Objective To study the clinical characteristics and treatment of adult patients with tsutsugamushi disease in Nantong area,and to reduce the misdiagnosis and missed diagnosis.Methods Clinical data of 24 adult patients with tsutsugamushi disease who were admitted between 2010 and 2012 at Department of Emergency Medicine in Affiliated Hospital of Nantong University were reviewed retrospectively.The patients were 13 males and 11 females who were aged from 25 to 70 years old.Minocycline capsule was orally administrated as the mainstay of the therapy.Results All of the 24 cases of tsutsugamushi disease were presented with fever,predominantly with high fever.The body temperature of higher than 39 ℃ was recorded in 23 cases,and temperature of 38.0 ℃ to 38.9 ℃ was recorded in one case.Three cases complained with sore throat and cough,and 1 case with palpitation and chest distress.One eschar or ulcer was seen in 21 cases,2 eschars or ulcers only in 1 case.Twenty-one cases were presented with lymphadenopathy,11 cases with rash,3 cases with enlargement of the liver,and 4 cases with splenomegaly.The distribution of eschar or ulcer included inaxillary fossa,groin,external genitalia and crissum,waist,popliteal fossa,the lower edge of the female breast and skin folds of chest wall,the inside of the wrist,ankle,neck,retroauricular region,chest-back and the buttocks.The white blood cell count of (2.5-3.9) × 109/L in blood routine test was seen in 4 cases,(10.1-18.6) × 109/L in 3 cases.The blood platelet count was decreased in 1 case.Urinary protein was positive in 4 cases by urine routine examination.Blood biochemical examination revealed that elevated serum alanine aminotransferase was seen in 2 cases,elevated serum creatinine was in 1 case,mildly elevated cardiac troporin I was in 1 case,increased C-reactive protein was found in 19 cases.On Weil-Felix test,17 cases showed OXk titers of 1∶160-1∶320.Four cases showed an increase in overall lung markings,localized pulmonary infiltration shadow and even small pleural effusion on chest radiography.Electrocardiogram showed premature ventricular beats and slight ST segment changes in 2 patients.Oral minocycline showed obvious effect.Conclusions The clinical manifestations of tsutsugamushi disease can be variable.Multi organ dysfunction could be presented besides fever.The skin eschar and ulcer are the most pathognomonic for this disease and thus should be thoroughly examined for its presence to avoid misdiagnosis.

Objective: To explore the therapeutic effects of immediate breast reconstruction after modified radical mastectomy of breast cancer with nipple-areolar complex preservation and partial skin-sparing. Meth- ods- We studied 24 eady stage breast cancer patients who received immediate breast reconstruction after modified radical mastectomy with nipple-areolar complex preservation and partial skin-sparing. Nine patients had silicone prosthesis, 3 patients had transverse rectus abdominis myocutaneous flap (TRAM), and 12 pa-tients had silicone prosthesis combined with part of latissmus dorsi-myocutaneous flap (LDMF). The effects of breast reconstruction were evaluated according to objective and subjective criteria after surgery. Results: All of the 24 patients obtained successful breast reconstruction. The appearance of the reconstructed breast was perfect and the two sides seemed symmetrical. The aesthetic outcome was good in 23 patients and satisfacto-ry rate was up to 95.83%, and the subjective evaluation was up to 100%. Necrosis of part of the nipple was found in only one case. Hematoma appeared in one patient and vanished after 3 months. All patients received adjuvant chemotherapy after surgery. No local recurrence and distant metastasis occurred during the follow up period (5～48 months). One patient died of primary hepatic carcinoma at 2 years after surgery. Conclusion:Immediate breast reconstruction after modified radical mastectomy of breast cancer with preservation of nip-ple-areolar complex and partial skin-sparing is safe and effective for early stage breast cancer patients. The reconstructed breast is satisfactory. Breast reconstruction surgery is economical and can reduce patients' psy-chological pressure due to loss of the breast, and improve quality of life. Immediate breast reconstruction does not affect postoperative adjuvant therapy and long-term therapeutic effect. Breast reconstruction surgery has been gradually accepted by more and more eady stage breast cancer patients.

