Objective To investigate the effect of atorvastatin on cytochrome c (CytC) expression and neuronal apoptosis after intracerebral hemorrhage in rots.Methods A total of 108 male Sprague-Dawley rats were randomly allocated into 3 groups:sham operation group,saline control group,and atorvastatin group (n =36 each group).All the groups were redivided into 6 h,12 h,day 1,3,5 and 7 time points (n =6 at each time point).An intracerebral hemorrhage model was induced by using a modified two-step injection method.After modeling,atorvastatin was used for gavages (20 rng/kg,once a day) in the atorvastatin group.The saline control group was given the same volume of saline.Behavior evaluation was used for neurological score.TUNEL staining was used to detect apoptosis in perihematoma tissue.Immunohistochemical method was used to detect the CytC expression in perihematoma tissue.Results Behavior evaluation showed that the neurological scores decreased gradually with the passage of time in the atorvastatin group and the saline control group.There were no significant differences at 6 h,12 h,day 1 and day 3,but the neurological scores in the atorvastatin group were significantly lower than those in thc saline control group at day 5 (0.50 ± 0.55 vs.1.50 ± 0.55; t =3.162,P =0.010) and day 7 (1.00 ±0.63; t =2.712,P =0.022).TUNEL staining showed that the numbers of apoptotic cells increased first and then decreased in the saline control group and the atorvastatin group.They reached the peak at 1 hour after modeling.There were significant differences in the number of apoptotic cells in each group in perihematoma tissue at the same time point (all P =0.000),and the significance in the saline control group was more than that in the sham operation group and the atorvastatin group (all P ＜0.05),but at day 7,there was no significant difference in the number of apoptotic cells between the atorvastatin group and the sham operation group (12.69 ± 3.35 vs.9.33 ± 2.07; P =0.148).Immunohistochemical method showed that the numbers of CytC positive cells increased first and then decreased in the saline control group and the atorvastatin group,reached the peak at 12 h after modeling in te saline control group (68.19 ± 11.93) and at 1 d in the atorvastatin group (35.64 ± 9.12).There were significant differences in the numbers of CytC positive cells in perihematoma tissue at the same time point in each group (P =0.000).The numbers of CytC positive cells in the saline control group was significantly more than that in the sham operation group and the atorvastatin group (all P ＜0.05),but there was no significant difference in the numbers of CytC positive cells between the atorvastatin statin group and the sham group at day 7 (16.08 ± 3.80 vs.13.67 ± 2.94; P =0.349).Conelusions Atorvastatin may inhibit the release of CytC of nerve cells in perihematoma tissue after intracerebral hemorrhage,and thus reduce CytC-mediated apoptosis and neurological deficit after intracerebral hemorrhage.

Objective To investigate the risk factors for nosoeomial pneumonia in elderly stroke patients(aged 60 years and over). Methods The clinical data of 259 patients with nosoeomial pneumonia from Jan 2002 to June 2007 were collected and the risk factors were retrospectively analyzed. Results The morbility rate of nosocomial pneumonia in elderly stroke patients was 41.3%,and the risk factors were aging,Iong hospitalization,unconsciousness,type of stroke,and underlying diseases,smoking,tracheal intubation,tracheotomy,application of respiratory machine (all P＞0.05). Conclusions The morbility rate of nosoeomial pneumonia in elderly stroke patients was high,and the risk factors are aging,long hospitalization,unconsciousness,type of stroke,and underlying diseases,smoking,tracheal intubation,tracheotomy,application of respiratory machine.

Objective To analyze the mierosurgery treatment and prognosis of cavernous hemangioma loca-ted in pons. Methods 12 cases with cavernous hemangioma located in ports underwent mierosurgery. 11 lesions lo-cated in dorsal tons were resected through midline suboccipital trans- rhomboid fnssa approach. 1 lesion located in ventrolateral pous was resected with suboceipital retrosigmoid approach. Results All the 12 cavernous hemangiomns were rosected totally and confirmed by the postoperative pathology. Clinical improvement was gained in 6 cases, no change in 3 ,aggravation of facial palsy in 1 ,death in 1. The mean follow-up time was 3 months,and Mill scan dem-onstrated good restoration of brain stem tissue with no recurrence signs of lesion. The symptoms due to the operation recovered to some extent. Conclusion The cavernous hemangioma located in brain stem can be resected safely and effectively given the selection of surgical indication and optimal surgical approach.

