Objective:To explore the value of apparent diffusion coefficient (ADC) measurement of diffusion weighted imaging(DWI) in diagnosis of brain abscess.Methods:Ten patients with brain abscess (8 being histologically verified,2 clinically confirmed) were examined using conventional MRI and DWI before operations or medications.ADC values of pus,abscess walls, edema at the periphery of abscess and opposite normal white matters of all 10 cases were measured with b values (0 s/mm~2 and 1000 s/mm~2) and their ADC mean values were calculated.Results:The ADC mean values in 10 cases of pus cavity,abscess walls,edema at the periphery of abscess and opposite normal white matters were (0.57?0.11)?10~(-3)mm~2/s,(1.14?0.06)?10~(-3)mm~2/s,(1.74?0.21)?10~(-3)mm~2/s and (0.77?0.05)?10~(-3)mm~2/s,respectively.The differences in the ADC mean values were significant between either two parts of pus cavity,abscess walls,edema at the pariphery of abscess and opposite normal white matters(P

Objective Insulin resistance is a possible cause of polycystic ovary syndrome(PCOS).It is presumed that ectonucleotide pyrophosphatase/phosphodiesterase 1(ENPP1) is associated with insulin resistance.The purpose of this study is to explore the expression of ENPP1 in granulosa cells of the ovary and its relationship with PCOS. Methods Twelve aliquots of follicular granulosa cells were isolated from 12 samples of the patients with PCOS and 22 aliquots from 22 samples of the patients without PCOS,respectively.ENPP1 expression was analyzed by reverse transcription polymerase chain reaction(RT-PCR) and in situ hybridization.The relative expression of ENPP1 mRNA was detected by real-time quantitative polymerase chain reaction(real-time PCR). Results ENPP1 was expressed in granulosa cells of the ovary.ENPP1 expression's 2~(-?Ct) in granulosa cells of PCOS was significantly higher than non-PCOS(1.67?0.89 vs.0.94?0.76,P=0.017).Conclusion ENPP1 expression plays a role in ovary function and may be closely associated with the development of PCOS.

Objective To analyze the gene expression profiles in response to ΔNp63α overexpression, and screen the potential target genes or signal pathways regulated by ΔNp63α. Methods To generate ΔNp63α overexpressed SiHa cells ( SiHa-ΔNp63α) and the control cells ( SiHa-NC) , recombinant lentivirus transfection was performed. Microarray was applied to detect the change of gene expression profiles, and the results were analyzed with bioinfor-matic software. Quantitative real-time PCR was used to validate the expression levels of selected genes. Results Among the 1405 differentially expressed genes which were statistically significant, >1. 5 fold increase or reduce of gene expression, 843 were up-regulated and 562 were down-regulated in SiHa cells with ΔNp63α overexpression. The genes were mostly involved in cell development,cycle regulation, signal transduction, communication, adhe-sion, metastasis and invasion, etc. The involved signal pathways consisted of antigen processing and presentation, cytokine-cytokine receptor interaction, cell adhesion, complement and coagulation cascades, and so on. Conclu-sion The research on the potential target genes or mediated signal pathways regulated by ΔNp63α could be helpful to explain the development of cervical cancer.

Objective To investigate the clinical efficacy of statins atorvastatin calcium on cerebral carotid atherosclerotic plaques in patients and the effects on C-reactive protein .Methods 76 patients admitted to hospital with cerebral carotid atherosclerotic plaques in patients randomized manner using its divided into the observation group and control group of 38 patients in the control group not using statins , given only hospital conventional therapy , observed in the control group were given atorvastatin group based on calcium statin treatment ,post-treatment comparison groups the size of carotid atherosclerotic plaque and plasma C-reactive protein changes .Results After treatment , plaque size(0.069 ±0.021)cm2,IMT was (1.29 ±0.28)mm,significantly less than before treatment,after treatment difference was statistically significant (t=7.538,7.132,all P<0.05)also significantly less than the control group ,the difference was statistically significant (t=7.131,6.372,all P<0.05);the observation group after treatment C-reactive protein(3.54 ±1.92 ) mg/L, significantly lower than before treatment , before and after treatment difference was statistically significant(t=6.831,P<0.05),and significantly lower than the control group ,the difference was also statistically significant(t=7.125,P<0.05).Conclusion For patients with cerebral carotid atherosclerotic plaque is concerned,the application of atorvastatin calcium treatment can not only effectively reduce plaque area , but also reduce C-reactive protein,and therefore worthy of further clinical application .

