Objective To describe survival of patients with aneurysm subarachnoid hemorrhage (aSAH) and its related factors. Methods Data of 88 patients with aSAH were analyzed retrospectively, including their age, gender, past medical history, therapeutic measures, complications and prognosis, and so on. Their survival and its related factors were identified by Kaplan-Meier method and COX proportional hazard regression model. Results Eighty-eight patients were followed-up for a total of 141. 9 person-year,with an average of (1.6 ?.0) years, and the longest of 5. 6 years. Survival was 78 percent, 73 percentand 68 percent in the first month, first year and 2. 5 - 5. 6 years after onset, respectively. Administration ofnimodipine (RR = 0. 981, 95 % CI = 0. 965 - 0. 997, P = 0. 023) was potential protective factor for deaths caused by aSAH. Compared with conservative medical treatment, both surgical occlusion (RR =0. 147, 95% CI = 0. 041 - 0. 532, P = 0. 003) and intervention embolotherapy (RR = 0. 221, 95% CI = 0. 060-0. 823, P= 0.024) were also protective factors. However, complications such as hyponatremia, pulmonary infection, alimentary tract hemorrhage (RR = 1. 965, 95% CI - 1. 404 - 2. 748, P ＜ 0. 05) and cerebral vasospasm (RR = 2. 951, 95% CI = 1. 473 - 5. 911, P = 0. 002) were independent risk factors for aSAH.Conclusions Prognosis in patients with hyponatremia, pulmonary infection, alimentary tract hemorrhage and cerebral vasospasm is unfavorable, and aneurysm occlusion by surgical operation, embolotherapy andadministration of nimodipine all can decrease fatality caused by aSAH.

Objective To investigate the risk factors related to cerebral vsospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH).Metrods The risk factors related to cerebral vasospasm in 88 patients with aSAH were identified through the multivariate logistic regression analysis and Cox analysis, including demographic factors, healthy habits, past mescal history, acute stress factors, acute complications, acute evaluation indexes, treatment time, therapeutic measures, and hemorrhage involving brain regions. Results Drinking history (OR=1.077,95%CI 1.015-1.142;P=0.014)was an independent risk factor for cerebral vasospasm before admission. Histories of smoking(RR=1.031,95%CI 1.001-1.063:P=0.042),diabetes mellitus(RR=1.333,95%CI 1.100-1.614;P=0.003)and hypertension (RR=1.066,95%CI 1.008-1.127;P=-0.024)were the independent risk factors for cerebral vasospasm during hospitalization. The increased leukocyte count(RR=1.117,95%CI 1.039-1.200;P=0.003)was a predictive factor for cerebral vasospasm; the administration of Nimotop(RR=0.990,95%CI 0.979-1.001;P=0.088)significantly decreased the risk of cerebral vasospasm;the blood glucose lexels in acute stage were not associated with the occurrence of cerebral vasospasm(RR=1.076,95%CI 0.968-1.196;P=0.175);there was no significant difference between endovascular embolization group and surgical clipping group in the risk of cerebral vasospasm(RR=0.792,95%CI 0.322-1.950;P=0.612).Conclusions The risk of cerebral vasospasm increased significantly in patients with aSAH who have the histories of long-term drinking, smoking, diabetes mellitus, hypertension as well as increased leukocyte count. The administration of Nimotop may significantly decrease the risk of cerebral vasospasm

infection.

