Objective To investigate the relationship between spontaneous hemorrhagic transformation and prognosis after cerebral infarction.Methods Three hundred and thirty-seven cases with acute ischemic stroke at the Brain Hospital Affiliated to Nanjing Medical University from Nov.2011 to Jul.2012 were selected as our subjects.All the relevant clinic and laboratory examination data which influencing spontaneous hemorrhagic transformation were collected.Brain CT or MRI within 3 d after admission or when neurological deficit deterioration happened was performed.Based on brain CT scan or MRI,patients were divided into hemorrhagic transformation(HT) group or non-HT(NHT) group.All cases were followed up for 3 month.Results All of 337 patients,44 cases occurred in spontaneous hemorrhagic transformation,accounting for 13.1％.The mortality rate was 6.8％ (3 cases) in 3 months followed-up at HT group,and the death/disability rate was 47.7％ (21 cases).Meanwhile,the mortality rate was 7.5％ (21 cases) in 3 months followed-up at NHT group,and the death/ disability rate was 35.5％ (104 cases).There was no significant difference between the two groups(x2 =3.10,P =0.376).Multivariate logistic regression analysis demonstrated that age (OR =1.054,95 ％ CI 1.021-1.087),gender(OR =2.131,95％ CI 1.151-3.945) and the national institutes of health stroke scale(OR =1.275,95％ CI 1.174-1.384) were independent predictors of death/dependence at 3 months after ischemic stroke attacked.Conclusion Spontaneous hemorrhagic transformation is not the risk factor of death/dependence on 3 month after symptom onset for ischemic stroke patients.Spontaneous hemorrhagic transformation should be detected as early as possible and adjusted therapy scheme in time,which will help in terms of prognosis.

Objective To investigate the application value of nutritional support therapy after resection of esophageal cancer.Methods The clinical data of 125 patients with esophageal cancer who were admitted to the Shandong Provincial Hospital Affiliated to Shandong University between May and November 2013 were retrospectively analyzed.According to the Nutritional Risk Screening 2002 (NRS 2002), 58 patients with scores of NRS 2002 ≥3 were allocated to the A group including 43 receiving nutritional support therapy in the A1 group and 15 receiving no nutritional support therapy in the A2 group;67 patients with scores of NRS 2002 ＜ 3 were allocated to the B group including 29 receiving nutritional support therapy in the B1 group and 38 receiving no nutritional support therapy in the B2 group.The NRS 2002 was used as a screening tool of nutritional risk within 48 hours after admission.There was nutritional risk in patients with scores of NRS 2002 ≥ 3 and no nutritional risk in patients with scores of NRS 2002 ＜ 3.Patients and their families would choose whether or not underwent nutritional support therapy after the risks being informed.Parenteral nutritional support therapy used any 2 kinds of intravenously infusions of glucose, fat emulsion and amino acid, and enteral nutritional support therapy included tube feeding enteral nutrition or oral nutriments.The calories ≥ 10 kcal/(kg · d) were offered for more than 5 days.The incidence of malnutrition in patients with nutritional risk was calculated, and the level of serum Alb and prealbumin before operation, at postoperative day 3 and day 7, postoperative recovery time of gastrointestinal function and duration of hospital stay were detected.Count data were analyzed using the chi-square test.Measurement data with normal distribution were presented as-x ± s.Comparison among groups was analyzed using the LSD-t test, and repeated measures data were analyzed by the repeated measures ANOVA.Results Of 58 patients in the A group, 51 patients were complicated with malnutrition with a incidence of 87.9％, and nutritional support therapy in 43 patients was well tolerated without abdominal pain, distension and diarrhea.The level of serum Alb before operation, at postoperative day 3 and day 7 were (29.4 ± 1.7) g/L, (29.8 ± 1.5) g/L, (32.2 ± 2.3) g/L in the A1 group, (28.5±1.9)g/L, (27.0±1.8)g/L, (28.3 ±1.7)g/L in the A2 group, (35.8±1.3)g/L, (36.0± 1.4) g/L, (37.4 ± 2.1) g/L in the B1 group and (34.5 ± 1.3) g/L, (35.3 ± 1.7) g/L, (36.3 ± 1.5) g/L in the B2 group, showing a significant difference in the changing trends between the A1 and A2 groups (F =2.541, P ＜0.05) and no significant difference between the B1 and B2 groups (F =0.734, P ＞ 0.05).The number of patients with level of prealbumin ＜2.5 g/L and ≥2.5 g/L before operation, at postoperative day 3 and day 7 were 17 and 26, 13 and 30, 10 and 33 in the A1 group, 6 and 9, 9 and 6, 10 and 5 in the A2 group, 5 and 24, 6 and 23, 7 and 22 in the B1 group and 7 and 31, 9 and 29, 13 and 25 in the B2 group, with a significant difference between the A1 and A2 groups (x2 =4.183, P ＜ 0.05) and no significant difference between the B1 and B2 groups (x2 =0.795, P ＞ 0.05).The postoperative recovery time of gastrointestinal function and duration of hospital stay were (3.2 ± 0.8) days and (11.6 ± 1.1) days in the A1 group, (3.8 ± 1.0) days and (15.5 ± 2.7) days in the A2 group, (2.7 ± 1.0) days and (10.6 ± 2.6) days in the B1 group and (3.2 ± 0.8) days and (11.3 ±1.5) days in the B2 group, with significant differences between the A1 and A2 groups (t =0.921, 3.005, P ＜0.05) and no significant difference between the B1 and B2 groups (t =0.927, 0.440, P ＞ 0.05).Conclusions Application of NRS 2002 for evaluating nutritional status and guiding nutritional support therapy in patients with esophageal cancer is accurate and trusted.The postoperative nutritional support therapy should be selectively and reasonably applied to patients with nutritional risk, and it can improve the nutritional status of patients with esophageal cancer, enhance postoperative recovery and reduce duration of hospital stay.

