Objective To investigate the clinical value of spiral CT in diagnosis of fracture of tibia plateau, to provide a reference for clinical treatment.Methods 50 cases of tibial plateau fracture were selected,they were diagnosed with X -ray and diagnostic multislice spiral CT three dimensional reconstruction scan respectively.The fracture type and so on of the two groups were compared.Results 50 patients were diagnosed as 14 cases of type Ⅰ, type Ⅱ 10 cases,Ⅲ type 6 cases,Ⅳ type 7 cases,Ⅴ type 5 cases,Ⅵ 8 cases,CT three -dimensional reconstruction diagnosis accuracy rate was 100.00%.X -ray diagnosis was accurate in 41 cases,diagnostic accuracy rate was 82.00%,the difference of two diagnostic ways was statistically significant (χ2 =8.657,P =0.000).All patients were not detected with significant artifacts,the line was good,the fracture line was blurred and visible fracture callus formation surgical outcome was good.Conclusion Spiral CT diagnosis in tibial plateau fracture has high accuracy,through clear and intuitive display morphological characteristics of the patients improves anatomical repair treatment,it is worthy of clinical application.

ABSTRACT:Objective To evaluate the features and related factors of decremental response in amyotrophic lateral sclerosis (ALS)patients to low-frequency repetitive nerve stimulation (RNS)in proximal nerves.Methods We performed RNS studies in proximal axillary and accessory nerves with recording in deltoid and trapezius mus-cle respectively in 87 ALS patients.Decremental compound muscle action potential (CMAP)and related factors were analyzed prospectively,and abnormal group of decremental response in ALS patients was compared with 39 pa-tients with myasthenia gravis.Results ① Abnormal decremental responses were found in 43.7% and 49.4% of ALS patients with deltoid and trapezius muscle recording respectively.They were found more frequent in trapezius muscle than those of deltoid muscle.② There was no relationship of decremental response with gender,age,onset or course of disease,ALSFRS-r scores,or rate of disease progression in ALS patients.③ There was significant rela-tionship between decremental response and fluctuating muscle weakness.Decremental responses decreased more ob-viously in ALS patients with fluctuating muscle weakness than in those with nonfluctuating muscle weakness.④ Dec-remental responses were greater in patients with myasthenia gravis than that in ALS patients.Conclusion Decre-mental response with proximal muscle recording is not an uncommon feature in ALS patients;therefore,it should not be treated as a criterium to rule out ALS.Abnormal decremental response of trapezius muscle is found more fre-quent than that of deltoid muscle.Decremental response range in patients with myasthenia gravis is significantly lar-ger than that in ALS patients.One should be more careful when diagnosing ALS patients with fluctuating muscle weakness and abnormal decremental response.

Dendritic cells are now given more attention th ese years in tumor immuno-therapy. In this review, we summarized the advances o f dendritic cells vaccines and their applications in malignant tumors such as me lanoma and renal carcinoma.

Background Idiopathic macular epiretinal membrane (IMEM) occurs probably along with vitreous macular traction syndrome (VMTS),persudo macular hole (PMH) and lamellar macular hole (LMH).Removing posterior hyaloid and completely peeling IMEM are the key to the treatment.Objective This study was to investigate the effectiveness of indocyanine green (ICG)-assisted macular epiretinal membrane combined internal limiting membrane (ILM) peeling for IMEM.Methods Twenty nine eyes of 29 patients with IMEM were collected in Affiliated First Hospital of Zhengzhou University from June 2010 to September 2012,including 16 eyes with simple macular epiretinal membrane,6 eyes with both IMEM and VMTS,3 eyes with IMEM and PMH,4 eyes with IMEM and LMH.A standard three-port pars plana vitrectomy was performed.After removal of posterior hyaloid,0.25％ ICG was used to assist IMEM and ILM peeling.The process and results were recored.Results After staining,the free boundary of the IMEM became obvious and IMEM was peeled directly in 17 of the 29 eyes (58％).In the others (42％),a free petal of ILM was made,IMEM and ILM were peeled together.In all the 29 eyes,the peeled zone could be easily recognized.No serious intraoperative complication was found.The mean postoperative follow-up was (9.65 ±7.58)months (ranged,1 to 28 months).Visual acuity was improved in 20 eyes (69％).The LogMAR vision was significantly improved in postoperation in comprison with preoperation (0.62 ±0.56 versus 0.72 ±0.67) (t =2.370,P=0.025).No IMEM recurred during the following-up duration.Conclusions ICG-assisted ILM peeling can make the surgery of IMEM safer and prevent recurrence.