Objective To evaluate the usefulness of extrapleural locating method in CT-guidod transthoracic pulmonary biopsy to prevent or reduce the size of peumothorax.Methods One hundred and fifteen cases of CT-gnided transthoracic pulmonary biopsy with the pulmonary lesions not in direct contact with the pleura were selected.Of 115 cases,46 were performed with extrapleural locating method (EPL) and 69 cases with lesion edge locating method (LEL).Taking the maximum distance between the partial and visceral pleura (MPVD) measured on the CT image after the procedure as the index of the volume of pneumothorax.The incidence and volume of pneumothorax of both groups were compared and statistically analysed with R ×C Chi-Square test.The retention time of the biopsy needle in the lung parenchyma of the two group was documented and the average time was calculated in each group.Results The incidence of pneumothorax was 45.7% (21/46),median 0.4 cm with EPL group,and 66.7% (46/69) and median 0.3cm with LEL group.When the distance between the lesion and pleura was equal or smaller than 2 cm (≤2cm),the incidence of pneumothorax was 39.4% (13/33) with EPL group and 73.2% (30/41) with LEL group,and the difference of incidence and volume of the pneumothorax between two groups was statistically signifieant(X2 =9.981,P =0.019).When the distance was larger than 2 cm( >2 cm),the incidence and volume of pneumothorax between two groups were not significant statistically.The average retention time of the biopsy needle in the lung parenchyma was (7.2±1.8)s with EPL group and (58.3±11.6) s with LEL group.Conclusion The extrapleural locating method can reduce effectively the retention time of the biopsy needle in the lung parenchyma and the incidence and volume of pneumothorax in CT-gnided transthoracic pulmonary biopsy.

Objective To study the proliferation and migration of vascular smooth muscle cell (VSMC) after transferred angiotensin Ⅱ (AngⅡ) type 2 receptor (AT2R) gene. 　Methods The recombinant adenoviral vector, AdCMV-AT2R, containing rat AT2 receptor gene was constructed by homologous recombination, and transfered to rat VSMC in vitro. The expression of AT2R mR NA was detected by RT-PCR. The rate of expression and the change of cell cycle in VSMC were analysed by flow cytometry. These assays including cell devision index. Incorporation of bromodeoxyuridine(BrdU) and 3-(4,5-dimethyl-thiazol-2-yl)2,5-diphenyltetrazolium bromide( MTT) were used to determine the proliferation of VSMC. The modified Boyden's chamber method was used to test the migration of VSMC. The r e-organization of F-actin in VSMC was analysed by confocal microscopy. 　Results RT-PCR showed that the expression of AT2R mRNA increased substantially in transferred VSMC, and the peak value of expression rate is about 89.51% at 48 hours. When the expression of AT2R is at peak value, the ratio of S, G2 and M periods was reduced from 31.7% to 13.9%(P<0.05). The OD values of MTT and BrdU incorporation were reduced by 61.4% and 51.6% respectively(P<0.0(1). the number of VSMC migration was reduced by 62.2%(P<0.05) and the expression of F-actin was also decreased signific antly. 　Conclusion AdCMV-AT2R induced high level expression of AT2 receptor in cultured rat VSMC and its expression can significantly inhibit the proliferation and migration of rats VSMC in vitro.

Objective To study the CT manifestations of delayed traumatic hematomas of the brain and evaluate their diagnostic significance in predicting the delayed traumatic brain hematoma. Methods The manifestations of initial CT studies and follow-up CT examinations of 31 delayed traumatic brain hematomas were analyzed. Another 50 CT studies of head trauma without delayed brain hematomas were included randomly as control. Results The abnormal findings of CT studies of the 31 delayed traumatic brain hematomas included: (1)Decreased density of the local brain parenchyma and disappeared difference between gray and white matter of the same area in 18 cases; (2)Local subarachnoid space hemorrhage in 24 cases; (3)Slight mass effect of local brain parenchyma in 16 cases. (4)Subdural hematoma in 9 cases. The locations of the abnormalities were roughly the same with the delayed hematoma except one local subarachnoid space hemorrhage, which was in the opposite of the delayed hematoma. The appearing rate of those abnormal findings in the control group was low and the difference was statistically significant. Conclusion The decrease of density of local brain parenchyma, the disappeared difference between the gray and white matter, local subarachnoid space hemorrhage, and local swollen of brain presented in the initial CT study of the patient with head trauma should be taken as indicators of delayed hemorrhage of the same area of brain, and it is necessary to do follow-up CT studies to exclude it.

