Objective To explore correlation between cerebral microbleeds(CMBs)and cognitive dysfunction in patients with cerebral small vessel disease.Methods A total of 80 patients with cerebral small vessel disease admitted to Department of Encephalopathy in Nanjing University of Chinese Medicine Affiliated Lianyungang Hospital from January 2020 to December 2022 were selected as research objects.They were divided into CMBs positive group(50 cases)and CMBs negative group(30 cases)based on the presence or absence of CMBs in the cerebral hemisphere.General clinical data of two groups were compared.Cognitive function was assessed by using Montreal cognitive assessment scale(MoCA).Results Age and incidence rate of hypertension in CMBs positive group were significantly higher than those in CMBs negative group(P<0.05).Total score of MoCA,scores of visuospatial and executive function,abstract thinking and delayed recall in CMBs positive group were significantly lower than those in CMBs negative group(P<0.05).Conclusion CMBs are closely related to the potential mechanism,clinical diagnosis and degree assessment of cognitive dysfunction in patients with cerebral small vessel disease.

Objective　To explore the clinical value of 3D artistic spin labeling technology in evaluating early perfusion changes of leukaraiosis.Methods　Ninety patients and 30 healthy volunteers with different degrees of LA who were examined by magnetic resonance imaging were collected from January 2018 to April 2020.According to the Fazekas scale,they were divided into LA0,LA1,LA2 and LA3 group,30 cases were included in each group.CBF values of cortical watershed and subcortical watershed were measured according to cerebral blood flow pseudocolor image,and cerebral perfusion differences in anterior,posterior,radial crown and semicircular center of cortical watershed in different LA grades were evaluated,and the characteristics of early hemodynamic changes of LA were analyzed.Results　The CBF values of LA2,LA3 were significantly lower than that of LA0.There was no significant difference between LA1 and LA0 (P>0.05),however,the CBF in subcortical watershed was slightly lower than LA0 (P<0.05).Conclusion　3D ASL perfusion imaging technology can be used to quantify the CBF in the watershed area,and can be used to monitor the state of cerebral perfusion in LA patients.The CBF response in the subcortical watershed area is more sensitive,which can be used to evaluate the early cerebral hemodynamic changes in LA.

OBJECTIVE:To explore the clinical efficacy and safety of oxymatrine membrane,rhEGF gel respectively com-bined with Yunnan baiyao for postoperative cervical wound after LEEP. METHODS:300 patients with cervical intraepithelial neo-plasia(CIN)Ⅱ and Ⅲ were divided into group A,B,C(100 cases in each group)based on CIN grading and stratification and random sampling in each stratification. After conventional LEEP,patients in group A were cleaned the wound by 0.9% Sodium chloride injection,spraying Yunnan baiyao powder,once only after surgery;patients in group B were additionally given recombi-nant human epidermal growth factor (rhEGF) on the basis of group A,once every week after surgery,for 3 weeks;patients in group C were additionally given oxymatrine membrane on the basis of group A,1 tablet every evening after surgery,for 2 weeks. Postoperative bleeding,bleeding duration,rebleeding and duration after postoperative bleeding stopped,postoperative drainage du-ration,the incidence of adverse reactions in 3 groups were observed. RESULTS:The patients of postoperative bleeding,bleeding time ≥7 d and rebleeding after stopping bleeding in group B were significantly lower than group A;the incidence of bleeding time ≥7 d in group C was significantly lower than group A,the proporition of postoperative drainage duration for less than 7 d was significantly higher than group A,for 8-13 d was significantly less than group A;early wound healing rate in group B and group C were significantly better than group A,with statistical significances (P<0.05). There were no significant differences in above-mentioned indexes in group B and group C(P>0.05),and there were no obvious adverse reactions in 3 groups. CONCLU-SIONS:Oxymatrine membrane and rhEGF gel respectively combined with Yunnan baiyao have better healing than Yunnan baiyao alone,do not increase the incidence of adverse reactions,while there is no significant difference in oxymatrine membrane and rhEGF gel.

Objective To analyze the clinical characteristics of adult patients with hemophagocytic lymphohistiocytosis (HLH) receiving haploidentical donor hematopoietic stem cell transplantation (HID HSCT).Method We retrospectively reviewed 20 adult patients with HLH from August 2009 to August 2014.The clinical features and outcome were analyzed.Results Conditioning regimens consisted of total body irradiation/etoposide/cyclophosphamide (TBI/VP-16/CTX) and busulfan (Bu)/VP-16/CTX in HLH with anti-thymocyte globulin (ATG) 8 mg/kg.The stem cells were mobilized from donors' peripheral blood.Median time to white blood cell engraftment was 13 (9-27) days.Median time to platelet engraftment was 14 (10-28) days.Mixed chimerism after transplantation developed in 4 patients and no patient presented graft failure.Eight patients developed grade Ⅱ to Ⅲ acute graft-versus-host disease (GVHD),while as chronic GVHD occurred in 9 patients.Among 12 patients with EB virus (EBV) reactivation,2 patients developed post-transplant lymphoproliferative disorder (PTLD),7 were suspected as PTLD and 3 were considered as relapse of primary disease.With a median follow-up of 20 months (range:0.5-108 months) after transplantation,the estimated 2-year overall survival (OS) rate was (60.0 ± 11.0) ％ in all patients.During the follow-up,12 patients survived,8 died including 5 within 100 days after HSCT.Among 5 non-remission patients before HSCT,4 patients died within 100 days after HCT.Conclusions HID HSCT is an effective treatment for adult patients with HLH to achieve remission and long-term survival.High proportion of mixed chimerism has been seen at early stage after transplantation.EBV reactivation and early transplant-related mortality are common.

