BACKGROUND: Vertigo caused by vertebral artery stenosis accounts for a corresponding large percent in vertigo patients. There is not a unified criterion in diagnostic method, which affects accuracy of diagnosis. Application of simply check such as neck rolling-flexion and head hypsokinesis test can give first diagnosis to patients with vertebral artery stenosis in clinic. Then examination of transcranial Doppler(TCD) and nuclear magnetic resonance angiography (MRA) can be given to increase accuracy of clinical diagnosis.OBJECTIVE: To appraise diagnostic value of vertebral artery stenosis by neck rolling-flexion test, TCD and MRA examination.DESIGN: Cases analysis based on patients.SETTING: Department of Neurology, Affiliated Hospital of Inner Mongolia Medical College.PARTICIPANTS: Totally 41 patients with diagnosis of vertigo were chosen in Clinic of Neurological Department in Affiliated Hospital of Inter Mongolia Medical College from February to April 2004. The cases with vertigo that were not caused by vertebral artery stenosis were excluded.METHODS: Totally 41 patients with vertigo whose symptoms were induced by neck rolling-flexion and head hypsokinesis test were given later examination of TCD and MRA to vertebral arteries and basilar artery.MAIN OUTCOME MEASURES: Three checking results of 41 patients.RESULTS: Totally 41 patients with vertigo whose symptoms were induced by neck rolling-flexion and head hypsokinesis test were chosen. Vertigo occurred after left-right neck rolling in 32 cases, which accounted for 78% in detectable rate, and vertigo occurred after neck flexion and head hypsokinesis in 25 cases, which accounted for 61% in detectable rate. Thirty cases were found dissymmetry of blood flow in vertebral arteries on two sides and diameter differences of vertebral arteries on two sides between 0.5-2.0 mm by examination of TCD, which accounted for 73% in detection rate. Thity-nine cases were found dissymmetry in inner diameter of vertebral arteries and the differences in diameter were between 0. 5-2.6 mm, which accounted for 95% in detection rate. The other two cases were detected vertebral artery stenosis.CONCLUSION: Neck rolling-flexion and head hypsokinesis test can induce vertigo symptom, which helps to give final diagnosis whether it is caused by vertebral artery stenosis. TCD examination has a corresponding higher accuracy in diagnosis of vertebral artery stenosis. MRA examination has the highest accuracy in diagnosis of vertebral artery stenosis.

Objective To evaluate the relationship between dyslipidemia and abdominal aortic aneurysm (AAA), with which as a theory base and proof we may further study about the mechanism of atherosclerosis (AS) leading to AAA. Methods Thirty abdominal aortic aneurysm patients in Guangdong General Hospital from 2013 to 2014 were enrolled into the experimental group and 26 healthy people into the control group. The serum levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), lipoprotein a (Lpa), nonestesterified fatty acid (NEFA), homocysteine (HCY), apolipoprotein A (ApoA) and apolipoprotein B(ApoB)were tested in the study. The statistical significance of the difference of them was examined by the independent two-sample t-test. Result The serum TG and HCY level in the experimental group were significantly higher than those in the control group (P<0.05). The serum ApoA and HDL level in the experimental group were significantly lower than those in the control group (P<0.05). The serum levels of TC, LDL, Lpa, NEFA and Apo B had no significant difference in both groups (P > 0.05). Conclusion The serum levels of TG and HCY are increased and the levels of Apo A and HDL are decreased in patients with AAA.

