Objective To analyse clinical and imaging characteristics of congenital airway abnormalities,and to guide the clinical diagnosis and reduce rate of missed diagnosis and misdiagnosis.Methods Clinical and imaging characteristics in children who had been diagnosed congenital airway abnormalities in Shengjing Hospital of China Medical University from 2005 to 2011 were reviewed and analysed retrospectively.Results Of 23 children,12 cases were male,11 cases were female,the age was from 1 month to 10 years,the average age was 32 months.The disease course was from 3 days to 3 months,an average was 18 days.Clinical manifestations were repeated coughing,wheezing,dyspnea and recurrent respiratory infection.Through the spiral CT and three dimensional reconstruction,enhanced CT examination,6 cases of tracheobronchial stenosis,3 cases of trachea and bronchus,1 case of dysplasia of the left pulmonary artery and vein,3 cases of pulmonary sequestration,4 cases of pulmonary cyst and 6 cases of pulmonary hypoplasia were found.Conclusion Missed diagnosis and misdiagnosis of congenital airway malformations often occurs.When the following features were observed,congenital airway malformations may be taken into account:persistent cough; repeated or persistent wheezing,treated ineffectively with anti-inflammatory agent and bronchodilators ; recurrent or persistent stridor; repeated pulmonary infections,dyspnea; repeated or persistent pneumonia in the same part and unexplainedly mediastinal shift in X ray chest radiography.Spiral CT three dimensional reconstruction and enhancement is of great value in diagnosis of airway malformation.

Objective To improve the diagnosis and treatment of inflammatory myofibroblastic tumor (IMT) of the urinary tract in pediatric.Methods The retrospective study of 12 IMT was based on information retrieved from Beijing Children's Hospital from January 2006 to July 2015.The literatures of urinary IMT were reviewed.There were 12 cases of urinary IMT, with 8 cases in bladder, 2 in kidney, 1 in ureter and 1 in prostate.Mean age at surgery was 6.4 years old (range 2months-13 years), 6 cases males and 6 females.Tumor resection were performed in 11 patients, biopsy was performed only in 1 patient.Results HE staining revealed diffuse appearing spindle myofibroblastic cells admixed with inflammatory cells.Immunohistochemistry showed positive ration for following markers as ALK (8/12), CK18 (6/12), Desmin (7/12), SMA (8/12), Actin (1/2), Vimentin (9/12).Negative staining were seen for Myoglobin, S-100 and Ki-67 ＜ 20％.Patients were followed up in 10 cases, lost to follow-up in 2;the mean follow-up time was 14.4 months (range 3-31 months).All patients recovered well without relapse or metastasis.Condusions Inflammatory myofibroblastic tumors of the urinary tract in pediatric were rare, without specific characteristic in clinical features and imaging.The main treatment of IMT is complete surgical excision.

Objective To discuss the clinical and pathological features of malignant rhabdoid tumor of the ureter (MRTU).Methods One case of MRTU was reported, a six-year-old girl was admitted to our hospital on May 29, 2014, and presented left loin pain 2 weeks, ultrasound showed gradually progressing hydronephrosis and hydroureter.During a physical examination, she felt tenderness in the left kidney area and no mass was palpable in abdomen.The ultrasound showed left sided gross hydroureteronephrosis and a round hyperechogenic mass in the inferior pole of the left ureter (In front of the left iliac vessel), with no obvious borders.Contrast-enhanced CT suggested a gross dilatation of the left kidney and ureter with a solidappearing lesion in the lower ureter;neither additional abdominal abnormalities nor enlarged lymph nodes were seen in both examinations.The surgery began with incision of left lower abdomen.The partial ureter of neoplasm was excised along with invaded psoas and posterior peritoneum by gross inspection, then ureteroureterostomy was performed.The severed ureter was completely blocked with the ill-defined neoplasm and was 3.3 cm in length and 2.1 cm in width.Results The ureteral neoplasm was excised,along with the invaded psoas and posterior peritoneum,after that ureteroureterostomy was performed.HE showed the diffuse large round nuclei, vesicular chromatin, prominent nucleoli cells, and moderate amounts of eccentrically placed eosinophilic cytoplasm.Immunohistochemical studies were positive for cytokeratin, epithelial membrance antigen and vimentin, negative for INI1, METU hereby was confirmed.She underwent a chemotherapy regimen consisting of ICE, alternating with VDC.Four courses chemotherapy (3 months) later,CT scan suggested hematogenous metastasis of lung.The family refused further treatment and the patient died of systemic metastasis eight months after surgery.Conclusion MRTU was a rare and highly aggressive tumor with a poor prognosis.

