Objective To explorethe chest x-ray and MSCT findings and the diagnostic value of pulmonary lymphangioleiomyomatosis (PLAM).Methods Four cases of PLAM proven by pathology were retrospectively analyzed,and the literature was reviewed.Result The clinical manifestations were dyspnoea(4 cases),cough(2 cases),haemoptysis(2 cases),recurrent pneumothorax(2 cases)and chylous effusions (1 case).The chest radiography presented diffused reticular shadows(2 cases),honey-comb changes(1 case),pneumatothorax(2 cases),and pleural effusion(1 case).The characteristic MSCT manifestations of 4 cases with PLAM were multiple different-sized and thin-walled cystoid transparent areas, which were diffusely-distributed throughout both lungs,most cysts were of 3-15 Him in diameter.One case combined with extensive pulmonary interstitial fibrosis,pleural thickening and adhesion.Conclusions PLAM is a kind of exceptional chronic diffuse lung interstitial disease.The chest radiography has been lack of characteristic imagines,but MSCT has characteristics of PLAM,and is more valuable for accurate clinical diagnosis of PLAM.

Objective To observe expression levels of N-methyl-D-aspartate (NMDA) receptor and cholecystokinin (CCK) in the hippocampus and spinal cord in morphine withdrawal or tolerance mice treated by electroacupuncture or catgut embedding and explore the difference between the regulating effects of electroacupuncture and catgut embedding on morphine withdrawal and tolerance.Methods Fifty-six male C57BL/6J mice were randomly allocated to withdrawal control, withdrawal model, withdrawal catgut embedding and withdrawal electroacupuncture groups, and tolerance control, tolerance model, tolerance catgut embedding and tolerance electroacupuncture groups, 7 mice in each group. A model of morphine withdrawal was made by subcutaneous injection of morphine hydrochloride using 7-day increasing addiction method. The withdrawal control group was injected with an equal volume of normal saline at the same time points. In the withdrawal electroacupuncture group, electroacupuncture at bilateral points Shenshu was performed using a Han’s acupoint nerve stimulation device (HANS-200) at 15 min after an injection of morphine hydrochloride. In the withdrawal catgut embedding group, 0.5 cm chromic catgut was embedded in bilateral points Shenshu at 15 min after an injection of morphine hydrochloride. Addiction was promoted by intraperitoneal injection of naloxone 4 mg/kg at 10 o’clock on the seventh day’s morning and Withdrawal reactions were observed in the mice. The score was recorded using the Ryuta Tomoji opioid withdrawal symptoms evaluation scale. NMDA receptor and CCK contents in the hippocampus and spinal cord were measured by enzyme-linked immunosorbent assay (ELISA). A model of morphine tolerance was made by subcutaneous injection of morphine 10 mg/kg. The tolerance control group was injected with tolerance normal saline 10 ml/kg at the same time. In the tolerance catgut embedding group, catgut was embedded in point Shenshu at the first day after model making. In the tolerance electroacupuncture group, point Shenshu was given electroacupuncture at the first day after model making. After seven days of treatment, NMDA receptor and CCK contents in the hippocampus and spinal cord were measured by ELISA.Results There were statistically significant differences in hippocampal NR2B and CCK expressions between the withdrawal model and withdrawal control groups (P<0.05). There was a statistically significant difference in hippocampal NR2B expression between the withdrawal electroacupuncture and withdrawal model groups (P<0.05). There was a statistically significant difference in hippocampal CCK expression between the withdrawal catgut embedding or withdrawal electroacupuncture group and the withdrawal model group (P<0.05). There were statistically significant differences in spinal cord NR2A, NR2B and CCK expressions between the withdrawal model and withdrawal control groups (P<0.05). There were statistically significant differences in spinal cord NR2A and NR2B expressions between the withdrawal electroacupuncture and withdrawal model groups (P<0.05). There were statistically significant differences in hippocampal NR2A, NR2B and CCK expressions between the tolerance model and tolerance control groups (P<0.05). There was a statistically significant difference in hippocampal CCK expression between the tolerance catgut embedding and tolerance model groups (P<0.05). There was a statistically significant difference in hippocampal NR1 expression between the tolerance electroacupuncture group and the tolerance model or tolerance catgut embedding group (P<0.05). There was a statistically significant difference in spinal cord CCK expression between the tolerance catgut embedding or withdrawal electroacupuncture group and the tolerance model group (P<0.05).Conclusions Both catgut embedding and electroacupuncture at point Shenshu have a reducing effect on morphine tolerance and withdrawal. The therapeutic effect of electroacupuncture is better than that of catgut embedding.