Objective To explore the pattern of feedback learning deficits in patients with schizophrenia.Methods Twenty-five patients with schizophrenia and 31 controls participated in the study of probabilistic stimulus selection task.The percentage of choose A and avoid B and individual training blocks of reach performance criterion were analyzed.Results There was no significant difference on the percentage ofchoose A between patient group and control group(control group:(66.13±26.31) ％ ; patient group:(63.75±20.57) ％ ; t=0.37,P=0.713).The percentage of avoid B in patient group was significantly lower than that in control group(control group:(62.10±27.10)％;patient group:(49.75±13.68)％; t=2.212,P=0.032).In addition,the training blocks of reach performance criterion in patient group was significantly greater than that in control group (control group:3.23±2.012;patient group:4.64±1.977; t=-2.635,P=0.011).Conclusion The deficits of feedback learning in patients with schizophrenia is largely due to the failure of avoiding negative feedback stimuli.Learning efficiency was lower in patients with schizophrenia than controls.

Objective To study the Mandarin long-term average speech spectrum (LTASS),the effects of gender,language and region material on LTASS were explored.This research would provide reference for clinical and academic use of Mandarin LTASS.Methods One hundred and sixty subjects from eight major dialectic regions of China,aging 16~30 (average 22.3±3.3),were asked to read two materials (storybook,newspaper)in Manda-rin at a steady speed and conversational level inside a standard soundproof booth.Ten males and ten females were in each dialectic region.A microphone (B&K 4192)was used to monitor each subject's speech which was analyzed with a real-time spectrum analyzer to obtain the long-term spectrum (B&K PULSE 3560C).Results Different Man-darin LTASS spectra were obtained based on gender,material and regions.The spectra were tested with profile a-nalysis.Language material had no significant effects on the Mandarin LTASS (F =2.52,P =0.11 ).There was, however,significant gender difference (F =116.39,P =0.00).Males had spoken with intensity levels higher than females at 100 Hz to 200 Hz.There was also a dialectic difference in the Mandarin LTASS (F =1.29,P =0.02). Speakers from Guangdong had the lowest intensity levels compared to those from other regions.Conclusion Genders and regions are factors that need to be considered when LTASS is used for clinical purpose and academic study.

Objective To evaluate the disease onset regions and spreading patterns in sporadic amyotrophic lateral sclerosis (ALS)patients and related influencing factors.Methods We performed a prospective analysis of 1 58 ALS patients.The disease-onset was confirmed according to the patients’self-reports,neurological examination results and electromyogram study.We followed up 1 5 1 patients with the second or other affected body regions during the disease progression.Data were analyzed according to the different groups of onset regions.Results 1.In 94.3% (149/1 58)of the patients,the early motor manifestations were focally in the bulbar,upper or lower limbs.2.The region of onset was associated with signs of lower motor neuron (LMN)and upper motor neuron (UMN)involvement (P = 0.000 ).The LMN involvement was more distinctive in patients with bulbar onset (65.4%,1 7/26 )group.Patients with cervical onset more frequently showed pure LMN (47.9%,45/94 )or concomitant UMN (52.1%,49/94)signs in the affected limbs.The highest proportion of UMN and LMN signs in the affected lower limb was found in the lumbar onset (83.8%,31/37 )group.3.Spreading patterns:Rostral to caudal spreading pattern was more frequent in bulbar onset patients.For patients with limb onset,there were significant differences between spreading patterns and disease-onset regions (P =0.04).Circular (31.5%,28/89),horizontal (30.3%,31/89)and vertical (21.3%,1 9/89)spreading patterns were more frequent in cervical onset patients whereas circular (47.2%,1 7/36)spreading patterns were more frequent in lumbar onset patients.4.There was a strong association between the rate of progression and age of disease onset (P =0.01 1).Patients aged over 60 had a faster progression.Conclusion ALS is a focal process at motor axis along the spinal cord and cerebral cortex.Different disease-onset can cause different distribution of UMN and LMN signs.Therefore,special attention should be paid to the signs of disease-onset clinically.ALS does start focally and spreads to adjacent regions.Elder patients have a faster disease progression.

