Objective To analyze the CT findings of heterotopic pancreas and the correlation with pathologic changes.Methods CT findings in 1 9 patients with heterotopic pancreas proven by surgery were reviewed retrospectively,14 of whom were scanned with enhanced CT.The correlation of CT findings and pathologic results were also analyzed.Results All patients had a single lesion with sized range from 0.8 to 4.7 cm and mean diameter of (2.2±0.6)cm.All lesions with homogeneous density were showed on plain scans including 7 lesions in stomach,8 in duodenum,2 in jejunum,1 in ileum and 1 beside the cardiac lymph nodes.The border of the lesions in 5 was unclear with exudative changes,mimicking acute pancreatitis.A sign of central umbilical concave was found in 2.Pathological results confirmed 14 lesions in submucosa,3 in muscular layer,1 in serosal layer and 1 in abdominal cavity.Hetero-topic pancreas presented early obvious enhancement in 9,mimicking normal pancreas,which was composed chiefly of pancreatic aci-ni.The enhanced degree of 4 lesions was lower than normal pancreas,which were composed of pancreas ductal epithelium and few pancreatic acini.No significantly enhancement was seen in 1,mimicing liomyoma,which was composed chiefly of pancreas ductal epithelium and smooth muscle hyperplasia.Conclusion Heterotopic pancreas in most cases presents characteristic submucosal disea-ses-like pattern,and different enhanced patterns of heterotopic pancreas are related with the pathologic changes.

According to the characteristics of pediatric resident training, the situation in clinic practice of medical imageology are analyzed and the major problems are pointed out.This article empha sizes significance of standardized resident training of medical imageology, presents detailed requirement which the residents must meet and aims to improve the training effect by the solutions summarized after years of experience.

Objective Cigarette smoking remains highly prevalent in most countries.It can affect drug therapy by both pharmacokinetic and pharmacodynamic mechanisms.Correlation between smoking and drugs has been reviewed, and the future study about situation of smoking and drugs also was reviewed.

Objective To investigate the effects of levocarnitine on pregnancy outcome of the patients with obstructive azoospermia treated with intracytoplasmic sperm injection ( ICSI ) . Methods A total of 74 patients with obstructive azoospermatism treated with ICSI randomly divided into 2 groups:treatment group( n=38) , taking levocarnitine before treatment with ICSI 1 g twice a day for three months;control group( n=36) , taking vitamine E before treatment with ICSI 0.1 g twice a day time for three months.tumor necrosis factor-α(TNF-α), reactive oxygen species(ROS) level, epididymal sperm motility and morphology in epididymal fluid of the two groups were determined before and after treatments. The number of matured oocytes, fertilization, and embryos of adequate quality, the rate of fertilization and embryo of adequate quality, and pregnancy rates after PESA-ICSI were compared between the two groups. Results TNF-α in epididymal fluid before and after the treatment was (5.39±2.28)and(4.05±2.14)ng.mL-1 in the treatment group(P<0.05), and(4.97±2.13)and(4.83±2.35)ng.mL-1 in the control group.ROS in epididymal fluid before and after the treatment was(62.72±8.51),(56.28±8.70)RLU.s-1(P<0.05)in the treatment group( P<0. 05 ) , and ( 62. 61 ± 7. 55 ) and ( 61. 05 ± 6. 77 ) RLU . s-1 in the control group. After treatment with levocarnitine, epididymal sperm motility was significantly increased(P<0.05).There were no significant differences in all the indexes in the control group before and after the treatment(P>0.05).After PESA-ICSI, the number and percentage of high quality embryo in the treatment group were significantly higher than those of the control group(P<0.05). Conclusion Levocarnitine can down-regulate epididymal TNF-α and ROS in patients with obstructive azoospermatism, thereby improve the environment of the epididymis and elevate the quality of sperm and ICSI pregnancy outcome.

