Shenyang Medical College Research Articles

Study on the efficacy of 3D printing technology combined with customized plates for the treatment of complex tibial plateau fractures

BackgroundAnatomical reduction and stable fixation of complex tibial plateau fractures remain challenging in clinical practice. This study examines the efficacy of using 3D printing technology combined with customized plates for treating these fractures.MethodsWe retrospectively analyzed 22 patients treated with 3D printing and customized plates at the Orthopedic Department of the Central Hospital affiliated with Shenyang Medical College from September 2020 to January 2023. These patients were matched with 22 patients treated with traditional plates with similar baseline characteristics. Patients were divided into an experimental group (3D-printed models and customized plates) and a control group (traditional plates). The control group underwent traditional surgical methods, while the experimental group had a preoperative 3D model and customized plates for surgical planning. We compared baseline characteristics and recorded various indicators, including preoperative preparation time, surgical time, intraoperative blood loss, number of intraoperative fluoroscopies, hospital stay duration, fracture healing time, complications, knee joint range of motion (ROM), Rasmussen anatomical and functional scores, and HSS scores.ResultsAll surgeries were successful with effective follow-up. The experimental group had shorter surgical time, less intraoperative blood loss, and fewer intraoperative fluoroscopies (P < 0.05). At 6 months and 1 year postoperatively, the experimental group had better knee joint HSS scores than the control group. Preoperative preparation time and total hospital stay were shorter in the control group (P < 0.05). There were no significant differences in fracture healing time and follow-up duration between groups. The experimental group showed better knee joint flexion angles (P < 0.05). Rasmussen scores showed no statistical difference between groups (P > 0.05). The incidence of complications was slightly lower in the experimental group but not significantly different.Conclusion3D printing technology combined with customized plates for complex tibial plateau fractures enables precise articular surface reduction, significantly shortens surgical time, and reduces intraoperative blood loss. This method improves knee joint function, offering a more effective treatment option.

Early Diagnosis of High-Risk Chronic Obstructive Pulmonary Disease Based on Quantitative High-Resolution Computed Tomography Measurements.

Quantitative computed tomography (QCT) techniques, focusing on airway anatomy and emphysema, may help to detect early structural changes of COPD disease. This retrospective study aims to identify high-risk COPD participants by using QCT measurements. We enrolled 140 participants from the Second Affiliated Hospital of Shenyang Medical College who completed inspiratory high-resolution CT scans, pulmonary function tests (PFTs), and clinical characteristics recorded. They were diagnosed Non-COPD by PFT value of FEV1/FVC >70% and divided into two groups according percentage predicted FEV1 (FEV1%), low-risk COPD group: FEV1% ≥ 95%, high-risk group: 80% < FEV1% < 95%. The QCT measurements were analyzed by the Student's t-test (or Mann-Whitney U-test) method. Then, feature candidates were identified using the LASSO method. Meanwhile, the correlation between QCT measurements and PFTs was assessed by the Spearman rank correlation test. Furthermore, support vector machine (SVM) was performed to identify high-risk COPD participants. The performance of the models was evaluated in terms of accuracy (ACC), sensitivity (SEN), specificity (SPE), F1-score, and area under the ROC curve (AUC), with p <0.05 considered statistically significant. The SVM based on QCT measurements achieved good performance in identifying high-risk COPD patients with 85.71% of ACC, 88.34% of SEN, 84.00% of SPE, 83.33% of F1-score, and 0.93 of AUC. Further, QCT measurements integration of clinical data improved the performance with an ACC of 90.48%. The emphysema index (%LAA-950) of left lower lung was negatively correlated with PFTs (P < 0.001). The airway anatomy indexes of lumen diameter (LD) were correlated with PFTs. QCT measurements combined with clinical information could provide an effective tool for an early diagnosis of high-risk COPD. The QCT indexes can be used to assess the pulmonary function status of high-risk COPD.

#3798 A MULTICENTER CLINICAL STUDY OF CELLULOSE TRIACETATE MEMBRANES AND POLYSULFONE MEMBRANE DIALYZERS IN MAINTENANCE HEMODIALYSIS PATIENTS