Objective To analyze the safety of indwelling neonatal umbilical vein catheter (UVC) at high or low tip positions.Methods We retrospectively analyzed 155 neonates with indwelling UVC in Guangdong Women and Children Hospital from March 2015 to May 2016.According to the position of the catheter tip,these infants were divided into high position group (the tip was at the same level as the central vein) or low position (the tip was below the portal vein) group.Several parameters including indwelling time,liver function,liver B-ultrasound and catheter-related bloodstream infections in the two groups were analyzed.Data were statistically analyzed using Mann-Whitney U test,Wilcoxon signed rank sum test or Chi-square test.Results (1) A total of 155 infants were enrolled in this study.Their gestational age ranged from 25 to 41 weeks and their birth weight were 700 g to 4 690 g.UCV was inserted at the age of 0.5-8.0 d for 0-12 d.In the low position group,seven cases ended in early extubation due to fluid extravasation caused by shallow insertion.The indwelling time of the low position group was shorter than that of the high position group [M (P25-P75),6 (4-7) d and 7 (5-7) d,Z=-2.580,P=0.010].There were no significant differences in gender,gestational age,birth weight,and age at catheterization between the two groups.(2) No abnormality in the two groups was revealed by liver ultrasound.Complications such as neonatal necrotizing enterocolitis,thrombosis and embolism,air embolism and liver abscess were not reported.The proportion of liver function abnormalities in the high group was 6.9％ (6/87),which was not statistically significant as compared with 4.4％ (3/68) in the low position group (3x2=0.431,P=0.512).(3) Blood culture was performed for all cases,of which 116 (74.8％) were catheter culture (including 71 in the high position group and 45 in the low position group).The incidence of catheter-related bloodstream infection in the high position group was 5.6％ (4/71) and the infection rate was 7.4 per thousand catheter days,while in the low position group these figures were 6.7％ (3/45) and 8.0 per thousand catheter days,respectively.There was no significant difference between the two groups (x2=0.052,P=0.820).(4) Results of catheter culture showed that seven cases were positive,including three for Staphylococcus haemolyticus (two in low position group and one in high position group),one for yeast-like fungus (high position group),one for Enterococcus faecium (high position group),one for Staphylococcus aureus (high position group) and one for Candida albicans (low position group).Conclusions The indwelling time of UVC at high tip position is longer than that at low position,and although there are no differences between the complications and the incidence of catheter-related bloodstream infection in the two groups,but its safety needs further study.

Objective:To understand the dilemma of active management in young and middle-aged postoperative patients with lumbar disc herniation, in order to provide reference for the formulation of active intervention program of self-health management meeting the needs of patients.Methods:Using the phenomenological research method, a total of 16 middle-aged and young patients with lumbar disc herniation were selected for semi-structured in-depth interviews, and the themes were analyzed and extracted by Colaizzi 7-step analysis method.Results:Three themes and nine sub-themes were extracted namely, inadequate disease response capacity and response resources (lack of disease symptom management capacity, limited access to disease management information, difficult use of disease management information, difficulty in maintaining positive self-management for a long time (forced to stop behavior change due to stress, lack of motivation to achieve good behavior change, doubts about the effectiveness of self-management) and multi-dimensional negative emotions (contrast between maintaining independence and dependence on others, fear of being misunderstood, fear of relapse) .Conclusions:Medical staff should provide comprehensive health information services for young and middle-aged postoperative patients with lumbar disc herniation, improve the out-of-hospital follow-up mechanism with the help of information technology, further improve family and social support strategies, reduce the difficulties faced in the process of active management and achieve long-term active disease management.

