Vascular cognitive impairment (VCI) is a main type of syndrome from mild cognitive impairment to dementia,which is caused by cerebrovascular risk factors (eg,hypertension, diabetes,hyperlipemia),obvious (cerebral infarction and hemorrhage) or unobvious cerebrovascular disease (leukoaraiosis and chronic cerebral ischemia).Its incidence is increasing,however,its pathogenesis remains uncertain,and effective therapeutic tools are lacking.Therefore,an increasing attention is being paid to all aspects of studies.This article mainly reviews the recent development in research of neuropsychology,imaging,electrophysiology,biology,and gene.

Child, Preschool ; Female ; Humans ; Infant ; Male ; Rotavirus Infections ; diagnosis ; therapy ; Vomiting ; etiology

OBJECTIVE To perform a retrospective analysis to determine the prevalence of hospital infection and associated risk factors and offer strategies in our neonatal intensive care unit(NICU).METHODS The study enrolled 1082 neonatal patients hospitalized between Jan 1,2006 to Dec 31,2007.RESULTS There were 58 nosocomial infections(NI) in 1082 neonatal patients,and the infection rate was 5.36%.The most common infection was superficial(62.07%).The mortality of NI was 6.90%.The lower gestational age and birth weight,were risk factors of NI.Logistic regression analysis indicated that mechanical ventilation and birth weight ≤1500g were independent risk ractors for NI(P

OBJECTIVETo analyze the changes of patients with type 2 diabetes in different stages in glucagon (GC) and free fatty acid (FFA) in fasting, OGT and L-Arg experiments, and discusses the role of pancreatic alphabeta cells in diabetes pathogenesis by studying the relations among indexes such as glucagon (GC), free fatty acid (FFA) and blood glucose (BG), insulin, insulin homeostasis model (HOMA) and glucose metabolism hormone secretion curve, in order to provide theoretical basis for the treatment of diabetes.

METHODStudy objects were divided into the T2DM group (45 cases), the IGT group (28 cases) and the NGT group (30 cases) for an OGTT experiment and then an L-Arg experiment on the next day. Under the fasting state, their blood glucose (FBG), insulin (F), glucagon (FGC), free fatty acid (FFA) were detected to calculate HOMA-beta, insulin sensitivity index (ISI) and HOMA-IR of different groups. Meanwhile, efforts were made to calculate different time quantum detected in OGTT and L-Arg experiments and area under the curve AUC(BG), AUC(INS) and AUC(GC).

RESULTObvious overall differences were observed in FFA and FGC of the three groups. FGC of each group was negatively correlated with HOMA-beta and ISI. Among all of the 103 study objects, FGC was positively correlated with FBG and HOMA-IR and negatively correlated with HOMA-beta and ISI, with no correlation with FINS; FFA was positively correlated with FBG, HOMA-IR and negatively correlated with FINS, HOMA-beta, ISI. FGC and FFA were positively correlated in the T2DM group and the IGT group, but with no statistical correlation in the NGT group. The sequence of the three study objects was T2DM > IGR > NGT in AUC(GC) in the OGTT experiment and T2DM > IGR > NGT in in AUC(GC) in the L-Arg experiment, with the significant positive correlation between AUC(GC) and AUC(BG) and significant negative correlation with AUC(INS).

CONCLUSIONGlucagon and free fatty acid of T2DM and IGT patients increased, which was positively correlated with blood glucose and HOMA-IR and negatively correlated with INS, HOMA-beta and ISI. The increase in glucagons of T2DM and IGT patients indicated inappropriate secretion of pancreatic alphabeta cells among patients with type 2 diabetes.

Adult ; Blood Glucose ; metabolism ; Diabetes Mellitus, Type 2 ; metabolism ; Fatty Acids, Nonesterified ; metabolism ; Female ; Glucagon ; blood ; Humans ; Insulin ; secretion ; Islets of Langerhans ; secretion ; Male ; Middle Aged

Objective To investigate the potential clinical factors associated with the prognosis and relapse of adult onset Still's disease(AOSD).Methods The factors possibly influencing the prognosis and relapse of AOSD were analyzed by logistic regression and COX regression in the cohort study.Ninety-six con- secutive inpatients of AOSD diagnosed based on Yamaguchi criteria in the hospital from March 1996 to September 2004 were included in the study.Results Nine cases(9.4%)were lost during the follow-up. Eleven patients(12.6%)were diagnosed as other diseases(5 with other rheumatic diseases,4 with tumor and 2 with infections)in the 87 follow-up cases.In 76 cases,3 patients(3.9%)died and 33 patients(43.4%) got remission over one year after treatment.Splenomegaly(OR=3.14,95%CI=1.01～9.74)and treated with methotrexate(OR=0.22,95%CI=0.07～0.67)were associated with the prognosis from the logistic regression analysis of the 76 cases.The serum ferritin(RR=I.05,95%CI=1.01～1.08)and treated with methotrexate (RR=0.13,95%CI=0.02～0.76)were associated with relapse from the COX regression analysis of the 61 remis- sion cases.Conclusion We need to be very cautious in the follow-up of AOSD patients because some of them may change to other diseases.Methotrexate may be an importent therapy of AOSD not only in improve- ment the prognosis but also in reduction of relapse.

