ObjectiveTo observe the changes of phosphorylated extracellular signal-regulated kinase 1/2 (pERK1/2) and c-fos in the medial prefrontal cortex (mPFC) of post-traumatic stress disorder (PTSD) rats. Methods Male Wistar rats were randomly divided into control group and PTSD model group. The model group rats were exposed to the single-prolonged stress (SPS) to set up the rat PTSD model. The expression of pERK1/2 was detected using immunohistochemistry and Western blotting, and the expression of c-fos mRNA was detected using reverse transcription-polymerase chain reaction (RT-PCR). Results The result of immunohistochemistry analysis showed that the number of pERK1/2-positive cells of control group and model group were 10.4±2.07 and 48.8±10.08 respectively (P<0.01), and integral optical density were 24.955±3.691 and 110.810±10.643 respectively (P<0.01). And Western blotting showed that relative expression quantities of pERK/β-actin were 0.510±0.052 and 1.109±0.106 respectively (P<0.01). The quantities of c-fos mRNA relative expression of control group and model group were 0.267±0.067 and 1.049±0.131 (P<0.01). Conlusion The levels of pERK1/2 and c-fos increase significantly in mPFC of PTSD model rats. The ERK signal transduction pathway in mPFC might play an important role in the pathogenesis of PTSD.

[Objective]To explore the reason of ulnar impaction syndrome misdiagnosed by tissue injury in wrist.[Method]From December 1998 to December 2005,216 cases who were diagnosed for soft tissue injury in ulnar wrist were checked and discriminated according to X-ray and MRI of the injured wrist,and 48 cases were re-diagnosed for ulnar impaction syndrome.The misdiagnosis rate was 22.2%.[Result]Most cases of ulnar impaction syndrome had positive lunar variance(68.8%).Carpal avascular necrosis were found in about 27.1% of cases through X-ray of wrist and 100% through MRI.Different degree changes of abnormal signal intensity were found in soft tissue,triangular fibro cartilage(TFC) and carpal bones by MRI which displayed swelling of soft tissue in carpal joint,strip-shape high signal intensity or mixed signal intensity at ligament around wrist and enhanced signal intensity at TFC area extending to ulnar carpal articular facet.The appearance of MRI in carpal bones showed local abnormal signal,articular cartilage thickening and hydropsia in bone below cartilage and marrow.[Conclusion]The misdiagnosis can be reduced through elevating acquaintance level of ulnar impaction syndrome basing on clinical symptoms,making the most use of imaging,especially MRI.

Objective To investigate the relationship between the onset of lower extremity venous thrombotic disease and seasons.Methods A retrospective study was conducted, 300 patients with lower extremity venous thrombotic disease admitted to HandanCity Hospital of Traditional Chinese Medicine (TCM) from August 2012 to February 2014 were enrolled, the incidences and TCM syndromes of patients with lower extremity venous thrombotic disease in different seasons were observed, and the pathogenesis and relationships between the types of TCM syndrome and seasons were analyzed.Results There were 142 patients with lower extremity superficial thrombophlebitis, and 158 cases with lower extremity deep venous thrombosis, the incidence of lower extremity venous thrombotic disease in spring was significantly higher than that in summer and autumn [32.8% (86/262) vs. 21.3% (54/254), 18.4% (50/272), bothP < 0.01], but lower than that in winter [32.8% (86/262) vs. 37.2% (110/296)], the difference was not statistically significant (P > 0.01); while the incidence of lower extremity venous thrombotic disease in winter was significant higher than those in summer and autumn (allP < 0.01). The incidences of damp and heat downward flow type in autumn and summer were increased compared with those in winter and spring [55.6% (30/54), 60.0% (30/50) vs. 20.0% (22/110), 23.3% (20/86), allP < 0.01], while the incidences of lower extremity venous thrombotic disease with damp heat and stasis syndrome in winter and spring were increased compared with those in summer and autumn seasons [80.0% (88/110), 76.7% (66/86) vs. 44.4% (24/54), 40.0% (20/50)].Conclusions The incidence of lower extremity venous thrombotic disease is related to seasons, and the onset is high in winter and spring, damp heat and stasis syndrome being the main type; according to different seasons, clinical treatment can direct to different pathogenic factors to adopt different preventive measures interfering with the patient's constitution in order to eliminate or reduce the risk factors, achieving the effect of the disease prevention.

