Objective:The somatosensory evoked cerebral potential (SEP)was used to assess the analgesia effect of clonidine. Method: Twenty-three SD rats was randomly divided into two groups, the control group (n=8) and clonidine group (n=15). The control group rats was injected 1 ml normal saline to peritoneal cavity and the clonidine group rats was injected 10mg(1ml) clonidine peritoneally. The SEP waves were recorded in both groups at preinjection and 20,40,60 min after injection. Pain relief ratio was calculated according to the N15-P25 peak-peak amplitude of SEP wave. Result:SEP amplitude and latency were markedly reduced in clonidine group and remained unchanged in control group. The peak Pain relief ratio was 80. 6％at 20-40 min after clonidine administration. Conclusion:Clonidine does have a effect of pain relief

Objective To study the clinical experience of extracorporeal circulation management in modified total arch replacement combined with stented elephant trunk.Methods Fifty-eight patients with Stanford A aortic dissection underwent modified total arch replacement combined with stented elephant trunk.With the modified surgical technique,the technology of extracorporeal circulation was also modified with bilateral antegrade cerebral perfusion,the management of the temperature and blood protection.Results All patients were operated successfully.The operative time was 248-485 (396 ± 67) min,extracorporeal circulation time was 175-260 (181 ± 33) min,cross clamp time was 64-104 (85 ± 12) min,stop circulation time was 22-48 (32 ± 5) min,and selective cerebral perfusion time was 26-54 (39 ± 7) min.The ventilator assisted breathing time was 5.0-35.5 (23.0 ± 4.5) h,and ICU monitoring time was 24-140 (88 ± 12) h.Postoperative complications included transient neurologic deficit in 3 cases (5.2％,3/58),renal dysfunction in 5 case (8.6％,5/58),and pulmonary infection in 4 cases (6.9％,4/58).Conclusion To modified total arch replacement combined with stented elephant trunk,the modified management of extracorporeal circulation with bilateral antegrade cerebral perfusion,the management of temperature and blood protection,has a low prevalence of morbidity and mortality.

Abstract: Objective To investigate the expression of serum C-C chemokine 22 (CCL22) and its receptor C-C chemokine receptor 4 (CCR4) in patients with chronic hepatitis B (CHB), and its correlation with liver function indicators and disease progression. Methods A total of 96 patients with CHB who were treated in Neijiang Traditional Chinese Medicine Hospital from October 2021 to November 2022 were recruited as the observation group, and divided into mild group (n=43), moderate group (n=36) and severe group (n=17) , according to the progress of the disease. In addition, 50 healthy people who underwent physical examination in the same hosiptal were selected as the control group. The levels of serum CCL22 mRNA, CCR4 mRNA and liver function indicators [alanine aminotrans-ferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin (ALB)] were measured. Pearson correlation analysis was performed to analyze the correlation between serum CCL22 and CCR4 levels and liver function indicators and disease severity, and logistic regression was applied to evaluate the factors affecting the progress of CHB patients. Results Compared with the control group, the levels of CCL22 mRNA, CCR4 mRNA, ALT, AST and TBIL in the observation group were obviously higher (P<0.05), the level of ALB was obviously lower (P<0.05); the expression levels of serum CCL22 mRNA, CCR4 mRNA, ALT, AST and TBIL in mild, moderate and severe groups increased in turn, while the expression level of ALB decreased in turn, with significant differences between groups (P<0.05); The levels of serum CCL22 mRNA and CCR4 mRNA were positively correlated with liver function indicators ALT, AST, TBIL levels, and negatively correlated with ALB level (P<0.05); Both CCL22 mRNA and CCR4 mRNA were positively correlated with the severity of the disease (r=0.646, 0.516, P<0.001); the expression levels of CCR4 mRNA, ALT, AST, TBIL and ALB were all factors affecting the development of CHB patients (P<0.05). Conclusions The expression of CCL22 and CCR4 in serum is closely related to liver function index and severity of CHB patients, which can provide reference for clinical evaluation and symptomatic treatment.

