Objective To clarify diagnostic value of C-reactive protein (CRP) in the pathological types of acute appendicitis in children and the role of CRP as a surgical indication marker for appendicitis.Methods Two hundred and six patients who underwent appendectomies and had pathologically confirmed appendicitis were reviewed between January 2010 and February 2014,and they were divided into gangrenous appendicitis group(n =53) and non-gangrenous appendicitis group(n =153) by postoperative pathological type.The correlation between preoperative clinical factors and the actual histological severity,and identify surgical indication markers were assessed by multivariate analysis and ROC analysis.Results There were significant differences in white blood count(WBC),neutrophils percentage and CRP level between gangrenous appendicitis group and non-gangrenous appendicitis group(P ＜ 0.05).Multivariate analysis showed that the level of CRP should be a risk factor for judging gangrenous appendicitis.It showed that the role of CRP in judging gangrenous appendicitis was superior to the proportion of neutrophils and WBC in the ROC curve.The ROC curve showed that the area under the ROC curve for the CRP level,neutrophils percentage and WBC was 0.931,0.659 and 0.599 respectively,and the optimal cut off value of CRP for surgical indication for classifying cases was around 44.4 mg/L,and the sensitivity was 75.5 ％,specificity was 93.5 ％.Conclusion The level of CRP is useful in identifying the pathological types of acute appendicitis in children,and can be considered to be a surgical indication marker for acute appendicitis in children.

Objecfive To investigate the expression of erbB4 and PTEN in cutaneous squarnous cell carcinoma(SCC)tissue and their significance.Methods Immunohistochemical Elivision method was used to measure the protein expression of erbB4 and PTEN in tissue specimens from 52 patients with SCC (11 cases with and 41 cases without lymph node metastasis)and 10 normal human controls.Results The positivity rate of erbB4 was significantly higher in the patients with SCC than in the normal human controls (75%vs.10%,x2=12.77,P<0.01),and in the patients with lymph node metastasis than in those without (100%vs.68.29%,P<0.05).Significant differences were also observed in the expression rate of PTEN between the patients with SCC and the normal controls (48.08%vs.100%,x2=9.20,P<0.01),between the patients with well-differentiated SCC and those with poody differentiated SCC(78.57%vs.36.84%,P<0.05),and between the patients with lymph node metastasis and those without (9.09%vs.58.54%,P<0.01).The expression of erbB4 was negatively correlated with that of PTEN (r=-0.42.P<0.01).Conclusion The disturbalice in mutual regulation between erbB4 and FIEN seems to be involved in the initiation.progression and metastasis of SCC.

Objective To explore the clinical significance and safety in hemihepatectomy for hepatoma without inflow occlusion.Methods A total of 62 patients with liver cancer were divided into 2 groups.The inflow was occluded in group A (n = 28) and not occluded in group B (n = 34) during hepatectomy.Subsequently,the influence of the two approaches on the parameters including intraoperative blood loss,postoperative hepatic function and complications incidence rate was comparatively analyzed.Results Hepatectomy was successfully performed in the two groups.There was no significant difference between the two groups in intraoperative blood loss (P ＞ 0.05).Significant difference existed between the two groups in postoperative hepatic function and complications incidence rate (P ＜ 0.05).Conclusions The hemihepatectomy for hepatoma without inflow occlusion can reduce complications incidence rate and profit the recovery of postoperative hepatic function parameters.

Objective To develop a simple new-type photographic device for the field battle and peace time,because of the function of the trivet of X-Ray machine is limited.Methods Circular chrome-plating seamless steel tubes,whose diameter is 4 cm and 5 cm respectively,were connected so as to constitute the arm structure in C shape and foundation in T shape.Results The simple new-type photographic device could project for patients in each kind of body posture and the range of focus adjustment could meet normal requirements.It was operated nimbly and freely.The material was durable and the structure was reasonable and stable.Conclusion The simple new-type photographic device meets the practical requirements in field battle and peace time.