Objective To extract characteristic parameters of ECG signals a new method of non-invasive diagnosis for coronary heart disease with artificial neural network. Methods ECG signals were digitized with A/D converter and filtered to eliminating the noise. Span of QRS interval, R-R interval,and voltage of S-T segment of filtered ECG were detected. These 3 characteristics were as the input parameters of the input layer. Samples were trained with an improved 3-layers back propagation(BP) artificial neural network, as trained samples. The non-trained samples were recognized with these BP neural networks. Results After 12 samples had been trained about 1500 times, the BP neural network could accurately distinguish samples of coronary heart disease from the trained samples and also recognize 20 non-trained samples, 19 to be correct except one. Conclusion It is showed that based on BP network and characteristic parameters of ECG, a new and promising method of non-invasive diagnosis for coronary heart disease has been found.

Objective To explore the causes of pulmonary infection of stroke patient during recovery period. Methods 122 stroke patients combined with pulmonary infection in neural rehabilitation department from January 2008 to July 2011 were analyzed for the relative causes according to clinical nursing. Results Repeated pulmonary infection was correlated with dysphagia and tracheotomy of acute stage (P<0.05); Bilateral pulmonary infection was correlated with dysphagia, tracheotomy of acute stage and age (P<0.05). Conclusion Pulmonary infection is correlated with dysphagia, tracheotomy of acute stage and age in sequence.

Objective To evaluate the prognostic value of urine paraquat (PQ) concentrations combined with poisoning time and creatinine clearance rate (CCr) on prognosis of patients with acute paraquat poisoning (APP). Methods A retrospective case control study was conducted. Clinical data of 96 patients with APP admitted to Department of Emergency of Shengjing Hospital of China Medical University from March 2014 to May 2016 were analyzed. The gender, age, body weight, urine PQ concentrations (determined by semi-quantitative colorimetric method), poisoning time (time from oral poison to urine detection) and CCr of patients were collected, and poisoning index (poisoning index = urine PQ concentrations × poisoning time/CCr) and simplified poisoning index (simplified poisoning index = urine PQ concentrations × poisoning time) were calculated. The patients were divided into death group and survival group according to 2-month outcome after poisoned with clinical data and telephone follow-up. The urine PQ concentrations, poisoning index, and simplified poisoning index between the two groups were compared. Binary classification logistic regression was used to analyze the risk factors affecting prognosis. Receiver-operating characteristic curve (ROC) and diagnostic test were used to analyze the prognostic value of the parameters. Results Compared with survival group, the urine PQ concentrations [mg/L: 30.00 (10.00, 100.00) vs. 10.00 (3.00, 10.00)], poisoning index [mg·h-1·μmol-1: 12.72 (1.86, 33.75) vs. 0.56 (0.18, 1.12)], and simplified poisoning index [mg·h-1·L-1: 600.00 (150.00, 1 000.00) vs. 60.00 (18.00, 120.00)] in death group were significantly increased (all P < 0.01). It was shown by logistic regression analysis that both urine PQ concentrations [odds ratio (OR) = 1.046, 95% confidence interval (95%CI) = 1.006-1.087, P = 0.022] and poisoning index (OR = 1.353, 95%CI = 0.029-1.815, P = 0.031) were independent risk factors affecting the prognosis of patients with APP. It was shown by ROC curve and diagnostic test that the poisoning index had greater area under ROC curve (AUC was 0.902) for evaluating the prognosis of patients with APP. When the best cut-off value was greater than 1.23 mg·h-1·μmol-1, the sensitivity was 90.91%, and the specificity was 73.08%. The AUC of urine PQ concentrations for evaluating the prognosis was 0.759. When the best cut-off value was greater than 20.00 mg/L, the sensitivity was 63.64%, and the specificity was 76.92%. The AUC of simplified poisoning index for evaluating the prognosis was 0.846. When the best cut-off value was greater than 135.00 mg·h-1·L-1, the sensitivity was 81.82%, and the specificity was 76.92%. Conclusion The poisoning index calculated with urine PQ concentrations combined with poisoning time and CCr has prognostic value for prognosis of APP patients, and the prognostic value of poisoning index is greater than that of the urine PQ concentrations alone.

Objective To evaluate the effects of post-operation rehabilitation treatment of patients with calcaneus fracture by dynamic plantar pressure analysis,and assess the value of the Footscan system.Methods Sixty-two patients with unilateral calcaneus fracture were randomly divided into a rehabilitation group and a control group.The patients in the rehabilitation group were given early,systemic standard rehabilitation treatment,while those in the control group took functional exercise following the doctors'advice.At 3 months and 6 months after operation,the plantar pressure distribution of the patients in both groups was analyzed with the Footscan system,respectively.Results After 3 months of treatment.there was statistically significant difference between the injured and the uninjured sides in both groups,with regard to the contact time,average plantar pressure and pressure-time integrals at different phases of gait.However,there was no significant difference between the injured and the uninjured sides after 6 months in rehabilitation group.But in control group,there was still statistically significant difference between the two sides with regard to the above parameters.Conclusion Early rehabilitation treatment could significantly improve the function outcome of patients with calcaneus fracture.Footscan System can objectively evaluate the recovery of the calcaneous fracture.