Objective To assess the utility of changes of muscle strength and compound muscle action potential (CMAP) of abductor digiti minimi (ADM) muscle after the exercise test in diagnosis of hypokalaemic periodic paralysis during inter-attack period. Methods Exercise test was applied on 59 patients with hypokalaemic periodic paralysis and 38 control subjects during inter-attack period. The changes of CMAP amplitude, muscle strength and the range of abduction of ADM muscle at 120 minutes after exercise were calculated and compared between the two groups. Results At 120 minutes after exercise, the M50 (M25, M75 ) of decrease in amplitude of CMAP recorded in ADM muscles were 54. 1% ( 43.1%,66. 3% ) in patients with periodic paralysis and 11.1% (2. 0%, 21.3% ) in control subjects(Z =6. 731,P=0.000), M5o(M25,M75) of decrease in range of abduction of ADM muscles were 39.4% (26.3% ,48. 9% ) in patients with periodic paralysis and 7. 8% ( 1.3%, 13.7% ) in control subjects ( Z = 5. 519,P=0. 000). The muscle strength of ADM muscle was less than Ⅳ grade in 96. 3% (52/54) patients with periodic paralysis and 8.6% ( 3/35 ) in control subjects ( x2 = 68.2, P = 0. 000 ). The sensitivity and specificity for decrease in CMAP amplitude ( best cutoff = 30% ) in diagnosis of hypokalaemic periodic paralysis were 87.5% and 93.7%, respectively. The sensitivity and specificity for decrease in range of abduction of ADM muscle ( best cutoff = 20% ) were 87.5% and 90. 5%, respectively. Conclusion Exercise test is recommended to apply on patients with suspected hypokalaemic periodic paralysis during inter-attack period. The decrease in range of abduction of ADM muscle more than 20% at 120 minutes after exercise supports the diagnosis of hypokalaemic periodic paralysis.

Objective To evaluate the feasibility and efficacy of twin grasper combined with endoloops on closing acute stomach perforation.Methods Two experimental porcines of stomach perforation underwent endoscopic closure by twin grasper combined with endoloops.Survival conditions and closure of perforating were observed.Results Mild infection and abdominal adhesions were observed in one week after operation.The nylon rope fell off and an ulcer-like lesion was presented in the closed position.The methylene blue leak test was negative.Histologic examination revealed chronic inflammatory cells infiltration,granulation,fibroplasias,and regenerative mucous membrane crawling toward the center of perforation.Conclusion The technique of twin grasper combined with nylon ropes in closing the acute stomach perforation is feasible and effective.

Objective To appraise the safety and validity of early enteral nutrition on the course on treating severe acute pancreatitis(SAP).Methods The clinical data of 71 patients with SAP were analyzed retrospectively. The album, prealbumin, TNF-β,CD4/CD8,IgG were observed. All the patients were randomly divided into two groups: enteral nutrition(EN)group for 36 patients and total parenteral nutrition(TPN)group for 35 patients. Results Fourteen days after treatment,CD4/CD8 and IgG in EN group were significantly increased than those in TPN group(P＜0.05),and prealbumin level in EN group significantly elevated(P＜0.05)and was higher than that in TPN group(P＜0.05).After treatment,TNF-α level in EN group significantly depressed(P＜0.05)and was lower than that in TPN group(P＜0.05).Conclusion Early enteral nutrition is safe and valid, and can promote albumin synthesis and prealbumin levels to improve their nutrition in patients with SAP, and may build-up the barrier of enteric mucosa to prevent bacterial shift, reduce systemic inflammatory reaction and improve its prognosis.

