Endovascular mechanical thrombectomy is an important progress in the treatment of acute ischemic stroke,and early and timely endovascular mechanical thrombectomy can provide significant clinical benefits.The treatment mode of endovascular therapy after intravenous thrombolysis is bridging therapy,while the traditional bridging therapy may have limitations such as time delay and increased bleeding risk.In recent years,with the completion of several large scale randomized controlled trial,whether to bypass intravenous thrombolysis and directly perform mechanical thrombectomy has become a hot topic in the field of stroke treatment.In addition,the third generation of thrombolytic drug Tenecteplase has a more convenient way of administration,it also provides new ideas for bridging therapy.This article compares and analyzes the benefits and risks of direct mechanical thrombectomy therapy and bridging therapy based on relevant research that has been completed,aiming to provide reference for the correct selection of treatment methods for acute ischemic stroke patients.

Objective To investigate the efficacy and safety of the 12-week regimen with sofosbuvir and coblopasvir hydrochloride in the treatment of chronic hepatitis C (CHC) in northwest China. Methods This study enrolled 101 patients with CHC of any genotype who received sofosbuvir (400 mg) combined with coblopasvir hydrochloride (60 mg) for 12 weeks in The First Affiliated Hospital of Air Force Medical University, The Second Affiliated Hospital of Air Force Medical University, The Second Affiliated Hospital of Xi'an Jiaotong University, and Baoji Central Hospital from July 1 to December 31, 2021, among whom 13 had liver cirrhosis and 88 did not have live cirrhosis. Other antiviral drugs such as ribavirin were not added regardless of the presence or absence of liver cirrhosis or the genotype of CHC. Related clinical data ere extracted, including HCV RNA quantification and liver biochemical parameters at baseline, at week 12 of treatment, and at 12 weeks after drug withdrawal. The primary endpoints were sustained virologic response at 12 weeks after the end of treatment (SVR12) and safety at week 12 of treatment, and the secondary endpoint was the effect of the 12-week treatment on liver biochemical parameters. The non-normally distributed continuous data were expressed as M ( P 25 - P 75 ), and the Mann-Whitney U test was used for comparison between groups. Results A total of 101 patients were included in the analysis, among whom there were 55 male patients (54.5%) and 46 female patients, and the median age was 53 years. Among these patients, 12.8% had liver cirrhosis, 1.0% had liver cancer, 3.0% were treatment-experienced patients, and 3.0% had type 2 diabetes. As for genotype distribution, 8% had CHC genotype 1, 60% had CHC genotype 2, 19% had CHC genotype 3, and 6% had CHC genotype 6, and genotype was not tested for 7% of the patients. After 12 weeks of treatment, all 101 patients had a HCV RNA level of below the lower limit of detection and an SVR12 rate of 100%, with a significant reduction in the serum level of alanine aminotransferase (ALT) from baseline to week 12 of treatment ( P < 0.05). Among these patients, 22.7% had concomitant medications such as atorvastatin calcium, aspirin, metformin, nifedipine, bicyclol, and compound glycyrrhizin. The incidence rate of adverse events was 16.8%, and fatigue (12.9%) was the most common adverse event. Conclusion The 12-week treatment with sofosbuvir and coblopasvir hydrochloride can obtain high SVR12 in CHC patients in northwest China and has good antiviral safety, with a significant improvement in abnormal serum ALT at week 12 of treatment.

The infectious disease outpatient service as a frontier is an important fulcrum of public health service. Its standardized construction is an important support for ensuring medical safety, reducing nosocomial infections, and controlling the epidemic of infectious diseases. The sub-specialty outpatient service of infection diseases includes fever outpatient service, intestinal outpatient service, tuberculosis outpatient service, AIDS outpatient service, liver disease outpatient service, etc. According to the characteristics of each subspecialty outpatient service and combining with clinical practice, we elaborated the setting norms of subspecialty outpatient service for common infectious diseases from the perspective of planning and design, building layout, equipment and facilities configuration, staffing, daily management and demonstration.

Cellular signaling networks act as the central processor to deal with environmental signals and regulate cell function, and determine cell fate. Using synthetic biology approach to engineer cell signaling networks is crucial for ultimately constructing man-made "cell machines". Cellular signaling networks can encode sophisticated cell information by processing quantitatively signaling dynamics, which enables multi-dimensional regulation of functional sub-circuits. Here, we first review the research progresses on the signaling coding mechanisms; and then elaborate the methodologies and applications of cells signaling engineering; finally, we envision that signaling-based cell engineering are important for the increasingly-complicated next generation synthetic biology.

