Objective To investigate the value of multiple sequential MRI in the differential diagnosis of vater ampulla carcinoma (VPC).Methods MRI data of 53 patients with VPC confirmed by surgery and pathology were analyzed retrospectively,which included 17ampullary carcinomas,15 pancreatic head carcinomas,10 duodenal papillary carcinomas and 11 distal common bile duct carcinomas.All patients underwent routine MRI plain scan,MRCP and multi-phase dynamic enhancement scan for the upper abdomen.The morphological characteristics and model of multi-phase dynamic enhancement of the tumor,and the morphological changes of pancreaticobiliary duct were focused,and relevant data were also measured.Results The differences of tumor size,central location,and signal homogeneity among the four different histological types showed statistical significance(P＜0.05),and their patterns of multi-phase dynamic enhancement also had differences.Double-segment sign was most found in VPC (26/53),four-segment sign was easy showed in pancreatic head carcinoma (8/15)and three-segment sign in distal common bile duct carcinoma (8/11).Beak sign was common seen in ampullary carcinoma(10/17),rat-tail sign was easy discovered in pancreatic head carcinoma (7/15) and truncated sign in distal common bile duct carcinoma(10/11).Diameter of major pancreatic duct in pancreatic head carcinoma was maximum and minimum in distal common bile duct carcinoma,and their difference had statistical significance(P＜0.05).Distance between obstructive end of bile common duct and major papilla of duodenum,and between obstructive end of major pancreatic duct and major papilla of duodenum as well as the pancreaticobiliary conjunction angle in pancreatic head carcinoma and distal common bile duct carcinoma were greater than that in ampullary carcinoma and duodenal papillary carcinoma.Conclusion MRI can prominently demonstrate various imaging characteristics of VPC with different histological origins.It is very valuable in the differential diagnosis of VPC with different histological types by comprehensive analysis of these findings.

Objective To study the effect of caffeine on hyperoxic lung injury of premature rats and its relationship with p38 motigen-activated protein kinase( MAPK) signal pathway. Methods Sixty Wistar premature rats were divided into 4 groups(n＝15) according to the random number table:air + normal sa-line group(A+N group),air + caffeine group( A+C group),hyperoxia + normal saline group( H+N group),and hyperoxia + caffeine group(H+C group). Among them,H+N group and H+C group were continually exposed to hyperoxia ( oxygen concentration was 60% ~70%). For A + C group and H + C group,the premature rats were injected with caffeine of 29 mg/(kg·d) into their peritoneal cavities every day after birth. For A+N group and H+N group,the premature rats were injected with normal saline of the same volume into their peritoneal cavities. In each group,the lung tissues of 5 premature rats were randomly select-ed on the third, seventh and fourteenth day respectively. The pathological changes of lung tissue, radiated alveolar count(RAC) and collagen content in lung tissue were observed under a light microscope. The wet/dry ratio ( W/D) was measured. Two-step immunohistochemistry was used to detect the distribution of p38MAPK in lung tissue. The content of phosphorylated p38MAPK( p-p38MAPK) protein was detected by western blot. Results Compared with the air groups,the lung tissues of premature rats in high oxygen expo-sure groups showed different degree of inflammatory changes on the third,seventh,and fourteenth day. The changes were more obvious with the prolonged exposure to hyperoxia. Pulmonary fibrosis was visible on the fourteenth day,which was improved after caffeine intervention. The RAC value of premature rats in hyperoxia exposure groups was significantly lower than that in air-exposure groups(P<0. 05),and the W/D ratio and collagen content in lung tissue increased significantly (P<0. 05),which were improved after caffeine inter-vention(P<0. 05). The results of two-step immunohistochemistry showed that the number of p-p38MAPK positive cells in the lung tissue of premature rats in hyperoxia exposure groups increased and widely distribu-ted, but decreased after caffeine intervention. The results of western blot showed that the content of p-p38MAPK protein in lung tissue of premature rats in hyperoxia exposure groups was significantly higher than that of air groups(P<0. 05),but it decreased after caffeine intervention(P<0. 05). Conclusion Hy-peroxia can promote the formation of pulmonary fibrosis by activating p38MAPK signal pathway. Caffeine can interdict the expression of p38MAPK to alleviate the fibrosis of lung tissue exposed to hyperoxia and thus protects the lung tissue.

Objective To discuss the effect of Kano model on improving satisfaction of nursing service in outpatient and emergency department of pediatrics.Methods Questionnaires about Kano model on the needs of nursing service in outpatient and emergency department were designed,and the attributes of needs were determined.Children' s needs were included in the nursing service process.And the satisfaction of nursing was investigated and compared before and after by a third party.Results There were ten must-be items (M),nine one-dimensional items (O) and six attractive itmes (A) in Kano model analysis of nursing service.After improving nursing process,the satisfaction rate increased from 78.23％ to 86.30％,with statistically significant difference (x2 =6.536,P ＜ 0.05).Conclusions Kano model can exactly screen the quality attributes of children's and parents' needs of nursing service,and significantly improve satisfaction in outpatient and emergency department of pediatrics.

Objective To isolate Japanese Encephalitis virus (JEV) from mosquitoes collected in Liaoning province and analysis the genotype of new isolated JEV strains and the characters of nucleotide and amino acid in the E gene. Methods Collected mosquitoes in Dandong Liaoning province in August, 2006. Virus isolation was using issue culture cells. Isolated viruses were identified by using serological and molecular methods. Results Two new JEV strains, LNDG07-02, LNDG07-16, were isolated from 1500 mosquitoes were belonging to genotype 1. The identity of nucleotide and amino acid of E gene between new JEV strains and live attenuated vaccine strain SA14-14-2 were 87.8%-88.0% and 97.2% , respectively. Total 11 amino acid sites were differences in E gene between new isolates and SA14-14-2. However, there were no differentiation between the new JEV strains and the isolates in Donggang 2002. Conclusion Genotype 1 JEV was isolated again from Donggang, since the first isolation of this genotype in 2002. Genotype 1 JEV continues in existence in Donggang Liaoning province.