Medical educational internationalization has already made teaching medical courses in English more and more important.Nephrology department in Tongji hospital affiliated to Tongji medical college,Huazhong university of science and technology has assumed the responsibility of teaching in English for medical students of five-year program,six-year program,seven-year program,eight-year program,and abroad student for several years.They practiced teaching in English in theory teaching,PBL teaching and clinical teaching according to the characteristics and requisitions of students in different educational systems.They accumulated some experiences,which was conducive to improving the quality of teaching in English.

Teaching urinary system diseases by problem-based learning method for eight-year program medical students was applied in nephrology department in affiliated Tongji hospital of Huazhong university of science and technology since 2008.They had accumulated experiences in compiling teaching plan,fostering teachers,practicing teaching and evaluating teaching.These steps may future intensify education reform on long schooling system and improve teaching quality of eight-year program.

Objective To analyze the MRI characteristics of malignant meningiomas,and to improve the level of diagnosis and differential diagnosis.Methods MRI data of 20 patients with malignant meningiomas proved by operation and pathological results were analyzed. Results Of 20 patients,meningiomas were located at the sagittal sinus and convexity of brain in 11 cases and 4 cases respectively.7 cases had regular shape,13 cases had irregular shape.The border was clear in 9 cases,ill defined in 11 cases.11 cases had hypointensity on T1WI, 10 cases had hyperintensity on T2WI.5 cases had obvious necrosis and cystic degenoration,2 cases had hemorrhage inside the tumor. Homogeneous enhancement were seen in 12 cases,heterogeneous enhancement were seen in 5 cases,ring-enhancement were seen in 2 cases and 1 cystic lesion without enhancement.16 cases showed dural tail sign.16 cases had peritumoral brain edema in different degree,4 cases had no peritumoral brain edema.4 cases invaded adjacent skull.1 case had relapsed.Conclusion Malignant meningiomas have some characteristic on MRI,know well it's characteristics of MRI can be helpful to improve the diagnostic accuracy.

In order to analyze the cai]ses of delayed diagnosis and raise the level of early diagnosis of atypical multiple myeloma (MM), the differences of presenting features between the patients presented to nephrologists and those presented to hematologists were compared. MM patients in our hospital were studied retrospectively. Those who referred renal impairment were divided into two groups: group I presented to nephrologists prior to MM diagnosis (n=29) and group II presented to hematologists directly (n=62). The age, sex, initial symptoms, haematological and biochemical parameters, the phenotype of paraprotein, bone marrow biopsy and cytology were undertaken and analyzed. The results showed that the median time between the initial symptoms and diagnosis in the patients of group I was longer than that in group II (P<0.001); patients in group I had significantly lower incidence of bone pain (P<0.01) and worse renal function (P<0.05) on presentation. There were lower level of myeloma cells (P<0.05), lower incidence of hypergammaglobulinemia (P<0.05), lower positive rate of monoclonal immunoglobulin (M protein) (P<0.05) and M protein level (P<0.05) in the patients of group I than those in group II. The ratio of monoclonal to lambda monoclonal proteins in a population was 1:3.67 in patients of group I, whereas 1:0.90 in patients of group II (P<0.01). Moreover, patients with λ type had a higher degree of renal insufficiency than those with κ type (P<0.05). It was suggested that the median time between the initial symptoms and diagnosis in the patients presented to nephrologists was longer than that in those presented to hematologists; the patients presented to nephrologists had the lower incidence of bone pain, lower level of myeloma cells and M protein, which made early diagnosis more difficult; more patients presented to nephrologists had the majority of λ light chain type, moreover, patients with λ light chain type had a higher incidence of renal insufficiency.

