Abstract:Autophagy, or cellular self-eating, is a cellular pathway involving the engulfment of intracellular organelles or pathogens, leading to protein and organelle degradation, elimination of pathogens or energy recycling. The two important steps of autophagy, the discovery of autophagosome formation and organelle degradation in lysosome, have won the 2016 and 1974 Nobel Prize in Physiology or Medicine, respectively, which indicates the great significance of autophagy. The primordial and vital function of autophagy is preserved in all eukaryotic organisms, from yeast to humans. Autophagic dysfunction can result in diverse pathological changes, and is closely associated with microbial infection, cancer, neurodegeneration and ischemic diseases. Moreover, autophagy plays complicated and even divergent roles in different types of diseases, cells, conditions and pathological processes.

Abstract:Cerebrovascular disease has become the first cause of death in China, which brings heavy social economy burden and psychological pressure to the patients and their families. Recent years have witnessed rapid development in cerebrovascular disease research, which promotes the rapid development of its prevention and treatment. This review summarized several focuses in studies of cerebrovascular diseases, including focuses of basic research, diagnoses and therapies of acute ischemic stroke and endovascular treatments, cerebral hemorrhage, prevention and rehabilitation of cerebral stroke, evidence-based medicine, translational medicine and precision medicine, hoping to provide insights for all those who involved in the field.

Abstract:Objective To observe the relation between blood pressure fluctuation and prognosis of patients with acute ischemic stroke during intravenous thrombolysis, so as to guide the blood pressure management during super early stage of acute ischemic stroke and to improve the prognosis after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA). Methods A total of 198 acute ischemic stroke patients,who received rt-PA intravenous thrombolysis during the time window between Sep. 2013 to Dec. 2015 in our stroke center, were included in this study, and the patients included 125 males and 73 females, aged (67.6±12.8) years old, ranging 22-91 years.NIHSS score was used to evaluate the function of the nervous system and modified Rankin Scale (mRS) score was used for evaluating the prognosis of patients. The blood pressure variation during the entire process of intravenous thrombolysis, which included the mean, maximum (max), minimum (min), range (max-min), standard deviation (SD), and successive variation(SV), were monitored. After baseline data correction,multiple logistic regression analysis was used to evaluate the influence of blood pressure on the long-term prognosis of patients. Results We found that the initial NIHSS score, time from onset to thrombolysis, average initial systolic blood pressure, and average initial pulse pressure, the maximum systolic/diastolic blood pressure during thrombolysis, SV of systolic/diastolic blood pressure during thrombolysis, and SV of the maximum systolic/diastolic blood pressure during thrombolysis, were the factors affecting the clinical outcomes of patients (P<0.05, P<0.01). The multiple logistic regression analysis showed that low initial NIHSS score, shorter time from onset to thrombolysis, low average initial systolic blood pressure, and low SV of systolic blood pressure and diastolic pressure were the independent predicting factors for good prognosis of acute ischemic stroke patients receiving rt-PA intravenous thrombolysis. Conclusion The prognosis of acute ischemic stroke is associated with the systolic blood pressure at beginning of thrombolysis, pulse pressure and pressure variability during thrombolysis. Great blood pressure fluctuation is associated with poor outcome of acute ischemic stroke, so efforts should be made to maintain stable blood pressure in the patients.

