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.

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.

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.

Objective To discuss the methods and clinical effects of phased treatment of ankylosing spondylitis (AS) combined with severe hip flexion contracture.Methods The study enrolled 8 cases (12 hips) of AS combined with severe hip flexion contracture hospitalized from September 2011 to November 2012.Phased treatments included lateral hip arthrolysis,articular capsulectomy,stripping of the reflected head of rectus femoris,femoral neck osteotomy,traction and stage Ⅱ biotype total hip arthroplasty (THA).Preoperative and postoperative Harris score,hip range of motion,and complication of femoral nerve injury were detected.Results Period of follow-up was 6-12 months (mean 10 months).One case developed heterotopic ossification,which affected postoperative hip activity and received resection one year later.One case sustained fissure fracture of calcar femorale during implantation of the prosthetic femoral stem,but no special handling was provided.Of all cases,active flexion and extension of the hip were both 0° before operation,but increased to (96.25 ± 4.33) ° and (24.17 ± 4.69)° respectively after operation ; mean Harris score was improved from (26.67 ± 2.39) points preoperatively to (90.92 ± 5.66) points postoperatively (P ＜ 0.01).Besides,no femoral nerve injury was observed.Conclusion Phased treatment of AS combined with severe hip flexion contracture restores hip function and minimizes femoral nerve injury following THA.

Objective To investigate the risk factors, diagnostic evaluation, etiology, and treatment in young patients with ischemic stroke. Methods The clinical data of young patients (age range 18 - 45 years) with ischemic stroke (within 2 weeks of stroke onset) admitted to the Stroke Center, the First Affiliated Hospital of Sun Yat-sen University from August 2008 to July 2013 were registered prospectively. Results A total of 300 patients were enroled, their age was 37. 8 ± 6. 8 years. There were 227 males (75. 7% ). The age of 84 patients (28. 0% ) was ≤35 years. The most common risk factors were smoking (43. 3% ), hypertension (38. 7% ), and hypercholesterolemia (38. 0% ). The positive result detection rates were lower in the antinuclear antibody (8/278), anticardiolipin antibody (34/250), 24-h Holter monitoring (2/60 ), and transthoracic echocardiography (38/232). According to the MRI findings, the detection rate of the white matter changes, old infarcts, single acute infarcts, and multiple acute cerebral infarcts were 40/282, 77/282, 145/282, and 137/282, respectively. The stroke subtypes of TOAST: large artery atherosclerosis (26. 7% ), smal artery occlusion (18. 0% ), cardioembolism (10. 0% ), other determined etiology (23. 0% ), and undetermined etiology (22. 3% ). Large artery atherosclerosis was mainly involved in anterior circulation (69/80) and intracranial arteries (75/80). In other definite causes, cerebral artery dissection was most common (36/69), and other causes included moyamoya disease (7/69) and infectious vasculitis (7/69), etc. The average length of hospital stay was 15. 4 d. The mean National Institutes of Health Stroke Scale score on admission was 7. 0, and the mean modified Rankin scale score at discharge was 2. 5. The complication rate during hospitalization was 9. 7% . 80. 3% and 48. 3% of patients received anti-platelet drugs and statins therapy during hospitalization.Conclusions This study used a prospective single-center method. It conducted a comprehensive analysis of risk factors, diagnostic evaluation, treatment, and etiology in current Chinese young patients with ischemic stroke. Its research data wil provide useful information for establishing a diagnostic strategy of high performance cost ratio, in-depth understanding of its pathophysiological mechanisms, and improving treatment strategies in Chinese young patients with ischemic stroke.

Objective To investigate the values of conventional magnetic resonance imaging (MRI),magnetic resonance angiography (MRA),and high-resolution MRI for diagnosing intracranial arterial dissection (IAD)caused ischemic stroke. Methods From August 2008 to April 2015,59 consecu-tive patients (age 45 ±15years,41males)with IAD caused ischemic stroke admitted to the First Affiliated Hos-pital of Sun Yat-Sen University were enrolled prospectively. All patients underwent conventional cranial MRI/MRA examination,25 of them underwent whole brain DSA examination,and 10 underwent high-resolution MRI. The findings of conventional MRI/ MRA and high-resolution MRI of IAD were analyzed. For patients undergoing DSA,the proportions of detection and compliance of IAD were compared between DSA and conventional MRI / MRA. Results (1)Conventional MRI / MRA revealed typical sign of artery dissection in 42 patients (71. 2%),among them,the intramural hematoma (n = 22,52. 4%)was most common. Other common signs included intimal flap/ double lumen sign (n = 13,31. 0%)and long irregular or thread-like stenosis (n = 9,21. 4%);while dissecting aneurysm (n = 7,16. 7%)and rat tail-shaped occlusion (n = 3, 7. 1%)were relatively rare. In 17 patients (28. 8%)with IAD that conventional MRI/ MRA did not detect the typical dissection sign,the dissections were involved in the middle cerebral artery (11 / 17,64. 7%), they were more common than the 42 patients with IAD (10 / 42,23. 8%)detected the typical dissection sign by conventional MRI/ MRA. There was significant difference (P = 0. 006). (2)Among the 25 patients undergoing DSA,DSA revealed that 15 patients (60%)had the typical dissection sign,and conventional MRI/ MRA only revealed 8 of them (32%)with the typical dissection sign,but there was no significant difference (P = 0. 088). In 15 patients with IAD that DSA detected the typical dissection sign;conventional MRI / MRA detected the typical dissection sign in 8 of them. The diagnostic coincidence rate was 8 / 15. (3)Both conventional MRI/ MRA and DSA revealed non-specific limitation stenosis or cut-off occlusion in 10 patients (16. 9%)with IAD,while the high-resolution MRI revealed intimal flap in 5 of them,intramural hematoma in 4,and intimal flap and intramural hematoma in 1. Conclusion Conventional cranial MRI/MRA is an effective technique for revealing IAD,whereas high-resolution MRI has the unique advantages for diagnosing IAD without typical dissection in other vascular imaging.

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.