Objective To study the ultrastructural changes of gunshot wounds at the brain stem and the cause of the death. Method A case died of the head injury and two cases died of gunshot wounds of the brain stem were studied. Brain stem tissues were taken 25 min after death. Tissue blocks from the tegmentum of the midbrain and the pons as well as the gray matter of the medulla oblongata in the deep portion of the base of the fourth ventricle were taken and were examined with ultramicroscopy and scanning electron microscopy. Results (1) The gunshot wound injuries inside the brain including burn and injuries caused by punch and pressure; (2) Although the primary gunshot wounds were located at the midbrain, the pathological changes extended to the whole brain stem; (3)The injuries of the axons and the nerve cells were more severe and extensive than those of the glia fibers. (4)The changes of the burn included condensation and degeneration of the myelin sheath and axonal cytoplasm, especially the mitochondria as well as edema of the myelin sheath and the axonal cytoplasm. The punch and pressure injuries included the torsion, deformation, fusion, compression, breach, torn and displacement of the axons with loss of cytoplasm as well as the deviation of mitochondria, micro ?neuro - fibrils and micro - tubules in the axons. Conclusion The severe and extensive injuries of the axons of nerve fibers in the brain stem might play an important role in the cause of death of gunshot.

Objective To analyze the MR signs of primary subdural extramedullary tumors so as to improve the correct diagnostic rate.Methods MR signs of 40 cases with primary neoplasms of extramedullary were studied retrospectively.All cases were verified by surgery. Results Neurinoma,neurofibroma,meningioma,lipoma and teratoman had specific MR features in location,size,shape,edge,signal and enhancement change. Conclusion Primary subdural extramedullary tumors can be correctly diagnosised.

Objective To analyse MRI findings of multicentric craniopharyngioma and improve knowledge to it. Methods MRI and Gd-DTPA enhanced SE T 1WI scaning were performed in 4 cases of multicentric craniopharyngioma proved by surgery and pathology before operation, PDWI scaning were performed in 2 cases.Results MRI manifestations of multicentric Craniopharyngioma is the tumors of Parenchymal -predominant mixed in the sella turcica region or Suprasellar region as the center focus in 4 cases, and different cystic focus were also found in the di-temporal lobe,the basis of anterior cranium fossa,the anterior part of third ventricle,the pontine cistern, the caudate nucleus.Cystic-Parenchymal focus has low-iso mixed signal on T 1WI and high-low mixed signal on T 2WI;cystic focus of the tumors had different signal,signal ranges form low up to high on T 1WI,while high signal on T 2WI and from iso-signal to high on PDWI. After Gd-DTPA enhanced,annular wall enhancement were seen on cystic focus,Parenchymal focus appeared as uniform enhancement.Conclusion The multicentric craniopharyngioma growth performance is multi-origination growth with the sella turcica region or suprasellar region center, the MRI signal specialty of craniopharyngioma is related to ratio of cystic-consolidated and the contents of the cystic fluid.

OBJECTIVE To understand the epidemiological and clinical features of enteritis caused by Norwalk virus in the hospital and observe the effectiveness of prevention and control system in order to provide the basis for the control of outbreaks.METHODS By adopting field epidemiological and clinical data study,investigation and analysis were conducted on eight cases of suspected patients with enteritis caused by Norwalk virus in the hospital.Control on gastrointestinal infections and droplet infection was implemented.RESULTS Bacterial test on feces was conducted on eight cases of suspected gastroenteritis caused by Norwalk virus.Results were negative,thus diagnosed as viral infection;among them,virology test on feces was conducted on two cases which were diagnosed as enteritis caused by Norwalk virus.All patients were recovered after proper treatment and no new cases were found after timely disinfection.CONCLUSIONS The epidemic outbreak of enteritis caused by Norwalk virus has been timely and effectively controlled in the hospital;because communication channel on infection control management is open,contingency plans are effective and the prevention and control taskforce functions well.