OBJECTIVETo investigate the relationship between chronic pyelonephritis (CPN) and immune function, and the therapeutic mechanism of Yishenkang granule (YSKG).

METHODSOne hundred and twenty patients of CPN were divided into 3 groups randomly, the YSKG group (treated with YSKG), the control A group (treated with Sanjin tablet) and the control B group (treated with western medicine). Serum levels of immunoglobulin (Ig), complement 3 (C3), interleukin-2 (IL-2), peripheral T-lymphocyte subsets, and urinary secretory immunoglobulin A (sIgA) were determined before and after treatment with monoclonal antibody assay, agar diffusion method, radioimmunoassay (RIA), and radioimmuno-equilibrium method, and compared with normal control.

RESULTSThere were disorders of T-lymphocyte subsets in CPN, lowering of serum Ig, C3 and urinary sIgA, and increase of blood IL-2 (P < 0.05 or P < 0.01). These abnormalities could be normalized after YSKG treatment.

CONCLUSIONFunctional disorders of cellular and humoral immunity exist in CPN patients of chronic stage, YSKG could correct the immune functional disorder, control the recurrence of CPN effectively and alleviate the immunopathological damage.

Adult ; Chronic Disease ; Complement C3 ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Immunoglobulin G ; blood ; Interleukin-2 ; blood ; Male ; Middle Aged ; Pyelonephritis ; drug therapy ; immunology ; prevention & control ; T-Lymphocyte Subsets ; drug effects

Objective The purpose of this study was to use diffusion tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI) alone or in combination to observe the distribution of white matter lesions and cortical malfunctional areas in human immunodeficiency virus (HIV) infected patients with mild cognitive decline and to explore the relationship between the DTI and the rs-fMRI methods.Methods Twenty-six HIV infected patients with mild cognitive impairment and 30 healthy volunteers were selected by Montreal Cognitive Asessment (MoCA) scale evaluation.DTI data and rs-fMRI data were obtained,fractional anisotropy (FA) value images were obtained with voxel based analysis and the resting-state default mode network (DMN),functional connectivity images were obtained with cingulate gyrus as a seed point.Overlay images were obtained with FA,DMN and Ch2 standard images.Results Compared with the control group,the white matter FA values were significantly decreased in the left precuneus(t=4.0499,P＜0.005) and right precuneus (t=5.1553,P＜0.005),right superior frontal gyrus(t=5.1517,5.1484,P＜0.005),right middle frontal gyrus (t=4.1444,P＜0.005),right precentral gyrus (t=3.7395,P＜0.005),right occipital lobe (t=7.2236,P＜0.005),and right inferior parietal lobule (t=4.1450,P＜0.005) in acquired immunodeficiency syndrome (AIDS) patients.In resting-state default mode network,areas significantly related to cingulate gyrus seed point included the left cingulate gyrus (t =32.78,P＜0.005),left precuneus (t =4.51,P＜0.005),left superior frontal gyrus (t =14.33,4.53,P＜0.005),left middle temporal gyrus (t =10.01,5.72,P＜ 0.005),left inferior temporal gyrus (t =5.99,P＜0.005),left parahippocampal gyrus (t =7.63,P＜0.005),right posterior cingulate (t =34.81,P＜0.005),right precuneus (t=32.09,P＜0.005),right superior frontal gyrus(t =14.12,P＜0.005),right middle frontal gyrus (t=17.71,P＜0.005),right superior temporal gyrus (t=14.59,P＜0.005),and right middle temporal gyrus (t=11.83,P＜0.005); while areas not significantly related to the cingulate gyrus seed point included the left precuneus (t =5.39,P＜0.01),left anterior cingulate gyrus (t =3.66,P＜0.01),left cerebellar tonsils (t =7.51,P＜0.01),right superior parietal lobule (t=4.44,P＜0.01),right parahippocampa gyrus (t =3.69,P＜0.01),and right cerebellar tonsil (t=6.15,P＜0.01).Overlayed images showed that the white matter FA value of the left precuneus were decreased and the functional activitis of the corresponding cortex were significantly decreased; while the white matter FA values of the left precuneus,right precuneus,right superior frontal gyrus,right middle frontal gyrus were decreased without affection of the functional activity of the corresponding cortex in AIDS patients.Conclusion White matter nerve fiber disconnection of multiple brain regions and its corresponding cortical function decline with compensatory activity co-participated in the pathogenesis of AIDS mild cognitive decline.

