Objective To investigate the relationship between the serum levels of vascular endothelial growth factor(VEGF) and severity and prognosis by evaluating its changes in severe sepsis patients. Method Us-ing control study design, a total of 29 severe sepsis patients who admired in ICU department of Second Hospital of Tianjin Medical University from July 2006 to November 2007 were enrolled. The patients were divided into survival group (n=16) and death group (n=13) according to the clinical outcomes at 28 days after onset.A total of 31 healthy persons were enrolled into the control group. Clinical and laboratory data including blood routine test,blood-gas analysis,blood chemistry,C-reactive protein,lactic acid were collected on the first,third and 7th day after on-set,respectively. APACHE Ⅱ score were calculated. VEGF levels were determined using ELISA method. Quantita-tive data were analyzed by Ftest. Results The VEGFlevels ofthe control groupwere (78.77±8.15) pg/mL, the VEGF levels of the survival group on the first,third and 7th day were (210.47±59.40) pg/mL, (161.79 ±32.58) pg/mL and (85.33±12.13) pg/mL, respectively. The peak value of VEGF levels appeared on the first day, Then,it decreased with the progression of the disease. The VEGF levels did not differ significantly between the control group and survival group on the 7th day (P>0.05). The VEGF levels in the death group on the first, third and 7th day were (324.12±44.35) pg/mL,(185.40±30.92) pg/mLand (273.32±55.23) pg/mL, respectively. The peak value of VEGF levels in the death group also appeared on the first day, but it did not de-crease significandy on the 7 th day as compared that on theist day. The value of VEGF levels on the 7 th day were significantly higher than that of the control group (P<0.01 ). The levels of VEGF were positive correlated with APACHEⅡ score(rs = 0.510,P<0.01), both VEGF levels and APACHEⅡ score were risk factors for the clinical outcomes of these patients. Conclusions The serum levels of VEGF are elevated at early stage in severe sepsis patients. The VEGF levels, which might be a potential prognositic factor for sepsis patients are significantly correlated with APACHE Ⅱ score.

Objective To observe the effects of a novel HLA-derived peptide, RDP1258, on the human peripheral blood mononuclear cell (PBMC) proliferation to ConA and MLR, and to investigate the mechanisms. Methods Peptide RDP1258 was chemically synthesized. The effects of the peptide on alloreactive cytotoxic activities of human PBMCs were observed using 3HTdR incorporation method. RDP1258, HLA-B2702.75-84, and control peptide were administrated respectively in every experiment. The activity of heme oxygenase-1 (HO-1) was analyzed by the enzymochemical method. Results The results showed that the synthetic HLA-derived peptide could obviously inhibit the proliferation of human PBMCs and inhibited HO activity in a dose-dependent manner in vitro. Conclusion HO-1 might participate in the inhibitory effect of RDP1258 on the proliferation of human PBMCs induced by mitogen and isoantigen.

OBJECTIVE: To explore the clinical results of rotating hinged knee systems in the treatment of complex knee diseases. METHODS: A total of 18 patients (11 males and 7 females, aged 58.7 years, ranging 34-66 years) with complex knee diseases were selected from Second Xiangya Hospital of Central South University, who underwent 20 primary knee arthroplasties (11 left and 9 right knees) using rotating hinged prosthesis from June 2003 to May 2008. These cases included 8 rheumatoid arthritis and 10 osteoarthritis, and presented 20?-30? varus or valgus deformity or 25?-40? fixed flexion deformity. Two patients underwent bilateral knee arthroplasty. Preoperatively bone loss and deformities in all cases was evaluated by AORI and X-ray. Postoperatively the clinical results were evaluated by the HSS knee rating score system. RESULTS: Knee arthroplasty was performed in all patients successfully and unilateral operative time was 95-147 minutes (average 129 minutes). The patients were followed up form 11 months to 6 years (average 4.2 years). All the knee pain was released and the deformities were corrected. The range of joint movements was up to 100?-136?. The patients could walk without assistance of walking stick. No light or deep infection, prosthesis subsidence, dislocation or fracture resorption was found. The average HSS score was 86 (78-95 scores) post-operation while 42 (25-56 scores) pre-operation. Excellent results were received in 11 cases, good in 6 cases. The rate of excellent or good was 94%. CONCLUSION: The knee arthroplasty using rotating hinged knee systems is an effective method to treat complex knee diseases such as severe extroversion or varus. It can release the knee pain and improve joint function and the quality of life.

