SUMMARY The male patient reported here presented as gangrene and central diabetes insipidus ( CDI) , who had characteristics of vasculitis. The patient complained about polydipsia and polyuria half a year ago, and then developed tingling, pain and blackish discoloration of some fingers and toes 3 month ago. He also had Raynaud' s phenomenon. After admission, his laboratory examination showed the rise of erythrocyte sedimentation rate, C-reactive protein, immunoglobulin,β2-glycoproteinⅠand the activi-ty of rheumatoid factors, lupus anticoagulant test. his pituitary gland showed loss of posterior signal on magnetic resonance imaging. In addition, his vasopressin test was active. However, there was no suffi-cient evidence to diagnose any specific disease;as a consequence the patient was diagnosed as idiopathic systemic necrotizing vasculitis ( SNV) . For SNV, the patient was treated with glucocorticoid 40 mg/d and impact therapy of cyclophosphamide 0. 4 g every 2 weeks. He also received symptomatic treatment for gangrene and CDI. Cutaneous involvement leading to gangrene was widely reported in SNV, however pi-tuitary involvement in SNV leading to CDI was rare. The prognosis of this patient was poor.

Objective To ecaluatc the diagnostic value of digital subtraction angiography (DSA) and carotid artery ultrasound for transient ischemia attack (TIA). Methods Among the 74 patients with TIA, 45 had internal carotid artery (ICA)-TIA and 29 had vertebrobasilar artery (VBA)-TIA. DSA examination was performed in order to detect intracranial and extracranial arterial stenosis in the above two systems. Cervical artery ultrasound examination was used to understand the distribution of arterial plaques. Results DSA shoved that the detection rate of vascular stenosis in patients with ICA-TIA was 84. 4% (n = 38),and the patients with serious, moderate and slight stenoses were 31.1% (n = 14), 26. 7% (n = 12) and 11.1% (n =5), respectively. Of those, intracranial arterial stenosis was 44.4% (n =20), and it was significantly higher than 22.2%(n = 10) in extracranial arterial stenosis (P ＜0. 001 ); the detection rate of vascular stenosis in patients with VBA-TIA was 65.5% (n = 19), and the patients with serious, moderate and slight stcnoscs were 17. 2% (n = 5), 27. 5% (n = 8), and 20. 7% (n = 6), respcctivegly. Of those, cxtracranial arterial stenosis was 44.8% (n = 13), and it was significantly higher than 13.8% (n = 4) in intracranial stenosis (P ＜ 0. 001 ). Carotid artery ultrasound shoved that the detection rate of ICA plaque was 44.4% (n = 20), and it was higher than 24, 1% (n =7) in patients with VBA-TIA; the detection rate of the plaques in the initial segment of subclavian artery in patients with VBA-TIA was 44. 8% (n = 13), and it was significantly higher than 13.3% (n = 6) in patients with ICA-TIA (P ＜ 0.001 ). Conclusions There were differences between the intracranial and extracranial vascular lesions and the distribution of atherosclerotic plaques in patients with ICA-TIA and VBA-TIA. 1he former was more common in intracranial lesions, and the latter was more common in extracranial lesions.

