Alkaloids ; Antineoplastic Agents, Phytogenic ; Chemical Phenomena ; Chemistry ; Harringtonines

Objective To evaluate the imaging findings and its pathologic basis of intrahepatic peripheral cholangiocarcinoma(IHPCC).Methods 25 patients with pathologically proven IHPCC were reviewed retrospectively.B-ultrasonic scanning (BUS) was performed in allpatients.CT(including conventional unenhanced and enhanced scan) was done in 21 patients.11 patients received MRI with dynamicscannings.9 patients underwent digital subtraction angiography(DSA).Results 15 patients were hypoecho and 10 patients were brieflyhyperecho or hyperecho in BUS, homogeneous or heterogeneous. On unenhanced CT, the lesions were of low density with ill-definedborder. The lesions were low intensity on T1WI and moderately high intensity with low intensity in central area on T2WI . Dynamic CT and MRI showed gradually enhancement from the periphery toward the center of the lesion in most patients. Focal dilatation and calculus of the intrahepatic bile ducts around the tumor could be seen and retraction of liver capsule could also be seen in imaging appearance of IHPCC. On selective DSA ,the lesions were resemble to the tumors with rare blood vessels ,on superselective DSA, tumor vascular plexus were tiny and like “flocculus” in arterial period, obvious staining with ill-defined during parenchymal phase in 9 patients. Pathologically,tumor vessels were rare, these were plenty of interstitial fibrous tissue between tumor cells. Conclusion The imaging features of intrahepatic peripheral cholangiocarcinoma are of certain characteristic.

Objective To explore the efficacy of trazodone replacement treatment on benzodiazepine drugs dependence and effect of cognitive function on senile patients.Methods 51 senile patients with benzodiazepine drugs dependence were assigned with dosage tacho-decrement and replaced by trazodone.The patients were discontinuanced taking benzodiazepine in 14 days and taken at a draught of trazodone before retiring about 6 months.Clinical effect and side effects were assessed with the Pittsburgh sleep quality index (PSQJ) and treatment emergent symptom scale(TESS) before and after treatment.Cognitive function was evaluated with Wechsler intelligence scale for adult-Chinese revised (WAIS-RC) and Wechsler mermory scale for adult-Chinese revised ( WMS-RC ) once before and after treatment.Results The scores total PSQJ( ( 13.17 ± 3.70),( 11.05 ± 3.48 ) ),the sleep quality( (2.36 ± 0.33 ),( 1.91 ± 0.29 ) ),daily function disorder,sleep disorder were significantly lower than before treatment while the other factor scores were not significantly changed.Trazodone wes effective without severe side effects and dependence.The study group showed significantly lower scores in learning,calculation,the signs of figure,wood puzzles,long-term memory,short-term memory,immediate memory,memory quotient in the assessment of cognitive function than after treatmemt (P ＜ 0.05 ).Conclusion Trazodone is an ideal medicine to senile insomnia.

Objective To study the difference of image quality and radiation dose between different exposure modes with full-field digital mammography (FFDM).Methods The Fluke18-220mammographic phantom was exposed by FFDM system with different exposure modes at automatic exposure control ( AEC ) ,including contrast mode,standard mode and dose mode,and the exposure factors and radiation dose were recorded.The images on monitor with the best window width and window level were read by four independent radiologists.The images of specks groups,nylon fibers and masses was assessed by the four experienced readers at the criterion of American College of Radiology.Results The detection of specks groups,nylon fibers and masses were statistically different at the contrast mode and standard mode (F =41.321,P ＜ 0.05),further at the contrast mode and dose mode.The detection of specks groups、nylon fibers and masses were not statistically different( P ＞ 0.05 ) at standard mode and dose mode,but the radiation doses were different.The ESD at standard mode and dose mode was 4.5 and 3.15 mGy,respectively.The AGD of standard mode and dose mode was 1.18 mGy and 0.78 mGy,respectively.Conclusions The standard mode and dose mode of FFDM might be fit for most patients,especially at the dose mode.Contrast mode of FFDM should be strictly controled in use.