BACKGROUND:In chronic gout patients,sodium urate is deposited in bone joints and around synovial membranes,eroding and destroying bone,leading to serious complications such as gouty arthritis and deformity.Research on the mechanisms by which sodium urate crystals erode and destroy bone can help early clinical intervention in gouty diseases and prevent and delay the complications caused by bone destruction. OBJECTIVE:To explore the destructive effects of gout crystals on bone through clinical imaging studies and experimental basic research,review the current progress and development prospects of research on the phenomenon and mechanism of bone destruction caused by gout,guide the clinical early intervention of gouty bone destruction,and guide the direction of research on the role of bone destruction. METHODS:The Chinese search terms were"gout,bone destruction,bone erosion"and the English search terms were"tophi,gout,RANKL,bone destruction,bone erosion,"which were used in the computer search of WanFang and PubMed databases.Finally,64 articles were selected for review according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION:The specific manifestations of clinical studies(imaging,histopathology)to some extent elaborate the osteolytic process of gout,and in basic studies,the mechanism of gout-causing bone destruction can be divided into the five aspects:(1)Sodium acid crystals have an important role in bone destruction,directly affecting osteocytes,chondrocytes,osteoblasts and proresorptive factors that promote bone destruction;(2)Receptor activator of nuclear factor-κB ligand and other proresorptive factors are involved in bone destruction;(3)T cell-mediated cellular immunity functions as a bridge in bone destruction,and activated T cells induce osteoclast differentiation;(4)Monocytes/macrophages are not only precursors of osteoclast-like cells,but also induce the expression of proresorptive factors such as Receptor activator of nuclear factor-κB ligand;(5)Neutrophils affect the morphology of osteoclast arrangement,and neutrophil extracellular trap networks promote osteolysis by promoting osteoclast differentiation.

The clinical study of multiple myeloma at various stages has been reported at 2019 American Society of Hematology Annual Meeting. This article focuses on several key studies of the treatment of high-risk smoking multiple myeloma (HR-SMM), newly diagnosed multiple myeloma (NDMM) and relapsed/refractory multiple myeloma (RRMM), especially the chimeric antigen receptor T-cell (CAR-T) therapy, in order to guide clinical selection of better treatment options. However, most of these studies are phase Ⅰ-Ⅱ studies, and the median follow-up period is short, the long-term follow-up and the results of phase Ⅲ studies with enlarged samples are needed to further determine the effectiveness and safety of each treatment plan.

Systemic amyloidosis is caused by misfolding of heavy or light chain in immune globulin and extracellular deposition of proteins as amyloid fibrils. The most common form is light chain amyloidosis, which results in dysfunction of vital organs. Specific biomarkers and amyloid imaging can prompt organ dysfunction at early diagnosis and prevent the organ failure at end stage. Combination therapy is the direction of light chain amyloidosis therapy in the future. The studies on the target therapy concerning clone light chain and amyloid deposition, and new drugs that can control light chain gathering and hydrolysis are under exploration. This paper reviews the treatment progress of light chain amyloidosis.

