BACKGROUND: In clinic, primary progressive aphasia is a dementia syndrome with the only or prominent characteristic of progressive decline in language function. In advanced stage, deficit of cognitive capability and loss of daily living ability would turn up while memory ability would be relatively preserved. The risk factors of primary progressive aphasia might include poor language ability in childhood and speech center involved by brain trauma.OBJECTIVE: To report the intracerebral image features of 1 case of primary progressive aphasia so as to disclose the general lesion area of the disease , the changes of intracerebral blood volume and metabolism , and connecting fibers among the language domains.DESIGN: Case-report.SETTING: Department of Intervention, Hongqi Hospital, Mudanjiang Medical College, Hei Longjiang Province.PARTICIPANTS: 1 case of patient with primary progressive aphasia,male, 56 years old and with senior high school culture, was in business before the onset of disease. He had "progressive decline in language ability for 3 years" as the main complaint and was diagnosed in Department of Neurology of Beijing Tiantan Hospital on March 20th, 2004. 3 years before that time, the patient could not tell the name of daily living appliances while his comprehensive ability was generally normal. 2 years before, he could still be in business. 1 year before, his language disorder was aggravated, auditory and comprehensive abilities gradually decreased and the changes of character turned up while he could take care of himself and had no obvious degeneration in memory ability. Neural systemic examination: systolic pressure was 130 mmHg and diastolic pressure was 80 mmHg, with clear consciousness, poor language expression ability, and nomenclatural disability while no abnormity was inspected in other neural systematic examinations. He was assessed as sensory aphasia with normal memory and intelligence according to aphasia assessment measuring scale made by the First Hospital of Beijing Medical University.METHODS: First, general magnetic resonance examination was taken to fix the lesion area of the patient. Then, functional magnetic resonance was carried out, which mainly included using magnetic resonance spectroscopy analysis to determine the metabolic rates of N-acetyl-aspartic acid, choline and creatine in the lesion area and then compare them with those in the contralateral corresponding area; Magnetic resonance perfusion imaging was carried out to detect regional cerebral blood volume, regional cerebral blood flow, average pass time and peak time of the contrast medium; Fibertracking method was used to track corticospinal tract and the amount of connecting fibers between left Broca and Wernicke areas and then compare them with those in the contralateral corresponding area.MAIN OUTCOME MEASURES: Detection of the metabolic rates of Nacetyl-aspartic acid, choline and creatine in lesion area and the contralateral area; Detection of regional cerebral blood volume, regional cerebral blood flow, average pass time and peak time of the contrast medium in lesion area and the contralateral area; Comparison of the amount of connecting fibers between left cortioospinal tract and left Broca and Wernicke areas.RESULTS: ①The results of general magnetic resonance: there was atrophy in left temporal and frontal lobes, especially significant in temporal pole, which was manifested as widening of cerebral sulcuses and fissures,thinness of cortex, and enlargement of frontal and temporal angles. ② The results of functional magnetic resonance: N-acetyl-aspartic acid, choline and creatine in left temporal lobe and anterior part of frontal lobe decreased more obviously and regional cerebral blood volume and regional cerebral blood flow in these areas decreased,while average pass time and peak time of the contrast medium in these areas slightly increased as compared with those in the conitralateral areas; fraction of anisotropy values and the tracked fasciculus in left corticospinal tract decreased, and the connecting fibers between Broca and Wernicke areas also decreased as compared with those in the contralateral area.CONCLUSION: The lesion area of primary progressive aphasia is mainly located in left temporal and frontal lobes where low perfusion, low metabolic state and decrease of connecting fibers between Broca and Wernicke areas were shown as compared with those in the contralateral area, which might be the pathogenesis of this case of primary progressive aphasia.

