Objective To study the MRI findings of spinal hemangioblastomas.Methods The MRI findings of spinal hemangioblastomas proved pathologically in 29 cases (20 males,9 females) were retrospectively reviewed.Results The lesions were single in 12 cases (41.4%) and multiple in 17 cases(58.6%).Seven patients combined with intracranial hemangioblastomas.On unenhanced MRI,36 tumors were isointense on T 1WI and T 2WI,16 were mixed iso-hypointense on T 1WI and mixed iso-hyperintense on T 2WI,one was hypointense on T 1WI and hyperintense on T 2WI.Small hemangioblastomas tended to be isointense on T 1WI and T 2WI.After contrast injection,all tumors enhanced markedly and homogenously with clear borders.21 tumors in 17 patients had associated vascular flow voids on T 2WI.40 tumors in 27 patients were associated with syringes or cysts.Conclusion Hemangioblastomas of the spinal cord are often multiple and in company with intracranial hemangioblastomas.The marked contrast enhancements with clear borders and associated vascular flow voids are the most important signs on MRI.

Objective To study the MRI findings in a series of intracranial hemangiopericytomas, and to compare these findings with those of intracranial meningiomas. Methods The MRI appearances and clinical features in 27 cases of intracranial hemangiopericytomas and 236 cases of intracranial meningiomas were retrospectively reviewed. All cases were proved by operation and pathology. The data were evaluated by using ? 2 test, rank sum test, and Logistic Regression. Results Sex (? 2=6 981), shape of tumor (? 2=39 949), signal voids of vessel in tumor (? 2=12 366), necrosis or cystic degeneration in tumor (? 2=37 432), the type of dural attachment ( broad based or narrow based ) (? 2=16 956), T 1WI signal intensity (? 2=14 880), T 2WI signal intensity (? 2=37 068), enhanced degree of tumor (? 2=10 081), homogeneous degree of tumor after contrast enhancement (? 2=17 014), and duration time were significant different ( P

Objective To construct the core competence index system of nursing postgraduates in TCM colleges and universities.Methods The Delphi method was used to investigate 30 nursing experts and consult about core competence that nursing postgraduates of TCM colleges and universities should have.Results The effective recovery rates of questionnaire were respectively 85.7％ and 86.7％.The authority coefficients were 0.86 and 0.84,and the consistency coefficients were 0.278 and 0.253 with statistical significance.Index system for core competence with 4 first-grade indexes and 20 second-grade indexes was formed.The full score ratio of first-class indexes was 0.96-1.00,coefficients variation was 0.10-0.13; for the second-class,the full score rate was 0.62-1.00,coefficient variation was 0.08-0.19.Conclusions For formation items of core competence index system of nursing postgraduates in TCM colleges and universities,the opinions of experts are centralized,which can provide reference for training program of nursing postgraduates in TCM colleges and universities.

Objective To compare the therapeutic effects in respect of ventilatory response and the change of hemodynamics of two modes of mechanical ventilation [ proportional assist ventilation (PAV) vs.Bi-level positive airway pressure ventilation (BiPAP) ] on patients with acute cardiogenic pulmonary edema (ACPE).Methods Thirty-two patients diagnosed as ACPE were recruited from May 2008 to April 2009.After conventional therapy ( cardiotonic,diuretic,vasodilators,oxygen) were ineffective for half an hour,32 patients were randomly divided into three groups:control group ( 12 cases kept conventional treatment without mechanical ventilation),BiPAP group ( 12 cases were treated with BiPAP mode of non-invasive mechanical ventilation plus conventional treatment) and PAV group (8 cases were treated with PAV mode of non-invasive mechanical ventilation along with conventional treatment ).Results PaO2,RR and oxygenation index were improved significantly in three groups after 1 hour treatment ( P ＜ 0.05 ).While PaO2 and oxygenation index in noninvasive ventilation groups were higher than those in control group ( P ＜0.05 ).The time required for amelioration of dyspnea in noninvsaive ventilation groups was shorter than that in control group ( P ＜ 0.05 ).The peak airway pressure and the index of degree of comfort ( VAS score,auxiliary respiratory muscles score) in PAV group were lower than those in BiPAP group (P ＜ 0.05 ).Conclusions Both modes of noninvasive mechanical ventilations could improve the oxygenation and relief of dyspnea in patients with ACPE.PAV and BiPAP had the similar effect in patients with ACPE.The synchronization and comfort in PAV group were better than those in BiPAP group.The PAV mode of noninvasive mechanical ventilation was well accepted by patients with ACPE.

