Objective To analyze the effect of serum creatinine, blood urea and renal function with angiography low permeability of non-ionic contrast agent in elderly patients with ischemic cerebrovascular disease,and provide reference for clinical treatment.Methods 100 elderly patients with ischemic cerebrovascular disease in hospital from April 2011 to May 2016 were selected,patient were given cerebrovascular, renal arteriography.The changes of serum creatinine and urea were detected at different time before and after 3 days, and the changes of renal function were detected.Results In 100 cases, 12 cases of contrast induced nephropathy, the incidence rate was 12%.Contrast nephropathy in patients with diabetes mellitus group proportion, renal insufficiency, the proportion of severe renal artery stenosis was significantly higher than the proportion of non contrast nephropathy group (P<0.05).Contrast nephropathy group contrast 1 days and contrast 2 days blood urea, serum creatinine and creatinine clearance rate were significantly increased (P<0.05), contrast to 6 days gradually returned to normal, no obvious change of non contrast nephropathy in patients with renal function index.Diabetes mellitus (OR=6.973), severe renal artery stenosis (OR=4.286) and renal insufficiency (OR=7.680) are the risk factors of contrast induced nephropathy (P<0.05).Conclusion Vascular elderly patients with ischemic cerebrovascular disease using non-ionic contrast medium hypotonic angiography safer, diabetes, renal patients need to continue to pay attention to changes in renal function.

Dermatology and venerology is a clinical discipline characterized by morphology.With the development of the internet and the application of internet in education,the features and advantages of internet teaching are gradually recognized including high flexibility,rich information and good student-teacher interaction.This article focused on the establishment and practice of internet teaching to improve teaching quality.

Objective To investigate the relationship of body mass index with hiatal hernia (HH) and reflux esophagitis (RE).Methods Two hundreds and twenty seven gastroesophageal reflux disease (GERD) patients with typical acid regurgitation and heartburn were enrolled and categorized into three groups according to body mass index (BMI, kg/m2) as normal weight (18.5≤BMI ＜24), overweight (24≤BMI＜28), and obesity (BMI≥28).RE, non-erosive reflux disease (NERD) and HH were diagnosed by gastroscopy.All the patients underwent ambulatory 24-hour pH monitoring and the pathological acid reflux was considered when the DeMeester score≥15.Effects of BMI on RE and HH were estimated by using logistic regression analysis.Results The percentages of RE and HH were 30.0%(68/227) and 5.7%(13/227), respectively.76.9% (10/13) HH patients had RE. Proportions of RE and HH increased significantly with increasing BMI (P＜0.05), so was that of RE above grade B in three groups (6.4%, 16.9% and 31.6%,P=0.003).DeMeester scores of the three groups were 15.9, 19.8 and 36.9, respectively (P＜0.05).The average 24-hour intra-esophagus pH value of overweight group, was significantly lower than that of normal weight patients in the afternoon and midnight (P＜0.01).Multivariate analysis showed obesity was a risk factor for HH with OR 7.058 (95% CI: 1.294～38.488, P=0.024), male (OR: 2.537, 95% CI: 1.350～4.766, P=0.004), overweight (OR: 1.921, 95% CI: 1.005～3.670, P=0.048), obesity (OR: 3.305, 95% CI: 1.123～9.724, P=0.030) and HH (OR: 6.879, 95% CI: 1.695～27.913, P=0.007) were risk factors for RE.Conclusion BMI has a significant association with HH and RE, obesity is a common risk factor for both HH and RE, HH may induce the development of RE.

Objective To investigate the delayed alteration of hippocampus proteome after an-esthesia with isoflurane in aduh and aged rats. Methods Ten 8-month-old SD rats were randomly divided into group Caduh and group Iadult (5 in each group) , and another ten 22-month-old SD rats were randomly divided into group Caged and group Iaged (5 in each group). The rats in group Iadult and group Iaged received 2 h anesthesia with 1.2 % isoflurane. The rats in group Cadult and group Caged inhaled 40% oxygen for contrast. The hippocampal proteome of each rat was measured by 2-dimensional gel electrophoresis and mass spectrometry. Results The vital signs of the rats in group Iadult and group Iaged were stable. There were 878±34 protein spots in group Cadult, 864±49 protein spots in group Iadult, 834±47 in group Caged, and 819±24 in group Iaged. There were 12 (4/8)different protein spots between group Iadult and group Cadult. There were 11 (3/8) different protein spots between group Iaged and group Caged. All of the protein spots were identified by MALDI-TOF-MS. Most of the different proteins were related to metabolism, anti-oxidation, and signal conditioning of synapse. Conclusion Isoflurane may cause the alteration of hippocampal pro-teome in rats, which is age-related.

