Objective:To investigate the application value of multi-slice spiral CT angiography in the clinical diagnosis of aortic dissection.Methods:The clinical data of 78 patients with aortic dissection diagnosed by digital subtraction angiography and treated between January 2015 and December 2019 in Putuo District People's Hospital of Zhoushan and Zhoushan Hospital were retrospectively analyzed. All patients underwent multi-slice spiral CT angiography and digital subtraction angiography. The type of aortic dissection, the number of aortic lacunas, the distance between the lacuna and the left subclavian artery, the involved branches, the percentage of artery wall calcification, and arterial dissection thrombosis determined by multi-slice spiral CT angiography and digital subtraction angiography were compared.Results:All 78 patients were diagnosed with aortic dissection by digital subtraction angiography, and 75 (96.2%) were diagnosed with aortic dissection by multi-slice spiral CT angiography. The same type of aortic dissection was detected by multi-slice spiral CT angiography and digital subtraction angiography, but three patients were misdiagnosed with pericarditis by multi-slice spiral CT angiography. There were no significant differences in the number of aortic lacunas and the distance between the lacuna and the left subclavian artery between the two methods ( t = 1.02, 0.57, both P > 0.05). The involved branches [61.3% (46/78),] the percentage of artery wall calcification [26.7% (20/78)], and the percentage of arterial dissection thrombosis [78.7% (59/78)] determined by multi-slice spiral CT angiography were significantly higher than 43.6% (34/75), 12.8% (10/75), and 62.8% (49/75) respectively determined by digital subtraction angiography ( χ2 = 4.83, 4.65, 4.62, all P < 0.05). Conclusion:Multi-slice spiral CT angiography exhibits a similar capacity to identify aortic dissection to digital subtraction angiography. It can accurately determine the number and location of aortic lacunas, display the calcification and thrombosis of vascular wall, and is minimally invasive and simply operated. Therefore, multi-slice spiral CT angiography is of high application value in the clinical diagnosis and preoperative evaluation of aortic dissection.

Objective To evaluate the correlation of ADC values on 3.0 T MR with the pathological grades in pT1b clear cell renal cell carcinoma(CCRCC).Methods Conventional MR images,ADC values and Fuhrman pathological grading of pT1b CCRCC were performed in 30 patients.Grade Ⅰ and Ⅱ were defined as low-grade group; grade Ⅲ and IV were defined as high-grade group.The differences of ADC values among four different pathologic grades were compared with a one-way analysis of variance. The comparison of ADC values of two different grade groups was performed with t test,and the ROC curve was performed to evaluate the diagnostic efficacy of ADC value. Correlation between pathological gradings and ADC values was assessed with Spearman rank correlation analysis. Results ( 1 ) The mean ADC value of grading Ⅰ ( 10 patients ), Ⅱ ( 8 patients ),Ⅲ ( 7 patients ),IV ( 5 patients ) was ( 0.94 ± 0.11 ) ×10-3 mm2/s,(0.82 ±0.13) × 10-3 mm2/s,(0.68 ±0.09) × 10-3 mm2/s,(0.59 ±0.03) × 10-3 mm2/s,respectively.Significant differences of ADC values among the four grades were present (F =16.422,P =0.000 ).( 2 ) The mean ADC value of the low-grade group was significantly higher than that of the high-grade group(t =5.738,P =0.000).Sensitivity and specificity of diagnosing the low-grade group was 88.9％ and 83.3％ respectively.There was a negative correlation between pathological grading and ADC value ( r =-0.807,P ＜ 0.05). Conclusions The ADC values of pT1b CCRCC have close correlation with pathological gradings.They can be used to predict the degree of tumor malignancy preoperatively and guide surgical planning.

BACKGROUND: Preliminary study has proved that the bone marrow-derived mesenchymal stem cells (MSCs) in a rat emphysema model produced by use of trypsin alone can "homing" to the lesioned lung tissues, and participate in the formation of pulmonary arteries to promote lung tissue repair. Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) play equally a powerful role in promoting angiogenesis. OBJECTIVE: To observe the influence of bFGF, VEGF and MSCs in regeneration of pulmonary capillary and pathological repair of pulmonary emphysema rats. METHODS: Except normal control group, the remaining 5 groups of rats were exposed to tobacco smoke and received a single intratracheally instillation of porcine pancreatic elastase to induce emphysema models. Following successful modeling, rats of bFGF group were intratracheally injected with 400 U bFGF and rats of VEGF group with 2 μg VEGF, once a week for three times. MSCs group was injected 1 mL suspension of 4×10~9/L MSCs into tail vein. MSCs+VEGF group was injected MSCs into tail vein and intratracheally injected VEGF (2 ug, three times) at the same time. Model control and normal control groups were intratracheally injected with equal volume of sodium chloride. Four weeks after treatment, arterial blood gas analysis was performed to observe pathological and morphological changes of lung tissues. CD34~+ expression in lung tissues was determined using immunohistochemistry method. RESULTS AND CONCLUSION: Compared with model control group, PaO_2 values dramatically increased in VEGF group (P <0.05), while other indices remained unchanged (P > 0.05); there were no obvious changes in each index in other groups (P >0.05). Gross and microscopic observations showed that, lung was smooth, pale pink, and elastic in normal control group, with uniform size of pulmonary alveoli on cross-section; pathological changes of chronic obstructive pulmonary emphysema existed in model control group, but improved in other 4 groups. Compared with model control group, mean pulmonary alveoli number and CD34~+ relative positive area dramatically increased in bFGF, VEGF, MSCs, MSCs+VEGF groups (P < 0.05), mean linear intercept and mean alveoli area were significantly reduced (P < 0.05). No significant difference was observed in each index among these 4 groups (P > 0.05). bFGF, VEGF and MSCs could improved the pathology of pulmonary emphysema models produced by tobacco smoking and intratracheally instillation of porcine pancreatic elastase. The possible mechanism of recovering the pulmonary emphysema is the proliferation of pulmonary capillary and enlargement of pulmonary artery, improved blood flow in the lung, improved ventilation/perfusion shunt, reduced pulmonary alveolus size and volume of the lung through self-compensation.

