Myosin heavy chain 9 (MYH9)disorders are a group of ihherited thrombocytopenias resulted from the mutation of MYH9 gene,including May-Hegglin anomaly,Epstein syndrome,Fechtner syndrome and Sebastian syndrome.MYH9 disorders are very often misdiagnosed as idiopathic thrombocytopenic purpura (ITP).For better understanding of MYH9 of clinical and laboratory and getting enough attention in clinical practice,this review will focus on the pathogenesis,clinical manifestations,laboratory examination and differential diagnosis.

Objective To investigate the relevant characteristic findings of rectal carcinoma in CT images which are associated with N staging.Methods Fifty-nine patients (38 male, 21 female, media age 58, range from 36 to 80 years old) underwent radical resection for rectal carcinoma after preoperative CT examinations were obtained. For N staging, pN0, pN1, pN2 were considered on the basis of pathological examination of excised specimens according to AJCC N staging criterion. Images were reviewed by two radiologists blindly using CT cine on workstation, making the consensus on the size, number and distribution of lymph nodes which were displayed perirectally, along superior rectal artery or along iliac vessels. The relationships between lymph node metastases and CT findings were analyzed statistically by SAS using Kruskal-Wallis test and ? 2 test. Results Lymph nodes were depicted in all node positive cases. Diameters of the largest nodes displayed in the group of pN0, pN1, pN2 were(4.13?3.21)mm, (7.43?3.27)mm, and (10.27?3.88)mm, respectively, which showed a statistically increase with N stage developing(? 2=23.842,P

10 days.All the patients received operations.Results:The prognoses of 80.49% patients in the early and middle stages were well ,the fadeaway of edema was evident,on the contrary,the prognoses of 83.33% patients of the later stage were worse,the fadeaway of edema was slow.Conclusion:The patients of LEDVT should receive operation as early as possibly in 10 days,the patients should receive conservative therapy after 10 days.

.All patients cured.Three-lumen nasogastrojejunal tube placed under X-ray monitoring proves to be a safe, convenient, highly tolerable and effective procedure.

Objective To investigate the value of prevention of cerebral ischemia with multi-modality neuroelectrophysiological monitoring in intracranial aneurysm embolization. Methods The clinical data of 44 patients with intracranial aneurysm treated with endovascular embolization from May 2013 to June 2014 were analyzed retrospectively. The patients were divided into two groups according to whether they used intraoperative neuroelectrophysiological monitoring. There were 21 patients in a monitoring group and 21 in a non-monitoring group. According to the site of the aneurysms,somatosensory evoked potential ( SEP),motion evoked potential( MEP),scalp electroencephalogram,and brainstem auditory evoked potential (BAEP)were monitored,and at one day after procedure,their newly developed neurological deficits and the follow up observation after 3 months in both groups were compared and analyzed. Results The intraoperative SEP,MEP,and scalp EEG changes in the monitoring group were observed in 9,3 and 4 patients,respectively. Timely preventive measures were taken for 9 of the patients with cerebral ischemia revealed by neuroelectro-physiological monitoring. At the first day after procedure,the incidence of patients with new neurological deficit was 17. 4%(4/23)in the monitoring group,and that was 47. 6%(10/21)in the non-monitoring group. There was significant difference between the 2 groups(χ2 =4. 623;P<0. 05). There was significant difference in the good prognosis rates(87. 0%[20/23]vs. 57. 1%[12/21])after 3-month follow-up (χ2 =4. 919;P<0. 05)between the 2 groups. There were no deaths in both groups. Conclusion Multimode in combination with neuroelectrophysiological monitoring may decrease ischemic complications in aneurysm interventional treatment and improve the safety of procedure.

For many years, TCM formula granules, as a new form of decoction pieces reform, have been favored by people with its three features—Three Efficacy, Three Small and Five Conveniences. As a result, it has become the ideal product in the course of TCM internationalization. In the face of growing sales, to formulate its standard becomes imminent. Therefore, how to establish a system that is unique to standardization of TCM formula granules has become a research hotspot of scholars. This article summarized Results of recent research on the preparation, quality control, pharmacology studies and clinical evaluation of TCM formula granules, with a purpose to put forward relevant suggestions, and provide references for standardization of TCM formula granules.

The training of 24-hour resident physicians is the key link of standard training for resident physi-cians.The question of how to improve the quality of residency training is an important task.The article summarized practices in standardized training process for 24-hour resident doctors and argued the construction of the monitoring and examining system for the purpose of promoting the training.

