Objective To study the characteristics of MR imaging and proton MR spectrscopy(~1H MRS)of stroke-like lesions in MELAS.Methods Clinical,MR imaging and proton spectroscopic findings of stroke-like lesions in 7 patients with confirmed MELAS were analyzed retrospectively.Results A total of 12 MR investigations had been performed in 7 patients.Stroke-like lesions showed by MR imaging included superacute in 12,acute in 12,subacute in 10 and chronic stage in 6.Early stroke-like lesions were demonstrated as focal edematous foci mainly involved cortex/subcotical areas of occipital,temporal and parietal lobes.At MR diffusion imaging,stroke-like lesions in the superacute(＜3 days)stage were showed as well-circumscribed lesions with high signal intensities for cytotoxic edema.During the acute(4～7 days),sub-acute(2～4 weeks)and chronic(＞4 weeks)stages,the lesions gradually expanded,and became blur,and presented with vasogenic edema mainly.Proton spectroscopy showed a prominently elevated lactate,varied decrease of NAA concentration and other brain motabolites in the stroke-like lesions early after onset,and depicted gradual decrease of lactate level and partial recovery of NAA concentration subsequently.Conclusion Stroke-like lesions in MELAS mainly involve the cerebral cortex and subcortical areas,in which cytotoxic edema appears early but for a short period.In ~1H MRS,the lesions are characterized by a double lactate peak with decrease of NAA concentration.

Objective To investigate the MSCT(multi-slice computed tomography) manifestation of different kinds of malignant tumor in Renal Sinus.Methods MSCT data of 31 patients with diferent kinds of malignent tumor in Renal Sinus were analyzed retrospectively.Results In our series,15 cases were renal pelvic carcinoma,and central mass in renal sinus with light or middle ehancement were revealed in their MSCT investigation,as well as pelvic filling defect and hydronephrosis to some extent were found in secretory phase of enhanced MSCT.10 cases were renal cell carcinoma with renal sinus invasion,and their MSCT muti-planar reconstruction showed the mass mainly located in renal parenchymal,with dramatical and heterogenous CT enhancement mostly,besides local oppression & latral destruction of pelvic wall were caused by renal pelvic invasion.2 cases leiomyosaocoma in renal sinus were big and had a sharp edge,after adminisration they demonstrated dramatical and heterogenous CT enhancement.3 cases were lymphnode metastasis located in renal sinus or renal gate,appeared as nodular lesion with CT enhancement,and hydronephrosis could be exsisted if renal pelvic were obstructed.1 case were retroperitoneal lymphoma,MSCT muti-planar recon-struction revealed a large retroperitoneal mass derectly invaded into renal sinus,with light or middle homogenous ehancement.Conclusion MSCT has advantages of high speed scan,excellent discrimination,and aplenty post-process technique,and is of diagonotic value to malignant tumor in renal sinus.

Objective To evaluate primary open reduction and wire-pin fixation for total dislocation of talus.Methods A retrospective study was conducted of the 12 patients who had been admitted into our hospital from October 2009 to December 2013 for total talar dislocation without fracture of the talar neck or body and had been available for complete follow-up.They were 10 males and 2 females.Their range of age was from 17 to 56 years (average,34.2 years).The total dislocation was open in 4 cases and close in 8.All of them underwent primary open reduction and wire-pin fixation.The functions of ankle joint and hindfoot were evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results The follow-up time ranged from 22 to 72 months (average,35.6 months).Postoperatively,one case suffered skin necrosis and another superficial infection,both of whom responded to skin flap transferring after debridement.Traumatic arthritis of the talotibial or subtalar joint was found more or less in 7 cases,one of whom complained of severe pain but refused the subtalar arthrodesis advised.Their AOFAS scores at the final follow-up ranged from 42 to 96 points (average,72.2 points).Five cases developed avascular necrosis of the talus,but no talar collapse happened.Conclusions Primary open reduction and wire-pin fixation is effective for treatment of close total talar dislocation and open total dislocation of Gustilo type Ⅲ A or below.Although avascular necrosis and traumatic arthritis are common postoperative complications,satisfactory functions can be achieved if there is no collapse,severe pain or infection.

Objective To investigate whether iron mass induces HO-1 overexpression and explore the role of HO-1 in rat intracerebral hemorrhage(ICH). Methods In this study,144 hydrated chloride aldehyde-anesthetized Sprague- Dawley rats were used,autologous blood were injected into the right caudate nucleus to establish the ICH model.Saline injection and health were served as controls.Deferoxamine(DFO)with an intraperitoneal injection served as intervention group.Enhanced Perl's reaction was used for iron staining and brain iron deposits were determined.Brain HO-1 level were examined by immunohistochemical analysis and reverse transcription polymerase chain reaction(RT-PCR). Results There was a 21-fold increase in iron deposits around the hematoma 7 days after the infusion of 100 μl of autologous blood.Markedly increased levels of perihematomal HO-1 immunoreactivity and HO-1 mRNA in all ICH rats were detected at 3-14 days.The addition of DFO significantly reduced iron deposits in the ipsilateral basal ganglia at 7-14 days after ICH.DFO also inhibited HO-1 overexpression at day 7,14.Correlations test showed that there were positive correlations of iron sediments with HO-1mRNA(r=0.647)and HO-1 immunopositive cells(r=0.209). Conclusions ICH causes iron accumulation in the brain.Iron overloading may induce HO-1 upregulation after ICH.Ratherly,the HO-1 moderate increasing possibly fits with the events,whereas HO-1 overexpression may result in its dysfunction.It may be prudent to intervene ICH with HO-1 inhibitor.

