Objective:To evaluate the distribution of lymph nodes metastases(LNM) in upper and middle abdomen from primarybiliary tract carcinoma and the imaging features of metastatic lymph nodes on contrast spiral CT scanning.Methods:A retrospective study was performed,consisting of 41 cases of biliary tract carcinoma(24 cases of extrahepatic cholangiocarcinoma and 17 cases of gallbladder cancer),with upper and middle abdominal LNM identified by surgically and pathological procedure.All patients underwent CT scanning with intravenous contrast-enhancement on single-slice or 16-slice spiral CT.According to the LN location,upper and middle abdominal LN was classified as eight sites in this study as follows:porta hepatis,hepatoduodenal ligament,gastrohepatic ligament,gastrocolic ligament,gastrosplenic ligament,celiac,superior mesenteric and paraaortic area.Anatomic distribution and CT appearances of metastatic LN were observed.Results:(1)The incidence of LNM in each site from biliary tract carcinoma was:19.5%(8/41)in porta hepatis,90.2%(37/41)in hepatoduodenal ligament,22%(9/41)in gastrohepatic ligament,63.4%(26/41)in celiac,39%(16/41)in superior mesenteric and 48.8%(20/41) in paraaortic area respectively.Hepatoduodenal ligament lymphonode was the most common site of LNM from primary biliary tract carcinoma.The patients with gallbladder carcinoma had more LN sites involved than extrahepatic cholangiocarcinoma.(2)The MSAD(Maximum Short Axis Diameter)of metastatic LN varied from 1.4 to 4.8 cm.The density of most of metastatic nodes was hypoattenuation or iso-attenuation,and necrosis of metastatic LN was found in 69% sites and occurred more frequently in metastatic LN with MSAD ≥2.5 cm.Necrosis of metastatic LN could be categorized as 3 types:no obvious necrosis was found(type 1,31%);the volume of necrosis region was less than 1/2 in metastatic LN(type 2,24.1%);the volume of necrosis region was more than 1/2 in metastatic LN(type 3,44.8%).Conclusion:Distribution of LNM is determined by the lymphatic drainage route of biliary tract.The patients with gallbladder carcinoma have more LN sites involved than extrahepatic cholangiocarcinoma.Hypoattenuation or iso-attenuation compared with crura of diaphragm,heterogeneous enhancement,incomplete patterns of necrosis,is the image feature of upper and middle abdominal metastatic lymph nodes from biliary tract carcinoma on spiral CT scanning with bolus intravenous contrast-enhancement.

Homebox genes are known to determine cell proliferation and differentiation and subsequently regulate the occurrence,development and prognosis of many tyhpes of malignant tumors in human.Some recent studies have shown that homebox genes are abnormally expressed in the esophageal,gastric,coloreetal and other gastrointestinal tumors.In this review,we consider that homebox genes may regulate the occurrence,development of gastrointestinal tumors by interacting with transcription factors in vivo and abnormal epigenetic modifications.Therefore,homebox genes are closely related to gastrointestinal tumors.

Objective To investigate the effect of electroacupuncture at bilateral points Quchi on blood pressure variability in hypertensive disease patients.Methods One hundred and two patients were randomly allocated to treatment and control groups, 51 cases each. Methods The treatment group received electroacupuncture at bilateral points Quchi and the control group, no treatment as a blank control. Twenty-four-hour dynamic blood pressure and blood pressure variability were observed in the two groups of patients. Results There were statistically significant post-treatment differences in 24-hour systolic pressure standard deviation (24 hSSD), daytime systolic pressure standard deviation (dSSD) and night systolic pressure standard deviation (nSSD) between the treatment and control groups (P<0.05). There were no statistically significant post-treatment differences in 24-hour diastolic pressure standard deviation (24 hDSD), daytime diastolic pressure standard deviation (dDSD) and night diastolic pressure standard deviation (nDSD) between the treatment and control groups (P>0.05).Conclusion Electroacupuncture at bilateral points Quchi can reduce systolic pressure variability in hypertensive disease patients.

Objective To investigate the perioperative management for patients of thyroid crisis complicating acute abdomen.Methods The clinical data of 11 acute abdomen patients combined with hyperthyroidism were analyzed retrospectively.Results In this study,the surgical procedures were appendectomy in 5 patients,perforation repair for duodenal ulcer in 2 patients,distal gastrectomy in 2 patients,choledochotomy in one patient and splenectomy in one patient.Thyroid crisis occurred postoperatively in 7 patients,intraoperatively in 2 patients and preoperatively in 2 patients.Emergency treatment succeeded in 8 patients,and death occurred in 3 patients,with a death rate of 27.3%,including the preoperative thyroid crisis patient complicating duodenal ulcer perforation,who died of heart sufficiency on the first day postoperation.The second patient suffering from intraoperative thyroid crisis during exploration for perforation of the small bowel died of muhiple organ dysfunction syndrome caused by intestinal fistula,intra-abdominal abscess and lung infection,in spite of successful rescue treatment of thyroid crisis.The third patient was of acute appendicitis with perforation who died of coma and multiple organ dysfunction syndrome on the postoperative 5th day because the concomitant thyroid crisis was overlooked.Conclusions The early recognizing thyroid crisis in perioperative surgical abdomen and adequate treatment is the key to rescue succesS,and the diagnosis mainly depends on comprehensive judgment of clinical presentation and laboratory examination.

