Objective To evaluate the clinical significance of the serum β2-microglobulin (β 2-MG) and lactic dehydrogenase (LDH) in multiple myeloma (MM) patients.Methods The serum levels of β2-MG and LDH in 63 MM patients (MM group) and 20 healthy person (control group) were measured by biochemical assay.Results The serum levels of β 2-MG and LDH in MM group were higher than those in control group[(3.81 ± 0.62) mg/L vs.(2.43 ± 0.91) mg/L and (296.4 ± 34.7) U/L vs.(145.5 ±17.8) U/L,P ＜ 0.05].Furthermore,the serum levels of β 2-MG and LDH increased gradually with MM clinical staging (P ＜0.05).After VAD chemotherapy,the serum levels of β 2-MG and LDH in clinical response MM patients(54 cases) were significantly decreased [(2.51 ± 1.36) mg/L vs.(3.57 ± 0.82) mg/L and (159.1 ± 35.2) U/L vs.(285.3 ± 87.6) U/L,P ＜ 0.05],while those in no response patients (9 cases)were unchanged (P＞ 0.05).Conclusion The serum levels of β 2-MG and LDH can be taken as a clinical index to classify the clinical phase,prognosis and effectiveness of chemotherapy in MM patients.

Objective To present the therapeutic effect of the free bilobed posterior interosseous flap for soft tissue reconstruction of two fingers.Methods According to the distance between the defects of two adjacent fingers,combining the cutaneous branches of different regin,the free bilobed flaps pedicded with posterior interosseous artery were applied for soft tissue reconstruction of 20 fingers in 10 patients.The defects of digits was on thumb and index( 1 case),index and middle(2 cases),middle and ring(4 cases),ring and little (3 cases).The size of defect was ranged from 2.5 cm × 2.0 cm to 9.5 cm × 3.0 cm.The size of single flap was from 3.0 cm × 2.5 cm to 10.0 cm × 3.5 cm.Results The flaps on 19 fingers were completely survived and the flap on 1 finger had the pointed end necrosis which healed by dressing changing.After 6 to 22 months (the average was 13.8 months ) followed-up visit,all flaps were with excellent colour and texture.The flaps in 8 cases were thin and the flap in 2 case was a little thick.Eight single flaps in which the cutaneous nerve was sutured recovered 2-PD of 10 to 15 mm (the average was 12.8 mm).There was no affection in motor function on donor site of all cases.Conclusion The free bilobed posterior interosseous flap is the valuable option for two fingers soft tissue reconstruction and it can achieve the cosmetically and fuctionaly acceptable result with low morbidity on donor site.

Objective To evaluate the prognostic value of hyperintense vessel (HV) in patients with acute middle cerebral artery (MCA) occlusion.Methods Seventy-four consecutive patients with first ever stroke(48 male and 26 female,the mean age was (60.7 ± 15.3) years) in the territory of MCA,retrieved from Nanjing Stroke Registry Program between May 2009 and February 2011,were enrolled assubjects.All subjects completed brain MRI,and MRA or DSA indicated proximal MCA occlusion.According to the location and extent of HV,all subjects were classified into 3 groups:without HV,proximal HV and distal HV.Clinical data were obtained and compared among patients with different grades of HV.Logistic regression analysis was employed to confirm the relevant factors of prognosis 90 days after index stroke.Results HV was observed in 49 (66.2％ ) of the 74 enrolled patients.Among patients with HV,7 (9.4％ ) were classified as proximal HV and 42 ( 56.8％ ) as distal HV.Initial NIHSS score ( 11 ( 1 -22) ),10-day NIHSS score ( 13.5(4-25) ),infarction size ( ＞2/3:5 cases(6.8％ ) ),and 90-day mRSscore (3-6 scores:12 cases( 16.2％ )) were significantly lower in patients with distal HV than those without (15(6-25),Z=-3.544;7(0-22),Z=-4.461;20 cases(27.0％),x2 =20.916;27 cases (36.5％),x2 =22.689;all P＜0.01).The NIHSS score decreased from baseline to that on 10 days and the mRS score decreased from 10 days to that on 90 days in patients with distal HV was more than that in patients without distal HV. Multivariate analysis revealed that patients with older age ( OR =1.111,95％ CI 1.036-1.191,P=0.003),high infarction size (OR=3.679,95％ CI 1.35-10.025,P=0.011) worsened outcome,whereas distal HV (P =0.012,OR =0.131,95％ CI 0.027-0.638)improved outcome.Conclusion Distal HV on FLAIR may predict a favorable outcome in patients with acute middle cerebral artery occlusion.

