Objective To sum up the clinical characteristics of children with severe pneumonia,and in order to improve the dingnosis treatment and prognosis.Methods Restrospective analysis was carried out on the clinical manifestations signs basic diseases etiology check imaging of children with severe pneumonia who had been in the hos-pital for ten years,and with the same period,120 children with common pneumonia in hospital were compared with and analyzed.Results Among 193 case,boys was 127 cases,girls was 63 cases,with males to females rate of 21.115 cases(60.0%)were aged 0 year to 3 years old.The onset of 125 cases(65.0%)were winter and spring.All patients had fever 98 cases(50.8%)with high temperature of 39 -41℃,all patients suffered from respiratory symp-toms,including 183 cases(94.8%)with cough,113 cases(58.5%)with breathing.All patients suffered from diffi-cult breathing,shortness of breath on cyanosis(=cyanopathy),105 cases(54.3%)with wet lung rate,152 cases (78.7%)with respiratory insufficiency on respiratory failure,12 cases(6.2%)with acute respiratory distress syn-drome,163 cases (84.5%)with heart failure,67 cases (34.7%)with abdominal distension,23 cases needed mechanical ventication.91 cases(47.2%)with antibodies positime for mycoplasma pneumoniae infection when testing servm virns antibody and respiratory virus antigen.20 cases(10.4%)were found to have positive antibody,conduc-ting fluid culture,cultivate a positive strains of 31 cases(16.1%),including 7 cases(3.6%)of psendomonas aerngi-nosa,6 cases(3.1%)of eschericria coli,6 cases(3.1%)of klebsiella pneumoniae,5 cases(2.6%)of enterobacter cloacae,3 cases(1.6%)of streptococlus pneumoniae,2 cases(1.0%)of viridans streptococci,1 case(0.5%)of hemolytic staphylococci,1 case(0.5%)of radiation agrobacterium,2 cases(1.0%)of candida mycoderma bacteria which was fungi.The imaging indicated.106 cases(54.9%)presented as lobi pulmonis or segmental large patches of dense increased shadom or pulmonary parenchymal inflammatory lesions the performance of lung interstitial inflammatory lesionsl(such as increased lung markings,fuzzy and with flocculant shadow etc)were 87 cases(33.2%).30 cases (15.5%)suffered from pleural effusion,18 cases(9.3%)suffered a telectasis with in the chest,16 cases(8.3%) suffered from empyema.Conclusion Children with severe pneumonia had prone to heart failure respiratory failure, complication.The clinical manifestations of severe pneumonia is severe.Clinically suspected severe.Pneumonia should complete etiological and chest radiographic examination for early diagnosis and treatment.

Intracranial stentosis is one of the important causes of ischemic stroke. In recently years, with the continuously development of endovascular intervention, angioplasty and stenting have become effective treatment options for intracranial stenosis. However, the indications, technical points, complications and prognosis of this treatment remain to be investigated and explored.

Objective To investigate the dynamic change of serum high sensitive C-reactive protein (hsCRP) after carotid artery stenting (CAS) and its correlation with in-stent restenosis.Methods The serum hsCRP levels were determined before procedure,at 12 hours,7 days,3 and 6 months after procedure in patients who underwent CAS in the Department of Neurology,Jinling Hospital,Nanjing Their cerebral angiography was reexamined and whether there was in-stent restenosis after 6 months was observed.Results Eighty-four patients treated with CAS were included in the study.Fifteen (24％) had in-stent restenosis after CAS.The stenosis in 3 of them was ＞ 50％,and the stenosis m 12 of them was 30％ to 50％.The serum hs-CRP levels in all patients after procedure were significantly higher than those before treatment (all P ＜ 0.01 ),and they were significantly lower at 6 months after procedure than before treatment (all P ＜0.01).Univariate analysis showed that the proportion of diabetes in the restenosis group was significantly higher than that in the non-restenosis group (P＜0.01).At 7 days (8.83 ± 1.94 mg/L vs.6.77 ± 1.63 mg/L,t =14.398,P=0.044),3 months after procedure (8.26 ± 1.32 mg/L vs.4.58 ± 1.45 mg/L,t =17.569,P =0.008) and 6 months after procedure (7.04 ± i.07 mg/L vs.3.12 ± 1.28 mg/L,t =21.867,P =0.003),the serum hs-CRP levels in the restenosis group were significantly higher than those in the non-restenosis group,and the difference of the serum hs-CRP level (△ hs-CRP) before procedure and at 6 month after procedure was significantly lower than that in the nonrestenosis group (0.85 ± 0.13 mg/L vs.4.89 ± 0.94 mg/L,t =16.987,P =0.000).Multivariate logistic regression analysis showed that /hs-CRP (odds ratio [ OR] 2.392,95％ confidence interval [ CI] 1.538 -3.513; P =0.009) and diabetes (OR 1.840,95％ CI 1.372 -2.241; P =0.023) were the risk factors for instent restenosis.Conclusions The serum hs-CRP level increased significantly at 12 hours after CAS procedure,and then decreased continuously.At 6 months after procedure,the more decrease of the serum hs-CRP level,the lower risk of occurring in-stent restenosis was.