Objective To study the clinical features,treatment methods and clinical outcomes of acute tibialis posterior tendon rupture.Methods Using [(posterior tibial tendon) OR (tibialis posterior tendon)] AND (rupture OR injury OR disruption OR trauma OR tear) as the search words,we searched the PubMed database to retrieve the 19 articles involving 24 cases of acute tibialis posterior tendon rupture.The injury mechanisms,X-ray manifestations,operational findings,treatment methods and clinical outcomes were analyzed.Results The mechanisms of the fracture-related tibialis posterior tendon rupture included motor accident (50.0％,12/24),falling from a height (41.7％,10/24) and sports injury (8.3％,12/24).The tendon rupture was mostly complicated with malleolar fracture (91.7％,22/24),especially the pronation type (70.8％,17/24).Direct suture of the tendon was adopted in 91.7％ of the cases (22/24).Favorable outcomes were achieved in 95.5％ of the cases (21/24).Conclusions Acute tibialis posterior tendon rupture is mostly seen in high-energy medial malleolus fracture.The mechanism of the rupture might be tendon distraction or bone flake incision.Early operation can lead to favorable outcomes.

Objective To investigate the efficacy of rituximab-containing regimen in Epstein-Barr virus associated hemophagocytic lymphohistiocytosis (EBV-HLH). Methods A retrospective analysis involving 6 EBV-HLH patients who had received treatment with rituximab-containing regimen was performed. The patients who were diagnosed with lymphoma or primary HLH subsequently were not included in the analysis. Results All patients were males. The median age was 27.5 years (range 20-61 years). Two patients received rituximab-containing regimen as primary therapy, and got partial remission (PR) within 2 weeks after the first course of rituximab, but relapsed within 4 weeks. Four patients received rituximab-containing regimen as salvage therapy, but none achieved remission. The 6 patients died due to HLH and complications, such as infection and hemorrhage. Laboratory data including white blood cell count, haemoglobin concentration, platelet count ferritin, alanine transaminase, aspartate transaminase,total bilirubin, fibrinogen and EBV-DNA did not show statistical significance (all P>0.05). Conclusion The efficacy of rituximab as a treatment for EBV-HLH is not as good as that in the previous study, and a prospective clinical trial of rituximab-based monotherapy is needed to answer the question.

Objective To explore the clinical efficacy and safety of low-dose decitabine combined with cytarabine for myelodysplastic syndromes (MDS). Methods Clinical data of 15 patients with MDS who took the therapeutic regimen with decitabine combined with cytarabine were collected from January 2012 to January 2015. The clinical efficacy and adverse effects were assessed. Results Among the 15 patients, 4 cases were complete remission (CR), 5 cases were partial remission (PR) and 6 cases were stable disease (SD) and progressive disease (PD). The total effective rate was 60.0 % (9/15). Grade Ⅲ-Ⅳ bone marrow depression occurred in 11 cases with incidence rate of 73.3 % (11/15), and the total incidence rate of infection was 40.0 % (6/15), including lung infection of 26.7 % (4/15). All the infections were controlled after active supportive treatment and anti-infection therapy. No patient died of chemotherapy. Conclusions Low-dose decitabine combined with cytarabine can effectively treat MDS and delay the progress of disease. The patients can tolerate the adverse effects in chemotherapy with a low mortality rate.

Objective To explore the clinical effect and toxicity of daunorubicin combined with cytarabine (DA regimen) and idarubicin combined with cytarabine (IA regimen) for the treatment of patients with acute myeloid leukemia (AML) as induction chemotherapy. Methods The clinical data of 84 newly diagnosed AML patients (except M3) treated with DA or IA regimen were analyzed retrospectively. DA regimen group included 32 patients (17 males and 15 females with median age of 46 years), while IA regimen group included 52 patients (29 males and 23 females with media age of 49 years). Efficacy index was complete remission (CR), total efficiency and adverse reactions after one course of chemotherapy rate. Results In DA regimen group,the CR rate was 65.6 %(21/32), and the total efficiency rate was 75.0 %(24/32), while in IA regimen group, the CR rate was 71.2 %(31/52), and the total efficiency rate was 80.8 %(42/52), respectively, but, the differences of media survival and 5-year survival rate were not statistically significant (16.8 months vs. 24.9 months, 26 % vs. 44 %, both P>0.05). The main side effect in the two groups included hematologic (bone marrow suppression) and non-hematologic adverse reactions, with no significant difference between the two groups (all P>0.05). Conclusion For newly diagnosed AML patients, remission rate and total efficiency of DA regimen are same as IA regimen after one course treatment, and adverse events between the two regimens do not differ significantly.

Humans ; Lymphoma, Mantle-Cell ; pathology ; therapy

For the current situation of the time background and the cultivation of innovation ability of undergraduates, the problems of fracture classification, function evaluation and postoperative rehabilitation were realized by a software research team which mainly consisted of medical undergrad-uates. We put the project into practice in forms of software production and software promotion trial separately in the field of teaching and clinical practice to encourage students to be involved in learn-ing in the process of software production of professional knowledge. The implementation of the project worked well, and developed the well-designed relevant mobile software which was convenient in clini-cal practice and acquired computer software copyright, indicating that it can effectively motivate the undergraduates' innovation interest and consciousness through participating in the various links and the software production process, and it can also contribute to the cultivation of the comprehensive practical and innovation ability of medical undergraduates.