Objective To observe the evolution process of cerebral blood flow spectrum in brain death by transcranial doppler ultrasound.Methods To detect the blood flow of bilateral middle cerebral artery in brain dead patients by transcranial doppler ultrasound.Results Twenty brain dead patients were collected in the study.The blood flow velocity of middle cerebral artery ranged s from 6 to 37cm/s,and the mean velocity was (12.13 ± 3.15)cm/s.There were three characteristic spectrums which include oscillatory wave (reverse wave in diastolic),nails wave (tip small wave in systolic),no blood flow sign,and they appeared in turn accoerding to worsen of the disease.The heartbeat irreversibly stopped within 8 days after the appearing of oscillatory wave,and ninty percent of the cases had the regular blood flow spectrums of oscillatory wave-nails wave-no blood flow sign.Conclusion The three regularly characteristic transcranial doppler ultrasound blood flow spectrums,which include oscillatory wave,nails wave and no blood flow sign could facilitate the diagnosis of brain death.

Objective To observe the effect of Tongsaimai Tablets on the leptomeningeal collateral circulation established after acute cerebral infarction by TCD.Methods 50 patients with acute cerebral infarction were randomly divided into control group (received conventional treatment) and treatment group (received Tongsainai Tablets three times a day,1.75g each time,on the basis of conventional treatment).The leptomeningeal collateral circulation of the two groups were observed after 6 months.Results The factors which may affect the leptomeningeal collateral circulation,such as age,the prevalence of hypertension and hyperlipidemia,original compensatory status of cerebral artery between the two groups had no statistically significant differences.The open rate of leptomeningeal collateral circulation in the treatment group was 64.00％,which was significantly higher than that of the control group(32.00％)(P =0.024).Conclusion Tongsaimai Tablets can promote the formation of leptomeningeal collateral circulation in patients with acute cerebral infarction.

Objective To assess the predictive value of cerebral arteriosclerosis to acute cerebral infarction evaluated by transcranial doppler ultrasound .Methods 170 cases suspected cerebral arteriosclerosis consecutively enrolled were given transcranial doppler ultrasound and were followed up for 6 months,then we assessed the correla-tion between the levels of cerebral arteriosclerosis and acute cerebral infarction within 6 months.Results By Spearman rank correlation analysis ,there was positive correlation between the severity of cerebral arteriosclerosis de-tected by transcranial doppler ultrasound and acute cerebral infarction within 6 months,the correlation coefficient was 0.575(P<0.05).Conclusion Through the detection of transcranial doppler ultrasound ,the higher levels of cere-bral arteriosclerosis,the greater probability of acute cerebral infarction within 6 months.

Objective To observe the influence of Gastrodia data capsule on cerebral blood flow in the treatment of patients with hypertension.Methods A total of 69 patients with hypertension were divided into the treatment group(36 cases) and the control group(33 cases).The treatment group received treatment of Gastrodia clara capsule combined with antihypertensive drug,the control group received treatment of antihypertensive drug only.Two groups received TCD test before and 20 days after treatment,and the changes of blood flow of intracranial vessels before and after treatment were assessed.Results The total effective rate in treatment group was 97.2％,12 cases cured,15 cases of tangible effectiveness,8 cases of effectiveness,1 case of invalidity.The total effective rate in control group was 75.8％,7 cases cured,12 cases of tangible effectiveness,6 cases of effectiveness,8 case of invalidity,The difference of clinical efficacy between the two groups was statistically significant ( Z =2.240,P ＜ 0.05 ).The mean velocity of MCA,ACA,PCA,BA,VA of control group 20 days after treatment was not statistically different compared to those before treatment.The mean velocity of MCA,ACA,PCA,BA,VA of treatment group 20 days after treatment was lower than those before treatment(t =-2.65,-2.44,-3.92,-3.31,-4.68,all P＜0.05).Conclusion The treatment of Gastrodia elata capsule conbined with antihypertensive drug can significantly improve curative effect of patients with hypertension and improve the condition of cerebral blood flow.

This article selected several typical clinical cases, analyzed many factors affect the doctor-patient relationship of ethical issues and new technology of differentiating the ethical dilemma for clinical application, and put forward some suggestions for the reference of medical staff , hospital ethics committees and health policy makers.