Objective To investigate the effects of intranasal administration of heparin-binding epidermal growth factor-like growth factor (HB-EGF) on expressions of nestin and caspase-3 in the perihematomal tissue after intracerebral hemorrhage in rats. Methods A total 36 adult male Sprague-Dawley rats were randomly divided into 3 groups: an HB-EGF group, a control group, and a sham operation group (n = 12 in each group). Then they were further divided into 4-, 7-, and 10-day subgroups (n = 4 in each subgroup). A model of intracerebral hemorrhage was induced by injecting type Ⅳ colagenase. At 1 to 3 days after modeling, the HB-EGF group was intranasaly administrated HB-EGF. The control group was administrated the same volume of saline. The Bederson score was conducted at the corresponding time points and the rats were sacrificed after the forelimb placing test. Immunohistochemistry was used to detect the expression of nestin and caspase-3 in the perihematomal tissue. Results The sham operation group did not have neurological deficits. The Bederson scores (P < 0. 05) and the result of forelimb placing test (al P < 0. 01) at day 4 and 7 in the HB-EGFgroup were better than those in the control group. There were no significant differences at day 10. At day 4, 7, and 10, the number of nestin positive cels in the perihematomal tissue in the HB-EGF group was significantly more than that in the control group (al P < 0. 05), and the number of caspase-3 positive cels was less than that in the control group (al P < 0. 01). Conclusions Intranasal administration of HB-EGF can improve the early neurological function, upreguate the nestin expression and downregulate the caspase-3 expression in the perihematomal tissue after intracerebral hemorrhage in rats, indicating that intranasal administration of HB-EGF may promote the proliferation of precursor cels and decrease cel apoptosis in the perihematomal tissue.

Objective To investigate whether nimodipine could reduce complications after microvascular decompression in patients with hemifacial spasm. Methods 220 patients with hemifacial spasm , admitted into our hospital from May 2011 to Oct. 2013 , were all treated by microvascular decompression. They were divided randomly into two groups. Patients in the treatment group were treated with nimotop 50 mg/d after the operation for the first 3 days, then was orally taken 30 mg/d for a week. Patients in the control group were treated with the same after the operation without nimodipine. The postoperative complications including hearing deficit and peripheral facial paralysis were closely observed within three months after operation. Results The total effective rate was 100% in both groups. The incidence rate of peripheral facial paralysis and hearing deficit in treatment group was significant lower than that of the control group (P < 0.05). Conclusion Nimodipine has significant effect on reducing the incidence rate of peripheral facial paralysis and hearing deficit after microvascular decompression in patients with hemifacial spasm.

Purpose To investigate the diagnostic value of high-resolution CT reconstruction techniques on the same slice in hypertrophy of transverse process of the fifth lumbar vertebra (HTPL5V), and to provide a basis for clinical diagnosis and treatment. Materials and Methods Twenty-two cases of clinically diagnosed HTPL5V and 20 normal adults were examined with GE LightSpeed 16-slice spiral CT (36 cases) and Philips iCT 256-slice (6 cases). L5 transverse process and the fifth lumber nerve were reconstructed and observed on the workstations. Results In 22 cases of HTPL5V, there were 26 pseudarthrosis formation and 2 sides with L5 transverse process touching the sacral ala. In 28 sides the iffth lumber nerve traveled through false foramina of the HTPL5V including 6 cases of bilateral compression and 16 cases of unilateral compression. In 21 cases, the nerve was compressed by hyperosteogeny on 27 sides (96.4%) and 1 side due to stenosis (3.6%). On 25 sides (89.3%) the compressed nerves were curved in shaper. There was bulging and/or herniated lumbar disc on 9 sides in 7 cases (32.1%). Conclusion High-resolution CT reconstruction techniques can demonstrate the iffth lumbar nerve of HTPL5V and provide evidence for clinical diagnosis and treatment.

