Objective To analyze the condition, distribution, constituent ratio, main symptoms, laboratory examination and other clinical features of juvenile rheumatic disease (JRD) in order to enhance theunderstanding of it. Methods Five hundred and sixty-one cases of JRD treated in the Department of Pediatrics of Henan Provincial People′s Hospital were analyzed retrospectively from January 1990 to August 2003. Results Henoch-Schonlein purpura (HSP), juvenile idiopathic arthritis(JIA), rheumatic fever (RF), systemic lupus erythematosus (SLE) occurred more in rural area than in urban. Mucocutaneous lymphnode syndrome (MCLS) occurred more in urban than in rural area.The initial symptoms of JRD were arthralgia, skin rashes and fever. The frequently involved organs were kidney, lymphnode, heart and liver. White blood cell count and erythrocyte sedimentation rate raised in 43.1% and 61.6% patients with JRD respectively. Rheumatoid factor was mostly positive in JIA. Three patients died. Conclusion 2.9% patients with JRD have been admitted to Department of Pediatrics. The most common diseases are HSP, JIA, MCLS, RF, SLE. The morbidity of HSP shows an increasing tendency and RF shows decreasing tendency. It is suggested to enhance the understanding of JRD. Improve the diagnostic and treatment level is the key to control disease and reduce complications.

Objective To investigate the 64-slice spiral CT angiography combined with negative contrast CT cholangiography in the evaluation of resectability of hilar cholangiocarcinoma.Methods The clinical data of 46 patients with hilar cholangiocarcinoma were analyzed.The resectability was observed by the 64-slice spiral CT angiography combined with negative contrast CT cholangiography,and compared with the postoperative results.Results Preoperative CT Bismuth-Corlette classification and postoperative results showed no significant difference (x2 =0.00,0.53,1.96,0.59,2.63,all P ＞ 0.05).Preoperative CT assessed the resectability of 26 cases with hilar cholangiocarcinoma,The intraoperation evaluated resectable 22 cases,the difference was not significant (x2 =1.51,P ＞ 0.05).Conclusion 64-slice spiral CT angiography combined with negative contrast CT cholangiography can make a good evaluation of hilar cholangiocarcinoma involving the degree of blood vessels and bile ducts,provide an important basis for the selection of clinical protocols.

Osteoporosis is a systemic metabolic degenerative skeletal disease, characterized by reduced bone mass and disrupted bone microarchitecture, leading to enhanced bone fragility, decreased bone strength and increased susceptibility to frac?tures. Its occurrence and development is an extremely complex biological process, which is a multi factor, multi gene and multi stage experience. Osteoporosis is the fourth chronic disease in our country, which mainly affects postmenopausal women and the el?derly. Bone mass is jointly maintained by the action of bone resorption by osteoclasts and bone formation by osteoblasts. If the im?balance between the two occurs, resulting in reduced bone formation and increased bone resorption, bone homeostasis is changed to cause osteoporosis. Traditional treatment for osteoporosis are drugs which just to depress bone resorption (such as bisphospho?nates and estrogen), or just to promote bone formation (such as PTH and statins), or just to supply the source of calcium. This sin?gle point of local treatment is clearly difficult to play a long?term part in complex lesions of osteoporosis. In recent years, research?ers have studied the molecular signaling pathways related to osteoporosis. The current studies reveal that signaling pathways in os?teoporosis include MAPK, PI3K/Akt, Wnt/β?catenin, RANKL/RANK/OPG, Hedgehog and Notch signaling pathways. These signal?ing pathways play an important role in the molecular pathogenesis of osteoporosis. In addition, there are GH/IGF?1, PPAR?γ, PTH signaling pathways and so on. Taking these signaling pathways as targeting points is a new strategy for the development of new anti osteoporosis drugs or the prevention of osteoporosis. But there are cross?talks and/or interactions between these signaling pathways related to osteoporosis and the pathogenesis of osteoporosiswhich make its therapy more difficult. This paper reviews the research progress of signaling pathway in osteoporosis in order to explore the molecular mechanism of its occurrence. Thus these signaling pathways can be taken as new targets to develop safer and more effective anti?osteoporosis drugs.