Objective To investigate the clinical effectiveness of procedure for prolapse and hemorrhoids(PPH)in the treatment of outlet obstructive constipation caused by moderate and severe recto-cele. Methods A total of 48 patients with moderate or severe rectocele were treated with PPH. Patients were followed up for 4 ~ 6 months. The preoperative and postoperative parameters from rectoanal manome-try were compared and analyzed. Results After the surgery,patients had loose stool for 1 ~ 2 times a day. Sense of defecation obstruction in all patients was obviously improved. After the surgery,there were no significant changes in rectum resting pressure,anal resting pressure and various rectal sensitivity( P >0. 05). However,the decrease of inside rectal pressure and residual anal pressure were significantly re-duced(P < 0. 05). Conclusion The subjective defecation feeling of postoperative patients with PPH is unblock. Objective results of rectoanal manometry is clearly improved and the function of the rectum and anal canal is obviously restored.

Objective To investigate the influence of truncated apoptosis inducing factor (AIFΔ1-480 ) on the proliferation and invasion of MCF-7 cells,and to clarify the possibility of promoting cancer gene-radiotherapy. Methods The human breast cancer MCF-7 cells were transfected with AIFΔ1-480 recombinant expression vector pcDNA3.1-Egr-1-AIFΔ1-480 (pE-AIFΔ1-480 )mediated by Egr-1;24 h after 2 Gy X-ray irradiation,MTT assay and Transwell invasion assay were performed to measure the changes of cell proliferation and invasion.The MCF-7 cells were diveded into normal control,pcDNA3.1,pE-AIFΔ1-480 ,2 Gy irradiation and pE-AIFΔ1-480+ 2 Gy irradiation groups.Results After transfection and 2 Gy X-ray irradiation,the cells proliferated very fast in normal control, pcDNA3.1 and pE-AIFΔ1-480 groups, and the proliferation regularity was similar. Compared with normal control group,the cell proliferation abilities were significantly decreased in 2 Gy irradiation and pE-AIFΔ1-480 + 2 Gy irradiation groups (P<0.05 ), and it was more obvious in pE-AIFΔ1-480 + 2 Gy irradiation group, and it was significant lower than that in 2 Gy irradiation group (P<0.05).The number of the cells permeating membrane was basically same in normal control,pcDNA3.1 and pE-AIFΔ1-480 groups;compared with normal control group,they were significantly decreased in 2 Gy irradiation and pE-AIFΔ1-480+ 2 Gy irradiation groups(P<0.05 or P<0.01);and it was more significant in pE-AIFΔ1-480+ 2 Gy irradiation group than that in 2 Gy irradiation group (P<0.01). Conclusion AIFΔ1-480 and ionizing radiation could inhibit the proliferation and invasion of human breast cancer MCF-7 cells,both of them have a synergistic effect,and Egr-1 promoter can enhance the suppression effect under radiation conditions.

Structure of natural product-ursolic acid was modified for increasing its antitumor activity. Ursolic acid was acylated, esterified, hydrolized or oxidized to obtain target pentacyclic triterpenoid compounds with different substitutes. Sixteen derivatives of ursolic acid were designed and synthesized including eleven new compounds. Anti-tumor activities of ursolic acid and these derivatives against HeLa, SKOV3 and BGC-823 cells in vitro were investigated by MTT assay. The results indicated that compounds 7a and 8a were found to have stronger cell growth inhibitory than ursolic acid on HeLa cells and SKOV3 cells separately, and are worth to be intensively studied further.

Objective To probe the most effective method for the diagnosis of early renal pelvic cancer. Methods Ultrasound, introvenus urogram (IVU), retrograde pyelography, CT, magnetic resonance urography and transurethral ureteropeyloscopy were performed, and the accuracy rate was evaluated. Results The accuracy rate of IVU, retrograde pyelography, CT, transurethral ureteropeyloscopy, MRU and ultrasound were 89%, 94%, 80%, 50%, 40% and 22% respectively. Conclusions IVU and retrograde pyelography are the common and necessary diagnostic methods for early renal pelvic cancer. Transurethral ureteropeyloscopy is an invasive method and used as a final method when other methods fail to identify the disease.

