PurposeWith the extensive use of percutaneous radiofrequency ablation (RFA) for the treatment of hepatic carcinoma (HC), the study of MRI findings and its clinical signiifcance after RFA of HC have important value and can improve the complete ablation rate.Materials and MethodsA retrospective analysis of post-procedure MRI ifndings of 79 patients (114 lesions) with HC were performed, the size of the lesion, the signal changes and enhancement condition were observed at the ifrst, fourth and seventh month after RFA; the two different ifndings of high signal ring on MRI T1WI and local recurrence rate were analyzed.ResultsOne month after RFA, peripheral region of RFA lesion showed high signal on T1WI, and slightly lower signal on T2WI, the size of lesions was slightly larger than pre-procedure, enhancement scan showed the thin homogeneous ring enhanced around the non-enhanced lesions; 4 months later, the size of lesions were relative stable and the periphery enhancement was weaken; 7 months later, the size of lesions were reduced and showed no enhancement. For recurrence lesions, the high signal ring was incomplete on TIWI, the incomplete area showed nodular enhancement on the arterial phase, and most of nodule showed slightly lower signal on the delay phase demonstrated a feature of quick wash-in and wash-out; 7 months after RFA, recurrence rate was 6.12% in patients with complete high signal ring and 43.75% in patients with incomplete high signal ring, the difference was statistically significant (P<0.05). The total survival rate and accumulated survival rate of the patients with complete high signal ring on T1WI were higher than the patients with incomplete ring, the difference was statistically signiifcant (P<0.05).ConclusionThere are characteristic ifndings of MRI examination of liver cancer after percutaneous RFA, observation of the integrity of high signal ring on T1WI image and ifnding of dynamic enhancement scan can early evaluate efifcacy of RFA guide the selection of treatment plan.

Objective To study the clinical characteristics,antimicrobial restistance of bloodstream infections (bacteremia) caused by multidrug-resistant Acinetobacter and analyze the outcomes of antibacterial therapy.Methods The clinical data were reviewed retrospectively for 74 patients with bloodstream infection caused by multidrug-resistant Acinetobacter who were trea-ted in HuaShan hospital from January 2005 to December 2011 .Results During the 6-year period,74 patients were diagnosed with multidrug-resistant Acinetobacter bacteremia,73 of which were nosocomial infections.The remaining one was community-acquired. Primary bloodstream infection accounted for 51 .4% (38/74),and secondary infection 48.6% (36/74), mainly secondary to pulmonary infections (23.0%,17/74). Solid tumor was the most common underlying disease (24.3%,18/74).Prior corticosteroid therapy,indwelling deep venous catheter,surgery and invasive procedures were predisposing factors of bacteremia. Acinetobacter-related bloodstream infections were associated with higher white blood cell count,increased neutrophil percentage,higher APACHE II score and lower serum albumin level.The bloodstream infection was caused by Acinetobacter baumannii in 65 pa-tients,Acinetobacter lwoffi in 7 patients,both Acinetobacter baumannii and Acinetobacter junii in one patient.The all-cause mortality rate was 27.0% (20/74).In vitro susceptibility testing showed that 20.0% (15/75 )of the Acinetobacter isolates were resistant to cefoperazone-sulbactam,which was the lowest among all the antibiotics tested.About 40.0% to 42.7% of the isolates were resistant to carbapenems.The outcome was related to the antimicrobial restistance.Carbapenem non-suscepti-ble Acinetobacter was associated with poorer outcome compared with carbapenem-susceptible Acinetobacter (mortality 46.9%vs 11 .9%,P <0.05 ).Cefoperazone-sulbactam non-susceptible Acinetobacter was also associated with poorer outcome com-pared with cefoperazone-sulbactam susceptible Acinetobacter (mortality 40.0% vs 18.2%,P <0.05).Of the 32 patients who had infections with carbapenem-non-susceptible Acinetobacter,20 received sulbactam-containing antimicrobial agent.The mor-tality of these 20 patients was 20.0% (4/20),significantly lower than that of the 12 patients who did not receive sulbactam-containing antimicrobial agent (66.7%).Conclusions Majority of the bloodstream infections caused by multidrug-resistant Acinetobacter are nosocomial infections.Surgical operation and serious condition may predispose the patients to develop Acine-tobacter bacteremia.Acinetobacter isolates are highly resistant to commonly used antibiotics.The Acinetobacter isolates not susceptible to carbapenem or cefoperazone-sulbactam are associated with poorer outcome and higher mortality.More attention should be paid to prevention and control of Acinetobacter-related nosocomial infections.

