objective To evaluate the prognostic value of five scoring systems including acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ ),Ranson score,sepsis-related organ failure assessment (SOFA),Balthazar CT severity index (CTSI) and modified early warning score (MEWS) in early prognosis of severe acute pancreatis.Methods One hundred and fifty-four patients with severe acute pancreatitis from January 2004 to January 2010 were studied retrospectively,and data pertinent to five scoring systems were recorded from day 1 to day 3 after admission in hospital All patients were divided into early non-survival group (43 cases) and early survival group ( 111 cases) by survival time after admission in hospital.Five scoring systems during first 3 days aftter admission and their prognostic value in early prognosis of severe acute pancreatitis was compared between two groups.Results Compared with that of early survival group,every day five scoring systems of early non-survival group were significantly higher in the first 3 days after admission (P ＜ 0.05 or ＜ 0.01 ).On day 1 after admission,APACHE Ⅱ was the most accurate predict of early mortality with area under curve (AUC) value of 0.879,closely followed by MEWS (AUC 0.858).On day 2 and 3 after admission,the MEWS was the most accurate predict of early mortality with AUC 0.900 and 0.942,respectively.Conclusion MEWS is more accurate predict of early mortality in severe acute pancreatitis among different scoring systems,worthy of generalization in clinic.

Objective To analyze the CT appearances with pathologic correlation and improve the recognition of pancreatic mucinous cystadenoma/cystadenocarcinoma.Methods CT findings in 20 patients with pathologically proven pancreatic mucinous cystic tumor were retrospectively and jointly reviewed by two observers blinded to the pathological results.All patients underwent precontrast and postcontrast helical CT.The number,size,location,and margins of the lesions were observed,along with wall thickness,septation,calcification witllin the lesions.and presence of mural nodules and their enhancement.The findings of malignant and benign tumors were compared.Results Twelve cases of mucinous cystadenoma.3 borderline cystadenomas and 5 cystadenocacinomas were included in this study.Sixteen tumors(16/20)were located at pancreatic body or tail.The findings of thick walsl,calcifications and mural nodules appeared in 4,2 and2 cases respectively in benign mucinous cystic tumors,while appeared in 7,5,and 5 cases respectively in malignant mucinous cystic tumom.Presence of tIlick walls.calcifications and mural nodules in the lesions were significantly associated with malignancy(P＜0.05).Conclusion CT manifestations of pancreatic mucinous neoplasm are variable,but has some specific radiographic features.A combination of CT findings is helpful ifl differentiation of malignant and benign pancreatic mucinous adenomas.

Objective: To investigate the innate immune response of influenza virus-infected glial cells,the transcription levels in chemokines in mouse microglia and astrocytes were detected which pre-infected by human H1N1 or avian H5N1 influenza viruses.Methods: The glial cells isolated from neonatal mice cerebral cortex were cultured and further microglia and astrocytes were purified.The primary mouse microglia and astrocytes were infected in vitro by H1N1 or H5N1 influenza viruses in a multiplicity of infection (MOI) 2.Eight hours post infection,the influenza virus nucleoprotein (NP) was detected by immunofluorescence to identify the proportion of infected cells.The cellular RNA were extracted at 6 h and 24 h to detect the transcriptional level of chemokines by semi-quantitative RT-PCR.Results: More than 95% of the microgha and astrocytes which isolated from mice were infected.The transcription levels of CCL-3,CCL-5,CXCL-2,CXCL-9 and CXCL-10 from infected microglia and astrocytes were upregulated.Futhermore,the mRNA level of CXCL-10 increased much more.In addition,avian H5N1 influenza virus could induce more stronger upregulation of those chemokines than human H1N1 did.Conclusion: The mouse microglia and astro cytes which are infected by H1N1 influenza virus or H5N1 influenza virus could induce upregulation of transcription level of chemokines.

