Objective To evaluate of the clinical effect of triple arthrodesis and bone grafting combined with plat screw internal fixation for treatment of necrosis of talus. Methods The clinical data of 24 patients with necrosis of talus who were treated by triple arthrodesis and bone grafting combined with plat screw internal fixation from April 2011 to January 2015 in Xiangya Second Hospital of Central South Univer-sity were retrospectively analyzed. And the clinical effect were measured by AOFAS Ankle Hind-foot Scale System. Results The 24 patients were followed up for 26 months averagely (12~36 months). According to AOFAS Ankle Hind-foot Scale System, there were 4 cases of mod-erate and 20 cases of bad before treatment, and there were 18 cases of excellent, 4 cases of good, and 2 cases of moderate after the treat-ment. Conclusion It can achieve good clinical results in treatment of necrosis of talus through triple arthrodesis and bone grafting combined with plat screw internal fixation.

Objective To measure the levels of human interleukin (IL)-32 in the serum and induced sputum of patients with chronic obstructive pulmonary disease (COPD) and investigate the possible roles of IL-32 in COPD.Methods Sixty patients with acute exacerbation of COPD ( AECOPD),60 patients with stable COPD,and 30 healthy subjects were recruited.The concentrations of IL-8,tumor necrosis factor alpha (TNF-α),and IL-32 in serum and induced sputum were measured by enzyme-linked immunosorbent assay (ELISA).The correlations among IL-32,IL-8,TNF-α,and lung functions were investigated. The data were analyzed using a statistical software package (SPSS 13.0).Variables were compared with one-way ANOVA,and correlations among variables were analyzed using Pearson's correlation coefficient or Spearman's correlation coefficient.Results The serum IL-32 level was significantly higher in AECOPD patients [(175 ± 88) ng/L] than in healthy subjects [ (59 ± 21 ) ng/L] and in stable COPD patients [ (89 ± 34) ng/L] (P ＜ 0.05) ; the serum IL-32 level was also significantly higher in stable COPD patients than in healthy subjects (P ＜ 0.05).The sputum IL-32 level was significantly higher in AECOPD patients [ ( 163 ± 117) ng/L] than in healthy subjects [ ( 75 ± 38 ) ng/L] and stable COPD patients [ ( 108 ± 63 )ng/L] (P ＜0.05); the sputum IL-32 level was also significantly higher in stable COPD patients than in healthy subjects ( P ＜ 0.05 ).The sputum IL-32 level in AECOPD patients was positively correlated with the sputum IL-8 and TNF-α levels (r =0.49 and 0.53,respectively) (P ＜0.01 ).The sputum IL-32 level in AECOPD patients was negatively correlated with FEV1 predicted values,FEV1/FVC,and PaO2 (r =-0.44to -0.33) (P ＜ 0.01 ).The serum IL-32 level in AECOPD patients was positively correlated with the serum IL-8 and TNF-o levels (r =0.45 and 0.61,respectively) (P ＜ 0.01 ).The serum IL-32 level in AECOPD patients was negatively correlated with FEV1 predicted values,FEV1/FVC,and PaO2 (r =-0.46to - 0.29) ( P ＜ 0.01 ).Conclusions IL-32 may be involved in the pathogenesis of airway inflammation in COPD.IL-32 may be a useful marker of acute exacerbation of COPD.

Objective　To investigate the characteristics of changes in mean red blood cell volume in patients with DWI-negative cerebral infarction.Methods　The patients were divided into two groups:(1)DWI negative group:46 patients.(2)DWI positive group:59 patients.All patients underwent routine axial,coronal,and sagittal thin-section DWI examinations on a 3.0T MRI scanner.The general information of the patients was recorded,and the electrolyte levels,carbon dioxide binding capacity,blood lipids,renal function and coagulation function of the patients were determined.Plasma osmotic pressure was calculated.The patient’s white blood cells,red blood cells,platelets,hemoglobin,mean corpuscular volume (MCV),hematocrit,mean platelet volume,platelet volume,and mean platelet volume were measured.Results　There was no significant difference in plasma osmotic pressure,carbon dioxide binding capacity,blood calcium concentration,hematocrit,mean platelet volume,platelet volume and D-dimer level between the DWI-negative group and the DWI-positive group (P values equal to 0.290,0.558,0.113,0.090,0.401,0.460,0.510 respectively).Compared with the DWI-positive group,the mean corpuscular volume of the DWI-negative group increased (P=0.009).Logistic regression analysis showed that the increase in mean red blood cell volume was an independent factor for DWI-negative cerebral infarction (OR=2.864,95%CI 1.385~5.360,P=0.003).Conclusion　Patients with negative imaging on DWI sequences are characterized by increased mean corpuscular volume in the blood.