Objective To explore the clinical and imaging features of reversible posterior leukoencephalopathy syndrome(RPLES).Methods The data of clinic five cases with RPLES were analyzed retrospectively.Results The primary diseases in this group were hypertension for one case,uraemia for three cases and lupus nephropathy for another.Clinical features of five patients include acute onset of hypertension,headache with vomiting.Neurological symptoms were conscious disturbance,seizures(in 5 cases)and visual disorder(in 3 cases).The movement of limbs were normal.The abnormal laboratery data was renal inadequacy in 5 cases.The findings of imaging of all cases included bilateral white matter of parietal and occipital lobe abnormalities,which appeared as large areas of low density on CT scan,hypo-intense in T1 and hyper-intense in T2 on MRI scan.Four cases presented clinical symptoms improvement in a short time and radiological recovery obviously after anti-hypertensive and anhydration therapy.One patient died caused on brain herniation.Conclusions Clinical features of RPLES is brain damage associated with malignant hypertension or the use of immunosuppressive agents.The most important pathogenesis is considered to be failure of the self regulation of cerebral vascular circulation.The imaging findings are bilateral symmetry cortical and subcortical edema in the posterior areas of the brain.Most patients can be recovery by timely therapy,otherwise the irreversible neuronal injury even death can be also found in very few serious cases.

Objective To confirm the presence of human cytomegalovirus (HCMV) antigen and DNA in intracranial arterial walls and the association of the virus with the development of atherosclerosis in patients with atherosclerotic cerebral infarction Methods The subjects of this study were divided into two groups, the atherosclerosis group and the control group All patients were autopsied within 12 hours after death During autopsy, samples from intracranial arteries were formalin fixed and paraffin embedded All sections were routinely stained with hematoxylin and eosin (HE) and observed on the presence of atherosclerotic plaques The atherosclerosis group was subdivided into grade Ⅰ～Ⅱ group and grade Ⅲ～Ⅳ group according to the degrees of arterial lumen stenosis Only those vessel walls without signs of atheroma formation were included in the control group HCMV antigens and DNA were detected by immunohistochemistry, in situ hybridization and polymerase chain reaction (PCR) respectively The monoclonal antibody was against HCMV early (E) antigen Probes and primers were derived from major immediate early (MIE) genomic regions of cytomegalovirus strain AD169 As a positive control for the reactions, tissues from human small intestine membrane known to be positive for HCMV by H&E staining were used Results There were 18 of 35 atherosclerotic arteries defined as grade Ⅰ～Ⅱ atherosclerosis, and the rest were grade Ⅲ～Ⅳ The DNA of HCMV was found in 14/35 and 2/20 of arterial walls with atherosclerosis and negative control group by in situ hybridization, in 21/35 and 6/20 by PCR, and HCMV antigen in 12/35 and 2/20 by immunohistochemical studies respectively, and significant difference was be found among them ( P =0 018, P =0 032, P =0 047) There was also significant difference between grade Ⅲ～Ⅳ and grade Ⅰ～Ⅱ atherosclerosis by all the above three types of studies ( P =0 027, P =0 009, P =0 003) Conclusion Our results revealed that HCMV could be found in the atherosclerotic arterial walls, and it is suggested that the arterial walls might be the potential sites of existence of the virus We also postulate that there might be an association between the HCMV DNA and antigens in intracranial arterial walls and atherosclerotic plaques

Objective To discuss effects of Trimetazidine Dihydrochloride Tablets and Composite Saliviae Dropping Pill in treating congetive heart failure.Methods 191 patients of congestive heart failure were randomly divided into the treatment group(n=96)and the control group(n=95).The treatment group based on therapy as the control group adds Trimetazidine Dihydrochloride Tablets(20 mg,three time per day,by mouth)and Composite.Saliviae Dropping Pill(15 grains every time,three times per day,hy mouth).The control group was treated with Aspirin,?-retarder, ACEI,diuresis,and tonify the heart and blood vessel activity drug.Results 49 patients(51.0%)were apparent, and 40 patients were effective in treatment group(41.7%),the total effective rate was92.7%; the control group's were apparent 39 patients(41.1%)were apparent,and 37 patients(38.9%)were effective in control group,the total ef- fective rate was 80.0%.The total effctive rate of two groups according to statistics(x~2=6.56,P

