Objective To explore the clinical value of CT in diagnosis of pulmonary Wegener's granulomatosis.Methods The clinical data of 11 cases with Wegener's granulomatosis of the lungs were selected.All patients underwent CT scan or enhanced MRI scans and misdiagnosis of CT images were analyzed.Results This group of patients with bilateral lung injury in 9 cases,unilateral lung injury in 2 cases.Main imaging features include:multiple nodules in 8 cases,irregular flakes consolidation shadow in 4 cases,wedge-shaped lesion in 3 cases,empty in 6 cases.Among 11 patients,8 patients were misdiagnosed,misdiagnosis rate was 72.72％ (8/11),of which 2 cases were misdiagnosed as primary lung cancer,3 cases were misdiagnosed as metastatic lung cancer,3 cases were misdiagnosed as tuberculosis.Conclusion The CT manifestations had a very important role in guiding the diagnosis of pulmonary Wegener's granulomatosis.

ObjectiveTo explore the clinical value of 256-slice CT and coronary angiography in the diagnosis of coronary artery disease.Methods46 patients with coronary heart disease,who underwent coronary angiography and 256-slice spiral CT were selected.Compare two methods for the detection of coronary artery disease.Results( 1 ) All 256-slice CT and coronary angiography achieved a satisfactory image,in the diagnosis of coronary artery stenosis and occlusion,the two methods had no statistically significant difference ( P ＞ 0.05 ).(2) according to standard coronary angiography,256-slice spiral CT for the diagnosis of coronary artery stenosis sensitivity was 93.0％ (132/142),specificity was 91.6％ (142/155),positive predictive rate was 91.0％ (132/145),negative predictive rate was 93.4％ (142/152).Conclusion256-slice spiral CT has a high time resolution,spatial resolution,the display of the coronary artery disease has high sensitivity,specificity,positive predictive value and negative predictive value.

Objective To investigate the effect of different concentrations of dexmedetomidine on the apoptosis of hippocampal neurons in neonatal rat induced by propofol in vitro. Methods Hippocampal neurons of primary cultured neonatal SD rat were divided randomly into three groups. Group C (control group)was normal cultured without any treatment for 12 h; group P (Propofol group)was incubated with 12 μg/mL propofol for 12 h and group DP (Dexmedetomidine + propofol group)was incubated with 0.002 5 ~ 25 μg/mL dexmedetomidine for 30 min, and then further incubated with 12 μg/mL propofol for 12 h. Results Compared with that of group C, the apoptosis rate of hippocampal neurons increased in group P and DP (P < 0.05 or P < 0.01); Compared with that of group P, the apoptosis rate of neurons decreased with the increase of dexmedetomidine concentration in group DP (P<0.05 or P<0.01). The result of transmission electron microscope indicated that compared with group C , group P showed obvious neuronal damage; the nerve cells damage alleviated in group DP, which were negatively associated with the concentration. Conclusions With the concentration ranging from 0.002 5 to 25 μg/mL, dexmedetomidine set pre-incubation and breeding can reduce apoptosis of hippocampus neuron of neonatal rats induced by propofol and the effect is concentration dependent.

Purpose To investigate the expression of androgen receptor ( AR) in molecular subtypes of breast cancer and its relation-ship with clinicopathological features. Methods The expression of estrogen receptor (ER), progesterone receptor (PR), HER-2, CK5/6, CK14 in breast cancer was detected by EnVision immunohistochemical staining, and they further be divided into 84 Luminal A subtypes, 27 Luminal B subtypes, 14 HER-2 overexpression subtypes, 11 Basal-like subtypes, and 17 Normal-like subtypes, respec-tively. The distribution of AR in 5 molecular subtypes and its relationship with clinicopathological factors, such as age, histopathologi-cal grading, tumor size, lymph node status and clinical staging, were analyzed. Results In 153 cases of breast cancer, the positive rates of AR expression were 73. 20%, Luminal A was the majority ( 62. 50%) in 5 molecular subtypes. In the HER-2 negative and positive breast cancer, the positive rates of AR expression were 75. 00% and 68. 29% and the difference between the two groups was no statistical significant (P=0. 196). Of the 153 breast cancers, 23 (15. 03%) were triple-negative breast cancers (ER-, PR- and HER-2-), 15 (9. 80%) breast cancers were negative for ER, PR and AR, 8(5. 23%) breast cancers were quadruple negative (ER-, PR-, AR- and HER-2 -) . There was significant difference of the expression of AR in ER/PR positive and negative breast cancer (P=0. 001),it was positively correlated with ER/PR protein expression (rs =0. 874, P=0. 024). The difference of AR ex-pression between histological grading was statistically significance ( P=0. 022 ) , the expression of AR was negatively correlated with histopathologic grading (rs = -0. 201, P=0. 013). The positive expression of AR was related to tumor size, but not correlated with lymph node metastasis ( P=0. 211 ) and clinical staging ( P=0. 065 ) . Conclusion The expression of AR in breast cancer tissues and its relationship with clinicopathological features may provide a basis for the further improvement molecular typing of breast cancer, and also provide the theoretical basis for clinical treatment and judging prognosis.