Objective To study the patterns of collateral circulation in adults moyamoya disease (MMD). Methods One hundred and nineteen consecutive adult patients with MMD (ischemic or hemorrhagic type) were identified by digital cerebral angiography in Nanjing Stroke Registry Program of Jinling Hospital between August 2004 and January 2010.The extracranial and (or) intracranial collateral circulations ipsilateral to stroke hemisphere were regarded as the research objects,and furthermore,these collateral circulations were divided into three different grades:Grade 1 collateral (anterior cerebral artery (ACA) → meningeal arteries (MLA) → middle cerebral artery (MCA) ),Grade 2 collateral ( dilating and extensing anterior choroidal artery beyond choroid fissure,patent posterior communicating artery → posterior cerebral artery→MLA→ ACA and(or) MCA,posterior cerebral artery→MLA→ACA and (or) MCA and posterior choroidal artery → posterior pericallosal arteries → ACA ) and Grade 3 collateral (collateral originating from the external carotid artery supplying to cerebral blood flow). The relationship between collateral distribution patterns in adult MMD and Suzuki' s classification was analyzed.Results In 117 assessed vessel units of the collateral circulation ipsilateral to stroke hemisphere,there were a total of 200 collateral circulations.The percentage of numbers in Grade 1,Grade 2 and Grade 3 collateral was 11.5％(23/200),52.0％ (104/200) and 36.5％ (73/200),respectively.The distribution percentage of Grade 1 was gradually decreased from Suzuki's Ⅰ to Ⅵ,mainly distributed in the early stage of MMD ( Suzuki's Ⅰ -Ⅱ ) and accounted for 91.3％ (21/23; Z =- 7.270,P ＜ 0.01 ).The distribution percentage of Grade 3 was gradually increased from Suzuki' s Ⅰ to Ⅵ,especially in the late stage of MMD ( Suzuki' s Ⅴ-Ⅵ) and accounted respectively for 37.0％ (27/73) and 63.0％ (46/73; Z =-7.270,P ＜0.01 ).Compared with the total distribution of Grade 1 and 3 collateral circulation,the distribution percentage of Grade 2 was 6.7％ (7/104),7.7％ (8/104),15.4％ ( 16/104),40.4％ (42/104),14.4％ (15/104)and 15.4％ (16/104) from Suzuki' s Ⅰ to Ⅶ.Although there was not significant difference,Grade 2 mainly distributed in the medium stage of MMD ( Suzuki' s Ⅲ-Ⅳ ).Conclusions The patterns of collateral distribution is various,changing with the progression of MMD. Grade 2 collateral circulation accounts for a higher proportion,especially in the medium stage of the disease,which suggests that these collaterals play an important compensatory role of blood flow.

Objective To study the effect of intranasal nerve growth factor (NGF) on the expression of amyloid-β,peptide (Aβ) in the central nervous system in rats with traumatic brain injury (TBI).Methods Eighty rats were randomly divided into sham(n =26),control(n =27) and treatment group (n =27 ).They were subjected to the modified Feeney' s weight-drop model.The treatment group was treated with NGF administered by nasal route,and the control group was given phosphate-buffered saline (PBS).Beam walking and Morris water maze test were performed in the three groups.The concentration of Aβ40 and Aβ42 in the injured ipsilateral hippocampus was elevated by ELISA measurement.Immunohistochemistry was used to detect the amyloid precursor protein (APP) positive cells near the region of injury in the hippocampus in rats after TBI.Results NGF group traversed the beam significantly quicker (s) than control group ( 19.00 + 6.99 vs 27.33 ± 7.39 respectively,F2,15 =12.87,P =0.028 ).Morris water maze performance revealed that mean time of latency in the NGF group was significant shorter than vehicle group,and significant memory retention in NGF group as evidenced by a greater percentage of the 60 s allotted time spent in the target quadrant (45.82％ ± 11.15％ vs 33.99％ ± 3.46％,F2,15 =6.814,P=0.037),as well as the number crossing of the former site of the removed platform in NGF group was significant more than control group (8.60 ±2.73 vs 3.60 ±2.06,F2,15 =5.346,P =0.04).The Aβ42 level in control group was increased significantly higher than NGF group as indicated by ELISA measurements.While the Aβ40 level did not have similar shown.Immunohistochemical staining showed that APP level had significant differences among three groups ( F2,15 =8.672,P =0.003).The APP level in NGF group did not alter with control group.Conclusion Intranasal administration of NGF can regulate Aβ42 overproduction,improve the motor and cognitive function after brain injury in rats.

