Objective To detect the levels of procalcitonin,blood routine,C-reactive protein of children with bronchopneumonia,to analyze the clinical value combined with the age and to provide the experimental basis for clinical diagnosis and treatment.Methods 100 children with bronchial pneumonia were selected.According to admission number,they were randomly divided into the study group and the control group,50 cases in each group.The control group received routine diagnosis and treatment.The study group was deteced blood calcitonin,blood routine,C-reactive protein level and diagnosed and treated combined with the age.The clinical curative effect,recovery time were observed.The referral rate,children fever,cough,X-ray pulmonary inflammation disappeared time,the average recovery time,and medical expenses were assessed and recorded.Results The cure rate of the study group was 80.0%(40/50),which was higher than 66.6%(33/50) of the control group,the referral rate of the study group was 6.0%(3/50),which was lower than 22.0%(11/50) of the control group,the differences were statistically significant (χ2 =8.61,8.95,all P<0.05).The medical expense of the study group was (3 273.15 ±260.35)yuan,which was lower than (5 426.42 ±238.20)yuan of the control group,the difference was statistically significant (t=11.47,P<0.05).The average recovery time of the fever,cough,X-ray pulmonary inflammation in the study group were (3.29 ± 0.48)d,(5.36 ±0.63) d,(4.17 ±0.57) d,(6.48 ±0.86) d,which were shorter than those of the control group [(4.51 ±0.41)d,(6.70 ±0.52)d,(5.84 ±0.61)d,(7.79 ±0.93)d],the differences were statistically significant (t=8.50,8.69,8.27,9.04,all P<0.05).Conclusion In basic hospitals,detection blood PCT,blood levels of C-reactive protein of children with bronchial pneumonia and combined with the age for diagnosis and treatment, the clinical curative effect is better, the improvement time of the clinical signs or symptoms is shortened, referral rate decreased,medical costs declined.It is worth popularization and application in the basic level hospital.

Objective To observe the efficacy of transjugular interventional therapy for patients with hepatic myelopathy after transjugular intrahepatic portosystemic shunt (TIPS).Methods Sixteen patients with hepatic myelopathy afte TIPS were treated with interventional therapy again.Four patients who were treated with drugs through shunt previously had poor prognosis,then the remaining 12 patients treated with current limited shunt had better prognosis,which were analyzed in this study.Activities of daily living were assessed by Barthel index,limb muscle strength scores were assessed by Lovette scoring system.The changes of liver function and portal vein pressure were analyzed by paired t-test,while other data such as serum ammonia level,Barthel index,Lovette scores before and after transjugular interventional therapy were compared by analysis of variance with repeated measurements.Results All the patients had no complication after operations.The liver function and portal vein pressure of 12 patients had no significan change before and after operation.Blood ammonia value were (77.9 ± 17.9) mmol/L after TIPS,(77.9 ± 14.8),(73.4 ± 21.5),(59.5 ± 14.5),(52.0 ± 16.5) mmol/L 1,3,6,12 months after current limited shunt.Compared with that of preoperation(F =6.45,P ＜0.05),it decreased significantly at the 6th and 12th month.Limb muscle strength scores were 2.1 ± 0.7 before current limited shunt,2.3 ± 0.8,3.1 ± 1.0,3.2 ± 1.1,2.8 ± 0.9 1,3,6,12 months after the operation.Compared with preoperation (F =4.97,P ＜ 0.05),muscle strength grading improved significantly at the 3rd,6th and 12th month.Activities of daily living Barthel index were 42.1 ± 10.5 before current limited shunt,47.1 ± 11.0,45.0 ± 8.8 3,6 months after the operation.Compared with preoperation (F =5.05,P ＜ 0.05),activities of daily living had improvement.There were 3,6,2,1 cases of hepatic encephalopathy of Ⅰ,Ⅱ,Ⅲ,Ⅳ stage after TIPS.Three months after current limited shunt there were 7,3,1,0 cases,while there were 8,1,1,0 cases 6 months after the operation.In other 4 patients treated with drugs,2 patients died of liver failure,one was lost to follow.Conclusions Interventional therapy can relieve symptoms of hepatic myelopathy.The operation is safe,effective,and helpful after TIPS treatment.