Abstract Background and Aims With the continuous improvement of dialysis membrane materials, polysulfone (PS) has replaced traditional cellulose membranes with excellent biocompatibility and dominates the market applications. In our clinical work, we found that the allergic reaction disappeared after the application of cellulose triacetate (CTA) in patients who were allergic to PS. In this study, we compared the differences in biocompatibility and solute clearance of CTA and PS dialyzers during long-term dialysis treatment. Method In this study, a multicenter clinical study was conducted, and patients attending Fuxin Mining Bureau Hospital, Northeast International Hospital and Shenyang Medical College Affiliated Central Hospital receiving maintenance hemodialysis from April 2019 to April 2020 were selected as the study population. The patients were divided into a polysulfone membrane group (n = 10) and a cellulose triacetate membrane group (n = 13) based on whether they tolerated the polysulfone membrane dialyzer, and all patients in the CTA group had an allergic reaction to the polysulfone membrane dialyzer. The effects of the two membranes on White Blood Cell (WBC), platelet (PLT), Hemoglobin(Hb), Complement3(C3), Complement4(C4), Tumor Necrosis Factor-α (TNF-α), Interleukin-1 (IL-1), interleukin-6 (IL-6), hypersensitive C-reactive protein (hs CRP), IgE, serum phosphorus (P), creatinine (CR), blood urea nitrogen (BUN), parathyroid hormone (PTH) were compared before and after the single dialysis session and after 12 months of dialysis,and Urea removal rate (URR) and spKt /V were calculated. Results There were no statistically significant differences between the two groups in the comparison of basic information such as age, gender, dialysis age and primary disease. Before the application of CTA and PS dialyzer treatment, there was no statistically significant comparison between groups for all observed indicators. After application of CTA and PS single dialysis: (i) The difference between the 2 groups of β2-MG (Z = -2.039, P = 0.041) and TNF-α (Z = -2.491, 0.013) was statistically different. (ii) There were no statistically significant differences between two groups in the comparison of hematological system, such as WBC, PLT, HB; complement, such as C3, C4; inflammatory factors, such as: IL-1, IL-6, hs CRP, IgE; uremic toxins, such as: P, CR, BUN, PTH (P&amp;gt;0.05). After the 12th month of regular hemodialysis treatment with PS and CTA: (i) The differences between the 2 groups for P (Z = -2.096, P = 0.036), BUN (Z = -2.038, P = 0.042), and spKt/V (t = -2.147, P = 0.049) were statistically significant. (ii) The difference between the 2 groups after 12 months of dialysis P (t = 0.114, P = 0.041) and before dialysis was statistically different between groups, and the other indexes mentioned above were not statistically different. Conclusion After a single dialysis session, TNF-αin the PS group was elevated and the biocompatibility of CTA was better than PS. The CTA group had better clearance of β2-MG than PS, and spKt/V reached the standard. After long-term dialysis, the effect of CTA on inflammation and complement system was not different compared with PS, and there was no difference in biocompatibility between the two membranes. spKt/V in the CTA group reached the standard, and the clearance of BUN and P was better than that of PS.

Associations between Abnormal Eating Styles and Irritable Bowel Syndrome: A Cross-Sectional Study among Medical School Students.

(1) Background: Few studies have investigated the association between eating styles and IBS. This study aimed to explore the association between abnormal eating styles and irritable bowel syndrome (IBS). (2) Methods: This cross-sectional study investigated students in China Medical University and Shenyang Medical College. Eating styles were evaluated by the Dutch Eating Behavior Questionnaire (DEBQ), and IBS was diagnosed according to Rome III criteria. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). (3) Results: A total of 335 students were diagnosed with IBS. Students with the total scores in tertile 2 and 3 had 1.29 times and 2.75 times higher risk of IBS than students with the total scores in tertile 1, respectively. Simultaneously, the risk of IBS in the tertile 3 of external eating, emotional eating, and restraint eating trends was 3.87 times, 2.71 times, and 3.82 times higher than that of tertile 1, respectively. (4) Conclusions: this study showed that a high score in both total eating styles and each eating style was associated with the odds of having IBS and suggested that the psychological factors behind eating styles may play a critical role in controlling the IBS.

The Role of Fever Clinics in the Strategic Triage of Suspected Cases of Imported COVID-19.

IntroductionNovel coronavirus pneumonia (COVID-19) is an acute respiratory infectious disease, which has the characteristic of human-to-human transmission and is extremely contagious. Correctly standardizing the process of early screening of infection or suspected cases in the fever clinic has become a key part of the fight against the pandemic.MethodsA retrospective analysis of patients in the fever clinic of Shenyang Medical College Affiliated Central Hospital from January 23 to March 1, 2020, was conducted in the present study.ResultsIt was found that 16 suspected cases of COVID-19 in the fever clinic were diagnosed with respiratory infections, accounting for 0.59%.ConclusionIn case of a negative result in the second nucleic acid test, strategic triage and typing might be more conducive for the following nucleic acid tests for suspected cases in order to prevent the spread of the epidemic caused by missed diagnosis.

