Objective To evaluate the clinical value of cerebrospinal fluid ADA,IL-23 joint detection in the diagnosis of tuberculous meningitis related diseases.Methods 253 cases with tuberculous meningitis related diseases were selected as the research subjects.According to the diagnosis,they were divided into tuberculous meningitis group (meningitis group,138 cases ),tuberculous meningitis complicated with hydrocephalus group (hydrocephalus group,35 cases)and control group(80 cases).All patients after admission received lumbar puncture, the part of cerebrospinal fluid specimens were inspected,the cerebrospinal fluid ADA,IL -23 joint test was conducted.Meningitis group and hydrocephalus group were given anti -TB drugs (INH,RFP and PZA +sm ) combined with chemotherapy.3 months after treatment,the meningitis group and hydrocephalus group received lumbar puncture cerebrospinal fluid ADA,IL -23 joint test again.The levels of ADA,IL -23 in cerebrospinal fluid were compared.Results Before treatment,cerebrospinal fluid ADA,IL-23 levels in the meningitis group were (12.64 ± 5.54)u/L and (48.38 ±10.78)pg/mL,those in the hydrocephalus group were (15.81 ±6.92)u/L and (77.21 ± 13.42 mm)pg/mL,which in the control group were (3.21 ±2.20)u/L and (9.05 ±3.89)pg/mL,ADA,IL-23 levels in meningitis group and hydrocephalus group before treatment were significantly higher than the control group (F=117.24,724.97,P<0.001).Spearma analysis showed that each group of cerebrospinal fluid ADA and IL-23 had no correlation.After treatment,the cerebrospinal fluid ADA,IL-23 levels in the meningitis group were (3.79 ± 3.13)u/L and (13.46 ±6.62)pg/mL,which in the hydrocephalus group were (6.42 ±4.35)u/L and (25.42 ± 8.54)pg/mL,the meningitis group before and after treatment had statistically significant differences in cerebrospinal fluid ADA,IL-23 (t=16.34,32.43,all P<0.001);hydrocephalus group before and after treatment had statistically significant differences in cerebrospinal fluid ADA,IL-23 (t=6.80,19.26,all P<0.001 ).Conclusion Cerebro-spinal fluid ADA,IL-23 joint detection in the early diagnosis of tuberculous meningitis related diseases and clinical observation has high clinical value.

Stereotactic body radiation therapy (SBRT) adopts different tumor-killing mechanisms from the conventional fractionated radiotherapy.In SBRT,a single high-dose radiation can destroy the membrane of tumor cells and induce the release of tumor-associated antigen,also named in situ tumor vaccine,which stimulates the immune system to kill the residual tumor;a single-fraction radiation with a dose larger than 8-10 Gy can induce rapid apoptosis of vascular endothelial cells via the acid sphingomyelinase pathway at 1-6 hours after radiation,which causes tumor vascular occlusion and secondary tumor-killing effects.In order to understand whether SBRT improves the clinical treatment outcomes via the above mechanisms,this paper reviews the clinical research advances in SBRT for primary liver cancer.

An indirect square polarographic method was established f or the determination of ascorbic acid in pharmaceuticals using the oxidation-re duction action between Cu2＋ and ascorbic acid. There was a reduction wav e of Cu2＋ at about －0．24　V in buffer solution of NH3-NH4 Cl. The quantities of ascorbic acid is determination according to the decrement of peak heights when ascorbic acid was added. The linear range for ascrobic acid was 2.0×10－6～3．0×10－4 mol/L. Ascorbic acid in Vitami n C tablets was determined, the relative standard deviation is 2.9%.

Objective To investigate the efficacy of intravenous antioxidants therapy in treating moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP).Methods Pubmed,Embase,Cochrane library and CNKI databases for all randomized control trials published before March 18st,2016 manually was searched by computer.Data on AP associated mortality and length of stay (LOS) were collected.The quality of the trials included was assessed by the Cochrane systematic review method.Results Fifteen trials with data of 620 patients were eligible for final inclusion.Among the 15 trials,detailed randomization for grouping was clearly described in 5 studies and obvious bias was observed in 1 study.Three studies had obvious biases considering whether outcome assessment was blinded,outcome data was incomplete and outcome report was selective.No other apparent bias was found.Statistical analysis showed that compared with control group,intravenous antioxidants administration did not significantly reduce mortality (12.1 vs 9.7,RD=-0.02,95％ CI-0.08～-0.03,P=0.44;RR=0.83.95％ CI0.51～ 1.34,P=0.44),but could shorten LOS (MD=-2.02;95％ CI-4.00～-0.05;P=0.04).Conclusions Intravenous antioxidants could greatly shorten LOS of patients with MSAP and SAP.

