Silent cerebral infarction is widely exist in the elderly population.It is considered to be the early clinical stage of symptomatic stroke and cognitive impairment.The incidences of silent cerebral infarction are higher in patients with atrial fibrillation and after atrial fibrillation ablation.It is not clear whether anticoagulant therapy can prevent silent cerebral infarction and improve cognitive function in patients with atrial fibrillation.This article reviews the hot issues related to silent cerebral infarction and atrial fibrillation.

Objective To establish a new method for determination of copper, nickel, silver, lead, cadmium and mercury in water with solid phase extraction followed by rapid high performance liquid chromatography. Methods The copper, nickel, silver, lead, cadmium and mercury ions were pre-column derived by tera-(4-dimethylaminophenyl)-porphine (T4-DMAPP). These chelates were enriched by solid phase extraction with C18 cartridge and the 100 times enriched products of were obtained. The chelates were separated on a ZORBAX Stable Bound (4.6 mm?50 mm, 1.8 ?m) by gradient elution with methanol and THF as mobile phase at a flow rate of 2.0 ml/min and detected with photodiode array detector from 350-600 nm. Results The detection limits of nickel, copper, silver, lead, cadmium, and mercury were 3, 2, 4, 3, 1.5 and 3 ng/L respectively, the recovery rates were 92%-104%, relative standard deviations were 2.8%-3.5%. Conclusion This method can be applied to the determination of nickel, copper, silver, lead, cadmium, and mercury in water with good results.

Objective To study the value of plasma level of matrix metalloproteinase-9 (MMP-9) for the early diagno-sis of Kawasaki disease. Methods The difference in MMP-9 level was studied by retrospective nested case-control method between children with early Kawasaki disease, Henoch-Sch?nlein purpura (HSP) or respiratory infection, and healthy control children. The associations of MMP-9 with serum procalcitonin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also analyzed. The cutoff-value, sensitivity and speciifcity of MMP-9, ESR and CRP in diagnosis of Kawasaki disease were studied by ROC curve. The areas under ROC curves were compared among different diagnostic markers to deter-mine their signiifcances in diagnosis of Kawasaki disease. Results The plasma level of MMP-9 was increased in early phase of Kawasaki disease, and higher than that in children with HSP or respiratory infections and in healthy controls (P<0.05). If MMP-9, ESR and CRP cutoff value were set to be 90.23 ng/ml, 56.5 mm/h and 27.55 mg/L, the sensitivity, speciifcity and area under ROC curve was 83.3%, 86.4%and 0.904, 95.8%, 66.1%and 0.807, 83.3%, 74.6%and 0.789 respectively. The diagnostic performance of MMP-9 for Kawasaki disease was better than that of ESR and CRP. Conclusions The plasma level of MMP-9 is increased in the early stage of Kawasaki disease. The sensitivity and speciifcity of MMP-9 in diagnosis of Kawasaki disease are highest if cutoff value is set to be 90.23 ng/ml.

The sex difference in stroke is increasingly receiving attention. The incidence and prevalence of stroke in males are higher than in females. There are greater differences both among the age groups and populations. The incidences of cerebral infarction and intracerebral hemorrhage in males are higher than females, while the incidence of subarachnoidal hemorrhage is even higher in females. Studies have shown that mortality of stroke in males is higher; however,because the females are older and have more serious symptoms at the onset of stroke, therefore their prognosis is poorer. Poststroke depression is common in females and their quality of life is lower. Stroke in females is mostly involved in cerebral cortex; their atypical symptoms are more common. Both males and females can benefit from thrombolytic and stroke unit therapies. Females with cardioembolic stroke may benefit more from anticoagulant therapy.

Objective:To elucidate the effects of calcitonin gene-re la ted peptide(CGRP) on the gene expression of osteoprotegerin(OPG) and receptor ac tivator of nuclear factor-?B ligand(RANKL) in rabbit osteoblasts. Meth ods:Osteoblasts were cultured in media containing 10 -10～10 -7 mol/L of CGRP. After 24-hour incubation,semi-quanitative RT-PCR was perfor med to detect the expression of OPG and RANKL mRNA,and with ?-actin mRNA as th e internal control. Results:CGRP increased the mRNA expressio n of OPG with the maximal effect at the concentration of 10 -8～10 -7 mol/L. CGPR downgulated the mRNA expression of RANKL dose-dependantly.C onclusion:CGRP may regulate the activities of osteoclasts by regulating gene expression of OPG/RANKL.

Objective Some cases of lipid storage myopathy (LSM) are similar to the polymyositis(PM) in clinic.To study the muscle pathology is helpful as to making clear the diagnosis and elucidating the mechanism of the LSM. Methods 14 cases of LSM with high level of CK in serum were analyzed clinically and compared with their muscle morphological and histochemical changes.Results Muscle weakness and fatigue were the main complaints of these patients.Most of them had acute or sub acute onset,some of them had relapse courses.All of the muscle specimens showed typical accumulation of lipid in muscle fibers.Necrotic fibers were found in 9 cases,3 of them showed changes with the courses. Conclusion Muscle biopsies and histochemical studies are necessary to differentiate LMS with PM.The fiber necrosis and CK leakage in LSM may be caused by changes of the inter circumstance and the membrane disturbance of cells.

