Objective To scrutinize the CT features of pulmonary actinomycosis and analysize the causes of misdiagnosis.Methods CT images of eleven patients with pulmonary actinomycosis proved by pathology were retrospectively reviewed.Among them,6 were scanned with additional enhanced CT scan.Results Among the 11 patients,the lesions located in the inferior lobe in 7 patients,and in the superior lobe in 4 patients.The lesions affected two or more pulmonary segments in 9 patients,6 of them involving two lobes.Irregular mass or nodules with necrotic low-attenuation areas were the main signs in all patients,and segmental consolidations were found in 6 patients.Peripherally progressive enhancement was found in all patients with contrast enhanced CT scan.Vicinity pleural thickening was found in 11 patients,while extrapleural fat deposition was found in 6 patients.One case showed erosion of the chest wall and rib.Conclusion Pulmonary actinomycosis is a chronic suppurative granulomatous inflammation,which is often misdiagnosed with neoplasm or other lung disease because of its mass-like performance.The peripherally progressive enhancement on CT has a certain diagnostic value for P\pulmonary actinomycosis.

Objective To study the clinic value of digital three-dimensional shaping titanium mesh in repairing skull defects and reconstructing temporal muscle attachment points. Methods Eighty-two patients with skull defects from December 2013 to January 2016 were enrolled in this study. They were divided into two groups according to patients' will with 41 patients in each group. The patients in control group received traditional hand-shaping titanium mesh repair, the patients in observation group received individual digital forming technology to produce titanium mesh repair and reconstruct the temporal muscle attachment points at the titanium mesh temporal corresponding position. The rate of appearance satisfaction, operation time, the number of titanium nail and the rate of postsurgery adverse reaction was compared between the two groups. Results The rate of appearance satisfaction in observation group was significantly higher than that in control group: 97.56%(40/41) vs. 80.49%(33/41), P<0.05. The operation time and the number of titanium nail and in observation group was significantly lower than that in control group:(8.9 ± 1.6) h vs. (12.4 ± 2.4) h, (10.3 ± 0.9) pieces vs. (11.8 ± 1.8) pieces, P < 0.01. The rate of postsurgery adverse reaction in observation group was significantly lower than that in control group: 0 vs. 9.8%(4/41), χ2 = 4.21, P < 0.05. Conclusions The operation of repairing skull defects and reconstructing temporal muscle attachment points with digital three-dimensional shaping titanium mesh is simple. It can shorten the operation time, decrease the postsurgery adverse reaction, and increase the appearance satisfaction.

Objective To evaluate the role of serine-threonine kinase (Akt)/glycogen synthase kinase-3 beta (GSK-3β) signaling pathway in isoflurane preconditioning-induced inhibition of mitochondrial permeability transition pore protein (mPTP) opening during myocardial ischemia-reperfusion (I/R) in rats.Methods Ninety-six male Sprague-Dawley rats,aged 3-4 months,weighing 200-250 g,were randomly divided into 4 groups (n =24 each) using a random number table:control group (group C);I/R group;isoflurane preconditioning group (group IPC);Akt inhibitor MK-2206 group (group MK).Myocardial I/R was induced by occlusion of the anterior descending branch of the left coronary artery for 30 min followed by 2 h of reperfusion.In group IPC,1.5％ isoflurane was inhaled for 30 min followed by 45 min washout,and then the model of myocardial I/R injury was established.In group MK,MK-2206 300 μg/kg (in dimethyl sulfoxide) was injected intraperitoneally at 30 min before isoflurane inhalation.At 2 h of reperfusion,8 rats were selected and sacrificed,and the hearts were removed for determination of myocardial infarct size.At 2 h of reperfusion,8 rats were selected,and blood samples were collected from the right internal jugular vein for determination of serum cardiac troponin Ⅰ (cTnI) concentrations.The rats were then sacrificed,and myocardial specimens were obtained for determination of the expression of phosphorylated GSK-3β (p-GSK-3β) in cytoplasm and mitochondria (by Western blot) and co-expression of p-GSK-3β with adenine nucleotide translocator (ANT),voltage-dependent anion channel or cyclophilin D in myocardial tissues (using co-immunoprecipitation).At 2 h of reperfusion,8 rats were selected and sacrificed,myocardial cells were obtained,and the opening time of mPTP was determined with a laser scanning confocal microscope.Results Compared with group C,the myocardial infarct size and serum cTnI concentrations were significantly increased,and the expression of p-GSK-3β in cytoplasm and mitochondria was up-regulated in I/R and IPC groups,the co-expression of p-GSK-3β with ANT was significantly down-regulated,and the opening time of mPTP was shortened in group I/R,and the co-expression of p-GSK-3β with ANT was significantly up-regulated,and the opening time of mPTP was prolonged in group IPC (P＜0.05).Compared with group I/R,the myocardial infarct size and serum cTnI concentrations were significantly decreased,the expression of p-GSK-3β in cytoplasm and mitochondria was up-regulated,the co-expression of p-GSK-3β with ANT was significantly up-regulated,and the opening time of mPTP was prolonged in group IPC,and the opening time of mPTP was significantly prolonged (P＜0.05),and no significant change was found in the other parameters in group MK (P＞0.05).Compared with group IPC,the myocardial infarct size and serum cTnI concentrations were significantly increased,the expression of p-GSK-3β in cytoplasm and mitochondria was up-regulated,the co-expression of p-GSK-3β with ANT was significantly down-regulated,and the opening time of mPTP was shortened in group MK (P＜0.05).No co-expression of p-GSK-3β with voltage-dependent anion channel or cyclophilin D was found in myocardial tissues.Conclusion The mechanism by which isoflurane preconditioning inhibits mPTP opening during myocardial ischemia-reperfusion is partially related to activation of Akt/GSK-3β signaling pathway in rats.