Moyamoya disease is a chronic progressive cerebrovascular disease which is characterized by progressive stenosis or occlusion at bilateral terminal portions of the internal carotid artery and its large branch vessels,and with an abnormal formation of new vascular network in skull base.As a noninvasive method,magnetic resonance imaging (MRI) plays an important role in the diagnosis and evaluation of moyamoya disease.This article reviews the application of MRI in the identification,diagnosis and treatment evaluation of the stroke subtypes in patients with moyamoya disease.

Objective To investigate the effects of the distribution characteristics of cerebral artery stenosis and the associated risk factors in patients with ischemic cerebrovascular disease.Methods The demographic data and vascular risk factors in patients with ischemic cerebrovascular disease who performed aortic arch and cerebral angiography were analyzed retrospectively.The patients were divided into intracranial lesion,extracranial lesion and extra-and intracranial lesion groups according to the lesion sites.The demographic data and vascular risk factors in all groups were compared.Results A total of 1272 patients were enrolled,and 1028 (80.8％) had cerebral artery stenosis or occlusion,in which 342 (33.3％) were intracranial lesions,330(32.1％) were extracranial lesions,and 356 (34.6％) were extra-and intracranial lesions.The mean age of the intracranial lesion group was significantly lower than that of the other 2 groups (F =41.995,P =0.000).There were significant differences in the constituent ratios of sex (x2 =10.602,P =0.005),hypertension (x2 =11.316,P =0.003),and diabetes (x2 =13.465,P =0.001) among all groups.There were significant differences in the distribution of extra-and intracranial artery stenosis among different age groups (P =0.001).Intracranial lesions were mainly in the youth and middle-aged groups,and extra-and intracranial lesions in the old age group were more common.Multivariate logistic regression analysis showed that age,hypertension,diabetes and history of transient ischemic attack were associated with the simple intracranial lesions and extra-and intracranial lesions,and the simple extracranial lesions were only associated with advanced age and hypertension.The 1028 patients with vascular stenosis or occlusion affected 2732 vessels,including 1759 vessels (64.4％) in anterior circulation and 973 (35.6％) in posterior circulation.The mild,moderate and severe stenosis in anterior circulation were most common in extracranial internal carotid artery,and the occlusion was most common in middle cerebral artery.The various degrees of lesions in posterior circulation were most common in extracranial internal carotid artery.Conclusions There were significant differences in patients with cerebrovascular lesions at different sites in sex,age,as well as in the incidences of hypertension and diabetes.Age,hypertension,diabetes and the history of transient ischemic attack were the independent predictive factors for the distribution of cerebral atherosclerotic lesions.

BACKGROUND:At present, liver transplantation is the only way to cure end-stage liver disease, but the complications after transplantation is stil an important factor of affecting the long-term survival of patients who received orthotopic liver transplantation, therefore it is necessary to establish a stable animal transplantation model. OBJECTIVE:To establish rat models of orthotopic liver transplantation. METHODS:After inhalation anesthesia with ether, 204 SD rats were perfused with 2-4℃ Ringer’s solution through the abdominal aorta. In order to reduce warm ischemia of the liver, the liver was not turned over before perfusion. The suprahepatic inferior vena cava was cut off along the phrenic ring after perfusion. No further trimming was needed when dressing, so as not to damage the vena cava. The donor liver was removed and preserved in 4℃Ringer’s liquid. The receptor liver was cut off and alogeneic orthotopic liver transplantation was performed using modified two-cuff method. After transplantation, rats could automaticaly turn over and drink water. Surviving more than 3 days is regarded as a successful transplantation. RESULTS AND CONCLUSION:102 liver transplantations were performed in 204 rats, with 86 rats surviving more than 3 days. The success rate of transplantation was 84%. The results demonstrate that rat models of orthotropic liver transplantation can be constructed successfuly through improving techniques.

