Objective To explore the abdominal pain as initial symptom of non-digestive diseases,the causes of misdiagnosis. Methods 74 patients with clear diagnosis non-digestive diseases which initial symptom was acute abdominal pain were analyzed. Results The most common causes of misdiagnosis were blood system diseases,circulatory diseases,metabolic diseases,endocrine system diseases,respiratory diseases,nervous system disease,accounting for 35.1% ,25.7% ,10. 8% ,8. 1% ,6. 8% ,6. 8%.The rest,such as the urinary system diseases,toxic diseases were not rare. Conclusion Non-digestive diseases which initial symptom was acute abdominal pain could be caused by the body's various systems,and the causes were complex,the diseases conditions were critical and changed rapidly,so it was difficult to diagnose and had to be Paid attention on.

Mild stroke refers to ischemic stroke with mild neurological defects.In recent years,its incidence rate has increased gradually.However,there is no standardized definition for mild stroke,and there is a great controversy about whether to conduct thrombolytic therapy for mild stroke.The conventional wisdom holds that the patients with mild stroke should not be treated with intravenous thrombolysis;however,many studies have indicated that the short-term and medium-term outcomes are poor in patients with mild stroke without receiving thrombolytic therapy,and many patients with mild stroke may benefit from thrombolytic therapy.This article summarizes about the definition of mild stroke and the clinical studies of thrombolytic therapy in recent years,hoping to provide reference for clinicians in order to make better clinical decisions.

Hematoma growth is an independent risk factor for the prognosis of htracerebral hemorrhage.It is very common in the acute stage of intracerebral hemorrhage.There are many uncertainties about the definition,mechanisms,and influential factors of hematoma growth,and the effective therapy is lacking,therefore,early prevention and identification are critical.

Objective To observe the characterization of fat emboli in cardiac chamber in pig model and the patients undergoing total hip arthroplasty(THA) by transesophageal echocardiography(TEE). Methods Different dose of fatty liquid was injected slowly via the internal jugular vein. The changes of the image were observed by continuous TEE. The lethal dose of fat embolism was recorded. Twenty-two patients underwent TEE during THA. Gray scale and echo intensity of fat embolism in right atrium were studied quantitatively in varied periods of the operation. Results With the increase of fat liquid injected in pig model, the strong- echo particles in right atrium and ventricle became more and more, the imaging of the particles was from “moving star”, “shower-like” to “snow fluffy”, at last paradoxical fat embolism occurred when the dose of fat liquid was over 4 ml. The accumulated lethal dose of fat embolism was 15.8 ～ 27.8 ml.②Fat emboli appeared as strong- echo particles in right atrium were found in different period of THA. Average gray scale and echo intensity of emboli in right atrium were significantly higher in period B than in other periods during THA. Conclusions Fat emboli in cardiac chamber can be found sensitively by TEE. Intra-operative monitoring and quantitative analysis is helpful to identifying fat embolism syndrome.Paradoxical embolism is a reliable evidence of fat embolism syndrome.

Objective To analyze the correlation between anterior circulation artery stenosis and lacune or lacunar infarct(LI) in elderly patients.Methods A retrospective analysis of data was performed in 111 patients with intracranial artery atherosclerosis,ischemic cerebral infarction or transient ischemic attack from January to December 2016 in our hospital.All the patients underwent non-contrast brain MRI or CT scan,as well as one-stop dynamic whole brain 4D CT angiography and CT perfusion scan(CTA-CTP/ perfusion).Imaging data were retrospectively analyzed.Intracranial 4D CTA was produced by using MIP and CPR post processing.The correlation of intracranial internal carotid artery(ICA)and middle cerebral artery (MCA)stenosis with lacunar infarct or lacune was analyzed by chi-square test using IBM SPSS Statistics 22.0 software.Results The average age of 111 patients was(68.4± 6.8)years.A total of 19 phases with 6080 images were obtained by one-stop scanning.The optimal phase of artery visualization was selected from 19 phases for evaluating artery stenosis.Intracranial ICA and/or MCA stenosis were revealed in 94 patients,including 73(65.8％)patients with LI or lacune and 21 patients(18.9％)without LI or lacune.17 patients without intracranial ICA or anterior circulation of MCA stenosis included 7 patients(6.3 ％)with LI or lacune and 10 patients(9.0％)without LI or lacune.Anterior circulation vessels stenosis was positively correlated with lacunar infarction or lacune(x2 =7.794,P=0.005).94 patients with anterior circulation vessels stenosis were further divided into 2 subgroups:unilateral and bilateral stenosis.39 cases showed unilateral vessels stenosis,including 25 cases (26.6 ％) with LI or lacunein,and 14 cases (14.9 ％) without LI or lacunein.And 55 cases showed bilateral vessel stenosis,including 48 cases (51.1％)with LI or lacune,and 7 case (7.4 ％) without LI or lacune.The risk for LI or lacunein was statistically higher in bilateral vessel stenosis than in unilateral vessel stenosis(x2 =7.061,P=0.008).Patients with anterior circulation vessels stenosis combined with LI or lacune were 73 cases,including 31 cases of grade Ⅰ,19 cases of grade Ⅱ,14 cases of grade Ⅲ,and 9 cases of grade Ⅳaccording to Trial criteria(NASCET)classification,with no significant difference between the different grades of anterior circulation vessels stenosis.Conclusions A correlation between ICA or MCA stenosis and lacunar infarction or lacune may exist.Risk for lacunar infarction or lacune is higher in patients with bilateral artery stenosis than in patients with unilateral artery stenosis.

