Neuromuscular diseases is one of the difficulties in neurology teaching and clinical practice. We chose the typical cases of Guillain-Barre syndrome and progressive muscular dystrophy as case based study, and evaluated the effect of teaching. The result shows that application of case base study can help medical students to enhance their learning interests and cultivate their good clinical thinking and then to meet the requirements of the teaching syllabus. So it is worth improving and promoting in clinical practice teaching.

There is significant evidence to show that many neurosurgical patients with hyponatremia, who were previously diagnosed with syndrome of inappropriate antidiuretic hormone secretion(SIADH), actually have cerebral salt wasting syndrome(CSWS). The critical difference between SIADH and CSWS is that CSWS involves renal salt loss leading to hyponatremia and volume loss, whereas SIADH is a euvolemic or hypervolemic condition. The primary treatment for CSWS is water and salt replacement. The mechanisms underlying CSWS are not understood but may involve ANP or other natriuretic factors and direct neural influence on renal function.

Multi-modality medical image fusion technology has become an important development along with the advancement of image equipments and various medical imaging modes,and has been used in diagnoses and therapy gradually.In this paper,the familiar CT-MRI images are fused by different arithmetic,and the result sare analyzed.

Objective To compare the application value and the clinical curative effect of longitudinal incision and tarsal sinus minimal-ly invasive approach in treatment of patients with intra-articular calcaneal fractures. Methods A retrospective statistical analysis was made by collecting and comparing the clinical data of 67 patients with intra-articular calcaneal fractures from March 2008 to March 2012,and they were divided into the longitudinal incision minimally invasive approach group ( ZW group,36 patients,37 feet) and the tarsal sinus minimally invasive approach group ( FW group,31 patients,33 feet) . The Bohler angle, Gissane angle before and after operation,complications healing time,and AOFAS scores were compared. Results The healing time,Bohler angle,Gissane angle of ZW group and other indicators were better than those of the FW group,but there was no significant difference between the two groups (P>0. 05). The infection of incision and compli-cations in ZW group was obviously less than those of the FW group (P<0. 05). According to the AOFAS scoring system,ZW group scored 82. 49 points while FW group scored 86. 53 points,which indicated no statistical significance (P>0. 05). Conclusion The two kinds of treatments are of no obvious difference,but the longitudinal small incision minimally invasive approach could receive better effect in terms of soft tissue damage,healing time,and postoperative complications.

Objective To probe the biological effect of multiple intraepithelial injections of recombinant adenovirus-p53(rAd-p53)on inducing the apoptosis in patients with dysplastic oral leukoplakia.Methods 18 patients clinically and histopathologically diagnosed as dysplastic oral leukoplakia were recruited for this study.Intraepithelial injections of rAd-p53 were administered.Immunohistochemistry was used to examine the protein expression of p53 and bcl-2.TUNEL was performed to detect apoptotic cells.Results In the post-treatment patients,p53 protein expression were significantly enhanced(100 ％,18/18),yet bcl-2 protein presented low expression(17 ％,3/18).Statistical analysis revealed the expression of p53 protein had a negative correlation with that of bcl-2 protein(r =-0.837,P ＜ 0.01).15 post-treatment samples (83 ％)were detected obvious apoptotic cells,especially in the samples that were strong p53-positive(r =0.684,P ＜ 0.01).Conclusion Intraepithelial injections of rAd-p53 can induce apoptosis for patients with dysplastic oral leukoplakia.It may be a promising treatment for oral leukoplakia.

Objective To explore the effects of cognitive rehabilitation on aphasia for the patients with severe traumatic brain injury. Methods 40 patients with traumatic brain injury following aphasia were randomly divided into simple language group (n=20) and language- cognition group (n=20). Both groups received conventional therapy and language therapy, and the language-cognition group received cognitive rehabilitation additionally, 30 minutes 1 day for 1 month. Results The index of Chinese Rehabilitation Research Center Aphasia Examination (CRRCAE) improved significantly after treatment in both groups (P<0.01). There were significant differences in all the indexes of CRRCAE (P<0.05) between 2 groups after treatment except dictation (P>0.05). Auditory comprehension correlated with orientation, visual perception, spatial perception, motor praxis, visuomotor organization and thinking operations. Conclusion Cognitive rehabilitation can improve the language function of traumatic brain injury patients with aphasia.

