Cerebral small vessel diseases refer to small intracranial vascular lesions caused ischemic or hemorrhagic disease.Although researches have performed a large number of studies for its pathogenesis,it remains unclear now.This article reviews the pathogenesis of cerebral small vessel diseases from endothelial dysfunction,blood-brain barrier damage,ischemic and hypoperfusion,amyloid deposition,and genetic factor.

Objective To depict the characteristics of the flow shape and distribution of superficial lymphadenophathy and to clarify the effiency of color Doppler flow imaging and power Doppler sonography in the differential diagnosis.Methods Prospectively,81 cases with 95 lesions were observed and clarified as four vascular patterns by sonography and were correlated with the histopathological or clinical diagnosis.The four vascular patterns were as follows: type Ⅰ shows central hilar vascularity with radial symmetric branches; type Ⅱ shows eccentric hilar vascularity with deformed radial branches; type Ⅲ shows subcapsular vessels(Ⅲa),mixed vessels(Ⅲb),or multifocal hilar vasculature(Ⅲc); type Ⅳ shows spotted or peripheral flow signals.Results The majority ( 85.0% ) of the benign reactive nodes revealed a vascular pattern of type Ⅰ,while a few ( 10.0% ) showed that of type Ⅱ.The most( 97.8% ) of lymphoma showed the patterns of type Ⅱ( 33.3% ) and type Ⅲ( 64.5% , and Ⅲa 28.9% ,Ⅲb 22.2% ,Ⅲb 13.4% ,respectively).The vascular patterns of metastatic lymphadenopathies were of type Ⅳ( 66.7% ) and type Ⅲb(26.7%).The lymphoma which revealed a vascular pattern of type Ⅱ were mostly of high grade differentiation in pathological results.The differrent vascular types of metastatic nodes has no correlation with its histologic source.Conclusions Color Doppler sonography is a valuable method for aid in the differential diagnosis of superficial lymphadenophathy by using findings of intranodal vascularity.

Studies have shown that cerebral small vessel diseases can affect the mechanisms such as neural circuits,local cerebral blood flow changes,and neuroendocrine changes through brain damage,causing sleep disorders,and poststroke depression and brain atrophy caused by cerebral small vessel diseases may be associated with sleep disorders.In return,sleep disorders can damage the blood-brain barrier and cerebrovascular autoregulation function,and increase the risk of the occurrence of cerebrovascular disease.Both of them are interrehted,reciprocal causation,and commonly affect the prognosis and quality of life in patients.

Objective To evaluate the correlation between the elastic modulus of prostate and the degree of bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) patients in order to build a new non-invasive diagnostic indicator for BOO.Methods From november 2011 to November 2012,a total of 34 BPH patients were enrolled in this prospective study.Clinical information of the patients including age,international prostate symptom score (IPSS) and quality of life (QOL) were collected.The morphological features of prostate including total prostate volume,transitaion zone volume and transition zone index were detected by transrectal ultrasound (US),and prostate elastic modulus was detected using shear wave sonoelastograhy.After US examination,urodynamic study was performed by the urologist and pressure-flow curves were used to determine the diagnosis and the degree of bladder outlet obstruction.The correlation of prostate elastic modulus and other features including clinical information,morphological features and urodynamic features with the degree of bladder outlet obstruction were evaluated.ROC curves were evaluated.The feature with the best diagnostic performance was obtained,the diagnostic values of which were calculated.Results 9 patients had no BOO,with the average prostate elastic modulus of (27.3±5.0) kPa; 12 patients had mild to moderate BOO,with the average prostate elastic modulus of (30.7±2.8) kPa; 13 patients had severe BOO,with the average prostate elastic modulus of (34.7±2.4) kPa.The prostate elastic modulus had higher correlation coefficient with the degree of bladder outlet obstruction than the other features (r =0.754,P=0.000).It also had the highest AUC of 0.853 (95％CI 0.720-0.986).At a cutoffof 31.65 kPa,the sensitivity,specificity and accuracy of the prostate elastic modulus for the diagnosis of BOO were 72％,90％and 81％ respectively.Conclusion The prostate elastic modulus is highly correlated with the degree of bladder outlet obstruction,which might serve as a novel,promising indicator to evaluate BOO in BPH patients.