Objective To investigate the effect of hyperacute intensive antihypertensive treatment on the prognosis of intracerebral hemorrhage in basal ganglia region. Methods From January 2013 to December 2015,100 patients with intracerebral hematoma in basal ganglia region (onset ≤3 h)at the Neurological Intensive Care Unit,the First Affiliated Hospital of Dalian Medical University were enrolled prospectively. They all randomly received the intensive antihypertensive or standard antihypertensive treatment voluntarily. They were divided into either an intensive antihypertensive group or a standard antihypertensive group according to the random number table (n = 50 in each group). Within 1 h after beginning to treatment,the target systolic blood pressure was controlled in 130 -140 mmHg in the intensive antihypertensive group,the target systolic blood pressure was controlled in 160 -180 mmHg in the standard antihypertensive group,and the target systolic blood pressure was maintained respectively in the following 7 d. Head CT was performed gain at 24 h after treatment. The intracranial hematoma expansion was evaluated. The National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS)were used to
evaluate their prognoses. The differences of the cumulative mortality in both groups were compared at the same time. Results The incidences of hematoma expansion of the intensive antihypertensive group and the standard antihypertensive group were 12. 0% (6/ 50)and 30. 0% (15/ 50)respectively. There was significant difference between the 2 groups (χ2 = 4. 882,P = 0. 027). There were no significant differences in NIHSS scores within or between both groups at each time points (all P > 0. 05). They were followed up for 90 d,no adverse events occurred in both groups. The favorable prognosis rates of the neurological function were 36. 0% (18 / 50)and 18. 0% (9 / 50)respectively in the intensive antihypertensive group and the standard antihypertensive group. There was significant difference between the 2 groups (χ2 = 0. 411,P =0. 043). Kaplan-Meier curves showed that the cumulative mortality at 24 h,within 7 d and 90 d in the intensive antihypertensive group and the standard antihypertensive group were 4. 0% (2 / 50),6. 0%(3 / 50),and 10. 0% (5 / 50),respectively,those of the standard antihypertensive group were 10. 0%(5 / 50),24. 0%(12 / 50),and 30. 0%(15 / 50),respectively. The results of Log-rank test found that there was significant difference in cumulative mortality between the 2 groups (χ2 =6.280,P =0.012). Conclusions The intensive antihypertensive treatment in the hyperacute cerebral hemorrhage is safe and feasible in basal ganglia region. It contributes to improve prognosis of neurological function,and reduce the incidence of hematoma expansion and the 90 d cumulative mortality.

Objective To investigate the influence of simvastatin treatment on Toll-like receptor 4 (TLR4) in monocytes of peripheral blood in patients with sepsis and severe sepsis and its significance. Methods A prospective randomized controlled trial was conducted. 106 patients with sepsis and 92 patients with severe sepsis admitted to Department of Critical Care Medicine of Henan Provincial People's Hospital from August 2013 to June 2015 were enrolled. These two groups of patients were randomized into conventional treatment group and simvastatin group. All patients received treatment according to the 2012 International Sepsis Treatment Guidelines, including anti-infection drugs, nutritional support, and palliative treatment, and the patients with severe sepsis were given early goal-directed therapy (EGDT). The patients in simvastatin group received simvastatin 40 mg daily orally for at least 15 days. The peripheral blood was collected and the monocytes were isolated at 1, 5, 10, 15 days after intensive care unit (ICU) admission. TLR4 expression on the surface of TLR4/CD14+ double positive monocytes was determined by flow cytometry, and adverse reaction was observed during treatment. Results TLR4 expression on the surface of monocytes showed a tendency of decreasing with prolongation of simvastatin treatment in the simvastatin group in patients with sepsis (n = 59) or severe sepsis (n = 54). However, in patients with sepsis, TLR4 level was significantly decreased from 10 days in simvastatin group as compared with that of conventional therapy group (n = 47), and it was decreased up to 15 days [mean fluorescence intensity (MFI): 21 (19, 28) vs. 27 (25, 33) at 10 days, Z = 2.198, P = 0.021; 16 (15, 21) vs. 26 (23, 34) at 15 days, Z = 4.611, P = 0.002]. In patients with severe sepsis, there was no significant difference in TLR4 level at different time points between simvastatin group and conventional treatment group (n = 38) [MFI: 55 (52, 63) vs. 56 (48, 65) at 1 day, Z = 0.313, P = 0.692; 47 (42, 56) vs. 49 (41, 58) at 5 days, Z = 0.827, P = 0.533; 40 (35, 42) vs. 42 (37, 45) at 10 days, Z = 1.012, P = 0.301; 33 (30, 38) vs. 38 (35, 41) at 15 days, Z = 0.539, P = 0.571]. No adverse reaction related with simvastatin was found during treatment in patients with sepsis or severe sepsis. Conclusions Statins could significantly down-regulate the TLR4 expression on peripheral blood monocytes in septic patients, while it showed no significant influence on TLR4 expression in patients with severe sepsis. A different effect of statins on TLR4 expression and the downstream inflammation process in sepsis and severe sepsis patients might partially explain the discrepancy in previous reports about the therapeutic effect of statins therapy in sepsis and severe sepsis patients.

