Objective To observe the clinical curative effect of edaravone on treatment of acute lagre area cerebellar irdarction(ALACI). Methods 31 ALACI patients attacked within 72h were randomly assigned to therapygroup( n = 16) and control group( n = 15). Therapy group took the basic treatment as well as edaravone infused at a dose of 30mg,twice a day for 14 days. Control group took similar treatment to therapy group expect for edaravone.At 0th ,7th, 14th ,21th day after treatment, the C.SS and ability of daily living(ADL) were used to evaluate the recovery of neurological functions. Results Significant difference of CSS and ADL grading were detected between therapygoup and control group at 7th, 14th day( P < 0.05 ), with lower grading in therapy group ; there were significant differ-ence of CSS and ADL grading between therapy goup and control group at 21th day( P < 0.01 ), with lower grading in therapy group. No evident side effect was detected in edaravone therapy group. Conclusion Edaravone is a safe a-gent. It can effectively improve the neurological deficits and daily living ability of ALACI patients.

Objective To analyze the clinical characteristic of autoimmune gastritis (AIG).Methods From January 1990 to April 2010,the clinical data of 55 AIG patients were retrospectively analyzed,which included hemoglobin,lactate dehydrogenase (LDH),α-hydroxybutyrate dehydrogenase (α-HBDH),gastrin,intrinsic factor antibody (IFA),parietal cell antibody (PCA),gastrointestinal endoscopy examination and 24-hour esophageal pH recording.Another 31 megaloblastic anemia (MA) patients were selected as control.Statistical analysis was performed by independent-samples t test.Results Among 55 AIG patients,49 patients were associated with MA,and three out of four cases were identified of IFA.About 43.8％ (21/48) patients were PCA positive.Before treatment,the levels of LDH and α-HBDH of AIG patients with MA were (1045.50±853.46)U/L and (853.71±824.23) U/L which significantly increased,than those of patients without MA [(166.67±41.03) U/L,(133.67±27.90) U/L],the differences were statistically significant (t=-4.665,-2.120,both P＜0.05),however there was no significant difference when compared with the control group [(1047.52±1028.31) U/L,(1050.23±1264.37) U/L,both P＞0.05)].A total of 46 patients underwent gastroendoscopy examination,63.0％ (29/46) patients had gastric body atrophy while gastric antrum not involved; 34.8％ (16/46) patients had neither gastric body nor antrum atrophy; seven patients gastric mucosal showed intestinal metaplasia and one patient showed intestinal metaplasia with atypical hyperplasia and 2.2％ (1/46) presented both the antrum and the body atrophy.Conclusions The levels of LDH and α-HBDH increased in AIG patients might be related with MA caused marrow in-situ hemolysis.IFA is recommended as a routine test for AIG.There is still some limitations of AIG diagnosis according to histopathological features of gastric endoscopy specimen.The clinical features should be taken into consideration.

OBJECTIVE:To evaluate the pharmacoeconomic effectiveness of three therapeutic schemes for lower respiratory tract infections.METHODS:The cost-effectiveness analysis of three therapeutic schemes for lower respiratory tract infections was carried out.RESULTS:The cost-effectiveness ratio of penicillin-piperacillin schemes(L1)was minimum in respect to the effective rate.However,the cost-effectiveness ratios had no significant difference between cefotaxime scheme(L3)and L1 scheme in regard to cure rate(P>0.05),the cost-effectiveness ratio of ciprofloxacin-clinadmacin scheme(L2) was higher significantly than those of L1 and L3 schemes(P<0.05,both schemes).CONCLUSION： L1 is the best therapeutic scheme.Although L3 scheme had higher cost,it had higher cure rate and lower ADRs occurrence.L3 scheme is benefitial to improvement of patient's life quality.

Objective To summarize the clinical features of Budd-Chiari syndrome.Methods A total of 151 Budd-Chiari syndrome admitted in Peking University People's Hospital from 1996 to 2012 were analyzed retrospectively.Results Abdominal distension was the most common complaint,with 62.9％ (95/151)of lower extremity edema,53.0％ (80/151)of typical bottom-up flow of the abdominal wall longitudinal varicose veins and 60.9％ (92/151) with ascites.Laboratory tests results showed median of alanine aminotransferase (ALT) was 21.5 (15.0,30.0) U/L,aspartate aminotransferase (AST) was 30.0 (23.8,42.0) U/L,total bilirubin was 31.1 (23.3,47.8) μmol/L,blood albumin 37.5 was (31.8,41.5) g/L,prothrombin activity was 71％ (61％,84％).WBC was 5.2 (3.5,7.5) × 109/L,hemoglobin concentration was 126.5 (108.8,144.2) g/L,and platelet count was 117.0 (85.5,155.5) × 109/L.Abdominal B-ultrasound examination showed hepatomegaly existed in 68.9％ (104/151) patients.Intraoperative angiography and surgical exploration showed that 41.1％ (62/151) patients were simple inferior vena cava obstruction or stenosis,15.9％ (24/151)were simple hepatic vein obstruction or stenosis and 43.0％ (65/151) suffered from the inferior vena cava combined with hepatic vein stenosis or obstruction.Surgically confirmation of the lesions showed that inferior vena cava membrane-like structure combined with thrombosis was in 59.6％ (90/151) cases.Conclusions Liver congestion,inferior vena cava congestion and portal hypertension are the main clinical manifestations of Budd-Chiari syndrome.With slightly liver function injury,liver dysfunction of Budd-Chiari syndrome isn't parallel with its portal hypertension.

