Objective To investigate the relationship of obstructive sleep apnea and atherosclerotic cerebral artery stenosis.Methods One hundred and twenty patients with acute cerebral infarction were enrolled in the study.Patients underwent polysomnography monitoring;according to the results, the sleep apnea/hypopnea index ( AHI) was ≥5/h in 60 patients ( OSA group) and AHI was <5/h in another 60 patients ( non-OSA group) .The degree, quantity and distribution of cerebral artery stenosis were compared between OSA and non-OSA group.Results The results showed that there were no significant differences in gender, age, NIHSS score and rates of diabetes, coronary heart disease, hyperlipidemia and smoking between two groups (P>0.05).The rates of increased BMI [(26.07 ±2.39)vs.(23.59 ±2.73) kg/m2] and hypertension [70%(42/60)vs.43%(26/60)] in OSA group were higher than those in non-OSA group (t=5.304,χ2 =7.603, all P<0.05).There were 47 (78.3%) patients in OSA group and 27 (45.0%) in non-OSA group presenting cerebral artery stenosis (χ2 =16.535, P<0.05), and both OSA group and non-OSA group displayed high proportion of intracranial artery stenosis ( 68.0% vs.81.5%, P>0.05 ) . The severity of cerebral artery stenosis in OSA group was higher than that in non-OSA group (χ2 =17.801, P<0.05).There were no significant differences in location distribution of stenosed cerebral arteries between two groups (P>0.05).Conclusion The study indicates that there is a close relationship between OSA and stenosis of atherosclerotic cerebral arteries.

As a treatment of noninvasive,safe,effective,and easy to operate,external counterpulsation has been widely used in the treatment of ischemic heart disease.The treatment mechanism of external counterpulsation may improve collateral circulation and hemodynamics.Therefore,it can provide a new measure for the treatment of cerebrovascular disease.However,the efficacy and safety of external counterpulsation in the treatment of ischemic stroke still need to be confirmed by a large sample clinical trial.

Objective To investigate the effects of exercises on expressions of retinol binding protein-4 (RBP4)in serum and phosphatidylinositol 3 kinase(PI3K)in skeletal muscles of insulin-resistant(IR)rats induced by diets.Methods A total of 30 Wistar rats were randomly divided into 3 groups:normal control group fed with normal diet,IR and exercises groups with high sugar and high fat diet.After 8 weeks,the Wistar rats in exercises group took swimming training for 6 weeks and all groups kept their assigned diets.At the end of 14-week experiment,the body weight(BW)of rats were measured,the general behaviors of rats were observed and then sacrificed.Rats' blood were sampled for measuring the levels of glucose(FPC)and serum RBP4,insulin(FINS),HDL-C,LDL-C,TG,TC.The indexes of IR(HOMA-IR)were calculated.The levels of RBP4 in serum were measured with ELISA technique.The ratios of visceral fat content to BW were calculated too.Immunohistochemistry method was applied to detect the expression levels of PI3K in skeletal muscle.Results(1)The levels of RBP4,TC,TG,FPG in serum in exercises group were lower than those in IR group significantly;the visceral fat content,ratio of visceral fat content to BW,FINS,RBP4,LDL and HOMA-IR in serum increased significantly in IR group after 6 weeks feeding compared with normal control group and exercises group(P＜0.01);the levels of HDL in serum in IR group were lower than those in the other two groups.(2)The expression levels of PI3K in skeletal muscles in exercises group were significantly higher than that in IR group(P＜0.01).(3)In a multiple stepwise regression analysis,FINS,ratio of visceral fat content to BW,LDL and HOMA-IR were correlated with RBP4 positively;HDL and PI3K were correlated with RBP4 negatively.Conclusion Exercises could downregulate the level of RBP4 in serum and upregulate the level of PI3K in skeletal muscles of IR rats.This effect was important for improving the organism sensibility to insulin.

