Objective To investigate the clinicopathological features,the diagnosis and therapy of primary pulmonary perivascular epithelioid cell tumor (PEComa). Methods One case of primary pulmonary perivascular epithelioid cell tumor diagnosed and treated in April 2010 was presented. The clinical symptoms,imaging, pathology features, treatment and follow-up record of the patient were analyzed retrospectively,and relevant literatures were reviewed. Results The patient had not special clinical symptoms and was found through the medical checkup. The imaging methods could easily find the tumor but hard to diagnose it. The final diagnosis depended on the pathologic features and immunohistochemistry techniques. Among present literatures, scarce cases of pulmonary malignant PEComa were reported. Conclusion Primary pulmonary PEComa is a very rare tumor that arises from mesenchymal tissues, especially the malignant cases. The diagnosis of PEComa mainly depends on the pathological features. Because of the uncertain biologic behavior pulmonary PEComa should be followed up closely for a long term.

Objective To investigate the effect of severe eraniocerebral injury patients with hypernatremia.Methods Review and analysis of 356 cases of severe craniocerebral injury and 185 cases of hypernatremia. Analysis on the relationship between hypernatremia and prognosis. Results The 185 eases of severe craniocerebral injury with hypernatremia, the incidence is 52 %. Including 136 death cases, the mortality rate was 73.5 %. Hypernatremia appeared after admission since 1～18 days,the average days for this were 4.1 days. 69 cases appeare hypernatremia in 24 hours,60 cases in 48 hours,16 cases in 72 hours,145 cases of hypematremia appeared after admission within 3 days,about 78%. Blood sodium level was 148～196mmol/L, average was 172mmol/L, duration time was 1～25 days, average was 5.4 days. Conclusion It seems that almost hypernatremia appeared, when severe crartiocerebral was injuried in 3 days. The mortality is very high.

Purpose To explore the expression of Toll-like receptor 4 (TLR4), PI3K, AKT and NF-κB in cervical lesions, and to in-vestigate their association with human papillomavirus ( HPV) 16 infection. Methods Immunohistochemical SP staining was performed to detect the expression of TLR4, PI3K, AKT, NF-κB in paraffin-embedded cervical tissue specimens from Uighur women with chroni-cal cervicitis, cervical intraepithelial neoplasia ( CIN) and cervical squamous cell carcinoma ( CSCC) . The HPV 16 DNA was detected by PCR. Results The positive expression rates of TLR4, PI3K, AKT, NF-κB in chronical cervicitis, CIN and cervical cancer were 32. 0%, 59. 4%, 77. 8%, 28. 0%, 56. 3%, 73. 0%, 24. 0%, 56. 3%, 79. 4%, and 8. 0%, 48. 4%, 81. 0%, respectively. The expression of them was higher in cervicitis than in CIN and cevical cancer ( P<0. 05 ) . The positive expression rates of HPV 16 in three groups were 8. 0%, 48. 4% and 81. 0% (P<0. 05). The expression of TLR4, PI3K, NF-κB and HPV 16 was related to cervi-cal cancer differentiation (P<0. 05). PI3K and AKT were significantly correlated with FIGOs’ stages (P<0. 05). NF-κB was corre-lated with lymph node metastasis. The expression of TLR4 was significantly associated with HPV 16 infection in CIN and CSCC ( r=0. 303, P=0. 015, r=0. 633, P=0. 000), and correlation with PI3K in CIN and CSCC (r=0. 254, P=0. 045, r=0. 386, P=0. 003). PI3K was associated with AKT only in CSCC (r=0. 298, P=0. 018). Conclusions The expression of TLR4 can be up-regulated by HPV 16 infection. High expression of PI3K/AKT signal pathway mediated by TLR4 may play important roles in the devel-opment and progression of CIN and CSCC, and HPV 16 infection may be a trigger factor affecting the molecular signal pathway.

