Vascular cognitive impairment (VCI) is a cognitive impairment caused by cerebrovascular disease and its risk factors,its mechanism is very complex Recent studies have shown that cerebral microbleed (CMB) is correlated with VCI.This article reviews the relationship between CMB and VCI.

Objective To evaluate the therapeutic effect and safety of insulin lispro mix 50/50 combined with mefformin in newly diagnosed overweight/obese type 2 diabetic mellitus patients.Methods Sixty-two patients with newly diagnosed overweight/obsess type 2 diabetic mellitus were randomly divided into observation group (32 cases) and control group (30 cases) by systematic sampling method.The observation group received insulin lispro mix 50/50 combined with metformin,and the control group received recombinant human insulin and insulin glargine.The therapeutic effect and safety were compared between the 2 groups.Results There were no statistical differences in the blood glucose before eating,before retiring and at mane primo 3:00 between the 2 groups (P ＞ 0.05).There were no statistical differences in the time of blood glucose standard and rate of hypoglycaemia between the 2 groups (P ＞ 0.05).Daily insulin dosage and costs in the observation group were lower than those in the control group [(0.6 ± 0.1) U/kg vs.(0.8 ± 0.1) U/kg and (15.8 ±2.1) yuan/d vs.(21.3 ±2.6) yuan/d],and there were statistical differences (P ＜0.05).Conclusion Insulin lispro mix 50/50 combined with mefformin provides a convenient,effective and safe therapy for newly diagnosed overweight/obese type 2 diabetic mellitus patients and high cost performance.

Object To investigate clinical features,surgical strategy and prognostic factors of bone metastasis from thyroid cancer.Methods A total of 46 patients with bone metastasis from thyroid cancer,who had undergone surgical treatment from January 1999 to July 2011 and had complete follow-up data,were enrolled in this retrospective study.There were 20 males and 26 females,aged from 40 to 87 years (average,56.87 years).Forty two (91.3％) cases of metastatic lesion located in axial skeleton,while 4 (8.7％) in limbs.The tumor histology type was well-differentiated in 35 patients and poorly differentiated in 11 cases.Nineteen patients (41.3％) had an isolated metastatic bone lesion,while other 27 patients (58.7％) had multiple lesions.Kaplan-Meier survival curve and Cox regression model were performed to identify prognostic factors among 19 factors including gender,age,tumor subtype,number of bone metastasis,site of bone metastasis,visceral metastasis,skeletal-related events,timing of metastasis,whether metastatic lesion was detected when thyroid cancer was diagnosed,whether thyroid surgery was performed,whether 131Ⅰ therapy was performed,whether chemotherapy or radiotherapy were performed,preoperative general condition (good or poor),surgical type (excisional surgery or palliative surgery),characteristics of metastatic lesion (osteolytic or mixed),intraoperative blood loss,whether measures were applied to prevent intraoperative bleeding,perioperative complications and long-term complications.Results Excisional surgery was performed in 36 patients (78.3％),while palliative surgery in other 10 patients (21.7％).The average amount of blood loss was 2603.26ml.The postoperative 5-year survival rate and 10-year survival rate were 37.3％ and 12.4％,respectively.Univariate analysis showed the significant prognostic factors include tumor subtype,number of bone metastasis,whether 131Ⅰ therapy was performed,and preoperative general condition (good or poor).Multivariate analysis showed the independent prognostic factors were number of bone metastasis (solitary or multiple) and whether 131Ⅰ therapy was performed.Conclusion For patients with bone metastasis from thyroid cancer,the prognostic factors are useful for determining indications for operation and improving treatment outcome.

