Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective To assess the effect of ultrasound-guided percutaneous 125I seed implantation for the treatment of osteolytic metastases. Methods From February 2011 to December 2013, a total of 18 patients with advanced cancer complicated by osteolytic metastases received ultrasound-guided percutaneous implantation of 125I seeds. According to visual analog score (VAS) the pain was estimated before and 3 days as well as one month after the treatment. One month after the treatment follow-up CT scan was performed in all patients to check the tumor size and the distribution of 125I seeds, and the therapy was repeated if necessary. The efficacy was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST). Results A total of 33 times of procedure were carried out in the 18 patients. Three days after the treatment, local pain was obviously relieved in all cases. Compared with preoperative VAS, the postoperative VAS was significantly improved (P=0.000). The pain was well controlled even one month after the treatment (P=0.000). One month after the last treatment the complete remission (CR) rate was 0% (n=0), partial remission (PR) rate 61.1% (n=11), stable disease (SD) 33.3% (n=6) and progress disease (PD) 5.6% (n=1), and local control rate (CR+PR) was 61.1%. No severe brachytheray-related complications occurred. Conclusion Ultrasound-guided percutaneous 125I seed implantation brachytherapy is technically simple and repeatable, it can safely and effectively guide the performance of percutaneous 125I seed implantation for the treatment of osteolytic metastases. Even in the circumstance of not using TPS, this technique can also obtain satisfactory local control rate and significant pain relief.

Objective: To observe the protective roll of atorvastatin on post-operative cardiac remodeling induced by transverse aortic constriction (TAC) in experimental mice with its possible mechanism.
Methods: A total of 48 C57BL/6 mice were randomly divided into 4 groups: Sham group, TAC group, TAC + valsartan group and TAC + atorvastatin group,n=12 in each group. Myocardial hypertrophy model was successfully established at 4 weeks after the operation, and then the animals were further treated by normal saline, valsartan 5mg/kg and atorvastatin 10mg/kg respectively for 8 weeks. Left ventricular anterior wall thickness at diastole (LVAWd), left ventricular posterior wall thickness at diastole (LVPWd), LVEF and left ventricular fractional shortening (FS) were examined by echocardiography, cardiac hypertrophy indexes were calculated. Protein expression of NF-κB was detected by Western blot analysis, cardiac tissue hydroxyproline (Hyp) level was measured by alkaline hydrolysis, serum levels of TNF-α, IL-1β were determined by ELISA, cardiac collagen deposition was identiifed by HE and Masson staining.
Results: Compared with Sham group, TAC group had increased LVAWd, LVPWd, cardiac hypertrophy indexes and increased area of cardiac fibrosis, allP<0.01; elevated protein expressions of NF-κB, Hyp, TNF-α, IL-1β, all P<0.01. Compared with TAC group, TAC + valsartan group and TAC + atorvastatin group presented improved cardiac hypertrophy indexes, decreased LVAWd, LVPWd and decreased area of cardiac ifbrosis, allP<0.01; reduced protein expressions of NF-κB, Hyp, TNF-α, IL-1β, allP<0.01.
Conclusion: Atorvastatin had protective roll on myocardial hypertrophy induced by pressure overload in experimental mice, which might be related to its anti-inlfammatory effect.

Objective:To investigate the complications of spastic cerebral palsy with selective posterior rhizotomy (SPR).Methods:In the study, 2 593 patients who had undergone SPR from January 2000 to September 2012 were followed-up for at least one year .The complications were classified .Results:Peri-operative complications:pulmonary system complications including bronchial spasm (5 cases, 0.19%) and aspiration pneumonia (4 cases, 0.15%);digestive system complications including abdominal bloa-ting (145 cases, 5.6%) and colic (80 cases, 3.1%);urinary system complications including tempora-ry bladder dysfunction (54 cases, 2.1%) and urinary tract infection (6 cases, 0.23%); peripheral nervous system complications including lower extremity weakness ( 327 cases, 12.6%) and lower extremity sensory disturbances ( 140 cases, 5.4%); central nervous system complications including headache (112 cases, 4.3%) and epileptic seizures (4 cases, 0.15%).None spinal or intracranial in-fection, intraspinal hematoma or intracranial hemorrhage were identified .General surgery complications including back pain (1 382 cases, 53.3%), delay wound healing caused by infection (5 cases, 0.19%) and cerebrospinal fluid leakage (8 cases, 0.31%).Long-term follow-up complications inclu-ding lower limb decreased exercise capacity ( incidence: 7.33%) and lower extremity sensory distur-bance (incidence:5.59%).Urination occurred in only one case and defecation function disturbance with no sexual dysfunction was identified .The incidences of scoliosis , thoracic kyphosis , spondylolisthe-sis and long-term back pain were 7.23%(31/429), 4.2%(18/429), 10.49%(45/429) and 9.72%respectively .Conclusion:SPR is one of the effective and safe surgical treatments for spastic cerebral pal-sy.Valid methods should be applied to reduce the incidence of postoperative complications , such as choosing the appropriate patients , meticulously operating in the surgery , assistance of electrophysiological guidance , reinforcing perioperative management and regular rehabilitation training after operation .

