Objective To explore the clinical features of meningeal carcinomatosis (MC). Methods The clinical data of 3 male patients with MC, administered to the authors' hospital within one-year period, were retrospectively analyzed. The pathological mechanism, clinical manifestations, diagnosis, treatment and the prognosis were summarized and relevant literature was reviewed. Results All the three patients presented neurological symptoms at the onset. Case 1, 52-year-old having a history of radical resection for gastric cancer 3 years ago, suffered from headache for 2 months without apparent digestive symptoms. Case 2, 71-year-old, presented diplopia for 2 months. Case 3, 46-year-old, complained diplopia for 3 months, followed by left hip pain and urinary retentions. For case 1, examinations after admission suggested no signs of local recurrence or systemic metastasi. For case 2 and 3, lung tumors were detected and then pulmonary carcinoma was diagnosed. Cerebrospinal fluid (CSF) of the three patients showed similar changes, including mild increase of protein, decrease of glucose and chlorides. Carcinous cells (heterocyst, signet-ring cell and large round heterocyst) were found and cells with positive tumor markers were found in the CSF of all the three patients. MRI also showed specific enhancement on meninges. All these patients, died on day 7, 47 and 24 respectively, after the diagnosis was established. Conclusions Neurological symptoms might be the earliest or the exclusive clinical features of meningeal carcinoma metastasis. A detailed neurological and oncological examination is necessary for the patients with progressive neurological lesions without obvious precipitating cause.

Objective To explore the clinical value of the ten-point scale in the early diagnosis of fat embolism syndrome.Methods The data of 129 patients with fat embolism syndrome diagnosed by Gurd criteria admitted from January 1993 to February 2012 were analyzed retrospectively.At the same time,another 97 patients with single or multiple long bone fracture and/or pelvic fracture without fat embolism admitted from July 2005 to February 2012 were enrolled as control group.Patients were excluded if they had any of the following diseases:simple brain trauma,thoracic injury,spine fracture,hemorrhagic shock and the complications of cardiopulmonary cerebral resuscitation (CPCR).The patients of two groups were comparable in respect of clinical setting.The clinical data were analyzed and scored by the ten-point scale.The x2 test were applied to statistical works.Results Among all the clinical characteristics,the incidence of increased D-dimer was the highest (74.1％) in early fat embolism syndrome,followed by the progressive decrease in hemoglobin (63.6％) and hypoxemia (57.4％),and the occurrence of dyspnea was the lowest (17.8％).The percentage of total scores over ten points in patients with fat embolism syndrome group was higher than that in those without fat embolism syndrome (x2 =202.6,P ＜ 0.01).The sensitivity of tenpoint scale was 96.12％ and the specificity was 99.8％.Conclusions Ten-point scale could be used to make early diagnosis of fat embolism syndrome,thereby reducing the occurrence of misdiagnosis and misseddiagnosis.

Objective To study the effect of Tongxinluo on the plasma C-reactive protein(CRP)and endothelin-1(ET-1)in acute coronary syndrome(ACS) patients.Methods 100 patients with ACS were randomly divided into conventional therapy group and treatment group(conventional therapy+Tongxinluo gelatin capsule).The changes of CRP and ET-1 in the first day,7th and 14th day were observed.Results In the treatment group,CRP and ET-1 were significantly decreased in the 7th and 14th day(P＜0.05,P＜0.01),and there was significant decrease only in the 14th day(P＜0.05)in the conventional therapy group.CRP and ET-1 levels in the treatment group were significantly different as compared with conventional thereapy group(P＜0.01).Conclusion Tongxinluo capsule may protect blood vessel endothelium through inhibiting CRP and ET-1 to decrease the inflammatory response of endangium.

AIM:To study whether cordycepin (Cordy) plays a role in myocardial protection by regulating the expression of microRNA-455 ( miR-455) and reducing apoptosis induced by endoplasmic reticulum stress in the ischemia -reperfusion (IR) rats.METHODS: SD rats (250 ~300 g) were randomly divided into 3 groups: control group, the chests of the rats were only opened;IR group, the rats were given myocardial ischemia for 30 min, and then reperfusion for 120 min;IR+Cordy group:before IR, the rats were given Cordy (10 mg/kg) through femoral vein injection once a day for one week, and the last injection was given 30 min before ischemia.Automated biochemical analysis was used to detect rat serum activity of LDH and CK-MB.The myocardial endothelial cell ( EC) apoptotic rate was measured by TUNEL , and the ultrastructural changes of the myocardial EC were observed under transmission electron microscope .RT-qPCR was used to detect the expression of miR-455 and the mRNA levels of glucose-regulated protein 78 ( Grp78) and caspase-12 in the myo-cardium.RESULTS:Compared with control group, EC apoptosis in IR group was significantly increased (P<0.05). Compared with IR group , EC apoptosis in IR +Cordy group decreased significantly ( P<0.05 ) .Compared with control group, swelling of mitochondria , irregular membrane , loose wrinkles with vacuoles , disappeared matrix granules , irregular nuclear membrane , chromatin condensation , disappeared nucleoli and even small apoptosis body in the EC were found in IR group.Compared with IR group , the symptoms in IR +Cordy group were greatly improved .Compared with control group, the mRNA expression of Grp78 and caspase-12 as well as the miR-455 level in IR group was increased (P<0.05). Compared with IR group , the mRNA expression of Grp78 and caspase-12, as well as the miR-455 level in IR+Cordy group was decreased (P<0.05).CONCLUSION:Cordycepin attenuates myocardial EC apoptosis , down-regulates the expres-sion of miR-455, and inhibits endoplasmic reticulum stress in the myocardium .