Objective To investigate the efficacy of intracoronary tirofiban during percutaneous coronary intervention(PCI)for patients with acute myocardial infarction(AMI).Methods Seventy-six consecutive AMI patients,treated with primary coronary angioplasty in 12 hours were enrolled.They were randomly divided into two groups:tirofiban group(39 cases)and control group(37 cases).Tirofiban group was treated with intracoronary timfiban during PCI and after the operation for 48 hours.Both of them were given heparin in PCI and aspirin,clopidogrel before PCI.At the end of PCI procedure,angiographic features such as TIMI flow grade and TIMI myocardial perfusion grade(TMPG)were analyzed.The difference of two groups in complication and major adverse cardiac events(MACE) was investigated.Results The myocardial reperfusion of tirofiban group was better than that of control group[TIMI grade 3 flow 94.9%(37/39) vs 78.4%(29/37),P<0.05;TMPG 3 grade 89.7%(35/39)vs 67.6%(25/37),P<0.05].There was no significant difference between two groups in bleeding complication.The occurrence of MACE in tirofiban group was less than that in control group[7.7%(3/39)vs 18.9%(7/37),P<0.05].Conclusion Intracoronary tirofiban dunng primary PCI in patients with AMI can improve coronary flow and myocardial perfusion,and has no more bleeding and less MACE occurrence.

Objective To compare the effects of different methods of general anesthesia on postoperative cognitive function in patients undergoing non-cardiac surgery.Methods One thousand ASA Ⅰ or Ⅱ patients,aged 18-60 years and undergoing non-cardiac surgery,were randomly divided into five groups (n=200 each):isoflurane + propofol + fentanyl group (group IPF),isoflurane + remifentanil group (group IR),sevoflurane + propofol + fentanyl group (group SPF),sevoflurane + remifentanil group (group SR),and propofol + remifentanil group (group PR).Two hundred patients receiving non-operative treatment served as control group (group C).In groups IPF and SPF,anesthesia was maintained with inhalation of 1.68％ isoflurane or 1.71％ sevoflurane,target controlled infusion (TCI) of propofol with the target plasma concentration of 2-5 μg/ml,and intermittent intravenous boluses of fentanyl.In groups IR,SR and PR,anesthesia was maintained with inhalation of 1.68％ isoflurane or 1.71 ％ sevoflurane,or TCI of propofol with the target plasma concentration of 2-5 μg/ml,and TCI of remifentanil with the target plasma concentration of 2-6 ng/ml.The patients' cognitive function was assessed with minimental state examination (MMSE) 1 day before operation,when leaving the post-anesthetic care unit (PACU),and 1 and 3 days after operation,respectively.Z score was used to identify the cognitive dysfunction as recommended by Moiler when leaving the PACU,and 1 and 3 days after operation.Results Compared with group C,the MMSE score was significantly decreased when leaving the PACU,and the incidence of cognitive dysfunction increased when leaving the PACU and 1 day after operation in the other groups (P ＜ 0.05).Compared with groups IPF,IR,SPF and PR,the incidence of cognitive dysfunction was significantly increased in group SR (P＜0.05).Conclusion General anesthesia with sevoflurane combined remifentanil exerts fewer effects on the postoperative cognitive function in patients undergoing non-cardiac surgery.

Objective To investigate the effect of arginase (Arg) inhibitor N-ω-Hydroxy-L norArginine (nor-NOHA) on high glucose cultured rhesus macaque retinal vascular endothelial cell line (RF/6A) in vitro.Methods The RF/6A cells were divided into the following 4 groups:normal control group (5.0 mmol/L of glucose,group A),high glucose group (25.0 mmol/L,group B),high glucose with 125 mg/L nor-NOHA group (group C),and high glucose with 1％ DMSO group (group D).The proliferation,migration ability and angiogenic ability of RF/6A cells were measured by Methyl thiazolyl tetrazolium (MTT),transwell chamber and tube assay respectively.The express of Arg Ⅰ,eNOS,iNOS mRNA of RF/6A cells were measured by real-time polymerase chain reaction (RT-PCR),Enzyme-linked immuno sorbent assay (ELISA) was used to detect the expression of NO and interleukine (IL)-1b of RF/6A cells.Results The proliferation,migration,and tube formation ability of group A (t=2.367,5.633,7.045;P＜0.05) and group C (t=5.260,6.952,8.875;P＜0.05)were significantly higher than group B.RT-PCR results showed the Arg Ⅰ and iNOS expression in group B was higher than that in group A (t=6.836,3.342;P＜0.05) and group C (t=4.904,7.192;P＜0.05).The eNOS expression in group B was lower than that in group A and group C (t=4.165,6.594;P＜0.05).ELISA results showed NO expression in group B was lower than that in group A and group C (t=4.925,5.368;P＜0.05).IL-1b expression in group B was higher than that in group A and group C (t=5.032,7.792;P＜0.05).Conclusions Nor-NOHA has a protective effect on cultured RF/6A cells in vitro and can enhance its proliferation,migration and tube formation.The mechanism may be inhibiting the oxidative stress by balancing the expression of Arg/NOS.