Objective To investigate the characteristics of cognitive development in different aged neonates.Methods Sixty-two newborns were randomly selected from relatively normal full-term babies in Changzhou Children's Hospital from December 2013 to September 2015.Electroencephalogram (EEG) and event-related potentials (ERP) were recorded with the auditory Oddball paradigm.Cognitive EEG delta power and the N2 wave area of different ages (1-10,11-20 and 21-28 days) were compared.Paired t test,analysis of variance and the LSD test were used for statistical analysis.Results (1) Delta power in the resting and cognition state:neonatal cognitive delta power in the 11-20 and 21-28 days old groups was (268.22± 132.09) and (236.01±97.40) μ V2,respectively,significantly higher than the resting delta power of the same groups [(175.80 ± 80.80) and (178.78 ± 104.74) μ V2,t=2.539 and 2.845,P=0.020 and 0.010,respectively].(2) Cognitive delta power in different aged neonates:cognitive delta power in the 11-20 and 21-28 days old groups was (268.22± 132.09) and (236.01 ±97.40) μ V2,respectively,higher than that of the 1-10 days old group [(116.70± 56.70) μV2],with statistically significant difference (LSD test,both P＜0.05).(3) Neonatal ERP:ERP of the 1-10 days old group presented with multiple peaks of a flat composite wave,in the 11-20 and 21-28 days old groups,the N2 wave showed a regular and rising trend,gradually to a single wave,and became gradually mature.The N2 wave area in the 11-20 and 21-28 days old groups was (6 435.08±2 212.34) and (6 536.75± 1 969.86) ms · μ V,respectively,which was larger than that in the 1-10 days old group [(4 230.04± 1 550.55) ms · μ V] (LSD test,both P＜0.05).Conclusions Neonatal cognitive development is enhanced with age and there may be a period of more rapid cognitive development,especially at 11-20 days of age.

Objective To explore the the rapeutic efficacies of different surgical methods for hypertensive intracerebral hemorrhage so as to find out their indications. Methods Admittedin to 218 eases of hypertensive intracerebral hemorrhage since, which treated by tereotaetie aspiration or eraniotomy through small bone window or eraniotomy through bone flap was divided into three subgroups according to GCS scores and hematoma volume indications and trerapeutic outcomes of these three surgical methods were analyzed comparatively. Results Satisfactory prognosis was found in 64(60.4%) patients of brain hematoma puncture drainage. Satisfactory prognosis was found in 35(54.7%) patients of small windowing skull. No significant was occurred between the two groups (P＞0.05). The mortality rate decreased obviously in the bone-flap eraniotomy group with greathematoma volume (29.2%). Conclusions Puncture drainagc has small wound and instauration quickly. And valid for time to relief encephalothlipsis. In most circumstances, puncture drainage can replace the small hole craniotomy. Bone flap craniotomy can lower a great deal of apoplexy death rate.

Objective To analyze the clinical manifestations,diagnosis and treatment of idiopathic left ventricular tachycardia(ILVT)in infants and young children.Methods The clinical data,including manifestations,lab results and treatments of 37 cases of ILVT in infants and young children were analyzed retrospectively.Results ILVT were seen more in young children older than 1 year old and male infants.A total of 37 cases with ILVT showed diverse clinical manifestations,5 children had cardiac insufficiency with oliguria and edema,2 children had syncope.There were 8 children without any symptoms,and 22 children had some symptoms,which mainly included agitation and crying,weakness and sweaty,vomitting and pale com-plexion.Holter showed incessant ILVT in 20 cases(54.1%),and paroxysmal in 17 cases(45.9%).Of the 37 cases,9 cases presented tachycardia-induced cardiomyopathy(TIC),8 of them were secondary to the in-cessant ILVT.Children with TIC compared with those without TIC,the ventricular rate were faster[(206.2 ± 38.7)beats/min vs.(171.8 ±38.7)beats/min,P<0.05],the duration were longer[(22.6 ± 15.3)days vs. (9.8 ±6.0)days,P<0.05].A total of 34 cases were given by antiarrhythmic drugs,verapamil was higher effective in reversion to sinus rhythm.Radiofrequency ablations were conducted in 8 cases,resulting in ven-tricular tachycardia elimination.All of children were fine during following up periods.After successful control of tachycardia,left ventricular end-diastolic diameter and left ventricular ejection fraction in patients with TIC gradually recovered[(35.4 ± 7.2 )mm vs.(28.9 ± 5.6 )mm,P <0.05;(46.7 ± 4.0 )% vs.(70.1 ± 1 .5 )%,P<0.0 1 ] .Conclusion ILVT in infants and young children are rare,and present different manifes-tions.An incessant ILVT with faster ventricular rate and longer duration are more frequently complicated by TIC.Radiofrequency ablation is the effective way of radical cure of the disease.The diagnosis and treatment for the tachycardia are particularly important in early time,and the prognosis are good.

ObjectiveTo explore the treatment desicions of Contusion and laceration of the brain at temporal lobe and frontal lobe with small hematoma and base pond changes. MethodsAccording to three grades of consciousnee,areas of brain contusion or quantity of hematoma,and changes of base pond,it divided 274 patients into different types,then analyzed treatments and retrospect to them. Results33 cases of Type Ⅰ:33 cases had operated immediatelly and 3 cases had died;44 cases of Type Ⅱ:17 cases had delayed operations and 1 case had died;27 cases without operations.Type Ⅲ: 15 cases without operations. ConclusionThese "three-3" method of grade could be regarded as the quantification index of treatment desicions before deterioration.