Abstract:Objective To analyze the efficacy and prognosis of intravenous thrombolysis in patients with acute ischemic stroke, so as to discuss the influence of time management on the thrombolysis outcome. Methods We retrospectively analyzed the clinical data of the 198 acute ischemic stroke patients who received intravenous thrombolysis in Changhai Hospital from Sep. 2013 to Dec. 2015. The patients were divided into two groups according to U. S. National Institutes of Health Stroke Scale (NIHSS) scores 24 h after thrombolysis:effective group and ineffective group. The clinical data of the two groups were compared to indentify the factors influencing the prognosis. The patients were also divided into two groups according to modified Rankin Scale (mRS) after 90 d:good prognosis and poor prognosis groups; the clinical data of the two groups were also analyzed to identify the influencing factors. The differences were compared between the effective group and ineffective group from the onset to different medication periods, so as to evaluate the influence of time management on prognosis. Results The 198 consecutive acute ischemic stroke patients included 74 in the effective group and 124 in the ineffective group. Single-factor analysis indicated that the pre-thrombolysis baseline NIHSS score, time from onset to the beginning of thrombolysis, and history of coronary heart disease were significantly different between the effective group and ineffective group (P<0.01, P<0.05).Logistic regression analysis showed that low baseline NIHSS score before thrombolysis, shorter time from onset to the beginning of thrombolysis, and no history of coronary heart disease were the independent predictors of a good effect. Single-factor analysis of indicated that the age, blood glucose level prior to thrombolysis, history of diabetes mellitus, history of atrial fibrillation, baseline NIHSS score and GCS score prior to thrombolysis, time from onset to the beginning of thrombolysis and history of coronary heart disease were significantly different between the good prognosis group (157 cases) and the poor prognosis group (41 cases) (P<0.01, P<0.05). Logistic regression analysis showed that low baseline NIHSS score before thrombolysis were independent predictors of good prognosis. Concerning the time management, the time periods from onset to the beginning of thrombolysis were significantly different between the ineffective group and effective group (P<0.01), which was mainly caused by the time from the onset to treatment (P<0.01). Conclusion Lower pre-thrombolysis NIHSS score, shorter time from stroke onset to beginning of thrombolysis, no history of coronary heart disease are associated with good short-term efficacy, and lower pre-thrombolysis NIHSS score is the independent factor of good prognosis for acute ischemic stroke. Early treatment may increase the efficacy of intravenous thrombolysis.

Abstract:Objective To analyze the high-resolution magnetic resonance imaging (HR-MRI) findings of middle cerebral artery (MCA) vessel wall for Moyamoya disease (MMD) and atherosclerotic Moyamoya syndrome (AS-MMS), and to explore the diagnostic value of HR-MRI for MMD. Methods We selected 24 MMD patients (MMD group) and 24 AS-MMS patients (AS-MMD group) from Changhai Hospital.HR-MRI comparison was made for the difference between the two groups concerning the ages and risk factors, including episode style, history of diabetes, hyperlipaemia, hypertension and stroke. 3.0T HR-MRI enhanced scanning was performed for MCA vessel wall changes in all patients.Then the inner and outer diameters of MCA, wall thickness, signal intensity of vessel wall, enhancement effect, microvascular adjacent to MCA and its remodeling index (RI) were analyzed. The outer diameters of two groups were analyzed by the receiver operating characteristic (ROC) curve. Results We found that ages and risk factors were significantly different between the MMD and AS-MMS groups (P<0.05). The MCA outer diameter was significantly smaller in MMD group than that in the AS-MMS group ([2.70±0.44] mm vs[3.31±0.54] mm, P<0.05), but the wall thickness was significantly thicker than that in the AS-MMS group ([1.99±0.32] mm vs[1.39±0.57] mm,P<0.05).The focal enhancement of MCA arterial wall in AS-MMS group was more commonly seen than that in MMD group (50.00% vs 33.33%, P<0.05). Compared with AS-MMS group, the RI in MMD group was mostly negative remodeling (79.17% vs 25.00%, P<0.05), with the average RI significantly decreased ([0.86±0.12] vs [1.05±0.21], P<0.05) and the occlusion incidence of microvascular adjacent significantly increased (83.33% vs 24.17%, P<0.05). ROC curve showed when the threshold value of MCA outer diameter was 3.13 mm, the differential diagnosis had a 90.7% sensitivity and a 64.0% specificity. Conclusion HR-MRI has an important value for differential diagnosis of MMD and AS-MMS.The arterial wall of MCA in MMD patients undergoes shrinkage and negative remodeling. The outer diameter is often less than 3.13 mm with concentric stenosis, and the arterial wall has no enhancement or concentric enhancement, with microvascular adjacent to MCA more commonly seen in MMD group.