Objective To evaluate the distribution and drug resistance of bacteria causing neonatal infectious pneumonia in Jiaxing,and to provide a therapy for clinical doctor to make a correct diagnosis,choose reasonable anti-biotics and avoid abuse of antibiotics.Methods Took expectoration from trachea in condition of asepsis to conduct culture and perform drug-sensitive test from 3025 cases.Results Totally 1 156 strains of aerobic bacteria were iso-lated.875 strains were gram negative bacilli(75.7%),269 strains were gram positive cocci(23.3%),and 12 strains were fungi(1.0%).Klebsiella pneumoiae,Escherichia coil,Acinetobacter baumanni,Enterobacter cloacae were com-mon in gram negative bacilli( respectively 178 cases,151 cases,87 cases,113 cases) .The proportion of the Staphylo-coccus aureus was the largest in gram positive cocci(245 cases) .The results showed that gram-negative bacilli were resistant to cefazolin, ampicillin, piperacillin and sensitive to meropenem, imipenem, piperacillin-tazuobatanna and cefoperazone-sulbactam.The drug resistance was severe of ESBL-positive.Staphylococcus aureus was resistant to penicillin, ampicillin, erythrocin, clindamycin and sensitive to linezolid, vancomycin, nitrofurantoin.Conclusion Gram-negative bacilli are the main bacteria in neonatals with infectious pneumonia.The drug resistance is severe.It is important to make a standard management and isolation.

Objective:To construct a fusion protein of extracellular domain peptide fragment of muscle specific kinase ( MuSK) and fluorescent protein mCherry ,and used as antigen in the detection of antibodies against MuSK ( MuSKAb ) in the sera of patients with myasthenia gravis ( MG).Methods:The mCherry gene was amplified by PCR from vector pRSET-B and cloned into pGEM-T Easy Vector,and furthermore, cloned into Eukaryotic expression vector pMT /BiP/V5-His ( MuSK), which contains MuSK extracellular domain 22-452 amino acid peptide fragment gene to construct the fluorescent fusion protein gene MuSK -mCherry.The recombinant vector was subsequently transfected into drosophila S 2 cells for expression.The expressed fusion proteins were verified in confocal mi-croscope ,and used as antigen in the detection of MuSKAb in sera of MG patents in fluorescence immunoprecipitation test .Results:The fluorescent fusion protein MuSK-mCherry was successfully constructed and expressed.The MuSKAb in sera of patents with MG could be detected in fluorescence immunoprecipitation test using the constructed MuSK-mCherry fusion protein as antigen.Conclusion: It is available to use the constructed fluorescent fusion protein MuSK-mCherry as antigen in fluorescence immunoprecipitation test for the detection of MuSKAb in sera of patents with MG.

Objective To compare the degree of pain in patients after radical gastrectomy under different anesthetic regimens.Methods One hundred and two ASA Ⅰ or Ⅱ patients of both sexes,aged 50-75 yr,weighing 45-70 kg,undergoing elective radical gastrectomy,were randomly divided into 3 groups ( n =34 each):general anesthesia (GA) group,combined general-subcostal transversus abdominis plane block (CGTA) group and combined general-epidural anesthesia (CGEA) group.The patients were sent to the postanesthesia care unit (PACU) after tracheal extubation,and the VAS score on arrival in the PACU was recorded.The degree of pain was evaluated by VAS score,and when VAS scores ＞ 3,the patients received intravenous morphine titration.When VAS scores ≤ 3,morphine titration was stopped and all the patients were connected to patient-controlled intravenous analgesia and/or epidural analgesia pump.The total amount of morphine consumed was recorded at the end of titration,and the occurrence of adverse reactions was also observed.Results Compared with groups GA and CGTA,the incidence of moderate to severe postoperative pain was significantly decreased in group CGEA (P ＜0.01).The incidence of severe postoperative pain,the VAS score on arrival in the PACU and the total amount of morphine consumed were decreased gradually in groups GA,CGTA and CGEA ( P ＜ 0.01 ).The incidence of sedation was significantly lower in group CGEA than in group GA (P ＜ 0.01 ).There were no significant differences in the other adverse reactions among the three groups ( P ＞ 0.05 ).Conclusion The degree of pain is reduced gradually in patients after radical gastrectomy under GA,CGTA and CGEA.