Objective To explore the roles and clinical significance of glutamine(GLN) in carbon tetrachloride(CCl_(4)) induced acute hepatic injury.Methods The SD rats were divided into model group,GLN pretreated group and control group.The animal model was established by CCl_(4) intraperitoneal injection.GLN at dose of 1 g/kg was intragastrically administrated for 7 d before intraperitoneal injection of CCl_(4) in the rats of GLN pretreated group.The rats were executed 4,8,12,16,24 h after injure.To evaluate the hepatic injury,the serum alanine aminotransferase(ALT) and aspartate aminotransferase(AST) were detected by automatic biochemistry analysator.The liver tissue was observed by light microscope and transmission electron microscope(TEM).The expression of nuclear factor-?B(NF-?B) was detected by immunohistochemistry and the tumor necrosis factor?(TNF-?) was detected by reverse transcription polymerase chain reaction(RT-PCR).The apoptosis of hepatocyte was detected by TUNEL.The oncosis index was detected by TEM.Results The levels of ALT,AST,NF-?B,TNF-? mRNA in model group were apparently elevated as compared to control group(P

Objective To investigate the relationships between vascular factors and plaque morphology in the patients with acute coronary syndrome(ACS). Methods lntravascular ultrasound(IVUS) was performed on 56 consecutively enrolled patients with ACS. Cytometric bead array for seven vascular factors(sPE,t-PA, MCP-I, IL-8,IL-6,sVCAM-1, and sCD40L) was measured by cytometry. The others biomarkers were tested by ELISA or biochemistry. Differences in bio-factors were compared between vulnerable plaque and non- vulnerable plaque groups, accte myocardial infarction (AMI) and ustable angina (UA) patients, and occurring plaque rupture. The relationship between the parameters of morphology and vascular factors was analyzed. Results There were positive correlations between sVCAM-1sPE, sVCAM-1-sCD40L, sCD40L-sPE, IL-6-IL8,IL8-MCP4, and MCPI-sVCAM-1; CRP (18.868±4.907mg/L vs 5.806±3.553 mg/L)and IL-6 (19.5 pg/ml [9.2±44.6 pg/ml]vs 5.3 pg/ml [2.3～ 13.4 pg/ml])were elevated in the vulnerable plaque group(P <0.05). sCD40L(473.82±126.11 vs 237.94±34.78 pg/mi),sPE (107.214±39.90 vs 49.06±5.61 μg/L) and MCP-1(132.42±17.85 vs 127.174±13.27 pg/ml) were increased in the plaque rupture group(P < 0.05);There was correlation between tPA and plaque morphology(P < 0.05). Increases in sCD40L, MCP-1, sPE, and TC were independent factors for plaque rupture. Conclusions IL-6 and CRP may be biomarkers for vulnerable plaque and for diagnosis ofAMI, sCD40L, MCP-1 and sPE are potential markers when for plaque rupture patient present with severe ACS.

BACKGROUND:Simple pedicle screw fixation for thoracolumbar fractures has better outcomes, but there are some deficiencies, such as poor applicability for severe compression or burst fractures, strong vertebral pain, easy to cause vertebral wound denervation and paraspinal muscle injury, and slow recovery. OBJECTIVE:To investigate the clinical effects of pedicle screw fixation combined with artificial bone graft for the treatment of thoracolumbar fractures. METHODS:A total of 126 patients with thoracolumbar vertebral compression fractures, who had undergone pedicle screw fixation without bone graft (control group,n=62) and with bone graft (test group,n=64) were enroled. The fracture healing, anterior vertebral height ratio, sagittal Cobb angle, and loss rate of vertebral height after 6 months were observed by X-ray in the two groups. RESULTS AND CONCLUSION:Al patients were folowed up, and had complete fracture healing after 12-16 months. The anterior vertebral height and Cobb angle were both improved in the two groups at 1 week after operation (P < 0.01), but there was no difference between the two groups (P > 0.05). New bone formation was observed in the test group at 6 months after operation, and patients were pain-free; but the speed of bone formation was slower in the control group, and patients stil suffered from painful thoracolumbar fractures. There was no difference in the loss of anterior vertebral height and Cobb angle between the two groups (P> 0.05). These findings indicate that pedicle screw fixation combined with artificial bone graft lead to a better recovery in thoracolumbar fractures.

