AIM To study the chemical constituents from twigs of Trigonostemon lutescens Y.T.Chang et J.Y.Liang.METHODS The ethyl acetate fraction of 95％ ethanol extract from T.lutescens twigs was isolated and purified by silica,Sephadex LH-20 and MCI column,then the structures of obtained compounds were identified by physicochemical properties and spectral data.RESULTS Ten compounds were isolated and elucidated as 3-O-acetyloleanolic acid (1),methyl 3-acetoxy-12-enly-oleanen-28-oate (2),taraxerone (3),spiciflorin (4),simiarenol (5),β-sitosterol palmitate (6),3,3',4-tri-O-methylellagic acid (7),β-sitosterol (8),stigamasterol (9),palmitic acid (10).CONCLUSION Compounds 1-6 are isolated from genus Trigonostemon for the first time,compounds 7 and 9 are first obtained from this plant.

Objective To analyze the clinical characteristics,imaging manifestations and prognoses of anti-GABAB receptor antibodies encephalitis.Methods The clinical manifestations,laboratory findings and radiological data of 13 patients with anti-GABAB receptor encephalitis,admitted to our hospital from September 2015 to March 2017,were retrospectively analyzed.Modified Rankin scale (mRs) was performed to evaluate the prognoses (good prognosis:mRs scores ＜ 2;poor prognosis mRs scores≥3).Results These 13 patients had an average age of 58 years (ranged 49-76 years) with a male to female ratio of 12:1.The major clinical features,including epileptic seizure,were found in 12 patients,psychiatric symptoms in 11 patients,cognitive disorder in 7 patients,and disturbance of consciousness in 4 patients.Brain MR imaging showed abnormal signal in 5 patients:4 were located in the hippocampus and amygdaloid,and one in the pons and left temporal lobe.Five patients showed abnormalities in PET-CT,including 4 with temporal hypermetabolism and 1 with cortical hypometabolism.Chest CT showed lung occupying lesions in 4 patients,of which 2 patients were diagnosed as having small cell lung cancer (SCLC) by pathological examination.Ten patients received immunomodulatory therapy,and three were with supportive care.After the average of 8 months of follow-up,7 patients had good prognosis,5 patients had poor prognosis and one patient lost of follow up.Conclusions Anti-GABAB receptor encephalitis frequently occurs in elderly male subjects and the main characteristic includes prominent refractory epilepsy and shows neurological improvement on immunotherapy.It can accompany by SCLC and have a relatively poor prognosis.

Objective To evaluate the difference in isokinetic strength of the knee muscles between knee osteoarthritis (KOA) patients aged 80 years and over and matched healthy controls,and to establish the association of isokinetic strength with pain and functional status in patients with KOA.Methods The study enrolled 32 patients aged 80 and over diagnosed with unilateral knee OA and 10 matched controls.Pain was evaluated by the visual analogue scale (VAS),the pain intensity scale and the Lequesne index for patients with knee OA.Functional status was assessed by the Timed Up and Go Test (TUGT),the Five Times Sit to Stand Test (FTSST) and the Timed 10 Meter Walk Test (TWT).Muscle strength was measured using the isokinetic dynamometer Biodex System 4 Pro.Bilateral isokinetic (concentric) knee flexion and extension with the protocol of 60 degrees/sec,180 degrees/sec was also performed.Results The difference in two angular velocities of extensor and flexor peak torques between the knee OA group and the control group was statistically significant (t=2.747,P＜ 0.05).The extensor peak torque was negatively correlated with age,Liquesce index scores,FTSST,TUGT and TWT (r=-0.39～～-0.75,P＜0.05),but had no correlation with the VAS score or the Lequesne index pain score (r=-0.23～ 0.31,P＞0.05).The regression analysis results suggested that the extensor peak torque and the VAS score together were important predictors for the Liquesce index (adjusted R2 =0.41).Conclusions The degree of knee muscle damage is closely related to the functional performance of the muscles in knee OA patients aged 80 years or over.The strength of the quadriceps and the intensity of pain are important predictors of disability for those patients.

