Objective To study the value of configuration of the fourth ventricle to indicate, surgical treatment in patients with spontaneous cerebellar hemorrhage. Methods The data of 52 patients with spontaneous cerebellar hemorrhage were retrospectively analyzed. The relationship between configuration of the fourth ventricle and consciousness, volume of the hematoma, frequence of hydrocephalus and incidence of deterioration of consciousness was investigated. Results The correlations between the degree of the fourth ventricular compression and the consciousness, the volume of the hematoma were strong (r= -0.881,P <0.01; r=0.808,P < 0.01, respectively). The more the degree of the fourth ventricular compression was severe,the more GCS score was low and the volume of the hematoma was large. The incidence of hydrocephalus in patients with composed the fourth ventricle[57.7%(15/26)] was significantly higher than that in patients with normal configuration of the fourth ventricle [16.7% (3/18)] (χ~2= 7.406, P < 0.01). The incidence of deterioration of consciousness in patients with compressed the fourth ventricle who accepted conservative therapy initially [72.7% (8/11)]was significantly higher than that in patients with normal configuration of the fourth ventricle [12.5%(2/16)] (P= 0.003). Conclusions The configuration of the fourth ventricle is an useful indicator for surgical treatment in patients with spontaneous cerebellar hemorrhage. When making decision whether surgical treatment was used or not in patients with spontaneous cerebellar hemorrhage, the configuration of the fourth ventricle should be take into account.

Objective To study the characteristics of intramedullaiy tumors of embryonal origin, surgical treatment and outcome. Methods The data of 26 cases with intramedullary tumors of embryonal origin, including clinical features, pathological types and imaging characters of the tumor, surgical treatment and outcome, were retrospectively summarized. Among the 26 patients, apart from the neurological symptoms, lower-extremity deformities were seen in 7 cases, scoliosis in 1 case, lower midline cutaneous abnormalities in 3 cases. The tumors involving lumber section of the spinal cord (thoracolumbar + lumbar segments + lumbosacral) in 21 cases, account for 80.8% (21/26). The tumor in different kinds had its characteristic MRI appearance. All of the 26 patients underwent surgical treatment. Subtotal resection of the tumor was performed in 19 cases, most partial resection in 5 cases, partial removal in 2 cases. Results Of the 26 patients, 25 patients had improved neurologically when leaving hospital. Twenty-one patients were followed up from 6 to 82 (30.0 ± 8.2) months, 12 patients had a good recovery without any neurological defect, 7 patients could live independently, 1 patient needed care offered by others, 1 patient with malignant teratoma died at 6 months after operation. In the follow-up period, no patient needed the second surgery for recurrent tumor. Conclusions Apart from the neurological symptoms, other abnormalities such as lower-extremity deformities, scoliosis, lower midline cutaneous abnormalities could be appeared in patients with intramedullary tumors of embryonal origin. Most tumors involving lumber section of the spinal cord, could be diagnosed by MRI. Other spinal abnormalities frequently occur with the tumors. It is difficult to remove the tumors totally, while the surgical outcome is satisfactory.

Objective To investigate the clinical characteristics and living conditions of hepatic diabetes (HD) patients and to analyze the risk factors of the prognosis of HD patient .Methods One hundred and sixty‐eight cases of cirrhosis cases were divided into liver cirrhosis group(n=74) ,the combined group cases(n=48)and combined HD type 2 diabetes (T2MD) group(n=46)se‐lected from January 2011 to December 2012 .Death was end point .The clinical features and prognosis of patients were compared . The risk factors for liver cirrhosis were analyzed by the simple factor analysis and Logistic regression analysis .Results The pa‐tients with history of diabetes in T2MD group were more than those in the HD group and the cirrhosis group (P<0 .05) .The pro‐portion of alcoholic cirrhosis cirrhosis of HD group and T2MD group were higher than those in liver cirrhosis group (P<0 .05) . The hepatic encephalopathy ,upper gastrointestinal bleeding ,electrolyte disorders and other complications ,mortality ,Child‐Pugh score and length of hospital stay of HD group and T2MD groups were significantly higher than those in liver cirrhosis group(P<0 .05) ,but there was no significant difference between HD and T2MD group(P>0 .05) .The total bilirubin (TBil) of HD group was higher than those of the T2MD group and liver cirrhosis group(P<0 .05) .The levels of fasting glucose levels(FPG) ,insulin resistance index (HOMA‐IR) ,total cholesterol (TG) ,C‐peptide of liver cirrhosis group were lower than HD group and T2MD group (P<0 .05) .The levels of FPG ,C peptide of HD group were higher than that of T2MD group (P<0 .05) .The levels of TG of T2MD group were higher than that of HD group (P<0 .05) .Logistic multivariate analysis showed that age ,alcohol consump‐tion ,diabetes ,Child‐Pugh score were independent risk factors for death in patients with liver cirrhosis .Conclusion The morbidity and mortality of HD patients may be higher than patients with liver cirrhosis ,and HD could increase the risk of death in patients with liver cirrhosis .