Objective:To assess the efficacy and safety of oncoplastic breast-conserving surgery (OBCS) in the treatment of early breast cancer. Methods:The clinicopathological data of breast cancer patients who were treated with OBCS (67 cases) and standard breast-conserving surgery (SBCS;117 cases) in Affiliated Cancer Hospital of Guangxi Medical University were retrospectively analyzed. Postop-erative complication, specimen weight, margins, and surgery re-excision rate between the two groups were compared. Results:Sero-ma (14.9%versus 48.7%, P<0.001), hematoma (4.5%versus 14.5%, P=0.035), and poor wound healing (3.0%versus 11.9%, P=0.036) were more common in the SBCS group than in the OBCS group. The patient satisfaction in the OBCS group was statistically higher than in the SBCS group (P<0.05). Compared with standard surgery, oncoplastic techniques can be employed for significantly larger tumors (25.04 mm versus 21.14 mm, P<0.001). OBCS resulted in higher mean specimen weights (92.24 g versus 57.44 g, P<0.001), wider clear nearest margins (12.04 mm versus 9.58 mm, P<0.001), and wider furthest margins (24.16 mm versus 15.24 mm, P<0.001). No statisti-cal increase was observed in further surgery re-excision of margins. Conclusion:OBCS is more successful than standard wide local exci-sion in treating larger tumors and obtaining wider radial margins. Oncoplastic approach showed no increase in postoperative complica-tion rate. The postoperative complication was excellent. OBCS is a safe and effective procedure for early breast cancer.

Objective To investigate the risk factors for vascular cognitive impairment and the effet of cerebral microbleeds (CMBs) on cognitive function in patients with ischemic stroke.Methods The data of patients with ischemic stroke over the age of 50 were collected.The Montreal cognitive assessment (MoCA) scale and Alzheimer's disease assessment scale-cognitive subscale were used to evaluate cognitive function.Hamilton depression scale (HAMD) was used to evaluate the depression status in order to exclude the patients with depression.The patients with ischemic stroke were divided into either a cognitive impairment group or a non-cognitive impairment group according to the scale evaluation results.The demographic and clinical characteristics in both groups were compared,and the multivariate logistic regression analysis was used to look for the independent risk factors for cognitive impairment in patients with ischemic stroke.The Spearman rank correlation method was used to analyze the degree of CBMs,total score of MoCA,and the correlations of all cognitive domains scores.Results A total of 169 patients with ischemic stroke were enrolled in the study.There were 80 patients in the cognitive impairment group and 89 in the non-cognitive impairment group; 34 patients had CMBs and 135 had no CMBs.The age was older (71.99 ±6.01 years vs.64.47 ±6.15 years; t =8.014,P =0.000),years of education were fewer (4.51 ± 1.534 years vs.6.94 ±2.357 years; t =8.023,P =0.000),systolic blood pressure was higher (156.19± 17.53 mm Hg vs.142.04± 16.03 mmHg,1 mmHg=0.133 kPa; t =5.479,P =0.000),scale of white matter lesion was higher (7.33 ± 2.04 vs.4.39 ± 2.17; t =8.951,P =0.000),cerebral infarction volume was larger (7 123.8 ± 1 587.1 mm3vs.5 628.4 ± 1 017.8 mm3;t =7.201 ; P =0.000),proportion of the patients with history of previous stroke or transient ischemic attack was higher (46.2％ vs.28.1％;x2 =5.982; P=0.014),and number of CBMs was larger (x2 =17.565; P=0.000) in the cognitive impairment group.Multivariate logistic regression analysis showed that the age (odds ratio [OR] 1.115,95％ confidence interval [CI] 1.013-1.227; P =0.026),years of education (OR 0.490,95％ CI0.325-0.793; P=0.001),systolic blood pressure (OR 1.048,95％ CI 1.014-1.083; P =0.005),scale of white matter lesion (OR 2.044,95％ CI 1.466-2.851; P =0.000),and cerebral infarction volume (OR 2.204,95％ CI 1.386-3.503; P =0.001) were all the independent risk factors for cognitive impairment in patients with ischemic stroke.Compared to the non-CBM group,the age was older (72.06 ± 5.59 years vs.67.01 ±7.15 years; t =4.427; P =0.000),years of education were fewer (3.97 ± 1.381 years vs.6.25 ±2.317 years; t =7.367,P =0.000),systolic blood pressure was higher (155.03 ±20.16 mm Hgvs.147.16 ±17.32 mm Hg; t =2.290,P =0.023),scale of white matter lesion was more higher (7.03 ±2.139 vs.5.47 ±2.591; t =3.247,P =0.001),cerebral infarction volume was larger (6 968.5 ± 1 507.4 mm3 vs.6 177.0 ±1 477.1 mm3; t =2.735,P =0.007),and proportions of hypertension (82.4％ vs.41.5％ ;x2 =18.149,P =0.000),hyperlipidemia (88.2％ vs.39.3 ％ ;x2 =26.067,P =0.000),history of previous stroke or transient ischemic attack (70.6％ vs.28.1％ ;x2 =21.061,P =0.000) and coronary heart disease (94.1％ vs.45.2％ ;x2 =26.278,P=0.000) were higher in the CBM group.The MoCA total score (M[Q1 ～ Q3]; 24 [24 ～25]vs.28 [27 ～ 28] ; Z =-7.092,P =0.000) as well as the scores of attention (6 [5 ～ 6] vs.6 [6 ～ 6] ; Z =-2.502,P =0.012),abstraction (2[1 ～2] vs.2[2 ～2] ; Z =-2.382,P =0.017) and visuoexecutive (2[1 ～2] vs.4[4 ～5]; Z=-7.321,P=0.000) in the CMB group were significantly lower than those in the nonCBM group.The Spearman rank correlation analysis showed that the CMB grade was negatively associated with the MoCA total score (rs =-0.879,P =0.000) as well as the scores of visuoexecutive (rs =-0.895,P =0.000),attention (rs =-0.337,P =0.005),and abstraction (rs =-0.333,P=0.006).Conclusions The age,years of education,systolic blood pressure,degree of white matter damage,and cerebral infarction volume are the risk factors for vascular cognitive impairment.The visuospatial executive dysfunction,attention and abstract thinking decline significantly in ischemic stroke patients with CBMs.CMBs and their numbers are closely associated with cognitive impairment.The more the CMB numbers are,the more obvious the cognitive impairment will be.