Objective To investigate the relationship between serum levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) and Suzuki' s grading system in adult moyamoya disease (MMD).Methods Fifty-two adult patients with MMD,who were diagnosed in Jinling hospital between April 2009 and January 2010,were retrieved from the Nanjing Stroke Registry Program (NSRP).Sixteen sex- and age-matched healthy individuals with MMD patients consisted of the control group.Using enzyme-linked immunosorbent assay,serum concentrations of VEGF and MMP-9 were compared between adult MMD patients and healthy individuals.By Suzuki' s six-grading system,patients were divided into different subgroups,and the correlation of serum levels of VEGF and MMP-9 corresponding to different subgroup and Suzuki's grading was respectively analyzed.In addition,the correlation of serum levels of VEGF and MMP-9 was also evaluated.Results Serum VEGF concentrations in ischemic and hemorrhagic MMD patients was respectively ( 289.4 + 69.2 ) pg/ml and ( 324.3 ± 95.6 ) pg/ml and were significantly higher compared to those in healthy controls ( ( 63.5 ± 7.6 ) pg/ml; F =69.43,P ＜ 0.01 ).Similar findings were observed for MMP-9 ( ( 499.4 ± 76.2 ) ng/ml and ( 531.2 + 100.2 ) ng/ml versus (257.1 ±30.7) ng/ml; F =66.023,P ＜0.01 ).With the increase of Suzuki' s grading,serum levels of VEGF and MMP-9 respectively showed a high trend ( r =0.879,P ＜ 0.01:r =0.838,P ＜ 0.01 ).In addition,a positive correlation between serum levels of VEGF and MMP-9 was found in the MMD group( r =0.590,P ＜0.01 ).Conclusion The results show that serum levels of VEGF and MMP-9 in adult MMD are higher than those in healthy controls,which may play a role in neovascularization in MMD,and moreover,serum levels of VEGF and MMP-9 show a high trend with the progression of MMD,which suggest that serum levels of VEGF and MMP-9 can reflect the severity of MMD.

Objective To investigate the possible formation mechanism and imaging features of the hyperintense vessel sign (HVS) on fluid attenuated inversion recovery (FLAIR) in patients with ischemic stroke or transient ischemic attack (TIA).Methods The baseline data of the patients with middle cerebral artery (MCA) ischemic stroke or TIA with digital subtraction angiography (DSA) showing the lesions of MCA M1 segment in clinical practice were retrospectively retrieved from Nanjing Stroke Registry Program from January 2010 to July 2011.FLAIR was used to observe HVS,and DSA was used to evaluate the degree of vascular stenosis and cerebral collateral circulation.Results A total of 101 patients were enrolled,76 (75.2％) were males,and their mean age was 53.94 ± 13.47 years; 90 patients (89.1％) with ischemic stroke and 11 patients (10.9％) with TIA; 55 patients (54.5％) were HVS negative and 46 (45.5％) were HVS positive.Among the patients whose MCA stenosis ＜50％,50％-70％,70％-90％ and ≥90％,the positive rates were 0％ (0/8),25.0％ (3/12),17.6％ (3/17),and 62.5％ (40/64),respectively.There were significant differences (Z=-4.479,P＜ 0.001).The leptomeningeal collateral circulation of the HVS positive group was significantly more than that of the HVS negative group (Z =-6.196,P ＜ 0.001).Multivariate logistic regression analysis showed that the degree of MCA stenosis was an independent risk factor for influencing the formation of HVS (odds ratio 3.943,95％ confidence interval 2.03-7.659; P ＜0.001).Conclusions The formed intracranial leptomeningeal colhteral circulation after severe intracranial vascular stenosis or occlusion is a major pathophysiological basis of HVS formation on FLAIR sequences in patients with ischemic stroke or TIA.

Objective To study the Sheng Mai San on the levels of cell factors induced by lipopolysaccharide in acute liver failure rats. Methods The models of chronic liver failure were constructed by injecting CCl4 in the abdomen of rats. The serum levels of lipopolysaccharide and cell factors were determined after treating with LPS and Sheng Mai San for 2 hours. Results The serum level of IL-6［(64.50±18.79)pg/ml vs (4.79±0.57)pg/ml］, ICAM-1［(25100.00±5258.85)pg/ml vs (4215.50±942.79)pg/ml］ and TNF-α［(17.55±2.39)pg/ml vs (10.92±5.02)pg/ml］ was increased by CCl4 (P＜0.05), but there is no effect on the serum level of LPS in rats ［(0.058±0.007)EU/ml vs (0.040±0.002)EU/ml,P＞0.05］. Sheng Mai San can significantly reduce the serum level of IL-6, ICAM-1 and TNF-α in rats with acute liver failure induced by CCl4 ［(17.20±3.12)pg/ml,(9490.00±2725.78)pg/ml,(3.00±1.00)pg/ml,P＜0.05］. After treating with LPS for 2 hours, the serum level of LPS, TNF-α, IL-6, ICAM-1 markedly increased ［(0.501±0.019)EU/ml,(19750.00±9655.17)pg/ml,(5615.00±490.50)pg/ml,(41000.00±589.88)pg/ml,P＜0.01］. Sheng Mai San could reduce the serum levels of LPS, TNF-α, IL-6, ICAM-1 and in rats with chronic liver failure (P＜0.01). Conclusions SD Rats in the state of chronic liver fail-ure, existing serious serum endotoxin, can induce the levels of cell factors by diversification inflammation reaction and. ShengMaiSan can regulating the levels of cell factors in rats with chronic liver failure.

