The silent cerebral infarct is an clinic symptom that is so slight or transitory as to be easily neglected. There are only neural symptoms and signs,but irresponsible infarct focus can be seen on image. The risk factors of silent cerebral infarct may be the same as those of symptomatic cerebral infarct. Such infarct is likely to influence the course, clinic symptom and prognosis of acute cerebral infarct and may foretell symptomatic cerebral infarct and deteriorate into pseudo-global paralysis or multi-infarcted dementia. Therefore elder who suffer from hypertension or diabetes and experience vertigo, headache, language barrier but without apparent signs and symptoms should receive cerebral CT or MRI. Minor or third-degree precautionary measures can be taken as a chief therapy for cerebral infarct. Alternatively vitamines B_6,B_(12) and folic acid can be supplied to reduce the chance of hyperhomocysteinemia. Headache is the initial symptom in silent brain infarct. Magnesium is effective when dehydration does not work.

Objective To evaluate the clinical outcomes and report the second-look arthroscopic findings of reconstructed anterior cruciate ligament (ACL) using deep-frozen allograft.Methods Sixty-six patients undergoing ACL reconstruction using deep-frozen allograft in our institute with at least twelve months follow-up from January 2012 to March 2016 were included and received second-look arthroscopy.The patients consisted of 51 males and 15 females with an average age of 30.6 years (range,18 to 55 years) at the time of ACL reconstruction.Knee functions were evaluated by Lysholm score and International Knee Documentation Committee (IKDC) score.Knee stability was evaluated by drawer test,Lachman test and KT-1000 arthrometer.Second-look arthroscopic evaluation was performed in all patients,focused on continuity of the reconstructed ACL,the synovial coverage and subjective tension of the graft,and the prevalence of cyclops-like lesion and other changes after reconstruction procedures.Resuits All patients were followed up for average 18.3 months (range,12 to 36 months).Thirty-one patients underwent second-look arthroscopy from 12 to 18 months,and the other 35 patients underwent second-look arthroscopy from 18 to 36 months after ACL reconstruction.No infection,rejection reaction and other serious complication were reported after operation.The knee range of motion was normal in all cases,except that 10° extension limitation in one case.The Lysholm score significantly improved from preoperative 54.95±9.01 to 12 months postoperatively 86.14±5.86,and the IKDC improved from 54.79±9.12 to 85.11±5.77.Lachman test was positive in 8 cases,but negative in 58 cases postoperatively.KT-1000 arthrometer measurement showed that the side-toside difference significantly improved from preoperative 6.70± 1.24 mm to postoperative 1.52± 1.02 mm.Complete discontinuity occurred in 2 cases of the reconstructed grafts,graft tear in 4 cases.Cyclops-like mass was identified in 2 cases.The overall synovial coverage was slightly better in the patients who were followed up more than 18 months than those less than 18 months.However,there was no significant difference among the groups in the field of graft tension.The patients with taut grafts showed statistically better KT-1000 values (1.14±0.35 mm) than those with lax grafts (2.95±1.38 mm).Conclusion Frozen allograft could be a reasonable choice for ACL reconstruction.However,the graft integration and remodeling could tend to be slow.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; Treatment Outcome ; Young Adult

Objective To explore the diagnosis,treatment options and outcomes of patients with ureteropelvic junction obstruction(UPJO)and ureterovesical junction obstruction(UVJO). Methods Clinical records of 12 children with UPJO and UVJO who received treatment in Children′s Hospital of Nanjing Medical University from April 2008 to December 2015 were reviewed. Presentations included prenatal hydronephrosis and symptoms caused by urinary tract in-fections. Ultrasonography,intravenous pyelography,magnetic resonance imaging and renography were performed before surgery. Results Four patients underwent nephrostomy,followed by pyeloplasty and eventually,ureteroneocystostomy. Five patients underwent heterochronic pyeloplasty plus ureteroneocystostomy. Two patients received pyeloplasty only. And another patient underwent heterochronic nephrostomy plus ureteroneocystostomy. The 12 patients received a 2. 0 months to 2. 5 years′ follow - up. Recurrent urinary tract infection and abdominal pain were relieved after the treatment. Ultrasonography showed hydronephrosis reduced obviously after the surgery. Conclusions UVJO patients with unparallel hydronephrosis should be considered with the coexistence of UPJO. Retrograde pyelography(RPG)is recommended for the diagnosis. And the treatment includes both pyeloplasty and ureteroneocystostomy. The patients diagnosed with UPJO should be first managed with pyeloplasty or nephrostomy instead of RPG. Subsequently anterograde pyelography can be performed to decide if the patients need additional ureteroneocystostomy.

