Objective To evaluate the efficacy and safety of argatroban in the treatment of progressive cerebral infarction.Methods Three hundred hospitalized patients with progressive cerebral infarction from October 2006 to September 2011 were collected,among which 150 cases who agreed to the use of argatroban as experimental group,and 150 cases who didn' t agree to the use of argatroban for economic reasons as control group.Experimental group was treated with venous argatroban.It was 60 mg/d within the first 2 days and 24 h continuous intravenous drip.From the beginning of the 3rd day,the dosage was changed to 10 mg each time,twice a day for 5 days.Additionally,75 mg clopidogrel was given once a day for 12 days.Control group was only treated with 75 mg clopidogrel once a day for 14 days.The degree of neurological deficit was compared using the National Institutes of Health Stroke Scale (NIHSS) scoring and the rehabilitation condition was evaluated by Barthel index (BI) and modified Rankin Scale (mRS) scoring between 2 groups before treatment and 3 d,14 d,30 d and 90 d after treatment respectively,and further compared to patients with large artery stenosis and anterior or posterior circulation infarction.The indexes of coagulation function of 2 groups were monitored meanwhile.Results The degree of neurological deficit was significantly improved in the short term (before treatment:NIHSS 15.19 ± 2.70,after treatment of 3 d 10.75 ±2.09,t =2.l14,P =0.037 ;14 d 8.77 ± 1.50,t =2.092,P =0.039;30 d 6.89 ± 0.79,t =2.520,P =0.013 ;90 d 4.85 ± 0.38,t =2.723,P =0.008),and the activities of daily living were significant enhanced in the experimental group (after treatment of 30 d BI 70.89 ± 12.69,90 d 88.16 ± 11.96,90 d mRS 1.57 + 0.39) when compared with the control group (after treatment of 30 d BI 60.26 ± 11.85,t =2.292,P=0.023;90 d 69.90 ± 12.63,t =2.790,P =0.006;90 d mRS 2.14 ±0.52,t =2.124,P =0.035).For large artery stenosis or posterior circulation infarction,the efficacy of argatroban was better.The indexes of coagulation function were in the normal range both before and after medication.No serious adverse reaction occurred during treatment.Conclusion Argatroban which has a higher security probably improves the prognosis and reduces the disability of patients with progressive cerebral infarction.

Objective：Our aim was to investigate the proportion of autosomal recessive (AR) inheritance among families with patients with Duchenne muscular dystrophy (DMD) and clinical feature in patients with AR form of DMD. Methods:A total of 193 families was studied， 8 of them with at least one girl with “DMD - like” phenotype and 185 with only boys with this kind of phenotype. Based on the number of families with at least one affected girl and the number of patients per sibship among these pedigrees, the proportion of families with DMD inherited as an AR trait was estimated. The clinical examination, family history and serum creatine-kinase were studied in 11 patients diagnosed as AR form of DMD. Results: The proportion of families with AR form of DMD was estimated as 9.4%. The average age of being able to walk is (1.47±1.00) year, serum creatine-kinase levels were (2785.10±1500.29) U/L. The clinical symptom occurred at the average age of (8.11±4.32) year in patients with AR form of DMD. Conclusion： The AR form of muscular dystrophy and DMD not be distingushed clinically. Some families with only affected boys diagnosed as typical DMD, in fact, have the AR form of the disease. This study is very useful for genetic consulting.