Objective To investigate the influence of pregnancy and delivery on maternal graft and newborns after renal transplantatior.Method Two cases of successful pregnancy and delivery after renal transplantation were retrospectively analyzed and the literatures were reviewed.Result The first recipient received the immunosuppressive treatment,which was based on the mycophenolate after renal transplantation.Three years after transplantation,the recipient had the requirement of pregnancy,but there was no pregnancy without contraception for over one year.On the next month after the myocphenolate-based immunosuppressive regimen changed to the purine-based,B ultrasound revealed follicular growth,ovulation and pregnancy.Caesarean section was performed at 37 gestational weeks and a body was delivered.The weight of the boy was 2 750 g,and the Apgar scores of the newborn were 10.The second recipient received triple immunosuppressive therapy (cyclosporin A + azathioprine + methylprednisolone),and got natural pregnancy 4 years after renal transplantation.The recipient was hospitalized due to the increased blood pressure and reduced fetal heart rate at 33 W+2 gestational weeks,and discharged after treatment.Caesarean section was performed at 38 W+1 gestational weeks,the weight of the boy was 3 000 g,and the Apgar scores of the newborn was 10.After follow-up for 8 years old,there was on abnormity of the function of the transplanted kidney and the growth of the newborns.Conclusion Successful pregnancy and delivery are possible in renal transplant recipients with normal renal function.Regulating the immunosuppressive regimen appropriately,and treating the complications of pregnancy effectively can obtained the satisfactory outcome of pregnancy.

Objective To investigate the regulation mechanism of silencing the DUSP1 gene on the release of proinflammatory cytokines in mice with acute pancreatitis(AP). Methods Two DUSP1 - siRNA and one scramble siRNA sequences were designed,and the sequence with higher silence efficiency was selected. Mice models with AP were established,and KM mice were divided into 6 groups:control group,AP group,AP + PD98059 group,AP + scram-ble group,AP + siRNA group and AP + PD98059 + siRNA group. Expressions of proinflammatory cytokines tumor necro-sis factor - α(TNF - α),interleukin(IL)- 1β and IL - 6 in serum were detected by using enzyme linked immunosor-bent assay(ELISA)after 12 h,24 h,48 h of modeling. Serum amylase levels were detected. The mRNA expression levels of DUSP1,TNF - α,IL - 1β and IL - 6 in pancreatic tissues were detected by using quantitative real time poly-merase chain reaction (qPCR). The protein expression levels of DUSP1,extracellular regulated protein kinases(ERK), c - Jun N - terminal kinase(JNK),p38,p - ERK,p - JNK and p - p38 in pancreatic tissues were detected by using Western blot. Results Compared with the control group,the other 5 groups displayed the increased expressions of TNF - α,IL - 1β,IL - 6 and amylase in serum,and expressions of DUSP1,TNF - α,IL - 1β,IL - 6,p - ERK,p -JNK,p - p38 in tissues,and there was a statistical significance (all P < 0. 05). Compared with the AP group,the AP +PD98059 + siRNA group showed the decreased DUSP1 expression in tissues,and there was a statistical significance (all P < 0. 05);the AP + PD98059 group had decreased expressions of TNF - α,IL - 1β,IL - 6 and amylase in serum,and expressions of TNF - α,IL - 1β,IL - 6,p - ERK,p - JNK,p - p38 in tissues,and there were statistical significances (all P < 0. 05);while the opposite results were observed in the AP + siRNA group with DUSP1 expression decreased. Conclusions The results support that silencing the DUSP1 gene promotes the release of proinflammatory cytokines through activating the mitogen - activated protein kinase signaling pathway in mice with AP.

