Objective To explore the clinical and imaging features of reversible posterior leukoencephalopathy syndrome(RPLES).Methods The data of clinic five cases with RPLES were analyzed retrospectively.Results The primary diseases in this group were hypertension for one case,uraemia for three cases and lupus nephropathy for another.Clinical features of five patients include acute onset of hypertension,headache with vomiting.Neurological symptoms were conscious disturbance,seizures(in 5 cases)and visual disorder(in 3 cases).The movement of limbs were normal.The abnormal laboratery data was renal inadequacy in 5 cases.The findings of imaging of all cases included bilateral white matter of parietal and occipital lobe abnormalities,which appeared as large areas of low density on CT scan,hypo-intense in T1 and hyper-intense in T2 on MRI scan.Four cases presented clinical symptoms improvement in a short time and radiological recovery obviously after anti-hypertensive and anhydration therapy.One patient died caused on brain herniation.Conclusions Clinical features of RPLES is brain damage associated with malignant hypertension or the use of immunosuppressive agents.The most important pathogenesis is considered to be failure of the self regulation of cerebral vascular circulation.The imaging findings are bilateral symmetry cortical and subcortical edema in the posterior areas of the brain.Most patients can be recovery by timely therapy,otherwise the irreversible neuronal injury even death can be also found in very few serious cases.

Objective:To explore changes of plasma levels of catestatin (CST)and brain natriuretic peptide (BNP)in patients with chronic heart failure (CHF)and their correlation.Methods:A total of 60 CHF patients treated in our department of cardiology from Jun 2014 to Dec 2014 were enrolled as CHF group,another 60 healthy subjects un- dergoing physical examination were regarded as normal control group.Enzyme linked immunosorbent assay was used to measure plasma levels of CST and BNP in two groups,then the results were compared.Linear correlation analysis was used to analyze the correlation between plasma levels of CST and BNP.Results:Compared with normal control group,there were significant rise in plasma levels of CST [(0.40±0.15)ng/L vs.(0.88±0.34)ng/L]and BNP [(30.84±12.56)ng/L vs.(678.21±120.35)ng/L]in CHF group,P<0.01 both.Linear correlation analysis indi- cated that plasma CST level was significant positively correlated with BNP level (r=0.38,P<0.05).Conclusion:Catestatin level is significant positively correlated with the most sensitive cardiac function index—brain natriuretic peptide level,suggesting that it could be used as a new biochemical marker diagnosing or excluding heart failure.

Objective:To measure serum levels of salusins and catestatin and analyze their correlation in patients with essential hypertension (EH) .Methods :A total of 90 EH patients were selected as hypertension group .According to blood pressure level ,they were further divided into hypertension stage 1 group (n=31) ,hypertension stage 2 group (n=30) and hypertension stage 3 group (n=29) .Another 40 normotensive subjects undergoing physical examina‐tion were selected as normal control group .Enzyme linked immunosorbent assay (ELISA) was used to measure ser‐um levels of salusins and catestatin , and the correlation between serum levels of salusins and catestatin was analyzed . Results :Compared with normal control group ,there were significant reductions in serum levels of salusins [ (3.01 ± 0.66) ng/ml vs .(1.44 ± 0.42) ng/ml ,(1.35 ± 0.89) ng/ml ,(1.41 ± 0.32) ng/ml] and catestatin [(132.24 ± 7.55) ng/ml vs .(89.22 ± 6.12) ng/ml vs .(82.51 ± 8.37) ng/ml ,(83.34 ± 4.47) ng/ml] in hypertension stage 1 ,stage 2 and stage 3 group , P<0.01 all;compared with stage 1 group ,there were significant reductions in serum catestatin levels in stage 2 and stage 3 group (P<0.01 both) ,but there were no significant difference in serum salusins level a‐mong three groups of hypertension ( P>0.05 all) .Pearson correlation analysis indicated that serum salusins level had no correlation with catestatin level ( r=0.363 , P>0.05) in normal control group ,while serum salusins level was significant positively correlated with catestatin level (r=0.723 ,P<0.01) in hypertension group .Conclusion:Serum levels of salusins and catestatin significantly reduce and they is positive correlation in patients with hyperten‐sion .Along with blood pressure level rises ,serum catestatin level reduces .

