Embolic stroke of undetermined source ( ESUS ) refers to non-lacunar brain infarcts without definite proximal arterialstenosis or major cardioembolic sources.Paroxysmal atrial fibrillation may be the most important cause of ESUS, thus anticoagulation may be more effective than antiplatelet therapy for secondary stroke prevention to this group of patients.This paper reviews the latest progress on the definition, epidemiology, diagnostic approach, relation to atrial fibrillation and management of ESUS.

Acrylonitrile ; toxicity ; Carcinogens ; toxicity ; Humans ; Mutagens ; toxicity ; Occupational Exposure

Objective To analyse the key influential factors for research performance of medical colleges and provide evidenes for further research management. Methods A questionnaire suvery was carried out in Shanghai Jiaotong University School of Medicine.Through stratified cluster sampling,those who assumed all ranks of projects from 2001 to 2006 in Basic Medical College and some affiliated hospitals were investigated.Two hundred and sixty questionnaires were sent out and 211(81.2%) were reclaimed.Delphi and comprehensive analysis were used to measure the research performance,and multi-Logistic regression was employed to analyze the influential factors for research performance.Results The key influential factors for research performance included research team,research investment,age of researchers,international exchanges and communications,and extra working hours for research.Conclusion To improve the research performance of medical colleges,it is most important to strengthen research team development,expand research investment,promote acedemic exchanges and communications,and initiate dedicated spirit for research work.

Objective To provide basis for the formulation of policies and measures that will reduce the work pressure on nurses and to provide them with a better working environment. Methods An investigation was made via questionnaires into 942 nurses working in designated SARS hospitals and a comprehensive analysis was conducted by means of multivariant stepwise regression. Results The major factors affecting the pressure on nurses include: lack of support from and communications with families, arduousness of tasks to an unbearable point, extreme strictness in management, and unsoundness of treatment and living conditions. Conclusion Good communications with families are of great significance to nurses working in isolated areas. It is imperative to rationally allocate the human resources of nurses, show more concern for them, encourage them to participate in management, and strengthen scientific prevention so as to create a better working environment.

Skillful in the treatment of gouty arthritis (GA) by integrated therapies of Chinese and Western medicine,chief physician Zhang Tang-fa proposes to ‘deal with the exterior with the needles,and attack the interior with the drugs,by integrated application of acupuncture and herbal medicine',in combination with comprehensive intervention of dietetic therapy and health education.In the treatment of GA,he adopts the syndrome differentiation based upon the pathogenic factors,in combination of syndrome differentiation based upon the six meridians,to reinforce and benefit the spleen and kidney,clear away heat and remove dampness as the therapeutic principle.By acupuncture mainly at the acupoints of the Spleen and Liver Meridians,he also proposes to select the acupoints by the theory of Na Zi Fa (earthly branch method) of Zi Wu Liu Zhu (midnight-noon ebb-flow),and to puncture the surrounding area of the involved joints shallowly by multiple needles as the major needling method,simultaneously with the reinforcing and reducing manipulations based upon the respiration.In the treatment,acupuncture and acupoint-injection are often used.In diet,low purine diet is often suggested.In health education,the patients are often instructed to understand the disease correctly,eliminate fears and cooperate with doctor's treatment positively.

Dao-di Herbs is specificity and locality, and its unique phenotypic features is closely related to the growth and development of medicinal plants. In addition to traditional genetic, epigenetic play an important role in formation of Dao-di herbs. This paper introduces the concept of epigenetic and the role of DNA methylation in the gene expression regulation. We further prospects epigenetic mechanism in study of Dao-di herbs formation from specific phenotype and regional analysis. And study on the relationship of epigenetic and Dao-di herbs will provide a basis for quality assessment and identification of Chinese drugs.
DNA Methylation ; Drugs, Chinese Herbal ; standards ; Epigenesis, Genetic ; Gene Expression Regulation, Plant ; Plants, Medicinal ; genetics