Ventilator aid respiration is important for patients with respiratory failure.But the negative emotional reaction of patient during connection and disconnection to ventilator will seriously influence the therapeutic effect,so a comprehensive underatanding about the emotional characteristic and dynamic emotion change of patient is of primary importance,because it will improve the diagnostic and therapeutic level,give patient personalized take care and make effective therapeutic plan,which will help keep a good emotion state for patient and accelerate recovery.This article will discuss how to use ventilator more effectively and economically.

Objective To investigate the diagnosis and treatment of pure red cell aplasia (PRCA) caused by human parvovirus B19 (HPVB19) after liver transplantation.Method The clinical data of one case of PRCA caused by HPVB19 after liver transplantation,including clinical manifestations,diagnosis and treatment,were retrospectively analyzed,and the related literatures were reviewed.Result The first case of PRCA caused by HPVB19 after liver transplantation in our center with typical clinical manifestations of anemia was diagnosed,including dizziness,fatigue,anhelation and so on.A progressive decrease in erythrocyte count,reticulocyte count and hemoglobin level were observed by blood routine test.Bone marrow aspiration biopsy showed an absence of erythroid cells and the HPVB19 DNA test of blood was positive.Erythrocyte count,reticulocyte count and hemoglobin level were back to normal after the anti-rejection strategy changing from tacrolimus and rapamycin to cyclosporin and rapamycin and a normal human myelogram was observed by bone marrow aspiration biopsy.The DNA concentration of HPVB19 in blood was below the lower test limit.The blood test of HPVB19 DNA showed a positive result again after the anti-rejection strategy changed back to tacrolimus and rapamycin duo to increased blood creatinine level while the reticulocyte count was still in normal scale.This is the first reported case of successfully cured PRCA caused by HPVB19 in liver transplantation patients through changing the anti-rejection strategy and also the first case of HPVB19 re-infection or relapse without PRCA recurrence in liver transplantation patients.Conclusion This case may indicate the importance of immunosuppressive drug changing in the treatment of liver recipients suffering from PRCA caused by HPVB19 infection,and the genotype test may promote the understanding and treatment for this disease.

Objective To investigate the manifestations and features of CT for glandular cystitis as well as cystic cystitis.Methods Clinical manifestations and CT imaging features of 39 cases with biopsy-proved glandular cystitis or cystic cystitis were analyzed retrospectively.Results Among 39 cases,33 were glandular cystitis and 6 were cystic cystitis.Two out of the 33 cases with glandular cystitis had a negative CT scan,and 31 had a positive CT scan among which 4 cases with extensive lesions showed diffuse thickening of the bladder wall,and 27 were with localized lesions.Furthermore,19 out of the 27 cases showed localized thickening of the bladder wall with smooth edge,which was a continuation of surrounding normal bladder wall;8 showed nodular lesions.17 of the 33 cases with glandular cystitis underwent contrast-enhanced CT scan which showed mildly enhancement consistent with or slightly stronger than the normal bladder wall in 15 cases and moderate uneven enhancement in 2 cases.The 6 cases with cystic cystitis showed diffuse thickened rough bladder wall.There were cystic shadows of various sizes in the inner wall of the bladder partially protruding into the bladder,which presented as a"beaded shape"manifestation.Conclusion The characteristic manifestations of glandular cystitis as well as cystic cystitis on CT scan are of great significance in diagnosing both of the diseases.