Objective:To investigate the mechanism of microRNA-4298 (miR-4298) targeting inhibition of peptidylarginine deiminase 4 (PADI4) expression in U251 cells apoptosis induced by histone deacetylase inhibitor trichostatin A (TSA).Methods:The experiment was divided into TSA group (0.2 μmol/L TSA) and contral group. CCK8 method was used to detect the effect of TSA on the proliferation of U251 cells. Flow cytometry was used to detect the apoptosis level of U251 cells after drug action. Reverse transcription PCR and Western blotting experiments were used to determine the changes of PADI4 gene and protein expression after miR-4298 interference. Luciferase assay was used to determine the effects of miR-4298 on targeted binding and luciferase activity in the 3′UTR region of PADI4. U251 cells were transfected with PADI4 to observe the rescue effect of miR-4298 on apoptosis. Each experiment was divided into 3 groups, NC group, miR-4298 mimic group, TSA+ miR-4298 mimic group and NC group, miR-4298 inhibitor group, TSA+ miR-4298 inhibitor group.Results:U251 cells were treated with 0.2 μmol/L TSA for 4 days, the Absorbancy ( A) values of the control group was 1.168±0.148, which was higher than those of the TSA group (0.737±0.007), with statistically significant difference ( t=4.948, P=0.008). Compared with the control group, after treatment with 0.2 μmol/L TSA for 48 h, U251 cells showed obvious apoptosis (27.62%±3.49% vs. 4.99%±0.13%, t=11.190, P<0.001). Compared with those before the drug treatment, the PADI4 gene expression (0.386±0.020 vs. 0.903±0.021) and protein expression (0.276±0.041 vs. 0.777±0.031) after TSA treatment for 48 h both were decreased, with statistically significant differences ( t=30.400, P<0.001; t=16.770, P<0.001). The expression of miR-4298 during the process of TSA-induced U251 cell apoptosis increased (2.573±0.289 vs. 1.003±0.136; t=8.487, P=0.001). There was a negative correlation between the miR-4298 expression and PADI4 expression ( r=-0.877, P=0.002). Luciferase experiment confirmed that miR-4298 has targeted binding and luciferase inhibitory effects on the 3′UTR region of wild-type PADI4. Compared with NC group (0.920±0.026), the relative expression levels of PADI4 gene of miR-4298 mimic group (0.413±0.049) and TSA+ miR-4298 mimic group (0.213±0.035) were decreased, with statistically significant differences (all P<0.001). The PADI4 protein expression level change was consistent with the gene change trend. Compared with NC group (3.78%±0.68%), the apoptosis levels of miR-4298 mimic group (7.96%±1.10%) and TSA+ miR-4298 mimic group (13.74%±1.26%) were increased, with statistically significant differences ( P=0.005; P<0.001). Compared with NC group (0.183±0.025), the PADI4 gene expression of miR-4298 inhibitor group (0.483±0.032) and TSA+ miR-4298 inhibitor group (0.386±0.025) were increased, with statistically significant differences ( P<0.001; P=0.015). The PADI4 protein expression level change was consistent with the gene change trend. Compared with NC group (4.96%±0.59%), the apoptosis levels of miR-4298 inhibitor group (23.83%±2.20%) and TSA+ miR-4298 inhibitor group (9.55%±1.49%) were increased, with statistically significant differences (all P<0.001). In the rescue experiment, the expression level of PADI4 in miR-4298 mimic group was significantly increased ( P<0.001), while the expression level of PADI4 in miR-4298 mimic+ PADI4 group was relatively reversed ( P=0.002). Conclusion:miR-4298 can participate in the process of U251 cell apoptosis by targeting the expression of PADI4 gene, and miR-4298 may be the target of targeted intervention therapy for glioma.

