39 cases of fatally abused children were collected during April,1984 to febraury,1987 in Los Angeless,U.S.A.73 cases of non-abused children were obtained as control.Both eyes of each case were taken and examined histo- pathologically.The intraocular changes occured in 64% of the fatally abused children.They were:Retinal hemorrhage,vitrous hemorrhage,retinal de- tachmedt,papilledema,subdural hemorrhage of the optic nerve and traum- atic cataract.On the other hand,the intraocular changes occured in 28% of control cass,especially in those of traffic and other accidents which usually caused the injuries of head and neck.Considering the intraocular changes and the general injuries together,we suggest that the most important mec- hanism of the intraocular changes be head injuries and whiplash syndrome.

Objective To investigate the hemostatic effect and influence on coagulation function of hemecongulase during neurosurgical operation.Methods Sixty patients with neurosurgical trauma at American statistical association(ASA) Ⅰ-Ⅱ were randomly divided into hemocoagnlase treatment group (n =30) and control group(n =30).Both two group were injected Baquting 2U at the day before the operation,30 min before the operation,every two day after the operation and end up 3 d.Treatment group were pedormed with Baqyting 4 U + physiological saline 10 ml topical spraying.The intelligibility of operating region,the volume of intraoperative,the volume of bleeding during the operation,transfusion of blood,postoperative drainage,and drainage tube exelcymosis time were recorded in all the patients.Prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen level(FIB),fibrinogen degradation product(FDP) and the two D-dimer and platelet count(PLT) before and after the surgery were also determined.All the patients were postoperatively followed up.Results The intelligibility of operating region was 70.0％ (21/30) in the hemocoagnlase treatment group,higher than that in control group (0％,P ＜0.05).The volume of bleeding during the operation in the hemecoagulase treatment group was (680.00 ± 95.22) ml,significantly fewer than that in the control group((790.00 ±47.00) ml,P =0.034).PLT significantly decreased after the surgery in both of the groups compare to that in preoperation (P ＜ 0.05 or P ＜ 0.01) and no significant difference was seen between two groups (P ＞ 0.05).No severe adverse events were found in both groups.Conclusion Hemocoagulase treatment during the operation can improve the intelligibility of operating region,reduce the volume of bleeding and transfusion of blood,and do not affect the coagulation function in the patients.Therefore,hemocoagulase is a safe and effective hemostatic and through local application during the operation it can improve curative effect.

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 investigate the molecular regulatory mechanism of glucagon like peptide 1 (GLP-1) on proliferation, differentiation and apoptosis of human umbilical cord blood endothelial progenitor cells (EPCs). Methods EPCs were isolated from the umbilical cord blood of healthy pregnant women and cultured in 6-hole cell plate at 2×105 density in vitro, transfected with empty vector plasmid (control group), pcDNA3-GLP-1 plasmid (GLP-1 group), pcDNA3-GLP-1plasmid+AMD3100 (GLP-1+AMD3100 group) and simple AMD3100 (AMD3100 group). The pcDNA3-GLP-1 was transfected into EPCs. The 25μmol/L AMD3100 was used to block the SDF-1/CXCR4 signal pathway of EPCs for 1 h. The cell proliferation was determined by MTT method. The mRNA expressions of differentiation and apoptosis related genes PPARγ, C/EBPα and Caspase-3 were investigated by RT-PCR, and Caspase-3 activity was determined by Caspase-3 activity assay kit. Results Compared to control group, AMD3100 inhibitor showed no effects on cell proliferation, differentiation and apoptosis, while over-expression of GLP-1 in EPCs obviously promoted cell proliferation, and differentiation related genes PPARγand C/EBPαmRNA expression, but down-regulated mRNA expression and the activity of Caspase-3 significantly (P＜0.05), indicating that GLP-1 increased proliferation and differentiation of EPCs while decreased cell apoptosis. When the SDF-1/CXCR4 signaling pathway was blocked by AMD3100, over-expression of GLP-1 induced promotion of cell proliferation, and the differentiation was decreased significantly and the apoptosis was significantly increased (P＜0.05). Conclusion These data confirm that GLP-1 might promote EPCs proliferation and differentiation, and inhibit cell apoptosis through the regulation of the SDF-1/CXCR4 signaling pathway.