Objective To investigate the relationship between the "prominent laterality of the posterior cerebral artery (PLPCA)" found on magnetic resonance angiography (MCA) and the size and distribution of cerebral infarction and the National Institutes of Health Stroke Scale (NIHSS)scores in patients with occlusion of the M1 segment of the middle cerebral artery (MCA).Methods Fifty patients with acute cerebral infarction caused by the occlusion of the M1 segment of MCA were divided into PLPCA positive group (n =24) and PLPCA negative group (n =26) according to MRA manifestation.the NIHSS scores,size of cerebral infarction scores,and constituent ratios of distribution in all the feeding subregions of MCA in both groups were compared.Results The proportions of the patients with ≥3 risk factors (9/24 vs.18/26,P =0.046),NIHSS scores (5.4 4.4 vs.10.4 ±4.9,t = -3.690,P =0.001),and the size of cerebral infarction scores (1.92 ± 1.10vs.2.88 ± 1.37,t = -3.690,P =0.001) in the PLPCA positive group were significantly lower than those in the PLPCA negative group.The proportions of the patients with cerebral infarction involying the middle branch of the MCA territory (6/24 vs.19/26,P =0.002) and the posterior branch of the MCA territory (2/24 vs.5/26,P ＜0.001) in the PLPCA positive group were significantly lower than those in the PLPCA negative group.The proportions of the patients whose infarction involving the area of the posterior watershed zone were significantly higher than those in the PLPCA negative group (6/24 vs.1/26,P =0.045),and the proportions of complete infarction were significantly lower than those in the PLPCA negative group (0/24 vs.6/26,P =0.023).Conclusions When MCA M1segment was occluded,if PLPCA were observed on MRA,it indicated that the infarct size was smaller and the NIHSS score was lower.The infarction was less involved in the middle and post branches of MCA,and it is prone to have posterior watershed infarction.

To study the efficacy and the mechanism of Colquhoumia root (Tripterygium hypoglaucum (Le,vL)Hutch) in the treatment of mesangial proliferation glomerulonephritis (MsPGN), SD rats were injected with anti-thymocyte serum (ATS) to make MsPGN model (anti-Thy1 model). The rats were then divided into 3 groups: normal control group, anti-Thy1 model group and treatment group. Histopathological (HE, PAS), immunohistochemical, RT-PCR technique and computer imaging analysis system were used to evaluate mesangial matrix production, the expression of TGF-β1 protein and mRNA in the tissues of kidney.Our result showed that proteinuria and the ratio of extracellular matrix/glomerular capillaries area (ECM/CA) were increased significantly in model group. The expression of both TGF-β1 protein and mRNA in glomeruli was much higher in model group than in control group (P<0.01). After the treatment with Colquhoumia root, proteinuria, ECM/CA and the expression of both TGF-β1 protein and mRNA in glomeruli were significantly decreased in treatment group as compared with those in model group. It is concluded that Colquhoumia root is effective in reducing proteinuria and mesangial matrix proliferation in MsPGN and it may achieve these effects by inhibiting the expressions of TGF-β1 protein and mRNA of mesangial cells.

Objective To compare the therapeutic effects of early enteral nutrition and delayed enteral nutrition on severe acute pancreatitis. Methods Sixty-four patients of severe acute pancreatitis were enrolled into two groups: early enteral nutrition group was used as the treatment group and delayed enteral nutrition was used as the control group. Two weeks after the treatment, Variables of TP, ALB, CRP, APACHEⅡscore, hospital stay and recovery time of blood and urine amylase were compared between the two groups. Results The TP and ALB of the treatment group were significantly higher than those in the control group (P<0.05). The CRP and APACHEⅡscore of the treatment group were significantly lower than those in the control group (P<0.05). Compared with the control group, the recovery time of blood amylase, urine amylase and hospital stay were significantly shorter in the treatment group (P<0.05). Conclusion Using early enteral nutrition treatment in patients with severe acute pancreatitis is efficient, worthy of clinical use.