Objective To discuss the opportunity of hemilateral craniotomy in treatment of a large area combined middle cerebral artery (MCA) infarction.Methods Thirty-two patients with a large area combined MCA infarction were performed by hemilateral craniotomy.Initial clinical presentation was evaluated by the Glasgow coma scale(GCS).All survivors were assessed three months after surgical decompression according to Barthel index(BI).The effects of pre-hemia decompressive surgery(before any signs of cerebral hernia,based on clinical status and CT or DWI findings)versus post-hernia surgery (after signs of hernia) on mortality,functional outcome.Results In 18 patients with pre-hernia decompressive surgery,3 patients (16.7%)were dead and average BI was (66.94±7.75)scores.The mortality was 57.1%(8/14)and average BI was (38.43±9.82)scores of post-hernia surgery with 3 cases severe aphasia.Conclusion Hemilateral craniotamy is performed before occurrence of cerebral hernia may decrease the mortality and improve outcome in these patients.

To investigate plasma N-terminal pro-brain natriuretic peptide (NT-BNP) levels and to assess their clinical significance in elderly patients with isolated diastolic dysfunction. Methods Plasma NT-BNP level were measured by electrochemiluminescence immunoassay in 34 symptomatic patients (Group 1), 34 asymptomatic patients (Group 2) with isolated diastolic dysfunction, and in 16elderly healthy subjects (control group, Group 3), serving controls. Colored Doppler echocardiography was performed to evaluate the patients' cardiac structures and functions. Results The plasma NT-BNP level in Group 1 was significantly higher than those in Group 2 and Group 3 and increased with the severity of heart failure. There was no significant difference of plasma NT-BNP levels between Group 2 and Group 3 (p＞0.05). A NT-BNP value of 102.75 pg/mL showed a sensitivity of 88.2%, a specificity of 87.5%, and an accuracy of 88.1% for diagnosing diastolic dysfunction. Patients with restrictive filling pattern on echocardiography had higher NTBNP levels than those of impaired relaxation pattern (1961.2±304.9 versus 460. 1±92.7pg/mL, p＜0.001). Conclusion The elevation of plasma NT-BNP level in elderly patients with isolated diastolic dysfunction correlates with the severity of their diastolic abnormalities.The level of plasma NT-BNP has an important clinical value in the diagnosis of elderly patients with isolated diastolic dysfunction.

Objective To investigate the prevalence of perimenopausal syndrome and relative risk factors in perimenopausal and postmenopausal women in Chongqing city .Methods Totally 1 680 questionnaires from women with perimenopausal syndrome , all the objects were patients who visited gynecology clinic from January 2013 to June 2014 in Chongqing .Results The average men‐arche age was (14 .71 ± 1 .95) years old ;average menopause age was (47 .22 ± 3 .13) years old in 1 680 perimenopausal women . 93 .51% (1 571/1 680) objects were diagnosed perimenopausal syndrome ,mainly presented to be forgetfulness ,sleep disorder ,irrita‐bility ,palpitation ,headache ,hot flashes ,sweating ,loss of libido ,orgasmic dysfunction ,dyspareunia ,colpoxerosis ,bone ,joint and muscle pain ,paraesthesia of skin ,depression .The risk factors were analyzed ,forgetfulness(P < 0 .01) ,sleep disorder(P < 0 .01) , menopause(P< 0 .01) ,normal sex or not(P< 0 .05) ,the attitude of sex(P< 0 .05) ,and the attitude of menopause(P< 0 .05) .Con‐clusion Most women in the period of perimenopausal have the problem with perimenopausal syndrome .The special service should be provided to perimenopausal women ,such as knowledge about perimenopausal and rational hormone replacement therapy .