Objective To explore the action mechanism of Yiqi Huayu Formula for postpartum subinvolution of uterus. Methods Fifty female SD rats were selected model with postpartum subinvolution of uterus was made by injecting escherichia coli in vagina. Rats were randomly divided into 5 groups according to pregnancy time:blank group, model group, Xinshenghua group, and Yiqi Huayu high and low dose groups. Blank group and model group received gavage with water;Yiqi Huayu low and high dose groups received gavage with Yiqi Huayu Formula;Xinshenghua group received gavage with Xinshenghua Granule, once a day for 7 days. Uterine endometrial morphology was observed by HE staining. The contents of NO and NOS were respectively detected by Nitrate reductase method. Results Uterus submucosal hyperemia, bleeding, and endometrial discontinuity with the infiltration of inflammatory cells of rats in the model group suggested that the models were successfully established. Compared with blank group, the contents of NO and NOS in model group were higher significantly. Compared with model group, the contents of NO and NOS significantly decreased in both Xinshenghua group and Yiqi Huayu high and low groups (P<0.01, P<0.01). Compared with Xinshenghua group, Yiqi Huayu high dose group was lower (P<0.05). Conclusion Yiqi Huayu Formula could promote reconstruction and repair of the endometrium by reducing the contents of NO and NOS and inhibiting abnormal uterine spiral arteries relaxation.

Objective To investigate the effects of ligustrazine (TMP) combined with salvia miltiorrhiza on the progression of chronic allograft nephropathy (CAN) in rats and the action mechanism.Methods Fischer 344 rats and Lewis rats were used as renal transplant recipients and donors for ortlotopic kidney transplantation. The CAN model was established.By using random number table,the kidney transplant recipients were divided into five groups:cyclosporine A (CsA) group (A),TMP + CsA group (B),Salvia + CsA group (C),TMP + Salvia + CsA group (D) and blank control group (E,receiving no treatment).At 2nd,4th,6th,8th and 12th week after operation,5 mice in each group were sacrificed,and the transplanted kidney was removed for examination of renal histopathological changes. The immunohistochemistry was used to detect the expression of transforming growth factor β1 (TGF-β1) in the renal allograts,and by using fluorescent quantitative polymerase chain reaction,TGF-β1 mRNA expression in the renal allograts assayed.Results In blank control group,the survival time was no more than two weeks.In group A,the CAN pathological changes occurred at 4th week postoperation,those in group B and group C occurred later than in group A,and latest in group D with mild pathological lesions.In all groups after operation,Banff scores showed an upward trend,and at the same time point,those in group A were significantly higher than groups B,C and D ( P＜0.05 and P＜0.01 ).and those in group D was significantly lower than in group B and group C (P＜0.05),but no significant difference was found between group B and group C (P＞0.05).With time over,the TGF-β1 expression intensity showed an increasing trend.At the same time point,TGF-β1 expression intensity in group A was strongest among groups A,B,C and D (P＜0.05 and P＜0.01 ),and that in group D was significantly lower than in group B and group C (P＜0.05),but no significant difference was found between group B and group C (P＞00.05).The changes of TGF-β1mRNA expression pattem in each group showed the same trends as TGF-β1 protein expression.Conclusion TMP or salvia miltiorrhiza can delay the progression of CAN in kidney transplant rats by down-regulating the TGF-β1 expression,and the combined use of them exerts synergic effects.

Objective To explore the use of CA199,CEA,CA50 and ALP combined with magnetic resonance imaging (MRI) in diagnosis of intrahepatic bile duct stones with early bile duct carcinoma.Methods The clinical diagnosis of 36 cases of patients with hepatolithasis-associated intrahepatic cholangiocarcinoma (HICC) and 118 cases with intrahepatic duct stone (IHDS) were analyzed retrospectively.Serum CA199,CEA,CA50,ALP and magnetic resonance (MRI,MRCP) were performed and the results were analyzed.Results Abdominal pain discomfort in Hepatolithasis-associated intrahepatic cholangiocarcinoma showed multiple symptoms.Three typical Charcot syndromes were rare.On the gender distribution,intrahepatic bile duct stones was frequently found in women,on the contrary,Hepatolithasis-associated intrahepatic cholangiocarcinoma was frequently more found in men (P ＜0.05) Abdominal pain and fever in patients of Hepatolithasis-associated intrahepatic cholangiocarcinoma was more than that of patients with Intrahepatic bile duct stone (P＜0.05) When alkaline phosphatase (ALP) was more than 169 U/L,significant difference was seen between two groups (P＜ 0.05) According to the diagnosis of HICC,the accuracy of CA199,CEA,CA50 combined with ALP was 88.6％,the accuracy of magnetic resonance examination alone was 90.2％,and the accuracy of multiple serological markers and magnetic resonance was 95.5％.Conclusion MRI combined with serum CA199,CEA,CA50 and ALP can effectively improve the HICC preoperative diagnosis rate.

