Objective To analyze the MRI characteristics of hematospermia seminal vesiculitis(HSV) and evaluate the diagnostic value of MRI in HSV. Methods The MRI parameters of 25 HSV patients underwent magnetic resonance imaging(MRI) imaging with SE T 1WI(TR/TE 558/14ms), Flash 2D water excitement(TR/TE 18.5/5.2ms), TSE T 2WI(TR/TE 4000/99ms) and fat suppression sequences were retrospectively analyzed. Results The bilateral seminal vesicles in all 25 patients with HSV enlarged. On SE T1-weighted images, intraseminal vesicle hemorrhage appeared as high signal intensity, which appeared more bright on Flash 2D water excitement sequence. The hypointensive duct wall of seminal vesicles could be clearly seen because of hyperintensive hemorrhage. On TSE T2-weighted images, intraseminal vesicle hemorrhage appeared as relatively lower signal intensity, and the duct wall of seminal vesicles could not clearly be depicted for being covered with relatively hypointensive hemorrhage. Conclusion Hematospermia seminal vesiculitis could be identified by MRI, and MRI was the best imaging method for examining hematospermia seminal vesiculitis.

Objective To study the value of CT and MRI in diagnosis of Caroli disease. Methods CT and MR findings in 10 patients with histologically proved Caroli disease were retrospectively reviewed. All the patients underwent both liver plane CT and contrast-enhanced CT. Five of 10 patients underwent MR imaging with Flash 2D T_1WI(TR/TE 148/4ms), True Fisp T_2WI(TR/TE 5.8/2.9ms) and MRCP(TR/TE 1120/86ms) sequences. Results The imaging paremeters of Caroli disease were multiple saccular/columnar dilatation of intrahepatic biliary ducts and communication with each other, which only partly were depicted at CT, however, all imaging findings were depicted at MRI True Fisp and MRCP without contrast-enhanced scanning. Of 10 patients, 4 cases were type Ⅰ of Caroli disease with hepatolith, but without hepatic cirrhosis and portal hypertention; 6 cases type Ⅱ,all complicated with hepatic cirrhosis and portal hypertension. Of 6 patients with type Ⅱ Caroli disease, 4 cases had not hepatolith, and 2 cases had hepatolith. Of 10 patients, 3 cases had bilateral sponge kidney. Conclusion Caroli disease could be identified by CT or MRI, but MRI was superior to CT in depicting Caroli disease.

Objective To investigate the influence of the core-veneer interfacial surface roughness on the flexural strength and failure mode of bilayered lithium-disilicate ceramic structure.Methods Forty IPS e.max Press bar-shaped specimens were fabricated and divided randomly into 4 groups.The core-veneer interfacial surfaces of the core materials were ground to specific surface roughness with silicon carbide papers of various grits.Specimens of the groups A,B and C were ground by silicon carbide papers of 1000 grits,600 grits and 320 grits,respectively.While specimens in group D were sandblasted without any grinding as recommended by the manufacturer's instruction.After veneer application and sintering,the flexural strength of bilayered specimens were measured utilizing three-point bending test,and the failure mode was observed using stereomicroscopy.Results The mean flexural strength value of bilayered specimens for groups A,B,C and D were (164.27±15.02),(159.21± 15.72),(156.14±17.10) and (152.97±15.61) MPa,respectively.However,there was no significant differences in fracture strength between groups (P＞0.05).All specimens demonstrated cohesive failure of veneer porcelain right underneath the indenter,without any core-veneer delamination.Conclusions The influence of core-veneer interfacial surface roughness on flexural strength of bilayer lithium-disilicate-based ceramics is not significant.The superior bond between core and veneer provides a reliable interface.

Objective　To study the changes of quantitative expression,adhering activity and genomic density polymorphism of complement type 1 in erythrocytes (CR1) of patients with liver cancer (104 patients) and their clinical significance.Methods　Polymerase chain reaction (PCR),HindIII restriction enzyme digestion,the quantitative assay of ECR1 and the adhering activity assay of CR1 in erythrocytes were used.Results　No difference was observed between the patients with liver cancer (29.8%) and healthy individuals (25.3%) in the spot mutation rate of CR1 density gene (χ2 =0.537,P>0.05).The number and the adhering activity of CR1 in patients with liver cancer (0.83±0.22 and 47.1±6.5) were significantly lower than those in healthy individuals (1.26±0.33 and 62.4±7.6; t=10.5,P<0.0001).The number and the adhering activity of ECR1 in high expression genomic type (HH) liver cancer were obviously lower than those of healthy individuals,expecially those of the patients with advanced liver cancer.There was a good relationship between quantitative expression,adhering activity of ECR1 and liver cancer development.Conclusion　Defective expression of CR1 in liver cancer is mostly acquired through central peripheral mechanisms.The changes of CR1 quantitative expression and adhering activity are consanguineously related to the severity and the activity of the development in patients with liver cancer.