Abstract:Objective To use high-resolution magnetic resonance imaging (HR-MRI) for studying the vascular remodeling and plaque characteristics of two types of basilar atherosclerotic infarction:branch occlusive disease (BOD) and non-BOD. Methods Thirty-two patients with symptomatic basilar artery stenosis were divided into BOD and non-BOD groups, with 18 patients in BOD group and 14 in non-BOD group. All the patients received 3.0T HR-MRI enhancement scanning for the basilar artery wall. The wall thickness and plaque area of steno-occlusive basilar artery at the maximal stenosis were measured and analyzed, so as to assess the vascular remodeling and plaque characteristics. Results HR-MRI scanning showed that the stenosis of non-BOD group was more obvious than that of BOD group ([68.9±19.1]% vs[43.8±18.8]%, P=0.017). Compared with BOD group, positive remodeling was more frequently observed in non-BOD (57.2% vs 16.7%, P=0.036). The wall area index of BOD group was also significantly lower than that of non-BOD group (P<0.001). Eccentric enhancement was the main form for the two types of basilar atherosclerotic infarction in study, and the plaque enhancements were not significantly different between BOD and non-BOD groups (P=0.196); however, the enhancement degree of BOD group was significantly milder than that of the non-BOD group ([39.9±23.2]% vs[65.3±21.1]%, P=0.004). Conclusion BOD and non-BOD have different vascular remodelings and plaque characteristics.

Abstract:Objective To study the clinical characteristics and differentiation of stroke mimics during super early intravenous thrombolysis of acute ischemic stroke. Methods The clinical data of patients who received intravenous thrombolysis between Sep. 2013 and Feb. 2015 in Changhai Hospital were retrospectively analyzed. And those with stroke mimics were identified and were compared with those with strokes; the clinical symptoms and laboratory findings were compared between the two groups. Results A total of 212 patients received intravenous thrombolysis, and 7 (3.3%) of them were identified as having stroke mimics. There were no notable differences in the baseline characteristics between mimics and stroke groups. Psychiatric and dementia history were of great value for differentiation of stroke mimics from strokes. MRI, vascular assessment, electroencephalogram (EEG), blood and cerebrospinal fluid assay greatly contributed to the final diagnosis of stroke mimics. Conclusion Only few patients receiving intravenous thrombolysis have been confirmed to have stroke mimics. Medical history combined with MRI may be of great value for differentiation of mimics and strokes.

Abstract:Recent advances in genomics have allowed us to begin addressing the genetic basis of stroke at molecular level. These advances are especially important for clinical diagnosis and therapy of stroke caused by monogenic variation, and they may even lead to a revolutionary treatment for these patients. In this review, we summarized the current status of genetic research in ischemic stroke, hoping to provide guidance for clinicians in clinical practice.

Abstract:Objective To evaluate the clinical value of total hemihepatic vascular exclusion (THHVE) for liver resection in hepatocellular carcinoma (HCC) patients and its effect on tumor recurrence, metastasis and patient survival. Methods Consecutive patients who were scheduled for elective hepatic resection were screened and allocated randomly to THHVE and Pringle maneuver groups. The total intraoperative blood loss, blood loss during transection, blood transfusion rate, operation time, vascular clamping time, complication, mortality, postoperative hospital stay, postoperative liver function index, overall survival time and disease-free survival time were analyzed and compared between the two groups. Results From Aug. 2011 to Aug. 2013, 143 patients were eligible and were analyzed, with 71 in THHVE group and 72 in Pringle group. Baseline data were similar between the two groups. Total blood loss (250.0[150.0-400.0] mL vs 350.0[200.0-637.5] mL,P<0.001) and blood loss during hepatic transection (100.0[50.0-200.0] mL vs 215.0[100.0-380.0] mL,P<0.001) in the THHVE group were significantly less than those in the Pringle group. The vascular clamping time in THHVE group was significantly longer than that in Pringle group (27.0[20.0-31.0] min vs 20.0[16.0-24.0] min, P<0.001); the serum ALT levels (P<0.05) on postoperative day 1, 3, 7 and the serum total bilirubin levels (P=0.013) on postoperative day 7 in the THHVE group were significantly lower than those in the Pringle group, and the serum pre-albumin level was significantly higher in the THHVE group than that in the Pringle group on postoperative day 7 (P=0.038). The incidence rate of postoperative complication in THHVE group was significantly lower than that in Pringle group (21.1% vs 37.5%,P=0.032). The overall survival time in THHVE group was significantly longer than that in Pringle group (P=0.036). Multivariate analysis by the Cox proportional hazard regression model showed that THHVE was one of the independent factors affecting overall survival, and the death risk of the patients in THHVE group was 47.6% that of the patients in Pringle group. Conclusion THHVE is a safe and effective method in liver resection for patients with HCC, and the method is associated with less intraoperative bleeding, better postoperative liver function recovery, lower incidence rate of complication and better overall survival compared with Pringle maneuver.

