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Objective To study the effect of age-related white matter changes (ARWMC) on first symptomatic ischemic stroke events in the oldsters. Methods For the prospective study, a total of 368 eligible oldsters were enrolled in the study from January 2010 to August 2012. The degrees of ARWMC were assessed by ARWMC scale;according to the scores, they were divided into non ARWMC group, mild-moderate ARWMC group and severe ARWMC group. The patients were followed up once every 3 months. The clinical endpoint events and time (first symptomatic ischemic stroke, myocardial infarction and all-cause death) were recorded. Analyses of variance and Chi-square test were used to compare the differences of clinical data among the 3 groups. COX regression was used to assess the risk differences of first symptomatic ischemic stroke in the oldsters of three groups. Results After an average of follow-up for 48.7 months, 50 participants (13.6％) had first symptomatic ischemic stroke;25 (25.8％) were categorized as the severe ARWMC group, 22 (10.9％) were as the mild-medium group, and 3 (4.4％) were as the non ARWMC group. Among the three groups, the differences in age, history of hypertension, systolic blood pressure, incidence of clinical endpoint events and first symptomatic ischemic stroke, and follow-up time of endpoint events were statistically significant (P<0.05); patients from the severe ARWMC group were the oldest, and had the longest history of hypertension, the highest systolic blood pressure, the highest incidence of clinical end events and first symptomatic ischemic stroke, and the shortest follow-up period for clinical end events. COX regression analysis showed that the risk of first symptomatic ischemic stroke in the severe ARWMC group was about 8 times higher than that in the non ARWMC group (hazard ratio=9.012, 95％CI: 2.310-35.154, P=0.002). Conclusion In oldsters, severe ARWMC often accompany hypertension history and poor blood pressure controll, and it is an independent and serious risk factor for long-term first symptomatic ischemic stroke.
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BACKGROUND: The researches of Pulling and Rotating Oblique Pulling Manipulation focus on clinical research and biomechanical changes of lumbar functional units, and the mechanical characteristics of manipulation are little reported.OBJECTIVE: To study the characteristics of the Pulling and Rotating Oblique Pulling Manipulation by digital method, so as to provide quantitative basis for inheritance, teaching and learning, promotion, and basic research of the manipulation.METHODS: The force-time curve and the force of the manipulators were tested and recorded with the multi-point membrane pressure measurement system. The kinetic parameters (the average load force, the average minimum force and the maximum impact force) were shown. The values of = the flip time, flip speed and impulse were measured by the test analysis system.RESULTS AND CONCLUSION: (1) The average load force was (145.86±34.80) N, duration was (1.43±0.46) s, the average minimum force was (72.24±13.87) N, the maximum impact force was (446.21±143.98) N, the flip time was (0.55±0.15) s, flip speed was (914.52±259.18) N/s, and the impulse was (256.21±82.30) N?s. (2) The rising slope of the impulse was (93.96±6.94), and the falling slope was (-82.70±26.10). (3) To conclude, the characteristics of manipulation from hand are analyzed in views of digitization, which provides an objective evaluation index for Lin's manipulation.
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ObjectiveTo analyze the complaints of outpatient of Guang’anmen Hospital, China Academy of Chinese Medical Sciencse, discuss the countermeasures to alleviate the contradiction and promote the normalization of the relationship between doctors and patients.Methods Based on analysis of outpatient complaints from Jan. 2008 to Dec. 2012 in our hospital, statistics and classification data were obtained from the aspects of service attitude, medical errors, process and communication.ResultsOutpatient amount of our hospital form Jan. 2008 to Dec. 2012 was 10.55 million. There were 1426 outpatient complaints (service attitudes 24.2%, medical errors 11.5%, process 40.3%, and communication 24%), etc. Complaints rate was 0.135‰ and satisfaction degree of dealing with complaints was 99.3%.Conclusion Through active service, the complaints of outpatients has been reduced, and diagnostic and treatment quality and satisfactory degree have been increased of our hospital.
