Objective:To evaluate the value of 64-slice CT portal venography(CTPV)in demonstrating portal system and its collaterals in portal hypertension.Methods:50 cases of portal hypertension were included in the study and undergone upper abdomen examination with 64-slice CT,image post-processing techniques such as MIP,MPR and VR were applied to display the portosystemic collaterals of portal venous system.Results:CTPV simultaneously depicted fourth or fifth branches of the intrahepatic portal veins and provided images of entire portosystemic collaterals,on CTPV images,left gastric varices were seen in 48 patients(96%),esophygeal and/or fundic varices in 46(92%),paraesophageal varices in 41(82%),shnrt gatric veins or posterior gastric veins in 19(38%),shunt between spleen/gastric-renal vein in 14(28%),abdominal wall and paraumblical varices in 20(40%),retroperitioneal varices in 19(38%),portal sponge degeneration in 8(16%).Conclusion:CTPV can much more clearly demonstrate the collateral vessels in patients with cirrhosis and portal hypertension.An understanding of the varied appearances of acquired abnormalities of the portal venous system will allow more definitive diagnosis and help avoid false diagnosis of disease,and may play a significant role in marking a clinical treatment plan.

Objective:To analyse the findings of MRI and CT in the diagnosis of spine metastases in 52 cases,and compare their sensitivity and specificity,in order to increase the early diagnosis rate of spinal metastases.Methods:The most common sources of skeletal metastases were carcinomas of lung,breast,nasopharynx.MRI and CT were performed in 52 patients with metastatic tumor.The detectability for vertebral metastasis was compared between the two modalities.Results:Of the 52 cases,there were destructions of 176 vertebral bodies,76 lesions of spinal canal involvement,68 paravertebral soft tissue.masses and pathological fractures of 47 vertebral bodies.In the cases of stage Ⅰ spinal metastases:21 were detected by MRI and nothing was detected by CT.In the cases of stage Ⅱspinal metastases:86 were detected by MRI;52 were detected by CT.In the cases of stage Ⅲ spinal metastases:68 were detected by MRI;61 were detected by CT.The sensitivity of spinal metastases by MRI(99.4%) higher than CT(64.2%).MRI demonstrated decreased signal intensity(86.9%)and other abnormal signal intensity(13.1%)on T1WI and increased signal intensity(60.8%)and other abnormal signal intensity(39.2%)on T2WI.Conclusion:The sensitivity and specificity of MRI is higher than that of CT.Two methods are complementary to each other,so MRI combined with CT can improve the sensitivity and accuracy in the diagnosis of spinal metastases.

BRAF gene has the highest mutation rate and plays an important role in the occurrence,development,invasion and metastasis of melanoma.The frequency of the mutation varies in different clinical phenotypes,clinical pathology classifications and stages of malignant melanoma,which indicate a certain association of BRAF gene with the growth and prognosis judgment in malignant melanoma.BRAF gene mutation is the new direction of treatment in malignant melanoma molecular target therapy.

Objective To explore the relationship between the expression of NF-κB and VEGF and the biological behaviors of prostatic carcinoma.Methods Immunohistochemical method was used to examine the expression of NF-κB and VEGF in 40 cases of benign prostatic hyperplasia (BPH) and 53 cases of prostatic carcinoma.Results The positive rates of NF-κB and VEGF in prostatic carcinoma and BPH were 64.2％ and 69.8％,12.5％ and 37.5％ respectively.There are more cases with positive NF-κB and VEGF expression in prostatic carcinoma group than in the BPH group( x2 =24.976,9.655,P ＜ 0.01 ).The expression of VEGF and NF-κB in prostatic carcinomas increased significantly with the decrease of tumor differentiation and advance of the TNM stages(x2 =15.936,18.459;4.316,14.205,P ＜0.01 or P ＜0.05);The expression of VEGF in prostatic carcinoma was positively correlated with NF-κB ( r =0.297,P =0.027 ).Conclusion The expression of VEGF and NF-κB in prostatic carcinoma are highly correlated with each other and may be suggestive to understand the biological behavior of prostatic carcinoma.

The erythrocyte complement receptor 1 (ECR1) activity and CR1 quantitative genotype distribution were studied and the mechanisms of decreased ECR1 activity in cerebral infarction revealed. By using red blood cell yeast rosette test ECR1 activities were measured and by using PCR-RFLP CR1 Hind Ⅲ genomic polymorphism detected in the patients with cerebral infarction and healthy controls. The results showed that the level of C3bRR was decreased and the level of CICRR increased in the patients with cerebral infarction as compared with healthy controls (both P<0.05). CR1 quantitative genotype distribution in the patients with cerebral infarction was differed significantly from that of healthy controls (P<0.05). It was concluded that the decrease of ECR1 activity in the patients with cerebral infarction was correlated with CR1 Hind Ⅲ genomic polymorphism.

