Increased catabolism, including reduced protein synthesis rates and increased protein degration rates, is common in patient with trauma and sepsis. There has been a long time search in how to reverse the increased catabolism. Besides nutritional support, people hope manipulation of anti catabolism hormone might reverse or at least ameliorate catabolism. Recent researches indicate that the GH IGF IGFBP axis plays a crucial part in regulating the metabolism of muscle protein on both basal and stress condition. This article aims to review the changes in GH IGF IGFBP axis and its clinical significance associated with trauma and sepsis.

LSAB immunohistochemistry and digoxin-labeled in situ hybridization methods were used to detect the expression of EGFR and TGF-a and the transcription of EGFR-mRNA in human renal cell carcinoma (RCC) tissues. The expression rate of EGFR and TGF-α in 46 cases of human RCC tissues were significantly higher than that in 38 cases of corresponding autologous normal kidney tissues (EGFR.. 53. 4 % vs 21.0 %;TGF-α: 39. 1 /% vs 13. 2 %, P＜0. 05). Both EGFR and TGF-α were simultaneously overexpressed in some cases of RCC tissues. No relationship existed between EGFR or TGF-α and the RCC staging and grading. The positive rate of transcription EGFR-mRNA in 25 cases of RCC tissues was significantly higher than that in 20 cases of corresponding autologous normal kidney tissues (44 % vs 15 %, P＜0. 05). The above findings demonstrated that RCC tissues overexpressed EGFR and TGF-αand overtranscribed EGFR-mRNA. The overexpressed EGFR and TGF-α might contribute to the growth and development of RCC by taking part in the autocrine growth loop in RCC.

Objective To explore the ultrasound appearance of primary synovial osteochondromatosis (PSO) of the knee. Methods Thirty-eight cases with PSO were confirmed by pathology, their ultrasound features were analyzed retrospective. Results Two hundred and sixty calcify nodules showed medium echo and several motting or bolus strong echo. Two hundred and eighty-nine ossify nodules showed slightly strong echo or strong echo,or only showed arc strong echo with rear sound shadow near nodules. Twenty-six mixed type nodules showed promiscuity moderately strong echo or with rear sound shadow. Forty introsynovium cartilage lesser nodules showed synovium thickening and similar round low echo nodules,30 sursynovium lesser nodules showed high echo, with a pedicel connected to synovium, can shift deform or sway because of the pressure from transducer, often concomitance other type nodules. Ten cartilage greater nodules showed similar round or lobulated low or medium echo tuberculum. Conclusions Ultrasound can show multiple nodules of PSO of the knee, especially noncalcific nonage smaller cartilage nodules. It is helpful for clinicians to decide more reasonable operation strategy.

Objective To study the diagnostic value of MR coronal iterative decomposition of water and fat with echo asymmetry and least-squares estimation(IDEAL) water imaging in the far later lumbar disc herniation(FLLDH).Methods A retrospective analysis of pre-operative routine CT axial imaging and MPR post-processing,conventional MR axial plane,sagittal plane and IDEAL imaging was performed in 10 patients with pathologically FLLDH.The above images were observed to find whether it could clearly show the spatial relationship outline of the nucleus pulposus and the nerve root,including the number of affected nerve root(1 or 2),and the compressed part(dorsal root ganglion,postganglionic nerve root or preganglionic nerve root),and the morphological changes of the compressed nerve root(distortion,thinning,enlargement),and were compared with surgical results.Results Surgery showed 2 cases with extra-intervertebral foramen herniation,2 cases with intra-intervertebral foramen herniation,6 cases with mixed herniation.Nine cases involved 1 nerve root,and 1 case involved 2 nerve roots.The conventional CT axial plane could roughly show the local relationship between nucleus pulposus and the nerve root.On conventional CT axial plane,9 cases were diagnosed correctly but 1 case of herniation of extra-intervertebral foramen shifting cephalic to the lower vertebral level was missed.Seven cases of the compressed nerve root were identified with difficulty,2 cases showed obliteration of the fat space and displacement of the nerve root.The spatial relationship of the nucleus pulposus and the nerve root was more visualized by CT MPR images than conventional CT images,but the image was less clear and it could not display the full view.Ten cases on CT MPR images were diagnosed correctly.Nine cases involved 1 nerve root,and 1 case involved 2 nerve roots,the image finding was obliteration of the fat space.Eight cases involved distortion of the compressed nerve root,3 cases involved thinning of the compressed nerve root,1 case involved thickening of the nerve root,6 cases were with no change or no confirmed diagnosis.MR regular scans could roughly show the local relationship of the nucleus pulposus and the nerve root and it is superior to the conventional CT axial scanning.On the conventional axial plane,7 cases of the compressed nerve root were identified with difficulty,3 cases showed obliteration of the fat space and displacement of the compressed nerve root.On the sagittal plane through the intervertebral foramen:5 cases of mixed herniation and 2 cases herniation of intra-intervertebral foramen showed intervertebral disc into the intervertebral foramen,with displacement or annihilation of the compressed nerve root.Two cases of extra-intervertebral foramen herniation were without positive findings.On MR coronal IDEAL water imaging,it could clearly and accurately show the spatial relationship of the nucleus pulposus and the nerve root.It is superior to the conventional CT axial image,CT MPR image and the conventional MR scanning.Ten cases were diagnosed correctly.Four cases were identified as compressed DRG,5 cases were identified as compressed postganglionic nerve root,1 case was identified with compressed L4 postganglionic nerve root and compressed L5 preganglionic nerve root.Ten cases were all identified with distortion of the compressed nerve root,6 cases were identified with the compressed thinning nerve root,and 2 cases with the compressed thickening nerve root.The other nerve roots were not compressed.Conclusion MR coronal IDEAL water imaging is a good tool to show the spatial relationship of nucleus pulposus and the nerve root in FLLDH patients,and it possesses diagnostic value.

