This article explains four cases of professor REN Ji-xue,including anasarca,serious blepharoptosis,head cold,summer diarrhea,from which we can find the laws of syndrome differentiation by him. In which,the key point of the pathogenesis of anasarca is spleen-qi deficiency, so replenishing qi and invigorating the spleen, warming yang for diuresis are the treatment nethod for anasarca. Sinking of qi due to deficiency of spleen leads to serious blepharoptosis and Invigorating Spleen and Replenishing Qi Decoction is the main prescription. The key pathogenesis of head cold is disharmony of nutrient qi with defensive qi, so regulating ying and wei, dispersing lung qi for resuscitation are the treatment methods, and both inside and outside therapies are in use. Cold-damp invasion of spleen is the main cause of summer diarrhea, so activating qi flowing and warming spleen and stomach, dissipating dampness for stopping diarrhea are used. Professor REN Ji-xue is good at taking different method according to different key point of the pathogenesis, so the efficiency is good. This is one feature of Professor REN in treating miscellaneous diseases.

Objective To observe the changes in enteric motor function and acetylcholine esterase(AchE)neuron and nitric oxide synthase neuron(NOS)in enteric nervous system after different abdominal operations,and to explore the mechanism of these changes.Methods Sprague Dawley rats were divided into experimental groups(laparotomy group,intestine massage group and intestinal operation group)and the control group.Rats in each group were gavaged with medicinal carbon powder,and then the transimission of carbon powder in small intestine was determined,and the spreading specimens of intestinal myenteric plexus of small intestine and large intestine were collected and stained with AchE and nicotinamide-adenine dinucleotide phosphate-D(NADPH-d)for histological study,and the density of distribution and positive stained AchE and NOS neurons were observed and compared.Results The changes in enteric motor function:the propellant rate of carbon powder was slower in enteric massage group and intestinal operation group than that in laparotomy group and control group(18.1?2.8,25.7?3.5 vs 47.4?3.6,49.8?4.5,P0.05).Compared with the control group,the number and positive expression of AchE positive neuron in intestinal myenteric plexus decreased in small intestine and large intestine in intestinal operation group and intestine massage group(small intestine 43.0?3.0,52.2?3.3 vs 65.3?3.9,P

Objective To explore the nervous mechanism of intestinal function disorder after intestine congestion through observing the changes of acetylcholinesterase (AchE) neuron and nitric oxide synthase neuron (NOS) expression in nervous system of rat intestinal tract. Methods Sprague Dawley rats were divided into experimental groups (intestine congestion 20min and 60min group) and the control group. Then the spreading specimens of intestinal myen-teric plexus of ileums were collected and stained by AchE and nicotinamide-adenine dinucleotide phosphate-D (NADPH-d) histochemistry, to observe and compare the density of distribution and staining of AchE and NOS positive neurons. Result Compared to the control group, the number and positive expression of AchE positive neuron in intestinal myen-teric plexus of ileums in the experimental group rats decreased (P

The development of equipment techniques of CT is comprehensively reviewed,including detectors, tube and data processing system. The clinical application of CT are analyzed. Several problems are put forward which must be dealt with urgently.

Objective To study the effect of early mechanical ventilation in treatment of patients with severe acute pancreatitis(SAP).Methods Fifty-two patients with SAP admitted in the First People's Hospital of Zhaoqing from January 2010 to January 2015 were randomly allocated into two groups (n =26),early mechanical ventilation group(observation group) and conventional mechanical ventilation group(control group).Patients in the observation group treated with early lung protective ventilation when PaO2 ＜ 13.3kPa.Patients in the control group treated without mechanical ventilation untill PaO2 ＜ 8kPa.The symptoms,the extent of inflammatory reaction,the severity of lung lesions and the mortality of two groups were compared through monitoring vital signs,abdominal circumference,APACHE Ⅱ score,bladder pressure,oxygenation index (PaO2/FiO2),C reactive protein (CRP),procalcitonin (PCT),hospital stay and mortality.Results No statistically significant differences in the APACHE Ⅱ score,bladder pressure,oxygenation index,CRP and PCT in two groups before treatment were observed(P ＞ 0.05).The APACHE Ⅱ score (12.8 ± 7.6) points,bladder pressure (14.9± 7.9) cmH2O,CRP (48.8 ± 30.1) rmg/L,PCT (1.25 ± 0.55) μg/L,mortality (3.84％) of the observation group after treatment were significantly lower than those of the control group (t =2.057,2.091,3.252,2.697,x2 =4.305,all P ＜ 0.05),while the oxygenation index in the observation group [(300.0 ± 34.9) mmHg] was significantly higher than that in the control group [(278.1 ± 32.8) mmHg],the difference of the two groups was statistically significant (t =3.322,P ＜ 0.05).Conclusion Early lung protective ventilation is safe and effective for treatment of the patients with SAP.