Objective: To observe the association of carotid artery plaque with all-cause mortality and cardiovascular events. Methods: A total of 7 017 participants who completed the carotid sonography examination between 2010 and 2011 were selected from the stroke and the elderly prospective cohort Kailuan study. The participants of stroke cohort received health examination between 2006 and 2007, and participants of elderly cohort received health examination between 2010 and 2011. All participants were divided into plaque group (3 285 cases) and without plaque group (3 732 cases) according to with or without carotid artery plaque.The all-cause mortality and cardiovascular events were compared between the 2 groups. Multivariate Cox regression analysis was used to identify the association of carotid artery plaque with all-cause mortality and cardiovascular events. Results: (1) There were 4 297 male (61.2%) and 2 720 female (38.8%) in this cohort and participants were (58.1±11.8) years old. Age, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol, rates of male, smoking, drinking, history of hypertension and diabetes mellitus were higher in the plaque group than in the without plaque group, and high density lipoprotein cholesterol was lower in the plaque group than in the without plaque group (all P<0.01) at baseline. (2) During a follow-up period of (4.92±0.59) years, the incidence rates of all-cause mortality in the plaque group and without plaque group were 5.5% (180/3 285) and 1.5% (57/3 732) ,respectively (P<0.01) .The incidence rates of cardiovascular events in the plaque group and without plaque group were 3.8% (124/3 285) and 1.4% (52/3 732) , respectively (P<0.01) . (3) Multivariate Cox regression analysis showed that carotid plaque was an independent risk factor of all-cause mortality (HR=1.667, 95%CI 1.160-2.395, P<0.01) and cardiovascular events (HR=1.942, 95%CI 1.312-2.876, P<0.01) after adjusting for age, sex, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, body mass index, total cholesterol,low density lipoprotein cholesterol, high density lipoprotein cholesterol, smoking, drinking, history of hypertension and diabetes mellitus, and use of lipid-regulating drugs. Conclusion Carotid plaque is an independent risk factor of all-cause mortality and cardiovascular events. Clinical Trial Registration Chinese Clinical Trials Registry, ChiCTR-TNC-11001489.

Objective:To establish an in vivo infection model of West Nile virus (WNV) pseudovirus and evaluate the neutralizing activity of antibody WNV-XH1.Methods:A stable cell line that can package the WNV pseudovirus was established in the early stage to prepare the pseudovirus supernatant. The supernatant was concentrated and infected BHK21 cells to detect the titer of the pseudovirus. After intraperitoneal injection of the pseudovirus into C57BL/J mice, bioluminescence imaging was performed to observe the infection status of the pseudovirus in the mice. After simultaneous infection, blood was collected and ELISA was used to detect NS1 levels in mouse serum. The in vivo functional activity of antibody WNV-XH1 was evaluated using the established mouse infection model.Results:Fluorescence was detected in C57BL/J mice infected with WNV pseudovirus, and the NS1 levels in the peripheral blood serum of mice infected with pseudovirus were significantly higher than those of non infected mice (1.453±0.09vs0.305±0.018). After intravenous administration of WNV-XH1 antibody before the attack, the fluorescence signal in the mice decreased and the serum NS1 level decreased (0.384±0.015).Conclusions:A successful in vivo infection model of WNV pseudovirus was established, and it was confirmed that the antibody WNV-XH1 had a protective effect against WNV pseudovirus infection in vivo.

It is of important significant to predict the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus infection in clinic. Various risks scoring systems can achieve better prediction effect by integrating a variety of risk factors, but they still need to be perfected. Recent researches have found that some genotypes and genetic variations are associated with the occurrence of HCC and they can indicate the tumorigenesis of HCC. Some known or newly discovered indicators such as WFA⁺ -M2BP can be used to predict the occurrence of HCC independently or jointly. With the development of research, more genes, indicators as well as newly built scoring system will be utilized to predict the occurrence of HCC in clinic.