Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a specific subtype of the stiff-person syndrome, which is rare and difficult to diagnose clinically. A case of PERM in a 66-year-old female with a fluctuating progressive course was reported in this article. She had increased facial muscle tone, pruritus and sensory hypersensitivity mainly in the head and neck, medullary involvement syndrome and bilateral lower limb rigidity as the main clinical manifestations, and a previous history of pulmonary malignancy, thymoma, typeⅠ diabetes and Hashimoto′s thyroiditis. The patient′s serum and cerebrospinal fluid were positive for anti-glutamic acid decarboxylase antibody. The electromyogram showed a large number of motor unit potentials in the trunk and proximal extremities in the quiet state, which were significantly enhanced during spastic episodes, consistent with the electromyographic manifestations of stiff-person syndrome. The final diagnosis was PERM, and immunotherapy including gamma globulin and hormone responded well. PERM is a rare neurological autoimmune disease with atypical early symptoms, which can be easily misdiagnosed, and it requires attention to avoid delaying the diagnosis.

Objective:To investigate the correlation between item d560 of the International Classification of Functioning, Disability and Health (ICF) and the swallowing function of convalescing stroke patients.Methods:A total of 140 convalescent stroke survivors were evaluated for dysphagia using the ICF-d560 and the modified Watian drinking water test. Linear regression was used to analyze the influence of clinical factors when choosing a swallowing function assessment scale. Spearman correlation was computed to explore the correlation between ICF item d560 and the modified Watian drinking water test.Results:According to the ICF-d560 results, 10% of the patients had a mild disorder, with another 37.1% moderate, 29.3% severe and 23.6% completely dysphagic. The corresponding percentages according to the improved Watian drinking water test were 44.3% mild, 31.4% moderate and 24.3% severe. The total correlation coefficient between the two sets of results was 0.86, which was related to the stroke type, age, gender and stroke risk factors. The correlation coefficient of the cerebral infarction group was significantly higher than the cerebral hemorrhage group′s coefficient, and that of the women was slightly higher than that of the men. The strength of the correlation increased with age. The correlation coefficient was 0.84 among both diabetics and hypertension sufferers.Conclusions:Results from the ICF-d560 and the modified Wada drinking water test correlate well, which can provide a screening tool for swallowing function based on the ICF theoretical framework.