Abstract:Objective To discuss the impact of cigarette smoke extract (CSE) and nicotine on the oxidative stress in thyroid-associated ophthalmopathy (TAO) and to explore the possible molecular mechanism involving NF-κB signal pathway. Methods The orbital fibroblasts (OFs) were originally generated from 5 patients without smoking history and 3 volunteers without smoking history and were identified by using immunohistochemistry. Primary cultured extraocular muscle OFs were stimulated with 10% CSE (10% CSE group), 0.5 μg/mL nicotine (low-concentration nicotine group) or 10 μg/mL nicotine (high-concentration nicotine group). MTT assay, ELISA and spectrophotometer method were used to determine the changes of cell activity, 8-hydroxydeoxyguanosine (8-OHdG) levels and malondialdehyde (MDA) contents after intervention for 24 h and 72 h. ELISA was used to determine reactive oxygen species (ROS) level after 24 h culture, while RT-RCR was used to determine NF-κB mRNA expression. Results After intervention for 24 h and 72 h, the cell activities of OFs were significantly decreased after intervention with CSE in both TAO patients and healthy volunteers (P<0.05), with the OFs of TAO patients being more sensitive. After intervention for 24 h, the 8-OHdG level was significantly increased in TAO patients' OFs treated with high-concentration nicotine (P<0.05); for a longer intervention duration of 72 h, the 8-OHdG level was also significantly increased in the group treated with low-concentration nicotine (P<0.05). After intervention with CSE, low- and high-concentration nicotine for 72 h, MDA contents were increased significantly in both OFs groups (P<0.01). After intervention for 24 h, the ROS content was significantly increased in the TAO patients' OFs treated with high-concentration nicotine than in the untreated group (P<0.01). After intervention for 24 h, the expression of NF-κB mRNA was significantly up-regulated after stimulation with CSE in the OFs of TAO patients than that in the untreated group (P<0.05); while the expression of NF-κB mRNA was significantly decreased in OFs stimulated with CSE and high-concentration nicotine compared with untreated group (P<0.05). Conclusion Smoking may influence TAO pathological process through stimulating oxidative stress in OFs of TAO patients, and the stimulation may accumulate and sustain even if the smoking is slight, which may be related to up-regulation of NF-κB mRNA expression.

Abstract:Objective To investigate the expression of retinoic acid receptors (RARs) subtypes RAR-α, RAR-β, RAR-γ and retinal dehydrogenases 1(Raldh1), Raldh2 in the mouse embryonic hematopoiesis, so as to discuss the role of different RAR subtypes in embryonic hematopoiesis. Methods The yolk sac (YS) at embryonic day 9.5 (E9.5), aorta-gonad-mesonephros (AGM) region at E10.5 and E11.5, fetal liver (FL) at E13.5, E14.5 and E17.5 were harvested from the pregnant mice. The bone marrow (BM) was also harvested from adult mice. The mRNA levels of RAR-α, RAR-β, RAR-γ, Raldh1 and Raldh2 at the above four different hematopoietic sites were assessed by quantitative reverse transcription polymerase chain reaction (RT-PCR). Results The mRNA levels of RAR-α, RAR-β, RAR-γ, Raldh1 and Raldh2 at E9.5 YS, E11.5 AGM regions and BM were significantly higher than those in other relevant hematopoietic tissues (P<0.01). Compared with the E10.5 AGM region, E11.5 AGM region had significantly increased mRNA levels of RAR-α, RAR-β, RAR-γ, Raldh1 and Raldh2 (P<0.01), but the mRNA levels of these genes in FL at E13.5-E17.5 were not significantly different. Conclusion The expressions of RAR-α, RAR-β, RAR-γ, Raldh1 and Raldh2 in YS, AGM regions and BM are consistent with the situation of colony forming unit erythroid (CFU-E), suggesting that retinoic acid is closely related to the formation of hematopoiesis in the YS, AGM region and BM in mouse, but has less correlation with the FL in mouse.

