Objective To investigate the imaging features and differential diagnosis of obstructive jaundice caused from non-neoplastic diseases.Methods The retrospective descriptive study was conducted.The clinical data of 62 patients with obstructive jaundice caused from non-neoplastic diseases who were admitted to the Peking University People's Hospital between August 2014 and August 2016 were collected,including 13 with immunoglobulin G4 associated cholangitis (IAC),2 with primary sclerosing cholangitis (PSC),21 with recurrent purulent cholangitis (RPC),2 with Mirizzi syndrome,4 with groove pancreatitis (GP) and 20 with Lemmel syndrome.All the patients underwent plain and enhanced scans of computed tomnography (CT) and magnetic resonance imaging (MRI) and magnetic resonanced cholangio-pancreatography (MRCP).Film reading were respectively done by 2 imaging doctors,and then was analyzed again by senior doctors when there is disagreement.Observation indicators:(1) situations of imaging exanination and imaging features;(2) treatment and follow-up.Patients received laboratory and related examinations and then underwent corresponding treatment after diagnosis.Follow-up using outpatient examination and telephone interview was performed once every 6 months to detect patients' prognosis up to November 2016.Results (1) Situations of imaging examination and imaging features:of 62 patients,21 underwent plain and enhanced CT scans,7 underwent plain and enhanced MRI scans,4 underwent MRCP,15 underwent plain and enhanced CT scans and MRCP,1 underwent plain and enhanced CT scans and plain and enhanced MRI scans,3 underwent plain and enhanced MRI scans and MRCP and 11 underwent plain and enhanced CT scans,plain and enhanced MRI scans and MRCP.Imaging features of 13 patients with IAC:MRI scans showed that diffuse and symmetrical bile duct walls were thickened,with delayed enhancement.The narrowed lumen of bile duct was mainly occurred in common bile duct,without occlusion.Of 13 patients with IAC,9 were combined with IgG4 associated pancreatitis and 7 with bilateral nephropathy.Imaging features of 2 patients with PSC:MRI scans showed that bile duct wall was multiple localized thickening and persistent enhancement,that was imaging feature of liver cirrhosis.MRCP examination showed that intra-and extra-hepatic bile ducts had multifocality stricture and beading-like and/or dry twig-like dilatation,and branches of intrahepatic peripheral bile duct were reduced.Imaging features of 21 patients with RPC:MRI and CT scans and MRCP examination showed that there was thickening bile duct wall and delayed enhancement.The first and second level of intrahepatic bile duct were segmental dilatation,distal bile duct dramatically narrowed and branches of intrahepatic bile duct were reduced.Most of extrahepatic bile duct was dilatation and a few were narrow-like changes.There were stones of intrahepatic bile duct and pneumobilia.Liver parenchymal atrophy with cholangiectasis occurred most frequently in left lobe or right posterior lobe of liver.There were secondary liver abscess and cholangiocarcinoma.Imaging features of 2 patients with Mirizzi syndrome:MRI scans showed that there was common hepatic duct stricture caused by stones in the junction between neck of gallbladder and common hepatic duct,and intra-and extra-hepatic bile ducts dilatation in proximal end of stones and normal bile duct in distal end of stones.There were gallbladder and biliary fistulas,irregular gallbladder wall thickening and inflammation around the gallbladder.Imaging features of 4 patients with GP:MRI scans showed that no clear mass was detected in duodenal loop and head of pancreas,with heterogeneous and slightly irregular enhancement.Cyst formation occurred in intramural wall of duodenum and head of pancreas.Enhanced MRI scans showed that common bile duct wall was thickened and slightly irregular stricture,pancreatic duct was normal or mild expansion,and thickened duodenal wall had varying degrees of stenosis of lumen.Imaging features of 20 patients with Lemmel syndrome:MRI scans showed that pouch-like structure was detected inside of the descending duodenum,with thin cyst wall and liquid in cyst wall.MRCP examination showed dilatations of common bile duct and intra-and extra-hepatic bile ducts.(2) Treatment and follow-up:of all the 62 patients,30 underwent corresponding surgeries,including 2 with IAC,1 with PSC,7 with RPC,2 with Mirizzi syndrome,3 with GP and 15 with Lemmel syndrome,and the other 32 without surgery received corresponding medical treatment.Sixty of 62 patients were followed up for 3-17 months.During follow-up,28 patients undergoing surgery received definitive diagnosis and good recovery,2 were lost after definitive diagnosis and 32 undergoing medical treatment were in stable condition.Conclusion Non-neoplastic diseases can cause obstructive jaundice,with a higher misdiagnosis rate,imaging findings of which can be conducive to diagnose diseases and provide clinical treatment.