Objective:To investigate the clinical characteristics and etiology of pulmonary embolism in children, and to discuss the efficacy and safety of anticoagulation therapy.Methods:The data of 30 children with pulmonary embolism, who were treated with anticoagulation therapy in the Department of Pediatrics, Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2021, were analyzed retrospectively.The etiology, clinical characteristics, complications, outcomes and prognosis after anticoagulation treatment were analyzed.Results:There were 17 males and 13 females, with an average age of (8.95±2.58) years (age range: 4-13 years). The follow-up duration was 3-59 months.(1) The symptoms included cough in 30 cases (100.0%), fever in 29 cases (96.7%), shortness of breath in 27 cases (90.0%), chest pain in 15 cases (50.0%), hemoptysis in 9 cases (30.0%), bloody secretions under bronchoscopy but no hemoptysis in 4 cases (13.3%), and respiratory failure in 2 cases (6.7%). (2) The protopathy was Mycoplasma pneumoniae infection in 23 cases (76.7%), whose symptoms accorded with refractory Mycoplasma pneumoniae pneumonia.About 16 cases (53.3%) were positive for Mycoplasma pneumoniae drug resistance mutation 2063A>G or 2064A>G.Two cases (6.7%) had nephrotic syndrome.One case (3.3%) had purpura nephritis (nephrotic syndrome type). One case (3.3%) was lupus nephritis (nephrotic syndrome type). One case (3.3%) was hereditary protein S deficiency.One case (3.3%) had osteomyelitis and Staphylococcus aureus sepsis.One case (3.3%) had congenital heart disease.(3) Complications included limb thrombosis in 7 cases (23.3%), atrial thrombosis in 2 cases (6.7%), thoracic and abdominal deep venous thrombosis in 2 case (6.7%), cerebral infarction in 2 cases (6.7%), and splenic infarction in 1 case (3.3%). (4) Imaging examination showed that 30 children had lung consolidation/atelectasis (100.0%), and 24 cases had pleural effusion (80.0%). (5) Coagulation function examination suggested D-dimer increased to ≥ 5 mg/L in 21 cases (70.0%). (6) One case (3.3%) was given thrombolytic therapy with urokinase at the acute stage.Nine cases (30.0%) were treated with heparin/low molecular weight heparin.Twenty-one cases (70.0%) first received anticoagulation therapy with heparin/low molecular weight heparin and later took oral anticoagulant.Four cases (13.3%) were treated with Warfarin and 17 cases (56.7%) with Rivaroxaban.The anticoagulant treatment lasted 1-9 months.No recurrence of embolism or sequelae of chronic thromboembolic pulmonary hypertension was observed. Conclusions:Infection, especially Mycoplasma pneumoniae infection, is the main cause of pulmonary embolism in children.The symptoms of pulmonary embolism in children are atypical, so it is difficult to distinguish this disease from primary underlying diseases.Bronchoscopy can help find occult pulmonary hemorrhage.Unexplained shortness of breath in children of any age suggests the possibility of pulmonary embolism.Combination of clinical symptoms and necessary examination contribute to early diagnosis of pulmonary embolism.Then selection of appropriate anticoagulant drugs and timely anticoagulant therapy can improve the prognosis of children.