AIM: To establish a method for determination of astragloside Ⅳ in Danqi Injection (Radix Salviae Miltiorrhizae,Radix Astragali). METHODS:HPLC-ELSD with Hypersil C_(18) column was used.The mobile phase was composed of acetonitrile-water(38∶62).The flow rate was 0.85 mL?min~(-1).An evaporative light-scattering detector(ELSD) model 2000 was used as detector. RESULTS:For astragloside Ⅳ,the linear range was 1.074-(3.408 ?g),and the average recovery was 100.71%,RSD was 1.79%. CONCLUSION:The method is simple,accurate,reproducible and can be applied to the quality control of the preparation. anqi

Objective To confirm the presence of human cytomegalovirus (HCMV) antigen and DNA in intracranial arterial walls and the association of the virus with the development of atherosclerosis in patients with atherosclerotic cerebral infarction Methods The subjects of this study were divided into two groups, the atherosclerosis group and the control group All patients were autopsied within 12 hours after death During autopsy, samples from intracranial arteries were formalin fixed and paraffin embedded All sections were routinely stained with hematoxylin and eosin (HE) and observed on the presence of atherosclerotic plaques The atherosclerosis group was subdivided into grade Ⅰ～Ⅱ group and grade Ⅲ～Ⅳ group according to the degrees of arterial lumen stenosis Only those vessel walls without signs of atheroma formation were included in the control group HCMV antigens and DNA were detected by immunohistochemistry, in situ hybridization and polymerase chain reaction (PCR) respectively The monoclonal antibody was against HCMV early (E) antigen Probes and primers were derived from major immediate early (MIE) genomic regions of cytomegalovirus strain AD169 As a positive control for the reactions, tissues from human small intestine membrane known to be positive for HCMV by H&E staining were used Results There were 18 of 35 atherosclerotic arteries defined as grade Ⅰ～Ⅱ atherosclerosis, and the rest were grade Ⅲ～Ⅳ The DNA of HCMV was found in 14/35 and 2/20 of arterial walls with atherosclerosis and negative control group by in situ hybridization, in 21/35 and 6/20 by PCR, and HCMV antigen in 12/35 and 2/20 by immunohistochemical studies respectively, and significant difference was be found among them ( P =0 018, P =0 032, P =0 047) There was also significant difference between grade Ⅲ～Ⅳ and grade Ⅰ～Ⅱ atherosclerosis by all the above three types of studies ( P =0 027, P =0 009, P =0 003) Conclusion Our results revealed that HCMV could be found in the atherosclerotic arterial walls, and it is suggested that the arterial walls might be the potential sites of existence of the virus We also postulate that there might be an association between the HCMV DNA and antigens in intracranial arterial walls and atherosclerotic plaques