Objective To study the causes, temporal courses, predictors and outcomes of delayed neurological deterioration (DND) after mild traumatic brain injury. Methods In a cohort of 254 patients, the incidence, causes and temporal courses of DND after mild traumatic brain injury were summed up. Univariate and multivariate (Logistic regression) analysis were performed to assess the predictors of DND. The short-term outcomes were compared between patients with and without DND. Results DND occurred in 14.2% (36/254) of the 254 patients. Intracranial causes of DND such as hematoma growth were observed in 91.7%(33/36) of patients with DND. The interval from arrival to DND was 0.5- 59.0 h. Thirty patients (83.3%, 30/36) deteriorated within 24 h. The univariate analysis revealed that dangerous injury mechanism, loss of consciousness, severe headache, more than 1 time vomiting, interval from injury to first CT scanning, first Glasgow coma scale (GCS) scores, basal skull fracture, hypocoagulability, heavy alcohol consumption were the predict factors for DND (P<0.05 or<0.01). The multivariate analysis revealed that interval from injury to first CT scanning (P=0.000, OR=0.169, 95% CI: 0.083- 0.344), first GCS scores (P = 0.004, OR = 0.355, 95%CI: 0.175- 0.721) and hypocoagulability (P=0.001, OR=0.077, 95%CI:0.017-0.354) were the independent predict factors for DND. All of the patients without DND recovered better. But in the patients with DND, 30 patients recovered better, 4 patients had slight disability, 1 patient had severe disability, and 1 patient died. The treatment outcome between two groups had significant difference (Z =-6.088, P = 0.000). Conclusions The causes of DND are mostly intracranial. Most patients deteriorat within 24 h. The interval from injury to first CT scanning, first GCS scores and hypocoagulability appear to be independent predictors of DND. DND is associated with poor short-term outcomes.

Objective To interpret the clinicopathological features and the key factors for diagnosis of polyomavirus-associated nephropathy (PVAN).Methods Clinicopathological data of 13casesof polyomavirus-associatednephropathyduring2008-2011inour hospitalwere retrospectively analyzed.Three cases received repeat biopsy.The clinicopathological features were analyzed according to thelight microscopicsceneandSV40-Timmunochemicalexpression.Results Recipients had a peak incidence of PVAN in 12 to 18 months period after renal transplantation,accompanied by elevated serum creatinine.Due to the progression of the disease,3patterns of histological findings could be identified.The early lesion was confined to the collected ducts,with slightly inflammatory infiltration in medullary interstitium,viral inclusions were not necessarily seen.The only findings could be enlarged nuclear and irregular arrangement of the tubular epithelial cells.At the developing stage,prominent tubulointerstitial nephritis was detected,and the involved tubules extended to other segments of renal tubule,even the parietal epithelial cells of Bowman's capsule could be compromised.The epithelial cells shed off,leading the tubular basement membrane exposed.Typical intra-nuclear inclusions as well as variable nuclear changes were found.At the end stage,the allograft showed notable chronic tubulointersititial change,with diffuse tubular atrophy and interstitial fibrosis.Although in this period,typical viral inclusions were rare, stillIHCshowedpositiveexpression of SV40-T. After immunosuppressantreductionor exchange,2 cases developed renal failure,4 cases showed sustained increment in serum creatinine,while 7 cases had a stabilized serum creatinine level.Conclusions Polyomavirus-associated nephropathy can display uneven pathological changes,as well as the morphology of the infected epithelial cells.Segments of the involved tubule are associated with the course of disease.Reduction of immunosuppressant at the early stage has a favorable effect.A prompt renal biopsy should be done in renal transplant recipient if who shows increased serum creatinine,and a routine polyomavirus immunohistochemical staining should be applied as well.