Objective To explore the clinical and etiological features of rare and special thalamic artery(thalamotuberal artery,thalamoperforating artery,and posterior choroidal artery) occlusion. Methods We included 48 patients with thalamogeniculate artery occlusion and 19 patients with non-thalamogeniculate artery occlusion to compare their clinical manifestations and etiological classifications. Results Compared with the thalamogeniculate artery occlusion group,the non-thalamogeniculate artery occlusion group showed a significantly higher percentage of decline in advanced cognition(0.00% vs 21.1%, χ2=10.747,P=0.001),a significantly lower percentage of unilateral sensory disturbance(75% vs 21.1%, χ2=16.466,P<0.001),a significantly higher percentage of large artery atherosclerosis in etiology classification(29.17% vs 84.2%, χ2=16.679,P<0.001),and a significantly larger infarct volume(t=10.86,P<0.001). Conclusion Patients with thalamic stroke caused by non-thalamogeniculate artery occlusion are more likely to have decline in advanced cognition and large artery atherosclerosis. More attention should be paid to large vessel disease screening for such patients.

The author studied the imaging features of meningeal vascular neurosyphilis，and provided guidance for the differential diagnosis of cerebral infarction. Methods Patients with meningeal vascular syphilis underwent head MRI plain scan + enhancement，PWI，MRA and SWI. The four parameters of PWI on the side of the lesion were compared with those on the contralateral side of the lesion. Results A total of 7 patients with neurosyphilis underwent head MRI examination，and a total of 9 responsible lesions were found. They are listed as follows，two pontine lesions，one radiative coronary lesion，one thalamic lesion，one occipital lobe lesion，two parietal lobe lesions，one insular lobe lesion，and one frontal lobe lesion. The edge of the lesion in a radiating crown is enhanced. Through MRA examination，6 patients were found to have vascular stenosis. PWI examination of patients with neurosyphilis found that compared with the contralateral side，the rCBV value［（72.47±46.51）vs.（130.68±38.92）］of the responsible lesion area decreased，t=4.172，P= 0.002；and the rCBF value［（111.10±37.89） vs.（153.43±50.81）］also decreased，t=2.804，P=0.025.Conclusion The PWI manifestations of intracranial lesions in patients with neurosyphilis may have different imaging features from cerebral infarction.

Objective　To study the symptoms and comorbidities of patients with cerebral infarction combined with decreased serum folic acid levels.Methods　Patients were classified as folic acid-reduced cerebral infarction group（n=372） and folate normal cerebral infarction group（n=218）.The symptoms and concomitant disease state characteristics of the two groups were compared.Results　Compared with the normal folic acid group,patients in the folic acid-reduced group developed bilateral lower extremity fatigue and decreased memory,walking instability（P=0.001、0.011、0.001,respectively）.Through binary unconditional Logistic regression analysis,it was found that a history of symptomatic cerebral infarction,dementia,diabetes,atrial premature beat,left ventricular hypertrophy,homocysteine are all related to the reduction of folic acid（P=0.000、0.011、0.002、0.002、0.032、0.006 respectively）.Conclusion　Cerebral infarction patients with reduced folic acid manifested as bilateral lower extremity weakness,walking instability,and decreased memory.Most patients had multiple history of cerebral infarction,dementia,hyperhomocysteinemia,and heart damage.

