Cholangitis is one of the most common complications after Kasai operation in children with biliary atresia (BA), whose precise etiology is still unclear. The occurrence of cholangitis may be the results of concurrent effects of various factors such as the structural change of intrahepatic bile duct or insufficient volume of bile flow. The diagnosis for cholangitis is based on clinical manifestations nowadays, and combined therapies including antibiotics, steroids and hepatoprotectants have been used empirically. The prophylaxis and treatment of postoperative cholangitis is the key to improve the liver survival of biliary atresai patients. Only by figuring out the etiology of cholangitis that we can prevent it and make sure the long-term survival of BA patients.

Biliary atresia (BA), an inflammatory sclerosing cholangiopathy, is the leading cause of cholestasis in infants. Pathologic features of BA include progressive inflammation and intrahepatic and extrahepatic bile duct fibrosis. BA is charac?terized by rapid liver fibrosis. The activation of hepatic stellate cell (HSC) is most important in liver fibrosis. Many mecha?nisms are involved in this process. miRNA can promote the activation of HSC through a variety of signaling pathways by regu?lating the expression of target gene, then playing a regulatory role in the synthesis and degradation of extracellular matrix (ECM). A lot of literatures show that PI3K/Akt is closely related to the occurrence and development of hepatic fibrosis. PI3K/Akt signaling pathway is involved in the activation of HSC proliferation and apoptosis. MiRNA activates PI 3K/Akt signaling pathway through various target genes, and then activates HSC to promote the development of liver fibrosis. In this paper, the miRNA related to biliary atresia of liver fibrosis is summarized.

Objective To study the value of thromhus precursor protein(TpP)in early diagnosis of acute ischemic cerebrovascular disease.Methods The patients who showed completely or partly anterior circulation infarcts syndrome and were within 6 hours from onset on admission were observed dynamically.All patients were divided into thrombotic cerebral infarction(TCI)group(40 cases),transient ischemic attack (TIA)group(42 cases), and lacunar infarction(LI)group(37 cases).Concentrations of TpP in plasma obtained from three groups on admission were detected by enzyme linked immunosorbent assay(ELISA),then were compared with each other.The diagnostic value of plasma TpP to TCI within 6 hours from onset was analyzed with ROC curve.Results The level of TpP in TCI,TIA and LI group was(24.43±3.21),(15.51±2.65)and(13.52±5.45)mg/L respectively,and was significantly higher than that of healthy people (3.9±2.5)mg/L(P<0.01).The level of TpP was significantly higher in TCI group than that in TIA and LI group(P<0.01).The level of TpP was significantly higher in TIA group than that in LI group(P<0.01).The area under ROC curve for TpP to diagnose TCI was 0.979±0.013(P<0.01).The level of TpP on optimal cutoff was 19.1 mg/L.When the level of TpP was over 19.1 mg/L,TCI was determined with 95% sensitivity and 96%specificity, sum of which was largest of all.Conclusion The level of TpP can differentiate TCI from TIA and LI within 6 hours from onset.

AIM:To investigate the pathological changes of aquaporin 4 (AQP4) and related proteins in the rats with focal cerebral ischemia injury , and to observe the effect of silent information regulator 1 ( SIRT1) on the AQP4 ex-pression in order to explore the pathological mechanism of cerebral ischemia and brain edema .METHODS: Adult male SD rats were randomly divided into sham group and middle cerebral artery occlusion ( MCAO) model group.The MCAO model group was divided into the 4 time point (6 h, 12 h, 24 h and 48 h) subgroups.The animal model of MCAO was es-tablished by suture method in mature SD rats .The neural symptom score was measured at the corresponding time points . Morris water maze test was used to study the cognitive function .The cerebral infarction volume was evaluated by TTC stai-ning .The changes of brain water content was analyzed by a dry /wet weight method .The morphological changes of the brain tissues were observed under microscope with HE staining .The protein expression of SIRT 1, MMP-9 and AQP4 was deter-mined by Western blot .RESULTS: Compared with sham group , the neural function score of the rats in MCAO model group was significantly elevated .With the increasing reperfusion time , the cerebral infarction volume , brain tissue permea-bility and the brain water content were also increased .The increases in the protein levels of AQP 4 and the related proteins showed apparent changes .The protein expression of SIRT 1 was decreased , while the MMP-9 expression was increased .The most obvious differences of the protein level changes in MCAO-48 h model group were observed (P<0.01).CONCLU-SION:Accompanied with the aggravating cerebral injury after cerebral ischemia , the process of AQP4 expression is activa-ted with the increasing expression levels of MMP-9 and SIRT1.These factors are combined to induce the formation of brain edema.