Objective To investigate the protective effect and the possible mechanism of intravenous infusion with perfluorocarbon pretreatment and posttreatment on acute lung injury in rats on LPS-induced acute lung injury in rats.Methods A total of 24 Wistar rats were randomly divided into 4 groups:control group(NS group),LPS group,Pre group and Post group.Normal saline was given to NS group as a control.Rats were treated with LPS by intratracheal instillation in LPS group,rats received PFC through femoral vein.prior to LPS instillation in Pre group and rats received PFC through femoral vein after LPS instillation in Post group.NS group were sacrificed at 6 h after being injected with NS,LPS group,Pre group and Post group were sacrificed at 6h after being given LPS.Pathological changes of king,PaO2,lung wet to dry weight ratio (W/D),expression of myeloperoxidase (MPO) and intercellular adhesion molecule-1 (ICAM-1) of lung were assessed.Results Intravenous.infusion with perfluorocarbons increased PaO2,decreased W/D,MPO and ICAM-1 significantly (P＜0.05),and this effect is more remarkable in Pre group.Conclusion Intravenous infusion of PFC significantly protects lung from acute lung injury,especially by pretreatment forms,probably by down-regulate the expression of ICAM-1.

An efficient modified route based on the targeting mechanism of antibacterial fluoroquinolones for the shift from the antibacterial activity to the antitumor one was further developed. Using a fused heterocyclic ring, s-triazolothiadiazine as a carboxyl bioisostere of ciprofloxacin, the title compounds, 1-cyclopropyl-6-fluoro-7-piperazin-1-yl-3-(6-substituted-phenyl-7H-[1, 2, 4]triazolo[3, 4-b][1, 3, 4]thiadiazin-3-yl)-quinolin-4(1H)-ones (5a-5e) and their corresponding N-acetyl products (6a-6e), were designed and synthesized, separately. Meaningfully, a ring-contraction of fused six-membered thiadiazine occurred by a sulfur extrusion reaction gave new tri-acetylated fused heterocycles related to pyrazolo[5, 1-c][1, 2, 4] triazoles (7a-7e). The in vitro antitumor activity against L1210, CHO and HL60 cell lines was also evaluated for the synthesized fifteen heterocycles compared to parent ciprofloxacin by methylthiazole trazolium (MTT) assay. Interestingly, the results displayed that fifteen fused heterocyclic compounds showed more significant growth inhibitory activity (IC50 < 25.0 micromo x L(-1)) than that of parent ciprofloxacin (IC50 > 150.0 micromol x L(-1)), and the active order decreased from 7a-7e to 5a-5e to 6a-6e, respective.

Objective To investigate the prevalence of drug-resistant mutations in reverse transcriptase and protease coding regions of HIV-1 in treatment-na(i)ve patients. MethodsPlasma specimens were collected from 88 patients from Zhejiang, Shanghai, Henan and Anhui. The entire protease gene and the first 1-251 amino acids of the reverse transcriptase gene were amplified by RT-PCR from viral RNA and sequenced. The sequences were analyzed with HIV drug resistance algorithm, and phyligenetic analyses were performed by PHYLIP software. SPSS 13.0 was used for statistical analysis, and Fisher' s exact test was performed to compare the proportions of each subtype between the groups. Results79 gene sequences were obtained, subtyping analyses indicated that 68.4％ (54/79) were subtype B, followed by CRF01 _AE 24.8％ (22/79), CRF07_BC2.5％ (2/79),andCRF08_BC1.3％ (1/79). 7 (7/79,8.9％)presented with primary mutations associated with resistance to antiretroviral drugs, mutations conferring primary resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors ( NNRTIs ) were detected in 3 ( 3. 8％ ) and 4 ( 5. 1％ ) cases, respectively. Protease inhibitors (Pls)associated primary resistance mutations were not found.Conclusion Antiretroviral drug resistant mutations have been found in treatment-na(i)ve patients with HIV-1 infections, while the prevalence level is low, which indicates that drug resistance test is not necessary for most HIV-1infected treatment-na(i)ve patients.