Objective To investigate the protective effect of basic fibroblast growth factor(bFGF) gene modified mesenchymal stem cells(MSCs-bFGF)on cerebral isehemia in rats.Methods MSCs or MSCs-bFGF were transplanted into rat models of focal cerebral ischemia by intravenous injection.The neurological deficits and infarction volumes were evaluated,and the survival rate and differentiation of grafted MSCs were observed by double immunofiuoreseent labeling.Results In the rat cerebral ischemic model, both MSCs and MSCs-bFGF showed protective effect on the rats in comparison with control group.However, the protective effect was more significant in MSCs-bFGF group.Double immunofluorescent staining showed the number of BrdU-labeled and NeuN co-expression cells in MSCs-bFGF treated animals(127.40?7.43 and 11.20?3.09)were much more than in those of MSCs treated animals.While there was no significant difference between MSCs-bFGF and MSCs group in the number of GFAP co-expression cells.Conclusion MSCs transplantation has protective effect on cerebral ischemia in rats.Basic fibroblast growth factor gene modified MSCs is more effective than MSCs in neuroproteetion.

Objective To explore the relationship between reduction of regional cerebral blood flow in the normal appearing white matter (NAWM) and the extent of age-related white matter lesions (WML).Methods We used Fazekas scale to divide all participants into four groups (normal,mild,moderate,severe) according to the extent of the lesions showed on MRI.Regional cerebral blood flow (rCBF) in the area of WML and NAWM was measured by xenon contrast CT examination.Results A total of 56 cases were selected.The average rCBF (ml · 100 g-1 · min-1) in the lesions (WML) around ventricle,in right centrum ovale and in left centrum ovale respectively was 20.33 ± 2.52,21.27 ± 1.02,21.03 ± 1.83 for mild; 16.33 ±2.03,15.55 ±1.71,15.91 ±0.98 for moderate; 14.05 ±2.63,14.46 ±2.17,14.23 ± 1.95 for severe.The average rCBF (ml · 100 g-1 · min-1) in the NAWM around ventricle,in right centrum ovale and in left centrum ovale respectively was 20.79 ± 2.78,22.26 ± 1.9,22.15 ± 2.4 for normal; 21.12 ± 2.95,22.17 ± 1.50,22.25 ± 2.13 for mild,18.02 ± 2.41,19.45 ± 1.94,19.62 ± 1.54for moderate; 16.38 ± 3.22,18.18 ± 2.84,16.74 ± 2.97 for severe.The decrease of rCBF in the severe and moderate lesion areas was more serious than that in the mild lesion areas and reached statistic significance (P ＜ 0.05) ; The decrease of rCBF in the severe and moderate lesion areas was more serious than that in the area of NAWM in the same grade and reached statistic significance (P ＜ 0.05).The decrease of rCBF in the area of NAWM around severe and moderate lesion areas was more serious compared with that around mild lesion areas or normal areas (P ＜ 0.05) ; But the difference of rCBF in the area of NAWM around mild lesion areas and normal areas did not show any statistic significance.Conclusions Chronic ischemia was found to be existed not only in the lesions (WML) but also in the area of NAWM around the lesions,and was related to the extent of the lesions.Chronic ischemia may play a key role in the mechanism of aged-related WML.

Objective To investigate the clinical features of pneumocystis carinii pneumonia (PCP)in patients with autoimmune diseases.Methods The data from 12 patients with autoimmune diseases who were hospitalized in Peking Union Medical College Hospital because of developing PCP were retrospectively reviewed.Clinical characteristics and T cell subsets in the peripheral blood were analyzed.Results The main clinical manifestations of these 12 patients were fever(12/12),cough(9/ 12),expectoration(9/12)and obvious dyspnea(12/12),which were progressive.Blood gas analysis presented with typeⅠrespiratory failure.Bilateral interstitial and alveolar infiltrates were observed in chest X-ray film.The counts of peripheral blood lymphocytes(0.44?0.31)?10~9/L,CD4~+ T-lymphocytes (0.120?0.079)?10~9/L and CD8~+ T-lymphocytes were(0.248?0.252)?10~9/L decreased significantly and the CD4/CD8 ratio reversed,which were significantly different from those of healthy person(P