Objective To design and manufacture an external fixator for close reduction of fibu la and tibial fractures.Methods The all-ring reduction and fixation system made of duroplasts comprises three main parts:two reduction rings with gears and worms,two modulation frames to correct lateral or anteroposterior re-placement,and four connecting rods.By cranking the handle,the gears wi ll be driven,which may in turn shift t he modulation frame,then the needle co nnecting the bone with the frame can s hift the fracture ends in three dimen sions and six freedom degrees.After reduction,the fracture is fixed by the cro ssed needles linked to several groups of half-ring fixation arms,which can b e shifted and locked onto the linking rod properly.Results The apparatus was used in 32patients.All cases got anatomic reduction,and the curativ e ratio was 100%.Conclusion The external fixator for close reductio n of tibial and fibula fractures has g ood reduction and fixation effect,a nd the design provides a very good clinical therap eutic method for close reduction of t ibial and fibula fractures.[

ObjectiveTo investigate the clinical and pathological characteristics of dermatomyositis with muscular perifascicular atrophy (PFA).MethodsA series of 104 consecutive patients clinically and pathologically diagnosed as dermatomyositis by muscle biopsy in our laboratory from December,2003 to August,2011,were enrolled in this study. Muscle biopsy of all the enrolled patients had shown PFA of muscle fibers.ResultsAmong the 104 patients,34 were males and 70 were females with a mean age of 45 years old.Among them,8 cases had normal electromyogram;42 had normal serum creatine kinase level;11 were diagnosed as carcinoma;75 were found to be combined with interstitial lung disease (ILD).Based on morphologic changes of muscle biopsy,they were divided into pure PFA group with 54 cases and PFA plus focal damage group with 50 cases.Compared with the pure PFA group,there was prominent mononuclear cell infiltration into perimysial intermediate sized vessels and membrane attack complement (MAC) deposition in the intramuscular capillaries in the PFA plus group.Skin biopsy had been taken in 12 cases together with muscle biopsy and had shown the border effectof both PFA and interface dermatitis in muscle and skin.ConclusionsOur study suggests that chronic immune vascular damage and insufficiency in dermatomyositis may cause ischemia and focal myofiber damage in watershed regions. The incidence of ILD in our dermatomyositis patients with PFA is high.

Objective To assess the efficacy of mycophenolate mofetil (MMF) combined with low dose of hormone and lamivudine in the treatment of hepatitis B virus associated glomerulonephritis (HBV-GN).Methods The clinical data of 49 HBV-GN patients diagnosed by renal pathology was reviewed.They were treated with MMF( ≥ 12 years old,0.75 g,two times a day; ＜ 12 years old,0.4 g/m2,two times a day),low dose of hormone [0.5 mg/(kg·d) ],lamivudine( ≥ 12 years old,100 mg/d; ＜ 12 years old,3 mg/kg,two times a day).Results Among of 49 HBV-GN patients,clinical cure rate was 71.4％(35/49),the total effective rate was 81.6％(40/49),85.7％(42/49) patients' HBV DNA level decreased from 5.43 ×104 copies/ml to ＜ 1000 copies/ml.The complete remission rate was 88.0％ (22/25),the partial remission rate was 8.0％ (2/25),the inefficiency was 4.0％ (1/25) in membranous nephropathy (MN);the complete remission rate was 44.4％ (4/9),the inefficiency was 55.6％ (5/9) in mesangial proliferative glomerulone phritis (MsPGN) ; the complete remission rate was 70.0％(7/10); the partial remission rate was 30.0％(3/10)in membrane proliferative glomerulone phritis (MPGN) ;the complete remission rate was 40.0％ (2/5),the inefficiency was 60.0％(3/5) in focal segmental glomerulosclerosts (FSGS).There was significant difference among the different pathological type (P＜0.05).There were less adverse reactions.Conclusions MMF combined with low dose hormone and lamivudine is safe and effective in treating HBV-GN.The efficacy and pathological type has some relationship,MN has the best response,MPGN and MsPGN are second,FSGS is poor.

Objective To study the influence of Apo E gene knockout on the lymphocytes . Methods Cells from the peripheral blood, spleen and bone marrow of Apo E knockout and wildtype mice were stained with kinds of antibodies , and analyzed by flow cytometry .Results Compared with wildtype mice , significant differences were found in B and T lymphoctes in the peripheral blood and spleen , but there was no significant difference in pre B cells , T lymphocytes in the thymus and long term hematopoietic stem cell in the Apo E knockout mice .Conclusion Numbers of B lymphocytes decreased in the peripheral blood and spleen , but there was no significant difference in B , T lymphocytes development , and numbers of long term hematopoietic stem cell in Apo E gene knockout mice .