Objective To investigate the ability of electrocardiogram-gated multislice CT(MSCT)in the diagnosis of myocardial bfidging.Methods Fifty-one patients(82 coronary arteries)with suspected coronary artery disease underwent multi-detector row CT,conventional coronary angiography and intravascular ultrasonography as well.The sensitivity,specificity and accuracy of MSCT for the detection of myocardial bridging were determined.The interobserver agreement was calculated by using Cohen's Kappa test.Results A total of 26 tunneled arteries exclusively located near the middle segment of left anterior descending coronary artery were found by coronary angiography and intravascular uhrasonography.Compared to the invasive methods,MSCT correctly detected 23 of 26 myocardial bridges with a sensitivity of 88%(23/26),specificity of 96%(52/54)and accuracy of 94%(75/80).The Kappa value for overall interobserver variation Was 0.62.Two myocardial bridges diagnosed by MSCT were missed with the invasive method.With the results of invasive and non-invasive methods combined as the standard of reference,the overall sensitivity.specificity,and accuracy of MSCT in detecting myocardial bridging were 89%(25/28),91%(21/23),and 90%(46/51),respectively.Conclusion As a non-invasive imaging modality,MSCT is feasible and reliable in the detection of myocardial bridging.

Objective To investigate the CT and MRI findings of primary hepatic neuroendocrine carcinomas.Methods Imaging findings of 6 patients with pathologically confirmed hepatic neuroendocrine carcinomas were retrospectively analyzed.Four patients underwent plain CT and contrast enhanced CT examinations.The other 2 patients underwent plain MRI and contrast enhanced MRI.Results One out of the 6 cases manifested multicentric tumor which appeared as one large tumor surrounded with multiple small nodules peripherally,and the tumors of the other 5 cases were solitary.On plain CT images,all lesions were well-defined and hypoattenuating with central areas of even lower density except punctuate calcifications at tumor periphery in 1 case.On pre-contrast MRI,the cases manifested heterogeneous low signal intensity on T1 wI and slightly high intensity on T2 WI.On dynamic contrast enhanced CT and MRI,Tumors manifested slight to mild enhancement in arterial phase,slight enhancement in portal venous phase or delayed phase with no enhancement in the center,accompanied by dislocation of surrounding vessels.There Was no lymphadenopathy in peritoneal cavity and retroperitoniurm. Conclusion CT and MRI scanning can demonstrate specific features of primary hepatic neuroendocrine carcinoma,which may help the diagnosis and differential diagnosis of the tumor.

Objective To evaluate MDCT findings and characteristics of metastatic pancreatic tumors. Methods A total of 23 cases with metastatic pancreatic tumors were collected and the CT findings including the size, number, location, density patterns, enhancement patterns and secondary signs (dilatation of the pancreatic duct and/or bile duct, involvement of peripancreatic vessels, atrophy of distal pancreas) were analyzed retrospectively. Results A total of 35 metastatic pancreatic tumors were identified in the 23 patients. Tumors were multiple in 7 patients, the other 16 patients had single metastatic pancreatic tumor. The mean maximum diameter of the tumors was 3. 3 cm; the majority was located in the pancreatic body/tail. Thirty tumors demonstrated no enhancement in the arterial phase, and in the portal phase 23 tumors were hypodensive compared with normal pancreatic tissue, 4 tumors were isodense and 3 tumors showed a peripheral rim of enhancement. Five tumors showed markedly enhancement in the arterial and portal phase. Only 1 patients had dilated biliary and pancreatic duct, and 2 patients had dilated pancreatic duct. Only 1 case demonstrated involvement of splenic vein. 13 of the 23 patients had extra-pancreatic metastasis. Conclusions Pancreatic metastasis showed certain imaging characteristics. The accuracy of CT diagnosis could be improved by understanding of these CT findings and clinical features.

Objective To evaluate the therapeutic effects of taurine combined with silybin meglumine in patients with non-alcoholic steatohepatitis (NASH). Methods One hundred patients with NASH were divided into two groups with 50 for each. The patients in the control group received polyene phosphatidyl choline (456 mg) combined with silybin meglumine (100 mg) 3 times daily for 24 weeks. While those in the treatment group received taurine (2 g) combined with silybin meglumine (100 mg) 3 times daily for 24 weeks. All patients were asked to take up basic therapy including drinking without alcohol, restricting sugary and fatty intake, improving food structure, carrying moderate aerobics and lightening body weight. Results At the end of 24 weeks, the clinical symptoms and the liver function ameliorated in two groups. Ultrasonic or CT examination showed that the steatohepatitits was improved significantly in two groups. Additionally, the levels of blood glucose, serum triglyceride and cholesterol as well as BMI decreased simultaneously (all P value <0. 05). Whereas the treatment group was superior to control group in aspect of amelioration of inappetite, nausea and vomiting as well as lever of serum triglyceride (all P value <0. 05). There was no side effect in the treatment group. Conclusion Based on the basic therapy, taurine combined with silybin meglumine can mitigate the degree of NASH, improve the metabolism of blood glucose and lipid with few side-effects.