Objective To enhance the diagnosis of cerebral infarction of the hematopathy patient by analyzing its causes and MRI manifestations.Methods Totally 36 hematopathy patients with cerebral infarction from April 2010 to November 2015 had their data discussed retrospectively on involved vessel,anatomic distribution and MRI manifestations.Results Of the 36 patients,12 ones had only an artery involved in and 24 ones had multi arteries affected,31 ones had multi cerebral infarction foci and 5 ones had single focus.The foci had high or slighdy high signals in T2WI and very high signals in DWI,and there were no enhancement or only gyrus-like enhancement around the foci found by enhanced scan.Conchusion MRI gains advantages over CT when used to diagnose and find the hematopaty patient with cerebral infarction,when it has to be differentiated with cerebral early infection and parenchymal infiltration.It's suggested that the hematopathy patient has to undergo MRI examination in case central nervous system symptoms especially cerebral infarction occur.

Objective:To establish a real-time fluorescent quantitative PCR for the detection of torque teno virus types 7 (TTV7), 8 (TTV8) and 10 (TTV10) and analyze its performance in clinical sample detection.Methods:Specific primers were designed based on the gene sequences of TTV7, TTV8 and TTV10 in GenBank. Recombinant plasmids of pMD19-T-TTV7, pMD19-T-TTV8 and pMD19-T-TTV10 were constructed and used as positive standard control to establish a real-time fluorescent quantitative PCR based on FAM-Eclipse probe method. The specificity and sensitivity of the established method were evaluated. Moreover, it was validated in terms of clinical sample detection.Results:The standard curve equations of the real-time fluorescent quantitative PCR for detecting TTV7, TTV8 and TTV10 were y=-0.340 2 x+ 114.780 0 ( R2=0.998 8), y=-0.351 1 x+ 114.940 0 ( R2=0.995 3) and y=-0.348 9 x+ 115.020 0 ( R2=0.991 7), respectively, and there was no cross-reaction with other viruses. The detection sensitivity of the established method for TTV7, TTV8 and TTV10 were 108 copies/μl, 84 copies/μl and 98 copies/μl, and the positive detection rates in clinical pediatric serum samples were 10.9%, 2.1% and 4.3%, respectively. Conclusions:The established real-time fluorescent quantitative PCR for detection of TTV7, TTV8 and TTV10 was featured by strong specificity and high sensitivity, which could be used for rapid TTV detection in clinical serum samples.

Objective To explore the effect of pulmonary rehabilitation on activities of daily living(ADL)and pulmonary function in patients with chronic schizophrenia complicated with pulmonary infection at stable stage. Methods From January,2014 to July,2017,62 patients with chronic schizophrenia complicated with pulmonary infec-tion at stable stage were randomly divided into control group(n=31)and observation group(n=31).Both groups accepted routine medication,while the observation group received pulmonary rehabilitation for two months in ad-dition.The distance of 6-Minute Walk Test(6MWT),the modified Barthel index(MBI),modified British Medi-cal Research Council Dyspnea Scale (mMRC), C-reactive protein (CRP), Zung Anxiety Self-Rating Scale and Zung Depression Self-Rating Scale were compared before and after training. Results The total effective rate was higher in the observation group than in the control group(χ2=5.415,P=0.020).Com-pared with the control group,the distance of 6MWT increased(t=5.463,P=0.008),the score of MBI increased(t=2.142, P=0.028), the score of mMRC decreased (t=3.689, P=0.013), and the level of CRP decreased (t=-2.179,P=0.031)in the observation group.The scores of Zung Anxiety Self-Rating Scale(t=5.048,P=0.009) and Zung Depression Self-Rating Scale(t=-1.388,P=0.045)both decreased. Conclusion An early implementation of pulmonary rehabilitation could improve ADL and the exercise endurance,and reduce the incidence of infection in patients with chronic schizophrenia complicated with pulmonary infection at stable stage.

OBJECTIVETo investigate the impact of penile surgery on the erectile function of the patient and to evaluate the role of small-dose vardenafil in restoring the impaired penile erection.

METHODSSixty cases of penile cavernosum surgery were equally and randomly divided into a vardenafil and a control group, the former treated 5 - 7 days after surgery with 10 mg vardenafil every other day, while the latter given vitamin E at 100 mg once a day, both for 12 weeks. The penile erectile function of the patients was evaluated with the IIEF-5 questionnaire before surgery and at 3 and 6 months after vardenafil medication.

RESULTSThe mean IIEF-5 scores of the vardenafil group were 18.83 +/- 2.98 and 20.13 +/- 2.98 at 3 and 6 months after vardenafil medication, significantly higher than 14.21 +/- 3.62 before surgery (P > 0.05), while that of the control group was significantly decreased at 3 months as compared with the preoperative score (13.38 +/- 2.82 versus 15.80 +/- 3.02, P < 0.05). The vardenafil group showed the highest IIEF-5 score after surgery (P < 0.05).