ObjectiveTo evaluate the impact of anatomic and non-anatomic liver resection on prognosisofpatientswithsmallhepatocellularcarcinoma( HCC ) usingaMeta-analysis.MethodsLiterature on anatomic versus non-anatomic liver resection for the treatment of small HCC ( ≤5 cm) was retrieved. ResultsFour nonrandomized controlled trials were included consisting of 776 patients:484 undergoing anatomic liver resection and 292 non-anatomic resection.The age ranged from 53.4 to 63.0 years.Male ∶ female ratio was 3.56 ∶ 1.87.1％ patients were Child-Pugh class A.Most patients (94.5％ ) had a single tumor.No significant differences were found conceming the 1,3,and 5 year disease-free survival rate between the two groups.There was no significant difference in overall survival and disease-free survival between the two groups at 1,3,and 5 years.Sensitivity analysis found anatomic resection was superior to non-anatomic resection in 3 year disease free survival rate (OR =0.72,95％ CI:0.52 - 0.99,P =0.04). ConclusionsAnatomic liver resection elevated the 3 year disease free survival rate of patients with small hepatocellular carcinoma when compared with non-anatomic hepatectomy but failed to further elevate long-term disease free survival and overall survival.

Aim To study the change of blood pressure in 1079 workers for fifteen years and the effect of anti-hypertension drugs therapy. Methods We investigated the blood pressure of 1079 workers who were enrolled in six organizations in the year 1983 and 1998 respectively. Results During the 15 years: (1)Mean value of blood pressure: systolic blood pressure increased 22 mmHg in man and 16.9 mmHg in women; diastolic blood pressure increased 9 mmHg in man and 12.7 mmHg in women (P<0.05);(2)The incidence of hypertension increased by 25.03% in man and 28.28% in women;(3)The prevalence rate of hypertension is 27.9 percent in people with initially normal blood pressure (1.86%/y) and 72.6 percent in initially broder line hypertension (4.84%/y);(4)The control rate of hypertension is 2.9 percent;(5)The incidence of stroke is highly related to hypertension (P<0.001);(6)46.6 percent patients had a regular drug therapy, mainly reserpini complex(25.2%);(7)Drug therapy has no obviously effect of the control of hypertension and the incidence of stroke. Conclusion Both the mean value of BP and the incidence of hypertension were increased with age. The control rate of hypertension was low and the drug therapy shows little advantage. We should do mach more works to popularize the knowledge of the prevention of hypertension. Improve people's self-prevention. Regular cheek should be given to the hypertension patients.

Objective To study the expression of toll rexeptor-4 in patients with systemic infanunatory response syndrome(SIRS)and multiple organ dysfunction syndrome (MODS) induced by acute cerebral vascular disease(ACVD).Method Totally 153 ACVD patients,admitted to Departments of Neurology Medicine and ICU of the First,the Second and the Forth Hospitals of Jilin University from October 2005 to March 2006,were enrolled in this study.The patients were admitted to the hospitals within 3 days after onset,and were confirmed by CT or MRI.The 153 patients in the prospective study was divided into three groupa:ACVD group(n=60).SIRS group induced by ACVD(n=45),MODS group induced by ACVD(n=48).The diagnosis criteria accorded with the criterion set by the Forth Conference of Cerebrovuscular Disease in China.The exclusion criterion inchided:①patients with infeetion or inflammatory disease two weeks before the onset of AVCD;②patients with cardiac disease,including acute myocarditis,acute myocardial infarction,angina episodes,degenerative calcific valvular disease,and so on;③patients with use of hormone recently;④malignant tumor,autoimmunity system disease,liver disease,kidney disease and hematologic disease.The expression of TLR-4 mRNA gene of the nucleated cell in the peripheral blood in the ACVD patient was measured by using RT-PCR.Statistics methods of t test,q test and simplex factor analysis of variance have been used Statistical analysis was carried out by using T-test,one-way analysis of variances,and q-test.Results The expression of TLR-4mRNA obviously increased on the third day after onset of AVCD.Compared with ACVD group,the expression of TLR-4mRNA in SIRS group was significantly higher (0.61±0.13 vs.0.98±0.15,P＜0.01).Compared with SIRS group,the expression of TLR-4mRNA in MODS group was significantly higher(0.98±0.15 vs.1.32±0.38,P＜0.01).The expression of TLR-4mRNA had a increasing tendency with the severity of AVCD.The expression of TLR-4mRNA was higher in patients with higher MODS score(P＜0.01).In the MODS group,the expression of TLR-4 mRNA was higher in the fatal patients than that in the survivors(1.56±0.16 vs.1.32±0.26,P＜0.01).Conclusions The mechanism of ACVD.which causes SIRS and MODS,may be associated with excessive immunologic respun of the organism.