Objective To enhance the understanding of cystitis, obstructive uropathy (OU) and chronic intestinal pseudo-obstruction (CIPO) in systemic lupus erythematosus (SLE). Methods We presented a case of SLE complicated with cystitis, OU and CIPO, and reviewed relevant English and Chinese literature. Results The case was a 37 year-old female with a history of SLE for 4 years. She developed urinary irritant symptoms for 1 year and abdominal distention for 1 month before admission. Ultrasound and cystoscopic studies revealed a thickening of bladder wall and reduced bladder volume; cystoscopic study revealed inflammatory and edematours mucosa; Ultrasound study and X-ray image confirmed the existence of OU and CIPO. Symptoms of urinary irritant and CIPO were relieved after initiation of prednisone and cyclophosphamide (CTX), but reducing the dosage of prednisone and CTX had caused a relapse. Conclusion Cystitis is a rare clinical manifestation of SLE, it is likely to be misdiagnosed. The pathological change of cystitis complicated with SLE is interstitial cystitis and is the most common cause of OU in SLE. OU is closely related to CIPO and it is suggested that patients with these complications may be classified as a unique subgroup of SLE. Intestinal obstruction is a severe complication of SLE with high mortality rate, clinicians should be aware of this unique subgroup of SLE and treat it properly.

Objective To investigate the role of micro-RNAs (miR-101 and miR-125a-5p) in autophagy of lipopolysaccharide (LPS) derived human THP-1 macrophages.Methods Human monocytic leukemia cell line THP-1 was cultured in vitro,and it was differentiated into macrophages after being induced with phorbol (50 μg/L) for 48 hours.THP-1 macrophages were stimulated with LPS in 0,250,500,1 000 μg/L respectively for 12 hours,miR-mimic was transfected into THP-1 macrophages as induced by Lipofectamine RNAiMAX,and the transfection efficiency of miRNA was determined with fluorescence microscopy.Enzyme linked immunosorbent assay (ELISA) was used to determine the levels of tumor necrosis factor-α (TNF-α) and monocyte chemotaxis protein-1 (MCP-1) in the supernatants of culture.Western Blot was used to detect the protein expressions of autophagy proteins ATG4D,Beclin1,and LC3 Ⅱ.The expression levels of miR-101 and miR-125a-5p were determined by quantitative reverse transcription-quantitative polymerase chain reaction (RT-qPCR).Results ① The releasing levels of TNF-α and MCP-1 induced by LPS with 250,500,1 000 μg/L were significantly increased as compared the cells without LPS stimulation [TNF-α (ng/L):1 336.1 ± 18.5,1 340.6±24.8,1 364.5± 14.9 vs.47.6±4.4;MCP-1 (ng/L):996.3 ±51.3,934.6±84.3,974.2±69.5 vs.21.3±6.5,all P ＜ 0.01],but no significant differences were found among the three LPS stimulation groups.The protein expressions of ATG4D,Beclin1 and LC3 1Ⅱ were up-regulated in the presence of different LPS concentrations (0,250,500,1 000 μg/L) for 12 hours in THP-1 macrophages (when compared with the cells without LPS stimulation,t value of ATG4D was 8.103,38.410,52.020,P value was 0.015,0.001,＜ 0.001;t value of Beclin1 was 3.026,5.328,3.482,P value was 0.047,0.034,0.037;t value of LC3 Ⅱ was 3.836,6.200,4.665,P value was 0.018,0.003,0.010),and the optimal concentration was 500 tg/L LPS.When THP-1 macrophages were stimulated with 500 μg/L LPS for 12 hours,the expression levels of miR-101 and miR-125a-5p were down-regulated significantly as compared with the cells without LPS stimulation [miR-101 (2-△ △Ct):0.68 ± 0.08 vs.1.95 ±0.26,t =8.047,P =0.001;miR-125a-5p (2-△ △Ct):0.23 ± 0.06 vs.1.69± 0.42,t =5.975,P =0.004].② The higher transfection efficiency was showed under fluorescence microscope.Westem Blot results showed the protein expressions of ATG4D,Beclin1 and LC3 Ⅱ were down-regulated as induced by an over-expression of miR-101 or miR-125a-5p in THP-1 macrophages,and more obviously down regulated by co-transfected with miR-101 and miR-125a-5p (compared with negative control group,t value was 14.550,5.855,14.180,P value was 0.005,0.014,＜ 0.001).Conclusion miR-101 and miR-125a-5p can inhibit the autophagy in LPS challenged THP-1 macrophages,and the potential mechanism might be related to target regulation of ATG4D.