Objective To investigate the syndromes, syndrome elements and target sites of diabetic cerebral infarction. Method Firstly, literatures were searched from January 2003 to October 2013 in China Academic Journals Database (CNKI) retrieval system, then a database of 22 eligible articles was established. Syndromes of diabetic cerebral infarction were extracted from the database, then syndromes, syndrome elements and target sites were analyzed. Results Totally 2550 cases of diabetic cerebral infarction were concerned with 15 syndromes, including 659 cases of stagnation of phlegm and blood (25.84%), 445 cases of stagnation of phlegm-heat (17.45%), 366 cases of wind-phlegm syndrome (14.35%) and 341 cases of qi deficiency and blood stasis (13.37%). There were 10 syndrome elements in the 2550 cases, of which 1588 cases with phlegm (62.27%), 1026 cases with blood stasis (40.24%), 649 cases with qi deficiency (25.45%) and 539 cases with yin deficiency (21.14%). And seven target sites were encompassed, the highlights of which included 2502 cases of liver (98.12%), 2194 cases of spleen (86.04%), 2096 cases of kidney (82.20%) and 1026 cases of brain (40.24%). Conclusion The important syndrome elements of diabetic cerebral infarction were phlegm, blood stasis, qi deficiency and yin deficiency. The four major syndromes comprising stagnation of phlegm and blood, stagnation of phlegm-heat, wind-phlegm syndrome and qi deficiency and blood stasis were concluded, mainly affected the liver, spleen, kidney and brain. And there were two fundamental pathogenesis in diabetic cerebral infarction:qi and yin deficiency, phlegm and blood stasis.

Objective To explore the relationship between paraoxonase1 (PON1) L55M gene polymorphisms and atherosclerotic cerebral infarction(CI)in Hunan Han people. Methods The study population was comprised of 153 atherosclerotic cerebral infarction patients and 153 healthy individuals. The PON1-L55M genotypes were determined by restriction fragment length polymorphism. Results MM genotype was not found both in CI and control group. In CI group, genotypic frequency of LL was 96.7% and LM was 3.3%. The allele frequency of L was 0.984 and M was 0.016. In control group, genotypic frequency of LL was 93.5% and LM was 6.5%. The allele frequency of L was 0.968 and M was 0.032. PON1-L55M polymorphism revealed no significant difference of genotype and allelic distribution in CI patients and controls.Conclusion The polymorphism of PON1-L55M is not related to the incidence of atherosclerotic cerebral infarction in Hunan Han people.

Objective To investigate the association between the presence of cerebral microbleeds and chronic kidney disease in patients with ischemic stroke.Methods Patients with ischemic stroke within 1-6 months were consecutively recruited.Cranial MRI was taken within two weeks after recruitment.Cerebral microbleeds were assessed using Microbleed Anatomical Rating Scale on gradient echo MRI.Demographics including sex,age and risk factors were obtained.Chronic kidney disease was defined and classified according to National Kidney Fundation-Kidney Disease Outcome Quality Initiative Guideline.Glomerular filtration rate (GFR) was estimated by using the abbreviated Modification of Diet in Renal Disease equation.Results Of the 636 patients included,mean age was (59.8 ± 10.1) years,435 (68.4％) were male.Sixty-six had decreased estimated GFR (eGFR; ＜ 60 ml · min-1 · 1.73 m-2).Two hundred and one (31.6％) patients had cerebral microbleeds,which were most commonly located in deep or infratentorial location (133/201,66.2％).The presence of cerebral microbleeds was much higher in patients with decreased eGFR than the others (48.5％ (32/66) vs 29.6％ (169/570),x2 =9.709,P =0.002).Age,history of hypertension and decreased eGFR were associated with the presence of cerebral microbleeds in univariate analysis.In multivariate analysis,decreased eGFR was independently associated with the presence of cerebral microbleeds in deep or infratentorial location (OR =1.457,95％ CI 1.044-2.034,P =0.027),but not associated with the presence of cerebral microbleeds in pure lobe.Conclusion Impaired kidney function is associated with the presence of cerebral microbleeds in deep or infratentorial regions in patients with ischemic stroke.