Objective To understand the drug resistance and antibiotic resistance mechanism ofβ-lactam antibiotics of invasive Streptococcus pneumoniae isolated from Shanghai Children′s Hospital, provides the reference for the rational use of antimicrobial agents.Methods This study is based on the research of the mechanism of drug resistance.62 isolates of invasive Streptococcus pneumoniae were collected from Shanghai Children′s Hospital from January 2005 to December 2011.Minimum inhibitory concentrations ( MIC) of strains to 9 antimicrobial agents were determined by E-test method.The penicillin binding protein coding genes pbp2x, pbp2b, and pbp1a of Streptococcus pneumoniae were amplified by PCR.Then, the correlation between the gene mutation andβ-lactam antibiotics resistant level were analyzed.The murM gene of Streptococcus pneumoniae was amplified by PCR and the correlation of mutation and β-lactam antibiotics resistant level was analyzed.Results Out of 62 strains of invasive Streptococcus pneumoniae from children, the detection rate of penicillin resistant Streptococcus pneumoniae was 43.6% (27/62).Between penicillin intermediate Streptococcus pneumoniae ( PISP ) ( 100%, 25/25 ) and penicillin sensitive Streptococcus pneumoniae (PSSP) (3/10), the difference of gene mutation rate near the pbp2b conserved sequence was statistically significant (χ2 =21.875, P<0.01).The same situation occurred between penicillin resistant Streptococcus pneumoniae (PRSP)(100%, 27/27)and PSSP (3/10) (χ2 =23.310, P<0.01).Also the difference of gene mutation rate of PISP (84%, 21/25) vs PSSP (0) and PSSP (0) vs PRSP (85.2%, 23/27) near or in the pbp2x conserved sequence were statistically significant (χ2 =21.000, P <0.01;χ2 =22.513,P<0.01).The difference of gene mutation rate near the pbp1a conserved sequence and Insertion sequence, which were statistically significant, occurred between PISP and PSSP (χ2 =13.22,P<0.01), between PRSP and PSSP (χ2 =37.000,P<0.01), between PISP and PRSP (χ2 =10.211,P=0.001). MurM gene mutation rate was statistically significant different between the 2 group penicillin MIC≥8 mg/L or ceftriaxone MIC≥2 mg/L group (95.8%, 23/24) and penicillin MIC<8 mg/L or ceftriaxone MIC<2 mg/L group (0) (χ2 =56.2,P =0.002 6).Conclusions The resistance phenomenon of invasive Streptococcus pneumoniae in Shanghai Children′s Hospital is serious.The gene mutations of pbps and murM play a role in amide in the beta of antibiotic resistance, and there is a certain correlation with the antibiotic resistance level.

Autoimmune encephalitis with GABAB receptor antibodies has been rarely reported.Two cases of GABAB receptor antibodies encephalitis were presented here.Epilepsy was the onset symptom,followed by declined consciousness and frequent seizures.Fever was presented in the whole course of the disease.Myorhythmia of the two hands and pilomotor seizures were shown in the later course of the disease.No specificity was demonstrated in electroencephalograms and magnetic resonance imaging.Sensitive response was shown to the first-line immunotherapy.

Objective To understand the mutations of macrolide resistance gene locus (23S rRNA) of Mycoplasma pneumoniae (MP) and its correlation with clinical features .Methods A total of 354 respiratory tract samples were collected from children pa-tients with pneumonia .MP and its mutations in 23S rRNA gene locus were detected by real-time PCR .The children cases of MP positive were divided into the mutation group and non-mutation group .Then the clinical data were compared between the two groups .Results Among 354 respiratory tract samples ,166 cases(46 .9% ) were MP positive ,moreover the mutation of 23S rRNA gene locus existed in 135 MP positive samples with the positive detection rate of 81 .3% ,while no 23S rRNA gene locus mutations were detected in 31 samples .Analyzing the clinical data of the mutation group and non-mutation group found that there was no sta-tistical difference in the aspects of age and gender between the two groups .The occurrence rates of severe pneumonia and extrapul-monary complications in the mutation group were higher than those in the non-mutation group (P<0 .05) ,moreover the average hospitalization time and fever duration in the mutation group were longer than those in the non-mutation group (P<0 .05) .Conclu-sion 23S rRNA gene locus mutation has higher detection rate ,prompting that MP shows high resistant rate to macrolides ,which could provide a certain basis for treatment of M P infections .