Objective To approach the significance of changes of percutaneous-arterial blood carbon dioxide partial pressure difference [P(tc-a)CO2] in liquid resuscitation of patients with septic shock. Methods One hundred and sixty-eight patients with septic shock admitted and treated in the Department of Intensive Care Unit (ICU) of Quzhou People's Hospital from January 2015 to January 2018 were enrolled, and after early goal-directed therapy (EGDT) for 6 hours, according to central venous oxygen saturation (ScvO2) and lactate clearance (LC), they were divided into ScvO2 and LC achievement group (ScvO2 ≥ 0.7 and LC≥10%), ScvO2 achievement group (ScvO2 ≥ 0.7 and LC < 10%), LC achievement group (ScvO2 < 0.7 and LC≥10%), and un-achievement group (ScvO2 < 0.7 and LC < 10%). The mechanical ventilation time, ICU hospitalization time, 28-day mortality, P(tc-a)CO2 etc. were compared among the four groups; the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of P(tc-a)CO2 for 28-day prognosis in patients with septic shock. Results The trends of mechanical ventilation time, ICU hospitalization time, and 28-day mortality were all ScvO2 and LC achievement group < LC achievement group < ScvO2 achievement group < un-achievement group [the mechanical ventilation times (days) were respectively 6.12±2.59, 8.43±3.24, 11.78±4.12, 13.03±4.75, ICU hospitalization times (days) were 10.31±2.32, 13.85±3.56, 16.41±3.83, 18.52±4.05, and 28-day mortality rates were 28.85% (15/52), 40.91% (18/44), 51.28% (20/39), 69.70% (23/33)] and the differences among the four groups were statistically significant (all P < 0.05). After 6 hours of EGDT, the heart rate (HR), lactate (Lac), and P(tc-a)CO2 were lower than those before fluid resuscitation, but the mean arterial pressure (MAP), central venous pressure (CVP), and ScvO2 were higher than those before fluid resuscitation among four groups. Except CVP, the differences of other indicators compared among the ScvO2 and LC achievement group, ScvO2 achievement group, LC achievement group and un-achievement group were statistically significant (all P < 0.05). After 6 hours of EGDT, HR, Lac, P(tc-a)CO2 in ScvO2 and LC achievement group, ScvO2 achievement group and LC achievement group were significantly lower than those in the un-achievement group [HR (bpm): 89.05±29.43, 98.82±30.21, 94.33±28.64 vs. 112.85±32.74, Lac (mmol/L): 2.97±1.95, 3.87±2.32, 2.69±1.52 vs. 4.17±2.44, P(tc-a)CO2 (mmHg, 1 mmHg = 0133 kPa): 7.18±4.61, 12.61±5.34, 9.71±4.11 vs. 16.56±10.19], MAP and ScvO2 were significantly higher than those of the un-achievement group [MAP (mmHg): 88.05±21.67, 77.33±18.56, 83.11±19.71 vs. 70.32±18.79, ScvO2: 0.76±0.14, 0.75±0.16, 0.67±0.14 vs. 0.63±0.18, all P < 0.05]. The P(tc-a)CO2 of 28 days survivors were significantly lower than that of the deaths among four groups (mmHg: 5.78±2.27 vs. 14.14±3.65, 7.07±2.81 vs. 15.06±4.11, 6.35±2.09 vs. 14.94±4.06, 7.93±3.81 vs. 18.34±4.63, all P < 0.05). When P(tc-a)CO2 > 7.24 mmHg predicted 28-day mortality in ScvO2 and LC achievement group, the sensitivity was 89.29%, specificity was 91.45%, and the area under ROC curve (AUC) was 0.86; when P(tc-a)CO2 > 9.46 mmHg predicted 28-day mortality in LC achievement group, the sensitivity was 88.72%, specificity was 85.83% and AUC was 0.91; when P(tc-a)CO2 >12.05 mmHg predicted 28-day mortality in ScvO2 achievement group, the sensitivity was 82.79%, specificity was 86.90% and AUC was 0.79; when P(tc-a)CO2 > 16.22 mmHg predicted 28-day mortality in un-achievement group, the sensitivity was 73.35%, specificity was 80.68% and AUC was 0.68. Conclusion P(tc-a)CO2 can be used as an indicator to evaluate fluid resuscitation effect and prognosis in patients with septic shock.

Objective To evaluate the clinical efficacy and safety of robotic-assisted laparoscopic Boari flap ureteroplasty for ureteral strictures after kidney transplantation.Methods The clinical data of 2 patients with ureteral stricture after kidney transplantation in our department from May 2017 to September 2017 were retrospectively analyzed.All 2 cases were male.Case 1 was 73 years old and the transplanted kidney was located in the left iliac fossa.The patient was hospitalized due to still recurrent fever with longterm retention of nephrostomy tube because of hydronephrosis with repeated urinary tract infection after calculi surgery.Case 2 was 62 years old and the transplanted kidney was located in the right iliac fossa.The patient was hospitalized due to hydronephrosis and ureteral calculi after calculi surgery.All 2 cases were treated by robotic-assisted laparoscopic Boari flap ureteroplasty.The operative and postoperative complications were recorded and the postoperative examination data were collected.Results The operation time of the 2 cases were 165min and 189min,and the bleeding amount were 50ml and 100ml respectively.No urinary leakage,renal colic,high fever and other complications occurred.In case 1,nephrostomy tube was removed 8d after operation.The urinary catheters were removed 14d after operation in the 2 cases.The postoperative hospital day was 9d and 6d respectively.CT examination was performed 3 months after surgery.Compared with preoperative,case 1 had no significant change in hydronephrosis and the hydronephrosis of case 2 obviously relieved.In case 1,double J tube was removed in 3 months after operation.In case 2,double J tube was replaced in 3 months after operation and was removed after 3 months.2 patients were followed up to 18 months and 14 months after operation,respectively.Nohydronephrosis aggravated.Conclusions Robotic-assisted laparoscopic Boari flap ureteroplasty is a safe and effective treatment for ureteral strictures after kidney transplantation.It has the advantages of small trauma,quick recovery,exact effect and few complications.

