Since 2007, a number of published population-based studies have shown that stroke epidemiology has changed. There are some differences in morbidity, mortality, risk factors and clinical prognosis of stroke between the high-income countries and the less developed countries.

Objective To evaluate the role of TCD examination in diagnosis of the early cerebrovascular diseases in aged diabetic patients.Methods 179 cases of aged type Ⅱ diabetic patients were divided into three groups(PDR,BDR and NDB)according to their retinopathy.TCD and retina examination were performed in all patients and the data be analysed. Results (1)The systolic peak flow velocity(Vp) of MCA、ACA、ICA and BA were significant increased in diabetic pa- tients than in normal control group(P

Objective To explore the outcome of modified bladder neck reconstruction in treating the urinary incontinence due to the sphincter dysfunction.Methods Between January 2010 and December 2014,a total of 23 patients,including 16 male and 7 female cases,with incontinence due to sphincter dysfunction had undergone a procedure of modified bladder neck reconstruction.The mean age was 36 years (range 17-61 years).Etiology of incontinence was secondary to pelvic fracture and urethral rupture procedure in 19 patients and other failure procedures in 4 cases.The mean duration of incontinence was 2 years (range 1-5 years).Urodynamic examination was performed in all patients and the mean maximum urethral pressure was 34 cmH2O (range 21-43 cmH2O).The modified bladder neck reconstruction was performed in 23 patients.Under the general anesthesia and vertical bladder incision,triangular mucosal strips,from the bladder neck to ureteral office,were denuded and leaving the central urethral plate,which was 2.0-2.5 cm in width.In order to form a neourethra and bladder neck,the multilayer triangular muscles were sutured interruptedly over a 14-16 F catheter using 2-0 or 3-0 polyglactin.And the anterior wall of the bladder was then closed over the new bladder neck using continuous sutured.Results The 23 patients were followed up for 6 months to 3 years,mean 1.4 years.Continence achieved in 5 patients.Of them,2 patients had difficulty in voiding but corrected by indwelling the catheter for another 2 weeks.Social continence was achieved in 7 patients.Incontinence status was improved in 7 cases and failed in 2 cases.Urodynamic examination was performed in 4 patients and the mean maximum urethral pressure was 64 cmH2O (range 52-72 cmH2O).Conclusions Our study suggested that the modified bladder neck reconstruction was a good procedure for the treatment of urinary incontinence due to sphincter dysfunction,particularly for the incontinence secondary to the traumatic urethral stricture or other operation.

