Because there are the fiber connections between striatum and substantia nigra, the striatal infarction may result in the secondary degeneration of the substantia nigra. In recent years, there have been a series of characteristics on secondary lesions of the substantia nigra, pathophysiological mechanisms, and the studies of how to detect the patients with striatal infarction in vivo. This article reviews the advances in this field.

A focal cerebral infarction results in anterograde and retrograde secondary degenera-tion in remote site. The secondary degeneration in remote site may progress gradually in a certain time and cause harmful effects on the neural function recovery of patients.

Objective To investigate the efficacy and toxicity of bortezomib in combination with dexamethasone for the treatment of patients with multiple myeloma(MM).Methods Fourteen patients(11 males,3 females,mean age 65.1 yrs)with MM,who were hospitalized in the First Affiliated Hospital of Wenzhou Medical College from June 2005 to July 2007,were treated with bortezomib(1.3 mg/m2)by intravenous bolus twice a week for 2 weeks in a 21-day cycle,followed by an intravenous injection of dexamethasone 20～40 mg.The patients received one to eight courses.Response to bortezomib was evaluated according to the criteria of the European Group for Blood and Marrow Transplantation(EBMT)before initiation of each bortezomib chemotherapy course.Adverse effects were graded according to the National Cancer Institute Common Toxicity Criteria,version 3.0.Results The median follow-up duration from the begining of bortezomib treatment was 3.5 months.Clinical reponse was observed in 12 patients(86%),including complete response in 2,nearly complete response in 6,partial response in 3,minimal response in 1 and progressive disease in 2.The most common adverse effects were fatigue(10 patients),peripheral neuropathy(7 patients),gastrocnemius myalgia(2 patients),gastrointestinal symptoms(4 patients),thrombocytopenia(5 patients),disseminated herpes zoster(1 patient)and refractory hyponatremia(1 patient).The adverse effects were subsided on routine supportive care.Conclusion Bortezomib in combination with dexamethasone is an effective therapy with a high response rate for MM patients.All the adverse effects are more than common but are manageable with symptomatic therapy and(or)dose modification.

Objective To determine the content of anabasine in Fengshiding tablets.Methods RP-HPLC method was established.Diamonsil-C18 was used as chromatographic column,the mobile phase consisted of methanol and 0.1 %triethylamine(5 ∶95,adjust pH to 3.6 with H3PO4),the flow rate was 1.0 mL?min-1 and the detection wavelength at 259 nm.Results The average recovery for Anabasine was 99.0 %,RSD=2.8 %(n=6).Conclusion The method can be used to determine the content of anabasine in Fengshiding tablets.

Objective To study the clinical results of patients with gallbladder stones and common bile duct stones treated either by laparoscopic cholecystectomy followed by endoscopic sphincterotomy (EST + LC) or laparoscopic cholecystectomy + common bile duct exploration (LC + LCBDE) in the elderly patients.Methods A retrospective study was conducted on 96 patients who had common bile duct and gallbladder stones treated from January 2012 to January 2016.The patients were divided into the control group and the observation group.46 patients were in the observation group who underwent LC three days after EST,while the remaining patients were in the control group who underwent LC and LCBDE.The serum amylase levels before LC,operation time,intraoperation bleeding volume,postoperative time to first flatus,total hospitalization stay and total hospitalization costs and incidences of postoperative complication were compared.Results The total operation time was (95.0 ±7.0) minutes and (125.0 ± 18.0) minutes,respectively,(P＜0.05).The total costs in the two group were (39515.0 ±4 135.0) yuan and (28287.0 ± 2 254.0) yuan (P ＜ 0.05),respectively.Postoperative complications were observed in 5 (6.1％) and 10 (13.2％) patients (P ＜ 0.05),respectively.The preoperative serum amylase levels were (97.6 ± 48.5) IU/L and (131.4 ± 68.7) IU/L,respectively.The blood loss was (35.7 ± 8.5) ml and (31.8 ± 7.3) ml,respectively.The postoperative time to first flatus was (1.7 ± 0.5) days and (1.9 ± 0.4) days,respectively.The total hospitalization stay was (16.3 ±2.8) days and (15.2 ±3.7) days.There were no significantly differences (P ＞ 0.05).Conclusions LC carried out on day 3 after EST to treat elderly patients with cholecystolithiasis and choledocholithiasis was safe and efficacious and the treatment had the advantages of minimal trauma,short operative time,rapid recovery and low complication rates.This should be recommended in clinical practice.