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Objective To preliminarily explore the influence of intervention of atorvastatin in vasculogenic mimicry of glioblastoma and its mechanism.Methods CCK-8 experiment was carried out to detect the cell activity of glioma cell line U87 under the intervention of atorvastatin at different concentrations (1010-10-4 mol/L),aiming at screening out the safety concentration of atorvastatin.U87 cells were incubated in the mediums containing atorvastatin with different safety concentrations as well as in the control medium without atorvastatin.Three-D cultivation was performed in the Matrgel to establish the in vitro vasculogenic mimicry models,then the ability ofvasculogenic mimicry was observed and the length of the tube structure was counted.RT-PCR and Western blotting were performed to detect the mRNA and protein expression levels of matrix metalloproteinase-2 (MMP-2) in the U87 cells of intervention group and control group,respectively.Results Safety concentrations of atorvastatin screened by CCK-8 experiment were 10-7,10-6 and 10-5 mol/L.U87 cells formed the typical vasculogenic mimicry tube structure at 6-8 h after inoculation; the number of tube structure decreased with the increase ofatorvastatin concentration.Compared with the control group,the length counting of tube structure in intervention groups (10-7,10-6 and 10-5 mol/L) was significantly reduced and the mRNA and protein expression levels of MMP-2 were markedly decreased (P＜0.05).Conclusion Atovastatin significantly inhibits the vasculogenic mimicry formation via down-regulating the MMP-2 expression level.
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ObjectiveTo investigate the relation between each subtype of cerebral ischemic stroke classified by NEW-TOAST criteria and the levels of blood sugar. MethodsA retrospective study in 624 patients hospitalized with acute cerebral ischemic stroke. All the patients were classified using NEW-TOAST classification standard. Blood glucose in patients with different stroke subtypes was recorded, and analyzed for the incidence of abnormal glucose metabolism in each subtype. The correlation of glucose to blood sugar,blood pressure and blood fat was analyzed using odd ratio (OR) and 95％ confidence intervals (CI).Results(1) Among 624 patients, the most common stroke subtype by NEW-TOAST classificationis atherothrombosis (AT), followed by small arterial occlusion (SAO). One hundred and nineteen patients (19. 1％ ) had diabetes history; another 40 patients(7.5％ ) were newly diagnosed with diabetes in this study; and 71 patients ( 11.4％ ) were found to have glycoregulation abnormality. The incidence of abnormal glycometabolism was high in patients with AT ( 40. 4％ ) and SAO ( 39. 7％ ). ( 2 ) Association analysis between stroke subtypes and blood sugar: x2 =14. 83,P =0. 020, r =0. 152; in SAO patients, OR was 1. 925 (95％ CI 1. 392-2. 664) ; in the patients with AT, there was no correlation to blood sugar levels.Association analysis of high blood pressure in stroke subtypes: in AT patients, OR was 2. 874 (95％ CI 1. 957-4. 222) ; in SAO, OR was 1. 609 (95％ CI 1. 100-1. 235). Association analysis of high LDL-C in each subtype: OR in SAO was 1.419 (95％ CI 1.026-1. 962) ;No significant correlation of LDL-C in AT patients, P =0. 929 ; (3) There is significant difference of frequency of abnormal glycometabolism between stroke subtypes: x2 =17. 79 ,P =0. 000; between AT and SAO patients, x2 =0. 024,P =0. 877; between AT or SAO patients to other three subtypes, P ＜ 0. 05. ConclusionsAmong the subtypes of cerebral ischemic stroke by NEW-TOAST classification, AT and SAO are the most common subtypes.All the subtypes have correlation to the high level of blood sugar, and SAO has the highest correlation to blood sugar levels. High blood pressure may affect both large vessels and small vessels, while high LDL-C may mainly affect small vessels.
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The special nature of medical care determines the high riskiness of the medical profession that is lacking in other professions. In view of the high-techness and high riskiness of the medical profession, it is only proper to start thinking about setting up corresponding mechanisms for guarding against and dissolving the risks so as to safeguard the legitimate rights of the doctors. Guarding against and dissolving risks of the medical profession fall into a systematic framework of regulations and legal arrangements that are composed of mechanisms for dispersing risks of the medical profession, mechanisms for sharing medical liabilities and systems of medical care and social security.