Objective To investigate the expression of Ezrin protein and c-met in esophageal squamous cell carcinoma, their significance in the progress of esophageal squamous cell carcinoma development and metastasis. Methods The expression of Ezrin protein and c-met in 50 patients with esophageal squamous cell carcinoma was studied using immunohistochemical (SP) method. The correlation of each score according to the intensity and percentage of labeled cells or intercellular substance with relevant clinical data was statistically analyzed. Results In normal esophageal squamous epithelium, the positive expression of Ezrin protein was 34 %, the positive expression of c-met was 8.0 %. In esophageal squamous cell carcinoma, the positive expression of Ezrin protein was 76.0 %, the positive expression of c-met was 58.0 %. The expression of Ezrin protein had close relation to depth of invasion and lymph node metastasis(P < 0.05). The positive rate of c-met protein expression in lymph node metastasis was obviously higher than those without lymph node metasis (P <0.05). The expressinn of Ezrin protein in c-met positive eases was obviously higher than those of c-met negative cases(P <0.05). Conclusion The test of Ezrin protein and c-met may have significant prognostic value for assessing the degree of malignancy and potential lymph node metastasis probability of esophageal squamous cell carcinoma. Ezrin protein may be a target to evaluate the tumor prognosis.

Objective To observe the clinical effects of Huoxue Dingxuan Capsules on treatment of vertebral artery type of cervical spondylosis, and evaluate its efficacy and safety. Methods Totally 130 cases of vertebral artery type of cervical spondylosis were randomly assigned to treatment group and control group, and treated with Huoxue Dingxuan Capsules and Sibelium capsules respectively. Integration method was used to compare the differences of main symptoms and signs, the overall efficacy and safety were evaluated, and relapse after six months was followed up. Results Both groups had a significant effect on the improvement of signs and symptoms in vertebral artery type of cervical spondylosis, the total efficiency was 94.03%(63/67) in treatment group and 82.54% (52/63) in control group. The treatment group had a better effect on the overall efficacy and relieving symptoms and signs compared with the control group (P<0.01). The mean blood flow velocity had a significant change after treatment (P<0.05), and the treatment group was better than the control group (P<0.01). Within six months, the treatment group had 4 cases (6.34%) with mild recurrence of symptoms and signs, and the control group had 18 cases (34.61%), the difference between the two groups was statistically significant (P<0.05), and no severe recurrence was found. The two groups showed no side effects. Conclusion Huoxue Dingxuan Capsules is safe and effective for treating vertebral artery type of cervical spondylosis, and the long-term efficacy and subjects’ compliance are better than oral Sibelium capsules.

Objective To investigate the clinical value of digital three-dimensional shaping titanium mesh and traditional hand-shaping titanium mesh in the repairing of skull defect surgery.Methods The clinical data of 78 patients with skull defect were retrospectively analyzed,they were divided into digital three-dimensional shaping titanium mesh group (41 cases) and traditional hand-shaping titanium mesh group (37 cases) according to the different titanium net,then the hospital stay,operative time,hospital costs,shaping satisfaction and postoperative complications between two groups were compared.Results The hospital costs and shaping satisfaction in digital three-dimensional shaping titanium mesh group were significantly higher than those in traditional hand-shaping titanium mesh group [(12 978.1 ± 4 765.7) yuan vs.(9 436.6 ±3 798.7) yuan,(9.87 ±0.13) scores vs.(9.41 ±0.09) scores],the complication rate was significantly lower than that in traditional hand-shaping titanium mesh group [4.9％ (2/41) vs.29.7％ (11/37)],there was significant difference (P ＜ 0.05).The hospital stay and operative time between two groups had no significant difference (P ＞ 0.05).Conclusion The digital three-dimensional shaping titanium mesh repair is convenient to operate,it can largely reduce the risks and complications of surgery,and can also achieve a high standard of modeling results,so is worthy of promotion.