Objective:To investigate the differentiation of human neural stem cells(hNSCs) in vitro and to assess the potential of hNSCs transplanted into the pylorus of nude mice.Methods:Central nervous system-derived hNSCs(CNS-hNSCs) were obtained from the subventricular zone of aborted fetus brain(10weeks),suspension cultured,passaged and induced to differentiate in vitro.Stem cell marker neuroepithelial stem cell protein(nestin),enteric neuronal marker protein gene production 9.5(PGP9.5) and glial cell marker glial fibrillary acidic protein(GFAP) were detected by immunofluorescence method.CNS-hNSCs(cultured for 3 months) were transplanted into the pylorus of nude mice and followed by immunofluorescence method.Results:Using the immunofluorescence method,nestin could be identified and the induced cells expressed PGP9.5 and GFAP.After being transplanted into the pylorus of nude mice,CNS-hNSC could be detected to survive at least for 6 weeks.Conclusion:CNS-hNSCs could be cultured,passaged and induced in vitro successfully;transplantation of CNS-hNSCs into gastrointestinal tract could be a potential cellular replacement strategy for gastrointestinal motility disorders.

ObjectiveTo assess fine needle aspiration (FNAC) in the early diagnosis for auto immune thyroid disease (AITD) in adolescent.Methods Seventy-one patients, age ranging from 9 to 23 years with thyroid enlargement underwent FNAC. Their smears were classified into 4 types according to the degree of degeneration of adenoidal cell and lymphocyte invasion by HE combining with rapid staining.The results were compared with B ultrasound and serum thyroid auto antibody measurement.ResultsB ultrasound showed hyperthyroidism in 12 cases, inflammation in 53, nodule change in 5, normal in 5. Thyroid function examination demonstrated hyperthyroidism in 22 cases, hypothyroidism in 9 cases, and euthyroidism in 40 cases. Auto thyroid antibody (TGAb,TMAb) were all beyond normal range except in 1 case, and TPOAb elevated in 37 cases. FNAC identified Grave′s disease in 14, Hashimoto′s diseases typeⅠ( HT-Ⅰ) in 35 cases,HT(Ⅱ) in 13,HT(Ⅲ) in 3, and HT(Ⅳ) in 6 cases. ConclusionsFNAC contributes to early diagnosis of AITD in adolescent for its safety, simplicity, rapidity and accuracy.

Objective Explore the diagnosis experience of sarcomatoid renal cell carcinoma (SRCC).Method There were 5 cases of SRCC from April 2011 to June 2013,3 of them were females and 2 were males,with a mean age of 49 (27-71).All the patients were presented with pain accompanied with other symptoms such as hematuria,fever and polyuria.CT urography suggested renal occupied lesions,withuneven density and enhancement,and malignancy was highly suspected.The mean diameter of tumors was 9.2 cm(4-18 cm).Radical nephrectomy was performed on all patients,tumors were located in renal parenchymal,and with adherence to other tissues.One patient with lung metastasis was found before surgery.Result Pathologic findings of the resected tissues after operation noted SRCC.Under the microscope,a large number of spindle shaped cells were seen,and Vimentin and PCK were all positive in immunohistochemical.Three patients with metastases were found after surgery (adrenal gland,liver,pancreas).Postoperative pathological stages were one T2N0M1,three T4N0M1 and one T3N0M0.One patient received IL-2 immunotherapy.All patients died within 9 months after surgery with a median survival of 3.8 months.Immunohistochemistry in the postoperative,there were four patients with the level of Ki-67 LI ＞ 50％,with distant metastasis and survival time was 1-4 moths.Conclusion The disease develops rapidly,and the prognosis of the patients is very poor.The Ki-67 LI may be considered as a prognosis marker and the patients with sarcomatoid differentiation can benefit little from surgery alone.

Objective To explore the pathogenesis of invasive pituitary adenomas,and to improve the effect of clinical treatment.Methods 15 pairs of invasive pituitary adenoma tissues and noninvasive pituitary adenoma tissues were selected from 114 specimens collected and the Id1 gene expression and Id1 protein expression in invasive pituitary adenoma tissues and noninvasive pituitary adenoma tissues were tested by quantitative RT-PCR,Western blot and immunohistochemical methods;Then small interfering RNA (siRNA) was used to interfer Id1 gene expression in NQ-04 cells.Results The Id1 gene expression in invasive pituitary adenoma tissues was significantly higher than that in noninvasive pituitary adenoma tissues(n =15,t =2.725,P =0.013) ;The migration of pituitary adenoma cells interfered was significantly reduced.Conclusion The invasive pituitary adenoma tissues has high level of Id1 gene expression,which may be correlated with its invasion.And Id1 is expected to become a biological marker of diagnosis and determination in the prognosis of pituitary adenoma.

