Objective To investigate the pathogenesis of cerebral watershed infarction (CWI) through analyzing the appearance examined by Color duplex Imaging(CDI) and transcranial doppler (TCD).Methods One hundred and forty-two patients with CWI diagnosed by magnetic resonance imaging(MRI) were enrolled in the study group and 150 patients with acute cerebral infarction were enrolled in the control group.The results of CDI and TCD were retrospectively analyzed of the two groups.The vascular stenosis,plaque detection rate,plaque characteration,plaque scores,the cause of low blood volume,intracranial collateral circulation were compared between the two groups to investigate the pathogenesis of CWI.Results Among the 142 cases in the study group,there were 72 cases of severe stenosis and occlusion,21 cases of moderate stenosis,31 cases of mild stenosis and 18 cases without stenosis and there were 19 cases of severe stenosis and occlusion,41 cases of moderate stenosis,23 cases of mild stenosis and 67 cases without stenosis among the 150 cases in the control group.There were significant differences in the two groups (x2 =66.583,P =0.000).There were significant differences on the plaque detection rate between the two groups (80.99％ (115/142) vs 49.33％ (74/150),x2 =32.010,P =0.000).There were significant differences on the scores of plaque between the study group and the control group ((11.47 ± 3.78) points vs (6.57 ± 3.53) points,t =4.019,P =0.001).There were significant differences on the defined cause of low blood volume between the study group and the control group (54.93％ (78/142) vs 11.33％ (17/150),x2 =63.164,P =0.000).There were 50 patients had collateral circulation in the study group and 38 cases in the control group,there were no significant differences between the two groups (35.31％ (50/142) vs 25.33％ (38/150),x2 =3.381,P =0.066).Conclusion Angiostegnosis,microemboli from the unstable atherosclerosis plaque,lower perfusion on the basis of hypovolemia are all the pathogenesis of CWI.CDI combine with TCD can provide more information in vascular evaluation and treatment.

Objective To explore the relationship between collateral circulation and clinical manifestation after se-vere stenosis or occlusion of internal carotid artery. Methods According to the clinical manifestation, 78 cases of ICA ste-nosis or occlusion confirmed by digital subtraction angiography (DSA) were divided into two groups:asymptomatic group (n=31) and symptomatic group (n=47). Collateral circulation pathway in circle of Willis and the mean flow velocity of the middle cerebral arteries (MVMCA) were measured by Transcranial Doppler Ultrasonography (TCD). The correlation of the types of intracranial collateral circulation and clinical manifestation was analyzed. Results ① The collateral circulation opening rate of severe stenosis or occlusion of internal carotid artery in 78 cases of patients was 70.5%(55/78). The collat-eral patency rate (27/31, 87.1% of patients) was higher in asymptomatic group than in the symptomatic group (28/47, 59.6%of patients)(P<0.01).②Collateral patency of anterior communicating artery (ACoA)in asymptomatic group (24/31, 77.4%of patients) was higher than that in symptomatic group (20/47, 42.6%of patients) (P<0.01). Collateral patency of ophthalmic artery (OA) in symptomatic group (21/47, 44.7%of patients) was higher than that in asymptomatic group(6/31, 19.4%of patients)(P<0.05). The opening rate of ACoA was significantly higher than that of either the posterior commu-nicating artery (PCoA) or OA collateral circulation in asymptomatic group (P<0.05).③The mean flow velocity of the af- fected side middle cerebral arteries (MVMCA) in asymptomatic group (51.58±12.36cm/s) was significantly higher than that in symptomatic group (32.23±10.31cm/s) (P<0.01). Conclusion The clinical manifestation is closely related to arterial circle of Willis collateral circulation opening after severe stenosis or occlusion of internal carotid artery and collateral patency of anterior communicating artery is the major collateral supply vessel.

OBJECTIVE To explore cognitive dysfunction of sleep apnea syndrome (SAS) and compare the sensitivity of different measuring methods. METHODS Odd ball auditory P300 (2t- P300), three- tone paradigm auditory P300 (3t-P300) and mini- mental status estimate (MMSE) were performed on 24 patients with SAS and 22 healthy subjects. Results of two groups were compared. RESULTS 2t- P300 of study group:(341?14.5)ms, (342?13.8)ms; 2t- P300 of normal group:(317?14.7)ms, (318?12.8)ms; r-dT1 of study group:(327?13.0)ms,(326?14.9)ms;r-dT1 of normal group: (309?11.1)ms,(309?12.0)ms; r-dT2 of study group:(325?14.9)ms,(326?11.1)ms; r-dT2 of normal group:(306?9.7)ms, (305?11.7)ms.Latency of P300 evoked by odd-ball and 3-tone paradigm were both statistically prolonged in SAS patients than those of normal controls. SAS patients had statistically lower MMSE scores than that of normal group but all of them were above 27. On the other hand, statistical difference of abnormal rate between 3-tone P300 and odd-ball P300 was not found in SAS patients group. CONCLUSION Cognitive function impairment was found in SAS patients both by P300 and MMSE. While P300 might be more sensitive than MMSE in detecting it, different paradigm of auditory P300 did not show difference in sensitivity.