PRF-RW: a progressive random forest-based random walk approach for interactive semi-automated pulmonary lobes segmentation

The computational detection of lung lobes from computed tomography images is a challenging segmentation problem with important respiratory healthcare applications, including emphysema, chronic bronchitis, and asthma. This paper proposes a progressive random forest-based random walk approach for interactive semi-automated pulmonary lobes segmentation. First, our model performs automated segmentation of the lung lobes in a progressive random forest network, eliminating the need for prior segmentation of lungs, vessels, or airways. Then, an interactive lobes segmentation approach based on random walk mechanism is designed for improving auto-segmentation accuracy. Furthermore, we annotate a new dataset which contains 93 scans (57 men, 36 women; age range: 40–90 years) from the Central Hospital Affiliated with Shenyang Medical College (CHASMC). We evaluate the model on our annotated dataset, LIDC ( https://wiki.cancerimagingarchive.net ) and LOLA11 ( http://lolall.com/ ) datasets. The proposed model achieved a Dice score of $$0.906 \pm 0.106$$ for LIDC, $$0.898 \pm 0.113$$ for LOLA11, and $$0.921 \pm 0.101$$ for our dataset. Experimental results show the accuracy of the proposed approach, which consistently improves performance across different datasets by a maximum of 8.2% as compared to baselines model.

Comparison of three teaching methods in critical care nursing teaching

Objective To explore the effects of lecture-based learning (LBL) , problem-based learning (PBL) and lecture-based learning plus problem-based learning (LBL+PBL) on nursing students′ emergency knowledge and skills learned in critical care nursing teaching. Methods Totally 60 college nursing students admitted by Shenyang Medical College in 2013 were selected and divided into three groups randomly and equally. Nursing students in the three groups received LBL, PBL and LBL+PBL, respectively. At the end of these courses, they were examined for relevant skills and theories. Results The skill and theory scores of the LBL group were (83.12±3.21) and (87.45±3.50) , respectively; the skill and theory scores of the PBL group were (86.45±4.50) and (86.85±4.55) , respectively; and the skill and theory scores of the LBL+PBL group were (87.25±3.41) and (89.85±2.89) , respectively (F=11.98, 3.66; P<0.05) . Conclusions LBL+PBL can strengthen nursing students′ theoretical knowledge and enable them to apply what they have learned in clinical analysis and practice, thus improving their overall competence. Key words: Critical care nursing; Lecture-based learning (LBL); Problem-based learning (PBL)

Influencing factors of alexithymia in Chinese medical students: a cross-sectional study

BackgroundA much higher prevalence of alexithymia has been reported in medical students compared with the general population, and alexithymia is a risk factor that increases vulnerability to mental disorders. Our aim was to evaluate the level of alexithymia in Chinese medical students and to explore its influencing factors.MethodsA cross-sectional study of 1,950 medical students at Shenyang Medical College was conducted in May 2014 to evaluate alexithymia in medical students using the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20). The reliability of the questionnaire was assessed by Cronbach’s α coefficient and mean inter-item correlations. Confirmatory factor analysis (CFA) was used to evaluate construct validity. The relationships between alexithymia and influencing factors were examined using Student’s t-test, analysis of variance, and multiple linear regression analysis. Statistical analysis was performed using SPSS 21.0.ResultsOf the 1,950 medical students, 1,886 (96.7%) completed questionnaires. Overall, Cronbach’s α coefficient of the TAS-20 questionnaire was 0.868. The results of CFA showed that the original three-factor structure produced an acceptable fit to the data. By univariate analysis, gender, grade (academic year of study), smoking behavior, alcohol use, physical activity, history of living with parents during childhood, and childhood trauma were influencing factors of TAS-20 scores (p < 0.05). Multiple linear regression analysis showed that gender, physical activity, grade, living with parents, and childhood trauma also had statistically significant association with total TAS-20 score (p < 0.05).ConclusionsGender, physical activity, grade, history of living with parents during childhood, and childhood trauma were all factors determining the level of alexithymia. To prevent alexithymia, it will be advisable to promote adequate physical activity and pay greater attention to male medical students and those who are in the final year of training.

Minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws for repair of distal radius fracture: study protocol for a randomized controlled trial

Background: Conventional open reduction internal fixation and external fixation are not ideal treatment options for distal radius fracture. Minimally invasive surgery for distal radius fracture results in less trauma than other techniques; fully threaded headless cannulated compression screws can increase the stability of fracture fragments and contribute to functional recovery after wrist fracture. In this proposed study, we hypothesize that minimally invasive closed reduction and internal fixation of distal radius fracture with fully threaded headless cannulated compression screws will promote functional recovery of the wrist joint. Methods/Design: In this prospective, randomized, controlled trial, we will recruit 60 outpatients with distal radius fracture from the Department of Orthopedic Surgery, Central Hospital Affiliated to Shenyang Medical College, China. Patients will be assigned to one of two treatment groups: C-arm fluoroscopy-assisted minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws (experimental group) or open reduction (palmar and dorsal incisions) and internal fixation with titanium plate (control group). Internal fixation will be maintained for 24 weeks in both groups. Our primary outcome measures will be X-ray and CT examinations 24 weeks after surgery. Secondary outcome measures include patient-rated wrist evaluation scores, used to evaluate wrist joint function; fracture healing time; and Visual Analogue Scale score, used to evaluate the severity of the patient's pain. Discussion: With this study we hope to confirm that minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws for distal radius fracture repair has advantages over conventional open reduction internal fixation with titanium plates, providing superior fragment stability and allowing for early rehabilitation exercise of the wrist joint, which improves recovery of function. We hope to show that minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws is the more suitable surgical method for repair of distal radius fracture. Trial registration: ClinicalTrial.gov identifier: NCT02784678. Ethics: The study protocol was approved by the Ethics Committee of Central Hospital Affiliated to Shenyang Medical College, China. The trial protocol will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Prior to the trial, patients and their family members will be informed of the risks and benefits of this trial. Signed informed consent will be obtained from each patient.