Objective To analyze the incidence of BK virus (BKV) infection after kidney transplantation in our center and to evaluate the efficacy and safety of conversion treatment with Mizoribine (MZR) on BKV infection after kidney transplantation.Methods The information of recipients who received BK virus screening in hospital or outpatient during 2015-02 to 2016-12 in our center was retrospectively analyzed.The recipients positive for BKV were divided into experiment group (given conversion treatment with MZR) and control group (not given MZR conversion) according to the inclusion criteria.The negative rate of BKV,AR,hyperuricemia and the function of renal allograft during the conversion treatment with MZR were observed.Results 182 recipients accepted BKV screening during 2015-02 to 2016-12 and 68 cases were positive.The positive rate of BKV was 38.5 ％.The positive rate of peripheral blood specimens and midstream urine specimens was 7.1％ and 36.8％ respectively.Twelve recipients were positive for BKV in both peripheral blood specimens and midstream urine specimens.There were 27 recipients in experiment group and 36 cases in control group.Fourteen recipients positive for BKV became negative after MZR conversion in experiment group and the negative rate was up to 51.9％.The mean time of negative rate was 3.2 ± 2.7 (1-10) months after MZR conversion.During the conversion treatment with MZR,AR occurred in 1 case and was reversed by the impact therapy with Thymoglobulin in experiment group.The value of serum uric acid was maintained stable before and after MZR conversion under the action of uric-acidlowering drug.The renal function was kept stable in both experiment group and control group after renal transplantation.No deaths and renal allograft failure cases occurred in both groups during the research period.The 2-year survival rate for patients and kidneys was both 100％.Conclusion The incidence of BKV infection after kidney transplantation was high and the treatment scheme of MZR conversion was safe and effective.

Objective To evaluate the correlation between serum uric acid with cognitive disorder after acute cere?bral infarction by prospective study. Methods Four hundred consecutively enrolled patients of acute cerebral infarction were divided into no cognitive impairment group and cognitive impairment group according to the assess of Montreal Cog?nitive Assessment (MoCA). Univariate analysises were conducted in the potential risk factors of cognitive impairment in?cluding age, sex, smoking, alcohol, hypertension, diabetes, dyslipidemia, level of education, infarction in key parts, atrial fibrillation, serum uric acid, blood homocysteine between two groups. The statistically significant indicators in univariate analysises were used as independent variables and the scores of MoCA were used as the dependent variable to conduct multiple linear regression analysis. The assessment on the risk of cognitive impairment after cerebral infarction were con?ducted according to serum uric acid, sex, age and TOAST classification further. Results Serum uric acid was indepen?dent risk factors of cognitive disorder after acute cerebral infarction. The risk of cognitive disorder after acute cerebral in?farction was significantly increased in patients with high level of serum uric acid than with normal level and the relative risk was 1.35,95%CI(1.098,1.660). Especially for the young, male or patients with cerebral infarction in classification of small artery occlusion, the risk increased further, and the relative risk was 1.513, 95%CI(1.092, 2.096)1.412, 95%CI (1.125, 1.771)and 1.464, 95%CI(1.128, 1.900)respectively. Conclusion Exaltation of Serum uric acid was indepen?dent risk factor of cognitive disorder after acute cerebral infarction. The risk of cognitive disorder after acute cerebral in?farction was significantly increased in patients with high level of serum uric acid than with normal level, and especially for the young, male and patients with cerebral infarction in classification of small artery occlusion, the risk increased fur?ther.

OBJECTIVE:To provide reference for TCM in the treatment of coronary heart disease (CHD) unstable angina and new drug research and development.METHODS:TCM inheritance auxiliary platform software was adopted to build prescription database of TCM in the treatment of CHD unstable angina.The software function of clinical collection,platform management,information management,knowledge retrieval,statistics,data analysis were adopted to analyze prescription database in respects of four properties,five tastes,channel tropism distribution,frequency statistics,rules of prescriptions and potential new prescriptions,etc.RESULTS:Through analyzing 178 prescriptions of CHD unstable angina,152 ingredients were involved.Top 3 in the list of distribution frequency of four properties were warm (617),cold (474) and mild (288).Top 3 in the list of distribution frequency of five tastes were bitter (750),sweet (732) and pungent (497).Top 3 in the list of distribution frequency of channel tropism were liver (860),heart (573) and spleen (549).A total of 40 ingredients were used more than 10 times,and top 5 were Ligusticum chuanxiong,Salvia miltiorrhiza,Astragalus membranaceus,Angelica sinensis and Carthamus tinctorious.According to the frequency of the drug combination,top 5 in descending order were L.chuanxiong-S.miltiorrhiza,L.chuanxiong-A.sinensis,L.chuanxiong-A.membranaceus,C.tinctorious-L.chuanxiong and S.miltiorrhiza-A.membranaceus.A total of 8 new prescriptions were obtained after evolution.CONCLUSIONS:Main prescriptions for CHD unstable angina included in CNKI are mild drug property,sweetness and bitterness in taste.Main selected ingredients can promote blood circulation,remove blood stasis and relieve pain,relieve restlessness and tranquilize the mind.It embodies the CHD unstable angina treatment principles of "treat both the incidental and fundamental aspects,tonification and purgation in combination".

