Objective To evaluate the relationship between the degree of corticospinal tract (CST) injury and motor function prognosis in patients with cerebral infarction using magnetic resonance diffusion tensor imaging (DTI)and diffusion tensor teactography (DTT)imaging. Methods Sixty-eight patients with cerebral infarction were selected prospectively. They underwent conventional MRI,DWI,and DTI examinations,and the DTT technique was used to perform CST 3D reconstruction. The white matter fractional anisotropy (FA)of the infarct zones and contralateral corresponding regions was measured within 7 days and at 3 months after onset. The Fugl-Meyer scale was used to perform motor function defect score. The CST involvement degrees were divided into four grades. The patients were divided into Group 1 (96-99,roughly return to normal;n=16),Group 2 (51-95,partial recovery;n=34),and Group 3 (<50,poor recovery;n=18)according to the Fugl-Meyer scale scores after treatment. The analysis of variance,Pearson,and Spearman correlation analysis were used to analyze the relationship between FA values,CST involvement degrees and motor function recovery. Results There were significant differences in the amplitude of variation of FA within 7 d (0. 05 ± 0. 06,0. 08 ± 0. 07,and 0. 18 ± 0. 02)and at 3 months after onset (0. 11 ± 0. 02,0. 21 ± 0. 06,and 0. 39 ± 0. 03)(within 7 d F=32. 821,at 3 months F=192. 372,all P<0. 05). DTT showed that the lesion sides of CST were presented as compression,deformation,displacement,and interruption. The CST grades were negatively correlated with the neurological functional rehabilitation of the patients within 7 d after onset (r= -0. 682,P <0. 01). The CST grades were negatively correlated with the neurological functional rehabilitation of the patients at 3 months (r= -0. 728,P<0. 01). Conclusion The decreased FA values in infarct areas and the degrees of CST involvement were associated with the motor function prognosis. MR DTT can directly display the degrees of CST involvement of cerebral infarction. It can provide an important basis for early identifying the prognosis of cerebral infarction.

To investigate the gene typing, molecular characteristics of virulence and resistance associated gene of Clostridium difficile from clinical isolates in China, the genes tcdA,tcdB of toxin A and B, cdtA,cdt B of binary-toxin, and erm B of clindamycin resistance were detected by conventional PCR. Genotyping of toxic C. difficile were conducted by means of analysis of 16s-23s internal spacer region polymorphism with PCR assay. Then the antibiotic resistance of toxic C. difficile to ampiciline, clindamycin, metronidazole and vancomycin was conducted with E-test. It was found that 8 toxic C. difficile strains were demonstrated out of 12 clinical isolates, in which 5 strains were tcdA+ and tcdB+, and 3 strains tcdA- and tcdB+, accounting for 62.5% and 37.5% respectively. Binary-toxin genes detection were negative in all the strains. Clindamycin resistance associated gene ermB was positive in 4 out of 8 toxic C. difficile strains, accounting for 50%. 8 toxic isolates were typed into 4 gene types, the dominant type was ZR I,accounting for 62.5%. Resistance rate of 8 toxic C. difficile strains against ampiciline(AC), clindamycin(CM), metronidazole(MZ) and vancomycin(VA) was 37.5%,87.5%,12.5%, and 0 respectively. No isolates belonged to ribotype 027 or 078. Isolation rate of toxic C. difficile is high to 66.7%. There is obvious gene polymorphism in clinical isolates of Chinese toxic C.difficite, and ZR I is preponderant genotype in 4 genotypes. C. difficile shows some resistance to ampiciline, clindamycin, metronidazole, but susceptive to vancomycin.

Objective To observe the effects of ACEI( enalapril) on expression of MMP-2 and MMP-9 in renal hypertension rats with focal cerebral ischemia-reperfusion injury. Methods Twenty-eight Wistar male rats were randomly divided into two groups: hypertension group and normaltension group. The former which formed model of renal hypertension rats by constricted renovascular were randomly divided into enalapril group (Y) and hypertension ischemia and reperfusion group(HIR),which fed with enalapril 2mg/kg and equal volum saline respectively;The latter were divided into sham-operation group ( N) and normaltension ischemia and reperfusion group (IR). The focal cerebral ischemia model was established in Wistar rats by using the method of thread inserting left middle cerebral artery occlusion(MCAO) for 2h. After ischemic 24h,the expression of MMP-2 and MMP-9 were measured by immunohisto-chemistry,and the gray scale value was measured by imaging analysis. Results Compared with N,the gray scale values of MMP-2 and MMP-9 in IR were higher(P <0. 01); Compared with IR, the gray scale values of MMP-2 and MMP-9 in HIR were higher(P<0. 05);Compared with HIR,the gray scale values of MMP-2 and MMP-9 in Y were lower(P<0.01). Conclusion Hypertension can increase the expression of MMP-2 and MMP-9 in rats with focal cerebral ischemia-reperfusion. ACEI (Enalapril) could inhibit the expression of MMP-2 and MMP-9 in renal hypertension rats with focal cerebral ischemia-reperfusion.