Background and purpose: Collecting duct carcinomas of the kidney are a rare malignant tumor accounting for<1%of renal malignancies. It is associated with aggressive nature and more than 50%of patients have metastatic disease at the time of initial diagnosis. The diagnosis of collecting duct carcinoma is often dififcult and to some extent is one of exclusion. This study aimed to study the clinicopathologic features of collecting duct carcinoma of the kidney. Methods:We retrieved the data of ifve cases of collecting duct carcinomas of the kidney from pathology ifles, and determined the expressions of CK19, CAM5.2, CK7, Vimentin, CD10, P63 and PaX-8 by pathohistological observation and immunohistochemical examination. Results: The most common symptoms were blood urine, bellyache and abdomen mass. The tumor originated from the medulla of the kidney central zone. Histologically, the tumors demonstrated irregular tubular or papillary architecture with the stroma of inflammatory cells and fibrous tissue proliferation. Immunohistochemically, the tumor cells were positive for CK19(5/5), CAM5.2(5/5), PaX-8(5/5), Vimentin(2/5), CK7(1/5), and negative for P63, CD10. Conclusion: The correct diagnosis in collecting duct carcinomas of the kidney is based on characteristic morphological features and immunophenotype labeling.

Objective To observe the influences of modified constraint-induced movement therapy (mCIMT)on lower-extremity walking ability and femoral artery blood flow among elderly patients with stroke. Methods Totally 67 patients with stroke were randomly divided into mCIMT group(n =35) aged ( 73.2 ± 5.2 ) years and neurodevelopmental treatment (NDT) group ( n =32) as control aged(76.4 ± 3.8) years.Patients in control group exercised by NDT 2 h/time,2 times/d,5 d/week for 6 weeks. Patients in mCIMT group exercised including: up and down exercise,100-120 times/d; movement flatbed exercise for 16-20 min/d; upstairs and downstairs exercise,balance training,standing in a single leg exercise,mandatory exercise time of lower-extremity about 4 h/d,5 d/week for 6 weeks.The patients were assessed for lower-extremities motor function using maximum walking speed (MWS),Berg balance scale (BBS),timed up to go test (TUGT) and Fugl-Meyer(FMA-L) at pre-treatment and post-treatment.The change of femoral artery blood flow velocity and lumen diameter on the affected lower limb were observed by color Doppler. Results There were no differences in the above scores,lumen diameter and blood flow velocity before treatment between the two groups (P＞ 0.05).After treatment,the scores of MWS (56.68 ± 6.57vs.45.61 ± 5.34),BBS(46.84 ± 4.05vs.29.84 ± 4.05),TUGT ( 14.55 ± 8.25vs.25.35 ± 8.70)were higher in mCIMT group than in NDT control group (t=15.09,17.38,15.25,all P=0.001)while no difference in FMA-L score between the two groups was found (35.24 ± 7.62 vs.31.32 ±3.28,t=19.99,P＞0.05).Lumen diameter of femoral artery [(9.05±1.15) mm vs.(8.05±0.68)mm,t=6.72,P=0.001] and blood flow velocity[(92.55±18.25)cm/s vs.(69.35 8.7)cm/s,t=6.83,P=0.001] were increased in mCIMT group as compared with NDT group. Conclusions The mCIMT therapy is better in improving the lower-extremity walking function and blood flow velocity of femoral artery.

Objective To determine the value of accommodation quotient (AQ) on dysphagia evaluation in the elderly. Methods 40 old cases with dysphagia were assessed with AQ, Kubota Water Swallow Test (WST) and Swallowing Evaluation (SE) before and after 3 weeks of treatment. The patients were divided into 2 groups based on the first AQ assessment: mild group (AQ=1.5~2.5) and serious group (AQ< 1.5). Results There was not significant difference in scores of WST between both groups (P>0.05) but SE (P<0.05). The AQ before treatment moderately correlated with the scores of WST and SE before treatment and improvement (P<0.001), and SE after treatment (P<0.001), but did not correlate with the score of WST after treatment (P>0.05). Conclusion The AQ may indicate the function of swallowing in the elderly, and predict the outcome of dysphagia.