Objective To compare the clinical efficacy of three different therapies,including transjugular intrahepatic portosystemic shunt(TIPS)treatment,endoscopic treatment and medication treatment,combined with transhepatic arterial chemoembolization(TACE)in treating primary liver cancer complicated by portal hypertension and upper gastrointestinal bleeding.Methods A total of 105 patients with primary liver cancer associated with portal hypertension and upper gastrointestinal bleeding,who were admitted to the No.980 Hospital of PLA Joint Logistics Support Forces of China to receive treatment between January 2014 and June 2020,were enrolled in this study.According to the therapeutic scheme,the patients were divided into TIPS+TACE group(TIPS group,n=25),endoscopy+TACE group(endoscopy group,n=30),and medication+TACE group(medication group,n=50).The clinical efficacy,recurrence rate of bleeding,incidence of hepatic encephalopathy,and survival rate were compared between each other among the three groups.Results The differences in the postoperative 6-month,12-month and 24-month recurrence rates of bleeding between each other among the three groups were statistically significant(all P＜0.05).In TIPS group,the portal vein pressure decreased from preoperative(38.47±9.35)mmHg(1 mmHg=0.133 kPa)to postoperative(25.24±5.68)mmHg,the difference was statistically significant(P＜0.05).After treatment,the hemoglobin level in the three groups showed varying degrees of elevation,which in the TIPS group and endoscopy group were better than that in the medication group,the differences were statistically significant(P＜0.05).In all three groups,the differences in the recurrence rate of bleeding between postoperative 6-month value,12-month value and 24-month value were statistically significant(all P＜0.05).The postoperative 6-month,12-month and 24-month recurrence rates of bleeding in the TIPS group were lower than those in the endoscopy group and the medication group,and the differences were statistically significant(P＜0.05).The postoperative 12-month and 24-month recurrence rates of bleeding in the TIPS group were lower than those in the endoscopy group,and the differences were statistically significant(P＜0.05).The postoperative 12-month and 24-month recurrence rates of bleeding in the endoscopy group were lower than those in the medication group(P＜0.05),and the difference in the postoperative 6-month recurrence rate of bleeding between the two groups was not statistically significant(P＞0.05).The postoperative 6-month and 12-month incidences of hepatic encephalopathy in the TIPS group were higher than those in the endoscopy group and the medication group,the differences were statistically significant(P＜0.05),while the differences in the postoperative 6-month and 12-month incidences of hepatic encephalopathy between the endoscopy group and the medication group were not statistically significant(P＞0.05),and the differences in the postoperative 24-month incidence of hepatic encephalopathy between each other among the three groups were not statistically significant(P＞0.05).No statistically significant difference in the 6-month mortality existed between TIPS group and endoscopy group(P＞0.05),and the 6-month mortality of both TIPS group and endoscopy group was remarkably lower than that of the medication group(P＜0.05).The postoperative 12-month mortality and 24-month mortality in TIPS group were lower than those in the endoscopy group and the medication group,and the differences were statistically significant(P＜0.05),but the differences in the postoperative 12-month mortality and 24-month mortality between the endoscopy group and the medication group were not statistically significant(P＞0.05).Conclusion For primary liver cancer associated with portal hypertension and upper gastrointestinal bleeding,TIPS combined with TACE can effectively control tumor progression and prolong survival.(J Intervent Radiol,2024,32:33-37)

Objective    To explore the mechanism of volume-related mitral regurgitation (MR) from the anatomy of mitral valve. Methods    A total of 32 patients with ventricular septal defect (VSD) combined MR meeting inclusion criteria in West China Hospital from September 2018 to November 2019 were enrolled in this study. The direction relative to the cardiac axis: the deviation of the MR bundle along the left atrial wall was eccentric, otherwises it was central. There were 23 patients of VSD and eccentric MR (EMR, a VSD-EMR group), including 10 males and 13 females aged 21 (10, 56) months, and 9 patients of VSD and central MR (CMR, a VSD-CMR group), including 4 males and 5 females aged 26 (12, 87) months. Besides, 9 healthy children were enrolled in a control group, including 4 males and 5 females aged 49 (15, 72) months. All patients underwent transthoracic echocardiography (TTE) examination at 2 weeks before surgery and 6 months after surgery, respectively, The MR degree, end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), antero-posterior diameter (AP), annulus circumference (AC), commissural diameter (CD) were assessed. Results    Before operation, EDV, ESV, SV, AP, AC and CD in the VSD-EMR and VSD-CMR groups were significantly larger or longer than those in the control group (P<0.05); after operation, EDV, ESV, SV, AP and CD decreased compared with those before operation (P<0.05), but there was no significant difference compared with the control group (P>0.05). Compared with the control group, AC was slightly decreased (P<0.05). There was no significant difference in EF between and within groups before and after operation (P>0.05). The improvement rate of MR was 78.9%(15/19) in the VSD-EMR group and 100.0% (9/9) in the VSD-CMR group. Conclusion    After unloading of volume, the valve structure is back to normal except AC. The improvement rate of MR in the VSD-EMR group is lower than that in the VSD-CMR group, which may indicate that the mechanism of VSD-EMR is more complicated.