Objective To evaluate the predictive value of ABCD3-I score for early stroke risk after transient ischemic attack (TIA). Methods A total of 136 consecutive patients with TIA admitted to the Department of Neurology,the First Hospital of Shangqiu from January 2010 to December 2012 were enrolled. The clinical data,medical history and image findings of the patients were collected. The incidence of stroke was observed within 90 days. The occurrence of stroke risk after TIA were scored with the ABCD2 and ABCD3-I. Logistic regression analysis was used to analyze the impact of risk factors for early stroke after TIA. The area under the curve (AUC)of receiver operating characteristic was used to compare the predictive values of the two kinds of scores. Results Of the 136 eligible patients with TIA,19 cases (14. 0%)had cerebral infarction within 90 days after TIA. There were no death and hemorrhagic stroke. The results of multivariate regression analysis showed that the duration of TIA≥60 min (OR,1. 060,95%CI 1. 012-1. 112)was an independent risk factor for early progressing stroke after TIA (P<0. 05). In the ABCD2 scoring model for risk stratification of low-,moderate-,high-risk groups,the incidences of stroke within 90 days were 5. 6%(4/72),18. 5%(10/54),and 50. 0%(5/10),respectively. In the ABCD3-I score model for risk stratification of low-,moderate-,high-risk groups,the incidences of stroke within 90 days were 0,7. 1%(6/84),and 52. 0%(13/25),respectively. In the low-,moderate-,high-risk groups,there were significant differences in the incidences of stroke in 90 days between the ABCD3-I and ABCD2 scoring models (P<0.01). The AUC of ABCD3-I score (0. 839,95%CI 0. 766-0. 896)was higher than that of ABCD2 score (0.783,95%CI 0. 704-0. 849;P<0. 01). Conclusion The ABCD3-I score may effectively predict the risk of early stroke after TIA,and its accuracy is better than ABCD2 score.

Objective To evaluate the effect of interventional vas embolism operation at ICU bedside in severe pelvis fracture patients complicated with hemorrhagic shock. Method Forty-eight severe pelvis fracture patients with hemorrhagic shock were treated by interventional vas embolism operation at bedside as well as intensive monitoring. The clinical results were compared with those of the traditional conservative therapy group. Results In the interventional therapy group, 46 patients with hemorrhage had been controlled within an hour after the operation and the success ratio reached 95.8%. The blood transfusion volume, the complication incidence and mortality rate were all significantly lower than those of the conservative therapy group. Conclusion Interventional vas embolism operation at ICU bedside is a safe, practical and effective treatment on pelvis fracture with iliac vas trauma.

Objective To investigate the different expressions of plasma M type phospholipase A2 receptor antibody and IgG subtypes deposition of kidney tissues in idiopathic membranous nephropathy and hepatitis B virus-associated membranous nephropa-thy,and to evaluate the significance of plasma M type phospholipase A2 receptor antibody and IgG subtypes in diagnosis of hepatitis B virus-associated membranous nephropathy.Methods Plasma samples were obtained from patients with idiopathic membranous nephropathy,hepatitis B virus-associated membranous nephropathy and minimal change disease,respectively,before immunosup-pressive therapy.Concentration of plasma M type phospholipase A2 receptor antibody was detected by sandwich ELISA and concen-tration of IgG subtypes were measured by immunofluorescence.Results Concentration of plasma M type phospholipase A2 receptor antibody was (15.4±7.2)μg/mL in idiopathic membranous nephropathy group,higher than that in the hepatitis B virus-associated membranous nephropathy group (10.3±5.7)μg/mL (P <0.01),between idiopathic membranous nephropathy group and hepatitis B virus-associated membranous nephropathy group.There was no distinct difference of IgG subtypes deposition in glomerlar capil-lary wall.Conclusion There is obvious clinical significance of concentration of plasma M type phospholipase A2 receptor antibody in differential diagnosis of idiopathic membranous nephropathy and hepatitis B virus-associated membranous nephropathy,while no distinct significance of IgG subtypes deposition.