BACKGROUND: Poly(lactic-co-glycolic acid) (PLGA) has been widely used as medical implants and drug vehicle. Due to various factors involved in the degradation process, it is rather difficult to simulate the mass loss properties of PLGA.OBJECTIVE: To investigate the mass loss properties of PLGA films, and observe the correlation between the stimulation and the factual measurement.DESIGN: Repeated measuring experiment. SETTING: School of Materials Science and Engineering, Dalian University of Technology.MATERIALS: PLGA 50:50, 70:30 and 75:25 with weight average molecular weight (Mw) of 63 000, 115 000 and 400 000 were purchased from Shandong Key Laboratory of Medical Polymer Materials, and 1,4-dioxane (analytically pure) was purchased from Tianjin No.1 Chemical Reagent Factory and used as solvent.METHODS: The experiments were carried out in the School of Materials Science and Engineering of Dalian University of Technology from April to July in 2006.①PLGA were dissolved in 1, 4-dioxane according to the mass ratio of 50:50, 70:30 and 75:25, and the solution were cast into 10 mm×10 mm×1 mm polymer films.②PLGA films were immersed in Hank's simulated body fluid (Ph 7.4) at 37 ℃, and then taken out every week (every 5 days for PLGA 50:50). The samples were washed and dried to measure the changes of number and Mw using gel permeation chromatography. Degradation velocity was also worked out. Meanwhile the mass loss properties of PLGA films were measured using electronic balance. Furthermore, an improved Monte Carlo method was applied to carry out the correlation analysis with experiment data. MAIN OUTCOME MEASURES: ①degradation rates of PLGA with different ratios of lactic acid and glycolic acid.②the correlation coefficient between simulation results and experiment data.RESULTS: ①The degradation rates for PLGA at 50:50, 70:30 and 75:25 were 0.058 5, 0.016 6 and 0.010 1 /d (based on Mn), or 0.061 0, 0.017 5 and 0.008 5 /d (based on Mw), respectively.②Correlation coefficients between simulation results and experiment data for PLGA 50:50, 70:30 and 75:25 were 0.973 6, 0.987 4 and 0.990 3 correspondingly. CONCLUSION:The numerical simulation results for the mass loss properties of PLGA fit the experiment data well.

Objective To research the relationship between the serum level of cystatin C (CysC),N-terminal pro brain natriuretic peptide (NT-proBNP) and the cardiovascular (CV) events in maintenance hemodialysis (MHD) patients,looking for a new and effective biological prediction method for cardiovascular disease (CVD).Methods According to the excluded criteria and included criteria,a total of 126 patients [male 67(53.2％),female 59 (46.8％)] were included in this study,screening out of 452 MHD patients from 3 blood purification centre,no secondary hyperparathyroidism,blood pressure controlled,hemoglobin standard,no lipid abnormalities,and without history of coronary heart disease,heart failure and arrhythmia.Participants adopted 3 dialysis treatment,including hemodialysis,hemoperfusion and hemodiafiltration.Every 3 months before the dialysis,the Cys-C,NT-proBNP,serum phosphorus,serum intact parathyroid hormone (iPTH),hemoglobin and electrocardiogram were detected.The heartbeat ultrasound was examined every 6 months,observed for 24 months and followed up for 3 years,recording the incidence and the inspection results.The correlation and the occurrence of CVD were analyzed by conducting a multiple factor logistic regression analysis.The forecast performance of Cys-C,NT-proBNP was evaluated by using receiver operating characteristic (ROC) curves and area under curves (AUC).Results Eighteen episodes of CV events occurred in 126 patients during the experiment and follow-up,including 8 episodes of heart failure,4 episodes of myocardial infarction,6 episodes of arrhythmia.Detection indexes had no statistically significant correlation (P ＞ 0.05),and the results of ECG and ultrasound heartbeat graph showed that no significant difference in cardiac structure and function before treatment (P ＞ 0.05).After 24 months duration,the research showed that the level of serum calcemia was lower,and the levels of phosphorus and iPTH were higher in hemodialysis group compared with that in the other 2 groups,and the differences had statistical significance (P ＜ 0.05).The median levels of Cys-C and NT-proBNP were 8.59 (9.74,7.10) mg/L and 7 739 (9 887,6 736) ng/L in the patients CV events occurred.Non conditional multivariate logistic regression analysis demonstrated that the increasing interdialytic weight,Cys-C,NT-proBNP,iPTH,dialysis hypotension were the independent risk factors of CV occurrence.AUCs to predict CVD occurrence in MHD patients was 0.64 (95％CI 0.53-0.71,P ＜ 0.05) and 0.79 (95％CI 0.72-0.89,P＜ 0.01) using Cys-C and NT-proBNP respectively.The cut-off values of serum Cys-C and NT-proBNP for CVD occurrence were 8.59 mg/L and 7 739 ng/L,with a sensitivity of 84.3％ and a specificity of 92.7％.Conclusions Cys-C,NT-proBNP can be used to predict the risk of CV events in dialysis patients.

Interventional management was performed in 10 patients with hemorrhage following hepatic biliary and pancreatic surgery.The super-selection arterial embolization was performed in 9 patients using gelfoam pledgets (n =6 ) or metal coils (n =3 ),the procedure was combined with local infusion of reptilase; 1 case was managed by local infusion of reptilase alone.Selective angiography revealed the pseudoaneurysm in 3 cases,contrast media extravasation in 6 cases; in 1 case no obvious bleeding site was found The interventional treatment was successful and hemorrhage stopped in all patients,including one case with reptilase alone with a successful rate of 10/10.The results indicate that interventional treatment is a safe and effective method for hemorrhage following hepatic biliary and pancreatic surgery.