Objective Three parameters include circumferential strain (CS),circumferential strain rate (CSr) and stiffness parameter (β) were measured to evaluate the elasticity of carotid artery using two-dimensional(2D) strain imaging and evaluate its clinical value in patients with type 2 diabetes mellitus (T2DM).Methods 60 patients with T2DM were collected and divided into carotid intima-midia thickness (CIMT) thickeness group(34 cases,1.0 mm＜CIMT≤1.2 mm) and plaque group(26 case,CIMT＞ 1.2 mm).33 normal people were supplied as control group.The systolic global peak CS and CSr of the carotid artery were obtained from short-axis view of the common carotid artery and the stiffness parameters β was measured using 2D strain imaging.All the parameters were compared among the three groups.Results The CS and CSr were decreased and β was increased in patients with T2DM (P ＜ 0.01),The CS and CSr obtained from the plaque group were less than that of the CIMT thickeness group(P ＜0.05),but the β was higher than that of the CIMT thickeness group (P ＜0.01).The CS and β were correlated significantly with CIMT respectively (r =-0.79,P ＜ 0.01 ; r =0.72,P ＜ 0.01).Conclusions 2D strain imaging is a technique for early assessing the carotid artery elasticity in patients with T2DM,the thicker the CIMT is,the smaller the deformation is and the larger the β is.

Purpose To quantitatively evaluate longitudinal strain and strain rate (SR) of left ventricular (LV) in normal infants and young children using velocity vector imaging (VVI). Materials and Methods A total of 50 normal infants and young children were enrolled in the study. The longitudinal strain peaks and SR peaks in three sections of LV walls during systole period and relaxation period were measured by VVI from apical four-chamber view, apical two-chamber view and long axis view, respectively. Results Forty-one cases (82%) presented a smooth strain curve without incisures and a double peak in SR curve (systolic peak and single diastole peak). The strain in anterior septum and posterior septum, the systolic SRs and diastolic SRs decreased from basal to apical segments. However, only the strain in basal segment and that in apical segment in anterior septum showed statistic difference (t=1.79, P<0.05);the systolic SRs of the same level in different walls and those in the same wall at different levels had no statistic difference (P>0.05). Conclusion Most normal infants and young children present a smooth diastolic strain curve and a double peak SR curve of LV, which can provide clinical guidance in the early diagnosis of myocardial abnormality for infants and young children.

Objective To investigate the application of echocardiography in the diagnosis of neonatal ductus arteriosus aneurysm (DAA).Methods A total of 27 neonates with DAA were detected by echocardiography.Echocardiographic features in these cases were explored and outcome of these neonates were followed up.Results There were four crucial features in DAA detected by echocardiography:① A vessel bump was shown on the left side of the origination of left pulmonary artery(LPA) in the high parasternal short-axis view.②A horizontal shunt jet from the bump to the origination of LPA was shown when interrogate the top of the bump.③The bump joined the descending arota when interrogate it down and back orientately.A ‘V' shaped sign was shown when the aortic arch appeared on the right side and the bump on the left side.④A slow red flow signal was found in bump when the scale of color Doppler was cut down.The follow-up echocardiography showed spontaneous closure of the DAA when 3 months of age except one case lost.There were no abnormality in the figure and function in heart.Conclusions Echocardiography can be a valuable method for the diagnosis of neonatal ductus arteriosus aneurysm.Neonate with DAA have a good outcome.

Objective To develop fast detection techniques for the diagnosis of gonococcal infections.Methods Prokaryotic expression vector for Neisserial surface protein A (NspA) was constructed using the NspA gene cloned by PCR.Mice were immunized with the renatured recombinant NspA (rrNspA)to prepare antibodies against NspA.Western blot and ELISA was used to analyze the binding of NspA antibodies to lysate of gonococcal cells or to intact gonococci.Results NspA antibodies that were prepared by the rrNspA expressed in E.coli could bind to rrNspA,the natural NspA existing in gonococcal cells,or intact gonococci.Conclusion RrNspA and its antibodies have potential value in developing fast diagnostic kits for gonococcal diseases.

Objective To investigate the diagnosis value of immunophenotype and karyotypes in newly diagnosed chronic lymphocytic leukemia (CLL).Methods To retrospect the flow cytometry (FCM) immunophenotype and karyotypes characteristics in newly diagnosed 70 CLL cases.Results In all cases,the positive rates of CD19,CD20,CD5,CD23,CD22 were 100 ％,88.5 ％ (54/61),77.1％ (54/70),67.6 ％ (23/34)and 51.9 ％ (27/52),respectively.And 6 were misdiagnosed,2 was CD+5CD+19(+),but CD20,CD22 were strongly positive,final diagnosed as mantle cell lymphoma (MCL) by FISH t(11;14) examination and CyclinDl; CD+5CD+19(-) CLL were 16 cases (22.9 ％),but 4 were misdiagnosed,the misdiagnosis rate was 25 ％,significantly higher than that of CD+5CD+19(-) CLL (P =0.030).59 cases were examined by conventional cytogcnetic (CC),and 13 cases were with abnormal karyotypes,positive rate was 22.0 ％,with complex karyotypes in 5 cases (8.5 ％); 10 cases combined with FISH abnormalities karyotype examination rate was 60 ％.Conclusion Typical CLL immunophenotypic characteristics were CD5,CD19,CD23 co-expression,and CD－5 CLL with higher misdiagnosis rate,combined with CD20 (,) CD22 expression and karyotype analysis helps to CLL and other B lymphoid proliferative diseases (B-LPD) identification.Conventional cytogenetic detection combined with FISH scan can improve the recognition ability of abnormal chromosome.