Objective:Eph receptors constitute the largest sub-family of receptor tyrosine kinases(RTKs) and have an important role in oncogenic transformation and tumor progression.This study aimed to analyze the aberrant expression of EphA1 gene in gastric cancer and its correlation with clinical parameters,so as to explore the significance of EphA1 in the etiology and progression in gastric cancer.Methods: Expression of EphA1 protein was determined using immunohistochemical staining in 60 gastric cancer patients.Correlation between EphA1 protein expression and clinical parameters was evaluated by statistics.Results: Over-expression was more commonly observed in more advanced patients(P=0.015) and in those with lymph nodes metastases(P=0.032).There was no correlation between EphA1 expression and other clinical parameters.Conclusion: EphA1 gene could promote the progression of gastric cancer.

ObjectiveTo compare the diagnostic value of X-ray, CT, MRI, and ultrasound in primary synovial osteochondromatosis ( PSO ).Methods The imaging data of X-ray, CT, MRI, and ultrasound of 42 patients with 44 knees with PSO proved by surgery and pathology were retrospectively collected and analyzed. ResultsThe Plain X-ray demonstrated 197 calcific nodules in 28 joints, 96 ossific nodules in 24 joints, and 5 mixed type nodules in 3 joints. Compared with the data of surgery and pathology,36 joints (81.8 ％, 36/44) were diagnosed correctly by X-ray. The CT showed 8 big cartilaginous nodules in 5 joints, 255 calcific nodules in 30 joints, 146 ossific nodules in 28 joints, and 16 mixed type nodules in 7 joints.Twenty-four knees underwent volume rendering technique reconstruction which displayed the quantity, size, shape, and position of non-cartilaginous nodules clearly. Compared with the data of surgery and pathology, 40 joints (90. 9％ , 40/44)were diagnosed correctly by CT. The MRI demonstrated 8 big cartilaginous nodules in 5 joints, 70 small cartilaginous nodules in 4 joints, 248 calcific nodules in 29 joints,146 ossific nodules in 28 joints, and 16 mixed type nodules in 7 joints. All nodules displayed low signal in DWI and there was no enhancement. Compared with the data of surgery and pathology, 43 joints (97.7％,43/44) were diagnosed correctly by MRI. The ultrasound showed 8 big cartilaginous nodules in 5 joints,70 small cartilaginous nodules in 4 joints, 232 calcific nodules in 30 joints, 142 ossific nodules in 28 joints,and 16 mixed type nodules in 7 joints. Compared with the data of surgery and pathology, 43 joints (97. 7％,43/44) were diagnosed correctly by ultrasound. ConclusionsThe less common manifestations of the PSO require multimodality imaging to make the diagnosis. Multimodalities (X-ray,CT, MRI and ultrasound) are particularly useful in fully characterising PSO and to allow for appropriate clinical planning.

