OBJECTIVE:To observe the effect and safety of small-dose argatroban vs. aspirin in the treatment of acute cerebral infarction. METHODS:136 patients with acute cerebral infarction were randomly divided into observation group and control group. All patients were given routine treatment,such as anti-intracranial pressure,oxidative stress,brain protection,oxygen,blood pres-sure,blood sugar control,anti-infective,water and electrolyte acid-base balance,etc. Based on it,control group was treated with Arginine aspirin for injection 100 mg,adding into 0.9% Sodium chloride injection 250 ml,iv,once a day. Observation group was treated with Argatroban injection 40 mg,adding into 0.9% Sodium chloride injection 500 ml,24 h continuous infusion for continu-ous 2 d,iv;then dose was decreased to 10 mg,adding into 0.9% Sodium chloride injection 100 ml,iv,once a day,for continu-ous 5 d. The course of both was 7 d. The clinic data was observed,including clinical efficacy,NIHSS(National Institutes of Health Stroke Scale)score,Bathel index scores before and after treatment,and incidence of adverse reactions. The recurrence rate of cere-bral infraction during the 2-year follow-up period was observed. RESULTS:The total effective rate in observation group was signifi-cantly higher than control group,the recurrence rates of cerebral infarction in observation group within 1 and 2 year(s)were signifi-cantly lower than control group,with significant difference(P<0.05). After treatment,the NIHSS score in 2 groups were signifi-cantly lower than before,observation group was lower than control group;Bathel score was significantly higher than before,and observation group was higher than control group,with significant differences(P<0.05). There were no significant differences in the incidence of adverse reactions between 2 groups(P>0.05). CONCLUSIONS:Based on the conventional treatment,compared with aspirin, small-dose argatroban can significantly commute the nerve function of acute cerebral infarction,and reduce the recurrence rate of cerebral infarction,with good safety.

Objective:To investigate the pathogenic bacteria distribution and risk factors of pulmonary infection after tracheotomy in patients with stroke coma,and to put forward preventive measures.Methods:96 patients with stroke coma from January 2016 to February 2017 in our hospital were retrospectively analyzed.The incidence of pulmonary infection and distribution of pathogenic bacteria of patients with stroke coma were analyzed.At the same time,the risk factors of pulmonary infection were analyzed by single factor and multiple factors logistic regression analysis,and corresponding preventive measures were put forward.Results:The incidence of pulmonary infection after tracheotomy in 96 patients with stroke coma was 48.96％ (47/96).A total of 104 pathogens were isolated and cultured,including gram negative bacteria 69 strains (66.35％),gram positive bacteria 20 strains (19.23％) and fungus 15 strains (14.42％).Single factor regression analysis results showed that pulmonary infection after tracheotomy in patients with stroke coma was closely related with age,basic diseases,time of tracheotomy,and bed time,use of broad-spectrum antibiotics,smoking history,artificial airway,times of sputum suction and inhalation(P＜0.05),and it was not related to the patient's gender,weight,stroke type (P＞0.05).Multivariate logistic regression analysis showed that age 45 years old,complicated with basic disease,time oftracheotomy 5 d,use of broad-spectrum antibiotics,smoking history and the establishment of artificial airway were risk factors of pulmonary infection after tmcheotomy in patients with stroke coma (P＜0.05).ROC analysis results showed that the critical point (threshold C) oftmcheotomy time was 4.3 days,and the sensitivity and specificity were 0.851 and 0.918 respectively.Conclusion:The main pathogenic bacteria of pulmonary infection after tracheotomy in patients with stroke coma is gram-negative bacteria,age 45 years old,complicated with basic disease,time of tmcheotomy 5d,use of broad-spectrum antibiotics,smoking history and the establishment of artificial airway can lead to pulmonary infection after tracheotomy in patients with stroke coma,and the risk of pulmonary infection in patients with stroke coma will increase considerably after the time of tracheotomy for more than 4.3 days.Targeted measures should be taken to reduce the risk of pulmonary infection according to pathogenic features and risk factors.

Objective To compare the efficacy of endovascular interventional treatment and surgical clipping in posterior communicating artery aneurysm (PCoAA) patients with fetal-type posterior cerebral artery (fPCA).Methods The PCoAA patients with fPCA were enrolled.Their baseline clinical data were collected.The modified Rankin Scale (mRS) was used to assess the clinical outcomes at six months after procedure.The mRS score 0-2 was defined as good outcome.Results A total of 35 PCoAA patients with fPCA were enrolled into the study,23 were treated with interventional embolization therapy and 12 were treated with craniotomy clipping.There were no significant differences in age,gender,preoperative Fisher grade,Hunt-Hess grade,baseline GCS scores,and aneurysm typing between the 2 groups.The good outcome rate of the interventional embolization group at 6 months was higher than that of the surgical clipping group,but there was no significant difference (65.22％ vs.41.67％;P =0.282).Results The efficacy of PCoAA using interventional embolization therapy combined fPCA is almost the same as craniotomy clipping.