Objective To investigate the accuracy of high-resolution magnetic resonance imaging (MRI) in diagnosis of the lymph nodes metastases (LNMs) and stage of rectal cancer (RC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 65 patients with RC who were admitted to the Peking University People's Hospital between April 2014 and April 2016 were collected.The results of postoperative pathological examination:of 65 patients with RC,24 had positive LNMs and 41 had negative LNMs;N0,N1 and N2 were respectively detected in 41,14 and 10 patients.Imaging data were captured using 3.0-Tesla MRI and body phased-array coil.Diagnostic criteria for LNMs of RC:criterion 1:irregular lymph node boundaries and signal characteristics were not considered;criterion 2:heterogeneous signal of lymph nodes and boundary characteristics were not considered;criterion 3:irregular lymph node boundaries and / or heterogeneous signal of lymph nodes.The American Joint Committee on Cancer (AJCC) cancer staging manual (7th edition) have established the N staging scheme for RC.Lymph nodes distribution according to the rectal lymphatic drainage:D1was located in fascia of the mesorectum;D1a above the level of tumor;D1b at the level of tumor;D1c under the level of tumor;D2 around the superior rectal artery and root of inferior mesenteric artery;D3 on the side of pelvic cavity.Observation indicators:(1) Efficiency and comparison of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria (postoperative pathological result as a gold standard).(2) Efficiency and comparison of N stage of RC diagnosed by high-resolution MRIaccording to the 3 criteria (postoperative pathological result as a gold standard).(3) Efficiency of LNMs of RC diagnosed by high-resolution MRI according to the maximum short diameter of lymph nodes:① maximum short diameter distribution of positive and negative LNMs of RC;②sensitivity,specificity,accuracy and consistency of LNMs diagnosed using different maximum short diameter of lymph nodes as a threshold (postoperative pathological result as a gold standard);③ comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes with highest diagnostic accuracy as a threshold and using the 3 criteria;④ sensitivity,specificity,accuracy and consistency (postoperative pathological result as a gold standard) of LNMs diagnosed using maximum short diameter of lymph nodes with highest diagnostic accuracy as a threshold combined with the highest efficiency in the (1),and its comparison in accuracy of LNMs with highest diagnostic accuracy as a threshold.(4) Distribution of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria.(5) Follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' postoperative survival up to October 2016.The sensitivity,specificity,accuracy and comparison of ratio were respectively done by the chi-square test.Kappa test was used for consistency,tκ ≤ 0.40was used as low consistency,0.40＜κ≤0.60 as moderate consistency,0.60＜κ≤0.80 as higher consistency,and κ＞ 0.80 very high consistency.Results (1) Efficiency and comparison of LNMs of RC diagnosed by highresolution MRIaccording to the 3 criteria:accuracies of LNMs of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were respectively 93.8％,87.7％ and 90.8％,showing very.high,higher and very high consistencies compared with postoperative pathological results (κ =0.87,0.74,0.81,P＜0.05),and with no statistically significant difference in diagnostic accuracy among them (x2=1.495,P＞0.05).(2) Efficiency and comparison of N stage of RC diagnosed by high-resolution MRI according to the 3 criteria:accuracies of N stage of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were respectively 87.7％,83.1％ and 84.6％,showing the same higher consistencies compared with postoperative pathological result (κ =0.77,0.68,0.72,P＜0.05),and with no statistically significant difference in N stage among them (x2=0.567,P＞0.05).(3) Efficiency of LNMs of RC diagnosed by high-resolution MRI according to the maximum short diameter of lymph nodes:① maximum short diameter distribution of positive and negative LNMs of RC:maximum short diameter ranges were respectively 3-18 mm in positive LNMs and 1-9 mm in negative LNMs,and maximum short diameter ＜3 mm and ≥ 10 mm were respectively negative and positive LNMs.② Efficiency of LNMs of RC diagnosed using different maximum short diameter of lymph nodes as a threshold:diagnostic accuracy of 70.8％was the highest when maximum short diameter ＞7 mm was used as a standard of positive LNMs,showing a low consistency compared with postoperative pathological result (κ =0.29,P＜0.05).③ Comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes ＞7 mm as a threshold and using the 3 criteria:there was a statistically significant difference among them (x2 =15.637,P＜0.05);accuracies of LNMs of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were higher than that diagnosed using maximum short diameter of lymph nodes ＞7 mm as a threshold (x2 =10.354,5.656,6.923,P＜0.05).④Comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes ＞7 mm combined with the criterion 3 as a threshold and using maximum short diameter ＞7 mm as a threshold:the criterion 3 was used as a threshold because there was no statistically significant difference in diagnostic accuracy among the 3 criteria (P＞ 0.05).Diagnostic accuracy was 78.5％ when maximum short diameter ＞7 mm combined with the criterion 3 as a threshold,showing a low consistency compared with postoperative pathological result (κ =0.36,P＜0.05),with no statistically significant difference in diagnostic accuracy compared with maximum short diameter ＞ 7 mm as a threshold (x2=0.154,P＞0.05).(4) Distribution of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria:positive LNMs of RC diagnosed by high-resolution MRI located mostly in D1 (76.1％-83.1％)and D1b(77.8％-81.4％).(5) Follow-up situations:of 65 patients,54 were followed up for 6-25 months,with a median time of 14 months.During the follow-up,7 patients had distant metastases and 47 had tumor-free survival.Conclusions There are higher accuracies of LNMs and N stage of RC diagnosed using preoperative highresolution MRI.Diagnostic accuracy of LNMs of RC cannot be improved when characteristics of lymph node morphology and size are used as a diagnostic standard.The positive LNMs of RC locate mostly in D1 and Dib.

Objective To develop a trauma database and its network version which could adapt to the need of accumulation and analysis of trauma care data in hospitals.MethodsThe Trauma Data-base System was developed based on the basic data of trauma care course, with assistance of the Windows operation system and SQL SERVER 2000 database, with vb.net and asp.net as programming language and Browser/Server model as visiting model.Results The trauma database with normative 313 fields adaptive to the process and management of trauma in hospitals was established, and the network version of Trauma Database System V3.0 was programmed.Information stream of trauma care was established,which helped implementation of functions including relational selection between international classification of diseases of trauma and abbreviated injury scale, trauma scoring and trauma care quality evaluation, ar-bitrary query and report (including tri-crosstab).The system has been used in several hospitals and data collection of seismic patients in "5 ·12" Wenchuan earthquake.Conclusions A trauma database with a network version has been developed and the software suits to the trauma care data registration in hospital, which facilitates registration of the data on occurrence, diagnosis, treatment, outcome, quality evaluation of trauma and provides convenient query and analysis of trauma data.

ObjectiveTo observe the effect of resveratrol on the oxidative stress and antioxidant levels of different mitochondrial subpopulations in the skeletal muscle and insulin sensitivity of rats fed with high-fat diet.MethodsMale SD rats,aged 8 weeks,were divided into normal chow (NC) group,high-fat diet(HF) group,high-fat diet plus resveratrol ( HFR ) group.After intervention for 8 weeks,the impacts of resveratrol on oxidative stress levels and antioxidant enzymes activities in subsarcolemmal ( SS ) and intermyofibrillar ( IMF ) mitochondria from skeletal muscle as well as general and skeletal mascle insulin sensitivity were assessed.ResultsCompared with NC group, insulin sensitivity was significantly reduced while reactiveoxygenspecies (ROS)and malondialdehyde(MDA) levels in SS and IMF mitochondria increased in HF group ( all P＜0.01 ).In addition,antioxidant enzyme activities were significantly decreased in SS mitochondrial and increased in IMF mitochondrial ( both P ＜ 0.05 ).Compared with HF group,the insulin sensitivity in HFR group was significantly improved.Moreover,the activities of antioxidant enzymes in SS and IMF mitochondrial were increased,and the oxidative stress levels returned to normal ( P ＜ 0.05 ).ConclusionResveratrol notably improves the oxidative stress of different skeletal muscle mitochondrial subpopulations and insulin resistance in rats fed with high-fat diet.

