Prof. SUN Guang-rong holds that how to define the representative clinical case records out of regular ones,what to learn from it,and how to direct other people to learn from it are the key questions to answer before moving to the study; in research process of the project of the Representative Clinical Case Records Collection and Study of Contemporary Eminent and Experienced Chinese Medicine Practitioners,conventional study method and modern information technology are used in conjunction on all the clinical case records of the screened eminent and experienced doctors from all over the country,the defined representative case records are studied and sorted out according to disease or symptom,highlights before and notes and comments following the case record details,guiding people easily to read each great Chinese medical talents,their academic thought and clinical technology; the academic analysis on each eminent and experienced practitioner is the most important part of the project and with it the academic whole story can be seen in a natural and close related way.

Objective To summarize the imaging features of neurofibromatosis.Methods Imaging data of 7 patients with neurofibromatosis proven by operation and clinical syndrome,were retrospectively analyzed.Results In 7 cases of neurofibromatosis,the findings of CT and MRI displayed 3 cases of bilateral vestibular schwannoma,2 of which were combined with optical nerve glioma;1 case of optical nerve glioma complicated with neurofibromatosis under cervical dura;1 case of meningioma and 2 cases with the changes of dura spinal sac.The last two cases displayed abnormal skull and spinal canal,concave change of vertebra and enlarged dura spinal sac,partially stretched to never root on CT plain flim and MRI.Conclusion Neurofibromatosis can be definitely diagnosed by optimal imaging examination based on comprehensive analysis of imaging features and typical syndromes.

Objective To analyze the clinical and CT characteristics of pancreatic metastasis to improve the correct diagnosis rate.Methods The clinical and CT data of 14 patients with pancreatic metastasis were reviewed retrospectively.Results Among the 14 patients,the primary malignancy was lung cancer in 6 cases,renal carcinoma in 3 cases,colon carcinoma in 2 cases,laryngeal cancer in 1 case,gastric cancer in 1 case and ovarian carcinoma in 1 case.Pancreatic metastases from renal carcinomas often developed a long period after initial nephrectomy and survived for a relatively long time.Abdominal CT plain scan and enhanced scan was performed in all cases.Four cases were of solitary type,9 cases were of multiple types and 1 was of diffuse type.Totally 28 lesions were found,which were usually located in the neck and body of the pancreas,the diameter of 28 pancreatic lesions was ranging from 0.5 cm to 11 cm,with a mean diameter of 2.3 cm.On CT plain scan,there were 19 hypodense lesions,7 slightly hyperdense lesions and 2 isodense lesions,5 necrotic lesions.On enhanced CT,the lesions showed moderate enhancement in 7 cases,circular enhancement in 6 cases,moderate and circular enhancement in 6 lesions,obvious enhancement in 8 lesions and no enhancement in 1 lesion.All patients had extra-pancreatic metastases,and 2 cases had peripheral vascular invasion.Conclusions Pancreatic metastases are rare,often accompanied with multiple lesions and extra-pancreatic metastases.The CT features of pancreatic metastases from renal carcinomas are slightly hyperdense and obvious enhancement; in other metastases,there are hypodense,morderate and/or circular enhancement lesions.Accurate diagnosis can be achieved by knowledge of patients' medical history.

Objective Background:MicroRNAs (miRNAs) are naturally occurring small non-coding RNAs,play important roles in cancer initiation and progression.Decreases in miRNAs levels are observed in human cancers,indicating that miRNAs may function intrinsically in tumor suppression.However,the underline mechanisms of miRNA function are little known.Methods MiR-34b in non-small cell lung cancer (NSCLC) tissues was detected using quantitative Real-Time PCR.The relations between miR-34b expression level and clinical pathological parameters were assessed.For in vitro studies,lung cancer cells were transfected with double stranded synthetic miRNA mimics and scrambled controls.Immunohistochemistry technology was explored to validate the related downstream proteins of miR-34b.Results Expression of miR-34b was lower in NSCLC tissues than that in pericarcinous tissues of lung cancer.Additionally,the Spearman correlation test showed lower miR-34b expression was correlated with higher lymph node metastasis (P =0.031).In vitro gain-of-function experiments indicated that miR-34b suppressed cell proliferation by inducing cell apoptosis.IHC results showed relations between lower miR-34b and over-expression of phospho-Met (P =0.012).Conclusion MiR-34b down-regulates Met,following with subsequent changes of downstream p53 and Mdm2,and inversely p53 up-regulates miR-34b in a feedback loop.MiR-34b plays profound roles in progression of NSCLC by inducing apoptosis and decreasing lymph node metastasis.