Objective To investigate the influencing factors of low birth weight infants (LBWI) in China in order to provide evidence for lowering the incidence of LBWI and improving the perinatal outcomes.Methods Clinical data were obtained from 14 different provinces, municipalities or autonomous regions in Northeastern, Northwestern, Northern, Central, Eastern, Southern and Southwestern of China, covering 39 hospitals of different levels.A total of 112 441 newborns were collected from January 1 to December 31 in 2011.After exclusion of those cases with incomplete information, miscarriage before 28 weeks of gestation, induction due to fetal malformation or intrauterine fetal death, 103 678 cases were restrospectively analyzed.Questionnaires were filled out and all data were recorded in computer network databases.Clinical data included maternal age, education background, height, weight, parity, histories of abnormal pregancy and comorbidities and complication.Independent sample t-test, Chi-square test, unvariate and ultivariate unconditional Logistics regression analysis were performed.Results The incidence of LBWI in mainland China was 7.21％ (7 474/103 678), 61.43％ (5 260/8 562) for preterm babies, and 2.33％ (2 214/95 116) for full-term babies.Univariate analysis showed that LBWI were associated with maternal age, education background, height, pregestational body mass index (BMI), weight gain during pregnancy, cord length, smoking, parity, histories of abnormal pregancy, gestational diabetes mellitus (GDM), preterm birth, hypertensive disorders in pregnancy, anemia, premature rupture of membranes and abnormal amniotic fluid volume.The following unconditional binary logistic regression analysis for those factors with P ＜ 0.3 in unvariate analysis showed that preterm birth (OR=46.246, 95％CI: 41.484-51.555), hypertensive disorders during pregnancy (OR=5.031, 95％CI: 4.325-5.853), histories of intrauterine fetal death ≥ 1 times (OR=2.446, 95％CI: 1.479-4.044), oligohydramnios (OR=2.068, 95％CI:1.659-2.578), pregestational BMI ＜ 18.5 (OR=1.637, 95％CI: 1.415-1.893), spontaneous abortion ≥ 1 times (OR=1.362, 95％CI: 1.043-1.777), age ≤ 20 (OR=1.332, 95％CI: 1.046 1.695), anemia (OR=1.230, 95％CI: 1.017-1.488) and premature rupture of membranes (OR=1.154, 95％CI:1.016-1.311) were risk factors for LBWI.The higher the maternal education level, weight gain, BMI and height, the lower the LBWI incidence.The risk factors of LBWI in premature small for gestational age (SGA) infants were hypertensive disorders during pregnancy and histories of intrauterine fetal death ≥ 1 times.The higher the maternal height and weight gain during pregnancy, the lower the incidence of LBWI in premature SGA infants.Conclusions The main influencing factors for LBWI are preterm birth and hypertensive disorders during pregnancy.In addition, LBWI is also associated with socioeconomic and genetic factors.

Objective To study the effect of gastrodin on arterial blood gas and brain injury of rats under simulated high altitude hypoxia environment. Methods A total of 60 adult healthy male Wistar rats were randomly divided into normal (N) group, hypoxia model (M) group, rhodiola crenulata (RC) group, low dose of gastrodin (GAS-L) group, medium dose of gastrodin (GAS-M) group and high dose of gastrodin (GAS-H) group (10 for each group). The intragastric administration on rats was continued for 7 days timely in each day. Under simulated 8000m altitude using low pressure oxygen cabin, the arterial blood gas of each group were tested, pathological changes of brain tissues were observed and related indexes of brain were detected after 12h hypoxia. Results Comparing with group N, the blood oxygen partial pressure (PO2), value of blood oxygen saturation (SO2), oxygenation index (PO2/FIO2), Na+ concentration (Na+), actual bicarbonate radical (HCO3–) significantly decreased (P<0.01), lactic acid (Lac), hemoglobin concentration (Hb) significantly increased (P<0.01) and pathological damage was inflicted in group M; and contents of malondialdehyde (MDA), hydrogen peroxide (H2O2) in brain tissue significantly increased (P<0.01), content of glutathione(GSH) and activity of glutathione peroxidase (GSH-Px) in brain tissue significantly decreased (P<0.01) in group M. Compared with group M, PO2, SO2 and PO2/FIO2 significantly increased (P<0.01, P<0.05) in group GAS-L; Na+ and HCO3– significantly increased (P<0.01, P<0.05) in three dose groups of GAS; Lac significantly decreased (P<0.01, P<0.05) in group GAS-L and GAS-H. Hb significantly increased (P<0.01) in group GAS-H, a rising trend appeared in group GAS-L but with no statistical significance. Damages of brain tissue were alleviated in group RC and three dose groups of GAS comparing with group M. Compared with group M, MDA significantly decreased (P<0.01) in three dose groups of GAS; there was a decreasing trend of H2O2 but with no statistical significance in three dose groups of GAS; GSH and GSH-Px significantly increased (P<0.01, P<0.05) in three dose groups of GAS. However, three groups of GAS has no dose dependent. Conclusion There was an protective effect of gastrodin on arterial blood gas and brain injury of rats under simulated high altitude hypoxia environment.