Objective To assess the effect of Marzulene as an adjuvant therapy for peptic ulcer disease in children and the safety of Marzulene.Methods From Dec.2011 to Feb.2013,138 cases of peptic ulcer disease in children from Chongqing,Guiyang,Guangzhou,Chengdu and Xinjiang were randomly divided into trial group (n =75) and control group (n =63).The treatment protocls of the trial group was Marzulene combined with Omeprazole,and the control group gave Omeprazole only,all the cases with Helicobacter pylori (Hp) infection were treated by antibiotics,then clinical manifestations,gastroscopy and laboratory examinations were followed up after 8 weeks.Results The remission rates of clinical manifestations in the trial group were abdominal pain 91.8％ (56/61 cases),vomiting 90.2％(37/41 cases),melena 92.9％ (26/28 cases),nausea 93.1％ (27/29 cases),hematemesis 89.5％ (17/19 cases),abdominal discomfort 100.0％ (19/19 cases),abdominal distension 100.0％ (11/11 cases),sour regurgitation 100.0％ (9/9 cases),ozostomia 90.0％ (9/10 cases),eructaion 88.9 ％ (8/9 cases),bloody stools 100.0％ (4/4 cases),poor appetite 50.0％ (1/2 case),and abdominal tenderness 89.3 ％ (50/56 cases) ;the remission rates of clinical manifestations in the control group were abdominal pain 90.4％ (47/52 cases),vomiting 89.7％ (26/29 cases),melena 96.4％(27/28 cases),nausea 87.5 ％ (21/24 cases),hematemesis 92.9 ％ (13/14 cases),abdominal discomfort 58.3 ％ (7/12 cases),abdominal distension 85.7％ (12/14 cases),sour regurgitation 100.0％ (13/13 cases),ozostomia 80.0％(8/10 cases),eructaion 100.0％ (8/8 cases),bloody stools 100.0％ (4/4 cases),poor appetite 33.3％ (1/3 case),and abdominal tenderness 90.0％ (45/50 cases).Abdominal discomfort,abdominal distension,ozostomia,eructaion and poor appetite had significant statistical disparity between control group and trial group (P ＜ 0.05).One hundred and thirty-one cases reviewed gastroscopy,in the control group their ulcer clearance rate was 65.1％ (41/63 cases) ;the remission rates of gastroscopic manifestations were edema 54.8％ (34/62 cases),hyperemia 51.7％ (31/60 cases),areola 76.0％ (19/25 cases),atrophy 0％ (0/1 case),and hemorrhage 85.7％ (12/14 cases),the Hp clearance rate in the control group was 67.9％ (19/28 cases).In the trial group the ulcer clearance rate was 66.2％ (45/68 cases),and the remission rates of gastroscopic manifestation were edema 63.0％ (46/73 cases),hyperemia 64.7 ％ (44/68 cases),areola 86.1％ (31/36 cases),atrophy 50.0％ (1/2 case),and hemorrhage 100.0％ (19/19 cases) ;the Hp clearance rate in the trial group was 72.7％ (24/33 cases),and the remission rates of atrophy and hemorrhage had significant disparity between the control group and the trial group.The clinical effective rates of the trial and the control groups were 98.7％ (74/75 cases) and 98.4％ (62/63 cases),and the gastoscopic detection rates were 98.5％ (67/68 cases) and 96.8％ (61/63 cases).There was no adverse reaction in the trial group due to using marzulene for 8 weeks and 4 weeks' follow-up after its withdrawal.Conclusions Marzulene is helpful for improving the clinical and gastroscopic manifestations of peptic ulcer disease in children,and is effective and safe as an adjuvant therapy in children.

Objective To investigate the clinical features and treatment strategy of brain arteriovenous malforma-tions(AVM) associated with arterial aneurysms. Methods The clinical manifestation, imaging data, treatment and out-come of the patients with AVM were retrospectively analyzed in 38(10.4%) of these 364 patients. Results Hemorrhage was the most common clinical manifestation (60.5%). The hemorrhage risk was higher in AVM associated with arterial an-eurysms than in single AVM(χ2=5.956,P<0.05). The most common type of associated aneurysms was feeding artery an-eurysm (69.4%). Hemorrhage more frequently occurred within the aneurysm.(χ2=8.869,P<0.05). The bleeding lesions and 43 associated aneurysms of the 37 patients were treated effectively by endovascular treatment and/or craniotomy. Thirty-four patients had excellent or good outcomes, six patients had complications, 3 patients had neurological deficits. Postoperative digital subtraction angiography (DSA) examination showed the complete disappearance of arteriovenous malformation and aneurysm in sixteen cases. Conclusions The AVM associated with aneurysms is common in patients with AVM. AVM associated with aneurysms has a higher risk of hemorrhage than single AVM. The aneurysm within AVM has a higher rate of hemorrhage. The treatment priority should be given to the bleeding lesions and aneurysms.

Objective To compare genomic expression differences between androgenic complete hydatidiform mole (AnCHM) and normal first trimester villi with similar gestation weeks,and search for potential adjuvant diagnostic molecular markers.Methods Short tandem repeat (STR) detection was used to identify AnCHM,human oligonucleotide array U133 Plus 2.0 was used to measure genomic expression differences between AnCHM and normal villi,and quantitative fluorescent RT-PCR was used to verify array of several genes.Results Nine of 11 histologically diagnosed complete hydatidiform moles were found to be AnCHM by means of STR,and the other 2 were biparental complete hydatidifonn mole (BiCHM). Compared with villi,oligonueleotide array showed 279 genes (0.72%,279/38 500) were over expressed and 1710 genes (4.44%,1710/38 500) under expressed in AnCHM.Bioinformatics analysis found that differentially expressed genes were involved in multiple biological processes and pathways.Changes of imprinting genes,growth hormone genes and chorionie somatomammotropin hormone genes were especially remarkable.Conclusions Pathogenesis of AnCHM is a complex process involving multiple genes and pathways.Altered expression of imprint genes may play important roles in the process.