Objective To evaluate the efficacy and adverse effects of the three dimensional conformal radia- tion therapy(3D-CRT) concurrently combined with chemotherapy for limited stage small cell lung cancer(LSCLC). Methods 33 patients with LSCLC received 6 cycles EP(cisplatin,etoposide) chemotherapy and 3 weeks was a cy- cle. The conventional radiotherapy was given after the first cycle chemotherapy or the third cycle chemotherapy, then the 3D-CRT and the total dose of the primary tumor was 45Gy per 3 weeks,1.5Gy for once,twice for a day. Results Toxicity was durable in 33 patients received 3D-CRT concurrently combined with chemotherapy. The total re- sponse was 97 %. Median time was 21.9 months, and the 1-,2-, 3-year survival rates was 69.7 % ,51.5 %, 30.3 %. The 1-,2-, 3-year local progress ion-freely survival rates were 66.7 %, 45.5 %, 30.3 %, respectively, with the median local progression-freely survival time of 18.5 months. Respectively during three year follow-up visit. Conclusion The 3D-CRT concurrently combined with chemotherapy for patients with limited stage small cell lung cancer could be more effectively, and the patients could tolerate the side effects, this therapy method was secure and received.

Background Inflammation is one of the most popular aspects in the studies of diabetic retinopathy (DR) mechanisms.Researches showed that S100A8/A9 participate in the inflammatory procedure of many diseases,however,the relationship between S100A8/A9 complex and retinal inflammation of DR needs to be researched.Objective This study was to detect the serum S100A8/A9 level of diabetes mellitus (DM) and DR patients,and explore its role in DM an DR development.Methods A cases-controlled study was carried out.The DR patients,type 2 DM patients without retinal change and heathy controls were enrolled in Shanghai Xuhui Central Hospital from January to June 2014,and 30 patients for each group.The DR patients were subgrouped to non-proliferative DR (NPDR) group and proliferative DR (PDR) group.The periphery blood was collected to isolate the serum,and serum S100A8/A9 complex level was detected by ELISA.Serum high-sensitivity C-reactive protein (hsCRP) and glycosylated hemoglobin A1C (HbAlc) level was assayed by immunity turbidimetry and immune agglutination respectively.Results Serum S100A8/A9 complex levels in the DR group,DM group and normal control group were (9.74±0.59),(11.41 ±0.64) and (6.46 ±0.62) μg/L,respectively,and the serum S100A8/A9 complex level in the DM group and DR group was significantly higher than that in the normal control group,and the serum S100A8/A9 complex level in the DM group raised in compared with the DR group (all at P＜0.01).Serum hsCRP levels in the DR group,DM group and normal control group were (1.40±0.34),(1.27±0.13) and (1.11 ± 0.12)mg/L,respectively,with the highest value in the DR group and the lowest value in the normal control group (all at P=0.00).The serum HbAlc levels were higher in the DR group and DM group than those in the normal control group (both at P =0.00),while no significant difference was found in the serum HbAlc level between DR group and DM group (P =0.12).There was no significant differece in the serum S100A8/A9,hsCRP and HbAlc levels between NPDR group and PDR group (t=-0.10,P =0.92;t =-0.17,P =0.87;t =0.66,P =0.51).A weak positive correlation was seen between serum S100A8/A9 level and serum hsCRP level (r =0.36,P =0.00).Conclusions As an inflammatory marker,S100A8/A9 complex might play an important role in the pathogenesis and development of DR.Intensive control of glycemia can alleviate retinal inflammation in DM patients.