OBJECTIVE: To investigate the correlation between the human epidermal growth factor receptor-2-related genes (HRGs) and survival prognosis of bladder cancer and to construct a predictive model for survival prognosis of bladder cancer patients based on HRGs. METHODS: HRGs in bladder cancer were found by downloading bladder tumor tissue mRNA sequencing data and clinical data from the cancer genome atlas (TCGA), downloading HER-2 related genes from the molecular signatures database (MsigDB), and crossing the two databases. Further identifying HRGs associated with bladder cancer survival (P < 0.05) by using single and multi-factor Cox regression analysis and constructing HRGs risk score model (HRSM), the bladder cancer patients were categorized into high-risk and low-risk groups accor-ding to the median risk score. Survival analysis of the patients in high- and low-risk groups was conducted using R language and correlation of HRGs with clinical characteristics. A multi-factor Cox regression analysis was used to verify the independent factors affecting the prognosis of the patients with bladder cancer. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) of HRSM was calculated, and a nomogram was constructed for survival prediction of the bladder cancer patients. Analysis of HRSM and patient immune cell infiltration correlation was made using the TIMER database. RESULTS: A total of 13 HRGs associated with patient survival were identified in this study. Five genes (BTC, CDC37, EGF, PTPRR and EREG) were selected for HRSM by multi-factor Cox regression analysis. The 5-year survival rate of the bladder cancer patients in the high-risk group was significantly lower than that of the patients in the low-risk group. High expression of PTPRR was found to be significantly and negatively correlated with tumor grade and stage by clinical correlation analysis, while EREG was found to be the opposite; Increased expression of EGF was associated with high grade, however, the high expression ofCDC37showed the opposite result. And no significant correlation was found between BTC expression and clinical features. Correlation analysis of HRSM with immune cells revealed a positive correlation between risk score and infiltration of dendritic cells, CD8⁺T cells, CD4⁺T cells, neutrophils and macrophages. CONCLUSION HRGs have an important role in the prognosis of bladder cancer patients and may serve as new predictive biomarkers and potential targets for treatment.
Humans ; Epidermal Growth Factor ; Prognosis ; Urinary Bladder Neoplasms/genetics* ; Nomograms ; Urinary Bladder

Objective:To report our experience of treating open comminuted limb fractures caused by gunshots using the Masquelet technique.Methods:Between January 2016 and July 2018, 3 patients were admitted to Institute of Orthopedics, 920 Hospital of Joint Logistic Service of People's Liberation Army for open comminuted limb fractures caused by gunshots.They were all male, aged from 18 to 41 years (average, 30.7 years).Their fractures were complicated with perforating wounds and belonged to Gustilo type ⅢB for open fractures.The bone defects were 5 to 9 cm in length (average, 6.7 cm), located at the proximal femur in 2 cases and at the upper middle humerus in one.They were treated by standard Masquelet technique at 2 stages.The postoperative functions of the hip, knee and shoulder were evaluated according to the Harris hip score, Lowa knee score and Constant-Murley shoulder function score.Results:The 3 patients obtained an average follow-up of 17.3 months.The bone defects were all repaired in the 3 patients without any signs of infection.The 2 patients with femoral defects were rated as both excellent by the Harris hip score, as excellent in one and as good in the other by the Lowa knee score; the patient with humeral defects was rated as excellent by the Constant-Murley shoulder function score.Conclusion:Masquelet technique is a desirable treat-ment of segmental long bone defects caused by gunshots.

Objective:Compare the anti-tumor effect and mechanism of Liushenwan and realgar (As₄S₄) on human endometrial cancer cells JEC. Method:The release of As in Liushenwan and As₄S₄ was measured by atomic absorption spectrometry. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used for cell proliferation, and cell migration was measured by Transwell assay. Flow cytometry and Western Blot were used to determine apoptosis and DNA damage. Result:The dissolution of As in Liushenwan was 17.4%, and that of As₄S₄ was only 1.6% according to atomic absorption assay. With the same content of As, compared with the As₄S₄ group, the cell viability in the 3，10 mg·L^-1 Liushenwan groups was decreased (P<0.05), the early apoptosis rate was significantly increased in 0.25，0.5，1 mg·L^-1 Liushenwan groups (P<0.05), the rate of cell migration was decreased in 1 mg·L^-1 Liushenwan group (P<0.05), the expressions of cleaved cysteinyl aspartate-specific proteinase-3 (cleaved Caspase-3), cleaved cysteinyl aspartate-specific proteinase-7 (cleaved Caspase-7), cleaved poly ADP-ribose polymerase (cleaved PARP), phosphorylated histone (p-H₂AX), phosphorylation of checkpoint kinase 2 (p-CHK2) and ataxia-telangiectasia mutated (ATM) were increased in 1 mg·L^-1 Liushenwan group (P<0.05), while the expression of phosphorylation of ataxia-telangiectasia mutated rad3-related (ATR) was decreased in 1 mg·L^-1 Liushenwan group (P<0.05), with no significant changes in the expressions of cysteinyl aspartate-specific proteinase-3 (Caspase-3) and cysteinyl aspartate-specific proteinase-7 (Caspase-7). Conclusion:With the same content of As, both Liushenwan and As₄S₄ could inhibit JEC cell proliferation and migration, and induce cell apoptosis and DNA damage. Liushenwan has a stronger effect than As₄S₄. It is suggested that there are other components in Liushenwan with an anti-tumor effect in cooperation with As.