Objective To explore CT diagnosis of atypical meningioma .Methods 18 cases of atypical meningioma were undergone MR plan scans, among them,17 cases were examined by CT contrast scans. All cases were proved by operation and pathology.Results The tumors appeared as mixed density in 11 cases,cystic in 4 cases,complete enhancement in 3 cases.Conclusion The tumors to be comfirmed at external cerebra is the key in diagnosing atypical meningioma exactly by CT.Atypical manifestations can be seen in a few meningiomas,therefore, it is significant in differential diagnosis of meningioma.

We reported a rare case of protoplasmic astrocytoma presenting small muscle atrophy of the right hand as an initial sign.A 39-year-old male was admitted to hospital complaining of chronic muscle atrophy and subtle headache.Electromyography(EMG) showed brief small denervation and no signs of sensory-motor conduction impairment.CT and MRI revealed multiply expansive intracranial lesion in left hemisphere,which was highly suspected of cerebral echinococccus or Balo disease.The patient underwent surgical excision and pathological report was protoplasmic astrocytoma,with glial fibrillary acidic protein(GFAP,+++) of immunohistochemical method.We reviewed clinical features,radiological manifestations and pathology of protoplasmic astrocytoma with medical literature documents.

This study is to assess the efficacy of BPCBG on the decorporation of uranium (VI) and protecting human renal proximal tubular epithelial cells (HK-2) against uranium-induced damage. BPCBG at different doses was injected intramuscularly to male SD rats immediately after a single intraperitoneal injection of UO2(CH3COO)2. Twenty-four hours later uranium contents in urine, kidneys and femurs were measured by ICP-MS. After HK-2 cells were exposed to UO2(CH3COO)2 immediately or for 24 h followed by BPCBG treatment at different doses for another 24 or 48 h, the uranium contents in HK-2 cells were measured by ICP-MS, the cell survival was assayed by cell counting kit-8 assay, formation of micronuclei was determined by the cytokinesis-block (CB) micronucleus assay and the production of intracellular reactive oxygen species (ROS) was detected by 2',7'-dichlorofluorescin diacetate (DCFH-DA) oxidation. DTPA-CaNa3 was used as control. It was found that BPCBG at dosages of 60, 120, and 600 micromol kg(-1) resulted in 37%-61% increase in 24 h-urinary uranium excretion, and significantly decreased the amount of uranium retention in kidney and bone to 41%-31% and 86%-42% of uranium-treated group, respectively. After HK-2 cells that had been pre-treated with UO2(CH3COO)2 for 24 h were treated with the chelators for another 24 h, 55%-60% of the intracellular uranium was removed by 10-250 micromol L(-1) of BPCBG. Treatment of uranium-treated HK-2 cells with BPCBG significantly enhanced the cell survival, decreased the formation of micronuclei and inhibited the production of intracellular ROS. Although DTPA-CaNa3 markedly reduced the uranium retention in kidney of rats and HK-2 cells, its efficacy of uranium removal from body was significantly lower than that of BPCBG and it could not protect uranium-induced cell damage. It can be concluded that BPCBG effectively decorporated the uranium from UO2(CH3COO)2-treated rats and HK-2 cells, which was better than DTPA-CaNa3. It could also scavenge the uranium-induced intracellular ROS and protect against the uranium-induced cell damage. BPCBG is worth further investigation.