Objective To investigate the head and neck CTA findings and cerebral CTPI in patients with transient ischemic attack (TIA),and their relationship with frequency of TIA,duration and CTA detected responsible vessels.Methods 180 TIA patients were selected as the research subjects,the GE Lightspeed 64 spiral CT perfusion CT scan and CTA examination were taken,and the differences in CTPI parameters measurement,head and neck artery disease of patients were analyzed.To observe the correlation between CTPI perfusion abnormalities in patients with TIA seizure frequency,duration and NIHSS score.The CTPI perfusion abnormalities and consistency of CTA display of responsible vessels were analyzed.Results The positive rate of CTPI examination was 75.56％,that of CTA examination was 81.11％.The positive rate of patients(NIHSS ≥4 points) with CTPI was 88.89％,which was higher than 66.67 ％ in patients (NIHSS ＜ 4 points) with CTPI (x2 =6.87,P ＜ 0.05).The positive rate of patients (seizures time ≥ 10min) with CTPI TIA was 71.43％,which was higher than 45.45 ％ of the patients (seizures time ＜ 10m in) with CTPI (x2 =7.23,P ＜ 0.05).The CTPI positive rate of patients with the TIA seizure frequency ≥ 2 times/d was 83.33％,which was higher than 61.67％ of patients with the seizure frequency ＜ 2 times/d(x2 =5.48,P ＜ 0.05).The CTPI positive and CTA responsibility vascular consistent proportion was 73.33 ％,which was significantly higher than 26.67％ of both inconsistent and negative (x2 =19.43,P ＜ 0.01).Conclusion The cerebral CTPI and head and neck CTA can response to TIA in patients with intracranial lesions accurately,consistency and clinical manifestations are very good,which have higher value in clinical application.

ObjectiveTo assess whether intravenous contrast medium would result in acute kidney injury (AKI), and to determine the risk factors associated with contrast induced AKI (CI-AKI) and its outcome.Methods A retrospective observational study was conducted in intensive care unit (ICU) of Fuyang People's Hospital in Zhejiang Province from January 1st 2011 to December 31st 2014. All enrolled critically ill patients had accepted CT scan, and the hospital length of stay was longer than 48 hours, and the patients who needed renal replacement treatment were excluded. Patients were divided into contrast medium group and control group. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria (serum creatinine content over 26.4μmol/L or 50% increase of it from baseline within 48 hours). The incidence of AKI was compared between the two groups, and risk factors for CI-AKI were determined by multiple logistic regression analysis. The relationship of CI-AKI and outcomes were also analyzed. Results A total of 2 370 critically ill patients were enrolled during the period. 474 (20.0%) of the 2 370 patients received contrast medium, and 70 of them suffered from CI-AKI (14.8%). In 1 896 patients who did not receive contrast medium, 235 of them suffered from AKI (12.4%). There was no significant difference in the incidence of AKI between two groups (χ2= 1.905,P = 0.168). After several confounding factors were adjusted, multiple logistic regression analysis showed that contrast medium was not found to associate with AKI in critically ill patients [odds ratio (OR) = 1.66, 95% confidence interval (95%CI) = 0.72-3.90,P = 0.201], and high acute physiology and chronic health evaluationⅡ (APACHEⅡ) score (OR = 1.70, 95%CI = 1.33-2.40,P< 0.001), sepsis (OR= 8.06, 95%CI =3.28-17.80,P< 0.001), shock (OR= 3.57, 95%CI = 1.73-8.01,P< 0.001) and use of nephrotoxic agent (OR= 1.96, 95%CI = 1.25-2.63,P = 0.015) were risk factors of CI-AKI. Ten of 70 patients with CI-AKI died (14.3%), and 21 out of 404 patients without CI-AKI, died (5.2%). There was no significant difference in the mortality rate (χ2= 8.060, P = 0.005). It was shown by multiple logistic regression analysis that age (OR=1.30, 95%CI = 1.05-1.71,P = 0.027), male sex (OR = 1.13, 95%CI = 1.05-1.20,P = 0.039), APACHEⅡscore (OR = 1.07, 95%CI = 1.03-1.18,P< 0.001), and sepsis (OR = 3.29, 95%CI = 1.92-6.46,P< 0.001) were highly associated with mortality of critically ill patients in whom contrast medium was used. However, the occurrence of CI-AKI showed no influence on the mortality rate (OR = 1.70, 95%CI = 0.88-3.56,P = 0.227).Conclusions The use of contrast medium is not a risk factor of CI-AKI in critically ill patients. CI-AKI will not raise mortality rate in ICU patients.