Objective To investigate the experience of diagnosis and management of coexisting ureteropelvic junction obstruction (UPJO) and nonreflux megaureter (NRM).Methods The retrospective study of UPJO with NRM was based on 10 years information retrieved from January 2005 to December 2015.The data of 13 patients (8 males and 5 females) were available and recorded.Mean age at surgery was 3.7 years old (range 1.8 to 14 years).The diagnosis and mangement were summarized.Coexisting ureterovesical junction obstruction (UVJO) and vesicoureteral reflux,iatrogenic stricture and vesicoureteral reflux were excluded.Intravenous pyelography,voiding cystourethrography,ultrasound and CT reconstruction were performed before operation.Only six patients had an accurate diagnosis as UPJO with UVJO before surgery.Pyeloplasty was the initial surgical management choice for 10 patients,and ureteroneocystostomy in 3 patients.Results UVJO were diagnosed with pyelography techniques in 3 patients after pyeloplasty,while 4 were diagnosed as nonreflux and nonobstruction megaureter.Of the 10 patients who underwent initial pyeloplasty,additional ureteroneocystostomy was required in 3 and the prognosis was good.Additional pyeloplasty was required in 2 of the 3 patients who initially underwent ureteroneoeystostomy.Mean follow-up time from last operation was 23.3 months (6-53 months),the overall prognosis was good.Conclusions It is often difficult to correctly diagnose coexisting UPJO and NRM.In patients with UPJO,it is highly recommended nephrostomy radiography after pyeloplasty to evaluate the distal ureterovesical junction.Initial pyeloplasty is always recommended as first-line therapy.Additional ureteroneocystostomy was required when hydroureteropelvic was aggravated.

Objective:To observe the effect of applying tuina to exterior-interiorly connected meridians for post-stroke upper limb spasticity.
Methods:A total of 150 patients with post-stroke upper limb spasticity were randomly allocated into a treatment group (n=75) and a control group (n=75) by the random number table. Patients in the treatment group received tuina on exterior-interiorly connected meridians, whereas patients in the control group received standard rehabilitation therapy. The therapeutic efficacies in both groups were observed after 3 weeks of treatment.
Results:The total effective rate in the treatment group was 89.3%, versus 61.3% in the control group, showing a statistically significant difference (P<0.05). After the treatment, the muscle tones by the modified Ashworth scale (MAS) were significantly improved in both groups (bothP<0.05); and the improvement of muscle tone was more significant in the treatment group than that in the control group (P<0.05).
Conclusion:Applying tuina to exterior-interiorly connected meridians can obtain an exact efficacy for post-stroke upper limb spasticity.

Objective To evaluate the role of spinal sigma-1 receptors in the maintenance of bone cancer pain (BCP) in rats and the relationship with extracellular signal-regulated kinase (ERK).Methods Part Ⅰ Twenty-four female Sprague-Dawley rats,weighing 180-220 g,were randomized into 2 groups using a random number table:sham operation group (S group,n =4) and BCP group (n =20).BCP was induced by inoculating Walker 256 mammary gland carcinoma cells into the medullary cavity of the right tibia.Four rats were sacrificed on day 10 after inoculation in S group or on day 3,5,7,10 and 14 after inoculation in BCP group,and the L4-6 segments of the spinal cord were removed to measure the expression of sigma-1 receptors by Western blot.Part Ⅱ Forty female Sprague-Dawley rats,weighing 180-220 g,were randomized into 4 groups (n =10 each) using a random number table:sham operation group (S group),sigma-1 receptor inhibitor BD1047 group (BD group),BCP group,and BCP + BD1047 group (BCP + BD group).On day 10 to 14 after inoculation,normal saline 20 μl was injected intrathecally once a day in S and BCP groups,or BD1047 120 nmol/20μl was injected intrathecally once a day in BD and BCP + BD groups.Mechanical paw withdrawal threshold (MWT) to yon Frey filament stimulation was measured one day before inoculation,on day 3,5 and 7 after inoculation,and on day 10,12 and 14 after administration.After measurement of MWT on day 14 after inoculation,the rats were sacrificed and the L4-6 segments of the spinal cord were removed to determine the expression of phosphorylated ERK (p-ERK) by Western blot.Results Part Ⅰ Compared with group S,the expression of sigma-1 was significantly up-regulated and peaked on day 10 after operation in group BCP.Part Ⅱ Compared with S group,no significant changes were found in MWT and p-ERK expression at each time point in BD group,and MWT was decreased and p-ERK expression was up-regulated in BCP and BCP + BD groups.Compared with group BCP,after intrathecal injection of BD1047,MWT was significantly increased and the expression of p-ERK was down-regulated in BCP + BD group.Conclusion Spinal sigma-1 receptors are involved in the maintenance of BCP in rats possibly through promoting phosphorylation of ERK.

Objective To study the possibility of establishment of an animal model of hydronephrosis by ureteropelvic junction obstruction,and to evaluate the value of CT perfusion imaging in assessment of the renal function in the animal models. Method Fifty 10-week-old male New Zealand rabbits were randomly assigned to two groups:sham-operated group with separation of the left ureter (20 rabbits),and model group (30 rabbits) with the left ureter embedded at the ureteropelvic junction under the psoas major muscle. The left kidney function in the two groups was confirmed to be normal by SPECT before operation. CT perfusion and SPECT imagings were performed to assess the left kidney function in the two groups at three months after surgery,and the results were compared with that of pathological examination. Statistical analysis was performed on the parameters of SPECT and CT perfusion imaging and glomerular filtration rate (GFR). Results The success rate of model establishment was 70%,showing pathological changes of chronic hydronephrosis. CT perfusion demonstrated that BF,BV,PS of the left renal cortex and medulla were decreased,and had a good positive correlation with the changes of GFR. Conclusions It is feasible to establish a rabbit model of chronic hydronephrosis by embedding the left ureter at ureteropelvic junction under the psoas major muscle,and CT perfusion imaging parameters can be used to evaluate the renal function in the animal models.