Objective:To investigate the efficacy and safety of continuous blood purification in the treatment of severe acute pancreatitis.Methods:60 cases of severe acute pancreatitis were selected and divided into two groups.The control group (29 cases) was given routine treatment and the observation group (31 cases) was given continuous blood purification.The efficacy of continuous blood purification in the treatment of severe acute pancreatitis was evaluated by CRP,ALT,PaO2/FiO2,HCO3-,Scr,APACHE Ⅱ and MODS scores before and after treatment,complications and survival situation during treatment.Results:Before treatment,there was no statistical significance in the CRP,ALT,PaO2/FiO2,HCO3-,Scr levels between two groups (P＞0.05).After treatment,the CRP,ALT,HCO3-,Scr levels of two groups were decreased.These indexes of observation group were lower than those of the control group (P＜0.05).The PaO2/FiO2 of both groups were increased.The PaO2/FiO2 of observation group was high than that of the control group (P＜0.05).Before treatment,there was no statistical significance in the APACHE Ⅱ and MODS scores between two groups (P＞0.05).After treatment,the APACHE Ⅱ and MODS scores were lower than those before treatment.The APACHE Ⅱ and MODS scores in the observation group were lower than those of the control group (P＜0.05).During treatment,there was no statistical significance in the complications and survival rate between two groups (P＞0.05).Conclusion:Continuous blood purification had a good therapeutic effect on the severe acute pancreatitis.It could improve the organ function,reduce inflammation and regulate the balance of water and electrolyte with high safety.

Objective To explore the clinical efficacy of Qingyi decoction (a preparation of Chinese herbal medicine) combined with DAR (combined use of dexamethasone,anisodamine and rhubarb) for the treatment of acute pancreatitis.Methods A total of 387 eligible patients met the criteria of acute pancreatitis were enrolled from January 2005 to April 2012 for prospective study.All patients,mild acute pancreatitis (MAP) or severe acute pancreatitis (SAP),were divided (random niumber) into four groups,namely conventional therapy (T),DAR therapy (DAR),Qingyi decoction therapy (Q) and Qingyi decoction combined with DAR therapy (Q + DAR).Outcome,fasting time,serum amylase,abdominal pain relief time,pancreatic or peri-pancreatic complications and average hospital-stay were analvzed with SPSS 13.0 statistic software.P ＜ 0.05 was considered statistically significant.Results None of MAP patients died.Of SAP patients,there was no difference in mortality among different groups (P ＞ 0.05).length of fasting time,tine elapsed for abdominal pain relief,time required for normalized serum amylase level and length of hospital stay in MAP patients were significantly shorter than those in SAP patients regardless of different therapies (P ＜ 0.05).Either patients of SAP or MAP treated with Q + DAR or DAR suffered shorter length of time than those treated with T or Q in respect of fasting,abdominal paiu relief,serum amylase level normalization and hospital stay (P ＜ 0.05).For SAP or MAP patients,there was no difference in abdominal pain relief time between receiving DAR and Q + DAR treatment (P ＞ 0.05),but the fasting time in Q + DAR was shorter than that in DAR (P ＜ 0.05).Patients with SAP were more likely to suffer pancreatic or per-pancreatic complications than those with MAP,but there was no difference for SAP or MAP with different treatments.Conclusions DAR or Q + DAR was an alternative to conventional treatment for MAP or SAP,and they were both superior to conventional treatment.And Q + DAR was more advantageous than DAR when fasting time,hospital-stay time and cost were considered.

Objective To investigate the diagnostic value of MR fast scanning techniques in fetal congenital diaphragmatic hernia. Methods 12 cases diagnosed or suspected fetal congenital diaphragmatic hernia by ultrasound with gestational age (>20 weeks) were underwent MR examination.The fast scan sequences were as follows:Half-Fourier acquisition single-shot fast spinecho se-quence(HASTE)、True fast imaging steady-state precession sequence (True FISP)、Turbo FLASH T1 WI sequence.The axial,co-ronal and sagittal scanning were focused on fetal head and body.The results of prenatal MR examination was compared with neonatal surgical findings or autopsy results after inducing labor.Results All of 12 cases,9 cases were left diaphragmatic hernia,2 cases were right diaphragmatic hernia and 1 case was hiatal hernia.2 cases of them were complicated with other congenital malformations. The features of MRI were as follows:Some portions of bowels and stomach crossed into the thorax were visible in the HASTE and TRUE FISP sequence.The herniated stomach and bowels showed high or scattered high signals.The intestinal types were visible as well.The lung tissue intruded at the apex of the lung and the heart deviated to the opposite side were demonstrated.T1 weighted im-ages obtained from ultra-fast FLASH (Turbo FLASH)T1WI sequence showed characteristic high signals in the meconium,which delineated clearly the shape of the colon and small intestine.The prenatal MRI results of all cases were consistent with surgical (10 cases)and autopsy (2 cases)findings.Conclusion MR fast scanning techniques can clearly show fetal congenital diaphragmatic her-nia.Multiple sequences scanning can comprehensively map the organizational structure and anatomical relationship of fetal congenital diaphragmatic hernia with the surrounding tissues.MR fast scanning techniques play an important role in the diagnosis of fetal con-genital diaphragmatic hernia.