Objective To investigate the accuracy of high-resolution magnetic resonance imaging (MRI) in diagnosis of the lymph nodes metastases (LNMs) and stage of rectal cancer (RC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 65 patients with RC who were admitted to the Peking University People's Hospital between April 2014 and April 2016 were collected.The results of postoperative pathological examination:of 65 patients with RC,24 had positive LNMs and 41 had negative LNMs;N0,N1 and N2 were respectively detected in 41,14 and 10 patients.Imaging data were captured using 3.0-Tesla MRI and body phased-array coil.Diagnostic criteria for LNMs of RC:criterion 1:irregular lymph node boundaries and signal characteristics were not considered;criterion 2:heterogeneous signal of lymph nodes and boundary characteristics were not considered;criterion 3:irregular lymph node boundaries and / or heterogeneous signal of lymph nodes.The American Joint Committee on Cancer (AJCC) cancer staging manual (7th edition) have established the N staging scheme for RC.Lymph nodes distribution according to the rectal lymphatic drainage:D1was located in fascia of the mesorectum;D1a above the level of tumor;D1b at the level of tumor;D1c under the level of tumor;D2 around the superior rectal artery and root of inferior mesenteric artery;D3 on the side of pelvic cavity.Observation indicators:(1) Efficiency and comparison of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria (postoperative pathological result as a gold standard).(2) Efficiency and comparison of N stage of RC diagnosed by high-resolution MRIaccording to the 3 criteria (postoperative pathological result as a gold standard).(3) Efficiency of LNMs of RC diagnosed by high-resolution MRI according to the maximum short diameter of lymph nodes:① maximum short diameter distribution of positive and negative LNMs of RC;②sensitivity,specificity,accuracy and consistency of LNMs diagnosed using different maximum short diameter of lymph nodes as a threshold (postoperative pathological result as a gold standard);③ comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes with highest diagnostic accuracy as a threshold and using the 3 criteria;④ sensitivity,specificity,accuracy and consistency (postoperative pathological result as a gold standard) of LNMs diagnosed using maximum short diameter of lymph nodes with highest diagnostic accuracy as a threshold combined with the highest efficiency in the (1),and its comparison in accuracy of LNMs with highest diagnostic accuracy as a threshold.(4) Distribution of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria.(5) Follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' postoperative survival up to October 2016.The sensitivity,specificity,accuracy and comparison of ratio were respectively done by the chi-square test.Kappa test was used for consistency,tκ ≤ 0.40was used as low consistency,0.40＜κ≤0.60 as moderate consistency,0.60＜κ≤0.80 as higher consistency,and κ＞ 0.80 very high consistency.Results (1) Efficiency and comparison of LNMs of RC diagnosed by highresolution MRIaccording to the 3 criteria:accuracies of LNMs of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were respectively 93.8％,87.7％ and 90.8％,showing very.high,higher and very high consistencies compared with postoperative pathological results (κ =0.87,0.74,0.81,P＜0.05),and with no statistically significant difference in diagnostic accuracy among them (x2=1.495,P＞0.05).(2) Efficiency and comparison of N stage of RC diagnosed by high-resolution MRI according to the 3 criteria:accuracies of N stage of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were respectively 87.7％,83.1％ and 84.6％,showing the same higher consistencies compared with postoperative pathological result (κ =0.77,0.68,0.72,P＜0.05),and with no statistically significant difference in N stage among them (x2=0.567,P＞0.05).(3) Efficiency of LNMs of RC diagnosed by high-resolution MRI according to the maximum short diameter of lymph nodes:① maximum short diameter distribution of positive and negative LNMs of RC:maximum short diameter ranges were respectively 3-18 mm in positive LNMs and 1-9 mm in negative LNMs,and maximum short diameter ＜3 mm and ≥ 10 mm were respectively negative and positive LNMs.② Efficiency of LNMs of RC diagnosed using different maximum short diameter of lymph nodes as a threshold:diagnostic accuracy of 70.8％was the highest when maximum short diameter ＞7 mm was used as a standard of positive LNMs,showing a low consistency compared with postoperative pathological result (κ =0.29,P＜0.05).③ Comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes ＞7 mm as a threshold and using the 3 criteria:there was a statistically significant difference among them (x2 =15.637,P＜0.05);accuracies of LNMs of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were higher than that diagnosed using maximum short diameter of lymph nodes ＞7 mm as a threshold (x2 =10.354,5.656,6.923,P＜0.05).④Comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes ＞7 mm combined with the criterion 3 as a threshold and using maximum short diameter ＞7 mm as a threshold:the criterion 3 was used as a threshold because there was no statistically significant difference in diagnostic accuracy among the 3 criteria (P＞ 0.05).Diagnostic accuracy was 78.5％ when maximum short diameter ＞7 mm combined with the criterion 3 as a threshold,showing a low consistency compared with postoperative pathological result (κ =0.36,P＜0.05),with no statistically significant difference in diagnostic accuracy compared with maximum short diameter ＞ 7 mm as a threshold (x2=0.154,P＞0.05).(4) Distribution of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria:positive LNMs of RC diagnosed by high-resolution MRI located mostly in D1 (76.1％-83.1％)and D1b(77.8％-81.4％).(5) Follow-up situations:of 65 patients,54 were followed up for 6-25 months,with a median time of 14 months.During the follow-up,7 patients had distant metastases and 47 had tumor-free survival.Conclusions There are higher accuracies of LNMs and N stage of RC diagnosed using preoperative highresolution MRI.Diagnostic accuracy of LNMs of RC cannot be improved when characteristics of lymph node morphology and size are used as a diagnostic standard.The positive LNMs of RC locate mostly in D1 and Dib.