Objective To investigate the characteristics of intestinal flora in infants with different feeding patterns.Methods Sixty-two cases of health infants(30-120 d)were divided into 4 groups according to their feeding patterns:breast feeding,imported powder milk feeding,domestic powder milk feeding and mixed feeding.Samples of their fresh feces in each group were collected and divided into sections equally:the bifidobacteria were isolated in anaerobic box and the number was counted for one section;for the other section,total DNA of intestinal flora was extracted and enterobacterial repetitive intergenic consensus (ERIC) fingerprints were amplified with the method of ERIC-PCR.After that,the specific bands observed in different groups were cloned and sequenced and alignmented.Results The colonies of bifidobacteria were more in breast feeding and mixed feeding groups[(9.10 ± 1.33) cfu/g;(8.62 ± 1.35) cfu/g]than those in domestic powder milk feeding and imported powder milk feeding groups[(7.62 ± 1.22) cfu/g;(7.32 ± 0.80) cfu/g,t =3.23,P ＜ 0.05];while there was no significant difference between breast feeding and mixed feeding groups,and between 2 powder milk feeding groups.Two specific bands were found from the ERIC fingerprints (A:1 100 bp mainly in breast feeding,domestic powder milk feeding and mixed feeding groups;B:1 000 bp mainly in imported powder milk feeding group).Sequencing and analysis of Basic Local Alignment Search Tool showed that homologous bacteria of A and B fragments were bifidobacterium longum.The encoding protein of A fragments might be related to the enzymes of carbohydrate metabolism,and B fragments were related to the enzymes of protein metabolism.Conclusions The colonies of bifidobacteria in intestinal tract are more in breast feeding and mixed feeding infants than those in formula feeding groups.The distribution of intestinal flora in domestic powder milk feeding infants is more similar to that of the breast feeding infants.

Objective To investigate the clinical features of Remitting Seronegative Symmetrical Synovitis with Pitting Oedema(RS3PE),especially it’s association with malignancy. Methods The clinical data of eight RS3PE patients hospitalized during Jan 2003 and June 2007 in Peking Union Medical College Hospital were reviewed. The clinical characteristics, laboratory tests, response to treatment as well as the outcome were studied. Among the 8 patients, five were male and 3 were female,the mean age of RS3 PE onset was 60.9 (38～79yr). 5 had idiopathic RS3PE without underlying disease, and 3 presented associated neoplasm. Results All patients had symmetrical polyarthritis and pitting edema on the dorsum of hands and/or feet. Extra-articular symptoms were more conspicuous in patients complicated by neoplasm. Serum RF、AKA、APF and anti-CCP antibody were all negative. antinuclear antibodies (ANA) was positive with low titer in five cases. Hand and foot radiographs did not show bone erosion in all cases. After steroid and/or immunosuppressive treatment, 2 cases exhibited persistent remission of articular symptoms and edema, whereas relapses occurred 6, 7 and 36 months respectively after the initial diagnosis in 3 cases who had been pathologically confirmed as having Non-Hodgkin-Lymphoma and thereby received periodical chemotherapy. Conclusion RS3PE is a group of clinical manifestations with prominent heterogeneity, therefore intensive follow-up is necessary, and the presence of systemic symptoms/ signs in RS3PE patients alert the physician for the potential concomitant malignancy.

Objective To discuss the effective methods to improve the teaching effect of Basis of Nursing and cultivation of high-quality persons. Methods We randomly divided 87 nursing students into the test group(42 eases) ,which adopt the combination of grouped scene teaching with role-playing teaching and the control group (45 cases),which received routine teaching methods.The effect of the two teaching methods was evaluated by questionnaires. Results The total score and the score of each section of the questionnaires in the test group were higher than those of the control group(P ＜ 0.05 ). Conclusions The combination of scene teaching with role-playing teaching could inspire students' interest,strengthen the role consciousness and improve their comprehensive quality.

ObjectiveTo investigate the clinical outcome of laparoscopic nephroureterectomy (LUNT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients.Methods We conducted a retrospective analysis on 1130 RT recipients,and 9 patients (0.8％,9/1130) with native upper tract UC were identified. UC was confirmed pathologically in the 9 patients,including 3 cases of unilateral ureter tumor (2 on the right,and 1 on the left),4 cases of unilateral renal pelvis tumor (2 on the right,2 on the left),1 case of bilateral ureter tumor and 1 case of tumor in the right ureter and left kidney.Females predominated (8/9) in the 9 patients with upper tract UC.The patients with left upper urinary tract cancer underwent LUNT using a retroperitoneal approach with a technique of transurethral circumcision of the ureteral orifice.The patients with right upper urinary tract cancer were subjected to nephroureterctomy with ureterectomy and bladder cuff excision by complete laparascopy through a transperitoneal approach. Immunosuppressive protocol conversion from calcineurin inhibitors to sirolimus was performed on all cases. Results In the 9 patients,11 LUNTs were performed successfully without conversion to open surgery.The follow-up period was from 6 to 48 months. One patient died of lung metastasis at 8th month after tumor excision,and 1 patient displayed ductal cancer of the left breast at 7th month after LNUT.Another seven patients showed no evidence of disease during the follow-up period with normal renal function.ConclusionOur present clinical experience suggested that LNUT for the native upper tract cancer in renal transplant recipients is feasible,safe,and effective.