Objective To explore the different operation modes for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney.Method A retrospective analysis was performed on 48 cases of native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney,including 14 cases receiving open surgery (open surgery),22 cases receiving laparoscopic radical nephroureterectomy with bladder cuff resection through a lower abdomen oblique incision (oblique incision group) and 12 cases receiving modified endoscope assisted Plunk technique (Plunk group).The operating time,amount of bleeding and blood transfusion during operation,recovery of intestinal function,time of indwelling drainage tube and wound suture,the total cost of hospitalization,the hospital stay and the incidence of complications were comparatively analyzed.Result The operating time in open group was shortest.Group of Pluck is better than other groups in the aspects of Time of wound suture and intestinal function time in shorter in Plunk group than the rest two group (P＜0.05),and amount of bleeding and incidence of complication in Plunk group were higher than oblique incision group (P＜0.05).The incidence of complications and amount of bleeding were decreased significantly as compared with the rest groups (P＜0.05).Conclusion The mode of the laparoscopic radical nephroureterectomy with bladder cuff resection through a lower abdomen oblique incision has the advantages of high security,minimal invasion and satisfactory treatment effect.It is especially suitable for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney.

A retrospective study was carried out to analyze 3 cases of renal echinococcosis confirmed by surgery and pathology in the hospital during 1999-2008.The patients were examined by 64-CT plain scan and multiple period enhancement scan.Among them,2 were multi-daughter-cyst hydatid disease,and 1 appeared as solitary one.Two cases were once misdiagnosed as renal cyst and renal hamartoma,and the other was diagnosed correctly before operation.CT signscanning combined with epidemiological information can make an accurate diagnosis for renal echinococcosis.

Objective To evaluate the diagnostic value and limits of 64-slice spiral coronary artery imaging,by com- parison with selective coronary angiography,in detection of coronary heart disease.Methods Fourty-two patients sus- pected CAD were performed 64-slice spiral CT coronary imaging and selective coronary artery angiography in two weeks, comparative analysis of results were progressed consequently.Results The sensitivity,specificity and positive and nega- tive predictive value to identify≥50% stenosis branches was 90.5%,96.6%,85.9% and 97.8%,respectively.The sen- sitivity,specificity and positive and negative predictive value to identify≥75% stenosis branches was 93.5%,98.9%, 87.9% and99.4%,respectively.Conclusion As a noinvasive quantitative assessment of coronary artery stenoses exami- nation,64-slice spiral CT is a valuable method to detect and diagnose the disease of coronary artery,but its clinical use maybe presently be limited due to image quality in a number of cases.

BACKGROUND:In recent years, tissue engineering has made great progress, and skin tissue engineering is especialy noteworthy. Artificial dermis (PELNAC) is relatively used widely, but there is a lack of relevant reports on wound repair in children. OBJECTIVE:To investigate the clinical efficacy of Pelnac? METHODS:In a retrospective study, 22 patients with the wound of severe trauma were treated with Pelnac as skin graft dressings on treatment of the wounds of severe trauma in children. ? graft, negative-pressure wound therapy and split-thickness skin graft as experimental group (Pelnac? group), and another 19 patients treated with granulation formation dressing and split-thickness skin graft as control group. We colected data including the graft livability, the required re-operative times and the epithelization time after the skin graft. During the folow-up, the skin color and texture of survival skin, subcutaneous fulness, scar hyperplasia and the joint function were also evaluated. RESULTS AND CONCLUSION: In the Pelnac ? group, the graft livability was up to 90% within 10-14 days after grafting. The secondary split-thickness skin graft was required in two cases in the Pelnac? group and in eight cases in the control group. There was a significant difference in the graft livability (P < 0.05). The average epithelization time after the skin graft was (13.86±3.09) days in the Pelnac? group, which was significant shorter than the control group, (19.10±4.62) days, after the first time operation (P< 0.05). During the 10 months folow-up, the survival skin color and skin elasticity in the Pelnac? group was significantly better than that in the control group (P< 0.05). Better subcutaneous fulness and milder scar hyperplasy in the injured sites were obtained in the Pelnac? group compared with the control gorup. Five cases had certain joint function limitation in the Pelnac? group, compared to 10 cases in the control group, with a significant difference (P < 0.05). Artificial dermis Pelnac? has a stronger anti-infectious ability and higher graft livability. Pelnac? graft combined with negative-pressure wound therapy, granulation culture and split-thickness skin graft can shorten the epithelization time, improve wound healing and aleviate harm to the joint function after the skin graft.