Objective To evaluate the methods of diagnosis and treatment of thyroid disease with concomitant focal lymphocytic thyroiditis(FLT), and explore the reasons for its confused with Hashimoto′s disease(HD).Methods During the recent 25 years, 207 patients underwent surgical trearment for pathologically diagnosed HD.Among this group, 143 cases of HD with other concomitant thyroid disease were retrospectively analysed.Results Of the 143 cases, 57 cases were found to have thyroid disease with concomitant FLT, and this was 27.5%(57/207) of the total HD group, or 39.9%(57/143) of the group with thyroid disease and concomitant HD.Intraoperative pathologic section revealed that focal lymphocytic infiltration was positive in 87.7%(50/57) of cases. The postoperative hypothyroidism occurrence rate was 19.3%(11/57), of which, 7 cases(7/57, 12.3%) were subclinical hypothyroidism.Conclusions The character of pathologic changes of thyroid disease with FLT and with HD was different. Intraoperative pathologic section can be helpful in the diagnosis of this condition and can have important significance as a guide to the scope of (surgical) resection of the thyroid gland.

Objective To determine the risk factors for development of succinylcholine-induced postoperative myalgia.Methods One hundred and fifty-five patients,aged 18-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index of 20-30 kg/m2,scheduled for elective craniofacial surgery,were included in the study.Total intravenous anesthesia with propofol or combined intravenous-inhalational anesthesia with sevoflurane was performed during surgery.The patients were divided into 2 groups according to whether or not myalgia occurred within 24.h after surgery:myalgia group and non-myalgia group.Factors including gender,age,body weight,duration of surgery,method of anesthesia,dose of succinylcholine,preinjection of lidocaine or nondepolarizing muscular relaxants during induction of anesthesia,use of hormone (dexamethasone or methylprednisolone) and nonsteroidal analgesics (parecoxib sodium) during surgery,and consumption of fentanyl were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for development of succinylcholine-induced postoperative myalgia.Results Forty-one patients developed postoperative myalgia,and the incidence of myalgia was 27.2％.The results of logistic analysis indicated that succinylcholine ＜ 1.5 mg/kg and no preinjection of lidocaine were closely correlated with the development of postoperative myalgia induced by succinylcholine.Conclusion Succinylcholine＜1.5 mg/kg and no preinjection of lidocaine are the risk factors for development of succinylcholine-induced postoperative myalgia in the patients.

Objective To investigate the effects of epidermal growth factor (EGF) on the proliferation , migration and apoptosis of adipose-derived stem cells (ADSCs) in vitro. Methods Starved cell model and FasL-induced apoptosis model were established in serum-free media. The effects of 10 nmol/L and 100 nmol/L of EGF on the proliferation, migration and apoptosis of ADSCs in vitro were observed. The exrpessions of signal pathway proteins like phospholipaseC-γ(PLC-γ) , extracellular regulated kinase (ERK) and AKT were also detected. Results The proliferation, migration and anti-ap-optosis of ADSCs were promoted by 10 nmol/L or 100 nmol/L of EGF, and the expressions of PLC-'y, ERK and AKT were up-regulated. Conclusion EGF can promote the proliferation, migration and an-ti-apoptosis of adipose-derived ADSCs in vitro.

Objective To investigate the extent of radiofrequency ablation of pig pancreas in vitro with various power and duration,and to establish the regression equation of radiofrequency ablation of porcine pancreas in vitro.Methods Among the 4 settings of power (from 5 w ～ 20 w) and 11 settings of duration (from 40s ～ 240s),44 combinations were selected,and every combination was performed twice,then a randomization table including 88 combinations was established,and 88 ablation procedures on porcine pancreases in vitro were performed.The uhrasonography changes were observed,ablation widths (Y) were measured,and pathological examination was performed.In order to construct optimal model and to establish the regression equation of radiofrequency ablation,9 parameters (duration,power,duration × power,the square of duration,the square of power,the square root of duration,the square root of power,the natural logarithm of duration,the natural logarithm of power) derived from duration and power were analyzed via stepwise regression method.Results A rectangular echo enhanced region was observed along the working area of catheter when radiofrequency ablation started,and it gradually became wider during ablation.A hoar-like cylindrical ablation region that was clearly different from surrounding normal pancreatic tissue was formed.Carbonation of necrotic tissue could be observed after radiofrequency ablation under 15 w or 20 w.The optimal model showed a linear positive correlation between ablation width (Y) with the square of power and the natural logarithm of duration.The coefficient of determination of this model was 0.71.Both Fitting curve and Residual scatter diagram showed good fitting effect.Finally,a significant regression equation of radiofrequency ablation was established:Y (mm) =0.005 × E2 + 0.9374 × ln (t)-0.6943.Conclusions A significant regression equation of radiofrequency ablation is established,which provides experimental base for EUS-guided radiofrequency ablation of pancreatic tumors in clinical practice.