Objective To explore the clinical effect of salt-hot compress based on the theory of“Maiweiji”on mechanical phlebitis after PICC catheterization. Methods According to random number table, 202 patients after PICC catheterization were divided into the control group including 100 cases and the experimental group including 102 cases. The study were divided into the prevention stage and the treatment stage. In the prevention stage, the control group were given routine nursing while the experimental group were received routine nursing plus salt-hot compress. In the treatment stage, all the patients in mechanical phlebitis after the prevention stage were randomly divided into the group of salt-hot and the group of wet-hot by lottery, meanwhile, the group of salt-hot were given salt-hot compress, the group of wet-hot were received wet-hot compress. Results In the prevention stage, the mechanical phlebitis rate of the experimental group was 8.82%(9/102), and it was 21%(21/100) in the control group, the difference had statistically significant (Z=-2.28, P<0.05). In the treatment stage, the cure rate in 3 days and 7 days of the Group of Wet-hot were 5/15 and 10/15, and were 9/15 and 6/15 in the Group of Salt-hot, the average treatment time were (3.71±1.82) d and (4.31±1.58) d respectively, but the difference had no statistically significant(P > 0.05). Conclusions Salt-hot compress has the positive effect of preventing mechanical phlebitis. Besides, the therapeutic effect on mechanical phlebitis between the group of salt-hot and the group of wet-hot is about the same. Because of the simple operation, bargain price, being not contaminated clothing, salt-hot compress is more advantage.

ObjectiveTo investigate the degree of acceptance of Emergency Medicine and the abilities of first aid in senior medical students, and study the methods of how to improve their abilities and skills.MethodsA random sample survey methodology.ResultsA total of 146 medical students of clinical medicine were surveyed.99.32％ of student believed that emergency medicine was essential and necessary in their learning process.The knowledge of first aid would play important role for their future work.55.48％ of students considered that there were partial overlaps in teaching content in emergency medicine and internal medical and surgery.Senior medical students accessed to knowledge mainly through books,followed by the Internet,television and newspapers and their first aid knowledge and skills were poor.ConclusionEmergency medical teaching should be focused on highlighting its characteristics.The visualization of the operation and standardized assessment will help to strengthen students' mastery of first-aid knowledge and skills.

Intrahepatic cholangiocarcinoma is the second most common intrahepatic primary liver tumor after hepatocellular carcinoma (HCC).Epidemiological study suggests a strong correlation between HBV infection and ICC development.This review focused on the potential mechanisms of HBV-induced ICC and gives a primary summary of suggested hypothesis,which included:(1) HBV infection of liver stem/progenitor cells will indirectly lead to HBV infection of intrahepatic biliary epithelial cells and lead to the development of ICC; (2) the changed microenvironment of intrahepatic biliary epithelial cells by HBV infection eventually results in carcinogenesis ; (3) the HBV infection of hepatic sten/progenitor cell can transform into tumor-like stem cells and ultimately differentiate into ICC-like tumor cells.

Objective To further understand choledoch stone in the elderly so as to guide the clinical work.Methods The clinical data of 223 elderly patients with choledoch stone were retrospectively analyzed.The clinical characteristic and treatments to the patients were summarized.Results The patients usually presented with nausea and vomiting (86.1％,192/223),fever (84.8％,189/223),jaundice (70.0％ 156/223),abdominal pain (65.0％,145/223) and combined septic shock (20.2％,45/223).Colibacillus (41.0％,66/161) and Klebsiella pneumoniae (27.3％,44/161) were the most predominat.Imipenem,meropenem,amikacin,piperacillin/tazobactam and moxifloxacin were sensitive antibiotics(＞ 80％).Endoscopic sphincteropapillotomy(EST) with injected sensitive antibiotics was effective treatment.Conclusion Treatment of endoscopic sphincteropapillotomy and injected sensitive antibiotics was effective for elderly patients with choledoch stone.