Objective:This study aimed to evaluate the performance of breast magnetic resonance imaging (MRI) abbreviated protocol (AP) in diagnosing breast neoplasms.Methods:We retrospectively analyzed the data of 86 patients who had undergone breast MRI examinations and compared the images using an AP and full diagnostic protocol (FDP). The AP consisted of axial T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and four-phase dynamic enhancement sequences. The FDP consisted of sagittal T2WI, axial T2WI, T1-weighted imaging, DWI, and seven-phase dynamic enhancement sequences. All the images were analyzed using the Breast Imaging Reporting and Data System (BI-RADS). The consistencies between the different protocols were then calculated. With the pathological diagnosis as the gold standard, the diagnostic capabilities of the two protocols were compared.Result:Two radiologists analyzed the AP and FDP images. The consistencies in the BI-RADS between the different protocols were 0.856 and 0.900, and those in time-signal intensity curves (TICs) were 0.822 and 0.922. Within the same protocol, the consistencies in the BI-RADS between different radiologists were 0.744 and 0.822, and those in TICs were 0.889 and 0.878. No significant differences were found ( P>0.05). In terms of diagnosing malignant neoplasms using the BI-RADS, the sensitivities of the AP and FDP were 89.8% (95 %CI: 0.785-0.958) and 91.5% (95 %CI: 0.806-0.968), respectively; their specificities were 71.0% (95 %CI: 0.518-0.851) and 77.4% (95 %CI: 0.585-0.897), respectively; and the areas under the curves (AUCs) were 0.804 (95 %CI: 0.698-0.910) and 0.845 (95 %CI: 0.748-0.941), respectively. Diagnosing malignant neoplasms using TICs, the sensitivities of the AP and FDP were 86.4% (95 %CI: 0.745-0.936) and 89.8% (95 %CI: 0.785-0.958), respectively; their specificities were 61.3% (95 %CI: 0.423-0.776) and 67.7% (95 %CI: 0.485-0.827), respectively, and the AUCs were 0.739 (95 %CI: 0.623-0.855) and 0.788 (95 %CI: 0.679-0.897), respectively. There was no significant difference between the AP and FDP ( P>0.05). The MRI acquisition times of the AP and FDP were 11.97±0.94 min and 21.25±1.12 min, respectively, with a significant difference ( P<0.001). The average reading time was reduced by 13.5% using the AP compared with that using the FDP. Conclusion:Compared with the FDP, the AP reduced the acquisition time and maintained the diagnostic accuracy, which can be used as an improved pattern for MRI screening in high-risk populations of breast neoplasms.

Objective:To introduce some rare clinical features of the variant Guillain-barre syndrome (GBS) and to explore its possible pathogenesis for the early diagnosis.Methods:The clinical data, laboratory data and treatment outcomes of four patients, who admitted to Shenzhen People′s Hospital from October 2017 to June 2018 and diagnosed with variant GBS were analyzed and summarized.Results:All the four patients presented limb weakness as a first manifestation. However, they all had clinical features that were inconsistent with typical GBS, and the clinical features were shown differently in each patient. One patient showed asymmetrical limb paralysis. The first manifestation of one patient was severe and persistent back pain accompanied by paraplegia. One patient was accompanied by obvious headache and positive meningeal irritation. One patients had the plane of sensory obstacles, paraplegia, and positive pathological sign. Cerebrospinal fluid examination showed protein cell dissociation in four patients. Electromyogram was consistent with peripheral neurogenic damage. Magnetic resonance imaging (MRI) of the brain and the spinal cord showed no obvious abnormalities. The four patients with obvious improvement in symptoms were treated with gamma globulin and glucocorticoid.Conclusions:Variant GBS is rare and clinical symptoms are various. Patients with atypical clinical symptoms should still be diagnosed by relevant auxiliary examinations to avoid delayed illness.