Obj ectiev The purpose of this study is to assess the impact of bone metastasis on survival in non-small cell lung cancer(NSCLC),Which were treated with gefitinib for more than 6 months,and to identify the prognostic factors of patients with NSCLC presenting bone metastasis .Methods We compared the overall survival(OS), progression-free survival(PFS),1-year2,-year and 3-year survival rates between two cohorts based on bone metastasis ,as well as the prognostic factors in the patients with bone metastasis .Results In total, 76 patients were included in the study ,in which there are44 patients with no bone metastasis and32 patients with bone metastasis.The cohorts were similar in OS (19.000 ±3.317 months vs.26.000 ±2.121 months,P =0.625)as well as PFS (14.000 ±1.843 months vs.16.000 ±1.411 months,P=0.328).The 1-year survival rate was 63.6%in no bone metastasis cohort,but was increased to 96.9%in the other cohort.The survival rates at 2 years(34.1%vs.56.3%,P=0.054)and 3 years(18.2%vs.18.4%,P=0.950)were similar.The univa-riate analysis showed that a worse prognosis was more likely existed in elderly patients ( aged >60 years) and with pulmonary progression ,whereby factors including gender ,pathology s,moking index ,brain metastases ,bone related events and the application of radiotherapy ,bisphosphonates might not be independently associated with the surviv -al late.Analysis of multiple variables indicated a favorable prognosis for patients with no pulmonary progression . Conclusion This retrospective study shows that bone metastasis may not shorten the survival in patients whose pulmonary lesion was controlled by gefitinib .On the contrary ,pulmonary progression may be more likely the cause of death in patients with bone metastasis .Non suggestion is given to discontinue gefitinib when the bone metastasis appears.

Objective To explore the feasibility of using digital imaging processing (DIP)to extract EUS image parameters for the differential diagnosis of autoimmune pancreatitis (AIP)and chronic pancreati-tis (CP).Methods A total of 81 patients with AIP and 100 patients with CP diagnosed from May 2005 to January 2013 were recruited to this study.A total of 105 parameters of 9 categories were extracted from the region of interest by using computer-based techniques.Then the distance between class algorithm and se-quential forward selection (SFS)algorithm were used for a better combination of features.A support vector machine (SVM)predictive model was built,trained,and validated.Results Overall,25 parameters of 5 categories were selected as a better combination of features when the incidence of accurate category was max (90.08%).A total of 181 sample sets were randomly divided into a training set and a testing set by using two different algorithms and 200 random tests were performed.The average accuracy,sensitivity,specificity, the positive and negative predictive values of AIP based on the half-and-half method were (86.04 ± 3.15)%,(83.66 ±6.57)%,(88.54 ±4.37)%,(85.96 ±4.44)% and (87.12 ±4.39)%,respective-ly.Conclusion Computer-aided diagnosis of EUS images is objective and non-invasive,which can improve the accuracy in differentiating AIP from CP.This technology provides a new valuable diagnostic tool for the clinical determination of AIP.