Objective To gain more pathophysiolgic knowledge about acute obstructive hydrocephalus and to explore its rapid and effective treatment by establishing canine acute obstructive hydrocephalus model.Methods Acute obstructive hydrocephalus model was established by injecting cyan-acrylic gel glue into the fourth ventricle via posterior fosse craniotomy in 9 male adult mongrel dogs.At the same time,lateral ventricle catheterization were performed and were fixed on the scalp to connect reservoir bag so that the changes of intracranial pressure (ICP) could be measured dynamically,and the changes of neurological function were observed.Results Acute obstructive hydrocephalus model was successfully established in 6 of the total 9dogs.ICP was (48.2 ± 6.1 ) cm H2 O at 48 hours after the injection and was (56.4 ± 5.7 ) cm H2 O at 72 hours after the injection,it increased 392％ and 459 ％ respectively.And the ICP after injection was significantly different(P ＜ 0.01 )compared with that before injection (12.3 ± 3.1 )cm H2O.Conclusion The establishment of acute obstructive hydrocephalus model has high success rate,and is easy to reduplicate; ICP could be measured dynamically and also could be reduced by releasing CSF;Thus,ventricular drainage is the most rapid and effective treatment for acute obstructive hydrocephalus.

Objective To discuss the clinical effect of different surgery in the treatment of shunt-dependent hydrocephalus by comparing the postoperative complications of ventriculoperitoneal(V-P) shunt surgery with different incidence of eminence puncture or the triangle puncture.Methods 98 patients with shunt-dependent hydrocephalus who underwent V-P shunt were analyzed.According to different operation methods,they were divided into eminence puncture group (63 cases) and triangle puncture group (35 cases).The operation time and postoperative complications were compared between the two groups,and the clinical efficacy was compared by Glasgow Coma Scale (GCS) score at the end of 12 months follow-up.Results The operation time of the eminence puncture group [(53.35 ± 5.72) rain] was longer than (35.52 ± 9.18) min of the the triangle puncture group (t =6.024,P ＜ 0.05).The incidence rate of complication in the eminence puncture group was lower than that in the the triangle puncture group at postoperative 12 months (x2 =4.395,P ＜ 0.05).Postoperative CT examination found that the ventricle width of the two groups was decreased in different degree.The improvement of Evan's index(t =40.86,P ＜0.05) and GCS score(U =4.50,P ＜ 0.05) in preoperative of the eminence puncture group were greater than those of the triangle puncture group after 12 months.Conclusion The clinical efficacy of V-P shunt of the frontal lateral ventricle puncture may be superior to the triangle puncture in the treatment of shunt-dependent hydrocephalus.

Purpose To investigate the expression of Beclin1, LC3 and mTOR in colorectal cancer ( CRC) and their significance. Methods Immunohistochemistry, Western blot and real-time PCR were employed to detect the expression of Beclin1, LC3 and mTOR in CRC. Results The positive expression rate of Beclin1, LC3 and mTOR in 242 cases of CRC was 90. 50%, 87. 19% and 46. 28%, respectively, which were higher than that in adjacent tissues ( P<0. 05 ) . Moreover, the expression of LC3 in moderately and poorly differentiated CRC was higher than that in well differentiated CRC, and the positive rate of LC3 in CRC with lymph node metastasis was higher than that in CRC without lymph node metastasis. The overexpression of mTOR was related to lymph node metasta-sis (P<0. 05), but both differentiation degree and lymph node metastasis were not associated with Beclin1 (P>0. 05). The expres-sion of LC3 was positively correlated with Beclin1 and negatively correlated with mTOR in colorectal cancer (rs =0. 593, P<0. 01, rs= -0. 165, P<0. 01), and the expression of Beclin1 was not associated with mTOR (P>0. 05). Kaplan-Meier survival analysis re-vealed that the five-year survival rate of patients without nodal metastasis, positive expression of Beclin1, LC3 and negative expression of mTOR was higher than those with nodal metastasis, negative expression of Beclin1 and LC3, and positive expression of mTOR. Cox survival analysis results revealed that LC3, mTOR and lymphnode metastasis were independent prognostic factors. The results of IHC, real-time PCR and Western blot in fresh CRC tissues indicated that the expression of Beclin1, LC3 and mTOR in colorectal cancer was significantly higher than that in adjacent tissues (P<0. 05). Conclusions The aberrant expression of Beclin1, LC3 and mTOR may be associated with the development and progression of colorectal cancer. The simultaneous detection of Beclin1, LC3 and mTOR genes in colorectal cancer may be helpful for the evaluation of the progressive degree and the judgment of prognosis.