Objective To investigate the effects of different doses of remifentanil on learning and memory ability,the expression of hippocampal tissue phosphorylation of cAMP response element binding protein (p-CREB)in developing rats.Methods A total of 72 Sprague-Dawley rats (1 9-23 g) were randomly divided into 4 groups (n =18 each):Group C:normal saline control group;R1,R2, R3 group received continuous intraperitoneal remifentanil 1,5,10 μg·kg-1 ·min-1 for 2 hours re-spectively.Both total volume of remifentanil and saline were 2 ml.The SpO 2 and pulse rates were mo-nitored during the experiment.Step-down test was used to evaluate the learning and memory ability, while Western blot analysis was performed to measure the expression of hippocampal p-CREB protein in 4 h,24 h,1 week when the rats were awake.Results Compared with group C,group R1 and R2, pulse rates of group R3 decreased significantly (P <0.05 ),but the changes of SpO 2 in each group were not statistically significant.At 4 h point:compared with group C and group R1,the error times in step-down test were increased in both group R2 and R3,the latencies were shortened (P <0.05);Compared with group R2,the error times were increased in group R3,latency was shortened (P <0.05).At 24 h point,compared with group C and group R1,the error times were increased in group R2,R3,latencies were shortened (P < 0.05 );Compared with group R2,the error times were in-creased in group R3,latency was shortened (P <0.05 ).The error times and latency of each group had not statistical significance in one week.At 4 h point,the expression of p-CREB protein in hippo-campus of group R3 downregulated compared with group C and group R1,R2,respectively (P <0.05).At 24 h point,the expression of p-CREB protein in hippocampus of group R2,R3 decreased compared with group C and group R1 respectively(P <0.05);The expression of p-CREB protein in each group had no statistical significance in one week.Conclusion 5-10 μg · kg-1 · min-1 dose of remifentanil can result in a decline of learning and memory ability in the developing rats in short-term,and the mechanism may relate to the inhibition of p-CREB protein expression in hippocampus.

Objective To evaluate 64-slice CT angiography in diagnosing spinal vascular malformations. Methods Fifteen patients,who were suggestive of spinal vascular malformations bv clinical manifestation and MRI,underwent CT angiography with a 64-slice spiral CT(GE lightspeed VCT).DSA were performed later within 1 week in all the patients and four of them were treated with operation as well.We evaluated CTA images in displaying the lesions according to the following aspects:the type of malformation,lesion range,feeding artery,draining vein and possible fistula.and compared those details with DSA and operation findings.Results All 15 patients acquired their final diagnosis by DSA and operation,which were intramedullary axteriovenous malformation in 6 cases,perimedullary arteriovenous fistula in 2,spinal dural arteriovenous fistula in 3 and Cobb syndrome in 4 cases. CTA was consistent with DSA in the classification of lesions and in the determination of the involved regions and it reveaIed the main feeding arteries and draining veins in all patients.CTA showed four arteriovenous fistulae confinned bv DSA.but it failed in a complex arteriovcnous fistula.In Cobb syndrome patients,not only the intramedullary but also paravertebral and subcutenous vascular malformation could be clearly seen on CTA images.Conclusion 64-slice CT angiography can be a preliminary method in spinal vascular malformation because it can determine the classification and reveal almost all the main lesions quickly,atraumatically.

OBJECTIVETo carry out clinical and genetic analysis for three pedigrees affected with myotonic dystrophy type 1 (DM1).

METHODSThree probands with clinically diagnosed DM and their familial members were recruited. Clinical data of the patients including clinical manifestations, electrocardiogram (ECG), and electromyogram (EEG) was collected.

RESULTSThe clinical symptoms of all probands have progressed slowly and included myotonia, muscle weakness and muscle atrophy as the main manifestations. Disorders of other systems have included cataract, arrhythmia, alopecia, sexual dysfunction, and cognitive impairment. The EEG of the probands showed characteristic myotonia discharges. Genetic analysis revealed over 50 CTG repeats at the 3' end of the DMPK gene in all three probands.

CONCLUSIONDM1 is a complex hereditary disorder involving multiple systems and overlaps with other diseases. In addition to clinical symptoms and EEG, genetic testing can facilitate its diagnosis at early stages.

Adult ; Electrocardiography ; Electroencephalography ; Female ; Genetic Testing ; Humans ; Male ; Middle Aged ; Myotonic Dystrophy ; genetics ; physiopathology ; Pedigree

Currently, concurrent chemoradiotherapy is the conventional treatment for locally advanced head and neck squamous cell carcinoma, but the 5-year survival rate of patients is still not high. In recent years, the development of radiotherapy technology has offered more options for patients. In addition, with the improvement of people's living standards, more and more patients begin to pursue the quality of life. There is an urgent need to explore better comprehensive treatment options to improve patient outcomes. In this article, research progress in comprehensive treatment of locally advanced head and neck squamous cell carcinoma was reviewed.

20 years)was 8.60%(48/558) , which was more than that in the second decade of life ( 5.22% ). The incidence of painful group was 9.79%(14/143),which was more than that in foot trauma group 6.78%(40/630).The positive C sign was presented in 61.1%(33/54),posterior-type coalition in 38.9%(21/54),short talar neck sign in 61.1%(33/54)and talar beak sign in 22.2%(12/54). Conclusion The talocalcaneal coalition is a common development abnormality in our country. We must pay attention to the diagnosis of talocalcaneal coalition for painful foot adulthood.

Objective To study the incidence and radiologic findings of calcaneonavicular coalition.Methods CR films of foot andankle in 1361 cases were presented,which were evaluated for acute trauma or chronic pain.There were 588 cases of foot CR and 773 cases of ankle CR,age ranged from 10 years to 91 years(984 cases of 20~40 years).The prevalence of calcaneonavicular coalition was determined and the different significance of both male and female,acute trauma and chronic pain group were analysed.Results In 1361 cases,72 cases of calcaneonavicular coalition(5.3%) were demonstrated,8.7%(47/588)on foot CR films and 3.2%(25/773) on ankle CR films.Calcaneonavicular coalition was more dipicted on foot CR films than on ankle CR films(P0.05).Conclusion The foot CR films is more superexcellent than the ankle CR films on demonstrating calcaneonavicular coalition.