Objective To explore the extent of axillary lymph node dissection in breast cancer patients with positive sentinel lymph nodes.Methods In this series,95 patients underwent complete axillary lymph node dissection (CALND) following positive sentinel lymph nodes identified and 97 patients underwent partial axillary lymph node dissection (PALND) at the absence of positive sentinel lymph nodes.The influence of different extent of axillary lymph node dissection was evaluated.Results The positive rate of level(Ⅰ + Ⅱ) non-sentinel lymph nodes (NSLN) and level Ⅲ lymph nodes was 68.4％ and 29.5％,respectively,in CALND group.In PALND situation,57.9％ CALND cases would have changed pathologic stage from pN1 to pN2 or pN3.But with level Ⅲ lymph node dissection followed PALND,only 2.1％ cases had changed pathologic stage from pN2 to pN3.Multivariate logistic regression showed that the number of positive SLNs (OR =2.157) and positive rate of SLNs (OR =10.374) were risk factors for having positive level Ⅲ lymph nodes.CALND needed longer operation time and larger postoperative drainage volume.Conclusions In cases of breast cancer with ≥ 3 positive sentinel lymph nodes,complete axillary lymph node dissection should be considered.

To observe the chelation of GRP78 with lead (Pb) and its localization changes, astroglial cells from Wistar rat brain were primarily cultured in medium with acetate Pb. The processes were terminated at different time points. The immunoprecipitation (IP) and Western blotting were used for GRP78 purification and expression and the Pb concentration was determined by employing atomic absorption spectrophotometry (AAS). The localization change of GRP78 was observed with colloid gold immunoelectron microscopy. The results showed that the expression of GRP78 was increased significantly in the cells treated with 1.0 mumol/L acetate Pb for 24 h and peaked at 96-192 h (P<0.01), and at the 12th day, the expression of GRP78 began to decrease but was still higher than normal (P<0.05). Pb content started to increase when cells were treated by acetate Pb for 24 h, and the peak appeared at 8 day (P<0.01), and then Pb content decreased gradually, but was still higher than normal (P<0.05). GRP78 protein expression began to remarkably increase when it transferred from ER to the cytosol around the nuclei 24 h after treatment with Pb. It is concluded that GRP78 in astroglia could strongly chelate with Pb ions and it might be a target protein of Pb.

Objective To analyze the relationship between obesity and arterial stiffness among population of different glucose tolerance status. Methods A cross-sectional study recruited the population aged 40 years or older from ShiJingShan district in Beijing. 9080 subjects were included by measured weight, waist circumference (WC), body mass index (BMI), waist/hip ratio (WHR) and WC/height ratio (WHtR) and hemodynamic indexes and the aortic stiffness (using brachial-ankle pulse wave velocity(baPWV). They were divided into 3 groups based on the results of OGTT and diabetes history: normal glucose tolerance group ( NGT group) ,impaired glucose regulation group ( IGR group) and diabetes mellitus group ( DM group) . The association between baPWV and different obese indexes was analyzed by multi-ple linear regression. Results According to the criterion of WC, WHR and WHtR, baPWV of central obesity group was significantly higher than the normal group(P<0. 01). There was no statistically significant differences based on BMI in DM group(P>0. 05), but it was of sta-tistically significant differences in NGT group and IGR group. Central obese indexes( WC、WHR、WHtR) showed a positive correlation to PWV in the studied groups(P<0. 05). BMI was only positively correlated with baPWV in NGT group, there was no significant correlation in IGR and DM group(P>0. 05). After adjusting for age, gender and cardiovascular risk factors, the multiple regression analysis found that for every 0. 1 point increase in WHR and WHtR, the PWV increased 40. 6 cm/s and 55. 3cm/s respectively. Conclusion There is a positive correlation between central obese indexes (WC、WHR、WHtR) and arterial stiffness, and the central obese indexes correlated with arterial stiffness better than BMI.