To explore the relationship between serum thyroid stimulating hormone (TSH) level and obesity and nonalcoholic fatty liver disease (NAFLD) in euthyroid subjects, 1322 subjects were subjected to a questionnaire survey and physical examination. Fasting blood samples were collected to test serum TSH, plasma glucose and lipids. Fatty liver was diagnosed by type B ultrasonography. The relationship between serum TSH level and body mass index (BMI), percentage of body fat and NAFLD was analyzed. The results showed that serum TSH level was significantly higher in females than in males at the same group, and it was significantly higher in overweight group than in control group. Levels of body weight, BMI, waist circumference and percentage of body fat were increased in TSH >2.5 group compared to TSH ≤2.5 group in women. However, plasma lipids showed no significant differences. In males all the parameters showed no significant differences between two groups. Serum TSH was significantly correlated with body weight, BMI, waist circumference and percentage of body fat after adjustment for age in females. Multiple linear regression analysis revealed that percentage of body fat and BMI contributed significantly to the variance of TSH. Serum TSH level was significantly higher in nonalcoholic fatty liver group than in normal group in females. Multiple logistic regression analysis showed that TSH level was not the independent risk factor of NAFLD. Taken together the data suggest that serum TSH in normal range is significantly correlated with BMI and percentage of body fat in females. And the change of TSH level would not influence the prevalence of NAFLD.

Objective To investigate the characteristics of spinal injury caused by earthquake as well as to improve its therapeutic ability by comparatively studying the medical records of the inpatients with spinal injuries caused by Wenchuan earthquake and the inpatients with spinal injuries in peace time.Methods Medical records of inpatients with spinal injuries were extracted from 5.12 earthquake injury database(earthquake group) and medical records of the patients with spinal injuries firstly admitted to Daping Hospital between 2001 and 2007 were extracted from Chinese trauma database systems (control group).The epidemiological characteristics of the two groups were comparatively studied,including gender,age,injury causes,injury severity,treatments and outcomes.Results (1) The incidence of spinal injuries in the earthquake group was 16.7％ (524/3145),which was significantly higher than that (6.4％,682/10644) in control group (P＜0.01).(2) The female ratio in the earthquake group was significantly higher than that in the control group (57.4％:31.8％) (P＜0.01).(3) The age range of the earthquake group was (47.9 ±20.9) years.The wounded number presented an undulately rising trend in the earthquake group as the growth of age,while it showed a parabolic distribution in the control group.(4)The main causes for spinal injuries were crush injury (69.3％) and multi-factor injury (2.8％) in the earthquake group,while slipping up/fall (56.0％) and traffic accidents (23.6％) were the main causes in the control group.(5) There were 82.3％ of the earthquake group that were combined with multiple injuries and 48.1％ combined with at least two injuries,while the control group accounted for only 28.9％ and 12.0％ respectively.The NISS (new injury severity score) in the earthquake group was significantly higher than that in the control group [(11.6±8.8) points vs (7.5±4.8)points](P＜0.01).Meanwhile,the proportion of NISS≥16 in earthquake group was significantly higher than that in the control group as well (P＜0.01).(6) The length of hospital stay of the wounded in the earthquake group was significantly longer than that in control group [(40.5±24.5)d VS (23.9±26.7)d](P＜0.01).The treatment inefficiency rate in the earthquake group was higher than that in the control group (9.2％ vs 4.8％) (P＜0.01).Conclusions The earthquake group has a higher proportion of spinal injuries,female and elder cases,and combined injuries,a much severer injury,a longer length of hospital stay,and a higher treatment inefficiency rate,as compared with the control group.In the earthquake relief,more importance should be attached to salvage,diagnosis,transfer regulation and missed diagnosis,misdiagnosis and secondary injury should be avoided so as to improve the treatment level of the spinal injuries in earthquake.