Background Acanthamoeba keratitis is a sort of serious infectious eye disease with high causing-blindness rate.Acanthamoeba keratitis often is misdiagnosed as fungal keratitis or viral keratitis in the early stage.Because conventional clinical diagnosis methods show a low specificity and take a long time,timely treatment often is delayed.Conventional PCR does not apply well because the lesion sample is not enough to extract DNA.However,direct PCR can amplify 18S rRNA conserved sequence of acanthamoeba keratitis without the extraction of DNA.Objective This study was to discuss the feasibility for rapid diagnosis of acanthamoeba keratitis using direct PCR to amplify the gene 18S rRNA fragment.Methods Ten acanthamoeba strains were isolated from 10 eyes with acanthamoeba keratitis in Qingdao Eye Hospital.The sensitivity of the direct PCR assay was tested using different numbers of amoebas.The specificity of the assay was tested using DNA extracted from acanthamoeba,candida albicans,pseudomonas aeruginosa,herpes simplex virus-1 (HSV-1) and normal human corneal epithelial cell.Acanthamoeba keratitis models were established using infected method in clean 6-week-old female BALB/c mice.Corneal lesion samples were obtained 1 day,3,5,7,10,15 days after modeled.The effectivity and feasibility of the direct PCR assay for rapid diagnosis of acanthamoeba keratitis were evaluated and compared with culture method,corneal smear examination and real-time PCR.Results Direct PCR primers could only amplify DNA of acanthamoeba rather than other pathogens,and 10 stains of acanthamoeba were detected at least in each sample.During the development of acanthamoeba keratitis in the mice,the diagnosis positive rate of direct PCR was 80.0％,90.0％,80.0％,70.0％,70.0％ and 50.0％ in 1 day,3,5,7,10,15 days after modeled with the total positive rate 73.3％,which was higher than 31.7％ of culture method,56.7％ of corneal smear examination and 61.7％ of realtime PCR,with a significant difference between the direct PCR and culture method (P =0.005),but no significant difference was seen in the total positive rate between the direct PCR and real-time PC R (P =0.172) or corneal smear examination (P =0.056).Conclusions The direct PCR assay is a simple,rapid,highly specific and sensitive method for the rapid diagnosis of acanthamoeba keratitis,especially for the limited lesion sample.

Objective To explore the association between the infection rate of Helicobacter pylori (Hp) and intake frequency of capsicum in dietary pattern. Methods A total of 914 health check-up participants were recruited from Tianjin Medical University General Hospital (male: 510,female:404). All participants were asked about the intake frequency of capsicum. Diagnostic criteria of the Hp infection included positive C13 breath test. Results The intake frequency of capsicum was ≥2 times/week, 1 time/week and <1 time/week. The infection rate of Hp was 56.08%, 49.04% and 48.29%. After adjusting for covariates, compared with the≥2 times/week, the odds ratios(95%confidence interval)of intake frequency of capsicum 1 time/week and <1 time/week: the frequency of capsicum intake ≥2 times/week was 1.00 (reference), the frequency of capsicum intake 1 time/week was 0.57(0.33-0.97) and the frequency of capsicum intake<1 time/week was 0.69(0.42-1.14) in men;the frequency of capsicum intake≥2 times/week was 1.00 (reference), the frequency of capsicum intake 1 time/week was 1.01(0.54-1.88), and the frequency of capsicum intake<1 time/week was 0.71(0.41-1.23) in women. Conclusions This study found that food intake frequency of capsicum≥2 times/week was associated with the infection rate of Hp in men. But similar relationship was not observed in women.