Objective To analyze the serotype distribution and antibiotic resistance characteristics of Salmonella strains isolated in Guangdong province for better understanding the condition of Salmonella infection in patients with diarrhea.Methods Fecal samples collected from patients with diarrhea in Guangdong province were used to isolate Salmonella strains.Biochemical analysis was performed to identify these isolated strains.Serotyping and antimicrobial susceptibility testing were carried out for further analysis of the isolated Salmonella strains.Results The rate of Salmonella infection was 7.64％in 2015, and the male to female patient ratio was 1.52∶1.A total of 2 377 patients of all age groups were positive for Salmonella infection and the patients aged 0-6 years accounted for 81.74％.The isolation rate of Salmonella strains in the summer and autumn was higher than that in the winter and spring (10.73％ vs 4.24％;X2=463.77, P<0.01).The Salmonella isolation rates in different areas were as follows: 16.82％ in Zhuhai, 15.85％ in Heyuan, 11.81％ in Yangjiang, 10.68％ in Jiangmen, 8.49％ in Zhongshan, 8.07％ in Maoming, 8.05％ in Jieyang, 7.35％ in Shaoguan, 6.97％ in Foshan, 6.03％ in Dongguan, 5.48％ in Guangzhou and 0.00％ in Zhanjiang.And the differences between different regions were statistically significant (X2=367.67, P<0.01).The 2 377 isolated Salmonella strains were classified into 108 serotypes except for oneSalmonella strain that could not be classified.The top four predominant serotypes were 4,5,12:i:-, Salmonella enteritidis,Salmonella stanley and Salmonella typhimurium.Most Salmonella strains were sensitive to imipenem, azithromycin, ceftazidime, cefotaxime and trimethoprim/sulfamethoxazole, but multidrug resistance was common among those strains.Conclusion Salmonella serotypes of 4,5,12:i:-and Salmonella enteritidis are the predominant pathogens causing human Salmonella infections in Guangdong province.Ceftazidime and cefotaximeare are preferred in the treatment of Salmonella infections.Surveillance for drug resistance in Salmonella should be strengthened as multidrug resistant strains have become a serious problem in Guangdong province.

Objective To prepare simulated stool specimens for proficiency testing ( PT) by mix-ing lentils with Salmonella, Shigella and Escherichia coli strains and to establish an assessment scheme for the detection of Salmonella and Shigella in clinical samples. Methods Salmonella, Shigella and Escherich-ia coli strains were respectively spiked to lentils in Cary-Blair transport medium to create simulated stool specimens. Various ratios of Escherichia coli to Salmonella strains were spiked to lentils to prepare mixed simulated stool specimens. The accuracy and stability of prepared stool samples for PT were tested in-house. Results of sample detection were collected from participating laboratories for further external quality assess-ment. Results The Escherichia coli and Salmonella strains mixed at ratios of 100 ∶ 1 to 106 ∶ 1 could be ef-ficiently isolated from the media. Enrichment was needed in order to effectively isolate Salmonella strains from the media when the ratios of Escherichia coli to Salmonella strains were 104 ∶ 1 to 106 ∶ 1. Of the16 participating laboratories, 14 laboratories (87. 5%) received a grade of“satisfactory” and the other 2 labo-ratories (12. 5%) received a grade of “mainly satisfactory”. Conclusion The simulated stool specimens and the PT procedures designed in this study were suitable for proficiency testing program on the detection of Salmonella, Shigella and other similar microbes.

BACKGROUND:A few of studies have showed similar efficacy and safety between domestic clopidogrel (Talcom?) and imported clopidogrel (Plavix?) in patients after percutaneous coronary intervention, but there is lack of large-scale, large sample, and prospective clinical comparative study in China.
OBJECTIVE:To compare the efficacy and safety of Talcom?and Plavix?on percutaneous coronary intervention.
METHODS:Total y 1 798 patients with Coronary atherosclerotic heart disease who received percutaneous coronary interventions were divided to two groups:Talcom?group (n=1 104) and Plavix?group (n=694). 300 mg clopidogrel was administrated oral y before percutaneous coronary intervention fol owed by 75 mg/d clopidogrel sequential y for 1 year. Al the patients were fol owed for 3-28 months to observe the incidence rate of stent thrombosis at acute, subacute, late, and very late stage, major adverse cardiac events of combination end point (including myocardial infarction, cardiac death, and stroke), and correlated adverse reactions, such as bleeding.
RESULTS AND CONCLUSION:There were no significant differences in the incidence of stent thrombosis, target vessel revascularization, cardiac death, bleeding, major bleeding and major adverse cardiac events of combination end point between Talcom?group and Plavix?group. In addition, event-free survival also showed no difference between the two groups. After treatment, white blood cellcount, erythrocyte count, hemoglobin, hematocrit, platelet count were significantly decreased in both the two groups (P<0.05). Hemoglobin level in the Talcom?group was fewer than that in the Plavix?group (P<0.05). The results suggest that effects and safety of Talcom?are similar to those of Plavix?for percutaneous coronary interventions.