Objective To explore the dynamic changes and clinical significance of relative pituitary hormones in children after craniocerebral injury.Methods The quantitative analysis and dynamic observation were performed in 125 children after craniocerebral injury and 20 voluntary healthy children of relative pituitary hormones including serum prolactin(PRL),cortisol(PTC),three free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH),growth hormone (GH) by applying electrochemical luminescence method.Tbe hormone variational characteristics were analyzed according to posttraumatic time,Glasgow Coma Scale(GCS) scores on admission and Glasgow Outcome Scale (GOS) scores on discharge,and the relationship between hormone variational characteristics of 58 cases was followed up over 2 years and the activities of daily living (ADL) were also investigated.Results The serum PRL was significantly increased on the first,third and fifth day compared with the healthy control group (P =0.000 0,0.000 0,0.006 7),respectively.There was significant difference between mild,moderate and severe groups within 30 days after suffering from craniocerebral injury (P ＜ 0.05).PTC was heavily increased within 3 days,and significant difference existed among mild and moderate groups mild and severe groups (all P ＜ 0.05) ; TSH,FT3,FT4 decreased slightly after injury and gradually rose in later;GH change wasn't significant;and the larger variation of relative pituitary hormones was responsible for lower GCS scores;FT3,FT4,TSH,and GH decreased in different degrees,which were found in parts of children with craniocerebral injury,and the significant difference of serum PRL existed between GOS scores 4-5 and GOS scores 1-3 groups (P =0.000 1).Conclusions The changes of relative pituitary hormones were associated with the posttraumatic time and the severity of craniocerebral injury.The PRL in serum can aid in prediction of outcome for the children with craniocerebral injury.

ObjectiveToevaluatethecorrelationbetweenfluoroquinoloneresistanceinNeisseriagonor-rhoeaeandmutationsingyrAandparCgenes.Methods①Thesusceptibilities58clinicalisolatesofN.gonorrhoeaeto5fluoroquinolonesweretestedbydiscdiffusionmethod.②Theminimuminhibitoryconcentration(MIC)ofciprofloxacinwasdeterminedbyE-test.③Thefragmentsincludingthequinoloneresistance-determiningregion(QRDR)wereamplifiedbyPCRingyrAgeneof18strains,andparCgeneof8strains,andtheirrelativefragmentsweredirectlysequenced.Results①Thenumbersofstrainssimultaneouslysensitive,intermediateandresistanttociprofloxacin,ofloxacin,lomefloxacin,fleroxacinandenoxacinwere2,4and39,respectively.②TherangeofciprofloxacinMICwas0.004～12.0?g/mLin58strains.Thenumbersofstrainssensitive,intermediateandresistanttociprofloracinwere2,17and39,respectively.③ThestrainswithciprofloxacinMICfrom0.004～0.016?g/mLhadnomutationingyrAandparCgenes.ThestrainswithMICfrom0.064to0.094?g/mLcarriedasinglepointmutationingyrAgene,whilethestrainswithMIC≥0.25?g/mLcontainedtwomutationsingyrAgene.Inaddition,thestrainswithMIC≤0.25?g/mLhadnomutationinparCgeneandthestrainswithMIC≥1.0?g/mLexhibitedasinglepointmutationinparCgeneandtwomutationsingyrAgene.④Of16strainscontainingmutationingyrAgene,15strainsexhibitedsubstitutionofSer91(TCC)→Phe(TTC).Conclusions①MutationswithingyrAgenemediatelowandmoderatelevelsfluoroquinoloneresistancewhilemutationswithinparCgeneparticipateinhighlevelfluoro-quinoloneresistanceinN.gonorrhoeae.②SubstitutionofSer91→PheingyrAgeneisthepivotalmutationresultinginfluoroquinoloneresistanceinN.gonorrhoeae.

Objective To investigate the application and clinical significance of the medial plantar flap on repairing the medial ankle and foot soft tissue defects. Methods A total of 13 patients with the medial ankle and foot soft tissue defects were repaired by the local transferred medial plantar flap alone or in combination with sural neurovascular flap transplantation in the Yuebei People's Hospital Affiliated to the Medical College of the Shantou University from Jun. 2006 to Dec. 2012. Results All patients were followed-up of 4-21 weeks,and the average follow-up periods were 6. 3 weeks. All of the skin and soft tissue defects of the medial ankle and foot were repaired,and there were 2 cases of partial necrosis of flap were repaired after tow times skin grafting operation,and all cases without complications of wound infection or iatrogenic nerve injury. Conclusion The medial plantar flap on treating ipsilateral medial malleolus and foot skin and soft tissue defects is useful and effective with less complications,satisfactory effects,intact the ankle flexor and extensor device,allowing early functional exercise,good functional recovery.