Objective To evaluate the accuracy of 16-detector row computed tomography coronary angiography in detection of hemodynamically relevant stenosis(≥50%) of the coronary artery. Methods Twenty-six patients undergoing both multi-detector row CT and conventional coronary angiography were included in this retrospective study. CT scan were obtained with collimation of 16 and rotation time of 500 ms. Retrospective electrocardiographic(ECG) gating was used for image reconstrution. The stenosis degree was detected with axial scanning and three-dimensional reformation. Results With the results of conventional coronary angiography as golden standard, the sensitivity, specificity, accuracy, positive predicted value and negative predicted value of the CT angiography in detection of hemodynamically relevant stenosis(≥50%) were 90.0%, 95.5%, 94.7%, 77.6%, and 98.2% respectively. Conclusion Sixteen-detector row computed tomography coronary angiography has high clinical value with evaluating hemodynamically relevant stenosis(≥50%) of coronary artery,and could be a significant guide for diagnosis and therapy of coronary heart disease.

Objective:To investigate the diagnostic value of microRNA-19(miR-19)and microRNA-21(miR-21)in elderly patients with differentiated thyroid carcinoma(DTC), and to analyze the relationship of miR-19 and miR-21 expression with pathological characteristics in elderly patients with DTC.Methods:A total of ninety-six elderly DTC patients visiting our hospital from January 2015 to January 2018 were included in this retrospective study.They underwent cervical lymph node puncture biopsy and radical surgery for thyroid cancer.The expression levels of miR-21 and miR-19 were detected in lymph node tissues, thyroid cancer tissues and normal para-cancerous tissue.The differences in miR-21 and miR-19 expression levels between three different pathological tissues in elderly patients were analyzed.The correlation of miR-21 and miR-19 expression levels with different clinico-pathological features in elderly patients was observed.Results:The expression levels of miR-21 from low to high were(0.92±0.33)in para-cancerous tissue, (3.41±0.64)in lymph node tissue and(4.28±1.56)in DTC tissue respectively( F=296.683, P<0.01), the difference was statistically significant( F=296.683, P=0.01). While, there was no significant difference in the expression levels of miR-19 among different tissues( P>0.05). Spearman correlation test showed that the expression level miR-21 in DTC tissue was positively correlated with that in lymph node tissue and para-cancerous tissue( r values were 0.724, 0.801, all P<0.01), while the expression level of miR-19 showed no correlation of DTC tissues with lymph node and para-cancerous tissues( r=0.127 and 0.165, P>0.05). The expression level of miR-21 in lymph node tissue was positively correlated with that in para-cancerous tissues( r=0.705, P<0.01), but the expression level of microRNA-19 had no correlation between the two kinds of tissues( r=0.191, P>0.05). There was no significant difference in the expression of miR-21 in cervical lymph nodes among patients with different gender and tumor diameter( P>0.05). The expression level of miR-21 in cervical lymph nodes was significantly higher in stage Ⅲ patients than in stage Ⅰ-Ⅱ patients( P<0.05). The expression level of microRNA-21 in cervical lymph nodes was higher in patients with extra-glandular infiltration than without extra-glandular infiltration( P<0.05). The expression of microRNA-19 in cervical lymph nodes showed no significant difference regardless of sex, tumor diameter, tumor stage, extra-thyroid invasion. Conclusions:MiR-19 may not be involved in the development of DTC in elderly patients, and microRNA-21 may play an important role in the development of DTC in elderly patients, especially in the process of tumor invasion and metastasis.Early cervical lymph node puncture for miR-21 detection helps early diagnose and evaluate DTC, to provide a basis for the choice of treatment options.

