Objective To explore the applicative value of contrast enhanced ultrasound (CEUS) through rectumin the T-staging of rectal cancer.Methods 24 cases with rectal cancer were examined preoperatively by endorectal ultrasound (ERUS) and CEUS during May 2012 to November 2013 in our hospital.The characteristics of contrast enhanced ultrasound imaging in early and late phase of the rectal cancers were studied,and the imaging distribution and enhancement mode were observed.The preoperative staging diagnosis was conducted by consulting T staging criteria.The diagnostic results were compared with the postoperative pathologic diagnosis.Results The contrast enhanced time in rectal cancer began at 14-35s.The early tumor showed uneven nodular,ribbon or ring in high enhancement.At the advanced late,angiographic tumor showed homogeneous enhancement and continued to be observed during the whole time.Normal rectal wall ultrasonography showed spotty low enhancement or no enhancement.The overall accuracy of ERUS in T-staging was 66.7％ (16/24) and the overall accuracy of CEUS was 83.3％ (20/24) respectively.There was a significant difference in the overall accuracy between ERUS and CEUS (P＝0.018).The sensitivity,accuracy and positive predictive value of CEUS were 100.0％ (2/2),100.0％ (2/2),100.0％ (2/2) inT1 stage,83.3％ (10/12),83.3％ (10/12),100.0％ (10/10) in T2 stage,100.0％ (8/8),88.9％ (8/9),88.9％(8/9) in T3 stage,and 100.0％ (2/2),100.0％(2/2),100.0％ (2/2) in T4 stage,respectively.Conclusions As compared toroutine transrectal ultrasound,transrectal contrast enhanced ultrasound imaging on rectal cancer shows the typical sonographic characteristic imaging on microvascular focus size and borders,on characteristic infiltration zone.Therefore,contrast enhanced ultrasound improves the diagnostic accuracy of preoperative T-staging in rectal cancer surgery.

Aim To investigate the combined effect of mangiferin and ephedrine as well as explore its underlying mechanism in mouse model of allergic asthma.Methods The mouse model of asthma was sensitized and challenged with ovalbumin(OVA).The behaviors of mice during the challenging period were observed.Continuous autonomic activities of mice after 1 h of drug treatment were monitored with the autonomic activity recorder for 14 days.The total and differential cells in peripheral blood were counted.Histological study of lung sections on airway inflammation was carried out with haematoxylin and eosin(HE) staining.The levels of ovalbumin-specific immunoglobulin E(OVA-sIgE) and(Cyclic Adenosine monophosphate) cAMP in serum were detected by enzyme-linked immunosorbent assay(ELISA).The mRNA expression of cytokines mainly produced by Th1/Th2 lymphocytes such as IFN-γ and IL-4, IL-5 were semi-quantitatively analyzed with reverse transcription polymerase chain reaction(RT-PCR).Results Combination treatment and mangiferin could reduce the aberrantly autonomic activity caused by ephedrine in mice.Compared with the model group, asthmatic symptoms in all treatment groups could be significantly relieved, the pathological changes of lung tissue were improved and airway inflammation was reduced.The effect of combined treatment was better than that of mangiferin treatment alone.Compared with the model group, the total number of white blood cells(WBC) and the eosinophils(EOS) ratio in peripheral blood in all treatment groups decreased, the level of OVA-sIgE declined and the level of cAMP increased in serum.Combination treatment could lower mRNA expressions of IL-4 and IL-5 from Th2 lymphocytes and increase the mRNA expressions of IFN-γ released by Th1 lymphocytes.Conclusions The effect of combined therapy of mangiferin and ephedrine is better than that of mangiferin treated alone, meanwhile it can reduce the side effects caused by ephedrine.The underlying mechanism is mainly associated with attenuating Th1/Th2 cytokine imbalance and increasing the level of cAMP.

Objective: To compare the chemical constituents in traditional planted and two-year-old cultivated Astragali Radix, and to discuss the chemical differences. Methods: The HPLC-ELSD fingerprint of Astragali Radix was collected, and the contents of astragaloside, calycosin-7-O-β-D-glucoside, total polysccharide, and extract were also determined. The similarity analysis, metabolomic multivariate statistical analysis, and quality comparison were performed. Results: The contents of calycosin-7-O-β-D-glucoside and total polysaccharide in traditional planted Astragali Radix were obviously higher than those in two-year-old cultivated Astragali Radix. But the contents of astragaloside and extract showed no difference. The two kinds of Astragali Radix could be distinguished by HPLC-ELSD metabolomic analysis. The differential metabolites were calycosin-7-O-β-D-glucoside, ononin, peaks 4, 5, 13, astragalosides I and II. Conclusion: HPLC-ELSD metabolomic approach combined with the content determination of index components could be used for the quality evaluation of traditional planted and two-year-old cultivated Astragali Radix.

Objective To observe the effects of preoperative acute hypervolemic hemodilution (AHH) on coagulation and fibrinolysis on the elderly patients undergoing hepatic carcinectomy.Methods Thirty ASA Ⅰ～Ⅱ liver cancer patients over sixty years old undergoing scheduled elective hepatic carcinectomy were random divided into AHH group ( n = 15) and control group ( n = 15).AHH was performed by infusing 15 ～20ml/kg 6% Voluven ( 130/0.4) in a rate of 30ml/min on patients in AHH group,and the patients in control group were infused routinely lactated Ringer's solution.Blood samples were collected for measuring coagulation function and platelet activation before anesthesia (T1) ,30 minutes after AHH (T2),1 hour ( T3 ), immediately (T4) and 24 hours (T5) after operation in group AHH, and the similar procure was used in control group.Results There was significant difference in the volume of allergenic blood transfusions between the two groups(20% vs 53.3%, P ＜0.05).PT and APTT in both groups prolonged significantly after T2, but they all remained in normal range.TT and DD had no significant changes between the two groups.SFMC and F1 + 2 increased in both groups, but it had no significant changes.PAC-1 and CD62P expressions of group AHH were significantly lower T2, T3 ,respectively ( 1.37 ±0.4) %, (1.28 ±0.4) %, than those at T1 [( 1.96 ± 0.6) %] ( P ＜ 0.05 ).Compared with control group, CD62P was significantly lower in AHH group at T2 and T5.Conclusion It is safe to take AHH of Hct 25% to 30% during hepatic carcinectomy for elderly liver cancer patients without cardiac and pulmonary disease.And it could decrease allergenic blood transfusions, with no apparently influence on coagulation function.