Objective To investigate the correlation of the lesion pattern of internal border zone infarction (IBZI) with atherosclerosis and outcome.Methods Eighty-one patients with IBZI were retrospectively divided into a simple IBZI group and a mixed IBZI group (combined with other infarct patterns) according to diffusion-weighted imaging (DWI).The clinical characteristics were compared between the 2 groups.And then,the mixed IBZI group was further divided into 3 subgroups:IBZI + pial infarct (PI),IBZI + perforating artery infarct (PAI),and IBZI + PI + PAI.They were compared with the simple IBZI group respectively.Results There were no significant differences in the dinical characteristics,such as age,hypertension,and the numbers of patients with stent implantation between the simple IBZI group and the mixed IBZI group.The proportions of severe stenosis and occlusion of internal carotid artery (ICA) and/or middle cerebral artery (MCA) (P =0.009) and MCA lesions (P =0.032) in the mixed IBZI group were significantly higher.Among the patients with MCA lesions,the severe stenosis in the simple IBZI group was significantly more than that in the mixed IBZI group (P =0.042),while the occlusive lesions in the mixed IBZI group were significantly more than those in the simple IBZI group (P =0.022).The short-term (within 7 days) exacerbation (P =0.039) and poor outcome at 90 days (modified Rankin Scale＞ 3) in the mixed IBZI group (P=0.030) were significantly higher than those in the simple IBZI group.The subgroup analysis showed that the proportions of the short-term exacerbation (P =0.001 ) and poor outcome in patients at 90 days (P =0.010) in the IBZI + PI +PAI subgroup were significantly higher than those in the simple IBZI group.Conclusions The IBZI patients combined with other infarct patterns often exist severe cerebrovascular stenosis and occlusion,and their clinical outcome was poorer.For patients with MCA lesions,the mixed IBZI occurred more in patients with MCA occlusion,and the simple IBZI occurred more in patients with severe MCA stenosis.

Objective To investigate the value of hyperintense vessel signs (HVS) on fluidattenuated inversion recovery (FLAIR) sequence for assessing the patterns of collateral blood flow in adult moyamoya disease (MMD).Methods Forty-one adult patients with non-hemorrhagic MMD retrieved from Nanjing Stroke Registry Program between August 2008 and January 2011 were identified by digital cerebral angiography and performed the examination of FLAIR sequence in Jinling hospital.According to the different sites of HVS located in the territory of the middle cerebral artery,the patterns of HVS were classified into grades 0-3: Grade 0,absence of HVS ; Grade 1,HVS limited in the cerebral sulci of temporal lobe and Sylvian fissure ; Grade 2,HVS in the cerebral sulci of frontal and parietal lobe regions and Sylvian fissure;and Grade 3,HVS in the combined territories of Grade 1 and Grade 2.According to the intracerebral collateral blood flow,steno-occlusions of the arteries were classified into three types: Type 1,residual antegrade flow across steno-occlusive lesions; Type 2,retrograde flow via leptomeningeal vessels; Type 3,the combined collateral blood flow of Type 1 and Type 2.The relationship between the patterns of intracerebral collateral blood flow and the location of HVS was analyzed.Results Of 41 adult patients with non-hemorrhagic MMD,there were 3 patients presented with unilateral vascular lesions and 38 with bilateral vascular lesions,so the total number of vascular lesions of the cerebral hemispheres was 79.Because three patients showed the absence of HVS in bilateral hemispheres,the total number of the presence of HVS of the cerebral hemispheres was 73.Therefore,the percentage of the presence of HVS was 92.4％ (73/79) in vascular lesions of the cerebral hemispheres.Importantly,the patterns of slow collateral blood flow corresponding to Grade 1 HVS were all antegrade (7/7) ; the collateral patterns corresponding to Grade 2 HVS were mainly retrograde leptomeningeal flow (95.0％,19/20) ; and the patterns corresponding to Grade 3 HVS were mainly slow combined collateral blood flow(84.8％,39/46).Furthermore,with the changing sites of HVS from the cerebral sulci of temporal lobe to the cerebral sulci of frontal and parietal lobe regions,the directions of collateral flow changed with a shift from antegrade to retrograde,which was statistically significant.Conclusion The different locations of HVS can reflect the different patterns of collateral blood flow,and the locations of HVS may predict the directions of intracerebral collateral blood flow in adult MMD patients.