OBJECTIVE: To study the clinical features, diagnosis and treatments of primary nasopharyngeal tuberculosis. METHOD: A case report was presented, and meanwhile etiopathogenesis and differential diagnosis were also reviewed. RESULT: A biopsy was taken and the histopathological examination showed tuberculosis granuloma with caseous necrosis. After anti-tuberculosis therapy, the symptoms disappeared. CONCLUSION Not only otologic disorders but also nasopharyngeal diseases need to be considered when aural fullness exists. More importantly, primary nasopharyngeal tuberculosis should be taken as one of the differential diagnosis.
Adult ; Female ; Humans ; Nasopharyngeal Diseases ; diagnosis ; microbiology ; Tuberculosis ; diagnosis

Objective To detect expression of epidermal growth factor receptor variant Ⅲ (EGFRvⅢ) in human suprarenal epithelioma to explore its relation with the genesis and development of suprarenal epithelioma.Methods Immunohistochemistry and pathologic image analysis were used to semiquantitatively detect the expression of EGFRvⅢ protein in eighty human suprarenal epithelioma tissues and twenty-four normal renal tissues.Results Positive expression rate of EGFRvⅢ was 46% in human suprarenal epithelioma tissues and 8% in normal renal tissues.Their average gray scale values were 148.49?13.05 and 155.65?14.86,respectively,which showed a significant difference (t=2.13,P=0.04).There was no obvious difference between males and females (149.01?13.70 and 147.40?11.76,t=0.54,P=0.59).No significant association was observed between EGFRvⅢ expression and age (r=0.01,P=0.92).Conclusion Many human suprarenal epithelioma tissues express EGFRvⅢ.EGFRvⅢ may play certain role in the genesis and development of human suprarenal epithelioma.

BACKGROUND:Traditional internal fixation for thoracolumbar vertebral fractures easily causes poor vertebral reduction, and postoperative vertebral height loss easily appears.
OBJECTIVE:To analyze the feasibility of lateral-position pedicle screw placement in spinal surgeryvia combined anterior-posterior approaches.
METHODS: A total of 36 cases undergoing spinal surgical operation in the Baoji City Chinese Medicine Hospital from February 2013 to October 2014 were enroled in this study. The patients were divided into two groups according to the method of repair. 18 patients in the control group received prone-position pedicle screw placement, and 18 patients in the experimental group received lateral-position pedicle screw placementvia combined anterior-posterior approaches. Postoperative CT and X-ray examinations compared the adverse rate of screw placement and the rate of nerve root injury between the two groups. Operation time, length of stay, time of beginning movement, intraoperative blood loss and American Spinal Injury Association impairment scale score were compared between the two groups.
RESULTS AND CONCLUSION:Significant differences in the adverse rate of screw placement and the rate of nerve root injury were detected between the two groups (P < 0.05), and the adverse rate of screw placement and the rate of nerve root injury were better in the experimental group than in the control group. Operation time, length of stay, and time of beginning movement were significantly better in the experimental group than in the control group (P < 0.05). Intraoperative blood loss was significantly lower in the experimental group than in the control group (P < 0.05). American Spinal Injury Association impairment scale scores were significantly higher in the experimental group than in the control group (P < 0.05). These findings confirm that lateral-position pedicle screw placementvia combined anterior-posterior approaches in spinal surgery can reduce intraoperative trauma, shorten the length of hospital stay, and promote functional recovery of spinal cord.

Objective To study the role of esophagogastric junction contractile index (EGJ-CI) in evaluating the function of anti-reflux barrier,and in differentiating patients with gastroesophageal reflux disease (GERD) from those with functional heartburn (FH).Methods A total of 115 patients presenting heartburn were enrolled in the study from January 2012 to June 2015.All subjects had completed Gerd-Q questionnaire and undergone gastroscopy,24-hour pH-impedance monitoring and esophageal high-resolution manometry.GERD patients were divided into as reflux esophagitis,acid-nonerosive reflux disease (NERD) and weakly acid-NERD groups.Patients with normal esophageal mucosa,normal acid exposure and negative proton pump inhibitor test were enrolled in FH group.EGJ-CI (mmHg · cm) as well as EGJ rest pressure and 4s integrated relaxation pressure (IRP 4s) were measured.Results Among the 115 patients,18 were reflux esophagitis [(49.0 ± 18.9) years,M ∶ F =10 ∶ 8],25 were acid-NERD [(48.7 ± 14.4) years,M∶F=13∶ 12],37 were weakly acid-NERD [(52.0 ±14.8) years,M∶F=15∶22] and 35 were FH [(53.6 ± 14.8),M∶ F =8∶27].No differences of Gerd-Q scores were noticed between the four groups.(1) Negative correlations were demonstrated between EGJ-CI and esophageal acid exposure time (r =-0.283,P =0.002),EGJ-CI and acid reflux events (r =-0.233,P =0.012),EGJ-CI and weakly acid reflux events (r =-0.213,P =0.022),EGJ-CI and non-acid reflux events (r =-0.200,P =0.032).(2)The value of EGJ-CI was significantly higher in FH patients than in the three subgroups of GERD(all P ＜ 0.01).EGJ rest pressure of FH group was higher than that of acid-NERD (P ＜ 0.01).IRP 4s in acid-NERD group was lower than that of FH and weakly acid-NERD (P ＜ 0.05).(3) The area under curve (AUC) of EGJ-CI was higher than that of EGJ-CIT,EGJ rest pressure or IRP 4s (0.686 vs 0.678,0.641 and 0.578).The cut-off value of EGJ-CI to differentiate GERD from FH was 9.74 mmHg · cm with sensitivity 82.86％ and specificity 51.52％.Conclusions The EGJ-CI values are negatively correlated with esophageal acid exposure time,weakly acid reflux events and non-acid reflux events.Thus it might be used as a metric to reflect the anti-reflux function of EGJ.According to the cut-off value of EGJ-CI 9.74 mmHg · cm,patients with GERD can be sensitively differentiated from patients with FH.