Three cases of Langerhans cell histiocytosis (LCH)with central diabetes insipidus as the first manifestation were reported, with the summary of their clinical manifestations, laboratory examinations, imaging examinations, pathological results, diagnosis process, and treatment response. All three patients presented with central diabetes insipidus in the early stage. The pituitary magnetic resonance imaging (MRI)showed thickened pituitary stalks, and all lost the normal high signal of the posterior pituitary. Two patients showed isolated hypothalamic-pituitary lesions, while one case showed pituitary and thyroid systems involvement. Pathological findings showed typical Langerhans cells, immunohistochemistry showed positive for S-100, CD1a, Langerin. The clinical manifestations of LCH manifested distinct heterogeneity, which is easy to be misdiagnosed and left out. The diagnosis should be confirmed by pathological examination. The biopsy of isolated hypothalamic-pituitary lesions is difficult. It is recommended to actively screen other organs to increase the probability of biopsy. LCH-induced neurohypophysis requires life-long hormone replacement therapy.

Objective:To report the diagnosis, treatment, and follow-up of a 21-hydroxylase deficiency boy with central precocious puberty caused by complex heterozygous mutation of CYP21A2 gene.Methods:The child was symptomatic of rapid growth and secondary sexual characteristics at the age of 6. The diagnosis of central precocious puberty was confirmed by serum testosterone, gonadotropin levels, and gonadotropin-releasing hormone (GnRH) stimulation test. 21-hydroxylase deficiency was diagnosed clinically based on the serum adrenocorticotropic hormone (ACTH), 17-hydroxyprogesterone levels, and images on the computed comography (CT) of the adrenal glands.Results:The CYP21A2 gene was detected to have a compound heterozygous mutation by Sanger sequencing and multiplex ligation-dependent probe amplification. During the 3 years follow-up, the effects of glucocorticoids, GnRH analogs, and recombinant human growth hormone were regularly monitored and evaluated.Conclusions:Glucocorticoid replacement followed the principle of the lowest effective dose. GnRH analogs showed an effective inhibition of the hypothalamus-pituitary-gonadal axis, while recombinant human growth hormone had no such growth-promoting effect.

The study was initiated from a child with diabetes. After we collected his clinical data and traced back his family history of diabetes, a clinical diagnosis of maturity-onset diabetes of the young(MODY)was made. To amplify and sequence the target gene, the genomic DNA was extracted from the anticoagulant blood samples of the patient and his first-degree relatives, revealing a missense mutation(c.779C>T)in exon 4 of hepatocyte nuclear factor-1α in the proband and his father. The above sequencing result confirms the diagnosis of MODY3. During one year follow-up, the proband achieved the strict control of blood glucose with the use of repaglinide and his father got a notable improvement of blood glucose after his drug was shifted to the long-acting sulfonylurea.

Objective:To explore the clinical characteristics and risk factors of abnormal urinary albumin/creatinine ratio(UACR) in obese population.Methods:Baseline data from 2011 to 2012 in Henan Sub-center of"Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal(REACTION) study"were utilized and those of body mass index≥28 kg/m 2 were screened. The patients were divided into UACR normal group and UACR abnormal group(101 pairs) upon being matched on a 1∶1 basis by age and gender. Multivariate logistic regression analysis, receiver operating characteristic(ROC) curve, and restricted cubic spline(RCS)analysis were performed to explore the risk factors for abnormal UACR. Results:Compared with the normal UACR group, the UACR abnormal group had a higher number of alcohol consumers, a higher prevalence of hypertension, elevated systolic blood pressure, and triglyceride(all P<0.05). Multivariate logistic regression analysis showed that alcohol consumption( P=0.008), systolic blood pressure( P<0.001), triglyceride( P=0.049), and homeostasis model assessment for insulin resistance(HOMA-IR, P=0.033) were independent risk factors for abnormal UACR in obese people. The ROC curve analysis indicated that systolic blood pressure had the strongest diagnostic performance as a single factor(ROC curve area=0.801), and there was no significant difference in diagnostic performance compared to multiple factors combination. RCS analysis results showed that the probability of abnormal UACR increased monotonically with the increase of systolic blood pressure when the systolic blood pressure was between 130 and 158 mmHg(1 mmHg=0.133 kPa). When systolic blood pressure was not in the interval, the probability of abnormal UACR did not change significantly. The results of regression analysis of triglyceride subgroup showed that when triglyceride level was greater than or equal to 5.6 mmol/L, the risk of abnormal UACR level was significantly increased( P=0.029). Conclusion:Systolic blood pressure, triglyceride, HOMA-IR, and alcohol drinking history are independent risk factors for abnormal UACR in obese people. When systolic blood pressure is≥130 mmHg or triglyceride is≥5.6 mmol/L, the risk of abnormal UACR is significantly increased.