Objective To evaluate the outcomes of small (5 ～ 10mm),arterially enhancing nodules (SAENs)shown exclusively at the hepatic arterial phase of CT in a hepatocellular carcinoma(HCC) surveillance population and to determine risk factors for developing HCC.Methods The study population included 112 patients (maleifemale =100 ∶ 12 ; aged 36 ～ 92 years) with 1 7 5 SAENs who were at risk of HCC.We evaluated serial changes during follow-up(1.4 ～41.8 months,mean 35.7 months) and analysed the initial CT findings of SAENs and the accompanying lesions to elucidate the risk factors for HCC development.Results Of 175 SAENs,101 (57.7％) disappeared and 34(19.4％) persisted.Forty SAENs(22.9％) became HCC in 33 patients(29.5％).Presence of HCC treatment history(P =0.005,risk ratio =7.429),a larger size of SAEN(P =0.003,risk ratio =1.630),presence of coexistent HCC(P =0.021,risk ratio =3.777) and absence of coexistent typical arterioportal shunts (P =0.003,risk ratio =4.459) turned out to be independently significant risk factors for future development of HCC.Conclusion SAENs are frequently seen in an HCC surveillance population and have a 22.9％ probability of becoming HCC on a per-lesion basis.Risk increased particularly when the lesion is associated with a previous or concurrent HCC,a large size or found without a coexistent typical arterioportal shunt.

Autoradiography of nicotinic acetylcholine receptors (N-AChR) with the application of histochemical staining location of cholinesterase was used to observe the effect of soman on junctional and extrajunctional N-AChR. Testing with the diaphragms and extensor digitorum longus muscles of mice and rats, we found that soman mainly increased the number of extrajunctional N-AChR. It did pot alter the number of junctional N-AChR significantly, nor did it have any pronounced effects on the glycoprotein property and isoelectric point (pI) of junctional and extrajunctional N-AChR. The change of extrajunctional N-AChR number caused by soman is similar to the phenomenon of increased extrajunctional N-AChR number and sensitivity resulting from denervation, but the mechanism of action is different from the latter. The increase of N-AChR number is one of the important characteristics of soman poisoning which make it different from other nerve agents. To maintain the metabolic balance of N-AChR may be an important new approach to the treatment of soman poisoning.

Objective To investigate the effect of super-aged multilevel cervical spondylosis different surgical treatment op tions Abstract Objective.Methods Selected July 2010 Ultra old multilevel cervical spondylosis March 2015 in our hospital 80 ca ses,the anterior cervical corpectomy and fusion (ACCF) and by anterior discectomy and fusion (ACDF) included anterior group,the posterior laminoplasty (PCL) included in the posterior group,the clinical efficacy of two groups were compared,and postoperative conditions and cervical spinal cord injury rates before and after treatment (JOA score),cervical Disability index (NDI index),lordosis and cervical spine.Results Anterior group of 43 cases,including 28 cases of excellent(65.12％),5 cases of good (11.63％),7 cases of moderate(16.28％),3 cases of poor(6.98％),the good rate was 76.74％;posterior group 37 cases,including 24 cases of excellent(64.86％),3 cases of good(8.l1％),6 cases of moderate(16.22％),4 cases of poor(10.81％),the good rate was 72.97 ％.The difference has no statistically significant (P＞0.05) in good rate.Anterior operative time was significantly higher than the posterior group (P＜0.05),blood loss,hospital stay was significantly lower than the posterior group (P＜0.05),the time of symptoms disappeared has no significant difference in two groups(P＞0.05).After treatment,patients in posterior group,the JOA score,cervical activity significantly were higher than the anterior group,lordosis anterior group were significantly higher than the posterior group,the difference was statistically significant (P＜0.05).Conclusion Anterior super aged multilevel cervical disease,posterior approach has achieved good clinical efficacy but greater advantage posterior surgery in patients with long term im provement in the cervical spine function.

Objective To describe the interpositional omentum and demonstrate its clinical significance.MethodsCT and clinical data of the cases whose suprahepatic gaps widen were reviewed and the contrast of CT was adjusted to observe further.ResultsIn 1 916 cases with upper abdominal CT data,suprahepatic gap was widen in all 152 cases,and 119 cases showed fat density(6.21％ ).There were 3 cases of trauma and 3 cases of acute abdomen in the 119 cases CT in the 119 cases displayed free gas under diaphragma,but displayed fat density after contrast adjusted.There were 11 cases undergoing operations,1 for sigmoid rupture 4 liver cirrhosis and portal hypertension,3 gastric cancer,and 1 acute cholecystitis,1 bile duct carcinoma and Ⅰ case congenital cystic dilatation of common bile duct.The other 108 cases did not undergo surgical operation.ConclusionsInterpositional omentum is a clinical phenomenon that the omentum was shift in suprahepatic gap covering the liver surface.It is not rarely,the incidence rate being 6.21％ ( 119/1 916) in our study.The occurrence mechanism may be similar to that of Chilaiditi syndrome.It is difficult to differentiate interpositional omentum from free gas under diaphragms on CT plain scan picture,but it is easy after contrast adjusted of CT.Free gas under diaphragma should not be identify incorrecdied and patients should not undergo unnecessary surgical procedure.