ObjectiveTo estimate the value of serum soluble scavenger receptor CD163 (sCD163) to the prognosis of patients with stroke associated pneumonia (SAP).Methods A prospective study was conducted. The clinically suspected SAP patients admitted to Department of Intensive Care Unit (ICU) and Emergency ICU (EICU) in Zhejiang Province Zhuji City Chinese Medicine Hospital from February 2014 to January 2015 were all enrolled. According to clinical pneumonia severity index (PSI), they were divided into SAP group and non SAP group according to the presence or absence of SAP, the patients of SAP group were subdivided into mild SAP group (PSI grade Ⅰ-Ⅲgrade) and severe SAP groups (PSI grade Ⅳ-Ⅴ grade) and according to the 28-day prognosis, the patients were subdivided into hospitalized death group and survival group. The clinical data were collected, including gender, age, history of stroke presence or absence, present stroke pattern, National Institutes of Health Stroke Scale score (NIHSS) on the day of stroke suspect diagnosis, Glasgow coma scale (GCS) score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, clinical pulmonary infection score (CPIS), PSI score, body temperature, result of chest X-ray film, oxygenation index (PaO2/FiO2), result of sputum culture, serum levels of white blood cell (WBC) and C-reactive protein (CRP) in a period of 7 days after the suspected diagnosis, PCT, sCDl63 levels on days 1, 3, 5, 7 days, length of stay in ICU, the total time of hospitalization and 28-day survival situation, etc. The ability of each index to evaluate the prognosis of SAP was analyzed by the receiver operating characteristic curve (ROC curve). The risk factors influencing the prognosis of SAP patients were analyzed by multivariate logistic regression analysis.Results ① Seventy-eight patients were finally enrolled in the study, 44 patients were diagnosed as SAP, 34 were non SAP. In 44 patients with SAP, there were 28 cases of severe SAP and 16 cases of mild SAP. On the first day of the suspected diagnosis, the NIHSS score [13 (7, 22) vs. 8 (4, 17), the CPIS score [6 (4, 9) vs. 4 (3, 5), sCD163 [mg/L: 0.80 (0.59, 1.32) vs. 0.33 (0.22, 0.46)], CRP [mg/L: 84.2 (50.8, 114.9) vs. 51.4 (26.2, 79.9)] and 28-day mortality [38.6% (17/44) vs. 11.8% (4/34)] in SAP group were significantly higher than those in non SAP group (allP < 0.05), and other basic indexes between the two groups were all of no statistical significant differences (allP > 0.05). ② The levels of sCD163 reached the peak value on the third day after the suspected diagnosis among SAP group and non SAP group, mild SAP group and severe SAP group, survival group and death group and then began to fall; the levels of sCD163, WBC, CRP, PCT within 7 days in SAP, severe SAP and death groups were higher than those in non SAP, mild SAP and survival groups (allP < 0.05). ③ROC curve analysis indicated: sCDl63 showed a better capacity for evaluating the 28-day prognosis of SAP [ROC curve (AUC) =0.673, 95% confidence interval (95%CI) = 0.515-0.807, sensitivity and specificity were 41.2% and 96.3% respectively and the cut-off was 2.65 mg/L]. However, the levels of other inflammatory indexes and scores on the first day after the suspected diagnosis had no value for early prognosis of SAP. The multiple logistic regression analysis showed that the level of sCD163 on the first day after the suspected diagnosis was the independent risk factor of death in hospital of SAP patients [dominance ratio (OR = 1.27, 95%CI = 1.06-1.52,P < 0.05]. Age (OR = 1.04, 95%CI = 1.01-1.06,P = 0.015), NIHSS score (OR = 2.86, 95%CI = 1.64-4.92,P = 0.010), CPIS score (OR = 1.52,95%CI = 1.28-1.90,P < 0.001) and APACHEⅡ score (OR = 2.06, 95%CI = 1.53-3.07,P < 0.001) were also the risk factors of influencing the death of patients with SAP.Conclusions Early sCD163 level is an independent risk factor in predicting the 28-day mortality of patients with SAP, and it has a certain value for the prognosis of SAP.