Objective To evaluate the radiation protective efficacy of different types and the positions of ceiling-suspended lead shield to the principal and assistant interventional operators in order to provide a scientific basis for the selection of optimal scheme in using ceiling-suspended lead shield.Methods At the principal and assistant interventional operators’ standing places the personal dose-measuring instruments were set up, which were placed at the height of 20 cm to 180 cm above the ground with an interval distance of 20 cm between each other.The postero-anterior (PA) projection and left lateral projection were used.The ceiling-suspended protection lead shields included lead glass (glass type) and lead glass with connected lead flexible stripe below (mixed type).The placed sites of the protection lead-shields were close to the principal operator, away from the principal operator, on the left side of the principal operator and close to the X-ray tube respectively.The radiation doses of PA projection and left lateral projection were determined.The real-time radiation dose rate and dose shielding rate at the nine measuring positions for the principal operator and assistant operator were separately calculated.The results were analyzed.Results The radiation protection of the glass type was slightly superior to that of the mixed type, but the difference was not significant.The principal operator was best protected when the shield was positioned close to him in the PA projection, and for left lateral projection the principal operator was best protected when the shield was positioned on his left side.For the assistant operator, the optimal protection was obtained when the shield was positioned close to him in both PA and left lateral projection.In the optimal position of ceiling-suspended lead shield, the highest radiation dose rate (0.71 mSv/h in glass group and 1.07 mSv/h in mixed group) was recorded on the principal operator at the height of 120 cm at PA projection, and higher radiation dose rate (≥0.47 mSv/h) was recorded on every point of both operators at the left lateral projection.Meanwhile, the overall received radiation doses of the two groups were very close.At the principal operator standing area, except for the position of 120 cm height (attenuation ratio 60.11% in glass group and 39.89% in mixed group), the attenuation ratio of each measuring point was above 93%.And the assistant operator standing area the attenuation ratio was 57%-97%.The lateral shielding ratio was generally slightly higher than PA shielding ratio.Conclusion The radiation protection effect of the two type shields is quite similar, both shields can obtain excellent protection efficacy.But the radiation dose at the height of 120 cm above the ground at PA projection is higher for the principal operator, while at lateral projection the radiation dose at all height levels is still relatively higher for both operators.Therefore, the radiation protection at the level of 120 cm height needs to be strengthened and the lateral projection exposure should be used as less as possible.

Objective To explore the the role of fraction exhaled nitric oxide(FeNO) in airway inflammation of Mycoplasma pneumoniae pneumonia(MPP).Methods Inpatients with low respiratory tract infection were enrolled from August to November in 2012,69 patients had MPP and 33 had no MPP(non-MPP).Patients with MPP were further grouped into a bronchopneumonia group and the lobar pneumonia group.Fifty-four inguinal hernia patients without respiratory tract infection during the last 2 weeks were enrolled as a control group.FeNO was measured by nitric oxide analyzer.Eosinophile level was detected by blood cells analysator.Results The level of FeNO in patients with MPP [(6.28 ±3.00) ppb] was lower than that of patients of non-MPP [(10.85 ± 2.86) ppb] and the control group [(9.74 ± 3.10) ppb] (t =7.30,6.26,respectively,all P ＜ 0.000 1) ; the level of FeNO between the bronchopneumonia group [(5.78 ± 3.06) ppb] and the lobar pneumonia group [(6.48 ± 2.98) ppb] with infection of Mycoplasma pneumoniae (MP) had no statistical significance(t =0.88,P ＞0.05).The proportion of blood eosinophile in patients with MPP [(0.60 ±0.51) ％] was lower than that of non-MPP group [(1.15 ± 0.76) ％] (t =4.14,P ＜ 0.000 1) ; the proportion of blood eosinophile between bronchopneumonia group [(0.61 ± 0.57) ％] and lobar pneumonia group [(0.60 ± 0.55) ％] with infection of MP had no discrepance (t =-0.05,P ＞0.05).Conclusions MP infection decreases production of FeNO.The possible mechanism for this phenomenon is that the cilia loss and hyperimmune response to MP may affect the production of FeNO.The airway inflammation of mycoplasma pneumonia is associated with cilia loss and hyperimmune response.

Objective To measure the dose to the primary operator and assistant operators by employing eight beam projections commonly used in coronary angiography with and without radiation protection shields in order to supply helpful guidance on radiation protection in cardiac intervention.Methods From 20 to 180 cm above the ground at the primary and assistant operators' locations,a DoseAware personal dose meter was placed in terms of an increment of 20 cm to measure radiation dose.Eight commonly used beam projections were performed,including LAO (left anterior oblique) 45°,RAO (right anterior oblique) 30°,CRAN (cranial)25°,cranial LAO (LAO45°/25°),caudal LAO(LAO45°/ 25°),CAUD (caudal) 25°,cranial RAO (RAO30°/25°),caudal RAO (caudal RAO30°/25°).Under the two different conditions,with or without radiation protection shields,the doses to the operators in the selected beam projections were respectively recorded at nine measuring positions and the shielding factor were calculated.Results The primary operator was effectively protected with radiation protection shields.In the standing area of the primary operator,except for the position at the height of 120 cm (radiation dose rate:0.35-4.78 mSv/h;shielding factor:27.67％-89.33％),the shielding factor for each measuring position was above 91％.Higher radiation doses were found at caudal LAO,LAO,and cranial LAO.The shielding factor for the assisting operator was lower than for the primary operator.In the standing area of the assisting operator (radiation dose rate:0.27-1.86 mSv/h;shielding factor:30.34％-92.13％),the peak levels were found at the height of 80,100,140 cm.And caudal RAO,caudal LAO,CRAN,LAO were found to have received higher radiation doses.Conclusions Emphasis should be attached to the use of radiation shields in coronary angiography.With radiation protection shields,higher dose is still recorded in caudal LAO,LAO,cranial LAO,caudal RAO.Furthermore,it should be paid more attention to radiation protection at 80-140 cm height,and less prolonged exposure should be employed in those beam projections mentioned above.