Objective To investigate the effect of ulinastatin (UTI) on peripheral CD4 + CD25 + Foxp3 + Treg cells in patients with acute pancreatitis (AP).Methods Between October 2014 to August 2016,127 patients with AP including three types of severity (MAP,MSAP,SAP) admitted to the Affiliated Union Hospital of Fujian Medical University consecutively were divided into two groups (the UTI group and control group).UTI was added to patients in UTI group.Treg cells were measured by flow cytometry,and the levels of IL-10 were detected by enzyme-linked immunosorbent assay (ELISA).Results On the third and seventh day,the percentage of Treg in UTI group (MAP:2.72％ ±0.76％,2.26％ ±0.61％;MSAP:3.04％ ±0.74％,4.12％ ± 1.10％;SAP:4.41％ ±0.86％,5.38％ ± 1.13％) were higher than that of control group (MAP:2.08％ ±0.50％,1.83％ ±0.67％;MSAP:2.24％ ±0.89％,3.25％ ±0.70％;SAP:3.35％ ±0.85％,4.56％ ±0.73％),all P ＜0.05.For patients with MAP,the levels of IL-10 in UTI group (48.85 ± 15.46) were higher than control group (37.43 ± 13.36) only on the third day.For patients with MSAP and SAP,the levels of IL-10 in UTI groups (MSAP:32.95 ± 10.72,59.79 ± 20.09;SAP:22.48 ±3.67,30.91 ±8.74) were higher than control groups (MSAP:25.15 ± 10.05,36.66 ± 16.80;SAP:18.73 ±2.69,23.72 ±5.73) both on the third and seventh day (P ＜0.05).The effective ratio of the treatment in UTI groups were higher than control groups (92.2％ vs.79.4％).Conclusions Ulinastatin regulates the immune function and alleviates inflammatory response during AP by inducing the expansion of Treg cells.

Objective To investigate the value of transcranial Doppler ultrasonography(TCD)for assessing the cerebrovascular reactivity (CVR)in obstructive sleep apneahypopnea syndrome (OSAHS)patients.Methods Sixty OSAHS outpatients and inpatients admitted to our neurology department from August 2015to December 2016served as an OSAHS group,then further divided into mild group(n=15),moderate group(n=27)and severe group(n=18)according to apneahypopnea index(AHI).Meanwhile,20healthy individuals served as a control group.They underwent TCD on admission to detect their CVR,including the average velocity of cerebral artery blood flow(Vm)during calm breathing and after breath holding.The breath holding index(BHI) was calculed.The relationship between BHI and CVR was analized by pearson linear correlation analysis. Results There was no statistically significant difference in Vm during calm breathing between the OSAHS and control groups(73.64±9.87cm/s vs 72.79±8.68cm/s,P＞0.05).Both of Vm after breath holding and BHI of the OSAHS group were lower than those of the control group(88.63±6.65cm/s vs 93.26±7.12cm/s,0.71±0.16 vs 0.93±0.37,P＜0.01).Both of Vm after breath holding and BHI of the mild group were the highest,while the severe group had the lowest values and the moderate group was in between(P＜0.05).No significant correlation was found between AHI and Vm during calm breathing(r=0.197,P=0.052),while AHI was negatively correlated with Vm after breath holding and BHI(r=-0.557,P =0.011;r=-0.605,P=0.000).Conclusion TCD can detect CVR changes in OSAHS patients,whose Vm after breath holding and BHI decrease significantly.The more severe the OSAHS is,the lower the CVR is.

To research the expression of key enzymes in saikosaponin biosynthesis and the content of saikosaponin under the drought stress, the study focused on the gene-level and the end product responses to environmental change. Taking the five months of Bupleurum chinense as research materials, the contents of saikosaponin A and saikosaponin D under different stress levels were measured by HPLC. The drought was simulated by poly ethylene glycol. The real-time fluorescence quantitative PCR was used to analyze the expression of four key enzymes genes HMGR, IPPI, FPS, β-AS and the expression of β-tubulin was set as a reference gene. The results showed that drought stress significantly improved the content of saikosaponin. The contents of SSa and SSd were highest researching 0.648% and 0.781%, respectively when the concentration of PEG was 10%. Meanwhile, the results reflected that the expression of four key enzymes had risen differently and FPS, β-AS raised significantly(P<0.01). In addition, the results of correlation analysis showed that there was a significant positive correlation between the expression of the four key enzymes genes and the content of saikosaponin. In a word, the contents of secondary metabolites were regulated by the expression of key enzymes genes under the drought stress in B. chinense.