Objective To explore the diagnostic value of ultrasound-guided aspiration biopsy in patients with unexplained refractory ascites.Methods The data of 25 cases of unexplained refractory ascites were retrospectively analyzed.For all the cases the diagnosis was based on the examination of contrast enhanced CT or ultrasound.Ultrasound-guided aspiration biopsy of locally thickened peritoneum or ti- ny masses in ascites was performed.Reults Ultrosonographic image of all cases was as follows.10 cases,with locally thickened peritone- um,were isoechoic or hypoechioc.In 2 of 10 cases contrast enhanced ultrasound examination was done,and the images were characterized by an obvious enhancement in arterial phase and quick wash-out in veinous phase.In 7 cases there was irregularly thickened peritoneum, accompanied by adhesion and caking of the omentum.Cystic formation in ascites or in peritoneum was found in 5 cases.Solid mass in asci- tes was found in 2 cases,and splenomegaly and enlarged pancreas were found in 1 case.Ultrasound-gnided aspiration biopsy was perfomed in all the patients.Among them 4 patients were operated on later.Histopathologic examination showed malignency in 20 patients.Among them,malignant peritoneal mesothelioma accoumted for 6 cases,pancreatic cystoadenoma in 2,mestastic adenocarcinoma in 9,malignant schwannoma in 1,lymphoma in 1,and histiocytoma in 1 patient.In the other 5 cases the lesion was benign,and it was verified by follow- up for about 6 months.Among them there were 3 cases of tuberculosis,1 case of inflammatory disease and 1 case of retroperitonesl fibro- sis.Conclusion Ultrasound-guided aspiration biopsy is valuable in the diagnosis of locally thickened peritoneum and tiny mass in ascitic fluid,and is valuable for diagnosis of unexplained refractory ascites.

Objective To assess the efficacy of diffusion weighted imaging( DWI) with Magnetic Reso-nance Imaging to predict the T-staging in rectal cancer.Methods One hundred and seven cases confirmed by pathology of rectal adenocarcinoma patients were retrospectively analyzed.T-staging was determined by MRI and DWI combined with MRI.All the patients were underwent surgery within one week after MRI.We compared the results with the pathological T-staging after surgery,and compared the two methods of the preoperative T-stag-ing rectal cancer diagnosis accuracy.Results The accurate rates for T-staging of rectal cancer using MRI was 84.11%(90/107) .There was a correlation between the result of preoperative MRI and postoperative pathological T-staging(kappa=0.652,P<0.001);The accurate rates for T-staging of rectal cancer using combined MRI with DWI was 90.65%(97/107).There was a better correlation between the result of MRI with DWI and postop-erative pathological T-staging(kappa=0.732,P<0.001).Conclusion Compared with the conventional MRI sequences,the accuracy of MRI combined with DWI for diagnosis of T-staging in rectal carcinoma is higher.It can provide a more reasonable treatment.

Objective To discuss the role of indoleamine 2, 3-dioxygenas e (IDO) and tryptophanyl-tRNA synthetase (TTS) mediated tryptophan catabolism in immune thrombocytopenia (ITP) patients treated with high doses of dexamethasone through the expressions of IDO and TTS in T cells , and the concentrations of plasma kynurenine and tryptophan. Methods 20 newly diagnosed or relapse ITP patients were treated with 40 mg/d × 4 d dose of dexamethasone. The heparin anticoagulant blood samples were obtained before treatment and the 5th day after treatment. 20 healthy subjects were selected as the control group. The IDO and TTS expressions in CD4+and CD8+ T cells were analyzed by flow cytometry. The concentrations of plasma kynurenine and tryptophan were detected by liquid-mass spectrometry system. Results Compared with healthy controls group, the plasma tryptophan and kynurenine concentration and the ratio of Kyn/Trp were significantly elevated in ITP patients (P <0.05); the IDO expressions of CD4+ and CD8+ T cells in ITP patients were significantly lower than those in healthy controls (P < 0.05), but the TTS expressions were significantly higher (P < 0.05). The concentration of tryptophan in effective group was significantly lower than before treatment (P < 0.05), in contrast, the kynurenine concentration and the ratio of Kyn/Trp were significantly higher than before (P < 0.05). The expression of IDO in effective group were significantly higher than that before treatment (P < 0.05), conversely, the expression of TTS in effective group were significantly decreased (P < 0.05). No significant difference can be found in ineffective group. Conclusion IDO/TTS-mediated tryptophan catabolism pathway could indicate the onset of ITP. The sensitivity of ITP patients with high dose of dexamethasone treatment can be observed through the level of IDO and TTS.