Objective To study plasma coagulation factor Ⅶ effects of intracerebral hemorrhage in patients with craniocerebral injury.Methods 120 cases of patients with traumatic brain injury were treated,for patients admitted to hospital,the hospital after 24 hours,48 hours of live clotting enzyme activation part (APlT),peripheral venous blood specimen testing international standardization ratio (INR)and the activity of platelet and F Ⅶ were detected.According to the intracranial bleeding lesions was expanded or the emergence of a new bleeding lesions,and so on and so forth were divided into research group and the control group,43 patients in the research group,77 cases in the control group.Results The study showed that the two groups of patients with injury to the first CT time, subarachnoid hemorrhage,epidural hematoma,there were no significant difference between the indexes of subdural hematoma,patients in the study group lost 48h PPSB was (653.2 ±489.8)IU,platelet (180.7 ±63.5)mL,plasma (582.7 ±411.3)mL and red blood cells (612.3 ±490.1)mL,which were higher than those of the control group [(465.7 ±278.8)IU,(0.0 ±0.0)mL,(335.1 ±261.9)mL,(378.3 ±46.3)mL],there were statistifically significant differences between the two groups(t =2.399,2.388,2.582,3.231,P =0.020,0.022,0.010,0.001), the platelet and F Ⅶ of the research group were (101.43 ±41.85)×109 /L,(93.04 ±20.98)%,which were lower than those of the control group[(128.37 ±51.49)×109 /L,(107.67 ±20.25)%],there were statistifically significant differences between the two groups(t =2.583,2.893,P =0.010,0.004).Conclusion Lower levels of platelet activity and F Ⅶ of closely associated with intracranial hemorrhage in patients with craniocerebral injury,according to the clinical indicators to predict whether patients with intracranial hemorrhage,in order to for the treatment of patients with timely and accurate to ensure the patient's life and health.

This study was aimed to identify original plants of Xi-Huang-Cao (XHC) through DNA barcodes. The nu-cleotide sequence information of rbcL, psbA-trnH, matK and ITS2 regions were abstracted using standardized man-ners from 41 samples (including Rabdosia serra, R. lophanthoides and R. lophanthoides var. graciliflora). Sequencing efficiency of each marker was calculated. Species identification capability was tested on the basis of TaxonGap. The results showed that sequence success rates were 100% for rbcL, 90.2% for psbA-trnH, 87.8% for ITS2, and 70.7%for matK. Three markers (rbcL, psbA-trnH and ITS2) were competent for species discrimination (not for subspecies). It was concluded that rbcL can be the preferred barcode for XHC because of its convenience and efficacy.

This article was aimed to study the species identification capability of psbA-trnH among Guanzhong herbs from Dryopteri. The nucleotide sequence information of psbA-trnH region was abstracted using standardized manners from 9 Dryopteri species (19 samples). The identification efficiency of psbA-trnH was analyzed based on TaxonGap among both tested materials (9 species, 19 samples) and tested materials plus GenBank data (17 species, 44 samples in total). The results showed that with the expanded species range, the discriminative efficiency of psbA-trnH de-clined from 100% (9/9) to 82.4% (14/17), while the proportion of within-specific heterogeneity larger than between-specific separability increased from 11.1% (1/9) to 52.9% (9/17). It was concluded that psbA-trnH can be recom-mended as the valuable barcode for homonym distinguishment among Guanzhong herbs, with attention of adequate sampling within species.