Objective To compare the usefulness of contrast-enhanced T1 high resolution isotropic volume excitation (THRIVE) sequence and fat-saturated TSE sequence in detection of spinal metastases.Methods Thirty-one consecutive patients with spinal metastases were recruited.All patients received post-contrast TSE T1WI followed by a fat-suppressed THRIVE sequence.The number of lesions,SNR and CNR for both sequences,and the scoring of image quality concerning motion-artifact and tumor conspicuity were compared.Results Acquisition time of the post-contrast TSE T1W sequence and the THRIVE sequence was 2 min 55 s and 33 s,respectively.No significant difference was found in the number of lesions detected between the two sequences (Z=-0.816,P=0.414).The SNR (432.54±271.60) and CNR (233.27± 197.65) of the THRIVE sequence were significantly lower than the SNR (674.32±375.79) and CNR (312.38±207.49) of the TSE T1W sequence respectively (t=-4.366,-2.660,P＜0.001,0.012).Tumor conspicuity of the post-contrast TSE sequence was better than that of THRIVE sequence (Z=-4.082,P＜0.001),while the motion-artifact in TSE sequence was more severe (Z=2.291,P=0.022).Conclusion The post-contrast THRIVE sequence is capable of decreasing acquisition time and motion-artifact.Besides,its detected efficacy is equal to that of TSE sequence.There is practical possibility to replace the conventional post-contrast TSE T1WI sequence with the THRIVE sequence in the imaging of spinal metastases.

Objective To evaluate prognostic indicators in severe traumatic brain injury and intracania hamatomas with hernia and analyze which is the most important indicator.Methods Data of 84 cases with severe traumatic brain injury were retrospectively analyze .Age,GCS,pupil reflex,midline shift,compression of the cisteme,decompression time and complex injury were considered as possible prognostic indicators.SPSS13.0 was employed to analyze the data,Logistic regression(Forward conditional)analysis was done to confirm which are the most important prognostic indicators for severe traumatic brain injury and to evaluate the practical value in predicting prognosis(X2= 22.92,P＜ 0.01).Results 48 patients died and 36 survived.56(67%)patients had a bad prognosis(GCS≤3)and 28(33%)had a good prognosis(GCS ＞3).Those who had a shorter decompression time(≤3h)had a better prognosis than those who had a longer decompression time(＞3h),with the mortality rate of 11% and 67% respectively.Lesser cisteme compression predicts better outcome.GCS,pupil reflex,midline shift,and complex injury didn' t enter the logistic regression equation.According to compression time,90.5% of the cases' prognosis was accurately predicted,according to compression time and cisterne compression,95.2% was accurately predicted.Conclusion The mortality rate of severe traumatic brain injury with hernia was high and surgical intervention was effective.Decompression time and cisteme compression were the most important factors affecting prognosis in severe traumatic brain injury and they could predict prognosis of most cases correctly.

Objective To investigate the treatment of Pipkin fractures and curative effect. Methods From January 2003 to November 2009, we treated 19 cases of posterior dislocation of the hip with fracture of the femoral head,with type Ⅰ 8 cases, type Ⅱ6 cases, type Ⅲ 1 case, type Ⅳ4 cases. Seventeen patients were treated according to the illness with internal fixation treatment. Results Among type Ⅰ 8 cases, 2 cases were good with conservative treatment, 3 were excellent and 3 were good with surgical treatment;Among type Ⅱ6 cases, 3 were excellent, 2 were good, 1 was fair; 1 patient of type Ⅲ was fair; In 4 cases of type Ⅳ, 1 case was excellent, 2 cases were good, 1 case was fair. Conclusions Surgical treatment as soon as quickly is preferred for posterior dislocation of the hip with fracture of the femoral head( Pipkin fractures) , but the surgical time and methods should be chosen according to patients' detailed illness. It is important reserving the hip bone for preventing traumatic arthritis, and surgical skills to protect blood supply should not be ignored.