Objective To evaluate the effect of penehyclidine hydrochloride on the expression of airway mucin 5AC(MUC5AC)during ventilator-induced lung injury(VILI)and the relationship with Toll-like receptor 4/myeloid differentiation factor 88(TLR4/MyD88)signaling pathway in rats.Methods Thir-ty-six clean-grade healthy male Sprague-Dawley rats,aged 6-8 weeks,weighing 200-250 g,were divided into 3 groups(n＝12 each)using a random number table method: sham operation group(group S),VILI group(group VILI),and penehyclidine hydrochloride group(group P).The rats were tracheotomized in group S.The rats were tracheotomized,connected to a small animal ventilator and mechanically ventilated for 4 h with the tidal volume of 20 ml/kg,respiratory rate 80 breaths/min,inspiratory/expiratory ratio 1 ∶1,and inspired oxygen fraction ratio 21％in VILI and P groups.At 30 min before mechanical ventilation,penehyclidine hydrochloride 2 mg/kg was injected via the tail vein in group P,and the equal volume of nor-mal saline was given instead in S and VILI groups.At 4 h of mechanical ventilation,the arterial blood sam-ples were taken for measurement of PaO2.The rats were then sacrificed,and broncho-alveolar lavage fluid(BALF)was collected for determination of interleukin-1β(IL-1β),IL-6 and tumor necrosis factor-α(TNF-α)concentrations by enzyme-linked immunosorbent assay.The lung specimens were collected for calculation of the wet/dry weight ratio(W/D ratio),for examination of pathological changes which were scored after haematoxylin and eosin staining(under a light microscope),and for determination of the ex-pression of MUC5AC(by immunohistochemistry),expression of TLR4,MyD88,p38 mitogen-activated protein kinase(p38MAPK)and nuclear factor-kappa B(NF-κB)in lung tissues(by Western blot),and expression of MUC5AC mRNA in lung tissues(by real-time polymerase chain reaction).Results Com-pared with group S,PaO2 was significantly decreased,the W/D ratio and lung injury score were increased,the expression of MUC5AC protein and mRNA was up-regulated,the concentrations of IL-1β,IL-6 and TNF-α in BALF were increased,and the expression of TLR4,p38MAPK,MyD88 and NF-κB was up-reg-ulated in VILI and P groups(P＜0.01).Compared with group VILI,PaO2 was significantly increased,the W/D ratio and lung injury score were decreased,the expression of MUC5AC protein and mRNA was down-regulated,the concentrations of IL-1β,IL-6 and TNF-α in BALF were decreased,and the expression of TLR4,p38MAPK,MyD88 and NF-κB was down-regulated in group P(P＜0.05).Conclusion Penehy-clidine hydrochloride can decrease the expression of airway MUC5AC during VILI,and the mechanism may be related to inhibiting activation of TLR4/MyD88 signaling pathway in rats.

Objective To build a method for calculating the optimal length of hamstring muscles in vivo, and make comparison with other indirect parameters which represent the optimal length. Methods By synchronously recording knee flexion torque and kinematic data, the musculoskeletal model of lower limbs was built to obtain hamstring strength and muscle length, and to further calculate the optimal length of hamstring muscles. Results Flexion angle at peak knee flexion torque was significantly greater than that at peak hamstring strength and their correlation coefficient was 0.741. The optimal lengths of each bi-articulated hamstring muscles were significantly greater than the corresponding muscle lengths during standing and their correlation coefficients was low. Conclusions The established estimating method for optimal length of hamstring muscles provided references for future studies on injury mechanism and risk factors. Flexion angle at peak knee flexion torque could partly represent the optimal length of hamstring. It is not suggested that hamstring muscle length during standing should be used as an approximation of hamstring optimal length.