To study the transport mechanisms of drugs for transplacental treatment of fetal tachyarrhythmia, MDCKII-BCRP and MDCKII cell models was used. MDCKII-BCRP and MDCKII cell monolayer model was used to investigate the bi-direction transport of sotalol, propranolol, propafenone, procainamide and flecainide. Drug concentrations were measured by HPLC-UV or chemiluminescence. The apparent permeability coefficient (P(app)), efflux rate (R(E)) and net efflux rate (R(net)) were calculated. Drugs with R(net) greater than 1.5 were further investigated using cellular accumulation experiments with or without a BCRP inhibitor. The R(net) of sotalol, propranolol, propafenone and procainamide were less than 1.5, while R(net) of flecainide with concentrations of 20 and 5 μmol x L(-1) were 1.6 and 1.9, respectively. The results showed that the transport of flecainide on MDCKII-BCRP cell monolayer could be mediated by BCRP; and the affinity increased when the concentration of flecainide decreased. Cellular accumulation experiments further suggested that accumulation of flecainide in MDCKII-BCRP cells was significantly lower than that in MDCKII cells in a concentration-dependent manner. BCRP inhibitor quercetin (50 μmol x L(-1)) significantly increased the accumulation of flecainide in MDCKII-BCRP cells (P < 0.05). Our preliminary data showed that flecainide but not sotalol, propranolol, propafenone or procainamide can be a substrate of BCRP. Thus the effect of flecainide may be affected by the BCRP in the maternal placental trophoblast membrane layer when treating fetal tachyarrhythmia.

Objective To discuss the effects of sevoflurane on perioperative hemodynamics and serum cardiac troponin I(cTnI) in patients undergoing abdominal surgery,and offer the reference for selecting anesthetic in clinic.Methods Forty patients with ASA Ⅱ—Ⅲ,undergoing radical gastrectomy were randomly allocated into sevoflurane group(group S) and propofol group(group P),with each 20 patients.Systemic blood pressure(SBP),diastolic blood pressure(DBP),heart reat(HR) and saturation of oxygen(SPO2) were monitored as routine.The concerntration of cTnI was examined at pre-anesthesia(T1),post-induction(T2),beginning of operation(T3),end of operation(T4),the first day post-operation(T5) and the third day post-operation(T6) with radioimmunoassay.Results SBP,DBP and HR in group P at post-induction were significantly lower than those in group S(P

Objective To investigate the prognosis and related factors of community acquired pneumonia (CAP). Methods From August 2003 to March 2009, 689 CAP cases from 37 hospitals of 23 cities in China were enrolled. The onset information and clinical outcomes in one month of onset were recorded. Pearson Chi-square test and Logistic regression test were performed using the SPSS 12.0 software to identify prognosis-related factors. Results Among 689 patients there were 396 male and 293 female. The median age was (53 19) years old, 247 patients (35.8%) were≥65 years old. Forty four patients died with a fatality rate of 6.4%. Univariate analysis identified 19 risk factors, they were age≥65 years old, smoking, aspiration, use of antimicrobial agents in 3 months, use of immunodepressant in 2 months, heart failure, chronic renal failure, chronic liver disease, eerebrovascular disease, diabetes, emaciation, altered mental status, respiratory rate > 28/min, pulse > 100/min, lower diastolic blood pressure, neutrophil ratio > 0.9, ALT >40 U/L, elevated blood urea nitrogen level and PORT classification ≥Ⅳ. By multivariate analysis, use of antimicrobial agents in 3 months, respiratory rate > 28/min, pulse > 100/min and PORT classifications≥Ⅳ were identified as the independent risk factors for mortality. Conclusions The general fatality rate of CAP is low in China. Use of antimicrobial agents in 3 months, respiratory rate > 28/min, pulse > 100/min and PORT classifications≥Ⅳ are independent risk factors for mortality.

Objective To evaluate the value of MSCT in the diagnosis of extrahepatic cholangiocarcinoma.Methods The MSCT appearances of extrahepatic cholangiocarcinoma confirmed by pathology in 27 cases were analyzed retrospectively.Among them,20 patients underwent plain and four-phase dynamic contrast-enhanced CT scans including early arterial phase,late arterial phase,portal phase and delay phase,7 patients only underwent contrast-enhanced CT scans.Results 15 lesions were located in the hilar and 12 lesions were located in the common bile duct.CT features of cholangiocarcinomas in this group were varied with its position and growth pattern.Besides the direct sign such as delay enhancement,the indirect findings were also specific such as hepatic lobe atrophy,dilated bile duct,etc.Conclusion MSCT is of great value in diagnosis of extrahepatic cholangiocarcinoma.