ObjectiveTo study the effects of rehabilitation training on the expression of brain derived neurotrophic factor(BDNF) around the cerebral infarcted area of rats.Methods60 SD rats were randomly divided into rehabilitation group and immobilization group 24 hours after cerebral infarction.The rehabilitation group were given water maze training,rotating bar and rolling cage exercises everyday while the immobilization group were fixed in cages. Histochemistry was used to detect the BDNF expression around the cerebral infarcted area at the 1st,3rd,7th,10th and 14th day after infarction respectively.ResultsAt 1st day after the infarction, the expression of BDNF increased obviously around the infarcted area in both group. More BDNF positive neurons were found in the rehabilitation group than that in the immobilization group at 3rd day (P<0.01). BDNF positive astrocytes showed obvious increasing in both group. BDNF positive neurons decreased with time going, and the color became lighter at the same time .At the 7th day after infarction, there were only a few positive neurons, and seldom obvious positive neurons could be seen around the infarcted area at 10th and 14th day. Great deal of BDNF positive astrocytes were found at 3rd,7th,10th and 14th day, and the rehabilitation group showed more expression than that of the immobilization group(P<0.01).ConclusionsThe rehabilitation training may increase the expression of BDNF which might take an active part in the recovery of the central nervous system injury and the rebuilding of its function.

Objective To assess the diagnostic value of glycosylated hemoglobin A1c (HbA1c) ≥6.5％ for diabetes in Chinese adults with oral glucose tolerance test(OGTT) as the reference standard.Methods Major databases were searched to get all diagnostic tests with HbA1c ≥ 6.5％ for diabetes in Chinese adults.QUADAS items were used to evaluate the quality of the eligible studies.Meta-disc software was used to perform comprehensive quantitative assessment for all included studies and summary ROC (SROC) curve were drawn.Results A total of 11 studies were included.The outcomes of the diagnostic value with HbA1c ≥6.5％ were as the following:pooled sensitivity 0.62 (95％ CI:0.60-0.64),pooled specificity 0.96 (95％ CI:0.95-0.96),diagnostic odds ratio (DOR) 40.25 (95％ CI:20.79-77.95) and AUCSROC 0.7702 (sx =0.0636).Conclusions The diagnostic specificity is pretty high for the diagnostic test with HbA1c ≥6.5％,while sensitivity is low.Combination of HbA1c and glucose tests is needed to reduce the missed diagnosis rate.

Objective To evaluate the follow-up diagnostic value of 3 T magnetic resonance angiography (MRA) after intracranial aneurysm coil embolization.Methods The databases such as PubMed,EMbase,Cochrane Library,CBM,CNKI and VIP were retrieved.According to the inclusion criteria of diagnostic tests,the diagnostic tests of the follow-up diagnostic value about MRA were screened after intracranial aneurysm coil embolization.The methodological quality included in the studies was evaluated using QUADAS items and the meta-analysis was conducted using Meta-Disc 1.4 software.The receiver operating characteristic curve was drawn and the area under the curve was calculated.The residual sensitivity and specificity diagnosed by MRA after intracranial aneurysm embolization were evaluated.Results A total of 6 studies were included,including 253 patients.The pooled sensitivity and specificity in 3 T MRA diagnosing residual intracranial aneurysms were 0.915 (95％ confidence interval [ CI]0.850 - 0.959) and 0.847 (95％ CI 0.787 - 0.896) respectively.The area under the receiver operating characteristic curve was 0.951,Q =0.892.Conclusions 3 T TOF MRA can be used as an effective and feasible imaging follow-up method after embolization of intracranial aneurysms,however,because of the methodological limitations,the high-quality research is needed to further validate the application value of the MRA during follow-up after intracranial aneurysm embolization.

Objective To explore the diagnostic value of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-Dimer(DD),antithrombin Ⅲ(ATⅢ),platelet(PLT)in activity and severity assessment of ulcerative colitis(UC),and to analyze whether they could evaluate the degree of activity UC in children.Methods The data of UC patients in the Department of Gastroenterology,Children's Hospital of Nanjing Medical University from January 2012 to September 2016 were analyzed,25 cases of remission and 36 cases of active UC patients were selected as the study subjects.Thirty healthy children were selected as healthy control group,combined with the coagulation function indicators for analysis.Results Receiver operating characteristic area under the curve(AUC)of PT,APTT,FIB,DD,ATⅢ and PLT in UC patients was 0.659,0.840,0.744,0.776,0.599 and 0.792,the activity of UC patients was 0.849,0.889,0.836,0.912,0.964 and 0.966,respectively.The results of PT,APTT,FIB,DD and PLT in children with active UC were significantly higher than those in the healthy control group,and ATⅢ was significantly lower than that in the healthy control group.Compared with the healthy controls,the levels in remission UC patients were not significantly different(P>0.05).The 3 subgroups of activity UC had no significant differences among PT and APTT(F=0.652,1.755,all P>0.05),However,there were significant differences among FIB,DD,ATⅢ and PLT(F=66.495,32.817,88.284,22.892,all P<0.05).FIB,DD and PLT were moderately positively correlated with severity of activity UC patients(r=0.857,0.648,0.654,all P<0.05),and ATⅢ had moderately negative correlation(r=-0.789,P<0.05).Progressive regression analysis showed that the severity of UC was associated with FIB,DD and ATⅢ(R2=0.830,F=39.962,P<0.05).Conclusion FIB,DD and ATⅢ can be used as index for the activity and evaluation of UC.