Objective To investigate the efficiency of intraclot microbubbles (MB) combined with urokinase (UK) mediated ultrasound (US) thrombolysis.Metho ds Fifty clots prepared by bovine whole blood were equally divided into 5 groups and were treated in a circulation system with collateral circulation tube.The clots were treated by US,MB and UK in group 1,by US and MBingroup 2,by US and UK in group 3 and by UK in group 4.The group5 was the control group without any treatment.The thrombolysis rate of each group was measured and compared.Residual clots were histologically observed with hematoxylin-eosin staining and immunofluorescence.Results The thrombolysis rate of group 1 ([73.64±14.16]％) was significantly higher than group 2 ([47.97± 11.66]％),group 3 ([57.33±8.65]％),group 4 ([50.85±9.63]％),and group 5 ([29.76±18.06] ％,all P＜0.05).Histological examination of the clots in group 1 showed multiple thrombolysis foci with clots collapse,and the degradation of fibrin network was further confirmed by immunofluorescence.Conclusion The intraclot MB mediated US thrombolysis combined with UK can enhance the rate of thrombolysis in vitro experiment.

Objective To explore the efficacy of constructing the neourethra using a bladder anterior wall for the treatment of female total urethral stricture or atresia.Methods We retrospectively reviewed 11 female patients with total urethral stricture or oblitalition,who were underwent a procedure of reconstructive neourethra using a bladder anterior wall,from January 2009 to November 2015.Of the 11 patients,urethral stricture was associated with vesicovaginal fistula and a severe hydrocolpos in the proximal vagina because of vaginal anterior strictures or atresia in four girls.The mean age was 16 years (ranging 5-48 years) in all patients.The etiology was posttraumatic urethral injuries after pelvic fracture in 9 patients,radical urethral resection because of urethral cancer in 1 patient and congenital bladder exstrophy with an absent urethra in 1 patient.All patients underwent a procedure of neourethral construction under general anesthesia.The bladder anterior wall,which was about 2.0 to 2.5 cm in width and 4.0 ～4.5cm in length,was separated from bladder neck to middle partion of the anterior bladder wall.The bladder flap was tubularized around a 12-14 French catheter using continuous 4-0 polyglycolic acid sutures for the mucosa and interrupted sutures of 3-0 polyglycolic acid for the muscle.The tubularized flap was then flipped caudally to the site of the original external urethral meatus to form a new urethra.4 patients with severe stenosis or oblitalition of the distal vagina underwent a procedure of vaginoplasty at same time,including island vulvar flaps enlarging vaginoplasty in two girls and reconstructive vaginal orifice using the proximal enlargedvagina wall in other two girls.Results There were no serious complications postoperatively.The catheter was removed 3 ～4 weeks after the operation.7 patients were completely continent with excellent voiding,3 patients had stress incontinence.One patient experienced dysuria.And the urethroscopy in this case showed that the mucosal prolapse was present at the 12 to 3 o'clock position on the neck of the bladder,which caused urinary obstruction.Endoscopic resection of the prolapsed mucosa was performed.The patient could easily void without incontinence after the operation.The patients were followed up a median of 38 months,(ranging 6-72 months).2 patients experienced dysuria 3 and 4 months after operation,separatively.Examination showed that the mucosal prolapse was present at the position on the neck of the bladder in one patient and urethral meatal stenosis in another patient.The two patients were separatively underwent a procedure of endoscopic resection of the prolapsed mucosa and meatal urethroplasty,using vulvar flap.All of them could easily void without incontinence after the operation.Of the 3 patients with stress urinary incontinence,one underwent a procedure of TVT-O one year later,and after which continence was achieved with good voiding;the other two cases were awaiting for reoperation.Four cases of postoperative vaginal fluid disappeared with unobstructed micturition.Conclusions Female neo-urethral reconstruction using the bladder anterior wall flap was a reliable technique for the management of complete urethral stricture or obliteration.