Objective To study the influence of survivin targetedly inhibited with antisense oligonucleotide (ASODN)technique on the apoptosis of hepatoma carcinoma cells SMMC-7221,and to clarify the mechanism of promotion effect of survivin-ASODN on the apoptosis of SMMC-7721 cells.Methods The ASODN sequence of survivin marked by FAM fluorescein was designed and synthized. The SMMC-7721 cells were transfected by different concentrations (100,200,300,400,and 600 nmol· L-1 )of survivin-ASODN (ASODN transfection groups),at the same time blank control group and blank liposome control group and sense oligonucleotide (SODN) control group were set up.The apoptotic rates and the changes of cell cycle of the SMMC-7721 cells 24,48,and 72 h after transfected with different concentrations of survivin-ASODN were detected by FCM. The expression levels of survivin were measured by Western blotting method.Results Compared with each control group,24 h after transfection,the apoptotic rates of survivin-ASODN transfected SMMC-7221 cells were increased,the growth of cells was inhibited (P<0.05),and the effects had time-dose dependent tendency.48 h after transfection,the hypodiploid apoptotic peak appeared in ASODN transfection groups before G1 phase, the number of the cells at G0/G1 phase was decreased (P<0.05)and the number of the cells at G2/M phase wsa increased (P<0.05). Compared with each control group,the survivin expression levels in the SMMC-7721 cells in ASODN transfection groups were decreased (P<0.05 ), and the effects of survivin-ASODN was time-dose dependent (P<0.05 ). Conclusion Survivin-ASODN can block the expression of survivin in SMMC-7721 cells and inhibit the proliferation of SMMC-7721 cells by changing the cell cycle and increasing apoptosis in a time-dose dependent manner.

Objective To investigate the enhanced CT features of papillary renal cell carcinoma (PRCC)and its subtypes (PRCC-Ⅰ, PRCC-Ⅱ)and chromophobe renal cell carcinoma(CRCC).Methods The CT features of 30 tumors with pathologically proved PRCC and CRCC were analyzed retrospectively,including location,size,enhanced types,calcification and necrosis etc.The differences in the CT features among PRCC and its subtypes and CRCC were evaluated.Results 1 2 cases of PRCC with single lesion (7 in the right kidney and 5 in the left)were shown;1 case was multifocal PRCC with 1 lesion in the right kidney and 2 lesions in the left.1 5 cases of CRCC were single lesion(9 in the right kidney and 6 in the left).The medium tumor maximum size of CRCC was larger than that of PRCC,and the PRCC-Ⅰ tumors tended to be smaller than PRCC-Ⅱ ones.53% of the PRCC had heterogeneous enhancement,and all calcification and necrosis were found in PRCC-Ⅱ lesions.Of all the CRCC,27% had uniform enhancement,20% had calcification and 40% had necrosis or central scar.There was no significant difference between PRCC and its subtypes and CRCC in location, maximum size,heterogeneity,calcification,necrosis and central scar.The degree of enhancement of CRCC(89.53 HU)was significantly greater than that of PRCC(66.60 HU),PRCC-Ⅰ(71.75 HU)and PRCC-Ⅱ(64.73 HU)in the cortical phase(P<0.05).The enhancement peak in the nephrographic phase was CRCC,PRCC-Ⅰ,PRCC and PRCC-Ⅱ from high to low in turn,which were all higher than that in cortical phase.In the excretory phase,the enhancement of all lesions was declined.Conclusion Contrast-enhanced CT is of certain value in the differential diagnosis among PRCC and its subtypes and CRCC.The enhancement degree of CRCC in the cortical phase is significantly greater than that of PRCC and its subtypes.The enhancement peak of PRCC and its subtypes and CRCC appears in the nephrographic phase.