Objective:To construct a fusion protein of extracellular domain peptide fragment of muscle specific kinase ( MuSK) and fluorescent protein mCherry ,and used as antigen in the detection of antibodies against MuSK ( MuSKAb ) in the sera of patients with myasthenia gravis ( MG).Methods:The mCherry gene was amplified by PCR from vector pRSET-B and cloned into pGEM-T Easy Vector,and furthermore, cloned into Eukaryotic expression vector pMT /BiP/V5-His ( MuSK), which contains MuSK extracellular domain 22-452 amino acid peptide fragment gene to construct the fluorescent fusion protein gene MuSK -mCherry.The recombinant vector was subsequently transfected into drosophila S 2 cells for expression.The expressed fusion proteins were verified in confocal mi-croscope ,and used as antigen in the detection of MuSKAb in sera of MG patents in fluorescence immunoprecipitation test .Results:The fluorescent fusion protein MuSK-mCherry was successfully constructed and expressed.The MuSKAb in sera of patents with MG could be detected in fluorescence immunoprecipitation test using the constructed MuSK-mCherry fusion protein as antigen.Conclusion: It is available to use the constructed fluorescent fusion protein MuSK-mCherry as antigen in fluorescence immunoprecipitation test for the detection of MuSKAb in sera of patents with MG.

Objective For decreasing the infected rate,the prevention and cure methods of intracranial infections following posterior fossa craniotomy were study. Methods Twenty-eight patients with the intracranial infections following posterior fossa craniotomy were examined by lumbar puncture,and analyzed cerebrospinal fluid with routine examination and reference to the bacteriological data and drug sensitive tests. All the patients were treated with high dosage sensitive antibiotics, and draining continually the infected cerebrospinal fluid by lumbar puncture catheterization and injected small dosages of antibiotics into intraspinal for most cases. Results Twenty-eight patients had intracranial hypertension by lumbar puncture examination, outcome of cerebrospinal fluid culture indicated that 17 cases had bacteria growth and 11 cases had no bacteria. The intracranial infection was controlled effectively,and 96.4%(27 cases) were cured, 1 case dead of systemic failure. Conclusions Strict aseptic techniques,reduce operative time,decrease intracranial place of foreign matters, such as gelfoam, hemostatic gauze and artificial implants, could reduce the possibilities of intracranial infections. Appropriate antibiotics selection,lumbar puncture catheterization and intraspinal administration of antibiotics can cure intracranial infections effectively.

Objective To investigate the growth inhibition of human osteosareoma cell line(MG-63) intervened by Hydralazine and 5'-aza-2'-deoxycytidine (5-Aza-CdR),and the effect on the mRNA expression of gene WW domain-containing oxidoreductase (WWOX).Methods Certain volume of 5 × 104/ml of human osteosarcoma cell line MG-63 in logarithmic growth phase were added into 96-well plate.There were Hydralazine group (drug concentration,0.1,1.0,10 μmol/L),5-Aza-CdR group (drug concentration,5,10,20 μmol/L),Hydralazine combined with 5-Aza-CdR group (drug concentration,0.1 μmo/L + 5 μmol/L,1.0 μmol/L + 10 μmol/L,10 μmol/L + 20 μmol/L) and control group (culture medium).Methyl thiazol tetrazolium(MTT) colorimetric methods were used to test the growth inhibition of MG-63 cells intervened by different concentrations of Hydralazine and 5'-aza -2'-deoxycytidine (5-Aza-CdR).Flow cytometry AnnexinV-FITC/PI methods were used to assay the effects of Hydralazine and 5-Aza-CdR inducing apoptosis in osteosarcoma cells in vitro.Real-time polymerase chain reaction (Real-Time PCR)methods were used to detect amplification of WWOX mRNA induced by Hydralazine combined with 5-Aza-CdR or alone.Western-blotting methods were used to examine the expression of WWOX in MG-63 cells.Results Hydralazine and 5-Aza-CdR effectively inhibited the growth of MG-63 cells in a concentration and time-dependent manner.Combined effect was more obvious.Further more the expression levels of WWOX mRNA and protein were increased significantly in combined groups as compared with other groups.Conclusion Hydralazine and 5-Aza-CdR could effectively inhibit the proliferation of MG-63 cells and induce apoptosis which is concurrent with the promotion of the expression of WWOX.The mechanism may be that Hydralazine/5-Aza-CdR effectively cause the demethylated of WWOX gene CpG-rich promoter regions,leading to the high expression of WWOX and inhibit the growth of MG-63 cells.The use of hydralazine in the treatment of osteosarcoma is worthy of further investigation.