Objective To investigate changes in bone mineral density (BMD) and analyze its related factors in community populations to provide the early diagnosis of osteoporosis (OP) and give right guidance to prevent osteoporosis. Methods The quantitative ultrasound BMD analyzer was used to measure BMD of heel in 8 711 adults in community. At the same time a questionnaire survey was conducted among these subjects. The data were analyzed by Logistic stepwise regression analysis. Results With the age changing, males and females tended to have different BMD variation. Male and female's BMD peak values were respectively in 35-age group, 30-age group and decreased as age increased. T value of BMD was different between male and female (-1.40(-2.0--0.7)vs-1.3(-2.0--0.5))(P<0.001). Both men and women had a higher incidence of low bone mass (53.34%vs 47.46%), and the difference was significant (P<0.001), whereas the incidence of osteoporosis after 55 years of age between men and women was statistically significance (P<0.05). BMD was the lowest for female than for male in 50-age group, and the prevalence rate of OP was remarkably increased. Analysis of related factors of BMD showed that body mass index (BMI), age, diabetes and menopause were risk facts. Conclusion The BMD among adults is related to many factors, in which the age, BMI and menopause are the most important factors. Much attention should be paid to low bone mass phenomenon, timely monitoring, timely intervention, develop healthy working and living habits, is important to the prevention of osteoporosis and its complications.

Objective To explore the clinical value of prospective electrocardiography-triggering high-pitch spiral acquisition by dual-source CT (HP mode ) in children with congenital heart diseases (CHD).MethodsThirty-six patients ( mean age:0.67 years,range:1 month to 2 years and 6 months; 25 males;mean weight:7.7 kg)underwent prospective ECG-triggering high-pitch spiral acquisition.The dose length product (DLP) was recorded to calculate effective dose ( ED ).Two experienced radiologists made diagnosis and assessed the overall image quality by a five-point scale independently.The consistency of their judgment was determined by Kappa statistics.Surgeries were performed in 29 patients,and conventional cardiac angiography(CCA) was performed in 7 patients.The accuracy,sensitivity and specificity of HP mode were calculated based on the surgical or CCA findings.ResultsThe DLP was (5.12 ± 1.64) mGy.cm with a range of 2.4 mGy · cm to 9.2 mGy · cm and ED was (0.125 ± 0.027 ) mSv ranging from 0.078 mSv to 0.179 mSv.The average subjective image quality score was 4.2 ± 0.7.All images were diagnosable.Two radiologists made good agreement ( K =0.774,P ＜ 0.05 ).The accuracy,sensitivity and specificity of HP mode were 98.9％,94.2％ and 99.8％,respectively.ConclusionLow radiation dose with the accurate diagnosis of anomalies makes HP mode a new choice for children with CHD.

BACKGROUND: Belladonna drugs have been widely used in clinic in our country to improve microcirculation, or as a herbal anesthetic drug. However,there are few reports regarding the animal experiments on belladonna alkaloid against morphine addiction further OBJECTIVE: To observe the effects of belladonna alkaloid combined with morphine on morphine(Mor)-addicted mice so as to provide an experimental basis for development of belladonna to morphine addiction.DESIGN: A completely randomized-controlled study based on the experimental animals.SETTING: Laboratory of physiology of a medical college.MATERIALS: The study was performed at the Laboratory of Physiology of Medical Department of Hebei Engineering College from June 2004 to August 2004. Fifty 2-month old male healthy Kunming mice of clean grade with a body mass of(20±2) g were obtained from Experimental Animal Centre of Hebei Medical University.METHODS: According to evaluation index of dependence in Morphine-addicted animals, we chose pain threshold and naloxone-urged jumping response as items to observe. Fifty mice were randomly divided into 5 groups with 10 mice each, which were the control group (saline), the morphine group, the scopolamine(Sco)group, the anisodamine(Ani), atropine(Atr)group. The corresponding drugs or saline was administered by intraperitoneal (I. P.) injection once a day for 7 days. The pain threshold at 1 hour after I. P. Injection of drugs was observed from day 1 to day 7 by hot-plate method. Mice were given I.p. Injection of naloxone (Nal, 5 mg/kg ) 6hours after the last injection. The jumping times within 30 minutes were observed to evaluate the ,formation of the Morphine addiction.Nal-urged mice.RESULTS: The pain threshold of the mice in Morphine group was decreased significantly, and the jumping times and jumping rate were obviously increased compared with that of the control group( P ＜ 0.05 or P ＜ 0.01).The co-administration of Sco-Mor mixtures for 7 days significantly increased the pain threshold of Mor-dependent mice( P ＜ 0.01) and markedly decreased the jumping times and the jumping rate( P ＜ 0. 05) . Atr-Mor and Ani-Mor had a weak effect on the elevation of the pain threshold of Mor-dependent mice, but had strong effects on the decrease of the jumping times and the jumping rate( P ＜ 0. 01 ).CONCLUSION: Belladonna alkaloids all could antagonize Mor-dependence in mice at different degrees, which provide an important experimental evidence to develop belladonna drugs for preventing opium addiction.