ObjectiveIn order to reveal the relationship between the increase of thyroid antibodies and the type of cerebral infarction and the distribution of vascular stenosis. MethodsAmong patients with cerebral infarction，99 patients with completely normal thyroid antibodies were selected，and 357 patients with elevated thyroid antibodies were selected. Different features of cerebral infarction classification and vascular stenosis distribution were compared between the two groups of patients. ResultsIn terms of cardiogenic embolism，17.17%（17/99）of the elevated thyroid antibody group and 10.92%（39/357）of the normal thyroid antibody group，the difference was statistically significant，P=0.037.In terms of small arterial occlusion，the thyroid antibody increase group was 37.37%（37/99）and the normal thyroid antibody group was 26.89%（96/357）. In terms of narrowed or occluded extracranial arteries，the thyroid antibody elevation group was 1.01%（6/594），and the normal thyroid antibody group was 1.45%（319/2142）. The difference was statistically significant，P=0.000.Regarding the intracranial segment of the vertebral artery，3.03%（6/198）of the thyroid antibody increased group and 0.70%（5/714）of the normal thyroid antibody group，the difference was statistically significant，P=0.025.After adjusting for all variables，it was found that thyroid antibody elevation was cardiogenic embolism（OR=2.781，95%CI=1.198～6.293，P=0.034），arterial occlusion（OR=0.492，95%CI = 0.392～0.820，P=0.013）. ConclusionsPatients with cerebral infarction with elevated thyroid antibodies have a higher proportion of cardiogenic embolism and arterial occlusion，a lower proportion of extracranial artery stenosis or occlusion，and a higher proportion of vertebral artery intracranial stenosis or occlusion.

Objective　A group of patients with instability of walking as the main manifestation and combined with hypofolateemia were collected and their clinical characteristics were summarized. Methods　54 patients with folic acid <3.1 IU/ml，without cerebrovascular disease，whose first symptom manifested as "walking instability" were classified as the first group with folic acid deficiency in walking instability. Folic acid <3.1 IU/ml combined with cerebrovascular disease was listed as the control group of folic acid reduction combined with cerebrovascular disease，a total of 129 patients. The characteristics of baseline data，biochemical metabolism data，and brain MRI brain ischemic lesion distribution were compared between the two groups，and Logistic multivariate regression analysis was performed. Results　The onset of folic acid deficiency in the onset of walking instability was （7.56±8.78） days，which was longer than the folic acid deficiency combined cerebrovascular disease control group at （5.19±6.87） days，t=4.586，P=0.001.The onset age of folic acid deficiency in the first manifestation of walking instability was （77.11±9.97） years，which was higher than the folic acid deficiency combined cerebrovascular disease control group at （73.30±12.42） years，t=2.906，P=0.022.The homocysteine in the folic acid deficiency group at the first manifestation of unstable walking was （19.88±9.00），which was lower than the folic acid deficiency combined with cerebrovascular disease control group （30.38±59.77），t=2.938，P=0.021.Focal deficiencies in the folic acid-deficient group at the onset of walking instability were higher （41.67%） than in the control group （33.72%），χ2=6.254，P=0.012.Instability of walking was first manifested in the folic acid-deficient group，and most of the ischemic foci in the cerebral hemisphere were spot-shaped and independent. Folate deficiency combined with cerebrovascular disease control group，most of the cerebral hemisphere ischemic lesions were fused into linear，band-shaped lesions with blurred borders. Using the folic acid deficiency group as the dependent variable for the first manifestation of walking instability，a binary logistic multivariate regression analysis revealed that the cerebral lobe ischemic focus was OR=2.311，95%CI 1.174～4.569，P=0.025.Conclusion　Patients with instability in walking and folic acid deficiency may have a longer onset，older age，and insignificant increase in homocysteine levels. A cranial MRI examination showed frontal，temporal and parietal lobes. The number of cerebral lobe ischemic foci is relatively large，and they are distributed in a dot-like and independent manner.

Objective　The aim of this study is to reveal laboratory and imaging features of cerebral infarction patients with reduced folate levels.Methods　There were 191 patients with reduced folate levels and cerebral infarction,and 186 patients with normal folate levels and cerebral infarction.The characteristics of laboratory examination,TOSAT classification of cerebral infarction,distribution of lesions and vascular stenosis were compared between the two groups.Results　Compared with the cerebral infarction group with normal folic acid,the fasting blood glucose levels and glycated hemoglobin levels were lower in the cerebral infarction group with reduced folic acid (P<0.05).There was no significant difference in the TOAST classification between the two groups (P>0.05).There was no significant difference in the number of head and neck stenosis or occlusion between the two groups (P>0.05).There was no statistically significant difference in the proportion of intracranial artery and extracranial artery stenosis or occlusion between the two groups (P>0.05).The normal folate cerebral infarction group is an independent predictor of type 2 diabetes.Conclusion　Cerebral infarction patients with lower serum folic acid levels have better glucose metabolism.Decreased folic acid levels had no effect on the TOAST classification of cerebral infarction and the distribution of intracranial and extracranial stenosis.