ObjectiveTo investigate the clinicopathological characteristics of non-diabetic renal diseases (NDRD) in the patients with diabetes mellitus.MethodsClinicopatholigical data of 202 patients with diabetes mellitus and NDRD identified by renal biopsy from January 1st,2003 to December 31st,2010 were analyzed retrospectively.All the patients were divided into three groups:the young (≤35 years old),the middle-aged (36-59 years old) and the elder (≥60 years old).Clinicopathological characteristics were compared among 3 groups.ResultsIn the young group (n=33),42.4％ of patients presented as chronic glomerulonephritic syndrome,while 36.4％ as IgA nephropathy for pathology.In the middle-aged group(n=136),35.3％ of patients presented as chronic glomerulonephritic syndrome,27.2％ as nephritic syndrome,17.6％ as chronic renal failure,14.7％ as latent glomerulonephritis,and 5.1％ as acute renal failure,while42.6％ as IgA nephropathy for pathology.In the elder group(n=33),30.3％ of patients presented as nephritic syndrome,30.3％ as chronic renal failure,while 27.3％ as membranous nephropathy for pathology.ConclusionsIn clinical manifestation,young patients are mainly chronic glomerulonephritic syndrome,middle-aged patients are diversified,and elder patients are mainly nephritic syndrome andchronicrenalfailure. Inpathology, youngandmiddle-agedpatientsaremainlyIgA nephropathy,and elder patients are mainly membranous nephropathy.

Objective To explore the relationship between traditional Chinese medicine (TCM) syndromes of state of evil domination and clinical and laboratory indicators of IgA nephropathy. Methods A prospective study was used to collect data on clinical and laboratory examination of IgA nephropathy in multi clinical centers. Patients’ TCM syndrome types were determined according to the national diagnostic criteria at the same time. Totally 266 patients with IgA nephropathy were included in the study to establish a database for analyzing the relationship between TCM syndrome of state of evil domination and clinical and laboratory indicators. Results In the relationship between syndromes of state of evil domination distribution and clinical subtypes, patients of wind-heat syndrome had more macroscopic hematuria;patients of phlegm-damp syndrome had more nephrotic syndrome;patients of damp-heat syndrome had more chronic nephritis type Ⅰ;patients of blood stasis syndrome had more chronic nephritis type Ⅱ. In the relationship between syndrome of state of evil domination distribution and clinical manifestation, the incidence of hypertension was higher in patients of blood stasis syndrome than in other three types. It was more serious for hematuresis in the patients of wind-heat syndrome. For patients of phlegm-damp syndrome, the incidence of heave proteinuria was highest. In the relationship between syndrome of state of evil domination distribution and laboratory examination, 24-hour urinary protein quantification was higher than in patients of wind-heat and damp-heat syndrome, but the level of blood albumin was lowest. For patients of blood stasis syndrome, serum creatinine level was significantly higher than in other three types;the level of eGFR was just the opposite. The levels of blood cholesterol and triglyceride in patients of phlegm-damp syndrome were higher than in other three types. The activated partial thromboplastin time (APTT) levels in patients of blood stasis and phlegm-damp syndrome were lower than in other patients, but the FIB level was the exact opposite of APTT. In the relationship between syndrome of state of evil domination distribution and the stages of chronic kidney disease (CKD), patients of wind-heat syndrome were more in the first stage of CKD;patients of blood stasis syndrome were more in the third stage of CKD. Conclusion There is relative correlation between TCM syndromes of state of evil domination and clinical and laboratory indicators in IgA nephropathy, which would provide some reference to narrow the gap in the information of the four methods of TCM with clinical and laboratory indicators to enhance accurate diagnosis of TCM syndrome.

Objective To investigate the morphologic characteristics of gonococcal inflammation of paraurethral glands in males. Methods Eleven male patients with gonococcal inflammation of paraurethral glands were examined by both real-time ultrasound imaging (Siemens Acuson X300) and 3.0 T magnetic resonance imaging (MRI, Philips Achieva). Results High-frequency ultrasound imaging revealed tubular echoic areas with well-defined borders and smooth margins in all the patients. The inside of these tubular areas was weak-echoic. These tubular echoic areas were blind in one end, but open in the other end, and ran in parallel with the urethra. The mean lumen diameter was 1.1 ± 0.2 mm (range, 0.7 - 1.3 mm) , and the mean lumen length was 8.4 ± 0.6 mm (range, 7.0 - 12.0 mm). Anechoic liquid-filled areas were seen in the tubular echoic areas in two patients. Paraurethral ducts were not detected by 3.0 T MRI in these patients. Conclusions High-frequency ultrasound imaging can clearly show the morphologic characteristics of gonococcal inflammation of paraurethral glands in males, and provide valuable ultrasound images for surgery.