Abstract:Objective To investigate the value of fractional exhaled nitric oxide (FeNO) in the treatment of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Methods The twenty-eight ACOS patients receiving no standard medication treatment were recruited from May 2015 to Oct. 2015 in Suzhou Kowloon Hospital; the patients inhaled corticosteroids/long-acting beta agonist (ICS/LABA) for 12 weeks and the changes of FeNO levels, FEV₁%pred, induced sputum eosinophil (EOS), blood total IgE, and high sensitivity C-reactive protein (hs-CRP) were examined before and after treatment. The correlations between FeNO and other indices were analyzed by Pearson correlation coefficient method. The patients were divided into different groups according to different age and smoking statuses, and the changes of the indices before and after treatment were compared between different groups. Twenty-eight healthy participants were recruited as control group and their FeNO levels were also tested. Results After treatment, the FeNO levels ([32.04±8.34]×10^-9 mol/L vs[25.56±4.13]×10^-9 mol/L, P<0.05), induced sputum EOS ([18.51±5.36]% vs[13.18±1.56]%, P<0.05), and blood total IgE ([251.91±42.24] ng/mL vs[204.65±28.52] ng/mL, P<0.05) of ACOS patients were significantly lower than those before treatment. There was no significant difference in FEV₁%pred ([52.03±7.03]% vs[55.16±8.20]%, P=0.391) or hs-CRP ([10.86±4.92] mg/L vs[9.16±1.82) mg/L, P=0.077) before and after treatment in ACOS patients. Meanwhile, the levels of FeNO in ACOS group were significantly higher than those in the healthy control group before and after treatment([32.04±8.34]×10^-9 mol/L,[25.56±4.13]×10^-9 mol/L vs[17.04±0.97]×10^-9 mol/L,P<0.05). The levels of FeNO, induced sputum EOS and serum total IgE were significantly different among different ages and smoking status before and after ICS/LABA treatment. The pre- and post-treatment FeNO levels were positively correlated with induced sputum EOS and serum total IgE (pre-treatment:r=0.924, P<0.01 and r=0.945, P<0.01; post-treatment:r=0.247, P<0.01 and r=0.443, P<0.01); while it was not correlated with serum hs-CRP or FEV₁%pred. Conclusion Our findings indicate that eosinophilic inflammation is present in the airways of ACOS patients, which can be treated with ICS/LABA inhalation. The curative effect is not affected by age or smoking status. FeNO detection can be used to evaluate the efficacy of ICS/LABA for ACOS, which is associated with induced sputum EOS and serum total IgE.

Abstract:Objective To establish an HPLC approach for determining the plasma drug concentration of evodiamine (EVO) in evodiamine novel nano emulsion (ENNE) in rats, and to investigate the pharmacokinetics and bioequivalence of ENNE in rats. Methods Twelve SD rats were evenly randomized into two groups and were administered intragastrically with ENNE (containing EVO 100 mg/kg) or EVO (100 mg/kg). The plasma drug concentrations of EVO were measured at 5 min, 10 min, 15 min, 30 min, 45 min, 1 h, 2 h,5 h, 8 h, 12 h, 24 h, 48 h and 72 h after administration of ENNE or EVO by HPLC. The chromatographic conditions were as following:the mobile phase was methanol and 0.1% of formic acid-water solution (66:34,V/V), the flow rate was 1 mL/min, the injection volume was 100 μL, and the detection wavelength was 225 nm. The concentration-time curve was drawn by excel software, and the main pharmacokinetic parameters and bioequivalence were calculated by DAS 2.1.1 software. Results The established method was fast, accurate, and had good linear correlation. The AUC_0-∞ of ENNE and EVO were (8 248.88±69.92) μg·h·L^-1 and (884.82±83.52) μg·h·L^-1, and the t_1/2 of ENNE and EVO were (1.70±0.60) h and (1.05±0.45) h, respectively. The AUC_0-∞ of ENNE was 9 times that of EVO, and the t_1/2 of ENNE was 1.62 times that of EVO.ENNE and EVO were not bioequivalent. Conclusion Bioavailability and absorption of ENNE are higher than EVO, and ENNE and EVO are not bioequivalent.

Abstract:Alzheimer disease (AD) is a neurodegenerative disease of the central nervous system, with complicated etiologies. Recent studies have found that vascular disease has a great impact on AD, and abnormal vascular endothelial growth factor (VEGF) expression is thought to play an important role in the course of AD. MicroRNAs expression has greatly changed in the brain of AD patients. This paper reviewed the latest advance in the effects of vascular and genetic factors on the occurrence and progression of AD, with discussion also on the probable pathogenesis, therapeutic targets and strategies of AD.