Objective To explore the effect of oxidative stress on intermittent hypoxia induced-hip-pocampal injury in rats. Methods 30 adult male Sprague-Dawley rats were random divided into three groups ( 10 rats in each group), control group( CON group), intermittent group( IH group), and melatonin group( MEL group). The levels of MDA and SOD were detected by colorimetric method, and RT-PCR was used to examine the mRNA levels of the Cu/ZnSOD, GPx, CAT in hippocampal tissues. Results The level of MDA in IH group was ( 1. 68 ±0. 23) μmol/g, and it was obviously higher than that in control group (1.25±0.14)μmol/g and MEL group(1.35 ±0.18) μmoL/g ( P ＜0.05, P ＜0.01). In IH group, the activity of SOD and the mRNA levels of the Cu/ZnSOD,GPx and CAT were 43.01 ±4. 96 103NU/g, 0.25±0. 02,0. 34 ±0. 09,0. 38 ±0. 03 respectively, which were significantly lower than those in control group(61.12 ±5.68 103NU/g protein,0. 48 ±0.06,0. 55±0.07,0.57 ±0.04) and MEL group (55.98 ±4.65 103 NU/g,0.43 ± 0.08,0.54 ± 0.05,0.53 ± 0.07 ) ( P ＜ 0.05, P ＜ 0. 01 ). Conclusion Intermittent hypoxia can induce hippocampal injury in rats by oxidative stress, and melatonin can inhibit intermittent hypoxia induced-oxidant stress, so it can protect intermittent hypoxia induced-hippocampal injury in rats.

Objective To compare the efficacy of ultrasound -guided bilateral superficial cervical plexus block combined with general anesthesia and single general anesthesia in patients undergoing thyroidectomy.Methods 60 patients with ASAI ~II undergoing thyroidectomy,in accordance with the random number table,were divided into bilateral superficial cervical plexus block combined with general anesthesia group (group A)and single general anesthesia group(group B),30 cases in each group.In group A,the patients were provided ultrasound -guided bilateral superficial cervical plexus block with 0.4% ropivacaine 40 ml(20 mL for each side)before general anesthesia induction.In group B,the patients were directly induced for general anesthesia.The patients of the two groups had the same general anesthesia induction drugs.SBP,DBP and HR were monitored and recorded at the time of pre -anesthesia,skin incision, postoperation and extubation.The cumulative amount of propofol and remifentanil during the operation were recorded. The extubation time was recorded and each patient was assessed 1,2,3,4h after surgery for resting VAS score. Results Blood pressure and heart rate at the different time points during operation were higher than pre -anesthesia significantly in group B[skin incision SBP (134.8 ±8.5)mmHg,the end of operation SBP (123.4 ±5.1)mmHg, tracheal extubation SBP (138.7 ±8.5)mmHg vs preanesthesia SBP (117.3 ±9.8)mmHg,t =7.39,3.02,9.04,all P =0.00;skin incision DBP (86.7 ±7.6)mmHg,the end of operation DBP (80.6 ±7.8)mmHg,tracheal extubation DBP (87.4 ±5.8)mmHg vs preanesthesia DBP (75.6 ±6.6)mmHg,t =6.04,2.68,7.35,all P =0.00;skin incision HR (92.4 ±6.5)times/min,the end of operation HR (86.8 ±6.3)times/min,tracheal extubation HR (96.9 ± 7.2)times/min vs preanesthesia HR (78.9 ±6.8)times/min,t =7.86,4.67,9.96,all P =0.00].The cumulative amount of general anesthesia during operation in group A was less than that in group B,the extubation time in group A was shorter than that in group B[propofol doses of group A (650.6 ±50.3)mg vs group B (762.3 ±43.5)mg,t =9.2,P =0.00;remifentanil doses of group A (0.61 ±0.08)mg vs group B (0.95 ±0.06)mg,t =18.62,P =0.00;extubation time of group A (10.6 ±5.1)min vs group B (15.5 ±5.2)min,t =3.68,P =0.00].The resting VAS score at the different time points after surgery in group A was less than that in group B[the resting VAS score at 1,2, 3,4h after surgery in group A vs group B,(0.99 ±0.81)vs (1.75 ±1.23),t =2.83,P =0.00;(1.23 ±1.02)vs (3.45 ±0.84),t =9.2,P =0.00;(2.80 ±0.85)vs (3.71 ±1.19),t =3.41,P =0.00;(3.11 ±1.02)vs (5.19 ± 1.36),t =6.7,P =0.00],there were statistically significant differences.Conclusion Ultrasound -guided bilateral superficial cervical plexus block combined with general anesthesia used in patients undergoing thyroidectomy can maintain the intraoperative hemodynamic stability effectively,reduce the amount of general anesthetics,shorten the extubation time,and ease the early postoperative pain,the efficacy is significantly better than single general anesthesia.