Objective To explore the effects of second biopsy and resection on tumor recurrence and progression in patients with high risk non-muscle invasive bladder cancer. Methods The second biopsy and resections were performed 4-6 weeks after the first transurethral resection in 52 patients. Routine follow-up was done in another 71 patients. The tumor recurrence and progression rates were compared. Results Residual tumors were found in 54%(28/52) of patients underwent second biop-sy and resection, including muscle-invasive tumors in 5 patients. Two patients underwent radical cys-tectomy due to resection findings. During same period, 71 patients were routinely followed. After a median observation of 27 months, patients underwent second biopsy and resection showed lower recur-rence rate (P<0.05). The progression rate was no difference between the 2 groups(P0.05). Conclusion Second biopsy and resection may reduce recurrence rate in high risk non-muscle invasive bladder cancers, but may not change the tumor progression rate.

Objective To compare the long-term outcomes in patients with newly diagnosed stage T1G3 bladder cancer treated with bladder preserving approach and intravesical instillation or im-mediate cystectomy.Methods of 113 patients with a median age of 64 years (range 27 to 88) diag-nosed with T1G3 bladder cancer from January 1993 to February 2007,81 cases were treated by tran-sureteral resection with additional intravesieal instillation and 32 were treated with immediate cystecto-my.Differences between the 2 groups in 5-year overall survival and tumor specific survival were calcu-lated using the Kaplan-Meier survival function and analyzed by the log rank test.Results of 81 pa-tients treated with organ preserving approach and postoperative intravesical instillation,53 patients developed local recurrence and 21 patients underwent deferred cysteetomy in a median 64 (range 6-140) months follow-up.The overall and tumor specific survival at 5 years was 64.2% (52/81) and 77.8%(63/81),and in those who had deferred cystectomy it was 61.9% (13/21) and 76.2% (16/21),respectively.Of the 32 patients treated with immediate cystectomy,the 5-year overall and tumor specific survival was 59.4%(19/32) and 75.0%(24/32) within a median follow-up of 62(range 4-141)months.There was no statistical difference of the 5-year overall and tumor specific survival be-tween patients treated with bladder preserving approach or immediate cystectomy.Conclusion Blad-der preserving approach and immediate eystectomy might have similar 5-year overall and tumor specific survival for primary T1G3 bladder cancers.

Objective To explore the effects of ureteral stent on renal pelvic pressure and other urodynamic parameters. Methods Forty-one patients, 28 males and 13 females, with unilateral renal calculi and/or ureteral calculi were recruited in this study. The mean patient age was 47 years old (ranging from 20 to 72 years old). All cases were placed a 4.7 F ureteral stent and 16 F nephrostomy tube after minimal invasive pereutaneona nephrolithotomy (MPCNL). There was no hydronephrosis and residual crushed stone in the ureter after MPCNL in all cases. Renal pelvic pressure, intra-abdo minal pressure, detrusor pressure, bladder pressure changes during the filling and voiding phases with intravesical perfusion flow rate of 40 ml/min were recorded and analyzed. Results At the baseline, IPP0, IAP0, DP0 and BP0 were (33.1±17.0)cm H2O, (27.5±7.0)cm H2O, (3.3±2.9)cm H2O and (30. 9±7.2)cm H2O, respectively; At the maximum cystometric capacity during the filling phase, IPPvol, IAPvol Dpvol and Bpvol were (39.4±67. 3)cm H2O, (31.1±7.3)cm H2O, (10.7±6. 6) cm H2O and (41.6±10.3)cm H2O, respectively; At the maximum bladder pressure during the voiding phase, IPPmax, IAPmax Dpmax and Bpmax were (65.7±17.0)cm H2O, (33.7±9. 7)cm H2O, (41.9±7.8)cm H2O and (75.0±12. 8)cm H2O, respectively;There were statistical significance comparing between any of IPP0, IPPvol and IPPmax(P<0. 01). 27% (11/41)patients were with the pain in kidney area at voiding IPPmax (87.1±14.6) cm H2O, which was significantly higher than IPPmax (57.8±9.5)cm H2O of asyrnptomatic group (30 patients)(P<0. 01). In all cases, the renal pelvic pressure was higher than 40 cm H2O during the voiding phase. Conclusions Renal pelvic pressure increases during the filling phase after placing the ureteral stent, especially during the voiding phase. As renal function will be damaged by the high renal pelvic pressure, we should decrease the utilization of ureteral stent if possible. It is encouraged to remove the ureteral stent as early as possible.