Objectives To investigate the delivery mode and perinatal outcomes of low birth weight infants in mainland China, and to explore the appropriate delivery mode and timing of delivery. Methods Clinical data of 103 678 babies delivered from Jan 1st to Dec 31th, 2011 in 39 hospitals in mainland China were analyzed retrospectively. The 39 hospitals located in 7 administrative regions, including Northeast, Northwest, North, Central, East, South and Southwest China. Result (1) The average birth weight of the newborns was (3 263 ± 540) g. Among them, 7 474 cases were diagnosed low birth weight infants, with the incidence of 7.209%(7 474/103 678). There were 2.328%(2 214/95 116 ) full-term low birth weight infants and 61.434% (5 260/8 562 ) preterm low birth weight infants. (2) From week 28 to week 36, the cesarean section rate of low birth weight infants increased with the increasing of gestational weeks. The cesarean section rate of full-term low birth weight infants were 61.14%(1 139/1 863) , which was higher than that of normal birth weight infants (52.947%, 45 108/85 195). The differences were statistically significant (P<0.01). (3) The constitution of the indication of cesarean section showed that social factor and maternal factor were 10.73%(443/4 128) and 48.91%(2 019/4 128) for low birth weight infants, respectively. While for the normal birth weight infants, they were 27.70%(12 495/45 108) and 38.60%(17 412/45 108), respectively. There was statistically significant difference(P<0.01). (4) The emergency cesarean section rate of full-term low birth weight infants was 41.09%(468/1 139), which was higher than that of normal birth weight infants (31.09%, 14 024/45 108). The difference was statistically significant (P<0.01). (5) The rates of stillbirth, neonatal asphyxia and the mortality of full-term low birth weight infants were 2.36%(44/1 863), 6.12%(114/1 863), and 3.17%(59/1 863), respectively. Those of normal birth weight infants were 0.11%(94/85 195), 1.41%(1 201/85 195), and 0.14%(119/85 195), respectively. The differences were statistically significant (P<0.01). (6) The stillbirth rate and mortality of low birth weight infants born by cesarean delivery were significantly lower than those born by vaginal delivery. The rate of neonatal asphyxia (17.95%) and other morbidity (3.61%) among low birth weight infants born by cesarean section in week 28 to week 33+6 were significantly lower than those born by vaginal delivery (30.09%, 6.62%, respectively). (7) With the increase of gestational age, the incidence of neonatal asphyxia and stillbirth decreased. The incidence of neonatal asphyxia(39.22%) and stillbirth(23.28%) was most seen in 28 to 29 gestational weeks, which decreased to 9.08% and 2.88% in 34 gestation weeks. Conclusions Low birth weight is one of the leading causes of adverse perinatal outcomes and cesarean section. To decrease the incidence of low birth weight, individualized management should be performed according to the gestational age and fetal condition. Extending the gestational age to at least 34 weeks may avoid iatrogenic preterm labor and improve the neonatal survival rate.