Through stating the current situation of the doctor -patient relationship , and combining with its characteristics in emergency ICU (EICU), to analyze the application basements and skills of progressive doctor -patient communication in EICU , in order to explore the present stage to build a harmonious doctor -patient rela-tionship , a feasible way to safeguard the rights and interests of both doctors to provide the reference .

Objective: To explore the role of toll-like receptor 4 (TLR4)/NF-κB signaling pathway in acute necrotizing pancreatitis (ANP)-associated lung injury and the intervention of lipoxin A4 (LXA4) analogue. Methods: Forty-five Sprague-Dawley rats were randomly(random number)divided into the sham operation group, experimental group, and intervention group, each group containing 15 rats. ANP animal models were prepared by injecting sodium taurocholate into biliopancreatic tube in the experimental group. No sodium taurocholate was injected into biliopancreatic duct in the sham operation group. After the preparation of ANP animal models in the intervention group, LXA4 was injected through the tail vein. Rats in each group were randomly divided into 3 subgroups (n=5 each subgroup). The serum amylase, TNF- α, IL-1β, IL-6 and endotoxin levels were detected 6, 12 and 24 h after the operation. The lung injury scores were assessed and the lung wet/dry weight ratio was calculated. The expressions of TLR4 and NF-κB p65 in lung tissues were detected by Western blot. Results: Serum levels of amylase, TNF-α, IL-1β, IL-6 and endotoxin in the experimental and intervention groups were significantly higher than those in the sham operation group, while the levels of the above indicators in the intervention group was significantly lower than those in the experimental group, and the differences were statistically significant (P<0.05). Postoperative lung injury scores and lung wet/dry weight ratio in the experimental group were significantly higher than those in the sham operation group, and the differences were statistically significant (P<0.05). Lung injury scores in the intervention group 6 h after operation had no significant difference compared with those in the sham operation group (P>0.05), while lung wet/dry weight ratio in the intervention group 6 h after operation, and lung injury scores and lung wet/dry weight ratio in the intervention group 12 h or 24 h respectively after operation were significantly higher than those in the sham operation group, with statistically significant differences (P<0.05). Postoperative lung injury scores and lung wet/dry weight ratio in the intervention group were significantly lower than those in the experimental group, and the differences were statistically significant (P<0.05). The expressions of TLR4 and p65 in the lung tissues of the experimental and intervention groups were significantly higher than those of the sham operation group, and the expressions of TLR4 and p65 in the lung tissues of the intervention group were significantly lower than those of the experimental group, with statistically significant differences (P<0.05). Conclusions LXA4 can reduce the severity of acute necrotizing pancreatitis-associated lung injury, and its mechanism is related to reducing the stimulation of endotoxin, thus inhibiting TLR4 signaling pathway and the activation of p65 to down-regulate the level of pro-inflammatory cytokines.

