur iu the early stage after using domestic custom-made prosthesis reconstruction.

Objective To evaluate the clinical efficacy and safety of tapering the dosage of recom-binant human tumor necrosis factor receptor-Fc fusion protein (rhTNFR-Fc) combined with DMARDs in the treatment of peripheral joints involvement of ankylosing spondylitis. Methods Sixty patients who met the classification criteria of ankyloding spondylitis were enrolled. Meanwhile, all patients had one or more of the following joint involvement: hip, knee, ankle, and shoulder. Their BASDAI was higher than 4, joint pain VAS≥4, ESR ≥30 mm/1 h and CRP≥8 mg/L. Tuberculosis, hepatitis B, hepatitis C infection or other microorgan-isms infections were excluded. All enrolled patients had no serious heart,liver,kidney, or other internal organ involvement. During the first stage (The first eight weeks patients were matched by age and, disease activity, then randomly divided into the rhTNFR-Fc (the control group) treatment group in which patients were treated with 25 mg rhTNFR-Fc subcutaneous injection twice per week for 4 months) and rhTNFR-Fc dosage tapering group in which 25 mg rhTNFR-Fc were subcutaneously injected once per week for 4 weeks and then followed by 12.5 mg per week for 4 weeks, then once every 10 days for 6 times. Then the dosage of rhTNFR-Fc dosage of the dosage tapering group (the experimental group) was changed to 12.5 mg subcutaneous injection once every 15 days for another 4 times combined with methotrexate 7.5 mg per week and Salfasalazine 2 g daily and thalidomide 100 mg per night. The second stage started from week 9 to 24. In addition to the 30 cases at the first stage, 42 cases were included based on the same inclusion criteria for stage one. Patients' clinical and laboratory parameters were evaluated at week 0, 4, 8, 16 and 24. Results During the first four weeks, all patients of both control group and experimental group reached ASAS20, 97% (29/30) patients reached ASAS50 in the control group, 83% (25/30) patients reached ASAS50 in the experimental group. At week 8, patients in both groups maintained at 100% ASAS20 improvement, 100% (13/13) patients in the control group reached ASAS50, and that of the experimental group was 97% (29/30), the differences between the two groups were not statistically significant (P>0.05). In the second stage, 72 cases (100%) could achieve ASAS20, 63 cases (88%) achieved ASASSO at week 16. At week 24, 72 cases (100%) remained to achieve ASAS20, 71 cases (99%) achieved ASAS50. The safety and compliance of the two groups were good. Two cases developed infection, one patient had mild elevation of serum transaminase. Conclusion Tapering the dosage combined with DMARDs is an effective and safe approach in the treatment of peripheral joints involvement of ankylosing spondylitis. The compliance of this strategy is good and only few patients have serum transaminase elevation. But attention should be paid to the increased rate of infection.

Objective To evaluate the efficacy of intratympanic steroid therapy compared with systemic ster‐oid therapy on the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) patients with damaged glu‐cose tolerance .Methods Fifty first -diagnosed unilateral ISSNHL patients with damaged glucose tolerance were randomized devided equally to the intervention group (intratympanic steroid therapy) or the control group (systemic steroid therapy) ,all patients received conventional drug therapy simultaneously .Pure-tone hearing threshold tests were performed in all patients every 3 days after the first time ,and repeated measures anova was used to assess effects of hearing recovery accompanied with time .Results The mean hearing threshold in the control group de‐creased from 85 .4 ± 5 .6 dB to 48 .2 ± 4 .9 dB ,while in the intervention group it decreased from 84 .8 ± 5 .6 dB to 31 .7 ± 4 .6 dB .Total effective rate in the intervention group (84 .00% ,21/95) was higher than that in the control group (68 .00% ,17/25)(P<0 .05) .Conclusion The intratympanic steroid therapy is more effective than systemic steroid therapy in the treatment of ISSNHL patients with damaged glucose tolerance .

Objective To evaluate the dosimetric effects of air cavity on primary tumor and organs at risk (OARs) during intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma patients.Methods Nine patients with nasopharyngeal carcinoma had CT simulation before treatment and on the 25 fraction of radiotherapy.Radiotherapy plan1 was first created by delineating the target volumes and OARs on the first CT image, which was then copied and merged with the second CT image.Air cavity that was formed following tumor volume regression was delineated on the first CT image, and the density of air cavity was set to zero.A new gross target volume (GTV) was formed by subtracting the air cavity from the original GTV, and the new CT image was named CTAir.Plan2 was then created by calculating the dose distribution on CTAir using the same portals and parameters as Plan1.Assuming that Plan1 and Plan2 were both used throughout the course of radiotherapy, the dosimetric parameters of nasopharyngeal tumor and OARs in the absence and presence of air cavity were then compared using the paired t-test.Results Dmean, D95, D90, D10, and D5 of tumor were significantly higher in plan2 than in plan1(P=0.000, 0.001, 0.001, 0.001, and 0.005, respectively), with a<0.5 Gy increase in dose.A dose build-up effect was observed within the tumor region posterior to the air cavity, where the highest dose was 1.4 cm posterior to the air cavity, resulting in a dose difference of 0.36 Gy.In addition, D2cc and D1cc of the brain stem were significantly higher in plan2 than in plan1(P=0.036 and 0.044, respectively).Dmax of the optical chiasm, left optical nerve, and right optical nerve were also increased in the presence of air cavity (P=0.438, 0.434, and 0.477, respectively), but the change in dose was<0.12 Gy.Conclusions Air cavity induces a small but negligible increase in the tumor and OARs dose in patients with nasopharyngeal carcinoma during IMRT.However, closer monitoring should be conducted for patients with OARs that is close to or has surpassed tolerance prior to radiotherapy.

Objective To investigate the diagnostic value of serum brain natriuretic peptide(BNP)in chron-ic cor pulmonale of different period.Methods According to the inclusion criteria,we recruited 216 cases from heart and respiratory medicine(including outpatients and inpatients)of Qingyuan People 's Hosptial from April 2013 to December 2014.All the cases were divided into healthy control group(group A,n =48),cor pulmonale heart function compensatory period group(group B,n =43),cor pulmonale right heart failure group(group C,n =45),the simple left heart failure group(D group,n =40)and the whole heart failure group(group E,n =40).The serum BNP value,pul-monary function,echocardiography were detected.We compared the differences amomg them with correlation analysis, and drew the ROC curves to obtain the best cutoff point.Results The BNP value was higher in group C(495.44 ± 219.90)ng/L than group B[(182.44 ±69.71)ng/L,P <0.001],while the value was higher in group D(882.57 ± 288.56)ng/L and E(891.78 ±256.45)ng/L than group C(P <0.001).In cor pulmonale groups,BNP was positive-ly correlated with RV,RVOT,and PASP,negatively correlated with FEV1 ,and not correlated with LVEF %.In group D and E,BNP was negatively correlated with LVEF %.The best cutoff point of BNP was 285.3ng/L between cor pul-monale heart function compensatory period group(group B)and cor pulmonale right heart failure group(group C). The best cutoff point of BNP was 764.2ng/L between cor pulmonale right heart failure group(group C)and the whole heart failure group(group E).Conclusion There is certain correlation between serum BNP level and the progress of chronic cor pulmonale.Dynamic monitoring of serum BNP level in the judgement of treating cor pulmonale is of certain reference significance.