Objective To explore the diagnosis and treatment of primary small bowel tumors. Methods The clinical data of 58 cases of primary small bowel tumors were retrospectively analyzed. Results Fifty-eight cases of primary small intestinal tumors were comfirmed by operation and/or pathology .Of them,19 suffered from benign tumors and 39 from malignant tumors.The main clinical manifestations of small bowel tumors were abdominal pain, abdominal mass, ileu and upper gastrointestinal hemorrhage.Twenty cases were diagnosed before the operation,and the misdiagnosis rate was 65.5%.All the 19 benign small intestinal tumors underwent local intestinal resection.In 39 malignant cases,18 underwent radical excision of the tumors, 6 received palliative excision and 5 underwent intestinal bypass operation. One patient died after the operation.The 1,3,5 -year survival rate of malignant tumors was 57.1%,28.6%and 9.5% respectively. Conclusions Primary small bowel tumor is uncommon and easy to be misdiagnosed.So attention must be paid to this disease.Endoscopy, X-ray ,BUS, CT and capsule endoscopy are the ideal diagnostic methods for small intestinal tumors .

ovel GCK-E339K mutation might be linked to this MODY2 pedigree.

OBJECTIVE To study the antidepressant effects of ammoxetine(AMX)and the underlying mechanisms. METHODS Two behavioral despair models,the tail suspension test (TST) and the forced swimming test(FST),were used to evaluate the antidepressant-like effects of AMX 2.5-20 mg · kg-1 following oral administration. Monoamine neurotransmitter p-chloro-phenylalanine(p-CPA)andα-methyl-p-tyrosine(AMPT) depletion models in mice were used to investigate the effects of AMX on levels of 5-serotomin(5-HT)and norepinephrine(NE)in the brain. RESULLTS The results of behavioral study showed that compared with normal control group,AMX(10 and 20 mg · kg-1)reduced the immobility time of mice by 51.4% and 80.7% in the TST(P<0.05,P<0.01) or by 48.0% and 66.2% in the FST (P<0.05),respectively. Locomotion activity test indicated that AMX did not increase or decrease the movement distance of mice,demonstrating that AMX had no excitatory or inhibitory actions on the central nervous system. Moreover,AMX(5,10 and 20 mg·kg-1)exerted antidepressant effects in the p-CPA induced 5-HT depletion model and AMPT induced NE depletion model,as evidenced by the significantly reduced immobility time,ie,63.9%,93.4%,90.5% and 61.9%,77.2%,100% reduction in the TST (P<0.01),respectively,and AMX at the dose of 20 mg·kg-1 significantly increased the concentrations of 5-HT and NE by 144.7% and 57.2% in the mouse brain(P<0.05) ,respectively. CONCLUSION AMX has strong antidepressant-like effects in behavioral despair models and monoamine neurotransmitter depletion models in mice,which is involved in the increased levels of 5-HT and NE in the brain.

Objective: To compare the clinical characteristics and plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) between the patients with hypertensive hypertrophic cardiomyopathy in elder age (HHCME) and the patients with hypertensive left ventricular hypertrophy (HTN-LVH).
Methods: Our work included 2 groups, HHCME group,n=47 and HTN-LVH group,n=44. Duplex Doppler echocardiography was performed to determine left atrial diameter (LAd), left ventricular end-diastolic dimension (LVEDd), interventricular septal thickness (IVST), left ventricular ejection fraction (LVEF), velocity of early diastolic period (VE) and velocity of end-diastolic period (VA) in mitral valve oriifce. Plasma level of NT-proBNP was measured by ELISA. The above indexes were compared between 2 groups.
Results:①Compared with HTN-LVH group, HHCME group presented decreased LVEDd and increased IVST, LVEF, allP<0.001. There were no signiifcant differences in VE/VA ratio and LAd between 2 groups, allP>0.05.②Plasma level of NT-proBNP was higher in HHCME group,P<0.01. With the adjusted age, gender, history of hypertension, LAd, IVST, left ventricular systolic and diastolic function, the level of NT-proBNP in HHCME group (1317.19 fmol/ml) was still signiifcantly higher than that in HTN-LVH group (526.19fmol/ml),P<0.01.
Conclusion: The plasma NT-proBNP level was higher in HHCME patients than that in HTN-LVH patients which indicated that HHCME patients may have worse prognosis. NT-proBNP might be helpful for differencing HHCME.