Objective: To investigate the effect of retinoic acid on the differentiation and development of B lymphocytes, and explore the mechanism of vitaminA in increasing the production of antibodies. Method: In vitro cultured cells from children’s normal mesentery lymph nodes, before and after administration of retinoic acid or retinoic acid antagonist, the changes of cell surface markers were analyzed by flowcytometry to observe the differentiation and maturation of B cells. Results: During culture in vitro, the percent of mature CD19+IgM+ B cells increased and relatively immature CD19+IgM- B cells decreased gradually, and the changes were especially obvious at 48 h. The administration of retinoic acid further increased the percent of CD19+IgM+ B cells, and the enhancement was markedly at 24 and 48 h (P

AIM: To evaluate the clinical effect and the rotational stability of AcrySof Toric intraocular lens ( IOL ) implantation to correct preexisting corneal astigmatism in cataract surgery.
METHODS: Twenty-three patients ( 28 eyes ) were enrolled from the department of ophthalmology in the first Affiliated Hospital of Nanjing Medical University. All patients underwent similar phacoemulsification procedure combined with AcrySof Toric IOL implantation from June 2012 to December 2013. The uncorrected visual acuity ( UCVA ) , best corrected visual acuity ( BCVA ) , anticipated residual astigmatism, postoperative residual astigmatism, and Toric IOL axis were detected and measured.
RESULTS:Three months after operation, the UCVA of all eyes were 0. 75±0. 16 and the BCVA were 0. 84±0. 15, there was no significant difference between UCVA and BCVA ( t = 1. 036, P>0. 05 ). The anticipated residual astigmatism was ( 0. 28±0. 12 ) D. The actual residual astigmatism after 3mo of the operation was (0. 42±0. 17) D. There was no significant difference between anticipated and actual residual astigmatism (t=1. 259, P>0. 05). The mean axis rotation of Toric IOL was 3. 02o±1.56o (0o-7o) after 1d of operation and 3. 28o±1. 85o (0o-7o) after 3mo. Among all the eyes, 25 eyes ( 89%) rotated <5o, in 3 eyes (11%) rotated 5o-7o.
CONCLUSION: The AcrySof Toric IOL implantation shows good effectiveness, predictability and stability in correcting pre-existing astigmatism in cataract patients.