ObjectiveBy studying acupuncture at Neiguan (PC6), Shuigou (GV26), and Baihui (GV20) in septic shock patients, to observe the effect of acupuncture on T cell subsets, vital signs, white blood cell (WBC) count, and procalcitonin (PCT) level in septicshock patients.MethodSixty patients were randomized into a treatment group and a control group. The control group was intervened by symptomatic managements including supplementing blood volume, anti-inflammation, nutrition support, and organ protection, and the treatment group was by acupuncture at Neiguan, Shuigou, and Baihui in addition to the intervention given to the control group. The T cell subsets contents were detected before and after intervention, and serum PCT level, APACHEⅡscore, vital signs, and WBC count were determined on day 1, 3, 5, and 7.ResultIn the treatment group, T cell subsets including CD3﹢, CD4﹢, and CD4﹢/CD8﹢increased significantly after intervention (P<0.01,P<0.05), while CD8﹢dropped significantly afterintervention (P<0.05), and the changes in the treatment group were all markedly superior to that in the control group (P<0.05). The decrease of PCT level in the treatment group was more significant than that in the control group after treatment, the PCTlevel dropped significantly on the 5th day in the treatment group compared to that before treatment, and the inter-group difference was statistically significant after the 3rd day (P<0.01); the APACHEⅡscore in the treatment group was different from that in the control group after 3 d treatment, and the score was significantly changed in the treatment group after 5 d treatment (P<0.05); the body temperature, heart rate, inspiration, WBC count all showed decrease or improvement, and the improvements of vitalsigns in the treatment group were more significant than that in the control group (P<0.01,P<0.05).ConclusionAcupuncture at Baihui, Shuigou, and Neiguan can improve the immune function of septic shock patients, and its treatment effect is confirmed.

Objective To study the effect of exogenous non secreted human urokinase type plasminogen activator(uPA) gene on the production of collagen in activated hepatic stellate cells(HSC) after delivery by replication deficient recombinant adenovirus vector. Methods Non secreted human uPA was inserted into the replication deficient recombinant adenoviruses AduPA in bacteria. After infected by AduPA, the expression of uPA in HSC cell line HSC T6 was detected by Northern blot and immunocytochemical staining, and the level of matrix metalloproteinase 2 (MMP 2) in the supernatant of cultured HSC T6 cells was measured by ELISA. In addition, immunocytofluorescent staining was carried out to evaluate the effect of AduPA on the production of collagen Ⅰ and Ⅲ in HSC after exogenous uPA gene delivery. Results 5?10 11 efu/ml titer of AduPA was obtained in the HSC infected with the recombinated virus. Northern blot and immunocytochemical staining showed that the expression of uPA in HSC increased significantly on the third day after infection with the AduPA. The level of MMP 2 in the supernatant of the cultured HSC was (274.45?7.63) pg/ml, which was higher than that in the control [(145.85?6.58) pg/ml, P

Objective To explore the clinical effect of acupuncture on acute renal injury of sepsis.Methods From January 2015 to May 2017,adult patients with sepsis who received ≥ 7 days of treatment were collected from the Central Hospital of Zhuzhou.The participants were randomly divided into the control group (n =35) and the treatment group (n =37),and the control group was given routine treatment according to the sepsis guidelines.On the basis of control group,the treatment group was given acupuncture treatment,acupoints Shenshu and Sanyinjiao,Taixi,Zusanli.The clinical effects of the two groups of patients were compared.Results The levels of cystatin C,blood urea nitrogen and creatinine in the treatment group were significantly lower than those in the control group (P ＜ 0.05).There was no significant difference in the number and proportion of patients with blood purification between the two groups (P ＞ 0.05),while the frequency and time of blood purification treatment in the treatment group were significantly lower than those in the control group (P ＜ 0.05).The levels of blood interleukin-6 and tumor necrosis factor-alpha in the treatment group were significantly lower than those in the control group (P ＜ 0.05).From the fourth day of treatment,the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score in the treatment group was significantly lower than that in the control group (P ＜ 0.05).There was no significant difference in mortality between the two groups at 28 days (P ＞ 0.05).Conclusions Acupuncture of Shenshu,Sanyinjiao,Taixi,Zusanli can improve sepsis patients with acute kidney injury in renal function.