Objective To explore the clinical diagnostic value of polyclonal all immunoglobulin.Methods The specimens of pa-tients were simultaneously tested and identified by quantitative immunoglobulins,Immunofixation electrophoresis of serum and u-rine,urine protein electrophoresis,and other ways.Results From 1 patients with rheumatoid arthritis were detected the serum IgG, M,A,KAP and LAM,and urine KAP and LAM,at the same time show the increment of the polyclonal polyclonal all immune glob-ulin hematic disease.Conclusion Polyclonal all immune globulin hematic disease often appear in the complications of chronic in-flammation,which should be paid attention during its in clinical doctors.

Objective To study the reasons of natural death of Oncomelania hupensis snails in marshland by comparing the differences of environmental factors between snail marshland and non-snail marshland in East Dongting Lake schistosomiasis en-demic areas. Methods Two adjoining marshlands were selected,one was a snail marshland and another was a non-snail marsh-land. The measuring points were set by grid of“20m × 20m”. The soil moisture,elevation,soil pH and temperature of the points were measured,and the snails of the points were surveyed. Results The elevation,soil pH and temperature of the snail natural death marshland were all lower than those of the snail marshland(P<0.01). The soil moisture,elevation,soil pH and temperature of different snail densities in the snail marshland were different(P<0.05). The soil moisture of the non-snail group was higher than that of other four groups(P<0.01)and the soil moisture of the group with 0-11 snails per frame was lower than that of other four groups(P<0.01). The elevation of the group with 0-11 snails per frame was lower than that of the group with 24-39 snails per frame and the group with more than 39 snails per frame(P<0.05). The soil pH of the group without snails was higher than that of other four groups(P<0.01)and the soil temperature of the group with 0-11 snails per frame was lower than that of the group with 24-39 snails per frame. The differences of soil moisture and elevation of different death snail densities were not significant, while the differences of soil pH and temperature were significant. The soil pH of the non-snail died group was higher than that of the 2-died,3-died and more than 3-died groups(P<0.05). The soil temperature of the non-snail died group was higher than that of other four groups(P<0.05). Conclusion The elevation,soil pH and soil temperature within the range of the research may be the factors affecting the snail natural death and the soil moisture,elevation,soil pH and soil temperature may be the factors affect-ing the distribution of snails.

Objective To understand the distribution of univalvia molluscs in Eastern Dongting lake area where the Oncome-lania hupensis is extinct,so as to explore the causes of extinction and to provide the evidence for formulating schistosomiasis con-trol strategy. Methods The univalvia molluscs of the Qianliang Lake district,Jianxin District and Junshan Park were investigat-ed in August of 2013. All the collected snails were classified and identified. The data were analyzed by using the method of Shapiro-Wilk normality test and non-parametric test. The ecological biodiversity differences from each district were compared by the biodi-versity indexes. Results The univalvia molluscs collected were from 6 species in 3 families in Gastropoda class,namely Oncome-lania hupensis Gredler in Pomatiopsidae family,Parafossarulus striatulus,Alocinma longicornis,Parafossarulus sinensis,Bithynia fuchsisana in Bithyniidae family,and one genus provisionally named Radix in Lymaneidae family. In Junshan Park ,a total of 4 553 snails were collected,among which 1 264 were Oncomelania snails. In Jianxin District,336 univalvia molluscs were collect-ed,and no Oncomelania snails were found. In Qianliang Lake district,there were only 7 Alocinma longicornis snails,2 Parafossa-rulus sinensis snails and 1 Parafossarulus striatulus snail collected. There were significant differences among the distributions of the samples from the three districts(χ2=166.225,P<0.01).The Simpson’s diversity indexes in Qianliang Lake area,Jianxin Dis- trict and Junshan Park were 0.402 8,0.718 6 and 0.678 8,respectively,and the Shannon-Wiener indexes of the 3 areas were 0.721 5,1.431 3 and 1.199 9,respectively. Conclusions With the extinction of Oncomelania snails,the species and quanti-ties of other snails become rare in Qianliang Lake area. Whether their causes are relevant is worth further studying.