Objective To evaluate the clinical effect of ultrasound-guided percutaneous transhepatic cholangial drainage (PTCD) combined with endoscopic retrograde cholangio-pancreatography (ERCP) in treating malignant obstructive jaundice, and to discuss its technical points. Methods A total of ten cases with malignant biliary obstruction were enrolled in this study. After the failure of ERCP treatment, the patients had to be treated with ultrasound-guided PTCD immediately. The guide-wire was inserted into the duodenum through intrahepatic bile duct and common bile duct to connect with ERCP, which was followed by the biliary stent implantation or the removal of physical factors causing obstruction. The clinical results were analyzed. Results Technical success was obtained in all 10 cases. In the patients who underwent a successful guide-wire docking with ERCP the postoperative serum bilirubin was significantly decreased. The main complications were fever, elevation of amylase and transient bloody bile. Conclusion With the help of docking technique the combination use of ultrasound-guided PTCD and ERCP is a new tentative treatment for malignant obstructive jaundice after the failure of initial ERCP treatment. This technique carries promising value in clinical practice as it can significantly increase the success rate of ERCP.

Objective To explore the value of MRI on fetal autosomal recessive polycystic kidney disease (ARPKD).Methods Sixteen pregnant women,aged from 28 to 38 years (average 30 years) and with gestation age from 22 to 36 weeks (average 25 weeks) underwent MR scanning with a 1.5 T MR unit within 24 to 48 hours after ultrasound examinations.The imaging sequences included steady-state free-precession (SSFP) sequence,single-shot turbo spin echo (SSTSE) sequence and T1-weighted fast imaging sequence.Prenatal US and MR imaging findings were compared with autopsy or pathological results.Results A total of 16 cases of ARPKD showed bilateral markedly enlarged kidneys and diffuse high signal small cysts in renal medulla on SSTSE sequence.Among the 16 cases,11 cases were with oligohydramnios,1 1 cases were with pulmonary hypoplasia,and 6 cases were with hepatic fibrosis.Eleven cases of pulmonary hypoplasia and 6 cases of hepatic fibrosis were all missed by US.For the diagnosis of the renal anomalies,US missed one case.MRI diagnosis was correct in all these cases.Conclusions MRI shows great advantages on the diagnosis of fetal ARPKD,and it is not affected by the amount of amniotic fluid.It can be used to evaluate kidney and lung abnormalities accurately.

Objective To understand the incidence of hemolytic disease in newborn (HDN)among the newborns with jaundice and the coincidence degree of the blood group serological results and the clinical diagnosis in HDN.Methods The microcolumn gel method was adopted to detect the 3 serological indexes in 276 jaundice newborns of maternal fetal blood group incompatibility,in-cluding the direct antiglobulin test,free antibody test and antibody release test.Results 108 cases of HDN were clinically diagnosed with the positive rate of 39.13%.The positive detection rate in newborns with 0-2 d old was highest(50.00%).Conclusion The serological test can provide the basis for the early diagnosis and treatment of HDN.Collecting the specimen as early as possible can improve the positive diagnosis rate of HDN.

Objective To assess the prostaglandin E2 (PGE2) levels in tumor mass and peripheral blood of patients with gastric cancer and explore their clinical significance. Methods The PGE2 levels in tumor mass, tumor margins of excision and peripheral blood of 40 patients with gastric cancer were measured by a kit of PGE2 ELISA. Results The PGE2 levels were higher in the tissues of gastric cancer than in tumor margins of excision [(8.225?2.425) vs (1.669?0.287) ng/g, P