Objective: To evaluate the effect of penehyclidine hydrochloride on the expression of airway mucin 5AC (MUC5AC) during ventilator-induced lung injury (VILI) and the relationship with Toll-like receptor 4/myeloid differentiation factor 88 (TLR4/MyD88) signaling pathway in rats. Methods: Thirty-six clean-grade healthy male Sprague-Dawley rats, aged 6-8 weeks, weighing 200-250 g, were divided into 3 groups (n=12 each) using a random number table method: sham operation group (group S), VILI group (group VILI), and penehyclidine hydrochloride group (group P). The rats were tracheotomized in group S. The rats were tracheotomized, connected to a small animal ventilator and mechanically ventilated for 4 h with the tidal volume of 20 ml/kg, respiratory rate 80 breaths/min, inspiratory/expiratory ratio 1∶1, and inspired oxygen fraction ratio 21% in VILI and P groups.At 30 min before mechanical ventilation, penehyclidine hydrochloride 2 mg/kg was injected via the tail vein in group P, and the equal volume of normal saline was given instead in S and VILI groups.At 4 h of mechanical ventilation, the arterial blood samples were taken for measurement of PaO₂.The rats were then sacrificed, and broncho-alveolar lavage fluid (BALF) was collected for determination of interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α (TNF-α) concentrations by enzyme-linked immunosorbent assay.The lung specimens were collected for calculation of the wet/dry weight ratio (W/D ratio), for examination of pathological changes which were scored after haematoxylin and eosin staining (under a light microscope), and for determination of the expression of MUC5AC (by immunohistochemistry), expression of TLR4, MyD88, p38 mitogen-activated protein kinase (p38MAPK) and nuclear factor-kappa B (NF-κB) in lung tissues (by Western blot), and expression of MUC5AC mRNA in lung tissues (by real-time polymerase chain reaction). Results: Compared with group S, PaO₂ was significantly decreased, the W/D ratio and lung injury score were increased, the expression of MUC5AC protein and mRNA was up-regulated, the concentrations of IL-1β, IL-6 and TNF-α in BALF were increased, and the expression of TLR4, p38MAPK, MyD88 and NF-κB was up-regulated in VILI and P groups (P<0.01). Compared with group VILI, PaO₂ was significantly increased, the W/D ratio and lung injury score were decreased, the expression of MUC5AC protein and mRNA was down-regulated, the concentrations of IL-1β, IL-6 and TNF-α in BALF were decreased, and the expression of TLR4, p38MAPK, MyD88 and NF-κB was down-regulated in group P (P<0.05). Conclusion Penehyclidine hydrochloride can decrease the expression of airway MUC5AC during VILI, and the mechanism may be related to inhibiting activation of TLR4/MyD88 signaling pathway in rats.

ObjectiveTo identify the functions of the AP2/ERF family members in Pinellia ternata and promote the genetic improvement of P. ternata varieties. MethodWe identified and conducted a systematic bioinformatics analysis of the AP2/ERF family member genes in P. ternata based on the three generations of transcriptome data. Real-time polymerase Chain reaction　（Real-time） PCR was employed to determine the expression pattern of AP2/ERF genes in different tissues and under different stress conditions. ResultA total of eight full-length AP2/ERF family members were identified from the transcriptome data， which were classified into three sub-gene families： AP2， ERF， and DREB. The deduced AP2/ERF proteins in P. ternata had the length of 251-512 aa， the theoretical pI of 5.29-11.72， the instability index of 45.90-82.41， subcellular localization in the nucleus， and conserved domains and motifs. AP2/ERF genes were expressed in different tissues of P. ternata， with high expression levels in the leaf. The stress response experiments showed that PtERF1 mainly responded to NaCl stress. The expression of PtERF2 and PtERF4 was significantly up-regulated under low temperature and polyethylene glycol （PEG）-simulated stress. PtERF3 responded to both low temperature and NaCl stress. The expression of PtERF5 was induced by high temperature， low temperature， NaCl and PEG stress. The expression of PtERF7 was up-regulated under high temperature， while that of PtERF8 under low temperature. ConclusionThe AP2/ERF genes in P. ternata can respond to stress and have the potential functions of regulating photosynthesis and improving root stress resistance.