Objective To evaluate the feasibility of renal artery angiography with interpolated finite impulse response (IRFR) sequence on 1.5T MR. Methods A total of 122 subjects underwent MR scan with IFIR sequence. On axial image of IFIR, bilateral signal-to-noise ratio (SNR) and breath artifact of renal artery were measured and 3D maximum intensity projection (MIP) images were reconstructed on workstation ADW 4.3, and each branch was scored according to its displaying quality. Influence of SNR, age and breath artifact on the displaying of renal artery were compared and analyzed. Results Renal segmental artery could be seen in 112 subjects (91.80%). Among them, segmental artery was showed clearly in 78 subjects (63.93%), post-segmental artery was showed in 54 subjects (44.26%) and branches of post-segmental artery was showed in 22 subjects (18.03%). There was statistical difference of renal artery scores mean rank between ≥60 years group and ＜60 years group (49.25 vs 67.48, P=0.006), as well as between the group without and with breath artifact (66.66 vs 43.35, P=0.002). No statistical difference of SNR was found among renal artery scores from 1-5 (P=0.177). Conclusion IFIR sequence is simple and safe for renal artery angiography on 1.5T MR, and different grades of renal artery branch can be showed clearly.

Objective To study the effect and prognosis of multiple channels percutaneous renal ureteral calculi removal in the treatment of patients with complex renal calculi.Methods One hundred and forty-four cases patients with complex renal calculi accepted treatment in Dongda Hospital of Shanxian County from June 2012 to March 2015 for research.According to the random number table method,the patients were divided into the observation group and the control group,72 cases in each group.The single channel type was used in the control group,while multi-channel type operation was use in the observation group.Indicators related to the operation,stones clearance rate,changes in the degree of hydronephrosis,and the major complications after treatment of the two groups were compared.Results The operation time of the observation group was (104.82 ±8.54) min,significantly longer than that of the control group ((90.23 ±7.68) min),but the duration of hospital stay,fistulation tube indwelling time and the residual stone surface area were (6.84±1.25) d,(5.23±2.16) d and (223.16± 113.49) mm2 respectively,significantly less than that of the control group ((8.33±2.13) d,(6.74 ± 2.19) d and (429.54 ± 107.88) mm2 respectively),the differences were statistically significant(P =0.000).The stone removal rate of the observation group was 86.11％ (62/72),significantly higher than that of the control group(72.22％ (52/72)),the difference was statistically significant (P =0.040).There was no significant difference in terms of the total stone clearance rate and the degree of kidney water after treatment between the two groups (P＞0.05).The total complication rate of the observation group was 11.11％(8/72),of the control group was 9.72％ (7/72),and the difference was not statistically significant(P ＞0.05).Conclusion The efficacy of multi-channel operation for complex renal calculi is better,safe and feasible,but should reduce the number of channels as much as possible,so as to reduce the damage to patients effectively.