CONCLUSIONLong-term administration of small-dose vardenafil after penile surgery helps to restore and maintain penile erectile function.

Adult ; Erectile Dysfunction ; drug therapy ; Humans ; Imidazoles ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Penile Erection ; Penis ; surgery ; Piperazines ; administration & dosage ; therapeutic use ; Postoperative Period ; Recovery of Function ; Sulfones ; administration & dosage ; therapeutic use ; Treatment Outcome ; Triazines ; administration & dosage ; therapeutic use ; Vardenafil Dihydrochloride ; Vasodilator Agents ; administration & dosage ; therapeutic use

BACKGROUNDGenetic variability in the renin-angiotensin-aldosterone system may modify renal responses to injury and disease progression. The angiotensin I-converting enzyme (ACE) gene insertion/deletion (I/D), the angiotensinogen (AGT) gene, M235T, the aldosterone synthase (CYP11B2) gene, C-344T, and the angiotensin II type 1 receptor (AT1R) gene, A1166C, have been shown to be associated with IgA nephropathy (IgAN) and its progression. We determined the presence of these polymorphisms in 130 Chinese patients with IgAN, including 47 patients with end-stage renal disease (ESRD) and 120 healthy Chinese subjects, to assess their impact on the susceptibility to disease and the liability of progression to ESRD.

METHODSGenotyping was performed with DNA isolated from peripheral leucocytes using polymerase chain reaction amplification of the polymorphic sequence, restriction enzyme digestion, and separation and identification of DNA fragments. Clinical data from renal biopsies were collected.

RESULTSACE, AGT, CYP and AT1R genotype distributions were similar in patients with IgAN and in controls. Comparing patients with ESRD (IgAN-ESRD) and those without ESRD (IgAN-non ESRD), there was a significant increase only in the ACE DD genotype (P < 0.05) among the four gene polymorphisms. There was significant dominance of the male (P < 0.05), more marked hypertension (P < 0.01), proteinuria (P < 0.01) and increased serum creatinine during renal biopsy (P < 0.01) in the IgAN-ESRD group.

CONCLUSIONAmong the ACE, AGT, AT1R and CYP gene polymorphisms, only the DD genotype may predispose the individual to increased risk of progression to ESRD in the Chinese population.

Adult ; Angiotensinogen ; genetics ; Asian Continental Ancestry Group ; genetics ; Cytochrome P-450 CYP11B2 ; genetics ; Female ; Genetic Predisposition to Disease ; Genotype ; Glomerulonephritis, IGA ; genetics ; Humans ; Kidney Failure, Chronic ; genetics ; Male ; Middle Aged ; Peptidyl-Dipeptidase A ; genetics ; Polymorphism, Genetic ; genetics ; Receptor, Angiotensin, Type 1 ; genetics ; Renin-Angiotensin System ; genetics

OBJECTIVETo explore the clinical characteristics of adult acute lymphoblastic leukemia (ALL), compare the efficacy of different induction regimens and analyze the prognostic factors.

METHODSData of 149 adult ALL patients hospitalized in our institute between June 1998 and December 2005 were retrospectively reviewed. The results were analyzed with the SPSS11.5 software.

RESULTS1) Out of 133 patients available immunophenotype data, 118 (88.7%) were B-ALL and 15 (11.3%) T-ALL. Cytogenetic analysis was performed in 105 patients, 40 cases (38.1%) of them had a normal karyotype and 65 (61.9%) chromosome aberrations. 2) 149 patients completed the VDCP, VDLP or VDCLP induction therapies (at least 4 weeks treatment for each), 140 (93.7%) of them achieved complete remission (CR) with the first course CR rates of 80.8%, 92.3% and 81.4% , respectively (P=0.618). CR rates in patients after the induction regimens with or without asparaginase were 95.5% versus 92.1% (P=0.566). With a median follow-up of 14.5 (1-75) months, the median disease free survival (DFS) was 12 (1-74) months and median overall survival (OS) 17.5 (1-97) months. DFS of the three regimen groups at 3 and 5 years were 18.5% and 14.8%, 24.7% and 9.9%, 39.5% and 39.5%, respectively (P=0.0066). 3) COX regression analysis showed that the age (over 40 years), white blood cell (WBC) count ( > 40 x 10(9)/L) , t(9;22) (q34;q11)-positive and less than 4 courses consolidation chemotherapy were the unfavorable prognostic factors.

CONCLUSIONSMost adult ALL patients are B-ALL and karyotype have more changed. More than 90% patients can achieve CR with induction regimens consisting of 4 or 5 drugs. Induction regimens containing L-asparaginase may not affect the CR rate, but can improve DFS and OS. Age and WBC at diagnosis, presence of t(9;22) (q34;q11) and the courses of post-remission treatment are important prognostic factors.

Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Young Adult