Objective To investigate the risk factors and patterns of radiation induced gastroduodenal complications in patients with pancreatic cancer following tomotherapy (TOMO) using endoscopy.Methods Patients with pancreatic cancer who were treated TOMO in Air Force General Hospital from February 2010 to May 2015 were collected.All patients underwent endoscopic examination before and after radiotherapy.The radiation injuries were observed,and factors influencing radiation-induced gastroduodenal complications were analyzed.Results The median time of gastroscopy after radiotherapy was 1 month,radiation gastritis and duodenitis were 41 cases (58.6％),radiation gastric and duodenal ulcers were 30 cases (42.9％),and hemorrhage 7 cases (10.0％),scar formation 3 cases (4.3％),6 cases (8.6％) had newly developed gastric retention,and 4 cases (5.7％) had newly developed gastric varix.Univariate analysis showed that relieving jaundice and radiation protection (amifostine) were associated with the development of radiation gastric ulcers (x2 =4.186,P =0.041;x2 =5.679,P =0.017).Conmon terminology criteria for adverse events (CTCAE) ≥2 was associated with the development of radiation duodenal ulcers (x2 =3.960,P =0.047).Mean dose (Dmean) ＞ 13.39 Gy and Dmean ≤13.39 Gy gastric ulcers rates were 25.0％ and 9.1％,respectively (AUC =0.740,P =0.048).Conclusion The TOMO induced gastroduodenal injury in patients with pancreatic cancer is frequent.Relieving jaundice is the protection of radiation gastric ulcer.Dmean ＞ 13.39 Gy is independent predictive factors for radiation gastric ulcers.Patients after TOMO should be examined by endoscopy early.

Objective To investigate the prevalence of liver damage in B-cell lymphoma patients with positive HBV surface antigen(HBsAg)after rituximab and chemotherapy.Methods Records of 19 B-cell lymphoma patients with positive HBV surface antigen(HBsAg)after rituximab and chemotherapy from June,2001 to Aug,2007 in Beijing Cancer Hospital were reviewed to analyze the prevalence of liver damage.At the same time,the relationship between the level of HBV-DNA and the damage of liver was analysed.Results According to WHO criteria of liver toxicity,of the 19 patients,12(63.2%)suffered liver damage,4(21.1%)patients in grade Ⅰ,6(31.2%)patients in grade Ⅱ and 2(10.5%)patients in grade Ⅲ.None of the patients in this study experienced grade Ⅳ liver toxicity.Of the 6 patients with HBV-DNA＞104 copy/ml before therapy,5(83.3%)suffered liver damage.Of the 5 patients with HBV-DNA＜104 copy/ml before therapy,3(60%)suffered liver damage.Conclusion The prevalence of liver damage is higher in B-cell lymphoma patients with positive HBsAg after rituximab and chemotherapy.These patients should be closely monitored for liver function when they received rituximab therapy and should reveive anti-HBV therapy.

Objective Using Morris water maze test to evaluate the effects of guanosine and curcumin on cognitive function of APPswe/PS1dE9 double transgenic mice .Methods 3-month old APPswe/PS1dE9 dtg mice were randomly di-vided into model group , donepezil HCL group , guanosine group , curcumin group , curcumin and guanosine group ( n=12), with age-matched Wild C57BL/6J mice of the same genetic background as normal control group .Medication was giv-en once a day for 1 month.Using Morris water maze to test the spatial learning and memory ability of mice .Results Guanosine and curcumin could improve spatial learning and memory disorders of AD mice , particularly in the group of cur-cumin.Conclusion Guanosine and curcumin improve the cognitive ability of APPswe /PS1dE9 double transgenic mice with early cognitive impairment .