AIM: To investigate the comparison of different types of catheter treatment of anastomotic ring canalicular effect.
METHODS:Retrospective analysis. A total of 114 cases 114 eyes were randomly selected between May 2013 to May 2015 jointly admitted to Huizhou Huizhou City People's Hospital and the Central People's Hospital of canalicular patients in accordance with the agreement of the annular catheterization divided into three groups, group A of annular nasal lacrimal duct catheterization in 36 eyes, group B for the whole nasal lacrimal annular catheterization in 33 eyes, group C between the upper annular tears point catheterization 45 eyes. Through the A, B, C three groups after 1, 3wk, 1, 3mo and 1y follow-up were analyzed to compare.
RESULTS:Group A of 31 eyes were cured, improved in 2 eyes, 3 eyes, the effective rate was 91. 7%;group B, 27 cases were cured, improved in 3 eyes, 3 eyes, the effective rate was 90. 9%;group C, 40 cases were cured, improved in 2 eyes, 3 eyes, the effective rate was 93. 3%. A, B, C three groups efficiency pointless difference (P=0. 124). Eye Effect: A, B, C meaningful difference among the three groups(F=36. 578; P=0.002), Group A scored the highest score of a minimum group C, respectively( 3. 5±0. 8 ) and ( 2. 3±0. 7 ); comparison meaningless difference between group a and group B( t=0. 086, P>0. 05 ); Group A and C and comparison of differences between group C and group B have the significance ( t = 15. 241, t = 17. 472; P<0. 05 ). Nasal influence: A, B, C meaningful difference among the three groups(F=778. 581;P=0. 001), the highest score in group B, group C minimum scores were(6. 6±0.8) and ( 0. 9 ± 0. 7 ); A, B, C three groups comparison of differences twenty-two have significance(t=17. 262; t=18.247; t = 16. 647; P<0. 05). Shape Effect: A, B, C difference among the three groups of meaningful ( F=481. 113;P=0. 002), Group A scored the highest score of a minimum group C, respectively(5. 8±0. 9) and(1. 2±0.6);Compare the difference between Groups B and C meaningless ( t = 0. 087, P > 0. 05 ); comparing the differences between the Groups A and B and between Group A and C were significance(t=26. 362, t=27. 532; P<0. 05 ). Unplug risk: A, B, C meaningful difference among the three groups(F=751. 121;P=0. 003), Group A scored the highest score of a minimum group C, respectively(6. 5±0. 7 ) and ( 1. 5±0. 7 ); A, B, C three groups comparison of differences twenty - two have significance(t=19. 642; t=20. 153; t=18. 345; P<0. 05). Group A had 8 patients had lower eyelid eversion, 5 cases of inferior lacrimal point expansion, 13 cases of sneezing, itchy nose, runny nose syndrome. Group B had 20 cases of varying degrees of now sneezing, itchy nose, runny nose syndrome. Group C had no serious complications.
CONCLUSION: Similar to A, B, C three groups of treatment efficacy, patient lacrimal functional recovery is safe and effective, which the group C treatment, during treatment and less material and fewer postoperative complications in patients, it is worth promotion.

Objective To investigate the diagnostic value of twinkling artifact in urinary calcium stones.Methods Calcium oxalate monohydrate,hydroxyapatite and whitlockite stone phantoms were prepared and embedded in porcine kidneys for ultrasound scanning.The length and width of twinkling artifact were measured.The intensity of twinkling artifact and the contrast-to-noise ratio (C/N ratio) of acoustic shadowing were recorded and all the data was analyzed statistically.Results All the stone phantoms generated twinkling artifact and acoustic shadowing.The difference of the intensity,length and width of twinkling artifact and the C/N ratio of acoustic shadowing had statistically significant each composition (P ＜0.01).There was no overlap between 95％ confidence interval of the intensity of twinkling artifact for any two compositions,and any two compositions of stones could be differentiated by the intensity of twinkling artifact (P ＜0.05).The C/N ratio of acoustic shadowing of calcium oxalate monohydrate and whitlockite stone phantoms were higher than those of hydroxyapatite ones (P ＜0.05).The receiver operating characteristic (ROC) curve displayed that the cutoff value of 1 127 of the intensity of twinkling artifact could be used to diagnose hydroxyapatite stones.The sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) and area under the curve (AUC) were 74 ％,68 ％,69.8％,72.3％ and 0.743 respectively.Conclusions Twinkling artifact could be used to differentiate the calcium stones,which will be helpful for clinical treatment.