The optimal time window for the use and dosage of nimodipine for acute massive cerebral infarction: study protocol for a randomized controlled trial

Background: A neuroprotective effect of nimodipine on acute cerebral infarction has been confirmed, but there are few reports regarding the therapeutic effect of nimodipine on acute massive cerebral infarction. There is also no consensus on the optimal time window for the use and dosage of nimodipine. This trial is planned to answer these questions using a double-blind randomized controlled design. Methods/Design: This is a double-blind randomized controlled trial. The experiments will be conducted in the Department of Neurology, Central Hospital Affiliated to Shenyang Medical College of China. One hundred patients with acute massive cerebral infarction will be randomly assigned to a control group and a treatment group. Patients in the control and treatment groups will receive intravenous infusion of citicoline and intravenous infusion of nimodipine (10 mg/d) respectively, for 7 consecutive days. Simultaneously, to determine the appropriate time window for treatment with nimodipine, patients in the treatment group will be divided into four subgroups according to the time of nimodipine administration: 24 hours. The main outcome measures are: the National Institutes of Health Stroke Scale and the Rankin scale will be used to assess the severity and recovery of neurological impairment, respectively. Cranial computed tomography and magnetic resonance imaging will be used to evaluate brain lesions and the Barthel index will be used to assess the activities of daily living. Secondary outcome measures are heart rate and blood pressure. Discussion: It is hoped that the experimental results can determine the best application time window and dosage of nimodipine for acute massive cerebral infarction. Trial registration: ClinicalTrials.gov identifier: NCT02248233; registered on 22 September 2014.

The teaching effect of "organ-system-based curriculum" integrated model on clinical graduation field work

Objective To explore the teaching effect of Organ-system-based curriculum integrated model on clinical graduation field work. Method 150 clinical medical undergraduates of Grade 2009 from Shenyang Medical College selected, were randomly divided into the experimental group (75 persons) and the control group (75 persons). The experimental group adopted the means of theOrgan-system-based curriculum integrated model, namely practicing according to human organ-system and the control group accepted the traditional pattern of discipline centered practice during the clinical graduation internship. The two groups of students carried out questionnaire survey and comprehend examinations when the practice ended, and then statistics analysis (the chi square test, t test) was done by the SPSS 19.0 software between the two groups in order to explore the teaching effect. Result The students' satisfaction degree from six aspects of the questionnaire survey showed in the experimental group was significantly higher than that in the control group (the degree of recognition of practicing pattern: χ2=11.437, P=0.003; the architectonic integrality: χ2=9.881, P=0.007; the improvement of the autonomic learning ability χ2=9.643, P=0.008; the teaching method and means: χ2=11.006, P= 0.004; motivating learning interest: χ2=13.550, P=0.001; increasing the ability of clinical thinking: χ2= 13.309, P=0.001), and the average test scores of students from three parts of examination results showed by comprehend examinations (speculative knowledge examination: t=2.768, P=0.006; technical skill examination: t=2.212, P=0.029; clinical capability examination: t=5.015, P=0.000) in the experimental group was obviously higher than that in the control group and the difference was significant. Conclusion Organ-system-based curriculum integrated model on clinical graduation internship is generally approved by the students, which has significantly improved the students' clinical thinking ability, and the quality of graduation internship teaching. Key words: Organ-system-based curriculum; Clinical medicine; Graduation internship; Curriculum integration; Practical effect

Tangent function transformation of the Abbreviated Injury Scale improves accuracy and simplifies scoring.