AIM: To investigate the inhibitory effect of L-carnitine on high glucose-induced apoptosis of human aortic endothelial cells (HAECs) and the molecular mechanisms.METHODS: The apoptosis of HAECs was induced by high-glucose incubation.HAECs were treated with L-carnitine at different concentrations (50, 100 and 200 μmol/L).The cell viability was measured by MTT assay.The cell apoptosis was assessed by Hoechst 33258 staining and flow cytometry.Colorimetric method was employed to detect the caspase-3 activity in the HAECs.The protein expression and phosphorylation levels were determined by Western blot.RESULTS: High-glucose incubation dramatically decreased the cell viability and induced apoptosis.The protein kinase R-like endoplasmic reticulum kinase (PERK), inositol-requiring enzyme-1 (IRE1) and activating transcription factor 6 (ATF6) signaling pathways of endoplasmic reticulum stress were activated to induce cell apoptosis via down-stream caspase-4/3 cascade.However, L-carnitine treatment significantly attenuated the cell apoptosis and increased the cell viability in a concentration-dependent manner.L-carnitine also significantly suppressed endoplasmic reticulum stress and ATF6 signaling in high glucose-incubated HAECs without attenuating PERK and IRE1 signaling.The expression of site-1 protease (S1P) and site-2 protease (S2P) was inhibited by L-carnitine treatment, thus decreasing pro-apoptotic factor ATF6 p50 produced by ATF6 cleavage.CONCLUSION: L-carnitine inhibits high glucose-induced apoptosis of HAECs by inhibiting ATF6 signaling.

Objective To investigate the method of endovascular puncture to establish rabbit models of cerebral vasospasm. Methods New Zealand white rabbits were divided into 5 groups (12 h,1 d,2 d,3 d and 7 d) randomly, and each group was separated into subarachinoid hemorrhage (SAH) subgroup (n = 5) and control subgroup (n = 2). cerebral vascular spasm (CVS) models were established atfer SAH with endovascular puncture. CT scans before and after operation were performed. The internal diameters and the wall thicknesses of posterior communicans artery (PcoA) and basilar artery (BA) were measured with HE stain after the animals were executed. Results CVS model was successfully eastblished in 35 rabbits (SAH subgroup 25,control subgroup 10), resulting a successful rate of 48.61% . Compared with control subgroup, PcoA and BA showed shrinkage of internal diameters of 43.60% and 51.82% 12 h after SAH, respectively, and the shrinkage appeared as biphasic patterns until the 7th study day with another peaks of 29.32% and 45.19%, respectively. Conclusions Endovascular puncture is an effective method to establish rabbit of CVS. The death rate of animals can be decreased with the asage of new interventional material and perfection for the details of operation.

BJ-DRGs grouping process was cited as an example, to describe the factors affecting the grouping process, grouping results and assessment results, and the solutions in transferring homepages into WJT form 4-1 for inpatient medical record homepages (WJT form 4-1 for short).Authors analyzed how to better information acquisition quality of such homepages by unifying the data interface standard of WJT form 4-1, for the purposes of enhancing BJ-DRGs grouping efficiency, and expanding its functions as a tool for medical quality management and that for medical insurance payment management.

Objective: To evaluate the clinical result of atlantoaxial reduction and fixation guided by the intraoperative CT.Methods: Sixteen cases were retrospectively studied, including seven males and nine females, with the mean age of 49.9 years.Twelve cases were diagnosed as chronic atlantoaxial instability or dislocation, while four cases as acute odontoid fracture and dislocation.Among the sixteen cases, fourteen underwent atlantoaxial fusion, while two underwent temporary atlantoaxial fixation without fusion.The intraoperative CT was used in the setting of: 1.Evaluating the atlantoaxial reduction before the screw insertion;2.Guiding the C1 and C2 pedicle drilling (two cases using additional three-dimensional printing drilling template);3.Evaluating the position of the screws and reduction after the atlantoaxial fixation.In addition, three-dimensional drilling template combined with intraoperative CT was used in two cases.CT scanning frequency was calculated.To evaluate the accuracy rate of screw fixation under the intraoperative CT, 19 cases without the intraoperative CT were studied as the control group.Results: Averaged CT scanning frequency was 1.4 times (Once in eleven cases, twice in four and three times in one).Among the sixteen cases, mal-positioned C1 screws were found and revised in two cases.No spinal cord injury or vertebral artery injury occurred.The follow-up ranged from three to ten months, with the mean of 6.7 months.Fourteen cases achieved solid osseous fusion, and two with temporary fixation had odontoid fracture union.Anatomic reduction was achieved in all the cases.Eleven cases with preoperative myelopathy had postoperative improvement and their mean JOA scores improved from 12.1 to 14.4.To the last follow-up, no hardware complications were found including screw broken, rod broken or fixation loosening.All the screws of intraoperative CT group had good positions.For 19 cases of the control group, there were two cases of mal-positioned screws (10.5%).Conclusion: Advantages of atlantoaxial reduction and fixation guided by the intraoperative CT included: improving the accuracy of the atlantoaxial screws, exactly evaluating the reduction of the atlantoaxial joint, immediately discovering the mal-positioned screws and avoiding the revision surgery.A good clinical result was found in the preliminary study.