Objective:To investigate the expression and clinical significance of wild-type p53-induced phosphatase 1 (Wip1) in thyroid carcinoma and biological effect of siRNA-targeting Wip1 on the thyroid carcinoma cell line. Methods:Immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR) were performed to detect the expression of Wip1 in 73 specimens of thy-roid carcinoma tissues and normal thyroid tissues (5 cm away from the margin of thyroid carcinoma), respectively. Wip1 siRNA was transiently transfected into the papillary thyroid carcinoma cell by using a liposome-mediated method and then detected by RT-PCR and Western blot. Methyl thiazolyl tetrazolium (MTT) assay and flow cytometry (FCM) were also conducted to observe cell proliferation, cell apoptosis, and cell cycle. Results:The positive rates of Wip1 protein were 80.8%in thyroid carcinoma tissues and 9.6%in the nor-mal tissues (χ2=47.036, P<0.05). The relative mRNA contents of Wip1 were 0.665 ± 0.046 and 0.225 ± 0.039 in carcinoma and normal tissues, respectively;these results significantly differed between the two types (t=12.637, P<0.05). Significant correlation was not ob-served between Wip1 expression and other factors, such as patient's gender, age, and tumor size (P>0.05). However, significant correla-tions among Wip1 expression, lymph node metastasis, clinical stages and tumor differentiation (P<0.05) were observed. RT-PCR and Western blot results showed that K1 cell-transfected Wip1 siRNA exhibited a relatively lower expression than normal cells (t=17.039, t=14.637, P<0.05). MTT assay results showed that the K1 cells transfected with Wip1 siRNA showed a lower survival fraction, higher cell apoptosis, higher percentage of G0/G1 phases, and lower cell concentration in G2/M and S phases (P<0.05). Conclusion:Wip1 pro-tein and mRNA were increased in thyroid carcinoma and are correlated with lymph node metastasis, clinical stages and tumor differenti-ation. Wip1 may be involved in proliferation, apoptosis, and cycle of thyroid cancer cells.

Objective To investigate the effects of acupuncture rehabilitation techniques combined with Xingnaojing injection on functional recovery and the plasam level of glial fibrillary acidic protein (GFAP) in patients with severe traumatic brain injury (STBI).Methods Eighty-four patients with STBI admitted to Department of Neurosurgery in Jiuquan People's Hospital from October 2013 to December 2015 were enrolled,they were divided into observation group (44 cases) and control group (40 cases) by random number table,all patients received the routine basic treatment,such as decreasing intracranial pressure,anti-infection,neural nutrition therapy,etc.In addition,the observation group was treated with acupuncture rehabilitation training (each training 50 minutes,1-2 times a day,10 times as a course of treatment,a total of 5 courses) and Xingnaojing injection (in 0.9％ normal saline or 5％ glucose injection 250 mL intravenous infusion,one time a day,10 days as a course of treatment,a total of 3 courses).The evaluation score of Montreal cognitive assessment (MoCA),Modified Barthel index (MBI),Fugl-Meyer assessment (FMA) of motor function score and the plasma levels of GFAP and myelin basic protein (MBP) were measured before and after treatment in the two groups.Results After treatment,the MoCA,MBI and FMA scores were significantly higher in two groups than those before treatment (all P ＜ 0.05),the contents of MBP and GFAP were significantly lower than those before treatment,and the changes in observation group were more significant than those in control group [visual space and execution capability (score):4.99 ± 0.67 vs.3.42 ± 0.73,denomination capability (score):2.98 ± 0.77 vs.2.84 ± 0.47,delayed memory (score):5.76± 0.33 vs.3.87± 2.08,attention (score):6.17± 0.65 vs.4.75 ± 0.81,speech capability (score):3.51 ± 0.46 vs.2.04 ± 0.13,abstract thinking capability (score):2.94 ± 0.27 vs.1.58 ± 0.96,orientation force (score):6.02±0.65 vs.4.88±0.62,FMA score:68.71 ±34.17 vs.41.13 ± 14.82,MBI score:69.12± 10.45vs.37.63±6.11,MBP (μg/L):1.32±0.23 vs.5.31±0.79,GFAP (μg/L):0.19±0.08 vs.0.39±0.04,all P ＜0.05].Conclusions Acupuncture rehabilitation training combined with Xingnaojing injection may obviously improve the cognitive and motor functions in patients suffered from STBI,and clinically the combined treatment is worthwhile to be used extensively.