Objective To evaluate the effectiveness and security of Botulinum toxin type A (BTX-A) in treating interstitial cystitis /bladder pain syndrome,and also the effect of different site injection.Methods Sixty-nine consecutive BPS/IC patients from October 2011 to February 2016 were divided into three groups randomly,including control group (group A) and treatment group (group B and group C).There were 5 males and 64 females,with age from 23 to 66 years old (average 44.5 years old).Twentythree patients (1 male and 22 females,aged from 23 to 69 years old,with mean age of 44.6 years old) in control group (group A) underwent hydrodistention.Twenty-four patients (2 males and 22 females,aged from 27 to 65 years old,with mean age of 42.8 years old) in group B underwent BTX-A detrusor combined triangle injection plus hydrodistention.Twenty-two patients (2 males and 20 females,aged from 30 to 68 years old,with mean age of 44.3 years old) in group C underwent BTX-A triangle injection alone plus hydrodistention.The parameters such as daytime frequency,nocturia,visual analogue scale/score (VAS),functional cystemetric volume (FCV),post-void residual volume (PVR),QOL score,maximal bladder capacity (MBC),interstitial cystitis symtom index (ICSI),interstitial cystitisproblem index (ICPI),Qmax,and Hamilton anxiey scale (HAMA) score between pre-treatment and 1,3,6 and 9 months after therapy in the three groups were compared.Results There were no serious complications observed in the three groups.All parameters 1 month after therapy were obviously superior to that of pretreatment.The efficacy in control group decreased significantly 3 months after treatment except nocturia (3.0 vs.5.0),daytime frequency(7.0 vs.14.0)and Q (14.0 ml/s vs.13.0 ml/s).However,all parameters in research groups except PVR were still obviously superior to pretherapy.The parameters except Q and nocturia in group B had statistically significant difference from contemporaneous group A (all P ＜ 0.05).However,the parameters except Q nocturia and somatic anxiety score in group C had statistically significant difference from contemporaneous group A (all P ＜ 0.05).VAS (2.0 vs.3.0) and somatic anxiety score (6.0 vs.10.0) in group B were superior to group C (all P ＜ 0.05).When it came to 6 months after therapy,urinary frequence and urgency and pain symptoms were the same to pretherapy and all parameters had no statistically significant difference between pretherapy and after therapy in group A(all P ＞ 0.05).But all parameters except PVR in research group was still superior to pretherapy.the parameters except PVR,Q and QOL in group B had statistically significant difference from contemporaneous group A (all P ＜ 0.05).However,The parameters except PVR,Q MBC,ICSI and QOL in group C had statistically significant difference from contemporaneous group A (all P ＜ 0.05).Meanwhile,efficacy in group B was better than group C in term of ICPI (6.0 vs.8.0) and somatic anxiety score (7.0 vs.10.0) (all P ＜ 0.05).The efficacy decreased significantly 9 months after treatment in both group B and C,with no statistically significant difference compared with that of pretreatment.ICSI(10.0 vs.13.0),ICPI(9.0 vs.13.0),QOL(5.0 vs.6.0)in group B,and QOL(5.0 vs.6.0)in group C had statistically significant difference compared with the contemporary parameters in group A.ICSI(10.0 vs.12.0),MBC(285.0 ml vs.237.5 ml) in group B was better than that in group C (P ＜ 0.05).Conclusions Symptoms in IC/BPS patients can be alleviated significantly by detrusor BTX-A injection plus hydrodistention.Quality of life can be improved remarkably and HAMA scores can be reduced significantly after treatment.Thus,it's an effective therapeutic mnethod for IC/BPS,and detrusor combined triangle injection can provide a better effect than single triangle injection.