Objective To investigate the feasibility,safety,and short term efficacy of endoscopicultrasound guided radiofrequency ablation (EUS-RFA).Methods Three patients with advanced,inoperable pancreatic carcinoma underwent EUS-RFA.Under the guidance of EUS,a 22 gauge fine needle was punctured into the pancreatic carcinoma,and 1 Fr radiofrequency (RF) catheter was placed into the cancer through this 22 gauge needle.RFA was applied at 10 watts for 2 minutes,and then 15 watts for another 2 minutes.The second needle's tract was selected and punctured about 1 ～ 1.5 cm apart from the first needle tract,and the ablation was repeated.Results The average age of these 3 patients was 63 years old.Two patients were diagnosed to have pancreatic tail cancer and one was pancreatic body cancer,and the mean diameter of the tumor was 3.6 cm.Pre-operative EUS-FNA confirmed the presence of malignant cells.EUS-RFA was performed three times at an interval of 2 weeks in the first patient and one time in the last two patients.The average session of EUS-RFA of each lesion was 3.67 times.After 2 weeks,EUS showed that the diameter of the lesions was reduced by 13.9％ on average.There were vacuolar degenerations of variable sizes in those lesions.The serum level of CA19-9 was averagely decreased by 46.5％.Abdominal pain was not obviously aggravated.There were no episodes of pancreatitis,perforation or bleeding within 48 hours after the procedure.The mean follow-up time was 49 days,and no complications occurred.Conclusions EUS-RFA can reduce the diameter of pancreatic carcinoma and decrease the serum level of CA19-9,and it is feasible and safe.

Objective To establish an anatomical classification of chronic portal vein thrombosis (PVT) in order to guide the transjugular intrahepatic portasystemic shunt (TIPS) manipulation, and to analyze the correlation between anatomical classification of PVT and the occurrence of hepatic encephalopathy (HE) after TIPS. Methods During the period from June 2010 to June 2013 at authors’ hospital, TIPS with fluency covered stent was carried out in a total of 73 patients with chronic portal vein thrombosis. Based on the location of portal vein thrombosis, the anatomical classification of portal vein thrombosis (PVT-type) was initially established. The changes in portal vein pressure after TIPS were evaluated. The occurrence of HE at 15 days and at 3 and 6 months after TIPS in patients with different PVT-type was statistically analyzed. As the understanding of 0-phase minimal hepatic encephalopathy (MHE) was deepened, the authors added a subdivision to the 0-phase, including normal cognitive function state and minimal hepatic encephalopathy (MHE) into West - Haven grading to further precisely assess the hepatic encephalopathy. Using paired samples t-test, the changes of portal vein pressure after TIPS were evaluated. The grading of hepatic encephalopathy and the number of occurrence after TIPS were particularly recorded, the results were compared between groups at the same time and between the types at different times. Results The preoperative and postoperative portal vein pressure in type Ⅰ patients receiving TIPS therapy was (42.7 ± 9.6) and (35.0 ± 6.7) cm H2O respectively, the difference was statistically significant (t = 7.61, P <0.01);in typeⅡpatients it was(39.8 ± 5.5) and(31.0 ± 5.7) cm H2O respectively(t=17.2, P<0.01);in type Ⅲpatients it was (43.2 ± 5.8) and (32.4 ± 5.0) cm H2O respectively (t = 25.0, P < 0.01); and in type Ⅳpatients it was (43.0 ± 3.7) and (36.6 ± 6.6) cm H2O respectively (t = 4.26, P <0.01). The occurrence of HE 15 days after TIPS was mainly seen in patients with type Ⅳ , Ⅰ and Ⅲb. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with PVT-type Ⅱa, Ⅲb and type Ⅰ. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with PVT-type Ⅱb, Ⅲb and type Ⅰ. Three months after TIPS, the occurrence of MHE was mainly seen in patients of Ⅲa, Ⅱa and Ⅱc type. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with Ⅲa, Ⅱb and Ⅳ type. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with PVT-typeⅡa,Ⅱb andⅢb. Six months after TIPS, the occurrence of MHE was mainly seen in patients of type Ⅱa, Ⅱc and Ⅲb. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with type Ⅱb, Ⅰ and Ⅲb. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with typeⅡb,Ⅲb andⅠ. The HE condition lasted for longer time in patients withⅡb,Ⅲb andⅠtype. Conclusion The establishment of a rational anatomical classification for chronic portal vein thrombosis can effectively guide the clinical application of TIPS. The occurrence of postoperative hepatic encephalopathy is higher in patients with pure main portal vein thrombosis or superior mesenteric vein thrombosis.