Objective To investigate the optimal dose of oxycodone for severe pain in cancer patients so as to try to alleviate the suffering rapidly.Methods Totally 135 cases with severe pain in terminal cancer patients were randomly divided into groups A,B,and C,45 cases in each group.Groups A,B,and C were treated with oxycodone hydrochloride sustained-release tablets 20 ～ 140 mg/d,150 ～ 290 mg/d,300 ～ 640 mg/d,respectively.Pain relief and incidence of adverse reactions were evaluated 2 weeks later.Results Pain intensity scores (numerical rating scale,NRS) in 3 groups dropped with statistical difference (P ＜ 0.05).Pain relief rates in groups B and C were statistically significant compared to group A (P ＜ 0.05).Quality of life score (appetite,mental status,sleep,daily activities,and interpersonal life) in group C had statistical significance compared to groups A and B (P ＜ 0.05).Group C had slightly higher incidence of adverse reactions than that of groups A and B without significant difference (P ＞ 0.05).Conclusions Large dose and extra large dose of oxycodone hydrochloride sustained-release tablets can effectively relieve severe pain in advanced cancer patients.Extra large dosage can improve patient's quality of life in spite of the higher incidence of adverse reactions,and patients can still be tolerated well.

Objective To construct the uniform electron density couch model (model A ED =0.25) and two components non uniform electron density couch model (model B FD =0.5and foam core=0.1) in the Monaco treatment planning system for the iBEAM(R) evo Extension 415,and to compare which model can better quantify the treatment couch influence on radiation dose.Methods Phantom was positioned in the center of the couch,the attenuation of the couch was evaluated with 6 MV for a field size of 10 cm× 10 cm.Dose measurements of couch attenuation were performed at gantry angles from 180.0° to 122.8°,using a 0.125cc semiflex ionization chamber (PTW),isocentrically placed in the center of a homogeneous cylindrical phantom.Each experimental setup was first measured on the linear accelerator and then reproduced in the TPS.By adjusting the relative-to water electron density (ED) values of the couch,the measured attenuation was replicated.The model accuracies of the model A and model B were evaluated by comparing the measured and calculated results at the minimum computational grid (2 mm) and maximum computing grid (5 mm),respectively.Results The maximum measured and calculated percentage deviation for the central phantom position was 4.01％.The couch model was included in the TPS with a uniform ED of 0.25 or a 2 component model with a fiber ED=0.5 and foam core ED=0.1.For model A and B under 2 and 5 mm voxel grid size,the mean absorbed dose with couch was reduced to 0.61％,0.84％,0.71％ and 0.92％from 2.8％ without couch.Conclusions Model A has a good agreement between measured and calculated dose distributions for all different voxel grid sizes and gantry angles.It can accurately describes the dose perturbations due to the presence of the couch and should therefore be used during treatment planning.

[Abstract ] Objective Stenosis is a common complication of Crohn′s disease (CD), different treatments for different cau-ses.The article aimed to investigate bowel stenosis by the application of MRI diffusion-weighted imaging(DWI) and explore its value of identifying CD. Methods From Jan 2014 to Jun 2014, 31 patients with histologically proven CD (18 males and 13 females;mean age:38.90 ±13.65 years) were recruited in this approved retrospective study .All patients underwent conventional 3.0T MRI and DWI sequences .According to the most serious stenosis part identified by MRI , DWI sequence examination was added and the apparent diffusion coefficient (ADC) of the lesion was measured.All patients would undergo colonoscopy in 24 hours.According to the endo-scopic manifestations and pathological results , the patients were divided into inflammatory group (n=21) and fibrotic group (n=10). We observed the difference of ADC between two groups and worked out the cutoff points . Results In the inflammatory group , the ADC value andthe mean ADC value of stenosis bowel wall were (1.01 ±1.83) ×103 mm2/s and (1.40 ±0.23) ×103 mm2/s, whereas (0.53 ±1.03) ×103 mm2/s and (0.80 ±0.16) ×103 mm2/s in the fibrotic group(P<0.05).The area under receiver operating characteristic curve was 0.981 (95%confidence interval 0.943-1.000), taking 1.11 ×103mm2/s as the cutoff point.The sensitivity of low ADC values in detecting inflammatory bowels was 90.5%, and the specificity of high ADC values in excluding inflammatory bowels was 100%. Conclusion Different pathological components limit the movement of water molecular at different degrees , therefore quantitative parameters can be acquired by measuring ADCs , which contributes to the identification and diagnosis of CD secondary bowel stenosis.