SUMMARY The male patient reported here presented as gangrene and central diabetes insipidus ( CDI) , who had characteristics of vasculitis. The patient complained about polydipsia and polyuria half a year ago, and then developed tingling, pain and blackish discoloration of some fingers and toes 3 month ago. He also had Raynaud' s phenomenon. After admission, his laboratory examination showed the rise of erythrocyte sedimentation rate, C-reactive protein, immunoglobulin,β2-glycoproteinⅠand the activi-ty of rheumatoid factors, lupus anticoagulant test. his pituitary gland showed loss of posterior signal on magnetic resonance imaging. In addition, his vasopressin test was active. However, there was no suffi-cient evidence to diagnose any specific disease;as a consequence the patient was diagnosed as idiopathic systemic necrotizing vasculitis ( SNV) . For SNV, the patient was treated with glucocorticoid 40 mg/d and impact therapy of cyclophosphamide 0. 4 g every 2 weeks. He also received symptomatic treatment for gangrene and CDI. Cutaneous involvement leading to gangrene was widely reported in SNV, however pi-tuitary involvement in SNV leading to CDI was rare. The prognosis of this patient was poor.

Objective To study the expressions of TLR4, CD14, MD-2 and NF-kB in colonic mucosa in patients with diarrhea-irritable bowel syndrome (IBS-D) , and compared with normal subjects. The purpose of this study is to explore the role of TLR4 and TLR4 signal transduction pathway in the pathogenesis of IBS-D. Methods The expressions of TLR4, CD14, MD-2 and NF-kB in colon mucosa were examined by immunohistochemistry (IHC) in 30 IBS-D patients and 12 healthy volunteers separately. The average absorbance (A value) of TLR4 was analyzed. The positive expression rates of CD14, MD-2 and NF-kB of colonic mucosa were studied. Results Compared with healthy controls, significant upregulation of TLR4 expression relative to controls was found in colon mucosa of IBS-D. A value of TLR4 in IBS-D was significantly higher (0.3971 ±0.0996 vs 0. 3044 ±0.0481). The positive rate and intensity of NF-kB in IBS-D were significantly higher than those in healthy. The number of positive cells of MD-2 showed significant increase in lamina propria of IBS-D against controls. The percent of CD14 positive was upregulated in lamina propria in IBS-D. The expressions of MD-2 and CD14 in intestine epithelial cell were low or negative. Conclusions There is the activation of the signal transduction pathway of TLR4/NF-kB in the colonic mucosa of patients with IBS-D. Up-regulated expression of TLR4 in IBS patients suppose that it might contribute to occurrence of IBS-D.

Two hundred male and 200 female patients with type 2 diabetes mellitus admitted from January 2007 to April 2008 were enrolled in the study. Of them, 267 were diagnosed as non-alcoholic fatty liver disease (NAFLD) by ultrasonography. The measurements included:body mass index (BMI) ,waist-to-hip ratio (WHR) ,fasting blood glucose( FBG), ALT, AST, total bilirubin(TBIL), cholesterol(CHO),triglyceride(TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol ( LDL-C) ,serum creatinine (Cr), supersensitive C-reactive protein (hsCRP) and urine albumin/creatinine. The relationship of above factors with NAFLD was determined. Our data showed that male NAFLD patients were in general younger than female. The BMI ( t = 11. 361, P = 0. 000), waist circumference ( t = 9. 771, P =0. 000), hip circumference (t = 10. 469, P =0. 000) ,TG(t =7. 352, P =0. 000) and hsCRP (t =2. 242,P =0. 026) of NAFLD patients were significantly higher than those without NAFLD. The hsCRP of patients with central obesity was also significantly higher than those without central obesity (t = 0. 266, P = 0. 045 ).BMI and TG were positively correlated with NAFLD. Waist circumference was an independent factor of NAFLD in male patients, same as hip circumference with NAFLD in female patients. In conclusion, gender,central obesity and dyslipidemia may be risk factors for NAFLD in patients with type 2 diabetes mellitus.