Objective To analyze injury characteristics and treatment of hospitalized patients wounded in Wenehuan earthquake so as to provide references for medical rescue in disasters. Methods The study involved data of seismic patients from Trauma Database System Version 3.0 that collected clini-cal data of seismic patients admitted into West China Hospital of Sichuan University, Chengdu, and First and Second Hospitals of Deyang City. Trauma Database System Version 3.0 was developed by Research Institute for Traffic Medicine of PLA, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing. A comparative analysis was done on patient distribution, injury severity and medical treatment. Results There were 826 qualified patients including 410 males and 416 females ( at age range of 1-102 years, mean 45.8 years). Of all, the patients at age of 31-60 years accounted for 50. 2%. The patients were mainly peasants (43.8%, 208/477), workers (15.7%, 75/477) and students (14.1%, 67/477). Blunt injury (53.2%), crush/bury injury (22.5%) and slip/fall injury were three main causes for injury. The patients for 92.1% were admitted into two hospitals of the City of Deyang within four days after earthquake, while 81.7% of patients were admitted into West China Hospital in Chengdu at days 3-9 after earthquake. Patients with bone injuries accounted for 75.3%. The patients had abbreviated injury score (AIS) for mainly 1-3 points, with incidence rate of se-vere multiple trauma ( ISS > 16 points) of 8.2%. Internal fixation was done in 120 patients ( 34. 1% ), debridement and suturing in 103 (29.3%), external fixation in 55 ( 15.6% ), extremity amputation in 22 (6.3%) and intracerebral surgery in 2 (0.6%). Conclusions The injuries are mainly induced by collapse of buildings during earthquake. Bone injuries are predominant injury type, with AIS of mainly 1-3 points and few severe multiple trauma. The results show that the patients receive late special treat-ment and slow evacuation, indieating necessity of strengthening capacity of early medical treatment and ef-fective evacuation during destructive natural disasters.

Objective Observation of the effects of Xinmailong injection on NGAL, hs-cTnT and RAAS in elderly patients with type 2 cardio-renal syndrome (CRS) , and EvaluatIon of the clinical efficacy and safety.Methods A total of 86 elderly patients who were collected from November 2015 to February 2017 were diagnosed as type 2 CRS in our department of geriatrics. According to the random number table method, they were randomly divided into two groups. Control group (43 cases) were treated with conventional medical therapy and xinmailong group (43 cases) were treated with xinmailong injection with a dose of 5 mg/kg twice a day for 15 days. The value of sneutrophil gelatin-associated apolipoprotein (NGAL) , hypersensitive troponin T (hs-cTnT) , brain natriuretic peptide (BNP) , plasma renin activity (PRA) , and angiotensin Ⅱ (Ang Ⅱ) , aldosterone (ALD) , left ventricular ejection fraction (LVEF) , six-minute walking test and other indicators were measured before and after treatment. Results After treatment, the value of NGAL, hs-cTnT, BNP, PRA, AngⅡ and ALD decreased in both groups, the value of LVEF and six-minute walking distance increased compared with those before treatment (P <0.05); The above indicators in the xinmailong group experienced a more significant alteration than in control group in the same period (P < 0.05); no side effect occurred in both two groups during the experiment. Conclusion Xinmailong injection can reduce the levels of NGAL, hs-cTnT and BNP in elderly patients with type 2 cardio-renal syndrome, improve heart and kidney function, and have curative positive effect and good safety. This study underlined the mechanism of Xinmailong injection may be related to the inhibition of RAAS activity.

To explore the relationship between serum thyroid stimulating hormone (TSH) level and obesity and nonalcoholic fatty liver disease (NAFLD) in euthyroid subjects,1322 subjects were subjected to a questionnaire survey and physical examination.Fasting blood samples were collected to test serum TSH,plasma glucose and lipids.Fatty liver was diagnosed by type B ultrasonography.The relationship between serum TSH level and body mass index (BMI),percentage of body fat and NAFLD was analyzed.The results showed that serum TSH level was significantly higher in females than in males at the same group,and it was significantly higher in overweight group than in control group.Levels of body weight,BMI,waist circumference and percentage of body fat were increased in TSH ＞2.5 group compared to TSH ≤2.5 group in women.However,plasma lipids showed no significant differences.In males all the parameters showed no significant differences between two groups.Serum TSH was significantly correlated with body weight,BMI,waist circumference and percentage of body fat after adjustment for age in females.Multiple linear regression analysis revealed that percentage of body fat and BMI contributed significantly to the variance of TSH.Serum TSH level was significantly higher in nonalcoholic fatty liver group than in normal group in females.Multiple logistic regression analysis showed that TSH level was not the independent risk factor of NAFLD.Taken together the data suggest that serum TSH in normal range is significantly correlated with BMI and percentage of body fat in females.And the change of TSH level would not influence the prevalence of NAFLD.