AlM:To study the refractive status characteristics aftser cataract surgery and the correlation between preoperative anterior chamber depth ( ACD) and refractive status.METHODS: Ninety-six cases of patients with cataract were randomly divided into two groups. The patients in phacoemulsification group were treated with phacoemulsification combined intraocular lens ( lOL ) implantation while the patients in small incision group were treated by small incision extracapsular cataract extraction combined with lOL implantation. Changes in ACD and postoperative refractive status and refractive fully corrected value were counted and the correlation of them were analyzed .RESULTS: ACD of the phacoemulsification group s deepened 0. 74mm while that of the small incision group deepened 0. 78mm after treatment and there was no significant difference (P>0. 05). After operation, the ACD of two groups significantly deepened ( P<0. 05 ). The postoperative visual acuity of two groups were significantly better than the uncorrected visual acuity of two groups (P<0. 05). The postoperative refraction of two groups patients were mainly 0 ~ +1. 0D ( 41. 67% and 54. 16%) and+1. 25~+2. 0D (43. 75% and 33. 33%) (P>0. 05). CONCLUSlON: ACD is significant deepened after operation. Surgeon needs full consideration of changes to improve the refractive lOL calculation accuracy.

The rate of corneal graft rejection is still high for high-risk keratoplasty although immune suppression drug is routinely used.The role of traditional Chinese medicine in corneal transplantation is concerned gradually.Heijingpaichitang on the prevention and treatment of rats with high-risk corneal allograft rejection needs further study.Objective This study was to investigate the inhibitory effect of heijingpaichitang on high-risk corneal transplantation immune rejection in rats.Methods Sixteen female SD rats were used as the donors and 32female Wistar rats were served as recipients.The high-risk corneal trasplantation models were established by corneal suture in 32 Wistar rats,and then homogeneity variant SD-Wistar corneal transplantation was performed.The recipients were randomized into model control group,cyclosporinc A (CsA)group,heijingpaichitang group and CsA +heijingpaichitang group.CsA,heijingpaichitang and CsA + heijingpaichitang was orally administered 4 days after operation once per day for 15 days,and normal saline solution was used at the same way in the model control group.Ocular anterior segment reaction was examined under the slit lamp and corneal opacification,edema and neovasculation were scored based on Larkin' s criteria.Rejection index of the corneal graft was recorded and the graft survival time was calculated.The pathological examination of the corneal graft was carried out in all rats,and the inflammatory cells in the corneas and CD4+ cells in the periphery blood were assayed using flow cytometry.The use of the animals complied with ARVO Statement.Results Corneal graft rejection occurred in 10 days after operation in the model control group,12-13 days in the CsA group and heijingpaichitang group and 22 days in the CsA +heijingpaichitang group.Compared with model control group,the scores of the corneal opacification,corneal edema and neovascularization were significantly lower in the CsA group,heijingpaichitang group and CsA+heijingpaichitang group (P＜0.05),and all the scores were declined in the CsA+ heijingpaichitang group compared with CsA group and heijingpaichitang group(P＜0.01),but no significant differences were seen in the scores between the CsA group and heijingpaichitang group(P＞0.05).The mean survival time of grafts was (10.38 ±1.69)days in the model control group,(22.50 ± 3.07) days in the CsA + heijingpaichitang group,with the significant difference (t =-9.790,P =0.000).The pathological examination of graft showed that the lymphocytes and new blood vessels were less in the CsA+heijingpaichitang group compared with CsA group and heijingpaichitang group 15 days after operation.Flow cytometry verified that the number of lymphocytes in graft,CD4+cells and CD4+/CD8+ in periphery blood were significantly lower in the heijingpaichitang group,CsA group and CsA+heijingpaichitang group compared with model control group (P＜0.05).Conclusions Heijingpaichitang can inhibit immune rejection to certain extent in high-risk corneal transplantation rat and has a similar effect to 0.1％ CsA.Heijingpaichitang and 0.1％ CsA have a synergistic effect.