Objective To investigate the choice and efficacy of surgury in treatment of hypertensive intracerebral hemorrhage. Methods The clinical data of 278 cases of hypertensive cerebral hemorrhage were retrospectively analyzed. These cases respectively used CT Stereotactic puncture and drainage, minimally invasive craniotomy and Craniotomy hematoma surgical treatment. According to the GCS cores and hematoma volume,they were divided into 3 groups so as to comparatively analyze the efficacy of different surgical methods. Results Hypertensive cerebral hemorrhage CT stereotactic puncture good prognosis group was 74 cases(59.6% ) ,minimally invasive craniotomy group of good prognosis ,48 cases(56.4% ) ,there was no significant difference between the two groups(P＞ 0.05). Craniotomy mortality is 15 cases (21.7% ). Conclusion Three surgical treatment of hypertensive cerebral hemorrhage had their own characteristics:CT stereotactic puncture and drainage characteristics with less trauma,faster recovery,timely and effectively discharge brain compression. It was a simple and effective treatment for hypertensive intracerebral hemorrhage. In many cases, CT sterotactic puncture and drainage could replace invasive hematoma evacuation.

Objective To compare the difference of the effects and safety of endoscopic submucosal dissection (ESD) and surgery for early gastric cancer. Methods We searched the Pubmed, CBM, Embase, Cochrane Library, CNKI, CQVIP and WanFang data from January 1990 to June 2016 studies comparing endoscopic resection with gastrectomy for treatment of early gastric cancer. We selected the eligible studies according the including and excluding criteria. The quality of the included studies was assess using the Newcastle-Ottawa Scale (NOS), then using Revman 5.3 to make the Meta analysis. Result The meta-analysis enrolled 12 studies with 4331 patients, all of the studies were retrospectively analyzed. The result of the meta-analysis showed that there were no significant difference regarding the recurrence rate [(22/2586, 0.85%) vs (6/1134, 0.53%), P = 0.370] and five-year survival rate [(852/909, 93.72%) vs (707/746, 94.77%), P = 0.340] between endoscopic resection and gastrectomy. Gastrectomy was associated with higher en bloc resection rate, which were 100.00% and 92.23% respectively. However, gastrectomy was also related to longer operative time (SMD = -3.04, 95%CI: -3.64 ~ -2.45, P = 0.000) and hospital stay (SMD = -2.53, 95%CI: -3.73 ~ -1.32, P = 0.000). The postoperative complication was also higher than endoscopic, which were (45/816, 5.50%) vs (101/686, 14.72%) respectively. Conclusion There were no significant difference regarding recurrence rate and five-year survival rate between endoscopic and gastrectomy. While the en bloc resection rate was lower than gastrectomy, endoscopic offers a shorter hospital stay, shorter operative time with minimal invasive and fewer operating and postoperative complications than gastrectomy. Endoscopic should be recommended as a standard treatment for early gastric cancer with indications.

Objective To evaluate the safety of anesthesia endoscopic retrograde cholangio pancreatography (ERCP) under general anesthesia.Methods From January 1st,2008 to June 30th,2016,patients underwent ERCP under general anesthesia were enrolled as anesthesia group and from January 1st,2005 to December 31st,2007,patients accepted ERCP without anesthesia were enrolled as control group.Chi-square test was performed to analyze disease composition,conditions during operation,success rate of operation and complications in these two groups.Results A total of 14 724 patients with ERCP under general anesthesia and 2 102 patients received ERCP without anesthesia were enrolled.In 14 724 patients with ERCP under general anesthesia,1 799 cases had malignant biliary and pancreatic diseases and 12 925 cases with biliary and pancreatic diseases.During the operation,transient hypoxemia occurred in 441 cases (3.00％) and relieved by increasing oxygen flow,lower anesthetic dose or lifting lower jaw.The success rate of ERCP in the anesthesia group (98.41 ％,14 490/14 724) was higher than that in the control group (97.34％,2 046/2 102),and the difference was statistically significant (x2 =11.500,P=0.001).The incidence rate of post-ERCP pancreatitis in the anesthesia group was 2.35％ (346/14 724),which was lower than that in the control group (3.85％,81/2 102),and the difference was statistically significant (x2 =16.813,P＜0.01).Conclusion ERCP under general anesthesia is safe,which could increase the success rate of operation and reduce the incidence rate of post-ERCP pancreatitis.