Objective:To investigate hemodynamic characteristics of the modified Blalock-Taussig shunt (MBTS) with the preservation or ligation of ductus arteriosus (DA) based on computational fluid dynamics (CFD), thus to help preoperative surgery design and postoperative prediction.Methods:A patient with pulmonary atresia and patent ductus arteriosus was included. Patient-specific three-dimensional model was reconstructed and virtual surgeries of shunt insertion and ductus ligation or preservation were performed via computer-aided design (CAD). CFD was utilized to analyze hemodynamic parameters preoperatively and postoperatively based on patient-specific anatomy and physiologic data.Results:The preservation of DA competitively reduced the shunt flow but increased total pulmonary perfusion. The shunt flow and ductal flow collided with each other, causing large and complicated turbulence in pulmonary artery where lower wall shear stress and higher oscillatory shear index were distributed, as well as higher energy loss.Conclusion:The preservation of DA is riskier in hemodynamics which may lead to pulmonary over-perfusion, inadequate systemic perfusion and heavier cardiac burden, thus increasing the risk of heart failure and it seems to bring no benefit in terms of reducing risks of thrombosis.

Objective To explore effects of three different anesthetic methods on cerebral oxygen partial pressure and cerebral oxygen metabolism in patents with severe traumatic brain injury.Methods A total of 78 patients with severe traumatic brain injury were randomly divided into group A (total intravenous anesthesia),group B (sevoflurane inhalation anesthesia) and group C (combined inhalation and intravenous anesthesia).Mean arterial pressure (MAP),heart rate (HR),jugular vein blood oxygen content (CjvO2),radial artery blood oxygen content (CaO2) and cerebral extraction of oxygen (CERO2) were observed in all groups at the time points of pre intubation (T0),pre anesthesia induction (T1),2 minutes after anesthesia induction (T2),10 minutes after surgery begin (T3),30 minutes after surgery begin (T4),end of surgery (T5).Results Compared with T0 and T1,MAP in all groups at T2 to T5 significantly decreased (F =5.112,4.040,4.301;P =0.0002,0.0018,0.0011).In all groups,SjvO2 significantly increased after anesthesia (F =3.833,3.322,8.114;P=0.0027,0.0071,＜0.0001),Da-jvO2(F=3.127,2.635,4.886;P=0.0094,0.0258,0.0004) and CERO2 (F =14.37,8.805,25.72;P ＜ 0.01) significantly decreased.Conclusion Propofol intravenous anesthesia,sevoflurane inhalation anesthesia and general anesthesia combined with intravenous anesthesia have good brain protection effects.

Objective To explore effects of three different anesthetic methods on cerebral oxygen partial pressure and cerebral oxygen metabolism in patents with severe traumatic brain injury.Methods A total of 78 patients with severe traumatic brain injury were randomly divided into group A (total intravenous anesthesia),group B (sevoflurane inhalation anesthesia) and group C (combined inhalation and intravenous anesthesia).Mean arterial pressure (MAP),heart rate (HR),jugular vein blood oxygen content (CjvO2),radial artery blood oxygen content (CaO2) and cerebral extraction of oxygen (CERO2) were observed in all groups at the time points of pre intubation (T0),pre anesthesia induction (T1),2 minutes after anesthesia induction (T2),10 minutes after surgery begin (T3),30 minutes after surgery begin (T4),end of surgery (T5).Results Compared with T0 and T1,MAP in all groups at T2 to T5 significantly decreased (F =5.112,4.040,4.301;P =0.0002,0.0018,0.0011).In all groups,SjvO2 significantly increased after anesthesia (F =3.833,3.322,8.114;P=0.0027,0.0071,＜0.0001),Da-jvO2(F=3.127,2.635,4.886;P=0.0094,0.0258,0.0004) and CERO2 (F =14.37,8.805,25.72;P ＜ 0.01) significantly decreased.Conclusion Propofol intravenous anesthesia,sevoflurane inhalation anesthesia and general anesthesia combined with intravenous anesthesia have good brain protection effects.