Objective To investigate the effect of the individualized nutritional support to hypoalbuminemia of elderly hip fracture patients after hip replacement.Methods A total of 100 elderly patients with hip replacement from February 2014 to May 2015 were included and divided into two groups randomly:control group (50 cases) and intervention group (50 cases). Patients in control group received routine care while patients in intervention group received individualized nutritional support in addition to the routine care. The serum albumin levels at 1st day and 3rd day, wound healing after surgery,start time of functional exercises, bed time and hospitalization days were analyzed and compared between two groups. Results The serum albumin levels at 1st day[(33.23±2.12)g/L] and 3rd day[(30.05±3.28)g/L] in intervention group were higher than those in control group, the differences were statistically significant (t=-5.82, -6.74; P<0.01). The first wound healing rate in intervention group (76.0%) was better than the rate in control group (64.0%), but the difference was not statistically significant (χ2=1.507,P=0.220). The start time of functional exercises, bed time and hospitalization days were shorter than those in control group, the differences were statistically significant (P<0.01).Conclusions Individualized nutrition support can effectively improve hypoalbuminemia in elderly hip fracture patients after hip replacement, improve postoperative wound healing, and encourage patients with functional exercise,shorten the time patients get out of bed for the first time and the hospital stay.

Objective To develop and validate a risk prediction model based on early platelet-related parameters for bronchopulmonary dysplasia(BPD)in neonates admitted to the neonatal intensive care unit(NICU),and to facilitate early identification and intervention in high-risk populations.Methods Clinical data of 291 preterm infants with a gestational age(GA)≤32 weeks or a birth weight(BW)＜1 500 g,admitted to the NICU,were retrospectively analyzed.Out of these,214 cases were selected as the modeling group.This group was further categorized into the BPD group(n=76)and the non-BPD group(n=138),based on whether they required oxygen therapy at 28 days post-birth.Perinatal data,platelet-related parameters and other indicators between the two groups.Univariate and multivariate Logistic regression analyses were conducted to identify BPD risk factors,followed by the construction of a nomogram.An additional cohort of 105 preterm infants with GA≤32 weeks or BW＜1 500 g,were used to validate the model.This cohort was divided into the BPD group(n=43)and the non-BPD(n=62)group.Receiver operating characteristic(ROC)curve and calibration curve were used to internally verify the efficiency of the prediction model.Results The Logistic regression analysis identified GA,BW,Apgar score at 5 minutes≤7,invasive ventilation,platelet count(PLT)and mean platelet volume(MPV)as significant factors in the model(P＜0.05).The constructed nomogram was formulated using R language,and the areas under the ROC curve(AUC)for the three models were 0.908,0.931 and 0.918,respectively(P＜0.05).The verification group was verified by Bootstrap.The calibration curve showed a good fit.The internal validation AUC values of the three models were 0.877,0.890 and 0.886,respectively.Conclusion GA,BW,invasive ventilation,Apgar score at 5 minutes≤7,MPV and PLT are key risk factors for BPD onset.The risk prediction model based on these indicators can effectively predict BPD,providing clinicians with a valuable tool for early detection and intervention in the development of BPD.

Objective To explore the effect of sufentanil combined with sevoflurane inhalation anesthesia on treating children with adenoidal hypertrophy resection.Methods A total of 58 children with adenoid hypertrophy were randomly divided into observation group and control group,29 cases in each group.The observation group was treated with sufentanil combined with sevoflurane inhalation anesthesia,and the control group was treated with propofol and remifentanil anesthesia.The extubation time and awakening time of the two groups were recorded,and the heart rate (HR) and mean arterial pressure (MAP) were compared between the two groups,and the adverse reactions 24 h after the operation were observed.Results In the observation group,extubation time and awakening time were significantly shorter than the control group (P ＜ 0.05).At each time point,the MAP and HR in the observation group were stable,while MAP and HR immediately after intubation in the control group were significantly higher than that before induction (P ＜ 0.05).No nausea and vomiting were observed 24 h after operation in both groups.There were 4 cases of bucking and restlessness (13.8％) in the observation group,which was significantly lower than 7 cases (24.1％) in the control group (P ＜ 0.05).Conclusion Sufentanil combined with sevoflurane inhalation anesthesia for children with adenoidal hypertrophy resection is effective,which has advantages such as stable anesthesia effect,fast postoperative awakening and less complications.