Objective To establish chronic stress model of depression in adolescent rats and to examine the effects of different antidepressant treatment on depression and anxiety-related behaviors.Methods Male Wistar rats were given 21-day chronic mild stress (CMS) during their adolescence (postnatal day 30～50, PND30～50).During stress period, rats were treated with fluoxetine (10 mg/kg i.p.) or imipramine (10 mg/kg i.p.), respectively.After stress, rats were tested for behavioral observation using body weight gain, saccharine test, open field and elevated plus-maze (EPM).Results Compared with control/vehicle (n=10) group, stress/vehicle (n=11) group displayed lower weight gain, saccharine preference index and the number of rearing in open field (P<0.05).Antidepressant fluoxetine, but not imipramine reversed anhedonia and the decrease of the number of rearing induced by stress.In addition, compared with early adolescent(PND29) rats, late adolescent (PND52) rats in control/vehicle group exhibited less open arm entries and open arm time, more closed arm time in EPM (P<0.05).Rats in stress/vehicle group showed more open arm entries and less closed arm time than controls(P<0.05).Both fluoxetine and imipramine had no effects on such changes.Conclusions Stress can induce the depression-like behavior in adolescent rats.Fluoxetine, but not imipramine,can effectively reverse anhedonia induced by stress.However, Both antidepressants have no significant effects on stress-induced decrease in developmental increment of anxious behavior during adolescence.These data suggest that chronic mild stress have complicated effects on depressive and anxious behavior in adolescent rats.

Objective Using apomorphine, a potent dopamine receptor agonist and rotating T-maze, the effect of apomorphine on the visual discrimination learning and reversal learning in rats was investigated. Methods All rats were trained in a visual discrimination task (food reward and light stimulus) in rotating T-maze. After reaching the acquisition criterion, rats were trained in a reversal task (food reward and without light stimulus) in the same maze. During the period of visual discrimination task, apomorphine was administrated either 30 minutes prior to learning or after learning immediately. Results The results showed that apomorphine, which was given either 30 minutes prior to visual discrimination learning or after learning, could impair the acquisition of discrimination learning( 259.20±26.29 and 264.00±16.97, compared to 168.00±16.97 and 163.20±20.08) and apomorphine, which was given only after visual discrimination learning, could impair the acquisition of reversal learning (451.20±39.44 compared to 360.00±29.39). Conclusion The results showed that apomorphine, which was given either 30 minutes prior to visual discrimination learning or after learning, could impair the acquisition of discrimination learning and apomorphine, which was given only after visual discrimination learning, could impair the acquisition of reversal learning.

AIM: To study the basic mechanism of transcriptional regulation, NKX3.1 gene promoter was cloned and its promoter activities in prostate cancer cell lines and other cancer cell lines were tested. METHODS: 1.04 kb - promoter fragment of NKX3. 1 gene was obtained by PCR and cloned into pGL3 - basic and pEGFP - 1 that are promoter - less reporter vectors to examine its promoter activity driving the reporter gene transcription. The promoter activity was determined by dual -luciferase reporter assay and the expression of GFP reporter observed under fluorescence micro scope. RESULTS: The sequence of the cloned 1.04 kb promoter proved to be correct by DNA sequencing. The dual - lu ciferase reporter assay (M1/M2) showed that the promoter activity in LNCaP cell transfected with pGL3 - 1.04 kb promoter was about 1.5 - fold higher than that of pGL3 - control transfection and 50 - fold higher than that of pGL3 - basic transfec tion. To investigate the 1.04 kb - promoter activity in different tumor cell lines, the constructed pGL3 - 1.04 kb promoter and pEGFP - 1.04 kb promoter were transfected into several cell lines, respectively. The results showed that the activity of 1.04 kb promoterin LNCaP was highest among the tested cell lines. Multiple consensus sequence elements have been iden tified within the 1.04 kb fragment using TRANSFAC database. Further experiments will be done to determine their founc tions. CONCLUSION: Cloned 1.04 kb fragment upstream of NKX3.1 gene presented a strong promoter activity and its activity was highest in LNCaP cell among the tested tumor cell lines.