Objective:To study the protective effects of various doses of Glycyrrhizin on hippocampus of young rats with status epilepticus (SE).Methods:Lithium chloride and pilocarpine were injected intraperitoneally into male Sprague-Dawley (SD) rats (with a postnatal age of 18-21 days), so as to induce SE in rats.The rats were divided into 5 groups according to the random number table method: control group, SE group, SE+ low dose Glycyrrhizin group, SE+ medium dose Glycyrrhizin group and SE+ high dose Glycyrrhizin group.Three different doses of Glycyrrhizin (20 mg/kg, 40 mg/kg and 60 mg/kg) were injected intraperitoneally into the rats.The levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6 in serum of SE rats were determined by enzyme linked immunosorbent assay.Quantitative real-time PCR (qRT-PCR) was used to detect the mRNA expression levels of TNF- α, IL-1β and IL-6 in hippocampus of SE rats.The expression levels of Bax, Bcl-2 and Caspase-3 in hippocampus were detected by Western blot.The damage of neurons was measured by hematoxylin and eosin (HE) staining and Nissl staining.Neurons apoptosis was examined by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL). The mitochondrial changes were observed under transmission electron microscopy.One-way ANOVA followed by Tukey post-hoc test was used for statistical analysis. Results:Compared to the control group, TNF-α[(369.69±58.07) ng/L vs. (75.46±14.64) ng/L], IL-1β[(242.27±25.23) ng/L vs. (45.29±5.90) ng/L] and IL-6[(288.15±24.60) ng/L vs. (46.59±8.80) ng/L] in the serum of SE rats were significantly up-regulated(all P<0.05). Compared to SE group, low, medium and high doses Glycyrrhizin could effectively reduce the levels of TNF-α[(216.67±8.31) ng/L, (158.81±5.03) ng/L and (113.69±12.54) ng/L vs. (369.69±58.07) ng/L], IL-1β[(131.21±5.50) ng/L, (86.60±7.79) ng/L and (65.06±4.39) ng/L vs. (242.27±25.23) ng/L] and IL-6[(150.24±9.48) ng/L, (101.70±5.85) ng/L and (91.60±2.81) ng/L vs. (288.15±24.60) ng/L] released in serum after SE occurred (all P<0.05). The neuronal damage, loss, apoptosis and mitochondrial damage were found in the hippocampus of SE rats.Glycyrrhizin could ameliorate these symptoms.Compared to the control group, Bax levels(0.57±0.01 vs. 0.14±0.01)and Caspase-3 levels(0.54±0.00 vs. 0.11±0.01)in the hippocampus of SE rats were markedly increased, while Bcl-2 levels(0.27±0.01 vs. 0.57±0.02)were decreased(all P<0.05). Compared to the SE group, low, medium and high doses Glycyrrhizin could effectively reduce the levels of Bax(0.51±0.02, 0.45±0.03 and 0.40±0.02 vs. 0.57±0.01)and Caspase-3(0.47±0.02, 0.42±0.02 and 0.37±0.01 vs. 0.54±0.00), and increase the levels of Bcl-2(0.41±0.02, 0.45±0.02 and 0.51±0.01 vs. 0.27±0.01)(all P<0.05). Conclusions:Glycyrrhizin can effectively protect the hippocampus of young rats with SE.

With increasing aging， cognitive impairment in elderly coronary heart disease is a "disease group" with high morbidity and mortality in the senior population， which seriously affects the health and quality of life of the elderly. This paper takes the "cardio-cerebral circuit" as the basis of co-morbidity， and under the guidance of the cardio-cerebral homoeopathy， based on the temporal sequential characteristics of the evolution of the disease mechanism of cognitive impairment in elderly coronary heart disease， we construct a “disease-syndrome-phase” prevention and treatment strategy based on the time-sequential characteristics of the pathogenesis of the disease mechanism of "deficiency-blood stasis-toxicity"， from the perspective of pathogenicity of the disease mechanism in time-phase and the spatial multidimensionality of cardio-cerebral homoeopathy. The prevention and treatment strategy of the "disease-syndrome-phase" is constructed from the perspective of the temporal phase of the disease mechanism and the multidimensionality of the space of cardio-cerebral homoeopathy. In the earlier stage， "kidney deficiency and brain emptiness are the foundation"， in the attack stage， "turbid stasis and brain injury are the key"， and in the progression stage， "toxicity and brain damage are the changes". It is emphasized that replenishing the deficiency and benefiting the kidneys to restore the smooth flow of collaterals， eliminating blood stasis and removing turbidity to promote the enrichment of blood， and detoxifying and clearing the heart to tranquilize the spirit and benefit the brain， the spatiotemporal thinking of cognitive impairment of coronary heart disease in the elderly is initially constructed with the spatial dimension to identify the location of the disease， and the temporal dimension to determine the stage of the disease， which will provide a theoretical basis for the spatiotemporal diagnostic and treatments for the heart and brain co-morbidities of TCM.