IntroductionThe Injury Severity Score (ISS) and the New Injury Severity Score (NISS) are widely used for anatomic severity assessments after trauma. We present here the Tangent Injury Severity Score (TISS), which transforms the Abbreviated Injury Scale (AIS) as a predictor of mortality.Material and methodsThe TISS is defined as the sum of the tangent function of AIS/6 to the power 3.04 multiplied by 18.67 of a patient's three most severe AIS injuries regardless of body regions. TISS values were calculated for every patient in two large independent data sets: 3,908 and 4,171 patients treated during a 6-year period at level-3 first-class comprehensive hospitals: the Affiliated Hospital of Hangzhou Normal University and Fengtian Hospital Affiliated to Shenyang Medical College, China. The power of TISS to predict mortality was compared with previously calculated NISS values for the same patients in each data set.ResultsThe TISS is more predictive of survival than NISS (Hangzhou: receiver operating characteristic (ROC): NISS = 0.929, TISS = 0.949; p = 0.002; Shenyang: ROC: NISS = 0.924, TISS = 0.942; p = 0.008). Moreover, TISS provides a better fit throughout its entire range of prediction (Hosmer Lemeshow statistic for Hangzhou NISS = 29.71; p < 0.001, TISS = 19.59; p = 0.003; Hosmer Lemeshow statistic for Shenyang NISS = 33.49; p < 0.001, TISS = 21.19; p = 0.002).ConclusionsThe TISS shows more accurate prediction of prognosis and a linear relation to mortality. The TISS might be a better injury scoring tool with simple computation.

Prenatal Exposure to Organophosphate Pesticides and Neurobehavioral Development of Neonates: A Birth Cohort Study in Shenyang, China

BackgroundA large amount of organophosphate pesticides (OPs) are used in agriculture in China every year, contributing to exposure of OPs through dietary consumption among the general population. However, the level of exposure to OPs in China is still uncertain.ObjectiveTo investigate the effect of the exposure to OPs on the neonatal neurodevelopment during pregnancy in Shenyang, China.Methods249 pregnant women enrolled in the Central Hospital Affiliated to Shenyang Medical College from February 2011 to August 2012. A cohort of the mothers and their neonates participated in the study and information on each subject was obtained by questionnaire. Dialkyl phosphate (DAP) metabolites were detected in the urine of mothers during pregnancy to evaluate the exposure level to OPs. Neonate neurobehavioral developmental levels were assessed according to the standards of the Neonatal Behavioral Neurological Assessment (NBNA). Multiple linear regressions were utilized to analyze the association between pregnancy exposure to OPs and neonatal neurobehavioral development.ResultsThe geometric means (GM) of urinary metabolites for dimethyl phosphate (DMP), dimethyl thiophosphate (DMTP), diethyl phosphate (DEP), and diethyl thiophosphate (DETP) in pregnant women were 18.03, 8.53, 7.14, and 5.64 µg/L, respectively. Results from multiple linear regressions showed that prenatal OP exposure was one of the most important factors affecting NBNA scores. Prenatal total DAP concentrations were inversely associated with scores on the NBNA scales.?Additionally, a 10-fold increase in DAP concentrations was associated with a decrease of 1.78 regarding the Summary NBNA (95% CI, −2.12 to −1.45). And there was an estimated 2.11-point difference in summary NBNA scores between neonates in the highest quintile of prenatal OP exposure and the lowest quintile group.ConclusionThe high exposure of pregnant women to OPs in Shenyang, China was the predominant risk factor for neonatal neurobehavioral development.

Clinical significance of expression of tissue factor and tissue factor pathway inhibitor in ulcerative colitis.

To investigate the clinical significance of expression of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in ulcerative colitis (UC). Thirty UC specimens taken by colonoscopy from patients with active UC treated at the Department of Pathology, Central Hospital Affiliated to Shenyang Medical College from February 2010 to January 2012 were included in an experimental group, and 30 normal colon tissue samples taken by colonoscopy from non-UC patients were included in a control group. Expression of TF and TFPI in UC and normal colon tissue samples was detected by immunohistochemistry. The positive rate of TF in UC was significantly higher than that in normal colon tissue (63% vs 33%, χ(2) = 5.41, P < 0.05). The positive rate of TFPI in UC was also significantly higher than that in normal colon tissue (43% vs 17%, χ(2) = 5.08, P < 0.05). Positive rates of TF and TFPI expression in UC are significantly higher than those in normal colon tissue. TF and TFPI may play an important role in the pathogenesis of UC.

Red blood cell count as an indicator of microvascular complications in Chinese patients with type 2 diabetes mellitus

BackgroundRheological disorders of red blood cells (RBC) and decreased RBC deformability have been involved in the development of diabetic microangiopathy. However, few studies have evaluated the association of RBC count with microvascular complications in patients with type 2 diabetes mellitus (T2DM). The purpose of this study was to investigate the association of RBC count with microvascular complications in patients with T2DM.MethodsThis study involved 369 patients with T2DM: 243 with one or more microvascular complications and 126 without microvascular complications. Anticoagulated blood was collected and analyzed in an automated blood cell counter. The presence of risk factors for microvascular complications was determined.ResultsThe proportion of patients with microvascular complications increased as the RBC count decreased (P < 0.001). After adjustment for known risk factors for microvascular complications by logistic regression analysis, lower quartiles of RBC count were associated with a higher risk of microvascular complications compared with the reference group composed of the highest quartile (first quartile, odds ratio 4.98, 95% confidence interval 1.54–6.19, P = 0.008; second quartile, odds ratio 3.21, 95% confidence interval 1.17–5.28, P = 0.024).ConclusionA decreased RBC count is associated with microvascular complications in Chinese patients with T2DM. The RBC count is a potential marker to improve further the ability to identify diabetic patients at high risk of microvascular complications.