Objective To compare the efficiency of acute physiology and chronic health evaluation (APACHE)Ⅱ and Ⅳ in mortality risk prediction of severe acute pancreatitis (SAP).Methods From January 2013 to December 2014,SAP patients admitted to intensive care units (ICU) were retrospectively analyzed in single center.The clinical data of the first 24 hours since the patients admitted into ICU were collected.The modified Marshall score,APACHE Ⅱ and APACHE Ⅳ score were calculated.The mortality risk predictive value of each patient was calculated by APACHE Ⅱ and APACHE Ⅳ.According to the final clinical outcome of patients,Hosmer-Lemeshow was performed to compare real mortality rate with predictive mortality rate,and calibration of APACHE Ⅱ and APACHE Ⅳ in the mortality risk of each patients was evaluated.The resoluation of the two scoring systems was compared by the area under the receiver operator characteristic curve (AUC).Results In the end,192 patients (152(79.2％) survivors and 40(20.8％) dead) were enrolled.Modified Marshall score,APACHE Ⅱ score and APACHE Ⅳ score of patients in dead group was 6.30±0.36,21.3±8.0 and 88.1± 30.2,respectively;and those of survival group was 3.70 ± 0.20,12.3 ± 5.6 and 53.4 ± 19.0,respectively,and the differences between two groups were statistically significant (t-6.436、-6.683、-6.913,all P＜ 0.01).The results of Hosmer-Lemeshowin calibration of APACHE Ⅱ and APACHE Ⅳ indicated that both two systems could predict mortality risk of SAP patients well (P＞ 0.05).The AUC of APACHE Ⅱ score (cut-off ≥26) and APACHE Ⅳ score (cut off≥91) was 0.81(95％CI 0.74 to 0.89) and 0.83(95％CI 0.75 to 0.90),respectively,and the difference was not statistically significant (x2 =0.21,P=0.644),which indicated that there was no statistically significant difference in calibration.Conclusions APACHE Ⅳ scoring system is not better than APACHE Ⅱ scoring system in prognosis prediction of SAP patients.The prognosis of SAP patients could be accurately evaluated by APACHE Ⅱ.

Acute kidney injury(AKI) is a common clinical severe emergency in children,with high morbidity,mortality and poor prognosis.The traditional indicators such as serum creatinine and urine can't diagnose early.Recently,with the deepening research of AKI,many higher specific and sensitive biomarkers have been found.But the study of biomarkers in children is behind the adult,and the etiology,pathophysiology of AKI in children have great difference from adult.So this paper will show the advances of biomarkers in children of AKI.

Objective To observe the clinical effect of dexamethasone combined with dezocine on the ultrasound guided interscalene brachial plexus block.Methods Accordance with the random number table,80 patients with ASAⅠ ~Ⅱ undergoing upper extremity operations were divided into four groups,with 20 cases in each group:group A was treated with 0.45% ropivacaine mesylate 20mL;group B was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg 20mL;group C was treated with 0.45% ropivacaine mesylate combined with dezocine 0.1mg/kg 20mL;group D was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg and dezocine 0.1mg/kg 20mL.The onset time,maximum block time,analgesia duration and the incidence of adverse reactions were recorded in the four groups.Results The onset time of group C and group D were faster than group A and group B[group C(3.65 ±0.88)min vs.group A(5.60 ±0.88)min,group B(5.35 ±0.81)min,t =7.303, 6.367,all P =0.000;group D(3.30 ±0.80)min vs.group A,group B,t =8.614,7.678,all P =0.000],the maximum block time of group C and group D were faster than those of group A and group B[group C(8.45 ±1.19)min vs. group A(12.75 ±2.05)min,group B(12.65 ±1.90)min,t =8.583,8.383,all P =0.000;group D(7.80 ±0.89)min vs.group A,group B,t =9.880,9.680,all P =0.000].The analgesia duration of the other groups were longer than those of group A[group B(430.50 ±30.86)min,group C(435.00 ±38.46)min,group D(534.50 ±46.73)min vs. group A(314.50 ±33.32)min,t =9.696,10.072,18.388,all P =0.000],group D was the best(group D vs.group B,group C,t =8.693,8.317,all P =0.000),there were no significant differences between group B and group C (group C vs.group B,t =0.376,P =0.708).In the 80 patients,only one case of group C had postoperative nausea and vomiting symptoms,there were no significant differences between the groups(all P >0.05).Conclusion Dexa-methasone combined with dezocine on the ultrasound guided interscalene brachial plexus block is a method with faster onset time,shorter maximum block time,longer analgesia duration,and it has less adverse reactions and better anesthetic effect,and it is more suitable for upper extremity operations.