Glaucoma is one of the leading causes of blindness worldwide.Its characteristics are chronic neurodegenerative disease of the optic nerve,such as apoptosis of retinal ganglion cells,progressive loss of optic nerve axons and visual fields defects.The elevated intraocular pressure and vascular insufficiency are considered as the major risk factors,and the other factors include the glutamate excitotoxicity,nitric oxide increasing and oxidative stress.In recent years,the immune system changes were found to be participated in the pathogenesis of glaucoma and its damages of optic nerve.The main findings are the autoantibodies of heat shock protein,the elevation of tumor necrosis factor and other proinflammatory cytokines in periphery blood and aqueous humor.The immunological advance of autoantibody,cellular immunity and cytokines in the glaucoma and its neuronal damage were reviewed.

AIM: To observe the effect of L arginine on blood pressure (BP) in stress rats. METHODS: Thirty rats were divided into three groups. L ARG+stress group: L arginine was added in drinking water and electric stimulus were given intermittently in rat foot plate for 15 days; stress group: electric stimulus was given as above; control group: no stress. The BP levels of tail artery were measured per two days, and the concentrations of nitric oxide (NO) of plasma were detected on 15th day. RESULTS: There were significantly differences on BP between control group and stress group in the 9th,11th,13th,15th day(P

Objective To investigate effects of cerebral isehemic preconditioning on neurological function,in- farct volume,and the expression of caspase-3 in brain issue after brain ischemia again,and to investigate the brain protection mechanism produced by cerebral ischemia preconditioning.Methods 48 healthy male Sprague-Dawley (SD)rats(weighted 200～250g)were randomly divided into 2 groups:ischemia group(n=24),ischemia precondi- tioning group(namely preconditioning group,n=24).Each group was divided into 4 subgroups according to 6h,1d, 2d,4d after ischemia again.Results At the same point of time after ischemia,neurological deficit in preconditioning group was much less than that in ischemia group,the difference was significant(P

Objective: To observe the efficacy and safty of intensity-modulated radiation therapy (IMRT) plus concomitant and adjuvant chemotherapy of temozolomide (TMZ) for glioma patients with postoperative residual. The target dose distribution and the dose to organs at risk were analyzed by dosiology of radiotherapy. Methods: Twenty-one glioma patients with postoperative tumor residual were enrolled between April 2008 and June 2009, including 10 cases of grade II and 11 cases of grade III-IV within the WHO 2000 classification. All patients received IMRT with a total dosage of 59.92-64.20 Gy/ 28-30 fx and concomitant chemotherapy (oral TMZ 50-75 mg·m-1·d -1), followed by 6 cycles of adjuvant TMZ (150-200 mg·m -1·d-1, in a 28-d cycle) 4 weeks after IMRT. Results: There were 2 cases of complete response (CR), 17cases of partial response (PR), and 2 cases of stable disease (SD), and the overall response rate (CR+PR) was 90.5%. The overall response rates of patients with grade II and III-IV were 100% (10/10) and 81.8% (9/11), respectively. The one-year progression-free survival rate was 80.9% and the overall survival rate was 85.7%, which were both 100% in grade II, whereas 72.7% and 81.8% in grade III-IV, respectively. The dose of each critical organ in IMRT was obviously lower than the minimum tolerance dose in conventional radiation therapy, and the radiation-related toxicities were mild. All patients in this study could tolerate the regimen. Conclusion: IMRT combined with concomitant and adjuvant TMZ chemotherapy for gliomas has a higher short-term efficacy with less side effects, meanwhile the IMRT for protection of vital organs around the target has certain advantages.