Abstract:Long non-coding RNAs (lncRNAs) are a class of RNA molecules with more than 200 nucleotides that function as RNAs with little or no protein-coding capacity.They maintain the normal physiological functions of cells and are involved in the development and progression of the tumor. Growing research suggests that lncRNAs are independent prognostic factors affecting the overall survival and disease free survival of ovarian cancer and are closely related to the development and progression of tumors. This review summarized the recent progress in the relationship between lncRNAs and ovarian cancer, hoping to provide reference for the prevention, diagnosis, and therapy of ovarian cancer.

Abstract:Objective To explore the advantage of motor evoked potentials (MEPs) monitoring for postoperative motor deficit evaluation under threshold-level electrical stimulation using cranial peg-screw electrode (CPSE) during cerebral aneurysm keyhole approach microsurgery. Methods A total of 31 patients who underwent anterior circulation aneurysm microsurgery through keyhole approach were selected in this study. MEPs monitoring of the operation side was conducted with threshold-level electrical stimulation using CPSE, and that of the non-operation side was conducted with transcranial electric stimulation using the same stimulation threshold. The change of minimum voltage required for MEPs monitoring was observed and recorded. The intraoperative MEPs monitoring results and postoperative neurological functions were analyzed by prospective observational study. Results MEPs of the operation side was successfully induced in 28 cases. No complications related to MEPs monitoring were observed. Intraoperative MEPs abnormalities were monitored in 3 cases, and 2 of them had postoperative transient hemiplegia, showing a sensitivity of 100% (2/2). No motor dysfunction was observed in the other 26 cases who were not presented with intraoperative MEPs abnormalities in 25 cases, showing a specificity of 96.30%(26/27). Conclusion MEPs monitoring with threshold-level electrical stimulation using CPSE is a feasible and reliable method and it has satisfactory sensitivity and specificity for predicting motor dysfunction induced by cerebral ischemia, indicating that this method can be an alternative for routine MEPs monitoring with conventional transcranial electrical stimulation in cerebral aneurysm microsurgery.

Abstract:Underwater weapons have been widely used and their applications have become a main characteristic of modern naval battles. It imposes a severe threat to the combatants above or below water surface. The injury mechanism and characteristics of underwater explosion are quite different from those of the land explosion, which has become a research focus of military medicine around the world. In this paper we systematically reviewed the literatures and the current status of biological effect of underwater explosion injury and discussed its future development, hoping to improve our understanding and promote further in-depth studies.

Abstract:Objective To validate the dimensions and items of safety culture of PLA navy by surveying the sailors and officers of a naval destroyer force using questionnaire, so as to provide evidence for designing and validating a safety culture scale for Chinese naval destroyer forces. Methods An initial safety culture scale was designed using 38 items of 6 dimensions based on previous literature. And a refined scale, which included 28 items of 5 dimnesions, was set up through pre-investigation and pre-analysis. The refined scale was then used to survey all the 421 military members of a naval destroyer force of Chinese PLA. A total of 396 (94.06%) validated questionnaires were recollected for analysis. Results It was found that 69 (17.42%) responders had experienced safety accidents, and 30.43% (21/69) of them were injured in the accidents. Exploratory factor analysis was performed to validate the five dimensions in the scale:satisfaction with safety, management commitment, supportive environment, priority of safety and work pressure, with the total variance explained being 67.62% and the Cronbach's α calculated for each dimension being all over 0.8, indicating a good internal consistency. The dimension scores showed that management commitment to safety was insufficient and the priority of safety was low. Conclusion The safety culture has great room for improvement in the naval destroyer force. Insufficient management commitment to safety impedes the education of safety, and the low priority of safety demands more emphasis on safety issues in the destroyer force. Although most dimensions of the scale have been confirmed, lack of communication dimension indicates pertinent dimensions should be designed with specific items for eastern nations.

Abstract:Objective To observe the expression of clasmatoblast-secreted tryptase in patients with diabetic cardiomyopathy (DCM) and its relationship with fasting blood glucose. Methods Patients with DCM (DCM group, n=32) or ischemic cardiomyopathy (ICM group, n=26) and age-matched healthy volunteers (healthy control group, n=20) were recruited from Changzheng Hospital of Second Military Medical University between August 2012 and March 2013. The clinical characteristics of the participants were collected and the biochemical indices including fasting blood-glucose were detected. ELISA detection reagent kit was used for detecting serum tryptase level in each group. Pearson analysis was used to analyze the correlation between plasma tryptase level and fasting glucose. Results The general clinical characteristics and the fasting blood glucose were not significantly different between the three groups. The plasma tryptase levels in DCM group and ICM group were significantly higher than that in the healthy control group ([7.19±0.62] μg/L,[6.81±0.94] μg/L vs[2.37±0.56] μg/L, P<0.01). DCM group had higher serum tryptase level than ICM group, but with no significant difference. Pearson analysis showed that the plasma tryptase level was positively correlated with fasting blood glucose level (r=0.637, P<0.01). Conclusion The plasma tryptase level is increased in patients with DCM, and it is positively correlated with the fasting blood glucose in all the participants of three groups.