BACKGROUND:Periprosthetic femoral fracture is a severe complication after total hip arthroplasty. More than 85% belongs to Vancouver B2 and B3 fractures, and the operation is difficult. OBJECTIVE:To explore the clinical effect of Cable-Ready fast system and biotype long-stem prosthesis and its effect on the recovery of joint function in patients with Vancouver B2 and B3 type periprosthetic femoral fractures after total hip arthroplasty. METHODS: A total of 60 patients receiving total hip arthroplasty suffered from Vancouver B2 and B3 type periprosthetic femoral fractures in the Huanggang Central Hospital from September 2011 to September 2012. They were equaly divided into control and observation groups according to different fixation methods. Patients in the control group were treated by ordinary steel wire cerclage fixation combined with uncemented long-stem prosthesis; those in the observation group were treated by Cable-Ready fast system combined with fast uncemented long-stem prosthesis. RESULTS AND CONCLUSION:The average operation time, the time of hospitalization and fracture healing time were shorter in the observation group than in the control group. Moreover, the intraoperative blood loss was less in the observation group than in the control group. After 1 year of folow-up, Harris hip score was higher in the observation group compared with pre-treatment (t=3.174 9,P=0.002 6), and significantly higher than the control group (t=2.479 8,P=0.015 4). The excelent and good rate of Harris hip score was significantly higher in the observation group than in the control group (χ2=11.294 5,P=0.002 6). The total incidence of complications was significantly lower in the observation group than in the control group (χ2=8.139 7,P=0.04 2). These data indicate that Cable-Ready fast system combined with uncemented long-stem prosthesis in the treatment of Vancouver B2 and B3 periprosthetic femoral fractures after total hip arthroplasty has smal injury, less postoperative complications and better recovery of hip function after operation.

Objective To compare the operation situation of pancreatico duodenectomy (PD) and pylorus‐preserving pancreatico duodenectomy (PPPD) ,and analyze the clinical efficacy of PPPD .Methods Data of 47 patients with periampullary carcinoma and pancreatic head carcinoma underwent pancreatico duodenectomy from January 2010 to December 2013 were retrospectively analyzed and divided into PPPD group (20 cases) and PD group (27 cases) according to different surgery method .Then compare the situa‐tion of intra‐operative and post‐operative situation in two groups of patients .Results The operation time of PPPD group was sig‐nificantly lower than that of PD group (P<0 .05);the incidence of postoperative complication rate of PPPD group was obviously lower than PD group (P< 0 .05);and postoperative infection rate of PPPD group was significantly lower than PD group (P<0 .05);there was no significant difference between two groups in pancreatic leakage ,bile leakage ,gastrointestinal leakage ,post oper‐ative bleeding ,mortality and the incidence of delayed gastric emptying after surgery (P>0 .05) .Conclusion PPPD operation could shorten the operation time ,promote post‐operative recovery ,lower complication rates and shorten hospitalization time ,and could al‐so help to improve the nutritional status of patients ,improve the postoperative quality of life of patients ,thus it should be further promoted .

Objective Primitive neuroectodermal tumor (PNET) is a rare malignant small round cell tumor .This paper aimed to study the clinical and pathological features of primary pulmonary primitive neuroectodermal tumor . Methods We collected 2 cases of primary pulmonary PNET to review the clinical and pathological features .Immunohistochemical staining was used to detect immune mark-ers, and fluorescence in situ hybridization (FISH) was applied to detect EWS translocation. Results 2 patients were aged 33 years and 17 years.Microscopically, the tumor cell was composed of single small round cells in diffusion or in distribution of sheets or beams , with scant cytoplasm , oval or spindle-shaped nucleus , high mitotic count .Irregular tumor necrosis scattered in the tumor along with visi-ble rosette structure.Immunohistochemical study showed that the tumor cells were positive for CD 99, FLI-1 and Syn, while CKpan, EMA, Desmin, CgA, TTF1, CD34 were negative.EWS/FLI1 translocations were detected positive in both the cases .2 patients died 7 months and 32 months after operation , respectively . Conclusion Primary pulmonary PNET is rare , so the selection of appropriate im-mune markers (CD99, FLI-1, Syn) and FISH for the detection of EWS translocation helps to improve the accuracy of diagnosis .