Objective To study the relationship between coagulation abnormal and inflammatory in the TNBS induced rats colitis model as well as the therapeutic effect of heparin on this model Methods Forty SD-rats were separated into 4 groups randomly, including normal control group, colitis group, heparin group and SASP group. PT, APTT and the activity of antithrombin (AT)were chosen as indexs of coagulation. The level of damage ancl inflammatory state of the colitis rats were assessed by macroscopical score, histological score and the level of TNFα in each group. Results Compared with normal control group, TNBS induced colitis group has a shorter PT [(14.83±0.45)s vs(16.68±1.08 )s, P < 0.05] and APTT[(12.49±1.30)s vs(29.06±1.60) s, P<0.05] and a lower activity level of AT [(111.33± 8.50)% vs(122.13±3.52)%,P<0.05]. In heparin group, PT, APTT were prolonged [PT: (17.83± 0.78)s vs (14.83±0.45)s,P<0.05, APTT:(53.34±9.49)s vs (12.49±1.30)s,P<0.05] and AT activity was higher than colitis group [(131.67±6.92)% vs (111.33±8.50) %, P < 0.05]. SASP group has a similar data in PT, APTT compared with colitis group and no statistical significance(P>0.05). The activity of AT in SASP group is higher than in colitis group [(122. 33±5.82)% vs (111.33±8.50)%,P <0.05]. The heparin therapy group showed lower macroscopical score(2.50±0.55 vs 4.75±1.16, P< 0.05), histological scores(3.83±0.41 vs 7.75±1.04, P<0.05) and the level of TNFα[(84.75± 18.03) ng/L vs (149.93±23.52)ng/L, P < 0.05] compared with the colitis group. Conclusion Coagulation was abnormality in the rat colitis model induced by TNBS; heparin therapy is effective in the colitis model It seemed that the abnormality of coagulation plays an important role in the pathogenesis of the rat colitis model.

Objective To investigate the clinical features of ulcerative colitis(UC).Methods Based on typical clinical manifestation,enteroscopy and pathological results,138 in-hospital patients were diagnosed UC during 1998 to 2006.Their clinical features were analyzed in this report.ResultsUC was more commonly seen in people aged 20～60(n=108,78.3％).Nearly forty-six percent of the patients (n=63,45.7％)had the disease less than one year.More patients(n=100,72.4％)showed mild or moderate UC.Bloody stool was the most common manifestation.erythrocyte sedimentation rate,hemoglobin,albumin and α1 or α2 globulin levels were closely related with the condition.The mean value of platelet counting was in the upper limit of the normal value.Enteroscopy found more lesion located in the whole colon (n=78,56.5％).Pathological results showed infiltration of inflammatory cells,especially in patients with chronic inflammation.Salieylazosulfapyridine(SASP)and/or 5-Aminosalicyclic(5-ASA)were effective in most UC patients(n=70,50.7％).ConclusionsChinese patients usually had mild to moderate UC,and their courses were often shorter than abroad.The disease was closely related with α1 and α2 globulin levels.Most of the patients had response to SASP and/or 5-ASA.

Objective To study the expressions of Toll-like receptor (TLR)2 and TLR4 in colonic mucosa of patients with irritable bowel syndrome (IBS) and in normal subjects. Methods Thirty patients with diarrhea predominant IBS and 12 healthy volunteers were enrolled. The expressions of TLR2 and TLR4 in colonic mucosa were examined by immunohistochemistry (IHC).TLR2 and TLR4 were semi-quantitative analyzed with average absorbence. Results Contrast to healthy controls, the lamina propria of IBS patients showed edema and looseness with lots of inflammatory cells infiltration. There was no difference in expression of TLR2 between healthy controls and IBS patients (P>0.05). Compared with healthy controls, TLR2 in crypt epithelium and TLR4 in luminal surface of IBS patients were significantly up-regulated (TLR2 : 6.7 % vs. 50.0 %,TLR4: 40.0% vs. 0, P<0. 05). The TLR4 expressed in intestine epithelial cell of both the apical surface and the basolateral surface in 86.7% of patients with IBS, and in 50% of healthy controls.The positive cells of TLR4 in lamina propria were higher in patients with IBS than those in healthy controls (70. 084 ± 21. 887 vs. 20. 577 ± 4. 546, P<0.01). The A values of TLR2 and TLR4 in colonic mucosa of the patients with IBS were higher than those in healthy controls (TLR2:0. 3079±0. 0283vs. 0.3886±0. 0510,TLR4:0. 3044±0. 0481 vs. 0. 3971 ±:010996,P<0. 01). Conclusions Inflammatory cells infiltrated into colonic mueosa in patients with IBS suggested that inflammation might participate in the pathogenesis of IBS. Up-regulated expressions of TLR2 and TLR4 in IBS patients supposed that they might contribute to the occurrence of IBS.