Objective To determine whether it is better to carry out laparoscopic cholecystectomy (LC) immediately or 3 days after endoscopic sphincterotomy (EST) in patients with common bile duct stones and gallbladder stones.Methods A retrospective study was conducted on 160 patients who had common bile duct stones and gallbladder stones treated from July 2013 to July 2015 in the First People's Hospital of Huizhou.These patients were divided into a control group and an observation group,with 80 patients in each group.The control group underwent LC immediately after EST,while the observation group underwent LC 3 days after EST.The levels of blood amylase before LC,operation time,intraoperative bleeding volume,postoperative time to first flatus,postoperative complication after EST,postoperative hospitalization stay,total hospitalization stay and total hospital costs and incidences of postoperative complication after LC were compared between the two groups.Results The time periods of total hospitalization stay in the observation group and the control group were (18.2 ±3.5) d and (12.3 ±3.0) d,respectively (P＜0.05).The total costs in the two groups were (32 164 ±9 125) RMB and (22 375 ±7 860) RMB,respectively (P ＜ 0.05).The overall incidences of postoperative complication [patients (％)] were 5 (6.3) and 9 (11.3),respectively (P ＜ 0.05).The differences on preoperative serum amylase levels,LC operative time,blood loss,postoperative time to first flatus and postoperative hospitalization stay were not significantly different (P ＞ 0.05).Conclusion LC carried out on day 3 after EST to treat common bile duct stones and gallbladder stones was clinically more efficacious.

AIM: To investigate the changes of bladder volume , pressures and pelvic nerve firing induce by different speeds and ways of instillation .METHODS:Female SD rats (n=20) were randomly divided into 2 groups.The rats in group A was performed using 3-F polyethylene tubing inserted into the bladder through the urethra .The rats in group B were performed using 3-F tubing inserted into the dome of the bladder and secured by silk suture .The rats in both groups were infused with saline into the bladder at different speeds of 50, 100, 200 and 400μL/min.The changes of bladder vol-ume and pressure were recorded by urodynamic measuring devices .The changes of pelvic nerve firing during instillation were recorded by multi-channel physiologic recorder .RESULTS:In group A, the maximum firing frequency , bladder leak point pressure ( BLPP) and maximum voiding pressure ( MVP) were increased with the increase in the instillation speed . No significant difference of the maximum bladder capacity (MBC) at different speeds was observed .In group B, the maxi-mum firing frequency had no significant difference at different speeds .MBC was decreased with the increase in the instilla-tion speed , and exhibited significant decrease at 200 and 400 μL/min.No significant difference of BLPP and MVP at dif-ferent speeds was observed .Compared with group A , the maximum firing frequency and MBC in group B significantly de-creased at different speeds .However , BLPP and MVP in group B were higher than those in group A at the speeds of 50 and 100 μL/min.CONCLUSION:Different instillation speeds with the method of group A will not change the bladder volume but influence the pelvic nerve firing , so the process of method A may take various speeds according to different aims .How-ever, process of method B at the speed of over 200 μL/min may not be good to MBC, thus instillation under 200 μL/min is re-commended .

The computerized imitating system constructed by the Second Affiliated Hospital of Guangzhou Medical University contains four blocks:administration of student infomation,administration of question bank,on-line tests and administration of score inquiry.It's designed to imitate typical pediatric cases,so that the medical students may put themselves into the practical clinical scenario and solve the challenges step by step in one-direction procedure.Teaching with computerized clinical scenario imitating patients can improve students' test resuhs and activate students' learning enthusiasm significantly.It not only helps to solve the contradiction between increasing number of medical students and clinical typical teaching case shortage but also improves the clinical thinking ability of the medical students.This system can also be used as a test bank for pediatric technical skills examination.