Objective To investigate the effect of extracorporeal membrane oxygenation (ECMO) combined with ultrafiltration in treatment of kidney injury induced by serious hemorrhagic shock in rabbits.Methods Models of pressure-controlled hemorrhagic shock was developed in 24 New Zealand white rabbits which were divided into unresuscitation group (n =8),ECMO combined with ultrafiltration group (combined resuscitation group,n =8),and fluid resuscitation group (n =8) according to the random number table.Heart rate was monitored via electrocardiograph and arterial pressure via fermoral artery catheter.Blood samples were collected pre-and post-shock and after resuscitation to measure levels of lactic acid,serum creatinine,IL-6,and TNF-α.Kidney samples were collected for measurement of histopathological changes via HE staining,expression of heat shock protein 70 (HSP70) via immunohistochemical staining.Results Arterial pressure was (53.1 ± 11.4) mmHg in combined resuscitation group,higher than (41.3 ± 11.1) mmHg in fluid resuscitation group and (25.9 ± 10.5) mmHg in unresuscitation group (F =41.425,P ＜ 0.05).Hemorrhagic shock induced significant up-regulation of lactic acid,serum creatinine,IL-6,and TNF-α(P ＜ 0.05),but all were lowered after resuscitation,especially in combined resuscitation group (P ＜ 0.05).HE staining showed the degree of kidney tissue necrosis and inflammatory cytokine infiltration in combined resuscitation group alleviated notably compared with fluid resuscitation group.Median and interquartile values of HSP70 were 17 828.960 0 (15 779.865 0-21 751.980 0) in unresuscitation group,2 714.270 0 (1 339.215 0-7 616.950 0) in fluid resuscitation group,and 262.930 0 (198.820 0-538.195 0) in combine resuscitation group,with statistical differences among groups(P ＜ 0.05).Conclusion ECMO combined with ultrafiltration is superior to conventional fluid resuscitation in improving hypoxia tissue injury and inflammatory reaction after hemorrhagic shock and is beneficial to attenuating kidney injury.

AIM:To investigate the effects of pioglitazone on the quantity and function-related factors of regu-latory and effector T cells ( Treg and Teff ) of uremic apolipoprotein E knockout mice in vitro with or without the stimulation of atherosclerotic plaque-specific antigen oxidized low-density lipoprotein ( oxLDL) .METHODS:Uremic apolipoprotein E knockout mouse model was established by 2-step surgical procedure.After intervention with different concentrations ( 2μmol/L and 20μmol/L) of pioglitazone and PPARγantagonist GW9662 (5μmol/L) on splenocytes of uremic mice for 12 h in the presence or absence of oxLDL (2 mg/L), the levels of CD4 +CD25 +Foxp3 +Treg and IFNγ+CD4 +Teff were de-termined by flow cytometry.The mRNA expressions of Foxp3 and IFNγwas detected by real-time fluorescent quantitative PCR.RESULTS:In vitro, oxLDL induced a Treg/Teff imbalance in splenocytes from the uremic mice.Pioglitazone up-regulated the level of Treg and mRNA expression of Foxp3 in the presence of oxLDL, which was not antagonized by GW9662.Meanwhile, pioglitazone downregulated the level of Teff and mRNA expression of IFNγin the presence or ab-sence of oxLDL, which was reversed by GW9662.CONCLUSION:oxLDL induces a Treg/Teff imbalance in uremic apo-lipoprotein E knockout mice.Pioglitazone modulates the Treg/Teff imbalance probably through PPARγ-independent and-dependent mechanisms.