Objective:To investigate the relationship between previous bleeding history and poor prognosis of patients with acute upper gastrointestinal bleeding.Methods:This study was a prospective multicentre real-world study (Acute Upper Gastrointestinal Real-word study, AUGUR study). The data of patients with UGIB who were admitted to the emergency department of 20 tertiary hospitals in China from June 30, 2020 to February 10, 2021 were collected. According to the number of previous bleeding history, the patients were divided into three groups (0 time, 1-3 times, and≥4 times). Based on the patient’s demographic data, clinical characteristics, laboratory data, treatment, and outcomes, univariate and logistic regression analysis were performed to investigate the correlation between the number of previous bleeding and the 90-day mortality and rebleeding of patients with gastrointestinal bleeding.Results:A total of 1 072 patients with acute UGIB were included in this study. The all-cause mortality and rebleeding rate of all patients were 10.9% (117/1 072) and 11.8% (129/1 072), respectively. Among them, 712 patients (66.42%) had no previous bleeding, 297 patients (27.71%) had previous bleeding 1-3 times, and 63 patients (5.88%) had previous bleeding≥4 times. In univariate analysis, age, vital signs and consciousness on admission, history of liver cirrhosis, onset with hematemesis, admission hemoglobin, varicose veins bleeding, peptic ulcer bleeding, red blood cell infusion, tracheal intubation and the use of vasopressors after admission were risk factors for the 90-day mortality and rebleeding rate. Multivariate logistic regression analysis showed that patients with previous bleeding≥4 times had a higher risk of the 90-day mortality ( OR=2.17, 95% CI: 1.04-4.57, P=0.040) and rebleeding ( OR=2.32, 95% CI: 1.19-4.53, P=0.013). Conclusions:The history of previous bleeding≥ 4 times can be used as an independent risk factor for the 90-day mortality and rebleeding in patients with acute UGIB.

This paper is to introduce our experiences in treating 2 batches of 13 burn victims transferred from remote areas on postburn days 3 and 4. Methods Thirteen burn victims of 2 mass casualties were transferred to our burns institute from remote areas on postburn days 3 and 4 on June 27, 2001 and June 2, 2002, respectively. There were 4 males and 9 females, age ranged from 20 to 43 years, with a mean age of 31.1±6.2 years. The mean total burn area was 74.3%±24.7% TBSA (range, 25% to 97%). Among them, 10 patients suffered from serious burn with mean total burn area involving 86.0%±11.5% TBSA (range, 60% to 97%), and mean full-thickness burn of 63.9%±26.3% TBSA. Four patients also manifested signs of severe inhalation injury, and 6 patients with moderate inhalation injury. In three patients with mean total burn area covering 35.5%±10.0% TBSA (range, 25% to 45%), with mean full-thickness burn of 15.3%±5.0%, were al having moderate inhalation injuries. Among these 13 patients, 3 were having high body temperature (39℃), while 3 manifested hypothermia. The heart rate was 140-160/min, and respiratory rate 26 to 32/min in 6 patients. Abdominal distension or loss of bowel sound were found in 4 patients. Low white cell and platelet count were found in some patients. In 13 cases, liver function, renal function, myocardiac enzyme, and coagulation function were abnormal. Results Among 13 burn victims, one patient died of myocarditis on postburn day 29, and another one died of hepatic failure (history of chronic hepatitis B) on postburn day 45 with only 2% TBSA of burn wound remained open. Conclusion Burns victims occurred in mass casualties who were transferred from remote areas to our Burns Institute were all in critical condition, usually with multiple complications, demanding most meticulous care. Our strategies in this regard consisted of dispatch of experienced surgeons and nurses to the referring hospitals and the airport to receive the patients to offer appropriate care to them during the journey,organization of the medical staff so that each of them was ordained specific function, thus conditions of the patients were evaluated immediately and appropriate treatment started expeditiously for those lethal complications on arrival. Timely and exact comprehensive treatments were prerequisite to save the patients’ life. Adequate metabolic support should be emphasized, and coagulant of anticoagulant treatment should be carried out when indicated.