OBJECTIVETo determine the factors affecting post-operative velopharyngeal function of cleft palate patients aged over two years old.

METHODSThe data on 245 patients, including first visit case records and those in the database, were searched and recorded. Post-operative velopharyngeal function and clinical features, such as cleft ratio, adequate ratio, diagnosis, operative age and method, were analyzed retrospectively.

RESULTSCleft ratio and adequate ratio in the velopharyngeal competence (VPC) group were not statistically different from those in the velopharyngeal incompetence (VPI) group. The difference in VPC rate in different age groups and diagnosis was not significant. The post-operative VPC rates under different methods were significantly different.

CONCLUSIONThe current therapeutic schedule for patients younger than two years old is inappropriate for patients older than two years old. Cleft ratio is not the main factor affecting postoperative velopharygeal function. Sommerlad-Levator Veli Palatini reconstructional operation combined with sphincter pharyngoplasty can obviously improve the velopharyngeal function of patients aged 2 years old and up. This method should be applied in primary palatoplasty.

Child, Preschool ; Cleft Palate ; Female ; Humans ; Infant ; Male ; Palatal Muscles ; Pharynx ; Postoperative Period ; Reconstructive Surgical Procedures ; Retrospective Studies ; Velopharyngeal Insufficiency

Objective To report clinical manifestations, electroencephalogram (EEG), and the genotypes of two siblings with type Ⅲ Gaucher disease.Methods Two patients with different features were siblings. Their clinical data, signs, peripheral leukocytes acid β-glucosidase activity, andGBA gene were analyzed.Results (1) The proband was a boy. He visited us at the age of nine years old because of hepatosplenomegaly, thrombocytopenia and growth retardation without any neurologic symp-toms. He had normal intelligence but abnormal EEG ifndings. The activity of acid β-glucosidase in his leucocytes decreased to 1.5 nmol h-1·mg-1 Pr (normal range 6.0-16.7 nmol h-1·mg-1 Pr), supporting the diagnosis of type Ⅲ Gaucher disease. (2) The elder sister of the proband was 12 years old. She had tonic-clonic seizure and myoclonus seizure from the age of seven years old. Mild hepatomegaly, abnormal EEG, poor effect for antiepileptics, and progressive deterioration of psychomotor abilities were found. Her blood leucocytes acid β-glucosidase activity decreased to 1.8 nmol h-1·mg-1 Pr (normal range 6.0-16.7 nmol h-1·mg-1 Pr). Two heterozygous missense mutations, c.680A>G, (p.N188S) and c.1342G>C (p.D409H) were detected from the two siblings, respec-tively.Conclusions Patients with type Ⅲ Gaucher disease usually have the onset in childhood with typical features of Gaucher disease without neurologic involvement. Abnormal EEG may be helpful to the differential diagnosis of type I or type Ⅲ. On the other hand, neurologic manifestations could be presented as the ifrst symptom in some patients without viscera enlargement. The patients of type Ⅲ Gaucher disease with the same genotype could have different phenotypes, even between the siblings.

Objective:The immunological effects of HCV-DNA vaccine with different adjuvants were detected by ELISPOT in mice.Methods:Female BALB/c mice were primed with naked HCV-DNA, HCV-DNA encapsulated by liposome DDAB/EPC or DC-Chol/DOPE, HCV-DNA mixed with Montanide ISA 720 or aluminum hydroxide, respectively, and boosted twice accordingly in a four-week interval. Cytokine production by splenocytes was assessed by ELISPOT.Results:In most cases, splenocytes from mice vaccinated with DDAB/EPC liposome produced more IFN-?. These splenocytes also have significant higher IL-2 production compared with the other groups. In expansion with NS5b, splenocytes from alum group have significance in IL-4 production compared with other groups. The profile of cytokine production revealed that the INF-? overwhelmed IL-4 in naked DNA, DDAB/EPC, and DC-Chol/DOPE groups while IL-4 surmounted IFN-? in alum and Montanide groups.Conclusion:Encapsulation with liposome DDAB/EPC has the strongest adjuvant effect in inducing Th1 dominated immunity. Alum and Montanide can convert the Th1 nature of DNA vaccine to Th2-biased immunity.