Objective To observe the effect of somatostatin on liver function in patients after splenectomy combined with de-vascularization.Methods The clinical data of 48 patients with liver cirrhosis,portal hypertension and esophageal varices were retro-spectively analyzed,26 cases (somatostatin group)were used somatostatin after splenectomy combined with devascularization,and the other 22 cases (control group)were not used.The changes of serum albumin (Alb),alanine aminotransferase (ALT),aspartate transaminase (AST),prothrombin activity (PTA)and total bilirubin (TBIL)was observed.Results All patients recovered well af-ter surgery,and no deaths occurred.However,ALT,AST and TBIL of using somatostatin group were significantly reduced than those of control group(P <0.05),Alb and PTA were also improved significantly (P <0.05).Conclusion The combination of som-atostatin can not only reduce postoperative portal pressure,control of bleeding,but also to be significantly promote recovery of liver function.

Objective To explore the efficacy and safety of recombinant human brain natriuretic peptide (rhBNP) in the patients with severe heart failure (HF). Methods A prospective multicenter study was conducted. Patients whose age > 18 years old, and with the New York Heart Association (NYHA) cardiac function grade overⅢ - Ⅳ , acute cardiac insufficiency and the acute exacerbation of chronic cardiac insufficiency admitted to intensive care unit/cardiovascular care unit (ICU/CCU) of 58 Hospitals in China were enrolled. On the basis of the conventional treatment, all patients would be given rhBNP (neo adjuvant) with a loading dose of 1.5 μg/kg for 3-5 minutes, and followed by a maintenance dose of 0.010-0.015 μg·kg-1·min-1 for 3-7 days. Before the treatment and 1, 3, 7 days after treatment, researchers detected indexes of cardiac and renal function, the levels of N-terminal B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), cardiac output (CO), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), urea nitrogen (BUN), serum creatinine (SCr), and urine output; the renal function index was re-evaluated at 30 days after administration, and the time entering ICU again, re-admission, cardiovascular events were recorded. Results 408 patients were enrolled, with 241 males and 167 females. Age range was 28-95 years, the average age was (63.0±15.8) years, and 50-70 years old accounted for 46.8%. Compared with the data before treatment, NT-proBNP, PCWP and CVP significantly decreased at 6 hours after treatment [NT-proBNP (μg·kg-1·min-1): 4378.58±4082.29 vs. 6403.41±5759.48, PCWP (mmHg, 1 mmHg = 0.133 kPa):12.41±2.21 vs. 14.26±2.85 , CVP (mmHg): 10.63±2.62 vs. 11.45±3.45, all P < 0.05], and with the prolongation of injection, NT-proBNP, PCWP and CVP were gradually declined; CO 1 day after treatment (mL: 4.89±0.81 vs. 4.40±0.92) and LVEF 3 days after treatment (0.465±0.100 vs. 0.431±0.107) were significantly increased (both P < 0.05), and with the prolongation of injection, CO and LVEF were gradually increased. There were no obvious changes in BUN and SCr during the treatment, but 30 days after treatment, SCr was significantly lower than that pre-treatment (μmol/L: 110.98±47.40 vs. 132.62±75.60, P < 0.01). Compared with the data pre-treatment, urine output per hour was significantly increased at 3 hours after treatment (mL: 129.59±82.16 vs. 89.60±53.49, P =0.000); urine output every 24 hours was significantly increased at day 1 and day 2 after administration (mL: 2676.54± 1006.83, 2678.74±975.97 vs. 2150.36±283.76, both P < 0.01). In 7 days, the re-entry ICU rate was 2.7%, and the re-hospitalization rate was 2.88% within 30 days, re-cardiac failure rate was 1.43% in 30 days, and the overall fatality rate was 9.55% in 30 days. Conclusions The rhBNP can significantly improve heart function in patients with HF. And, it has a certain effect on renal function. The rhBNP is effective and safe for the treatment of cardiac insufficiency.