Objective To explore the effect of continuous hyperglycemia on learning and memory capacity in rats, and to observe the changes of expressions of ubiquitin and apotosis-related proteins, so as to provide a relative basis for diabetic encephalopathy. Methods The male SD rats were randomly divided into normal control group and diabetes mellitus (DM) group. The DM rats was made by intraperitoneal injection of streptozocin (STZ). The capacities of learning and memory were tested by Y-maze. The structure changes in frontal lobe cortex and hippocampus were observed by Nissl's staining and immunohistochemistry. The apoptosis cell count was measured by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL). The expressions of Bcl-2 and P53 were assessed by Western-blot analysis. The expression of ubiquitin mRNA was detected by reverse transcription-polymerase chain reaction (RT-PCR). Results In DM rats, the learning and memory capacities were worse than in control rats (P＜0. 05), and the apoptosis cell counts in frontal lobe cortex and hippocampus were higher than in control rats, the expression of Bcl-2 gene was reduced while the expressions of ubiquitin and P53 gene were increased (P＜0. 05). Conclusions In the frontal lobe cortex and hippocampus, the expression of Bcl-2 gene is reduced while the apoptosis cell numbers and ubiquitin P53 gene expression are increased, which may contribute to neurodegeneration in DM rats.

Objective To determine the effect of reducing mA on the diagnostic quality of images and the radiation dose to the lens in patients undergoing paranasal sinus CT. Methods Fifty patients undergoing paranasal sinus CT at 200 mA or 50 mA. The lens dose was measured using thermoluminescent dosemeters [LiF(Mg?Cu?P)]. Image quality was evaluated for six anatomical structures, including middle turbinate, uncinate process, maxillary ostium, ethmoid infundibulum, frontal recess, and cribriform plate. These anatomical structures were assessed as: not seen (0 points), demonstrated but not clearly visualized (1 points), or clearly demonstrated (2 points). Results Mean radiation dose to the lens was significantly reduced from 7.339 mGy (200 mA) to 1.108 mGy (50 mA). No significant difference of image quality between the two mA protocols was found in either rhinosinusitis group or non-rhinosinusitis group. And for rhinosinusitis the image quality showed no significant difference between high-resolution arithmetic and soft arithmetic. Conclusion CT scanning of the sinuses can be performed at greatly reduced mA without loss of diagnostic quality of the images. As far as the rhinosinusitis is concerned, high-resolution arithmetic can not improve the image quality and soft arithmetic is enough.

Cardiac biomarkers of sensitive and specific are very important to the early diagnosis of cardiovascular diseases,such as cardiac troponin (high sensitivity),myoglobin,heart-fatty acid-binding protein,ischemia modified albumin,B-type natriuretic peptide and N-terminal-pro-B-type natriuretic peptide.They also play an important role in risk stratification and prognosis evaluation,but improvement is still needed.Biomarker of high sensitivity and specificity,convenient detection control is still required in clinical application.

Objective:To evaluate the clinical effect of hemostatic air cushion with exhaust control valve for compression hemostasis after hemodialysis.Methods:From May to October 2019, 50 patients with autogenous arteriovenous fistula who underwent regular hemodialysis in the blood purification center of the first hospital of Jilin University were selected and randomly divided into two groups. After dialysis, self-made hemostatic air cushion with exhaust adjustment (experimental group) and gauze block compression hemostasis (control group), 25 cases in each group. The complete hemostasis time, compression displacement, bleeding, hematoma incidence and the convenience of single hand operation were compared between the two groups.Results:The complete hemostasis time of the control group was (36.37±2.12) min, and that of the experimental group was (20.52±3.65) min, the difference was statistically significant ( t value was 83.695, P<0.01). The incidence of displacement, hemorrhage and hematoma in the control group were 5.20% (26/500), 13.60% (68/500) and 3.00% (15/500) respectively, and those in the experimental group were 0, 8.20% (41/500) and 0 respectively, and the differences between the two groups were statistically significant ( χ2 value was 7.506, P<0.01). The one hand operation rate of the control group was 44.00% (220/500), and that of the experimental group was 98.00% (490/500). The difference between the two groups was statistically significant ( χ2 value was 354.055, P<0.01). Conclusions:The hemostatic air cushion with exhaust regulating valve is applied to patients with autogenous arteriovenous fistula after needle extraction, which has good hemostatic effect, simple and convenient operation, and is worthy of clinical promotion.

With the body senescing,the endocrine function decreased.In the recent more than ten years,a relationship between pituitary-thyroid axis dysfunction and senile psychosis has attracted increasing attention.Thyroxin is thought to be closely related with the cognitive dysfunction and senile dementia.