Objective To study retrospectively the efficacy and complications of different surgery approaches used to treat primary spinal tumors and to discuss the surgical strategy in treating them. Methods 135 patients with primary spinal tumors had been treated between July 1998 and July 2005. The following diagnoses were made based on histopathological findings: multiple myeloma in 25 patients, giant cell tumor in 17, neurofibroma or neurilemmoma in 23, chondrosarcoma in 7, osteoblastoma in 6, aneurysmal bone cyst in 4, lymphoma in 9, eosinophilic granuloma in 6, hemangioma in 15, osteosarcoma in 3, Ewing sarcoma in 5, and other different tumors in 15. Anterior approach and posterior approach was used in 73 cases and 31 cases respectively. Posterolateral approach was used in 13 cases and combination of anterior and posterior approach was used in 18 cases. Results Pain relief was obtained in 126 of the 135 patients(93.3%). Improved neurological function was seen in 86 of 92 patients who had suffered from impaired neurological function. No severe complications were found in the follow-up period. Cerebrospinal fluid leakage was observed in 11 patients, and which was successfully treated using antibiotics therapy and raising the foot of the bed. 3 patients suffered from stress ulcer after operation, but they recovered soon after blood transfusion and anti-acid treatment. Other complications included subcutaneous emphysema (in 3 patients), superficial wound infection (in 3 patients),nerve root injury (in 2 patients), implant loosening (in 2 patients), and neurological morbidity due to surgery (in 1 patient). Conclusion When single or two adjacent vertebrae are involved by spinal tumors such as giant cell tumor and chondrosarcoma, tumor resection should be performed through combination of anterior and posterior approach. Aggressive resection based on the Tomita or WBB staging system is the treatment most likely to achieve long-term local control.

Objective:To explore the effect of autoimmune regulator to TLRs expressions on peripheral antigen presenting cells(APC).Methods:①pEGFPC3-AIRE plasmid was transfected with liposome.②Confocal microscopy was used to observe the effect of transfection.③RT-PCR assay was used to detect the expressions of AIRE and TLR1-9 in RAW264.7cells at 36,48,72,96 h after transfection.Results:①The plasmid was transfected into RAW264.7 cells successfully,and the efficiency of transfection was 60~70%.②AIRE transfected RAW264.7 cells were achieved,and the best time was 72 h.③At 72 h after transfection,the expressions of TLR1,4,5,9 increased,and TLR3,7,8 reduced.The expression of TLR2,6 increased at 96 h.Conclusion:AIRE may regulate the immune response by control TLR expression in APC.It maintain the effective response to pathogen and tolerance state to self tissues through the effects to different TLRs.

Objective: To investigate the influence of the expression of retinoic acid receptor genes on the development of B cells in lymph nodes of young children. Method: In situ hybridization was performed on the frozen section of lymph node of young children (≤age 5 ). Six digoxin labeled antisense RNA probes for retinoic acid receptors mRNA(RAR?、?、?、RXR?、?、?)were used. The expression and distribution of retinoic acid receptor genes in lymph nodes and their influence on the differentiation and maturation of B cell were observed. RT-fluorescent PCR was also used to observe the expression levels of retinoic acid receptor genes and their relation to the maturation of B cells. Results: In situ hybridization showed all the 6 retinoic acid receptor genes were expressed in lymphocytes and reticular cells of lymph node, and the distribution was widespread. RT fluorescent PCR also showed a varying expression of 6 retinoic acid receptor genes in lymph node among different age children, but lower in children younger than 1 year, and then increased gradually with the development of immune system. Conclusion: The expression and regulation of retinoic acid receptor genes may take part in the ontogenesis of B cells, and play a key role in the regulation of retinoic acid and enforce the anti-infective immunity in children.