Objective To investigate the pathogen distribution and drug resistance of gram-negative bacteria causing lower respiratory tract infections in patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods A total of 742 sputum samples were collected from AECOPD patients with lower respiratory tract infections in Taizhou Hospital of Zhejiang Province during January 2013 and December 2014.Vitek 2 Compact system combined with disk diffusion was used for strains identification and drug susceptibility test.Modified Hodge test and ethylenediamine tetraacetic acid (EDTA) synergic test were used to screen carbapenem-resistant strains.Statistical analysis was performed using WHONET 5.6 and SPSS 20.0 software.Results A total of 593 strains of gram-negative bacteria were isolated , in which 367 strains were nonfermentative bacteria (61.89%), 220 strains were enterobacteriaceae (37.10%), and the rest 6 strains ( 1.01%) were other gram-negative bacteria.Acinetobacter baumannii ( 186 strains ), Pseudomonas aeruginosa (99 strains), Stenotrophomonas maltophilia (33 strains) and Burkholderia cepacia (22 strains ) were top 4 nonfermentative bacteria , and they all showed high resistance to ampicillin , ampicillin/sulbactam, cefazolin, ceftriaxone, cefotetan and nitrofurantoin with resistant rates of 67.20%-100.00%. Drug resistance rates to other β-lactams, fluoroquinolones, aminoglycoside, compound sulfamethoxazole and minocycline were significantly higher in carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains than those in non-carbapenem-resistant strains , and the differences were statistically significant (P <0.05 or <0.01).Stenotrophomonas maltophilia and Burkholderia cepacia strains were only sensitive to levofloxacin , compound sulfamethoxazole and minocycline . Klebsiella pneumonia (89 strains), Escherichia coli (80 strains) and Enterobacter cloacae (25 strains) were top 3 enterobacteriaceae , which were almost completely resistant to ampicillin , but were sensitive to piperacillin/tazobactam , cefoperazone/sulbactam , amikacin and carbapenems ( with resistant rates <15%) .More than 50%strains of extended spectrum β-lactamases ( ESBLs )-producing Klebsiella pneumonia and Escherichia coli were moderately or highly resistant to ampicillin/sulbactam , most cephalosporins ( except cefotetan and cefoperazone/sulbactam ), gentamycin, tobramycin, fluoroquinolones, aztreonam, compound sulfamethoxazole and minocycline , and the resistant rates were higher than those in non-ESBLs-producing strains (P <0.05 or <0.01).Conclusions Nonfermentative bacteria and enterobacteriaceae are the most prevalent gram-negative bacterial pathogens in lower respiratory tract infections in patients with AECOPD . Carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains, as well as ESBLs-producing Klebsiella pneumonia and Escherichia coli strains are highly resistant to most antibacterial agents .

OBJECTIVE Toexploretheantagonisticeffectofadrenaline(Adr)onproarrhythmiain-duced by Chinese herbal intravenous injection of Shuanghuanglian Injection (SHL).METHODS ① In vivo ECG recording was made to analyze effects of jugular intravenous (iv)injection of SHL alone and SHL plus adrenaline on ECG in guinea pigs.SHL and/or adrenaline were injected accumulatively in this order:SHL 276 mg·kg -1→2760 mg·kg -1→adrenaline 0.0078 mg·kg -1→adrenaline 0.039 mg·kg -1 .② In vitro ECG recording was made to analyze effects of SHL and SHL plus adrenaline on ECG in isola-ted hearts of guinea pigs.SHL and/or adrenaline were perfused in this order:SHL 0.3 g·L-1→SHL 1 .5 g·L-1→SHL 1 .5 g·L-1 +Adr 0.42 mg·L-1→SHL 1 .5 g·L-1→control perfusion solution.③ Single ventricular myocyte action potential was recorded to analyze the effect of SHL alone and SHL plus adren-aline on the action potential durations at 50% (APD50 )and 90% (APD90 )repolarization levels.SHL alone was perfused in such order:SHL 0.3 g·L-1 →SHL 1 .5 g·L-1 →SHL 3 g·L-1 +adrenaline 0.83 mg·L-1 .RESULTS ①SHL (2760 mg·kg -1 )significantly reduced heart rate and prolonged QRS and QTc intervals in vivo ECG.Adrenaline (0.0078 mg·kg -1 and 0.039 mg·kg -1 )significantly amelio-rated the proarrhyth mia of SHL by shortening QTc,P-R intervals and increasing heart rate.② SHL (1 .5 g·L-1 )remarkably reduced heart rate and prolonged P-R interval in isolated guinea pig hearts in vitro.Adrenaline (0.42 mg·L-1 )significantly increased heart rate and shortened the QTc interval.③ SHL (3 g·L-1 )remarkably prolonged the APD50 and APD90.Adrenaline abolished the prolonged effectofSHLonAPD50APD90.CONCLUSION Adrenalinemightbeclinicallyusedtotreatsevere adverse drug reactions induced by SHL based on its antagonistic effect on arrhythmia.