Objectives To explore the effects of nasopharyngeal bacterial colonization in children with acute bronchiolitis due to respiratory syncytial virus (RSV).Methods Hospitalized children of acute bronchiolitis were enrolled to detect pathogen and bacterial colonization.Their clinical data and laboratory results were collected and analyzed.Cases of elective surgery were also obtained as control group.Results Fifty-five percent of all children with bronchiolitis had a lower positive rate of nasopharyngeal bacterial culture (55.0％ vs.74.1％,P ＜0.01).Children with nasopharyngeal bacterial colonization had a higher rate of severe bronchiolitis (13.8％ vs.4.2％,P =0.018),presented dyspnea more frequently (19.8％ vs.9.5％,P =0.037) and had a longer hospital duration (8.2 vs.7.5 days,P =0.036) as compared with those without bacterial colonization.In terms of laboratory results,a higher proportion of C-reactive protein was found in children with bacterial colonization than those with non-bacterial colonizations (17.2％ vs.4.2％,P =0.003).Conclusion Bacterial colonization may be a predictor for severe bronchiolitis.

Objective To study the epidemiological and clinical features of human parainfluenza virus (HPIV) infection in children in Suzhou,and to provide the evidence-based foundation for early warning,diagnosis and treatment of respiratory infection in children.Methods The sputum specimens and medical history were obtained from children with acute respiratory tract infection hospitalized at the Childen's Hospital Affiliated to Soochow University from January 2006 to December 2015.Seven kinds of common respiratory viruses including respiratory syncytial virus,influenza virus A,influenza virus B,HPIV Ⅰ,HPIV Ⅱ,HPⅣV Ⅲ and adenovirus were detected by using the direct im-munofluorescence.Mycoplasma pneumoniae(MP),chlamydia pneumoniae,human bocavirns (hBoV) were detected by using fluorescence quantitative PCR.Rhinovirus and human metapneumovirus were detected by using reverse transcription-PCR.Sputum was cultured for bacteria.Results In 21 769 cases,the detection rate of HPIV positive was 3.21％ (829 cases),among which,HPIV Ⅰ,HPIV Ⅱ,HPIV Ⅲ were respectively detected in 113 cases (0.52％),16 cases (0.07 ％) and 700 cases (3.21％),respectively.There were 378 cases of simple infection and 428 cases of mixed infection,and the mixed infection was very common in Streptococcus pneumoniae,Haemophilus influenza,MP and hBoV.There was a difference in HPIV infection among genders,and the detection rate of the boys was higher than that of girls[4.14％ (563/13 591 cases) vs.3.25％ (266/8 178 cases),x2 =11.036,P =0.001].In the 28 d-1 year old and ＞ 1-3 year old group,the detection rate of HPIV was higher[4.71％ (494/10 476 cases) and 4.21％ (244/5 793 cases),respectively].In spring and summer,there was a higher detection rate of HPIV infection.The clinical manifestations with simple infection of HPIV Ⅰ and HPIV Ⅲ were cough,fever and wheezing.The rate of fever and shortness of breath in those of HPIV Ⅰ was 71.74％ (33/46 cases),10.87％ (5/46 cases),and that in HPIV Ⅲ was 40.12％ (134/334 cases),2.10％ (7/334 cases),HPIV Ⅰ infection was more likely to cause fever and shortness of breath than those of HPIV Ⅲ,there were significant differences (x2 =16.410,P ＜ 0.001;x2 =10.177,P =0.001).Pneumonia had the highest detection rate of viral infection.Conclusions HPIV Ⅲ is the leading pathogen among the types of HPIV in the hospitalized children in Suzhou area.Among the subtypes of HPIV,the peak of HPIV infection occurs in spring and summer.The children less than 3 years old are the most susceptible to parainfluenza virus,and the HPIV detection rate is gradually declines with age.