Problem-based learning(PBL)plays an improtant role in fostering the ability of problem-solving,creative thinking and active learning of medical undergraduates.Based on the present clinical education resources,how to implement PBL at the largest advantages is the main issue we should concern.

Objective To study the effect of phonophoresis on transdermal delivery of sinomenine hydrochloride ( SH ) gel in vitro. Methods Ultrasound at one of two frequencies ( 800 kHz or 1 MHz) was applied with a sonicator with a transducer in this study. The skin of male Sprague-Dawley rats was used as the model and SH gel was used as the ultrasound couplant. The permeation rate of SH was detected using a modified Franz diffusion cell maintained at 32±0.5℃ and filled with 20% polyethylene glycol 400 physiological saline solution. The transdermal phonophoresis experiments were carried out in five groups: Group Ta, f=800 kHz, / = 0.75 W/cm2, t = 10 min:Group Tb,f=1 MHz,I=0.7 W/cm2, t=10 min; Group Tc,f=1 MHz,I=0.35 W/cm2, t=10 min; Group Td,f=800 kHz, I = 1.5 W/cm2, t = 10 min and Group Tc,f=800 kHz, I=1.5 W/cm2,t=5 min. There was also a control group (C) in which the SH was allowed to diffused passively. Samples were withdrawn at the indicated intervals and the concentration of SH was determined by high-performance liquid chromatography. The transdermal parameters such as average accumulated delivery quantity per unit area Q8h, average transdermal steady delivery rate J, and Tlag were calculated. Results The Q8h and Js of the control group were 20.65±10.23 μ/cm2 and 3.02±0.11μ/cm2/h respectively. The phonophoresis parameters in groups Ta and Tb were, on average, significantly higher than in the control group. The parameters in group Tb were significantly larger, on average, than in Te. In group Td the parameters were significantly larger than in groups Ta and Te. Conclusions The results show that phonophoresis can enhance the transdermal delivery of SH. Phonophoresis variables such as frequency and time influence its effects on drug permeation. Almost no change was observed in the structure of the skin after phonophoresis, though under a scanning electron microscope the surface of the corneum appeared rough and porous. Phonophoresis is there-fore an effective and safe method for SH transdermal delivery, and the effect is positively relation with the applied intensity and exposure time.

Objective To investigate the feasibility,safety and efficacy of laparoscopic and endoscopic cooperative surgery (LECS) for elderly patients with gastric gastrointestinal stromal tumor (GIST).Methods 54 cases with GIST aged 65 years and over in Department of Gastrointestinal Surgery in Beijing Hospital from Dec.2008 to Dec.2012 were selected.31 cases underwent LECS and 23 cases underwent open surgery.Clinical data including operation time,intraoperative blood loss,complications,tumor size,length of incision,postoperative gastrointestinal function recovery time,postoperative in hospitalization and follow up data were retrospectively analyzed in patients.Results There were 17 males and 14 females in the LECS group,and the mean age was (72.8±5.9)years.29 patients underwent laparoscopic-assisted partial gastrectomy,and 2 cases underwent laparoscopicassisted endoscopic dissection in LECS group.All operations were successful with no conversion to open surgery and death.There were 13 males and 10 females in the open surgery group,and the mean age was(73.3±6.1)years.The mean operation time was longer in LECS group than in open surgery group [(120.6±32.8) min vs.(86.3±33.5) min].The mean intraoperative blood loss,mean tumor size,mean length of incision,mean time of gastrointestinal function recovery,mean postoperative hospitalization were less or smaller in LECS group than in open surgery group [(40±23.4) ml vs.(130±65.6) ml,(2.3±1.2)cm vs.(3.6 ±1.8)cm,(3.6±1.1) cm vs.(14.4±3.5) cm,(47.7± 10.4)h vs.(61.4±11.9)h,(5.1±2.3)d vs.(7.2±2.5)d,respectively,t=3.192,1.831,5.212,2.014,3.519,P=0.002,0.012,0.000,0.015,0.001].According postoperative tumor risk assessment,13 cases were at very low risk,15 cases at low risk and 3 cases at middle risk in LECS group; 4 cases were at very low risk,14 cases at low risk and 5 cases at middle risk in open surgery group.The risk degree was lower in LECS group than in open surgery group (x2 =5.63,P=0.017).During a follow-up of 5 53 months,death without GIST was found in 5 patients in LECS group and 4 cases in open surgery group.Hepatic metastasis was found in 1 case in open surgery group.Conclusions LECS is a safe and feasibility alternative approach for elderly patients with gastric GISTs.It has more minimal invasion,fast recovery and satisfaction with short term outcomes as compared with conventional open surgery.