BACKGROUND:Nerve growth factor has been shown to play an important role in bone healing, but little is reported on the effect of growth factor composite scaffolds via the immediate implantation in the repair of canine bone defects. OBJECTIVE:To analyze the effect of nerve growth factor composite scaffolds via the immediate implantation for the repair of canine bone defects. METHODS:Nerve growth factor composited strontium apatite scaffolds were prepared. Canine mandibular defect models were established and divided into three groups, fol owed by implanted with composite scaffold (experimental group), strontium apatite (positive control group), or nothing (blank control group). The three-dimensional CT reconstruction and hematoxylin-eosin staining of canine mandibular bone defects were observed. RESULTS AND CONCLUSION:In the blank control group, there were few new bones surrounding bone defect. Trabecular bones spread from the defect center to the surrounding tissues in the experimental and positive control groups. The bone density, volume, thickness, and implant-bone contact were significantly increased, while the trabecular separation was significantly decreased in the experimental group compared with the positive control and blank control groups (P<0.05), and al above indicators in the positive contro group were significantly higher than those in the blank control group (P<0.05). Hematoxylin-eosin staining showed that in the experimental group, there were a large number of new bones that contacted with the surrounding bones closely, and trabecular bones arranged regularly. In the positive control group, newborn osteoid, trabeculare, and a smal amount of debris were found. In the blank control group, few new bones were connected with the surrounding bones untightly and trabecular bone arranged irregularly. These results indicate that the nerve growth factor composite scaffold can promote the bone regeneration in the canine bone defects after immediate implantation.

Objective To research the tourniquet effect on cement mantle thickness in total knee arthroplasty.Methods From June 2013 to June 2014,112 cases of patients were received total knee arthroplasty in the First People's Hospital of Foshan and 94 cases of which received primary operation,82 cases were recruited of the research and randomly divided into experimental group(n=41) without tourniquet and control group(n =41)with tourniquet.The radiological cement mantle thickness was evaluated postoperatively in 2 zones (tibia) on anteroposterior and 4 zones (tibia 2;femur 2) on lateral radiographs,and values were cumulated.Additionally,the calculated blood loss,haemoglobin loss,blood transfusion rate,average transfusion volume,VAS pain score,arc of motion,swelling,ecchymosis and micro thrombus in venules were recorded.Results The study showed that (3.57± 0.62) mm on without tourniquet group and(3.74 ±0.71)mm on tourniquet group in tibia (P=0.240).However,the cement mantle thickness of mm on without tourniquet group(2.00±0.43) mm on tourniquet group(2.19±0.48) in femur (P=0.053),there was no statistically significant difference between two groups.The tourniquet group were reduced on the calculated blood loss,haemoglobin loss,blood transfusion rate and average transfusion volume compared with without tourniquet group(P＜0.05).But VAS pain score,arc of motion,swelling,ecchymosis and micro thrombus in venules were slightly increased in tourniquet group compared with without tourniquet group (P＜0.05).Conclusion The use of a tourniquet in total knee arthroplasty can reduce the calculated blood loss,haemoglobin loss,blood transfusion rate,average transfusion volume,but without using a tourniquet has a better clinical results.

BACKGROUND:Now experimental and clinical research on suitable bone substitutes for alveolar bone defects after dental implantation is an issue of concern.OBJECTIVE:To study the therapeutic effect of titanium core/bone morphogenetic protein (BMP) composite material on alveolar bone defects after immediate implant placement.METHODS:Twenty-four New Zealand rabbits were randomly assigned into normal group (no intervention),experimental group or control group.Animal models of bone femoral greater trochanter defect were made in the experimental and control groups.Dental implant and titanium core/BMP composite material were implanted in the experimental group,while dental implant and titanium core were implanted in the control group.Percentage of CD4+,CD8+ T lymphocytes,natural killer cell activity and interleukin 2 level were detected at postoperative 4 weeks;bone mineral density and osteogenesis around the implant were detected at postoperative 16 weeks through X-ray and histological examinations.RESULTS AND CONCLUSION:X-ray results showed that the bone mineral density in the experimental group was significantly higher than that in the control group (P ＜ 0.05).Histological results showed that in the experimental group,different degrees of cell lysis around the composite,more bone cells and bone matrices were found,implant-bone osseointegration formed well,and red-dyed mature bone tissues were detective inside the implant.Compared with the experimental group,lower number of bone cells and fibrocytes were found in the control group.Additionally,the percentage of CD4+ and CD8+ T lymphocytes,natural killer cell activity and interleukin 2 level in the experimental group were significantly lower than those in the control group (P ＜ 0.05).To conclude,the titanium core/BMP composite material can effectively repair alveolar bone defects after immediate implant placement to guide the growth of bone cells.