Objective To investigate the effects of exosomes from cultured human retinal pigment epithelium (ARPE-19) cells affected by oxidative stress on the proliferation and expression of vascular endothelial growth factor-A (VEGF-A) and Akt of ARPE-19 cells. Methods Culture ARPE-19 cells. The concentration of 2.5μmol/L rotenone was selected to simulate oxidative stress and isolated ARPE-19-exosome. Exosomes were isolated by ExoQuick exosome precipitation solution. Transmission electron microscopy was used to identify the morphology of exosomes. Western blot was used to detect exosomes’ surface-specific maker protein CD63. ARPE-19 cells affected by oxidative stress were cultured with exosome as experimental group, normal ARPE-19 cells were cultured with exosome as control group. The cell proliferation was examined by methyl thiazolyl tetrazolium assay. Western blot and immunofluorescence assay were used to detect the expression levels of VEGF-A and Akt protein. Real-time quantitative polymerase chain reaction (RT-PCR) was used to detect the levels of VEGF-A mRNA and Akt mRNA. Results The diameter of normal ARPE-19-exosomes ranged from 50 to 150 nm. The isolated exosomes expressed CD63. AREP-19 cells were cultured with ARPE-19 (affected by rotenone)-exosome, the cell viability in experimental group was significantly reduced than in the control group. Green fluorescence was observed in the cytoplasm under fluorescence microscope. Compared with the control group, VEGF-A was up-regulated expressed and Akt was down-regulated expressed. Western blot results showed that, VEGF-A protein expression in the experimental group were higher than the control group. Akt protein expression in the experimental group were less than the control group. The difference was statically significant (t=3.822, 6.527;P<0.05). RT-PCR results showed that VEGF-A mRNA expression levels was higher in the experimental group than the control group. Akt mRNA expression levels was lower in the experimental group than the control group. The difference was statically significant (t=8.805,?7.823;P<0.05). Conclusions Exosomes from ARPE-19 cells affected by oxidative stress inhibit the proliferation of normal ARPE-19 cells, increase the expression of VEGF-A and reduce the expression of Akt.

Acute Disease ; Humans ; Lumbar Vertebrae ; Male ; Middle Aged ; Osteochondroma ; diagnosis ; pathology ; therapy ; Spinal Neoplasms ; diagnosis ; pathology ; therapy

Objective To evaluate the effect of the collaboration care model on posttraumatic growth and resilience in patients with breast cancer.Methods 70 patients who were diagnosed with breast cancer in department of Breast Surgery of the First Affiliated Hospital of Dalian Medical University were assigned into two groups by random number table.32 patients who completed the research in the experimental group received collaboration care while 31 patients who completed the research in the control group received routine care both for there months.The patients were investigated with the Posttraumatic Growth Inventory (PTGI) and Connor-Davidson Resilience Scale (CD-RISC) before and after intervention.Results After the intervention,there were significant differences in scores of posttraumatic growth [(63.83±11.87) scores vs.(60.33±10.09) scores,t=2.384] and resilience [(66.52±15.23) scores vs.(61.33±10.09) scores,t=2.472] between the two groups (P＜0.05).And also there were significant differences of posttraumatic growth scores before and after intervention in the experimental group [(56.24±10.01) scores vs.(63.83±11.87) scores,t=-3.988,P＜ 0.01] and the control group [(56.68±10.32) scores vs.(60.33±10.09) scores,t=-2.426,P＜0.05].Differences of resilience also existed in the experimental group [(61.28±14.40) scores vs.(66.52±15.25) scores,t=-3.225,P＜0.01] and the control group [(63.97±17.66) scores vs.(61.33±10.09) scores,t=-2.370,P＜0.05].Conclusions Collaboration care model can significantly improve the level of patients' posttraumatic growth and resilience.