Objective To explore the diagnosis value of morphology changes of pleomorphic megakaryocytes in the bone marrow (BM) smears and BM sections in chronic MPD(CML-CP, ET,PV and PMF). Methods BM aspiration was taken in 182 patients of MPD aspiration and biopsy examination was performed synchronously to obtain the BM smears and BM sections samples. The BM smears were subjected to Wright/Giemsa stain and immunohistochemistry stain, while the BM sections were subjected to Haematoxylin-Giemsa-Fuchsin stain. The morphology of pleomorphic megakaryocytes was classified into five groups, which were Ⅰ type ( inclusion type), Ⅱtype ( hypolobulated muclei type), Ⅲ type ( giant hyperlobulated nuclei type), IV type (micro pyknotic type), and V type(extrusion type). The size of megakaryocytes clusters was recorded as no clusters(0) , predominantly small clusters of fewer than 6 cells (1) or predominantly large clusters of at least 6 cells (2) . The detection rates of various types of pleomorphic megakaryocytes and megakaryocytes clusters were both analyzed in the BM smears and BM sections. Results In CML-CP group, the detection rates were (3. 73±3. 84)% , (14.19 ±7. 62)% ,(5.99 ±4.67)%, (34. 37 ±10.79)%, (9.45 ±6. 87)%, (32. 28 ±7. 67)% and 3.13 ±2. 30)% ,(12.61 ± 9.28)%,(4.94±4.27)%,(35.26±9.63)%,(9.47 ±5.89)%,(34.58 ±6.81)% for I tⅠype,Ⅱ type,Ⅲ type, Ⅳtype and Ⅴ type pleomorphic megakaryocyte in BM smears and BM sections. There were no significantly differences between the BM smears and BM sections(t value were 0.524,0.510,0.645, 0.239,0.011,0. 869,all P>0.05). In ET group, the detection rate of I type [ (6.17 ±2. 89)% ] in BM smears was significantly higher than that in BM sections [ 2.42 ± 1. 28) % ] (t = 7. 183, P < 0. 01) , while the detection rate of V type [ (6. 28 ± 3. 34) % ] in BM smears was significantly lower than that in BM sections [ (10. 18± 4.03) % ] (t = 3.940, P < 0.01). Besides these, the detection rates of other types were not significantly different between the BM smears and BM sections(t value were 0.079,0. 122,1.643, 1. 638,all P>0. 05). In PV group, the detection rate of V type in BM smears [ (6. 55 ±4. 11)% ] was significantly lower than that in BM sections [ (10. 30±3. 34) % ] (t = 2. 351, P < 0.05 ). However, the detection rates of the other types were not significantly different between the BM smears and BM sections (t value were 1. 635,0. 301,0. 132,0. 704,0. 681 ,all P' >0. 05). In PMF group, the detection rate of IV type in BM smears [(13.05 ±5.24)%] was significantly lower than that in BM sections [(29.14± 8. 72) % ] (t = 5. 245, P < 0. 01). And the detection rate of normal type in BM smears [ ( 33. 58 ± 14.39)% ] was significantly higher than that in BM sections [(23. 01±7.96)%] (t =2. 132,P<0. 05). Besides these, the detection rates of the other types were not significantly different between BM smears and BM sections( t value were 0. 787,0.646,2.062,0. 869, P > 0. 05 ) . In CML-CP and PV groups, the detection rates of size of clusters were not significantly different between the BM smears and BM sections (x~2 = 2. 772, P > 0. 05 ). In ET group, the detection rate of small clusters (1) in BM smears was obviously higher than that in BM sections, however, the detection rate of larger clusters (2) in BM smears was obviously lower than that in BM sections (x~2 = 13. 748, P < 0.01). In PMF group, the detection rate of no clusters(0) in BM smears was obviously higher than that in BM sections, however, the detection rate of large clusters(2) in BM smears was obviously lowers than that in BM sections (x~2 =18.741 ,P<0. 01). Conclusions Both BM smears and BM sections can be applied to observe pleomorphic megakaryocytes. The morphology changes of pleomorphic megakaryocytes have certain reference values for identification of MPD subtypes and differential diagnosis.

Objective To discuss the frequency of ventilator pipe replacement in ICU ward for reducing the frequency of VAP occurrence caused by bacterial colonization in ventilator-line. Methods 30 patients hospitalized to ICU ward from Janurary,2008 to June, 2009 who had mechanical-ventilation above 48h were randomly divided into group A, B and C with 30 patients in each group, then bacteria culture and strain analysis were employed for the pipeline sample of ventilator inspiratory side at the time point to be use and used mechanical ventilation for 1 day, 3 days and 7 days. Results There was no bacteria grew after ventilator-line sterilization, and positive ratio of bacterial culture in 1d, 3d and 7d were 46.66%,53.33% and 100.00%, respectively. Conclusions The frequency of ventilator pipe replacement should be shortened in patients with abdominal infection, to replace every 3 days is suitable in ICU where infectious patients gathered.