Objective:To screen and analyze ferroptosis-related genes (FRG) impacting the prognosis of colorectal adenocarcinoma patients based on bioinformatics.Methods:RNA sequencing data including the clinical information of 545 colorectal adenocarcinoma patients and 602 data sets were downloaded from the Cancer Genome Atlas (TCGA) database. FRG gene sets were downloaded from FerrDb database. FRG expression dataset could be obtained after taking the intersection between FRG gene sets and TCGA database gene sets. Differentially expressed FRG and prognosis-related genes between colorectal adenocarcinoma tissues and the adjacent tissues were screened by using R software, and finally FRG influencing the prognosis of colorectal adenocarcinoma were obtained. According to protein-protein interaction networks, the interaction and the expression association of proteins were analyzed. LASSO regression analysis was used to build a risk model for patients' 5-year overall survival rate. The risk value was calculated for 509 colorectal adenocarcinoma samples in the TCGA database, and then the median risk value was taken as the cut-off value. All patients were divided into the high-risk group (≥ median risk value) and the low-risk group (< median risk value), and the survival curves of the two groups were drawn. The receiver operating characteristic (ROC) curve was drawn for predicting the 5-year overall survival rate of colorectal adenocarcinoma patients in a time-dependent way in TCGA database according to the risk value of FRG prognosis model. Cox proportional risk model was used to make univariate and multivariate survival analysis in order to screen factors affecting the prognosis. The pathway enrichment analysis of prognosis-related FRG of colorectal adenocarcinoma was performed based on gene ontology (GO) database and Kyoto Encyclopedia of Genes and Genomes (KEGG) database.Results:The clinical information of 545 patients and 602 datasets were extracted from the database. A total of differential expressed 199 FRG in colorectal adenocarcinoma and 28 prognosis-related FRG were identified. After taking the intersection, 21 FRG affecting the prognosis of colorectal adenocarcinoma patients were identified. DUOX2, NOX4, NOX1, DDIT3, JDP2, ATP6V1G2, ULK1, ATG3 were probably associated with WIPI1; expressions of NOX4, NOX5, PLIN4 were positively correlated with ATP6V1G2, while the expression of ULK1 was negatively correlated with MAPK1, MYB, FANCD2, ATG3 and ATP5MC3. LASSO regression analysis showed that 15 FRG were finally screened out (ATP5MC3, NOX4, NOX5, ALOX12B, ATG3, WIPI1, MAPK1, MYB, AKR1C1, DDIT3, JDP2, ATP6V1G2, DRD4, SLC2A3, PLIN4), and the risk model was constructed by calculating the risk value, and the risk value = NOX4×0.139-ATP5M3×0.108+NOX5×1.486+ALOX12B×0.475-ATG3×0.030-WIPI1×0.170-MAPK1×0.271-MYB×0.063+AKR1C1×0.021+DDIT3×0.186+JDP2×0.292+ATP6V1G2×0.777+DRD4×0.294+SLC2A3×0.059+PLIN4×0.113. The overall survival of patients in the high-risk group was worse than that in the low-risk group ( P < 0.001). The 5-year overall survival rate was 48.2% in the high-risk group and 76.8% in the low-risk group. Multivariate survival showed that the age and risk value were independent affecting factors of the prognosis. ROC curves revealed that the risk model constructed by using prognosis-related FRG could well predict the 5-year overall survival rate of patients (the area under the curve was 0.728). The differential expressed genes of both groups may be associated with genetic pathways such as extracellular matrix composition, extracellular structure composition and focal adhesion. Conclusions:The prognostic risk model constructed by the screened FRG can better evaluate the prognosis of colorectal adenocarcinoma patients. These FRG are expected to become new candidate biomarkers related to the prognosis of colorectal adenocarcinoma.

Objective:To evaluate the efficacy and safety of azacytidine (AZA) combined with homoharringtonine (HHT) and low-dose cytarabine (LDAC) in the treatment of acute myeloid leukemia (AML) patients with 3+ 7 conventional regimen intolerance.Methods:A retrospective analysis was conducted on the clinical characteristics, efficacy, prognosis, and adverse events of 33 AML patients (15 initially diagnosed and 18 relapsed/refractory) admitted to the Second Xiangya Hospital of Central South University.Results:Among the 33 AML patients treated with this regimen, the median age was 55 years old, 9 patients had a moderate cytogenetic risk, and 18 patients had a high cytogenetic risk. Among the 33 patients, 3 were lost to follow-up and 1 had incomplete data. Among the remaining 29 patients who received AZA+ HHT+ LDAC treatment, the total complete response (CR) rate was 69.0%(20/29), and the total response rate (ORR) was 79.3%(23/29); The median progression free survival (PFS) was 7.0 months. Among the subgroup analysis, including age, gender, Eastern Cooperative Oncology Group (ECOG) score, disease classification, bone marrow progenitor cells, peripheral blood leukocytes, risk stratification, and epigenetic abnormalities, only CR rates and PFS differences were statistically significant among different ECOG scoring groups ( P=0.048; P=0.021). A total of 29 patients underwent 69 AZA+ HHT+ LDAC chemotherapy cycles. Retrospective grading was performed on 69 cycles based on common toxicity criteria for adverse events (CTC AE version 5.0). The most common grade Ⅲ-Ⅳ hematological adverse events were thrombocytopenia (54/69, 78.3%) and granulocytopenia (48/69, 69.6%). Common non hematological adverse events included nausea (19/69, 27.5%), infection (17/69, 24.6%), and hypokalemia (18/69, 26.1%). Conclusions:AZA combined with HHT and LDAC has a good therapeutic effect in the treatment of acute myeloid leukemia, and adverse reaction events are controllable.