Objective Neutrophil/lymphocyte ratio (NLR) is an easy-to-analyze inflammation biomarker but few studies have assessed the relationship between NLR and type 2 diabetes. In order to evaluate how NLR is related to type 2 diabetes, we designed a large scale cross?sectional study in an adult population. Method A cross?sectional study (including 49 861 men and 40 376 women) was conducted on participants recruited from the Health Management Center of Tianjin Medical University General Hospital in Tianjin, China. Measurements of neutrophil and lymphocyte counts, fasting blood glucose and other potential confounding factors were performed. Type 2 diabetes was defined according to the criteria of American Diabetes Association. Adjusted logistic regression models were used to assess relationships between NLR quintiles and type 2 diabetes. Result In the final multivariate models, the odds ratios (95% confidence interval) for T2D across NLR quintiles were 1.00 (Reference), 1.19 (1.05, 1.35), 1.33 (1.17, 1.50), 1.28 (1.13, 1.44) and 1.34 (1.19, 1.51) (P for trend<0.000 1), in men. Similar relationships were also observed in women. Conclusion This study demonstrated that NLR was related to the prevalence of type 2 diabetes in men and women, and suggesting that NLR may be an efficient and accurate prognostic biomarker for type 2 diabetes.

Objective To evaluate whether the serum uric acid (SUA) levels are related to development of prediabetes. Methods This was a 6-year cohort study, subjects were recruited from Tianjin Medical University General Hospital Health Management Center. A prospective assessment (n=30 910) was performed. Subjects without a history of prediabetes were followed up for 6 years (with a median follow-up of 2.7 person-years). All relevant variables including SUA concentrations, and fasting plasma glucose were assessed at baseline and yearly during the follow-up. Prediabetes was defined in accordance with the American Diabetes Association criteria of 2014. Multivariate-adjusted Cox proportional hazards regression models were fitted to assess relationships between the quintiles of baseline SUA and the incidence of prediabetes. Results The incidence of prediabetes was 55 per 1 000 person-years. In comparison with subjects in the lowest quintile, the odds ratios and hazard ratio (95%confidence interval) of higher quintile of SUA were 1.04 (0.93, 1.15), 1.07 (0.95, 1.19), 1.13 (1.01, 1.28) and 1.15 (1.02, 1.30) (P for trend=0.01), respectively, after adjusting for potential confounders. Conclusion SUA levels predicted an increased risk of prediabetes in adults.

Objective To quantitatively analyze the value of color Doppler twinkling artifact and CT in distinguishing urinary stone composition of uric acid from that of cystine,and to assess the ability of color Doppler twinkling artifact and CT to diagnose urinary stone composition of uric acid.Methods Artificial stones made of uric acid and cystihe were inserted in porcine kidneys respectively.Color Doppler ultrasound and CT scanning were performed in vitro and twinkling artifact videos were recorded.The CT attenuation value,the width and length of twinkling artifact (TAW,TAL) were measured.The color pixels representing twinkling artifact intensity (TAI) were calculated.The differences between artificial cystine and artificial uric acid stones in TAW,TAL,TAI and CT attenuation value were compared.The receiver operating characteristic (ROC) curve was used to assess the ability of TAW,TAL,TAI and CT attenuation value to diagnose urinary stone composition of uric acid.Results The TAW [(4.16 ± 1.54)mm vs (4.97 ± 1.93)mm],TAL[(3.75 ± 1.05)mm vs (5.12 ± 2.51)mm] and TAI [(3 005.50 ± 812.33) vs (5 433.86±2 505.81)] of artificial cystine stones were less than those of artificial uric acid stones while the CT attenuation value of artificial cystine stones [(573.75 ± 110.10)HU vs (364.09 ± 67.28)HU] were greater (P ＜0.05).The ROC curve was displayed to diagnose urinary stone composition of uric acid,and the area under curve of CT attenuation value was bigger than that of TAI (0.936 vs 0.817,Z =2.308,P =0.021).Combination of color Doppler twinkling artifact and CT value would dramatically increase the diagnostic accuracy to 98％.Conclusions Both color Doppler ultrasound and CT were reliable examinations for distinguishing urinary stone composition of cystine from that of uric acid.Combination of color Doppler ultrasound and CT would be good references to diagnose urinary stone composition of uric acid.