Studies on the criteria of two-way referral between hospital and community health-care service centerfor patients with cerebral hemorrhage: an analysis of 91 cases

This study aimed to study the criteria of two-way referral between tertiary-care hospital and community health-care service center for patients with cerebral hemorrhage and a protocol of implementation to promote its treatment and rehabilitation.The criteria of two-way referral between tertiarycare hospital and community health-care service center for patients with cerebral hemorrhage after surgical operation were formulated on a trial basis with mutual consultation by the department of neurosurgery,Shenzhou hospital affiliated to Shenyang Medical College and Hunhewan Community Health-Care Service Center,Heping district,Shenyang. Totally,91 patients of cerebral hemorrhage admitted to the hospital during October 2007 to September 2010 were recruited for the study,46 in the intervention group with two-way referral and 45 in the control group by self-referral determined by their family members.All the patients of the two groups were followed-up for three years.During the follow-up in the intervention group,40 of 46 (95％) patients could comply with taking medication ordered by physicians,ability of daily living remarkably improved by Barthel index in 21 (50％),physical function recovered well in 33 (79％),34 (81％) could insist in self-monitoring and 32 (76％) could visit physicians for regular consultation,all these being significantly better than those in the control group (64％,31％,28％,25％ and 25％,respectively) (P ＜0.01 ).Medical and rehabilitative cost for patients with cerebral hemorrhage accounted for 575 RMB yuan per month in intervention group,as compared to 2246 RMB yuan for those in control group.Two-way referral for patients with cerebral hemorrhage can reduce their medical cost and promote their better rehabilitation. Key words: Cerebral hemorrhage; Referral and consultation

Textual research on the modern circulation of Zhong jing quan shu (Zhongjing's Complete Works) block-printed edition in the Ming dynasty and collected in the library of China Medical University in modern times

The edition of Zhong jing quan shu (Zhongjing's Complete Works) recorded in the China Bibliography of Medical Books is different from the one in the Supplement to China Bibliography of Medical Books. The version of Zhong jing quan shu collected in the library of China Medical University is the Zhao Kai-mei's version of the Ming dynasty, printed after the Song version in Supplement to China Bibliography of Medical Books. This book was formally collected by the Manchuria Medical University on 8 November, 1936 (the 10th years of Japanese Showa). In 1945, Manchuria Medical University was taken over by the government of Kuomintang, and changed its name to National Shenyang Medical College. The Ministry of Public Health of Northeast People's government took over it in 1948, and merged into the China Medical University in June, 1949 together with its numerous rare ancient TCM books. All of them were borrowed by Liaoning College of Traditional Chinese Medicine in 1964. In March and April of 1970, these books were carried to Liaoyang, and then, to Shenyang in October. In 1978, the ancient books were retrieved by the China Medical University. Thus, the Zhao Kaimei's version of Ming dynasty of Zhongjing quan shu is preserved until today.

Wnt pathway in the formation of ischemic brain injury*: Interventional pathway of basic fibroblast growth factor

Background Basic fibroblast growth factor (bFGF) can reduce neuronal apoptosis following ischemia/reperfusion (I/R) injury. Mechanism of the phenomenon should be elucidated. Objective The goal of this study was to observe the effect of bFGF on the expressions of Dickkopf-1(DKK-1) and β-catenin in the Wnt pathway in hippocampal tissue of rats following brain I/R injury, in order to investigate the role of Wnt pathway in the formation of ischemic brain injury. Design Randomized controlled experiment. Setting Shenyang Medical College. Materials Thirty healthy 3 months old male Wistar rats, weighing 300–350 g, were provided by the Experimental Animal Center of Shenyang Medical College. Thirty rats were randomized into sham-operation group, model group and treatment group. Goat anti-rat monoclonal antibody β-catenin was purchased from SANTA CRUZ Company. BFGF was developed by Beijing SL Pharmaceutical Co., Ltd. Methods This experiment was carried out in the Shenyang Medical College between November 2005 and May 2006. ▪ Focal brain I/R by suture-occluded method was modeled in rats in the treatment group and model group. Their middle cerebral artery was occluded 1 hour and reperfused for 24 hours. While in the sham-operation group, only the right common carotid artery and external carotid artery of rats were occluded for 90 minutes. ▪ The rats in the treatment group were intraperitoneally injected with 10 μ/kg bFGF, and those in the other groups were intraperitoneally injected with the same amount of saline. Main outcome measures Following I/R 48 hours, the expressions of β-catenin and Dickkopf-1 mRNA in the neurons of hippocampal CA1 region by immunohistochemical SABC and RT-PCR. Results Following I/R 48 hours, the expressions of β-catenin and Dickkopf-1 mRNA in the neurons of hippocampal CA1 region was evaluated by means of immunohistochemical SABC and RT-PCR. ▪ Expression of DKK-1 mRNA in the sham-operation group was at low level, it was significantly higher in the model group compared to the sham-operation group; Expression of DKK-1 mRNA in the treatment group was significantly lower than that in the model group. ▪ Expression of β-catenin in the cerebral cortex and hippocampal cytoplasm of rats: The mean gray scale of β-catenin of model group was significantly lower than that of sham-operation group (74.27±2.65 vs. 111.36±5.39, P < 0.05); The mean gray scale of β-catenin of treatment group was significantly higher than that of model group (86.18±7.41 vs. 74.27±2.65, P < 0.05). Conclusion bFGF may influence Wnt pathway by participating in the regulation of DKK-1 mRNA and β-catenin expressions, and thereby protect neurons.