Objective To study the relationship between stress rise of blood glucose and the PEEL prognostic index of the patients with acute myocardial infarction, and provide the basis for a quick judgement and evaluation of prognosis to nurses. Methods Taking the 6.8,7.8 and 8.8 mmol/L as demarcation point to study the PEEL prognostic index in 59 patients with acute myocardial infarction, and compare the PEEL score value on two sides of each demarcation point. Results No significant difference in PEEL evaluation score when taking 6.8 mmol/L as the demarcation point, there was significant difference when taking 7.8 mmol/L as the demarcation point, PEEL score in blood glucose > 7.8 mmol/L group was higher than that of ≤7.8mmol/L group, so was when taking 8.8 mmol/L as the demarcation point. Conclusions There was instructive signifi-cance for nurses to observe a stress rise of blood glucose timely in evaluating the prognosis of patients with a-cute myocardial infarction. Nurses should strengthen disease observation and preventive nursing of admission patients whose fasting blood glucose are above 7.8 mmol/L as well their blood glucose monitoring.

Objective To analyze the clinical features in patients with primary cardiac tumors and surgical treatment of primary cardiac tumors.Methods A retrospective analysis of primary cardiac tumors patients from June 2002 to September 2012 was performed.79 patients were confirmed using cardiac echocardiography.Primary cardiac tumors were excised using general anesthesia during cardiopulmonary bypass.Results Only 5 patients relapsed after the follow-up for 6 months to 5 years.No tumor recurrence and distant metastases were found in the other patients.Conclusion Left atrial myxoma should be removed by surgical resection as soon as possible once there is a clear diagnosis.The surgical effect of left atrial myxoma is good but it may relapse.The malignant cardiac tumors progress rapidly and should be removed by early surgery combined with comprehensive treatment to improve the prognosis.

Objective To evaluate the early and midterm effect by retrospective analysis of the cone reconstruction in Ebstein′s anomaly. Methods From January 2012 through June 2016,16 patients with Ebstein′s anomaly underwent the cone reconstruction in our hospital. There were 7 males and 9 females at mean age(28.21 ± 11.88)years,including 12 patients of Carpentier B type,4 patients of Carpentier C type. There were 9 patients in New York Heart Association(NYHA)functional class Ⅲ,5 patients in NYHA functional class Ⅳand the others in NYHA functional class Ⅱ. All patients had Tricuspid insufficiency ,including 2 patients with Grade 2 ,10 patients with Grade 3 and 4 patients with Grade 4. All patients were followed up over a period of 6 to 51 months (mean:24.36 ± 10.71). By comparing the details of pre-operation with post-operation and post-operation with current stage,we analyze the outcomes of early and midterm effects. Results All patients are well survived. There were one patient recovering from the low cardiac output syndrome with adding the strength of the positive inotropic drug in the first day after operation ,and one patient recovering from bigeminy of ventricular prematurebeat with the aid of amiodarone and lidocaine the third day after operation. The remaining patients recovered smoothly. Early post-operative echocardiograms showed good right ventricular morphology and reduction in tricuspid regurgitation grade from(3.13 ± 0.62)to(1.75 ± 0.45)(P<0.001)with the functional class improved from(3.19 ± 0.66)to(2.00 ± 0.52)(P<0.001). After mean follow-up of(24.36 ± 10.71)months,the situation is improving furtherly with the tricuspid regurgitation grade reducing to(1.31 ± 0.48)(P=0.016)and the functional class rising to(1.50 ± 0.52) (P = 0.031). Conclusions This surgical technique for Ebstein′s anomaly can improve the function of tricuspid valve and the right ventricular morphology. It showed a satisfactory performance in the early and midterm results by enhancing the Cardiac function and life quality. But indications should be strictly grasped and more experiences need to be accumulated. Long-term effect need to be furtherly explored.