Objective To investigate the changes of cortical thickness and relative resting state functional connectivity in patients with generalized anxiety disorder (GAD).Methods The present study analyzed structural and eyes-open resting state functional MRI were performed in 21 patients with GAD and 22 matched healthy controls.Cortical thickness was estimated with FreeSurfer.The structurally altered regions were defined as region of interest (ROI) to analyze functional connectivity (FC) using resting state functional MRI data by DPABI.Results Cortical thickness of patients with GAD were increased in right rostral middle frontal gyrus (rMFG;MNI:x =27.9,y =53.4,z =-11.1;size:241.93 mm2;FDR corrected,P ＜ 0.1) and right inferior temporal gyrus (IGT;MNI:x =49.7,y =-57.8,z =-8.7;size:138.93 mm2;FDR corrected,P＜0.1) compared with healthy controls.FC between right rMFG and right superior/middle occipital gyrus as well as well as FC between rMFG and right precentral gyrus showed decreased in patients with GAD compared with healthy controls(AlphaSim corrected,P＜0.05).FC between right rMFG and right angular gyrus showed increased in patients with GAD compared with healthy control (AlphaSim corrected,P＜0.05).Conclusion The rMFG may play an important role in the pathophysiology of GAD,which can be used as an stimuli target in physicotherapeutics to improve anxiety symptoms.

Objective To investigate the therapeutic effects of erythropoietin sustained-release gelatin hydrogel microspheres (EPO-GHM) on a murine model of hindlimb ischemia and related mechanisms.Methods Fifty two ten weeks old male C57BL/6J mice were assigned to 5 groups:shamoperated group (the right femoral artery suture was passed through the right femoral artery but not tied,n =8);saline group (right femoral artery ligation and intramuscular injection of saline at a dose of 4 ml/kg into the right hind limb,n =12);EPO group(right femoral artery ligation and intramuscular injection of EPO at a dose of 5 000 IU/kg into the right hind limb,n =12),empty GHM group (right femoral artery ligation and intramuscular injection of empty GHM at a dose of 4 ml/kg into the right hind limb,n =8);EPO-GHM group(right femoral artery ligation and intramuscular injection of EPO-GHM at a dose of 5 000 IU/kg into the right hind limb,n =12).The blood flow ratio of ischemic limb (right)/nonischemic limb (left) was measured using a laser Doppler perfusion imager.After 8 weeks,immunohistochemical analysis were used to evaluate the vessel density (vessel density of CD31 positive),arteriole density(vessel density of α-smooth muscle actin(α-SMA) positive) and muscle area(HHF35 positive area).The proliferating index of vessels was evaluated by double immunofluorescent labeling to evaluate effect of EPO-GHM on angiogenesis of ischemia limb.Western blot was used to evaluate the protein expression of EPO receptor,protein kinase B (AKT),p-AKT,endothelial nitric oxide synthase (eNOS),p-eNOS and matrix metalloproteinase 2(MMP-2).Results (1) Eight weeks later,the blood flow ratio of ischemic limb/nonischemic limb was significantly higher in the EPO-GHM group compared with other groups(0.810 ±0.080,0.563 ±0.051,0.570 ±0.056and 0.561 ± 0.052 respectively,all P ＜ 0.05).(2) CD31 antibody positive and α-SAM antibody positive densities were higher in the EPO-GHM group compared with other groups(P ＜ 0.01 or 0.05).(3)HHF35 positive area in saline group,EPO group,empty GHM group and EPO-GHM group were smaller than that of sham-operated group(all P ＜0.05).HHF35 positive area in saline group,EPO group,empty GHM group and EPO-GHM group were similar(all P ＞ 0.05).(4) The proliferating index of vessels was higher in the EPO-GHM group compared with other groups (P ＜ 0.01 or 0.05).(5) Compared with other groups,the protein levels of EPO receptor,AKT,p-AKT,p-eNOS and MMP-2 were significantly higher in EPO-GHM group(P ＜ 0.01 or 0.05) and level of eNOS was similar among five groups (P ＞ 0.05).Conclusion Results from present study suggest EPO-GHM could improve blood perfusion of ischemia limb in mice through increasing capillary and arteriolar densities and these beneficial effects are possibly mediated by EPOR up-regulation and AKT/p-eNOS/MMP-2 signaling pathway activation.

Clinical medicine is a comprehensive discipline integrating natural science and hu-manities and social science. Lemology is closely related with basic medicine and medical microbiology and medical immunology are the basis of lemology. Therefore, in the process of cultivating postgradu-ates of lemology, we should not only should attach importance to the cultivation of basic medical knowl-edge and clinical professional quality, but also pay more attention to the development of the intelligence factors and non-intelligence factors. Meanwhile education on humanity, social sciences and relevant laws and regulations should be enhanced to cultivate doctors' professional quality. Reverse thinking and lateral thinking in the clinical diagnosis should be strengthened to achieve the training objectives of cultivating international medical talents.