ObjectiveTo estimate the cognitive function of subarachnoid hemorrhage patients with negative digital subtraction angiography(DSA),and analyse its relevant factors and clinical characteristics.Methods 96 subarachnoid hemorrhage patients were selected,and the disease condition were classfied into different grades by Fisher scale,Hunt-Hess scale and the cognitive function were estimated by mini-mental state examination (MMSE),then calculated its incidence,analysed the relationship between the classification and cognitive impairments.ResultsThe incidences of cognitive impairment in subarachnoid hemorrhage patients with negative DSA were 51.04％.Cognitive impairment was closely related to Hunt-Hess and Fisher grade (P＜ 0.01 ).ConclusionSubarachnoid hemorrhage patients with negative DSA exist different extent of cognitive impairment.The higher Hunt-Hess or Fisher grade,the more serious cognitive impairment.

Objective To study the nutritional evaluation and clinical effects of perioperative enteral nutrition (EN) versus parenteral nutrition support (PN) in elderly patients undergoing gastrectomy for gastric carcinoma.The safety,feasibility and superiority were also compared between EN and PN.Methods Totally 50 cases (aged 65 years and over) undergoing gastrectomy for gastric carcinoma in Department of Gastrointestinal Surgery of Beijing Hospital were recruited and divided randomly into two groups of EN and PN (25 cases for each).NRS2002 nutritional assessment scoring system was used to evaluate the patients.The patients in EN group were given Rui Su at 2 d before surgery,then Wei wo,Bai pu li and Rui su were sequentially given from 12 h after the surgery.The patients in PN group were received total parenteral nutrition (TPN) via central venous for 7 days.Results The average absolute lymphocytes[(1.22±0.23) ×109/L and (1.31±0.27) ×109/L vs.(1.02±0.21) × 109/ L and (1.14 ± 0.23 × 10)9/L],pre-albumin[(151.442± 48.15) mg/ L and (167.38± 46.23) mg/ L vs.(115.22 ± 47.34) mg/L and (131.27 ± 43.58) mg/L] and transferring [(1.71±0.33)g /L and (1.83±0.31)g/L vs.(1.50±0.32)g/L and (1.65±0.32)g/L,all P＜0.05] levels after surgery of 3 d and 7 d in EN group were higher than those of PN group (P＜0.05).The CRP levels at 3 d and 7 d after surgery were increased in PN group compared with EN group [(63.71±35.26)mg/L and (41.58 ± 22.55)mg/L vs.(54.26±29.13)mg/L and (18.12 ±14.35)mg/L,P＜0.05].The blood sugar and insulin levels of EN group at 3 d and 7 d after surgery were (5.93±1.12) mmol/L and (5.61± 1.03)mmol/L,(6.72±5.14) U/L and (6.21±2.63) U/L,which were decreased compared to PN group (8.31 ± 2.62) mmol/L and (8.85 ± 2.92) mmol/L,(12.81±7.26) U/L and (15.21±8.24) U/L (P＜0.05).ALT in the PN group was (38.43±18.37) U/L at 7 d after surgery,higher than EN group (23.91± 14.82) U/L(P＜0.05).The perioperative average costs of EN group was (2714.5± 1391.7) yuan,lower than PN group (5041.6± 3007.7) yuan (P＜0.05).For the patients complicated with delayed gastric emptying after surgery,nutrition cost reduction was more evident.There were no significant difference between the two groups of patients in the liver and kidney function changes and postoperative complications.Conclusions It is safe and feasible for elderly gastric cancer patients with perioperative EN sequential therapy in view of its reduced stress response of surgical trauma and insulin resistance,improvement of hyperglycemia,reduction of medical costs compared with PN for elderly gastric cancer patients.

Objective To investigate the correlation of serum concentrations of interleukin(IL)-6,IL-10 and tumor necrosis factor(TNF)-α and the prognosis of sepsis in children.Methods Fifty-seven septic patients in PICU were enrolled in the study,of whom 44 patients survived(sepsis survival group),13 patients died(sepsis dead group).Another 65 cases of non-sepsis patients served as control(non-sepsis group).The critical illness score,the number of damaged organs,and serum levels of IL-6,IL-10,TNF-α,IL-6/IL-10,TNF-α/IL-10 in each group were compared.Results The critical illness score was decreased and the number of damaged organs was more in sepsis dead group than those in non-sepsis group and sepsis survival group.Compared with non-sepsis group and sepsis survival group,the expression of IL-6 and IL-10 increased,TFN-α/IL-10 ratio significantly decreased in sepsis dead group(P ＜ 0.05),but the difference between the sepsis survival group and non-sepsis group was not statistically significant(P ＞ 0.05).The serum levels of TNF-α and IL-6/IL-10 ratio showed no significant difference among three groups(P ＞ 0.05).Conclusion In sepsis patients,the serum concentrations of IL-6,IL-10 are higher and the TNF-α/IL-10 ratio is smaller,the prognosis is worse.