Objective To explore the clinical efficacy and adverse reactions of children with acute promyelocytic leukemia (APL) by adopting Chinese children APL-2010-protocol in single center.Methods Forty-seven children with newly diagnosed APL in Soochow University Affiliated Children's Hospital from October 2010 to September 2015 were selected,including 30 boys and 17 girls with the median age of 7 years (1.2-14.0 years).The patients were divided into 3 groups,including 11 cases in the low-risk group,20 cases in the intermediate-risk group and 16 cases in the high-risk group.Their clinical features and therapeutic prognosis were analyzed retrospectively and the clinical efficacies were compared in low-risk group[white blood cell(WBC) ≤ 10 × 109/L,platelets (PLT) ＜ 40 × 109/L],intermediate-risk group (WBC ≤ 10 × 109/L,PLT ≤40 × 109/L) and high-risk group (WBC ＞ 10 × 109/L).Five-year event-free survival (EFS) rate and overall survival (OS) rate of each group were analyzed by using Kaplan-Meier curve method.Results The peak comparative difference of peripheral blood WBC among 3 groups was statisticallysignificant(x2 =7.618,P =0.002).The occurrence rate of disseminated intravascular coagulation (DIC) was 68.8％ and the occurrence rate in the high-risk group was higher compared with low-risk group and intermediate-risk group (x2 =8.217,P =0.016).Arsenic trioxide related side effects including abnormal liver tests,electrocardiogram and anaphylactic reaction were invertible after supportive therapy.Hematologic complete response (HCR) rate in the high-risk group was 93.7％,HCR time was (39.3 ± 2.7) days and molecular complete remission (MCR) time was(71.0 ± 9.7) days.HCR rate in the intermediate-risk group was 95.0％,HCR time was (44.6 ± 3.1) days and MCR time was (80.0 ± 8.2) days.HCR rate in the low-risk group was 100.0％,HCR time was (32.4 ±2.3) days and MCR's time was (71.5 ± 12.0) days.HCR time among 3 groups had statistical significance (F =3.652,P =0.034),but HCR rate and MCR time among 3 groups showed no statistical significance (F =0.318,P =0.729).In the high-risk group,EFS rate was (93.3 ± 6.4) ％,5-year OS rate was (86.7-± 8.8) ％.Meanwhile,5-year OS rate and EFS rate were 100.0％ in other 2 groups.Conclusions Treating patients with APL by using 2010 protocol according to the risk stratification in our center has achieved high long-time survival.The higher the risk,the higher the incidence of DIC in induction period,but eventually achieve a very high rate of 5-year EFS was achieved.No chronic arsenic toxicity or second malignancies were found during the follow-up time.

Objective To evaluate spiral CT in diagnosing vascular complications of pancreatitis. Methods The clinical and surgical results and the CT findings of 316 patients with acute or chronic pancreatitis were comparatively analyzed. Special attention was paid to the CT findings of the patients with peritoneal hemorrhage and vascular abnormality. CT Hu of celiac blood effusion was measured. Pseudoaneurysms, phlebothrombosis and venous thrombosis of peripancreatic vessels in CT enhancement were carefully analyzed. Results Acute pancreatitis was found in 275 out of the 316 patients, and chronic pancreatitis in 41 cases. Among those with acute pancreatitis, 20 had peritoneal cavity vascular complications. In the 13 cases of peritoneal cavity hemorrhage(including 5 patients complicated with digestive tract hemorrhage), CT identified 11 with as regional or diffuse slight high density fluid collections, and failed in 2 cases. CT scans detected gastric varices in 4 out of 7 patients with digestive tract hemorrhage. Of those with chronic pancreatitis, CT found celiac artery pseudoaneurysm in one, spleen artery pseudoaneurysm in one and splenic vein thrombosis with gastric varices in one. Conclusions (1)Regional or diffuse slight high or high density fluid collections were common CT findings of peritoneal cavity hemorrhage. (2)Enhanced spiral CT scanning could demonstrate peripanreatic vascular pseudoaneurysms. (3)Varices in gastric fundus and necrosis in pancreatic body and tail often indicate the formation of spleen venous thrombosis.

Objective To investigate the clinical presentation,diagnosis,and surgical management of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis.Methods One case of anti-NMDA receptor encephalitis in a previously healthy 17-year-old female related to the development of NMDA receptor autoantibodies triggered by an ovarian teratoma was reported.The related literature was reviewed and the clinical feature was summarized.Results Removal of the ovarian teratoma combined with intravenous immuneglobulin and corticosteroid proved curative with eventual resolution of the paraneoplastic disease process and associated psychiatric symptoms.Conclusion Increasingly,reports of anti-NMDA receptor encephalitis associated with ovarian teratomas,as well as a novel assay to measure these antibodies suggest an etiology for this disease process that may be amenable to prompt surgical excision.