Objective To explore cognitive change in schizophrenic patients with concomitant metabolism syndrome,and to provide theory basis for early intervention and treatment.Methods According to inclusion standard,56 schizophrenic inpatients with metabolism syndrome and 56 schizophrenic inpatients without metabolism syndrome were included.The matrics consensus cognitive battery(MCCB),stroop test,digit span,UPSA-B were used to assess the cognitive function.Results There were significant differences for test scores of symbol coding subtest,verbal memory subtest,digit sequence subtest,Maze subtest,continue performance among MCCB between schizophrenic patients with and without metabolism syndrome(27.07±10.46 vs 32.18±12.12,16.04±5.07 vs18.71±6.02,13.39±5.18 vs 15.79±5.48,1.38±0.66 vs 1.7±0.68,all P＜0.05),as well as stroop test and digit span test(31.14±11.68 vs 36.57±13.32,13.77±3.64 vs 15.82±4.38,P＜0.05 for both).Conclusion The schizophrenic patients with metabolism syndrome have severer cognitive impairment than those without metabolism syndrome.

OBJECTIVETo study chemical constituents contained in Desmodium caudatum.

METHODThe chemical compounds were separated by using such chromatographic methods as macroporous resin, Sephadex LH-20, ODS and normal phase silicagel column, and their structures were identified by spectroscopic data analysis.

RESULTFifteen compounds were separated and identified as stigmasterol (1), beta-sitosterol (2), citrusinol (3), hibiscone A (4), yukovanol (5), kenusanone I (6), neophellamuretin (7), desmodol (8), erythrotriol (9), hibiscone D (10), kaempferol (11), 8-prenylquercetin (12), leachianone G (13), 5,7,4'-trihydroxy-dihydroflavonol (14), and 4H-1-benzopyran-4-one, 2-(3,4-dihydroxyphenyl) -2, 3-dihydro-3,5,7-trihydroxy-8-( 3-methyl-2-butenyl) -, (2R-trans)-(9CI) (15).

CONCLUSIONAll of the compounds were separated from D. caudatum for the first time except compound 8.

The role of three-dimensional brachytherapy (3D-BT) in the radical treatment of cervical cancer has been widely recognized. Obtaining the image information through simulated positioning is a key step of 3D-BT.Currently, MRI/CT positioning has been commonly applied in clinical practice, which has respective limitations when applied in radiosurgery. Consequently, it is of necessity to explore an accurate, highly efficient and convenient positioning approach. Besides MRI and CT, ultrasound is a novel positioning method in clinical settings. Through literature review, the application of ultrasound in 3D-BT was summarized, aiming to provide reliable reference for clinicians.

OBJECTIVE: To provide transsphenoidal endoscopic surgery with the anatomic reference through anatomic study on the lateral wall of sphenoid sinus under transnasal endoscope. METHOD: The dissection of the lateral wall of sphenoid sinus were performed on 10(20 sides) damp cadaveric heads of Chinese adults via transsphenoidal approach. The anatomic relationship of the lateral wall of sphenoid sinus and its adjacent structures were observed. The distance and angle from the bony prominence of optic canal and internal carotid artery to the columella nasi and midline of sellar floor were measured by ruler and protractor respectively. RESULT: From the study of endoscopic anatomy, the specific structure of optic canal and internal carotid artery were found, and the lateral wall of the cavernous sinus could be exposed by tracing the internal carotid artery. The mean distance from the midpoint of the medial wall of optic canal orbital aperture and the anterior bony prominence of internal carotid artery to the columella nasi were (75. 33 +/- 5. 59)mm and (81. 02 +/- 5. 29) mm respectively, to the midline of sellar floor were (5. 81+/- 1. 52)mm and (5. 53 +/- l. 47)mm respectively. The angle from the midpoint of the medial wall of optic canal orbital aperture to columella nasi was (53.4 +/- 4. 1) degrees. CONCLUSION Taken the columella nasi and midline of sellar floor as the reference points, the anatomic observation and measurement under endoscope via transsphenoidal approach can provide a guide for surgeons.
Adult ; Anatomy, Regional ; Endoscopy ; Humans ; Sphenoid Sinus ; anatomy & histology ; surgery

Primary Sj(o)gren's syndrome (pSS) is a chronic autoimmune disease characterized by lymphoplasmacytic infiltration of the exocrine glands that results in multiple organs and systems damage.Renal injury affects 0.3％-27.0％ patients,The most frequent form of nephropathy in pSS is tubulointerstitial nephritis.The main clinical manifestation is renal tubular acidosis.The renal prognosis in patients with pSS is usually favorable,but renal failure may occur.At present,it still lacks of strict consensus or guideline for the treatment.