Correlation between carotid atherosclerosis and serum high-sensitivity C-reactive protein in patients with cerebral infarction

Background Some researches demonstrate that high-sensitivity C-reactive protein may be a risk factor to cause carotid atherosclerosis in patients with cerebral infarction. Inflammatory reaction may participate in formation of carotid atherosclerosis in patients with acute cerebral infarction. Objective To investigate the correlation between levels of serum high-sensitivity C-reactive protein and carotid atherosclerosis in patients with acute cerebral infarction accompanied with carotid atherosclerosis. Design Contrast observation between two groups. Setting Department of Neurology, Zhenzhou Hospital, Shenyang Medical College. Participants A total of 102 patients with acute cerebral infarction regarded as cerebral infarction group were selected from Department of Neurology, Shenzhou Hospital Affiliated to Shenyang Medical College from February 2005 to September 2006. There were 55 males and 47 females and their ages ranged from 55 to 86 years. All patients met the variously diagnostic points of cerebral infarction established by the Fourth National Cerebrovascular Disease Academic Meeting and were finally diagnosed with CT or MRI examination. Illness course was in an acute phase. A total of 96 healthy subjects were regarded as control group, including 51 males and 45 females aged from 48 to 78 years. All accepted subjects provided the confirmed consent. Methods ▪ Patients in the cerebral infarction group received carotid ultrasound Doppler examination and serum high-sensitivity C-reactive protein detection within 72 hours after onset. IMMAGE immune biochemical system and latex reinforcement particle-enhanced nephelometric immunoassay (PENIA) were used for quantitative detection of serum high-sensitivity C-reactive protein. ▪ Healthy subjects in the control group received the same detection. SEQUOIA512 color Doppler ultrasound (Siemens Company, USA) was used to detect carotid artery of all subjects so as to observe intima media thickness of artery and formation of artery atherosclerostic plaques. If artery atherosclerostic plaques were formed, their properties and amounts were determined based on the characteristics of light-echo signals. Evaluating criteria: Intima media thickness of artery was the vertical dimension from crossed face between lumen and tunica intima to crossed face between tunica media and tunica adventitia. Intima media thickness ≤ 0.9 mm was regarded as normal; 0.9 mm < intima media thickness ≤ 1.2 mm was regarded as thickening; when local eminence thickening was processed towards to lumen, the intima media thickness was more than 1.2 mm and plaque of tunica intima was formed at the same time. Properties of plaque were classified into 4 types: steady low-echo lipid malacoplakia, equal-echo fiber plaque, strong-echo or sound-imaging calcification hard plaque and unsteady-echo ulcer mixed plaque. Fiber plaque and calcification hard plaque were steady but malacoplakia and mixed plaque were unsteady. Main outcome measures Thickness of tunica media, characteristics of plaque and level of serum high-sensitivity C-reactive protein in carotid artery in two groups. Results All 102 patients with cerebral infarction and 96 healthy subjects were involved in the final analysis. ▪ Comparisons of level of high-sensitivity C-reactive protein: Level of high-sensitivity C-reactive protein in normal tunica media was higher in the cerebral infarction group [(4.66±1.55) mg/L] than the control group [(3.49±1.24) mg/L, t =2.541, P < 0.05]. In addition, level of high-sensitivity C-reactive protein in patients with thickening tunica media and plaque was not significantly different between the cerebral infarction group and the control group ( P > 0.05). ▪ Correlation between various degrees of vascular lesion and level of high-sensitivity C-reactive protein in the cerebral infarction group: Level of high-sensitivity C-reactive protein was statistically significantly higher in patients with thickening tunica media [(8.16±2.42) mg/L] than patients with normal tunica media [(4.66±1.55) mg/L, t =4.132, P < 0.01]. In addition, level of high-sensitivity C-reactive protein was statistically significantly higher in patients with carotid plaque [(12.08±3.85) mg/L] than patients with normal tunica media ( t =5.994, P < 0.01) and thickening tunica media ( t =4.197, P < 0.01). ▪ Levels of high-sensitivity C-reactive protein in patients with various kinds of carotid plaque: Level of high-sensitivity C-reactive protein was statistically significantly higher in patients with unsteady carotid plaque [(13.54±2.62) mg/L] than patients with steady carotid plaque [(8.61±3.71) mg/L, t =2.002, P < 0.05]. That was to say level of serum high-sensitivity C-reactive protein in patients who suffered acute cerebral infarction combined with carotid atherosclerosis especially carotid plaque was higher than that in those patients who did not have carotid lesions. This suggested that serum high-sensitivity C-reactive protein had a certain correlation with onset of carotid atherosclerosis in patients with acute cerebral infarction. Conclusion Serum high-sensitivity C-reactive protein certainly correlates with onset of carotid atherosclerosis in patients with acute cerebral infarction, while inflammatory reaction may participate in formation of carotid atherosclerosis in patients with acute cerebral infarction.