Objective:Atherosclerotic reanal artery stenosis(RAS) exists as one manifestation of more generalized atherosclerosis.It is important to find RAS in the population of carotid artery stenosis.The aim of the present study was to evaluate the prevalence of RAS in patients with carotid artery stenosis and to identify the risk factors for RAS.Methods:A total of 126 patients were carried out renal artery angiography after cerebral angiography.A univariate and multivariate Logistic regression analysis was performed to investigate the association of the clinical variables with RAS.Results: Renal artery stenosis was identified in 23(21.4%) patients.Multivariate predictors included coronary artery disease(OR=6.34,95%CI: 2.20-18.26) and peripheral vascular disease(OR=3.67,95%CI: 1.29-10.46). Conclusion: Coronary artery disease and peripheral vascular disease may be clinical predictors for RAS.

Objective To evaluate the effects of posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle in the treatment of severe throracolumar fractures.Methods A retrospective study was conducted to evaluate the outcomes of 11 patients with severe thmracolumar fracture who had been treated with posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle at our department from March 2009 to March 2012.They were 10 males and one female,aged from 20 to 42 years (mean,31.1 years).According to AO classification,there were 2 cases of type B1,3 cases of type B2 and 6 cases of type C2.The Gaines scores for anterior column stability were more than 6 in all.All the patients had neurological disorders.The fracture reduction,fusion of bone grafting and recovery of neurological function were followed up.Results Their operation time ranged from 200 to 300 minutes,averaging 243.2 minutes;the amount of bleeding ranged from 800 to 1,600 mL,averaging 1,023.3 mL.No deterioration of neurological symptoms or no new neurological symptoms were observed postoperatively.Cerebrospinal fluid leakage was found in 3 patients who healed spontaneously following extubation,compressive dressing and elevation of the bed end.All the patients were followed up for 12 to 30 months (average,18.3 months).A loosened screw cap was found in one patient after 6 months who had no discomfort and received no treatment.X-ray films showed satisfactory fracture reduction and fine bone grafting locations.No spinal canal stenosis was found by CT scans.It took 3 to 6 months (mean,4.3 months) for the bone grafts to get fused.No height loss of the injured vertebrae was no found at the last follow-ups.No functional recovery was found in the patients with complete spinal cord injury whose Frankle grade remained A.The spinal function recovered from Frankel grade B to grade D in one patient with incomplete spinal injury.Of the 8 patients with medullary cone injury,7 recovered Frankle grade E and one Frankle grade D.The symptoms were relieved in one patient with simple cauda equine injury.Conclusion Posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle is an effective alternative for treatment of severe throracolumar fractures,because it can lead to satisfactory fracture reduction,thorough decompression of the spinal canal and good reconstruction of spinal stability.

Objective Neuroinflammation following traumatic brain injury (TBI) may give rise to neurodisorder.This study aimed to investigate the effect of intranasal delivery of nerve growth factor ( NGF) on neuroinflammation following TBI and its action mechanism in rats. Methods Thirty-six male adult Sprague-Dawley rats were equally divided into a sham , a TBI, and a TBI+NGF group.The rats in the TBI +NGF group were treated with NGF intranasally at 12 and 24 hours after TBI.The levels of IL-1βand TNF-αin the injured cerebral cortex were detected by ELISA , the DNA-binding activity of NF-κB evaluated by EMSA , and the expres-sion of amyloid-β( Aβ42 ) determined by Western blot . Results NGF attenuated the inflammation following TBI .Compared with the TBI group, the level of IL-1βwas obviously decreased in the TBI +NGF group at 12 hours (70.65 ±3.10 vs 37.51 ±1.92) and 24 hours (68.85 ±8.10 vs 36.23 ±2.99, P<0.05), and so was that of TNF-α(47.12 ±7.38 vs 27.63 ±5.77 and 56.15 ±11.20 vs 29.94 ±8.62, P<0.05).The DNA-binding activity of NF-κB was reduced to 111.62 ±0.49 and 131.52 ±0.88, and the expression of Aβ42 to 0.23 ±0.008 and 0.52 ±0.004 at 12 and 24 hours respectively after treatment with NGF , both with statistically significant differences from the TBI group (P<0.05). Conclusion Intranasal administration of NGF attenuates TBI-induced neuroinflamma-tion in rats, which may be associated with its regulatory effect on the Aβ42/NF-κB signaling pathway .