ObjectiveTo analyze the clinical characteristics of inflammatory bowel disease (IBD) in neonates.MethodsFrom July 2010 to July 2015, seven neonates were diagnosed with IBD in Affiliated BaYi Children's Hospital, Clinical Medical College in Chinese People's Liberation Army General Hospital, Southern Medical University. The data regarding these neonatal cases were analyzed and compared with 45 children with IBD from literature. Thet-test andChi-square test were used for statistical analysis of the data.ResultsSix cases had ulcerative colitis, and one case had Crohn's disease, both occurred 2-20 days after birth, and were characterized by diarrhea, no increase in body weight, anemia and intermittent higher hypersensitive C-reactive protein. Compared with IBD in children, abdominal pain and abdominal mass were rarer, while anemia was more common in neonatal IBD. All fecal cultures and blood cultures in the seven cases of neonatal IBD were negative. Abdominal X-ray revealed intestinal wall thickening in four cases. Multiple ulcers were observed from the cecum to the rectum by colonoscopy. Chronic intestinal mucosal inflammation associated with acute inflammation were found on pathological examination. Six infants received treatment with 5-aminosalicylic acid (combined with glucocorticoid in four cases), and one received glucocorticoid treatment only. One infant was started on infliximab treatment from two years old. One of these seven cases died one month after discharge due to refusal to continue treatment, and the disease was controlled in the other six cases. After treatment, one infant was lost to follow-up six months after discharge, two were cured at six and 12 months old without further treatment, and three improved and continued treatment.ConclusionsIn neonates with diarrhea, anemia and no increase in body weight, especially when antibiotic treatment is ineffective, colonoscopy should be performed to facilitate early diagnosis of IBD. Standard treatments result in good outcomes.

Objective To evaluate significance of the quantification of bcr-abl mRNA in diagnosis and therapy of chronic myeloid leukemia (CML),essentiality significance for monitoring minimal residual disease. Methods Bcr-abl mRNA of 518 CML patients were detected using real-time PCR. Results Expression of bcr-abl mRNA was gradually increased among blastic phase (BP) (12.6 %),accelerated phase (AP) (25.4 %) and chronic phase (CP) (57.2 %) (P<0.05). Quantification of bcr-abl mRNA was cut down gradually after allotransplantation in the patients and becomes normal after treatment for 6 months. But quantification of bcr-abl mRNA inpatients treated with imatinib mesylate became normal after 12 months. Conclusion Real-time PCR was reliable and can be used for diagnosis,monitoring the treatment outcome,detecting the minimal residual disease,and predicting blast crisis.

Objective To evaluate the efficacy,adverse events of gemcitabine vs.5-FU with radiotherapy for locally advanced pancreatic carcinomas.Methods Between January 2007 and January 2011,a total of 56 patients with locally advanced pancreatic carcinomas was included and clinical data were retrospectively analyzed.All patients received 3-DCRT radiotherapy with individual dose of 1.8 ～ 2 Gy,5 times per week,and total dose of 45 ～ 50.4 Gy for 25 ～ 28 fractions,and received concurrent chemotherapy (5-FU or gemcitabine).The patients (n =30) in gemcitabine group were treated with gemcitabine (500 rng/m2 at the 1st,8th,15th,22nd day,at 10 mg · (m2)-1 · min-1,through micro-pump) during radiotherapy; 3 weeks after radiotherapy the patients received gemcitabine infusion at a dose of 800 mg · (m2)-1 · d-1,one time per week,for 3 or 4 cycles.The patients (n =26) in 5-FU group were treated with 5-FU (500 mg/m2 at the 1 ～ 5th day per week,IV),the cycle was repeated every 2 weeks during radiotherapy; 3 weeks later the patients received 5-FU infusion at a dose of 800 mg · (m2)-1 · d-1,the 1st ～5th day per week,the cycle was repeated every 2 weeks ; with a total of 3 or 4 cycles.The efficacy and adverse events were observed,and the patients were followed until June 2013,and the median survival,1 year and 2 year survival was calculated.Results Of the 56 patients,the overall response (CR + PR) rate was 73.2％,and it was 65.3％ in radiotherapy with 5-FU group,80.0％ in radiotherapy with gemcitabine group (P ＜ 0.05).The overall one and two year survival rate was 48.2％ and 14.3％,while median survival was 15.2 months,and the corresponding values were 42.3％,11.5％,13.3 months in radiotherapy with 5-FU group,and 53.3％,16.7％,16.6 months in radiotherapy with gemcitabine group,and the survival difference between the two groups was not statistically significant (P =0.071).At the end of treatment,the pain-relief rate (VAS score ＜4) of the 56 patients was 83.3％,it was 75.0％ in 5-FU group and 90.0％ in gemcitabine group.In radiotherapy with gemcitabine group,the incidence of 3～ 4 grade myelosuppression was significantly higher than that in radiotherapy with 5-FU group,and the difference between the two groups was statistically significant (20.0％ vs 7.6％,P ＜ 0.05).Conclusions For the locally advanced pancreatic carcinomas,radiotherapy with gemcitabine can improve pain-relief and prolong survival compared with radiotherapy with 5-FU,but the incidence of adverse event of myelosuppression is higher.