Objective: To explore the correalation between change of postoperative cognitive function and injury of the draining veins around meningiomas in superficial middle cerebral vein areas, to discuss the importance and protection method of draining veins around meningiomas in order to guide the microneurosurgery. Methods: From July 2013 to July 2017, the clinical data of 54 patients with superficial middle cerebral vein areas meningiomas(tumor group) in the Central Hospital of Guangdong Nongken were retrospectively analyzed.And 52 healthy volunteers were selected as the control group.The preoperative and postoperative cognitive function and meningiomas peritumoral edema(MPE) were assessed by the Montreal Cognitive Assessment(MoCA) and CT/MRI. Results: The scores of visuospatial and executive[(3.23±1.27)points], order[(2.52±1.27)points], memory[(2.20±1.14)points], attention[(4.71±0.97)points], language[(2.19±0.74)points], abstract[(1.43±0.63)points], location[(5.83±0.42)points], total[(22.06±0.33)points] in the tumor group were significantly lower than those in the control group[(4.83±0.38)points, (3.0±0.02)points, (3.5±1.04)points, (5.98±0.14)points, (2.54±0.50)points, (1.88±0.38)points, (5.98±0.33)points, (27.83±0.16)points](t=4.504, 6.116, 9.338, 2.782, 4.509, 2.390, 8.670, all P<0.05). According to the injury of the draining veins around meningioma, 54 patients were divided into the two groups, 43 cases in the no-injuried group, 11 cases in the injuried group.There were no statistically significant differences between the no-injuried group and injuried group in all measurements before operation(all P>0.05). Both no-injuried group and injuried group had decline in MoCA and increase in MPE at 5 days after surgery.Both no-injuried group and injuried group had rise in MoCA[(26.35±0.36)points vs.(22.00±0.67)points] and decrease in MPE[(23.95±4.34)cm³ vs (44.64±9.68)cm³] at 30 days after surgery(t=5.944, 2.098, all P<0.05). The MoCA[(22.59±0.31)points vs (26.35±0.36)points] was obviously increased and the MPE[(87.84±12.78)cm³ vs.(23.95±4.34)cm³] was obviously increased in 30 days after operation in no-injuried group(t=7.289, 5.014, all P<0.05), but the injuried group had just the opposite. Conclusion Injury of the draining veins around meningiomas in superficial middle cerebral vein areas can lead to cognitive dysfunction and compromise the quality of postoperative life in patients, every effort should be undertaken to preserve the draining veins around meningioma.

Objective To study the reasons of natural death of Oncomelania hupensis snails by comparing the differences of the indicator days covered with water DCW in snail marshland and non?snail marshland around the build of Three Gorges Dam in Eastern Dongting Lake areas. Methods Two marshlands were selected one was a non?snail marshland Qianliang Lake and another was a snail marshland Junshan Park . The measuring points were set through the mechanical sampling. The snails and elevation of the points were surveyed and the data of the water levels from the hydrological station were collected and then DCWs were calculated. Results From 1995 to 2013 DCWs of the marshland of natural death of snails were all more than that of the snail marshland P<0.01 . In Qianliang Lake marshland the difference between DCW before natural death and DCW from natural death until the dam was not significant P=0.23 while DCWs of the two stages both were more than that after the dam P1=0.045 P2=0.002 . Before the build of the dam DCW of the Qianliang Lake marshland of natural death of snails was more than that after the build of the dam P=0.013 and there was the same situation in Junshan Park marshland P=0.005 . The relationship between snail density and DCW was not significant in Junshan Park marshland rs=0.008 P=0.914 and the reference range of DCW of all the measuring points was 76-251 days. Conclusion In the eastern Dongting Lake district the build of Three Gorges Dam and DCW may be not the direct factors affecting the natural death of snails and the latter may change the distribution of snails.

The theories of "absence of kidney excess syndrome" and "treating kidney disease only by the tonifying method without the purgative method" have been highly praised by medical practitioners throughout history. However,the syndrome of intermingled deficiency and excess of kidney in clinical practice is not uncommon,and there are many cases that treating kidney disease with the method of expelling kidney turbidity. However,its theoretical basis has not been systematically organized and studied. This article,based on the consideration of the "three purging" herbs of Liuwei Dihuang Pill,finds that "kidney" in traditional Chinese medicine not only stores essence,but also removes turbidity. From the theory of storage-expelling of five zang viscera,the physiological characteristic of kidney is integrated with storing and expelling functions. In addition to storing essence and qi to maintain normal life activities in the human body,it also exercises the function of excretion through the bladder and sanjiao. Under pathological conditions,both the function of storing essence and excretion of turbidity in kidney can be affected,which manifests as lack of essence and accumulation of turbidity. The pathological features of this disease are characterized by kidney qi deficiency as the root cause,accumulation of turbidity as the result,and intertwined with each other. Based on the physiology and pathology of visceral manifestation of kidney in traditional Chinese medicine,the theory of "retaining essence and removing turbidity" can be used in the clinical diagnosis and treatment of kidney disease. When treating kidney disease,the method of invigorating the kidney can also be combined with the method of expelling kidney turbidity,such as promoting diuresis,dissipating phlegm,promoting blood circulation,or removing toxin. Flexible selection of the above treatment methods can improve the therapeutic effect.