24. Of 6 patients positive in SDS, 4 cases scored 56 as moderate depression. Mean score was 47.62 for SDS, and 20.31 for HAM before treatment, and 32.23 for SDS, and 8.97 for HAM after 5 weeks of treatment. The differences were statistically significant (P

Objective To explore the molecular effect and interaction among nephrin, podocin, CD2AP and ?-actinin-4. Methods Firstly, the recombinant RNA interference (RNAi) plasmid-psiRNA-hH1GFPzeo, specifically targeting to the mRNA of nephrin, podocin, CD2AP or ?-actinin-4, was respectively tansfected into the mouse podocyte clone (MPC5) to each knockdown (KD) the expression of nephrin, podocin, CD2AP or ?-actinin-4. Molecular distributions were revealed by confocal microscopy, and the mRNA and protein expressions were detected with semi-quantitative RT-PCR and Western blotting. Results (1)In podocin KD group (siPod966 and siPod54), the mRNAs of podocin and nephrin were not detected, their protein decreased 92% and 79%, 82% and 67%, respectively. The mRNA and protein level of CD2AP increased 62% and 42%, 71% and 46%, respectively, whereas ?-actinin-4 did not change. In nephrin KD group (siNep492), the mRNA expression and protein level of nephrin were not detected, CD2AP increased 35% and 48%, respectively; and whereas podocin and ?-actinin-4 did not change. In CD2AP KD group (siCda744 and siCda21), the mRNA of expression CD2AP was not detected, and its protein level decreased 92% and 83%, the mRNA and protein of nephrin decreased 60% and 48%, 76% and 72%, respectively; podocin increased 38% and 22%, 56% and 44%, respectively; whereas ?-actinin-4 did not change. In ?-actinin-4 KD group (siAct1790 and siAct319), the mRNAs expression of ?-actinin-4 and nephrin decreased 69% and 58%, 64% and 49%, respectively; their protein level decreased 81% and 55%, 71% and 64%, respectively. However, the mRNAs of podocin and CD2AP increased 50% and 34%, 45% and 28%, respectively; and their protein level increased 64% and 46%, 65% and 42%, respectively. (2) With their expression change, the distributions of nephrin, podocin and CD2AP shifted evidently from the cell membrane surface to the nucleus circumference, whereas ?-actinin-4 showed no change, which was still localized in the cytoplasm and further extended to foot processes. Conclusion (1) Nephrin might more independently play a crucial role in the slit diaphragm complex. (2) Alpha-actinin-4 might interact direcdy or indirectly with nephrin, podocin and CD2AP. (3) The relationship among these podocyte molecules might not be spontaneous, either a single-directional or bi-directional reaction. (4) The normal localization of these podocyte molecules might depend on their normal expression quantity.

Objective To explore the molecular mechanisms underlying therapeutic responses of the anti-proteinuria drugs from the view of podocyte molecule. Methods Adriamycin (ADR) nephropathy was induced by a single tail intravenous injection of adriamycin. Lisinopril, prednisone and all-trans retinoic acid (ATRA) were administered once a day to the adriamycin-induced nephrotic rats at the first day after adriamycin injection respectively. Renal tissue samples were collected at day 3, 7, 14, and 28 after adriamycin injection respectively. The distribution, mRNA expression and protein expression of nephrin, podocin, CD2AP and ?-actinin-4 were examined by indirect immunofluorescence, real-time PCR and Western blotting, respectively. The interactions among nephrin and podocin, nephrin and CD2AP, as well as the nephrin phosphorylation were detected by immunoprecipitation, respectively. Results Compared to the control rats, 24 h urinary protein of the ADR rats increased significantly at day 14 (P

Objective To investigate the distribution and antibiotic resistance of clinical isolates in People’s Hospital of Qingyang during 2014 to provide evidence for rational antimicrobial therapy.Methods Bacterial strains were isolated and identified by routine methods and tested by disk diffusion method and E-test for antimicrobial susceptibility. The data were analyzed according to CLSI breakpoints using WHONET 5.6 software.Results Of the 2 121 nonduplicate strains isolated from January through December 2014, 1 565 (73.8%) were gram-negative and 556 (26.2%) were gram-positive strains. The top ifve pathogens wereE. coli, K. pneumoniae, A. baumannii, S. aureusand P. aeruginosa. The prevalence of methicillin-resistantStaphylococcus aureus (MRSA) and methicillin-resistant coagulase negativeStaphylococcus (MRCNS) was 44.6% and 15.4%, respectively.E. coli was the most common gram-negative bacterial species, whileS. aureus was the most common gram-positive bacteria species. Gram-positive bacteria were still highly susceptible to vancomycin, and gram-negative bacteria (such as Enterobacteriaceae) were still highly susceptible to carbapenems.ConclusionsE. coli is the most prevalent pathogen isolated from inpatients in this hospital during 2014. The prevalence of ESBLs-producing strains is the highest inE. coli isolates. The pathogenic bacteria in this hospital showed increasing resistance to a variety of antibacterial agents. Surveillance of antibiotic resistance and effective control measures are necessary to control the growing antimicrobial resistance.