Changes of serum high sensitive C-reactive protein in patients with acute cerebral infarction

Background Serum high sensitive C-reactive protein (hs-CRP), which regards as a high sensitive mark of systemic inflammatory response syndrome, can provide a lot of valuable information for the treatment and prognosis of cerebrovascular disease. Objective To observe the differences of blood glucose, lipid, homocysteine and previous disease history among patients with acute cerebral infarction at various levels of hs-CRP and compare changes of hs-CRP of patients with various degrees of neurologic impairment. Design Contrast observation. Setting Department of Neurology, Shenzhou Hospital, Shenyang Medical College. Participants A total of 102 patients with acute cerebral infarction were selected from Department of Neurology, Shenzhou Hospital of Shenyang Medical College from February 2005 to September 2006, including 55 males and 47 females aged from 55 to 86 years. All accepted patients met the diagnostic criteria of cerebral infarction established by the Fourth National Cerebrovascular Disease Academic Meeting and were diagnosed with CT or MRI examination. All patients provided the confirmed consent. Based on clinical criteria of neurologic impairment established by the Fourth National Cerebrovascular Disease Academic Meeting, patients were randomly divided into mild group (0–15 points, n =46), moderate group (16–30 points, n =38) and severe group (31–45 points, n =18). In addition, based on hs-CRP level within 72 hours, patients were divided into normal group (hs-CRP ≤ 3 mg/L, n =53) and increasing group (hs-CRP > 3 mg/L, n =49). Methods ▪ 2 mL venous blood was selected from hospitalized patients in the next morning to separate serum. Quantitative measurement of hs-CRP was dealt with Latex Enhnced Turbidimetric Immunoassay (LETIA). ▪ Fasting venous blood was colleted from hospitalized patients in the next morning to measure numeration of white blood cells, fibrinogen, blood glucose, total cholesterol (TC), triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and homocysteine. ▪ Measurement data were compared with t test or analysis of variance. Main outcome measures ▪ Comparisons of serum biochemical indexes among patients with various levels of hs-CRP; ▪ comparisons of risk factors among patients with various levels of hs-CRP; ▪ comparisons of levels of hs-CRP among patients with various degrees of clinical neurologic impairment. Results A total of 102 patients were involved in the final analysis. ▪ Plasma fibrinogen and numeration of leucocytes were more in the increasing group than those in the normal group ( t =4.39, 3.54, P < 0.01); while, there were no significant differences of blood glucose, TC, TG, HDL-C, LDL-C and homocysteine between the two groups ( P > 0.05). ▪ Percentage of patients with hypertension and diabetes mellitus (DM) was higher in the increasing group than the normal group (χ 2=3.98, 4.23, P < 0.05); while, percentage of patients with smoking in the increasing group was not significantly different from that of patients in the normal group ( P > 0.05). ▪ Level of hs-CRP of patients with severe neurologic impairment was higher than that of patients with moderate neurologic impairment ( t =2.273, P < 0.05); that of patients with moderate neurologic impairment was higher than that of patients with mild neurologic impairment ( t =2.586, P < 0.05); that of patients with severe neurologic impairment was obviously higher than that of patients with mild neurologic impairment ( t = 4.913, P < 0.01). Conclusion ▪ With the increase of hs-CRP, plasma fibrinogen and numeration of leucocytes of patients with acute cerebral infarction is increased, especially, they are increased remarkably among patients who have history of diabetes mellitus and hypertension. ▪ Increase of level of hs-CRP can be regarded as one of marks to evaluate severity of acute stroke.