ObjectiveTo observe anatomy of the blood vessel arches and their blood circulation in the ileum and further establish surgical strategy for preventing excessive tonicity and ischemia of the ileum after anastomosis of the ileum pouch and the anal canal.MethodsThe blood vessel arches were dissected in the ileum of 45 corpses and their blood circulation routes were observed.ResultsThe 2-tier blood vessel arches were found in 2 cases (4％), the 3-tier blood vessel arches in 35 cases (78％), the 4-tier blood vessel arches in 5 cases (11％), and the 5-tier blood vessel arches in 3 cases (7％).ConclusionsUnder the right colic artery, curing the superior mesenteric artery and vein can release the length of the small intestines, prevent tonicity and ischemia of the ileum after anastomosis of the ileum pouch and the anal canal, and supply enough blood to the ileum by the 2 -5 tier blood vessels.

Objective To explore the method and management of pre-hospital care and raise the level of traffic injuries in pre-hospital care by summarizing the clinical features of death patients with severe tragic accident trauma Methods The basic data of 62 death patients with severe traffic accident trauma was analyzed according to death report statistics of severe traffic accident trauma from January 1st,2005 to December 31th,2008 Results Brain injury death accounted for most of traffic accident trauma death.The mortality rate of brain injury in the wounded wag 8.28%(13/157),but of asphyxia and hemorrhagic shock was 2.55%(4/157),3.18%(5/157)respectively in 2005.With the development of treatment and rescued in time, the mortality rate reduced to 6.11%(11/180),0,0.56%(1/180)in 2008.Conclesions It should be trying to shorten the time of pre-hospital care for pafients with trsffic accident trauma,especially in patients combined with hemorrhagic shock,asphyxia,severe brain injury.It is concluded that rapid and effective pre-hospital care can significantly reduce death rate and self-help or each other rescue training would also be effective to reduce mortality.

Objective:To survey bone age, vitamin A, vitamin D and IGF-1 levels among stunted children, and to explore the clinical values.Methods:The experimental group was composed of 200 stunted children who visited the growth retardation clinic of Jiangning Hospital Affiliated to Nanjing Medical University between October 2017 and October 2019.The control group consisted of 200 children of normal height during the same period.The differences of developmental level, the qualified rates of serum vitamin A and vitamin D, and the number of the children whose serum IGF-1 at or above the median and their corresponding measurements were compared between the two groups.Results:Totally, 26% of the experimental group fell behind normal children by two years in their bone ages, as compared with 12% of control group.The differences in developmental levels of bone ages between the two groups were statistically significant( χ2=12.74, t=5.42、7.92, P<0.01). Compared with the control group, the experimental group had obviously lower rates of vitamin A and vitamin D levels( χ2=26.85、13.65, t=8.45、12.47, P<0.01). A total of 88 children (44%) of the experimental group had serum IGF-1 levels at or above the median, as compared with 138 children (69%) of the control group( χ2=25.43, t=32.31, P<0.01). Conclusion:This finding supports the potential use of the bone age, vitamin A and D status and IGF-1 levels in growth retardation screening among children.