Port-wine stains(PWS)are a common congenital capillary malformation. The lesions of PWS appear to gradually darken in color and thicken with age, and even progress into nodules in late stage. Based on the principles of selective photothermolysis, pulsed dye laser (PDL)has become a standard treatment for PWS. However, for some intractable PWS, single PDL treatment shows unsatisfactory and even no effects. Considering this state, the authors summarize multiple treatment strategies for intractable PWS with thick or nodular lesions, providing a reference for their treatment.

Alanine aminotransferase (ALT)abnormality is an indicator of the degree of liver inflammation caused by immune activation in patients with chronic hepatitis B (CHB).However,approximately half of the CHB patients with normal or mildly elevated ALT levels have concealed significant changes in hepatic histology.CHB patients with normal or mildly elevated ALT levels may have significant histopatho-logical changes in hepatic tissues,and those changes vary between HBeAg(+)and HBeAg(-)CHB patients.Attention and investigation on the clinical management of CHB patients with normal or mildly elevated ALT levels may have great significance in grasping the right treat-ment opportunity and reducing the risk of liver cirrhosis.

Objective To analyze prognostic relative factors in treatment by evaluating the surgical results of tibial pilon fracture retrospectively. Methods 32 cases with unilateral tibial pilon fracture were treated operatively between January 1997 and December 1999. Among them, 16 cases were found with unsatisfied results due to incisional complications, degenerative changes and stiffness of the ankle joint. Of 16 cases, there were 13 males and 3 females. The average age was 36.5 years (range, 25 to 55 years). The mechanisms of injury were fall in 7 cases, traffic accident in 5 cases, crash in 3 cases and other cause in 1 case. 6 cases with open fracture were treated in emergency. However, 10 cases with closed fracture were operated with an average interval of 8.1 days from injury to surgery(range, 2 to 25 days). According to the Ruedi-Allgower classification, there were type Ⅱ fracture in 7 cases and type Ⅲ fracture in 9 cases. Furthermore, there were 14 cases associated with fibular fracture. During operation, 7 cases were treated with open reduction and internal fixation with plates and screws, and 9 cases were treated with open reduced minimally and external fixation with a cast. Results The average period of follow-up was 24 months (range, 12 to 36 months). According to Mazurs criterion, the result of the treatment was evaluated as fair in 6 cases, 4 cases of which were type Ⅱ fracture, and 2 cases type Ⅲ fracture; poor in 10 cases, 3 cases of which were type Ⅱ fracture, and 7 cases type Ⅲ fracture. Complications included wound dehiscence in 1 case; infection in 4 cases, 2 of which with open fracture were superficial infection, and 2 cases with closed fracture were deep infection; posttraumatic arthritis of the ankle joint in 9 cases; and severe varus deformity in 2 cases.11 cases suffered from ankle stiffness. Conclusion Discouraged results of pilon fractures are significantly related to fracture type, reduction status and time of operation, reduction and fixation of fibular fracture, and bone grafting.

Objective To analyse the imaging characteristics of solitary pulmonary nodules(SPNs) with the spiral CT, and detection clinical values of the definitive diagnosis to SPNs. Methods 32 cases of SPNs were identified by spiral CT, 9 cases of them were examinated by enhancement scanning. The diffrentical imaging features were analyzed. Results 24 cases were malignant in imaging(18 cases were identified), 8 cases were benign in imaging(6 cases were identified). 15 cases of malignant SPNs by clinical identified were smooth at edge; 6 cases of benign SPNs by clinical identified. 5 cases of them were anomaly;4 cases of them were burr;2 cases of them were bronchial sign and vesiclat sign.6 cases of the SPNs were calcified. 6 cases of SPNs(9 cases with contrasting) were benign in imaging, 3 cases of them were malignant in imaging. Conclusion The differential diagnostic of SPNs is difficult by spiral CT, but enhancement scanning and epidemiology combined with spiral CT is very valuable for definitive diagnosis.