Objective To investigate the clinical application of the combined the anterior malleolus flap and anterior tibia flap. Methods Based on the dissection of the perforating branches of anterior tibial artery on the middle and inferior section, the combined the anterior malleolus flap and anterior tibia flap was designed to repair the necrotic skin of anterior foot for 5 patients. The sizes of the flaps ranged from 17 cm×10 cm-10 cm× 5 cm. And the area of the flap was from tibial tuberosity(upper bound) to the line between internal malleolus and external malleolus (lower bound), and from the median line of one side of leg to the other side. Results Postoperatively, all flaps survived, and the primary healing of transplanted skin in donor site was achieved. The texture of flaps were excellent, the phenomenon of abrasion did not happen, and the clinical therapeutic efficacy was satisfactory after a follow up of 2-24 months. Conclusion It's a good method that combined the anterior malleohls flap and anterior tibia flap, which not only could enlarge the area of the flap but also has reliable blood supply, in repair of large size skin defect of anterior foot.

Objective To investigate the clinical application of anti-β2 glyeoprotein Ⅰ antibodies (IgG, IgM, IgA)in systemic lupus erythematosus(SLE). Methods The anti-β2-GP Ⅰ antibodies and anti-cardiolipin antibodies(ACL) level were measured by ELISA in 100 SLE patients, 39 other rheumatoid arthri-tis patients and 30 healthy control people. Their clinical application was analyzed in SLE diagnose and thera-py. Results The level of anti-β2-GP Ⅰ (IgG, IgM, IgA)were significantly higher in SLE than that in healthy (P < 0. 01 ). Sensitivity, specificity, positive predictive value and negative predictive value were 17.2%, 95.7%, 85.0% and 44. 6%, respectively. There was a significant and positive correlation be-tween anti-β2-GP Ⅰ antibodies and ACL antibodies ( IgG, IgM, IgA) (r = 0.418, 0. 624, 0.518, 0. 583, P <0.01). In multivariate analysis the factors(anti-β2-GP Ⅰ antibodies, ACL antibodies, dsDAN, u1-RNP, Sm, SSA, SSB, Jo-1, Scl-70, P-protein, PT, APTT) associated with SLE disease activity index(SLEDAI) were anti-β2-GP Ⅰ (IgG) and dsDNA. Conclusion anti-β2-GP Ⅰ antibody has high specificity and positive predict value, also is associated with SLE's thrombosis. It has some values in the clinical application.

ObjectiveTo study the role of laparoscopic splenectomy (LS) using the anterior approach with sequential layered dissection. MethodsFrom December 2007 to July 2009, we performed 27 LS using the anterior approach with sequential layered dissection. The clinical data were retrospectively analyzed. ResultsThe range of splenic length was 8-20 cm. Accessory spleen was found in 6 patients (22.2%). The mean operative time was 125 mins. The mean intraoperative blood loss was 90 ml, and the mean postoperative stay was 5.5 days. ConclusionsLaparoscopic splenectomy using the anterior approach with sequential layered dissection could be carried out smoothly and rapidly. It reduced accidental injuries and shortened the operative time.