Objective To study the differences of esophageal manometry (M),pH set-up method (P) and X-ray (X) on positioning of the 24-hour esophageal pH catheter and relative factors. Methods Fifty subjects underwent M, then pH catheter was located by P and X. The difference between methods and the relative factors such as body height,lower esophageal sphincter (LES) length etc were analyzed. The difference of less than 2 cm between two methods was accepted. Results The length between the location determined by M,Pand X and nose were (37.9 ±2.9),(40.8 ±4.4) and (40.7 ±5.3) cm, respectively.There was significant difference between P and M as well as between X and M (P＜ 0.01 ). The coincidence rate was 62.0%(31/50) between P and M;84.0%(42/50) between P and X;and 58.0%(29/50) between X and M. Compared with P,M was (2.9 ±3.9) cm nearer to the stomach. Age, body height and LES length were main factors which affect the difference between P and M (P＜ 0.01 or ＜ 0.05),body height and LES length were main factors which affect the difference between X and M (P＜0.05 or ＜0.01). Conclusions Compared with M, the location determined by P is nearer to stomach. The location of X is varied. Body height and LES length are main relative factors.

Objective To investigate the predictive value of left ventricular diastolic function on mechanical ventilation weaning in patients with left ventricular ejection fraction (LVEF) > 0.50.Methods A retrospective case control study was conducted. Sixty-five patients with LVEF > 0.50 undergoing mechanical ventilation for more than 48 hours admitted to surgery intensive care unit (ICU) of China-Japan Friendship Hospital from June 2014 to December 2016 were enrolled. The clinical data and parameters of echocardiography before spontaneous breathing trial (SBT) were collected. The possible relationship between left ventricular diastolic function and the results of weaning was analyzed according to analysis of blood flow filling parameters of mitral valve orifice. According to the grading standard of left ventricular diastolic function, the patients were divided into normal, mild (level 1) and moderate to severe (level 2-3) groups, and the outcomes of weaning were compared among the groups. Then patients were also divided into two groups of weaning successfully and weaning failure, and the clinical data and left ventricular diastolic function parameters of patients were compared between the two groups. The predictive value of left ventricular diastolic function on results of weaning was evaluated with receiver operating characteristic curve (ROC).Results Sixty-five patients were enrolled and 28 patients (43.1%) failed weaning, 22 patients failed the first SBT and 6 required reintubation within 48 hours, 31 of the patients presented normal left ventricular diastolic function, 9 of patients presented mild diastolic dysfunction, and 25 of them presented moderate to severe diastolic dysfunction. So with the gradual increase of the severity of diastolic dysfunction, the rate of weaning failure was gradually increased, which was 16.1%, 44.6% and 76.0% respectively (χ2 = 20.240,P = 0.001). Patients who failed weaning presented evidence of increased left ventricular filling pressures at pre-SBT, by demonstrating decreased deceleration time of E (DTE, s: 180.4±5.1vs. 196.8±4.0,t = 2.567,P = 0.013), increased left ventricular mitral valve diastolic early and late filling velocity ratio (E/A: 1.47±0.08 vs. 1.14±0.05, t = 3.827,P = 0.000), increased lateral, septal and averaged left ventricular mitral valve diastolic early velocity and maximal velocity of mitral annulus in early diastolic velocity ratio (E/Em: 10.26±0.52 vs. 7.28±0.41,t = 4.535, P = 0.000; 10.08±0.58 vs. 8.16±0.40,t = 2.797,P = 0.007; 10.17±0.48比7.72±0.35,t = 4.231,P = 0.000), and the rapid shallow breathing index (RSBI) was also increased significantly (61.7±3.6 vs. 50.6±2.7,t = 2.507, P = 0.015). It was shown by ROC curve analysis that the basic left ventricular diastolic function at pre-SBT had the diagnostic performance in predicting the outcome of weaning from mechanical ventilation, especially E/A and lateral E/Em. Pre-SBT values of E/A greater than 1.2 and lateral E/Em greater than 7.9 predicted weaning failure with an area under the ROC curve (AUC), sensitivity, and specificity of 0.81±0.06 and 0.85±0.06, 82.6% and 91.3%, 81.4% and 80.7%, respectively, and the AUC was higher than RSBI (0.70±0.07). The AUC of combination of E/A > 1.2 and lateral E/Em > 7.9predicting weaning failure was 0.86±0.05 with a sensitivity of 78.3% and a specificity of 93.6%.Conclusions The results suggest that left ventricular diastolic dysfunction is significantly associated with weaning outcome in critical patients with LVEF > 0.50. The combination of E/A ratio greater than 1.2 and E/Em ratio greater than 7.9 may identify patients at high risk of weaning failure.