Objective To Compare different methods of quantitative breast density measurement.Methods The study included sixty patients who underwent both mammography and breast MRI. The breast density was computed automatically on digital mammograms with R2 workstation. Two experienced radiologists read the mammograms and assessed the breast density with Wolfe and ACR classification respectively. Fuzzy C-means clustering algorithm (FCM) was used to assess breast density on MRI. Each assessment method was repeated after 2 weeks. Spearman and Pearson correlations of inter- and intrareader and intermodality were computed for density estimates. Results Inter- and intrareader correlation of Wolfe classification were 0. 74 and 0. 65, and they were 0. 74 and 0. 82 for ACR classification respectively.Correlation between Wolfe and ACR classification was 0. 77. High interreader correlation of 0. 98 and intrareader correlation of 0. 96 was observed with MR FCM measurement. And the correlation between digital mammograms and MRI was high in the assessment of breast density (r = 0. 81, P ＜ 0. 01). Conclusion High correlation of breast density estimates on digital mammograms and MRI FCM suggested the former could be used as a simple and accurate method.

The study is to prepare taste masking and enteric-coated clarithromycin granules by melting and fluid bed coating technology. Clarithromycin and matrix materials were melted at a certain temperature, and then made into particles by fluidized bed coating. X-ray powder diffraction and scanning electron microscopy were used to identify the crystal and morphology of drug loading granules. In vitro dissolution method was used for the observation of the drug release behavior. The results showed that the drug particles size range was 0.2 - 0.6 mm; the crystal form of clarithromycin in the granule did not change; enteric-coated granules accumulated release in 0.1 mol L(-1) hydrochloric acid in 2 h was less than 10%, while in pH 6.8 phosphate buffer in 1 h was more than 80%. The taste masking and enteric-coated clarithromycin granules not only have good taste masking effect, but also have a good release behavior. It is expected to have better clinical application.

ObjectiveTo analyze the clinical features of tertiary hyperparathyroidism. MethodsThe data including symptoms, past history, bone and joint X-ray, bone mass density, bone SPECT, blood routine, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone ( PTH), as well as parathyroid ultrasonic or CT,parathyroid ECT, and parathyroid pathology were collected from seven patients with tertiary hyperparathyroidism.ResultsThe first symptom in 6 patients was bone ache, one of them was thirsty, and 1 patient had fracture. Four patients had past history of gallbladder stone or renal stone. Four subjects presented with osteoporosis and 2 of them had fractures. All 7 patients suffered from hypercalcaemia, along with high PTH level, 6 with hypophosphataemia and 6 with high alkaline phosphatase level. The enlarged parathyroid glands were detected in five patients by ultrasonic or CT. Tc99 scans of parathyroid gland revealed hyperfunctioning nodes in 3 subjects. Six patients were operated, and pathological results showed adenoma in parathyroid gland in 5 patients and adenocarcinoma in 1 patient. Serum calcium and PTH levels returned to normal in all the operated patients.ConclusionsPatients who present bone ache, osteoporosis, spontaneous fracture, past history of gallbladder stone or renal stone, high serum calcium, and PTH levels, should be aware of the probability of tertiary hyperparathyroidism. The confirmed diagnosis depends on pathological result.