Objective:To investigate the status of rumination in patients with primary glaucomatous visual field defect and explore the influencing factors.Methods:Totally 267 patients with primary glaucomatous visual field defect were selected via convenience sampling method. Invasive rumination, purpose rumination, and self-management behaviors among different visual field were compared. The main influencing factors of invasive rumination and purpose rumination were analyzed.Results:Total score of rumination in patients with primary glaucomatous visual field defect was (29.90±5.58) points, average item score of self-management behaviors was (2.81±0.31) points. There were no significant difference in invasive rumination, purpose rumination, self-management behaviors among different visual field ( P>0.05). Accidental injury, life adjustment, income of family per mouth and degree of education could explain 30.7% of the total invasive rumination variation; disease management, body function promotion and accidental injury could explain 11.1% of the total purpose rumination variation. Conclusions:Rumination and self-management behaviors in patients with primary glaucomatous visual field were at a lower middle level and middle level respectively. Medical staff should attach importance to assess the invasive rumination among these patients with accidental injury, poor ability of life adjustment, low income of family per mouth and low degree of education. Through lowering the negative experience, changing the cognitive and taking correct self-management behaviors, then prognosis of disease would be improved.

Objective To investigate the incidence and risk factors of cerebral microbleeds(CMB) in ischemic stroke patients.Methods Patients with cerebral infarction for 1～6 months were recruited.Clinical data were recorded.MRI was reviewed blindly to determine the number of CMB and lacunar infarcts and the white matter lesions(WML).The independent risk factors of CMB were analyzed with the Logistic multivariable regression.Results 636 subjects were included.CMB were found in 250 cases(39.3%).The incidence of CMB in patients of ≤50,50～65 and >65 years old were 27.2%,38.1% and 47.6% respectively(P<0.05).CMB was more frequent in patients with more lacunar infarcts(P<0.05).The incidence of CMB in patients with negative,mild,moderate and severe WML were 21.9%,33.8%,46.9%and 63.1% respectively(P<0.05).Logistic regression analysis showed that history of hypertension(OR=1.523,95% CI 1.019～2.276),severity of WML(OR=1.535,95% CI 1.258～1.874) and lacunar infarcts(OR=1.517,95% CI 1.087～2.118) were the independent risk factors for presence of CMB.Conclusion CMB was frequent in ischemic stroke.The frequency of CMB increased with aging,grade of lacunar infarcts and WML.History of hypertension,severity of WML and lacunar infarcts were the independent risk factors for CMB presence.

Objective To assess the feasibility of a novel 99Tcm labelled polypeptide analogue for interleukin-11 receptor ( IL11R) imaging in a bone metastases model for prostate cancer. Methods A novel circular polypeptide analogue of IL11 ( c( CGRRAGGSC ) ) was indirectly labeled with 99Tcm and the product was named as 99Tcm-DTPA-IL11 RR. The labeling efficiency, radiochemical purity and stability of the product were measured with paper chromatography and high performance liquid chromatography (HPLC). The biodistribution of 99Tcm-DTPA-IL11RR was investigated in 28 ICR normal mice. The organ radioactivity was measured as percentage activity of injection dose per gram of tissue ( %ID/g). The models of bone metastases from prostate cancer were established at the tibias of BALB/c nude mice bearing human prostate cancer PC-3 cells. The tumor bearing ( n= 5 ) and standard closed fracture nude mice models underwent both 99Tcm-DTPA-IL11RR and 99Tcm-methylene diphosphonate (MDP) scintigraphy study. The images were acquired at 0.5, 1,2, 4, 6, 8, 24 h after intravenous injection of the tracers. The competitive inhibition imaging was perfomed in three tumor bearing mice. One-way variance analysis was used. Results The labeling efficiency was 90.7%. The radiochemical purity of 99Tcm-DTPA-IL11RR in normal saline solution was (99.57 ±0.09)%, (99.29 ±0.18)%, (98.95 ±0.78)%, (98.67 ±0.11)%, (96.53 ±0.91)%, (95.20±0.70)%, (88.38 ±0.22)% and (36.17±1.29)% at room temperature after0, 1,2, 3, 4, 6, 8 and 24 h, respectively. The tracer radiochemical purity in the blood of ICR mice remained over 90% at 37 C for 6 h. The labeling compounds were excreted mainly through kidney. The peak uptake of bone ( ( 1.910 ±0.109) %ID/g) and liver ( (0.366 ±0.030) %ID/g) was at 4 h after injection. In the tumor bearing mice, the uptake of spine marrow and large joints of extremities was mild. The highest uptake at tumor region was at 4 h and persistent at 6-8 h after injection. The tumor to non-tumor ratios (T/NT) were 1.17 ±0.17, 2.20 ±0.29, 3.20 ±0.15, 3.67 ±0.23, 13.61±0.85, 9.45 ±0.37 and 3.33 ±0.30 at 0.5,1, 2, 4, 6, 8 and 24 h, respectively (F=621.54, P＜0.05). In the standard closed fracture models,high uptake of 99Tcm-MDP was shown at the fracture site, with no increased 99Tcm-DTPA-IL11RR uptake noted. The tumor uptake was significantly depressed after a pre-injection of the unlabeled polypeptide analogue. Conclusions The synthesis of 99Tcm-DTPA-IL11RR is stable and the labeling efficiency is high. It may be a potential molecular probe in metastatic bone imaging for prostate cancer.