Abstract:Objective To compare the clinical efficacy and safety between LARS system and autografts in anterior cruciate ligament (ACL) reconstruction. Methods The PubMed database, China National Knowledge Infrastructure (CNKI), Chinese biomedical literature database (CBMdisc), and Wanfang database were searched to obtain the published article comparing the LARS and autografts for ACL reconstruction. The references of the retrieved articles were also read for related articles. Results A total of 9 articles with 456 cases were included in this study.The results showed that Lysholm and Tegner scores were improved significantly after LARS replacement (Lysholm:MD=50.05, 95% CI 48.41-51.68; Tegner:MD=4.41; 95% CI 3.40-5.42). Compared with autografts, the improvements of Lysholm and Tegner scores for LARS replacement were more significant 2 years postoperatively (Lysholm:MD=0.20, 95% CI 0.04-0.35; Tegner:MD=0.18, 95% CI 0.04-0.32). Meanwhile, complication (such as synovitis) rate of LARS replacement was low 2 years postoperatively, showing no notable difference with that of autograft techniques. Conclusion The LARS artificial ligament is effective and safe for ACL reconstruction. LARS has more advantages than autografts concerning the stability 2 years postoperatively. However, high-quality studies with long-term follow-up are required for further confirmation.

Abstract:Objective To analyze the relative factors in early diagnosis for cases with cerebral venous thrombosis(CVT). Methods The retrospective analysis of the clinical data in 95 patients with CVT from 2007.11to 2015.08 in Changhai Hospital was conducted. The patients were divided into early CVT diagnosis group(≤7 days) and delayed CVT diagnosis group (>7 days) according to their time from having symptoms to have a definite diagnosis．The clinical data was analyzed by univariate analysis and multivariate logistic regression analysis. Results 48 patients （50.5%）with early CVT diagnosis and 47（49.5%） with delayed CVT diagnosis. Univariate analysis showed that there was statistical significance of difference in age (P=0.016), the illness of pregnancy or puerperal (P=0.021), the level of plasma D-dimer (P=0.004), multiple CVT (P=0.010), hemorrhage (P=0.001) or venous infarction (P=0.023). Multivariate Logistic regression analysis showed that age (OR=4.197,95%CI=1.378~12.785；P=0.012), the level of plasma D-dimer （OR=0.896,95%CI=0.809~0.992；P=0.034），hemorrhage （OR=0.167,95%CI=0.052~0.540；P=0.003） or venous infarction（OR=0.093,95%CI=0.013~0.659；P=0.017）were the independent risk factors of early diagnosis. Conclusion Young patients, the increase of the level of plasma D-dimer, merged with hemorrhage or venous infarction are important conditions for the early diagnosis of CVT.

Abstract:Objective To explore the factors which influence patients in the illness-caused poverty families in rural to request for discharging from hospital so as to provide evidence for perfecting medical security system. Methods By convenience sampling method, 453 inpatients in the illness-caused poverty families were face-to-face interviewed in Miyi County of Sichuan Province, Binhai County of Jiangsu Province and Xingtai County of Hebei Province. Chi-square test was used to assess the affecting factors of respondents’ own request for discharging from hospital. Results Respondents were more likely to choose higher level hospitals, but 24.8% of them needed financial support or loans and 7.1% of them asked for discharging from hospital. The main factors are medical institutions, age, education, employment, self-rated health, the familial asset per capita and average agrarian area, per capita annual incomes and expenditure, Engel coefficient, the proportion of expenditure on education and health care, hospitalization expenses and payment methods, and belief in doctors. Factors in different regions are different. Conclusion The catastrophic health care system should be established according to regional characteristics. More attention must be paid to the ratio of individual payment in county-level hospitals. The implementation of the system has its definite realistic meaning and anticipated effect on effectively solving “sickness poor” and “poverty due to illness” for vulnerable groups.

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