Objective To study the occurrence of renal adverse reactions caused by cephalosporin antibiot-ics.Methods Reviewed 2000 -2014 Chinese medicine literature databaseadverse reaction under the cephalospo-rin antibiotics kidney damage caused by the reports,and the results were retrospectively analyzed.One by one to find and examine relevant literature,for which complete data of 52 papers in 182 cases of statistical analysis.Results In due to the use of cephalosporins and renal damage in 158 patients in neonates and the elderly accounted for the high-est proportion,respectively 26.58% and 22.78%.In addition,the statistical analysis found that the proportion of women(55.06%)was higher than men(44.94%),but the difference was not statistically significant(χ2 =0.65,P >0.05).In the event of 158 patients with renal damage of adverse reactions to use of the third generation cephalospo-rins was most,accounted for 59.49% (94 /158 );The second was patients with first generation cephalosporin [(20.25%(32 /158)];The second generation box of the fourth generation cephalosporin use accounted for the smal-lest proportion,13.92%(22 /158),6.33%(10 /158).The statistical analysis showed that the third generation cepha-losporin use ratio was significantly higher than that of the first generation,the second and the fourth generation,the differences were statistically significant(χ2 =50.74,70.61,92.32,all P <0.05).Add up to of all cephalosporins involves 11,which lead to renal adverse reactions were the most three kinds of cephalosporins antibiotics were ceftazi-dime,cefoperazone /sulbactam,ceftriaxone,the three belong to the third generation cephalosporins.In 158 patients appeared in 132 cases of hematuria,accounted for 83.54%.The main clinical manifestations for the course of medica-tion appeared visible to the naked eye hematuria,and few patients had pain in the waist or abdominal pain.In addi-tion,there were 12 cases of acute renal failure accounted for 7.59%,including 7 cases of death.14 cases of patients with urinary retention occurred,which accounted for 8.86%.Among them,8 patients for the use of cefazolin 2 -4 days after appeared dysuria,all male,aged 45 -75 years old,prompt discontinuation of the drug,after symptomatic treatment returned to normal.In addition,6 patients had dysuria,abdominal distension and pain in the use of ceftezole and cefuroxime,after discontinuation of the drug,symptoms improved obviously.Conclusion The clinical use of head hold bacteria cephalosporins drugs,if indeed there is a sign to caution in the use of the drugs,for age,kidney function is not complete person should also reduce drugs or careful with these drugs.At the same time,we should according to the patients'condition and individual differences in selecting the right drugs,should not give with other nephrotoxic drugs such as non steroidal anti -inflammatory drug,cyclosporine,and in the use process should closely monitor the blood concentration of patients and detect at any time in urine and kidney function change,and strive to achieve the rational use of the head hold bacteria carotenoid drugs.

In view of the increased incidences of cardiac arrest outside hospital year by year and younger tendency of the patients,foreign medical education practice showed that school-age children accepting cardiopulmonary resuscitation (CPR) skill training will benefit most from this survival skill in the future.This article elaborated on the meaning and methods of promoting CPR training in primary and middle school based on the present situation of CPR in order to promote its further development.

Objective To investigate the application value of intraoperative ultrasound (IOUS) in living donor liver transplantation(LDLT). Methods In LDLT, IOUS techniques (gray scale ultrasound and color Doppler flow imaging) were adopted in 26 donors and recipients for parenchymal and vascular examinations. The abnormal sonograms were observed, and the anatomic findings of hepatic veins were recorded. All the reanastomosed blood vessels were examined by gray scale ultrasound and color Doppler flow imaging before the operations were completed. Results A hepatic parenchymatous tumor was revealed by IOUS in one donor. Besides, middle hepatic veins in 13 donors and secondary hepatic veins with diameter﹥0.5 cm in 5 donors were confirmed by IOUS. Furthermore, one operation procedure was changed and one hepatic artery stenosis was established according to IOUS findings. Conclusion IOUS is a very useful means in evaluation of parenchymal and vascular conditions of donors and recipients in LDLT, which helps to select the best cross section and provides evidence for the change of surgical procedures.

Actins ; metabolism ; Carcinosarcoma ; metabolism ; pathology ; Craniopharyngioma ; pathology ; Diagnosis, Differential ; Esthesioneuroblastoma, Olfactory ; pathology ; Humans ; Immunohistochemistry ; Keratins ; metabolism ; Male ; Middle Aged ; Mucin-1 ; metabolism ; Nasal Cavity ; Nose Neoplasms ; metabolism ; pathology ; Paranasal Sinus Neoplasms ; metabolism ; pathology ; Pituitary Neoplasms ; pathology ; Teratoma ; metabolism ; pathology ; Vimentin ; metabolism

Objective To evaluate the effect of surgical treatment in facial nerve paralysis.Methods Clinical data of 29 cases in facial nerve paralysis were retrospectively analyzed.All of the 29 cases of facial paralysis,18 cases is the suppurative otitis media,9 cases is the temporal bone fracture,2 cases is the neoplasms of the temporal bone.The 29 cases of facial nerve paralysis were surgical treatment.8 cases by vertical segment or horizontal segment of facial nerve decompression,19 cases by the stylomastoid foramen to the geniculate ganglion of facial nerve decompression,2 cases by the itratemporal course of facial nerve decompression.1 case was underwent end-to-end anastomosis,2 cases of the greater auricular or the sural nerve graft for repairing facial nerve defect.All data were analyzed with Rank sum test.Results Makes a follow-up visit for 6～18 months,the facial nerve function(House-Brackman grading system)before the technique Ⅱ 6.9%,Ⅲ17.2%,Ⅳ34.5%,Ⅴ 31.0%,Ⅵ 10.3%,after the technique,restores Ⅰ 6.9%,Ⅱ27.6%,Ⅲ27.6%,Ⅳ 24.1%,Ⅴ 13.8%,statistics analysis facial nerve function restoreS has the significance difference(P＜0.005).Conclusions The facial nerve decompression and the nerve graft are useful method to treat facial paralysis.Surgical treatment of facial paralysis is satisfied in the suppurative otitis media and the temporal bone fracture.

In view of the contradictory phenomenon between yingfen dominating the interior when suffering exogenous epidemic febrile disease and ying disease dominating the exterior in cold pathogenic diseases,the authors revealed the misunderstanding of yingfen dominating the interior in epidemic febrile disease by a systematical analysis on the headstream of the theory,the connotation for diagnosis and treatment and logical relation. Based on the requirement of the theory guiding the clinical effectively,at the same time,the authors put forward a new opinion on classification of diagnosis and treatment on wei,qi,ying,blood system by the theory of the cold integrating the warm,which was a courageous exploration for the purpose of seeking unity of thinking on syndrome differentiation and treatment of external infection diseases.