OBJECTIVE:To prepare collagen bilayer minipellet of recombinant human erythropoietin(rhEPO)and for which to establish a content determination method.METHODS:The bilayer minipellet was prepared and shaped by pressuriz-ing gel with the collagen protein as coating material and the sodium chondroitin sulfate as releasing moderator;the content of rhEPO in minipellet was determined by RP-HPLC.RESULTS:The linear range of rhEPO was0.25～20?g/ml(r=0.9998),the average recovery rate was96.2%,the intraday RSD was0.9%and the interday RSD was2.6%(n=3).CONCLUSION:The preparation for the rhEPO bilayer minipellet is easy and the content determination method of which is accurate and reli-able.

Objective To investigate the effects of simethicone on the quality of video capsule endoscopy (VCE) examination.Methods A prospective study was performed in 90 patients received VCE examination from February 2010 to October 2014.The randomized table was set according to different dosage of simethicone the patients received,by which patients were divided into three groups.Group 1 (35 cases) received 15 mL simethicone,group 2 (30 cases) received 30 mL simethicone and control group (25 cases) received no simethicone.The small intestinal visualization quality of VCE was scored by segments.Segment A was proximal small intestine (one hour after VCE passing pylorus).Segment B was distal small intestine (one hour before VCE passing ileocecal valve).Segment A and B were scored according to the air bubbles and degree of cleanliness.Gastric transit time,small bowel transit time and VCE completion rate were recorded.Student's t test,Mann Whitney rank sum test and chi square test were performed for statistical analysis.Results The average scores of segment A of group 1,group 2 and control group were 0.58,0.33 and 1.67,respectively,and the average socres of segment B were 0.25,0.00 and 1.17,respectively.The lesion detection rates of group 1,group 2 and control group were 68.6％ (24/35),80.0％ (24/30) and 52.0％ (13/25),respectively,and the differences was statistically significant (x2 =8.238,P=0.016).The detection rate of group 2 was significantly higher than those of group 1 and control group (x2 =7.354 and 9.349,P=0.034 and 0.005).The detection rates of small intestinal erosion of group 1,group 2 and control group were 22.9％ (8/35),70.0％ (21/30) and 32.0％ (8/25),respectively,and the differences was statistically significant (x2=8.714,P=0.013).The detection rate of group 2 was significantly higher than those of group 1 and control group (x2 =10.600 and 7.380,P=0.005 and 0.025).There was no statistically significant difference in the detection rates of ulcer,vascular malformation and protrusion among the three groups (all P＞0.05).The detection rates of lesions＜0.5 cm of group 1,group 2 and control group were 37.1％ (13/35),66.7％ (20/30) and 32.0％ (8/25),respectively,and the differences was statistically significant (x2 =8.242,P=0.016).The detection rate of group 2 was significantly higher than those of group 1 and control group (x2 =9.250 and 7.842,P =0.011 and 0.017).Conclusion Oral adminstration of 30 mL simethicone could obviously decrease air bubbles in small intestine,and increase lesion detection rate of VCE.