Objective To discuss the mechanism and characteristics of clinic presentation and neuropathology in idiopathic hypereosinophilic syndrome (IHES) encephalopathy. Methods IHES encephalopathy was diagnosed by clinical presentations,lab examinations,neurologic images,marrow and brain biopsy,then treated with corticosteroids and continuous follow-up. Results The IHES patient presented progressive limbs weakness and cognitive deficit with elevated eosinophil count. Results of lab examinations and bone marrow biopsy ruled out secondary eosinophilia and clonal eosinophilia such as eosinophilic leukemia.Brain magnetic resonance imaging (MRI) study showed multiple lesions in right frontal lobe, bilateral parietal and occipital lobe, presenting hypointensity in T1 weighted images,hyperintensity in T2 and fluid-attenuated inversion recovery weighed images. Brain biopsy showed proliferation of vascular membrane,small vessels stenosis,ischemia-induced morphological change and necrosis of neurons in the lesions.The patient was continuously treated with corticosteroids,and the situation was stabilized with follow-up.Conclusions IHES encephalopathy should be paid more attention in clinical practice of neurologists for its rarity. Brain vascular damages caused by elevated eosinophil may be an important pathophysiological mechanism of IHES encephalopathy,and corticosteroids or hydroxycarbamide should be used for the treatment.

Objective To explore the clinical symptoms and neuroimaging features of a patient with atypical hypomyelinating leukodystrophy with atrophy of the basal ganglia and cerebellum (H-ABC) caused by a novel TUBB4A mutation.Methods We analyzed the clinical data, imaging features and the result of genetic testing of a case diagnosed as atypical H-ABC.Results The initial symptoms were progressive spasticity, mild cerebellar ataxia and mild cognitive impairment.MRI showed regional blurring of slight high signal on T2-weight and FLAIR image in white matter of the bilateral midbrain ventral, internal capsule, posteior horn of lateral ventricle and centrum semiovale, with normal bilateral cerebellar and caudoputamen nucleus.Compared with normal subjects of the same age and gender, hypometabolism was found by 18F-FDG-PET in brainstem, cerebellar and caudoputamen nucleus in the patient.Genetic testing revealed a de novo pathogenic exome missense heterozygous mutations c.70G>A in TUBB4A, which was not reported in the human gene mutation database (HGMDpro) and was assessed to be a pathogenic mutation by pathogenic mutation prediction software.Conclusions The diversity of TUBB4A gene mutations may cause different functional and/or structural impairment in subcortical white matter, cerebellar and caudoputamen nucleus, leading to atypical symptoms and neuroimaging features.Genetic testing for pathogenic mutation in TUBB4A gene is a key for the diagnosis of H-ABC.

Nucleic acid sequence-based amplification(NASBA) is a sensitive,isothermal,transcription-based amplification system specifically designed for the detection of RNA targets,which could amplify templete RNA in 2h under isothermal condition at about 42?C and without any special equipment.NASBA is now widely applicated in diagnosis of many pathogenic microorganism.It is mainly about principles and applications of NASBA in viral diagnosis.

Objective To explore the application of furosemide/hydrochlorothiazide load test in clinical classification of Bartter syndrome and Gitelman syndrome and the significance of selecting target genes. Method The clinical features, biomarkers, the furosemide/hydrochlorothiazide load test, and gene detection in 5 patients with Bartter syndrome and Gitelman syndrome were retrospectively analyzed during 2012 to 2014. Results All of those 5 patients were manifested low potassium and metabolic acidosis; basis of renin, angiotensin II, and aldosterone were elevated. The blood pressures were normal. Most of the patients suffered from polydipsia, diuresis, and different degrees of growth retardation. The gene analysis of these 5 patients made the same diagnoses as furosemide/hydrochlorothiazide load test did. Conclusions Furosemide/hydrochlorothiazide load test can make a differentiation of Bartter syndrome from Gitelman syndrome and thus it can guide the selection of targeted gene detection.

Objective To evaluate the imaging features of pneumonia caused by A (H1N1) influenza virus. Methods Imaging data of 51 patients with pneumonia caused by A H1N1 influenza were retrospectively reviewed. All patients underwent mobile chest radiographs and 44 patients underwent CT as well. On the basis of the lesion degree in the lung, the patients were classified into mild, moderate and serious types. Results Mild type showed patchy consolidation at chest imaging in 4 patients. Moderate type demonstrated consolidation and(or) ground -glass opacities more than 2 lung fields in 33 patients, including 30 bilateral and 3 unilateral. Serious type displayed diffuse consolidation and ground-glass opacities, probably accompanying with interstitial lesions in the lungs in 14 patients, including 6 patients with ARDS, 2 with infection and 1 with cutaneous emphysema. Conclusion The imaging features of pneumonia caused by A H1N1 influenza mainly manifest as consolidation and ground-glass opacities, probably accompanying with interstitial changes. The imaging findings show various in patients with infection. Some serious patients even develope to ARDS.