Objective To investigate the effects of dexmedctomidine pretreatment and postconditioning on renal ischemia-reperfusion (I/R) injury in rats.Methods Thirty-two male Wistar rats,aged 3-4 months,weighing 220-300 g,were randomly divided into 4 groups ( n =8 each):sham operation group ( group S),I/R group,dexmedetomidine pretreatment group (group Pre) and dexmedetomidine postconditioning group (group Post).The rats were anesthetized with phenobarbital sodium 65 mg/kg.Renal I/R was produced by occlusion of both renal pedicles for 60 min followed by 48 h reperfusion.Dexmedetomidine 50 μg/kg was given intraperitoneally at 30 min before ischemia and at the beginning of reperfusion in Pre and Post groups respectively.The concentrations of serum creatinine and blood urea were determined at 0,24 and 48 h of reperfusion (T1-3).The renal tissues were obtained at the end of reperfusion for microscopic examination and detection of apoptosis by TUNEL assay.Acute kidney tubular necrosis was scored and apoptosis index (AI) was calculated.Results Compared with group S,the concentration of serum creatinine and blood urea at T2.3,and acute kidney tubular necrosis score and AI were significantly increased in I/R,Pre and Post groups ( P ＜ 0.05).Compared with I/R group,the concentration of serum creatinine and blood urea at T2.3,acute kidney tubular necrosis score and AI were significantly decreased in Pre and Post groups ( P ＜ 0.05).Conclusion Both dexmedetomidine pretreatment and postconditioning can attenuate renal I/R injury through inhibition of cell apoptosis in rats.

Objective To explore the correlation between ultrasonographic findings and relevant technical factors in traumatic lipohemarthrosis. Methods Fifty-two patients with traumatic lipohemarthrosis underwent ultrasonic examination in supine position (26 in unbent, 16 in external rotary position, 10 in unbent and 45° rotation) before operation, and 22 of them underwent dynamic examination. Findings of ultrasography were compared with manifestations of MRI and CT regarded as gold standard.Results Fifty-two patients with traumatic lipohemarthrosis were diagnosed correctly. The best effect of ultrasonic examination of lipohemarthrosis was observed on suprapatellar bursa. Superior border of patella were showed well in supine straight position, then turned to the level of patella, and the structure below patella were showed badly. The best posture was in supine genuflex position with 45° rotation when the joint effusion presented, by which thicker layer liquids could be displayed than in straight position. Three layer liquids could not be displayed synchronously in mild external rotary rest position of lower extremity, and the combination of findings at internal and external side were favorable to the diagnosis. Liquids bed changed from one layer to two layers and then to three layers, from fuzzy to clear gradually in dynamic examination.Conclusion Ultrasonic manifestations of traumatic lipohemarthrosis are closely correlated to the position, posture and arresting time during examination.

Objective: To study the distribution of levofloxacin in the serum and ascites in patients with cirrhosis and to evaluate its efficacy in treatment of patients with spontaneous bacterial peritonitis(SBP). Methods:（1）Concentration of levofloxacin in the serum and ascites was detected with HPLC in 7 patients with cirrhosis at different time (in the serum: 0.5, 1, 1.5, 2 and 12 h;in the ascites:2, 4, 6 and 12 h). （2）The effects of levofloxacin were observed in treatment of 30 patients with SBP. Results:（1） Levofloxacin was determined in serum and ascites of patients with cirrhosis, whose concentration depended on the duration after oral administration. In serum: tmax was 1.5 h and cmax was (3.913±1.388) μg/ml. In ascites: tmax was 6.0 h and cmax was (2.520±1.213) μg/ml. The levels decreased gradually after reaching peak concentration, then stabilized from 12 h.（2）The symptoms and signs were significantly improved in patients with SBP treated with the levofloxacin. Conclusion: After the oral administration, levofloxacin can both distribute in serum and ascites, and it is efficient in the treatment of the patients with SBP.

Objective To investigate the braking time in diagnosis of lipohemarthrosis by ultrasound. Methods Experiment group:After 20 tubes containing fresh blood and pig marrow were uniformly mixed, they were instantly continuously detected by high-frequency linear array transducer in fixed-area at short-interval.Clinical group: Ten walking patients with lipohemarthrosis were examined with continuous detection by ultrasound,CT and MR before operation.Results Experiment group: Cloudy echo and slowly floating up of lipoids were detected at the beginning.After 2.7 to 3.7 minutes (average 3.17 minutes), the liquid was divided into two layers with vague boundary.After 5.3 to 8.0 minutes (average 6.75 minutes) ,the liquid was divided into 3 layers with thickening serum laye.Clinical group: Ultrasound findings: Cloudy medium echo was detected at first.After 2.0 to 4.0 minutes (average 3.08 minutes),the liquid was divided into two layers.After 4.4 to 10.0 minutes (average 6.92 minutes) , the liquid was divided into 3 layers with thickening serum layers.Three knees showed fracture line and 2 knees with occult fracture were diagnosed as lipohemarthrosis.CT and MR findings: Ten knees showed fracture line in CT examination,of which 7 knees showed double liquid-liquid layer and 3 knees showed single liquid-liquid layer in the suprapatellar bursa.Ten knees showed fracture line in MR examination,6 knees showed double liquid-liquid layer and 4 knees showed single liquid-liquid layer in the suprapatellar bursa. Conclusions The best braking time in diagnosing lipohemarthrosis by ultrasound can be shorten to 10 minutes and the necessary braking time is 2 to 4 minutes.