Objective:To explore the mechanism of pioglitazone in reducing lung injury induced by acute pancreatitis.Methods:Thirty healthy male SD rats were randomly(random number) divided into the sham operation group, model group and pioglitazone group, with 10 rats in each group. After anesthesia, the rats in the sham operation group were injected with normal saline retrogradely through the pancreaticobiliary duct. In the model group, after anesthesia, the rats were retrogradely injected with sodium taurocholate into the pancreaticobiliary duct to construct the lung injury model of severe acute pancreatitis. In the pioglitazone group, the model was established after intraperitoneal injection of pioglitazone. Six rats in each group were randomly selected and killed 12 h after operation, and then lung tissue and venous blood were collected. The levels of serum amylase and TNF-α and NO in lung tissue homogenate were detected and compared among the three groups; the expression of TLR2 mRNA and TLR4 mRNA in lung tissue was detected by RT-PCR and compared among the three groups; the lung tissue pathological injury score and lung leakage index were calculated and compared among the three groups. The correlation of TLR2 and TLR4’s mRNA expression with lung tissue pathological injury score and lung leakage index was analyzed.Results:The levels of serum amylase and the levels of TNF-α and NO in lung tissue homogenate in the model group were significantly higher than those in the sham operation group, and the above indexes in the pioglitazone group were significantly lower than those in the model group ( P<0.05). The expression levels of TLR2 mRNA and TLR4 mRNA in lung tissue, the lung tissue pathological injury score and lung leakage index in the model group were significantly higher than those in the sham operation group, and the above indexes in the pioglitazone group were significantly lower than those in the model group ( P<0.05). Spearman correlation analysis showed that the expression levels of TLR2 mRNA and TLR4 mRNA in lung tissue were significantly positively correlated with the lung tissue pathological injury score ( rs=0.959, P<0.001; rs=0.924, P<0.001). Pearson correlation analysis showed that the expression levels of TLR2 mRNA and TLR4 mRNA in lung tissue were significantly positively correlated with the lung leakage index ( r=0.957, P<0.001; r=0.958, P<0.001). Conclusions:Pioglitazone may reduce the severity of severe acute pancreatitis induced lung injury by inhibiting the expression of TLR2 mRNA and TLR4 mRNA in lung tissue.

Objective:To explore the mechanism of miR-494 negatively regulating ROCK1 and PTEN in inhibiting apoptosis of pancreatic cells and participating in the occurrence and development of acute pancreatitis.Methods:Pancreatic acinar cells AR42J from rats were treated by caerulein, and then the levels of amylase, tumor necrosis factor alpha (TNF-α), interleukin 1 (IL-1) and IL-6 in the supernatant of cell culture were detected by ELISA to verify the cell model of acute pancreatitis. RT-PCR was used to detect the expression of miR-494 in normal AR42J cells (control group) and acute pancreatitis cell model (model group). Flow cytometry was used to detect the apoptosis of the control group, negative control miRNA transfected acute pancreatitis cell model (negative control group) and miR-494 transfected acute pancreatitis cell model (miR-494 transfection group). Western blot was used to detect the expression of ROCK1 and PTEN in the control group, negative control group and miR-494 transfection group.Results:The levels of amylase, TNF-α, IL-1 and IL-6 in the supernatant of AR42J cells treated with caerulein for 8 h and 12 h were significantly higher than those at 0 h and the control group ( P<0.05), indicating that the model was successfully constructed. The expression levels of miR-494 at 8 h, 12 h and 24 h after the establishment of acute pancreatitis cell model were significantly higher than those at 4 h and the control group ( P < 0.05). The apoptosis rate of the model group was significantly higher than that of the control group ( P<0.05), and the apoptosis rate of the miR-494 transfection group was significantly lower than that of the model group ( P<0.05). The expression levels of ROCK1 and PTEN in the miR-494 transfection group were significantly lower than those in the model group and negative control group ( P<0.05). Conclusions:When acute pancreatitis occurs, overexpression of miR-494 can inhibit the expression of pro-apoptotic protein, thus inhibiting the apoptosis of pancreatic acinar cells and promoting the development of acute pancreatitis.