Objective To compare the enhancement characteristic of the gallbladder diseases and to evaluate the diagnostic efficacy in differential diagnosis of the gallbladder diseases between contrast-enhanced sonography (CEUS) and contrast-enhanced computed tomography (CECT).Methods Seventy-two patiens with gallbladder lesions were examined by CEUS and CECT before operation and all final diagnoses were confirmed by surgery and/or pathological diagnosis.Results 1)In early phase,84.6％ (33/39) and 79.5％ (31/39) of benign diseases showed hyper-enhancement on CEUS and CECT,and 97.0％ (32/33) and 87.9％ (29/33) of malignant diseases showed hyper-enhancement on CEUS and CECT respectively (P =0.250).In later phase,91.2％ (31/34) and 88.2％ (30/34) of benign diseases showing hypo-enhancement (P =1.000),and 100％ of the malignant diseases showing hypo-enhancement on CEUS and CECT respectively.2)The time of enhancement from hyper-to hypo in CEUS for benign and malignant diseases were (39.9 ± 15.7)s and (29.9 ± 5.6)s respectively (t =3.61,P =1.000).3)The inhomogeneous enhancement on CEUS and CECT were 41.0％ (16/39) and 53.8％ (21/39) in the benign diseases respectively (P =0.063),84.8 ％ (28/33) and 97.0 ％ (32/33) in the malignant diseases respectively(P =0.125).4)The destruction of the gallbladder wall on CEUS and CECT are 87.9％ (29/33) and 90.9％ (30/33) respectively(P =1.000).5)The accuracy,diagnostic sensitivity,specificity of CEUS and CECT were 91.7％(66/72) and 87.5％(63/72),97.0％(32/33) and 93.9％(31/33),87.2％(34/39) and 82.15％ (32/39) respectively (P =0.250,1.000,0.500).Conclusions The enhancement pattern of the gallbladder diseases on CEUS and CECT were much similar.CEUS has equal diagnostic efficacy in comparison with CECT,but CEUS can supply more diagnostic information than CECT.

ObjectiveTo assess the diagnostic value of ultrasonography in the diagnosis and pathological classifi cation of appendicitis with pathological results.MethodsThe study included 111 cases who confi rmed by surgery and pathology in the Six Affi liated Hospital of Sun Yat-sen University from June2012 to December 2013. The image characteristics of ultrasonic images performed before surgery were analyzed retrospectively. The cases were divided into five groups based on the pathology: 6 acute simple appendicitis, 45 acute suppurative appendicitis, 15 acute gangrenous appendicitis, 33 chronic appendicitis, and 12 acute attack of chronic appendicitis. The length, width and wall thickness of the appendicitis measured by preoperative ultrasound between various pathological type were compared with Kruskal-Wallis statistical methord, and also used the same method to compared the one which had statistically signifi cance between the fi ve groups. As in the above case, Fisher Exact Test was used to compare the characters′ of ultrasonography included gradations of the appendix, the tube cavity expansion, stercorolith, the appendiceal abscess, mergering lymph node enlargement and the appendix around effusion, if there was statistically signifi cance, the same methord was used to the further comparison between thefi ve groups.ResultsTotally 90 of 111 cases of were reminded appendicitis by preoperative ultrasound, the diagnostic accuracy rate was 81.08%, including acute suppurative appendicitis 91.11% (41/45), acute gangrenous appendicitis 93.33% (14/15), acute simple appendicitis 83.33% (5/6), chronic appendicitis 60.61% (20/33), chronic appendicitis onset acute 83.33% (10/12). There were no statistical differences of preoperative ultrasound measured between various pathological type of appendicitis in length, while the appendix width measured by preoperative ultrasound of acute gangrenous appendicitis was wider than the acute simple group and chronic group, and there were statistically signifi cance between them (P<0.05), in the aspect of wall thickness, the acute suppurative appendicitis and the acute gangrenous appendicitis groups were thicker than the chronic group, and these differences had statistically signifi cance (P<0.05). The stercorolith, lymph node enlargement and the appendiceal abscess in different types of appendicitis had no statistical difference. There were statistically differences (P<0.05) between the acute suppurative goup, acute gangrenous group and the chronic group respectively, both in gradations of the appendix and the tube cavity expansion. Also there were statistically difference (P<0.05) between the acute gangrenous appendicitis group and the chronic group in the aspect of the appendix around effusion.ConclusionsUltrasound is valuable in the diagnosis of appendicitis, especially for acute gangrenous appendicitis and acute purulent appendicitis. The measurement of appendix with wide diameter, wall thickness by ultrasond preoperatively, and the characteristics of the wall layers, lumen expansion degree and the appendix around effusion are valuable in identifying chronic appendicitis, acute suppurative appendicitis, and acute gangrene appendicitis; The ultrasonic measurement of appendix wide diameter could identify acute gangrenous appendicitis and acute simple appendicitis. Ultrasound had limited value in identifying acute suppurative, acute gangrenous appendicitis, acute simple appendicitis, chronic appendicitis, and chronic appendicitis onset acute.