Objective To compare the clinical efficacy and radiologic changes between constrained and non-constrained titanium plate in anterior cervical corpectomy and fusion (ACCF) in elderly cervical spondylosis patients.Methods A total of 58 elderly cervical spondylosis patients who underwent ACCF were divided into group 1 (patients treated with constrained titanium plates,n =30) and group 2 (patients treated with non-constrained titanium plates,n=28).The Japanese Orthopedic Association (JOA) score,fusion rate,the loss of segmental height and cervical lordosis were recorded.The clinical efficacy and imaging features were compared between the two groups.Results The improvement rate of JOA score had no significant differences between group 1 and group 2 [(77.7±18.6)％ vs.(75.8±23.2)％,t=0.340,P＞0.05].At 3 months after operation,the fusion rate was higher in group 2 than in group 1 (89.3％ vs.63.3％,x2 =5.327,P＜0.05).At 3,6 and 12 months after operation,there were no significant differences in the loss of segmental cervical height and lordosis between group 1 and group 2 [(2.42±3.05)mm vs.(0.98±2.86)mm,(3.95±3.65)mm vs.(2.34±2.97)mm,(3.60±4.33)mm vs.(2.40±2.96)mm,(1.64±2.33)° vs.(0.66 ± ±2.14)°,(2.13∧±±3.79)° vs.(0.70±2.99)°,(2.39±4.26)° vs.(0.86±3.25)°,respectively,all P ＞0.05].Conclusions The clinical efficacy is similar in ACCF with the two types of titanium plates.The non-constrained titanium plate can increase the fusion rate in early time,but may aggravate the loss of segmental cervical height and lordosis,which should be used with caution in elderly osteoporosis patients.

Objective To study the mutations of Env sequence of SIVmac239 after infection of Chinese rhesus monkeys, and compare the differences and characteristics of Gp120 sequences of enterotropic and neurotropic SIV strains. Methods Six strains of simian immunodeficiency virus were analyzed in this study: four separated from peripheral blood mononuclear cells of SIVmac239-infected monkeys and two neurotropic SIVmac251 strains.Isolated and cultured monoclonal virus was obtained by limiting dilution assay.Gp120 sequences were amplified after the RNA extraction and phylogenetic analysis was processed thereafter.So did the Gp120 amino acid sequence and N-glycosylation sites analysis of the enterotropic and neurotropic strains.Results SIVmac239 had different mutations in four rhesus monkeys.The diversity in amino acid sequences of the enterotropic and neurotropic strains concentrated in the V1 and V4 regions of Gp120.The enterotropic strains had an addition of glycosylation site in V4 but the glycosylation site changes of neurotropic strains were located in the conservative regions of C1, C2 and C3.Conclusions The addition of one glycosylation site in V4 region of GP120 and loss of one glycosylation site in C1 region are associated with enhanced enterotropism and neurotropism.The differences between the enterotropic and neurotropic strains are not dipicted in Gp120 V3 region which is closely related with the tropism of strains.

Objective To observe the efficacy and acute inflammatory reactionof Qingjin Huazhuo Prescription combined with Western medicine therapy for treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Totally 60 hospitalized patients with AECOPD (Grade Ⅱ) and acute exacerbation course≤1 week were enrolled in this study. The patients were randomly divided into two groups, with 30 cases in each group. The control group was treated with conventional Western medicine. The observation group was treated with conventional Western medicine and oral administration of Qingjin Huazhuo Prescription for 10 days, once a day. TCM syndrome and dyspnea grading (mMRC score), white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT) and partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), were measured before and after the treatment. Results The total scores of TCM syndromes and cough, expectoration, wheezing, fever, and cyanosis in the two groups decreased significantly (P<0.05). The improving degrees of cough and expectoration were better in the observation group than in the control group (P<0.05). The scores of mMRC in the two groups were better than before treatment (P<0.05). The levels of WBC, CRP and PaCO2 in the two groups were lower than those before treatment (P<0.05). The decreased degrees of CRP and PaCO2 in the observation group were better than those in the control group (P<0.05, P<0.01). Conclusion Qingjin Huazhuo Prescription combined with Western medicine therapy can relieve clinical symptoms, reduce the acute inflammatory reaction of AECOPD patients and improve respiration.