Objective To examine the test-retest reliability of 5 pain intensity assessment scales, i.e., Visual Analog Scale (VAS), Numeric Rating Scale (NRS), Verbal Descriptor Scale (VDS), Facial Pain Scale - Revised (FPS-R), and Mix Scale (MIX) in older adults with low back pain. Methods 30 older patients with low back pain volunteered in this study, and rated their pains with VAS, NRS, VDS, FPS-R, and MIX twice within 24 h. Test-retest reliability was assessed with intraclass correlation coefficient (ICC). Results ICC was in range of 0.543~ 0.754, and ranked as NRS, FPS-R, MIX, VAS, VDS from more to less. Conclusion All the assessments were appropriate to evaluate the intensity of back pain among elderly, recommending NRS and FPS-R.

Objective To evaluate the concurrent validity and preference of pain intensity assessment scales in elderly with back pain. Methods 30 elderly with back pain were asked to rate their pains by using Visual Analog Scale (VAS), Numeric Rating Scale (NRS), Verbal Descriptor Scale (VDS), Facial Pain Scale-Revised (FPS-R), and Mix scale (MIX). Concurrent validity was assessed using the Spearman correlations. The preference for using scales were collected. Results FPS-R、MIX、VAS and VDS correlated with NRS (r=0.753~0.957, P<0.001). The preference for using scales was ranked by FPS-R, NRS, VDS, MIX, VAS. Conclusion FPS-R、MIX、VAS and VDS show good concurrent validity, and they were appropriated to evaluate the back pain among elderly. FPS-R had the highest scale preference.

Objective To observe the correlation of brain functional reorganization and motor functional restoration with application of single-photon emission computed tomography (SPECT) and regional cerebral blood flow ( rCBF) in modified constraint-induced movement therapy ( mCIMT) in cerebral infarction patients with hemiplegia.Methods Twelve patients with cerebral infarction with hemiplegia (7 males and 5 females, aged 62-75 ( 67.9 ± 6.5) years) were treated with mCIMT for eight weeks.No movement restriction was applied to the limbs at the intact sides.The affected sides exercised 4 h per day with 1 h on the upper limbs and 3 h on the lower limbs.At the same time, semi-quantitative analysis method of analyzing SPECT and rCBF was used to record changes in brain.Simple test for evaluating hand function (STEF), 10 m maximum walking speed ( MWS) , rCBF changes in the cerebral cortex ischemic lesion were respectively assessed in the pretreatment and post-treatment.Results After the treatment, STEF score of affected sides was 76.33 ± 17.13(t = -6.09) ; STEF score of intact was 86.25 ± 16.84(t = -5.86) ;The score of MWS was 6.78 ± 3.72 (t = 4.88); Ischemic score of radioactive counts was - 10.12 ± 7.25 (t = 5.33), improved from pre-treatment and the difference was statistically significant (all P ＜ 0.05 ) .Conclusions mCIMT markedly improved motor function in senile cerebral infarction patients with hemiplegia as shown on SPECT.It showed that this improvement is associated with changes in brain plasticity, suggesting that improved motor function may be related to the redistribution of regional cerebral blood flow in the cerebral cortex.

Objective To assess the test-retest reliability of Tetrax posturographic balance assessment system in determining the balance function in elderly individuals. Methods 22 elderly subjects (66~84 years old) were measured with the stability index (ST), the spectrum analysis of postural sway and the weight distribution harmony between two foots or heels and toe parts in standing on solid surface with eyes open using Tetrax balance system. All tests were repeated 1 week after the initial test and each subject underwent the test under the same instructions and conditions. The intraclass correlation coefficients (ICC) were used to determine the test-retest reliability. Results ICC of all balance functional parameters ranged from 0.797~0.882 (P<0.01). Conclusion The posturographic balance assessment system has good test-retest reliability for determining the balance function in elderly people.