ObjectiveTo analyze the levels of matrix metalloproteinase 9 (MMP-9 ) in cerebrospinal fluid (CSF) of patients with central nervous system (CNS) infection caused by different pathogens.MethodsThe levels of MMP 9 in CSF were detected by enzyme linked immunosorbent assay (ELISA) in 10 patients with tuberculous meningitis in both acute phase and recovery phase,10 purulent meningitis,10 cryptococeal meningitis,10 viral encephalitis and 10 controls.The differences among the groups were compared by t test. The correlations between MMP-9 levels and the cell count,glucose, chloride, and protein in CSF were analyzed by Spearmanrank correlation.ResultsThe CSFMMP-9levelsingroupsoftuberculousmeningitis, purulentmeningitis,cryptoeoccal meningitis and viral encephalitis were (569.46±162.42),(182.79±99.06),(54.69±19.93) and (18.52±10.31) ng/mL,respectively,which were all significantly higher than that in controls (3.51± 1.53) ng/mL. There were significant differences between tuberculous meningitis group and other groups (t=2.925,3.041,3.237,3.454;P0.0340,0.0270,0.0080 and0.0001,respectively). Moreover,in tuberculous meningitis group,the MMP-9 level in acute phase was (569.46±162.42) ng/mL,which was significantly higher than that in recovry phase (294.30+89.06) ng/mL.The CSF level of MMP-9 in tuberculous meningitis group was positively correlated with CSF protein (r=0.509,P=0.044),negative correlated with CSF glucose (r=-0.451,P=0.008) and chloride (r=-0.637,P=0.007),but no correlation with CSF cell count (r=0.308,P=0.246). And there were no correlations in other groups. ConclusionsMMP-9 level in CSF increases significantly in patients with tuberculous meningitis and purulent meningitis,which can be used as a marker of CNS infection.Dynamic monitoring of thc CSF level of MMP-9 may be meaningful for the diagnosis and treatment.

Objective To investigate the clinical characteristics,manifestation and management of adrenal ganglioneuromas. Methods The data of 15 cases of ganglioneuromas diagnosed by pathology were reviewed retrospectively.Of the 15 cases,5 was male,aged 24 to 45 with an average of 29 years,and other 10 was female,aged 25 to 69 with an average of 31.Ten tumors were located in the right side,which was twice as many as that of the left side.There were 8 patients discovered by B ultrasonograpgy during health check-up,4 patients were detected because of paroxysmal abdominal pain. Three cases mainly presented with paroxysmally hypertension,and one of them had a high level of aldosterone ( 112 pmol/L). One of them had a high level of epinephrine (210 nmol) and nor-epinephrine (496 nmol). The B-ultrasound showed low-echo in all cases.Five cases showed calcification,the border was legible.The border lines of the tumors are not clear with vana cava in two cases. On unenhanced CT scanning,all cases showed low density areas.Eleven of the 15 cases underwent the enhanced CT,but 10 cases showed no enhanced areas on CT scanning.One case underwent MRI and showed low signals in T1 WI and inhomogeneous high signals in T2WI. Results Twelve cases underwent adrenal glands tumorectomy with abdominal NO.11 intercostals incision while other 3 underwent adrenal glands tumorectomy through posterior abdominal laparoscope.The tumors were completely removed in 14 cases,partly removed in 1 case.All patients recovered soon without complications such as bleeding or adrenal crisis.All cases were followed-up 13 to 74 months.The blood pressure of 3 cases with hypertension decreased to normal.The tumors recurred in 1 case,but no metastasis 55 months later. Conclusions It is difficult to differentiate adrenal medullary tumor from ganglioneuromas.The imaging data of iconography before surgery can give helpful information in the diagnosis of ganglioneuroma.Complete surgical excision is the only method for curing and the outcome is satisfactory.

Objective To explore the protocol of tissue matching and anti-rejection therapy in highly sensitized patients (HSP). Method The panel reactive antibody (PRA), human leukocyte antigen (HLA) matching and renal transplantation outcomes of 45 HSPs were retrospectively analyzed. Results Hyperacute rejection occurred in 2 patients. Acute rejection occurred in 9 patients and reversed by anti-rejection therapy. One year patient/graft survival rate was 95.6% / 91.1% respectively. Conclusions To avoid specific antibody through HLA matching is the key point for successful renal transplantation of HSP. Antithymocyte globulin (ATG) induction therapy combined with tacrolimus, mycophenolate mofetil therapy can decrease the rate of acute rejection and prolong graft survival.