Aim To study the effect of different doses of l-Tetrahydropalmatine( l-THP) on morphine-induced conditioned place preference(CPP) and observe whether l-THP itself induces CPP.Methods ①♂SD rats were administered with morphine (5.00 mg?kg -1 ,sc) or saline and trained for 8 days;on d 9,the rats were tested CPP with no treatment or 40 min after they were given different doses of l-THP(1.25～5.00 mg?kg -1,ip) to observe the effect of l-THP on morphine-induced CPP;② With daily injection of l-THP (ip) at different doses,effect on the extinguishment of morphine-induced CPP was tested weekly; ③ Normal saline (NS) or l-THP (1.25～5.00 mg?kg -1 , ip) was used as a training drug to test whether l-THP could induce CPP in the rats. Results 5.00 mg?kg -1 morphine (sc) induced CPP; l-THP of 2.50 mg?kg -1 and 5.00 mg?kg -1 administered prior to the testing reduced the expression of morphine-induced CPP significantly (P

Objective To observe the effects of CO2 pneumoperitoneum on the enteric motor function and acetylcholine esterase(AchE) neuron and nitric oxide synthase(NOS) neuron in the enteric nervous system,and explore the neuromechanism of the CO2 pneumoperitoneum on renteric motor function.Methods Thirty-six Sprague Dawley rats were randomly divided into experiment group(n=24) and control group(n=12).The experiment group was divided into two subgroups namely pneumoperitoneum 30min group and pneumoperitoneum 60min group(12 each) based on the maintenance time of pneumoperitoneum.Rats in each group were gavaged with medicinal carbon powder,and then the transmission of carbon powder in small intestine was determined.The spreading specimens of intestinal myenteric plexus of small intestine were prepared and the stained AchE and NOS neurons were observed and compared.Results The propellant velocity of carbon powder was slower in pneumoperitoneum 60min group than that in pneumoperitoneum 30min group and control group(28.55%?3.45% vs 45.90%?6.30%,48.25%?5.28%,P0.05).The number of positive expression of AchE neurons in intestinal myenteric plexus decreased in pneumoperitoneum 60min group compared with that in pneumoperitoneum 30min group and control group(48.00?3.16 vs 58.82?4.62,61.83?4.17,P0.05).The number of positive expression of NOS neurons in intestinal myenteric plexus increased in pneumoperitoneum 60min group compared with that in pneumoperitoneum 30min group and control group(42.17?4.45 vs 32.50?4.34,30.83?3.6,P0.05).Conclusions Prolonged CO2 pneumoperitoneum can affect or damage cholinergic neurons and nitroxidergic neurons in the enteric nervous system to some extent,and it may be the underlying mechanism of the intestinal motor dysfunction after operation.

Objective To explore the risk factors of initial surgery and postoperative complications of Crohn's disease (CD).Methods The retrospective case-control study was conducted.The clinical data of 227 patients with CD who were admitted to the Cangzhou Central Hospital from April 2011 to July 2015 were collected.Treatment principles included reducing the clinical symptoms,promoting healing of intestinal mucosa under endoscopy,delaying CD progression and preventing intestinal exhaustion and related complications.The medication was performed in the early period.The resection of partial intestines was applied to patients if there was poor effect of medication or combined with intestinal obstruction,intestinal fistula,digestive tract perforation,abdominal abscess and complex anal fistula.Observation indicators:(1) treatment situation,(2) follow-up situation,(3) related factors analysis affecting initial surgery of patients with CD,(4) related factors analysis affecting postoperative complications of patients after initial surgery for CD.Follow-up using regular telephone interview and outpatient examination was performed up to May 2016.Follow-up included the wound infection,abdominal abscess,intestinal obstruction,anastomotic fistula and pulmonary infection.Measurement data with normal distribution were represented as-x ± s and comparison between groups was analyzed using the t test.Count data were represented as the proportion and analyzed by the chi-square test.The univariate analysis was done using the chi-square test and Kruskal-Wallis test,and multivariate analysis was done using the Logistic regression model.Results (1) Treatment situation:of 227 patients,68 underwent initial surgery and 159 didn't undergo surgery.The duration from diagnosis to initial surgery in 68 patients was (4.7 ± 2.5) months.Of 68 patients with surgery,28 received the emergency surgery and 40 received the selective surgery.Operation time and volume of intraoperative blood loss were (175 ±44) minutes and (285 ± 110) mL,respectively.The side-to-side anastomosis was conducted in 47 patients and non-side-to-side anastomosis in 21 patients.Other 159 patients without surgery received the medication of mesalazine,hydrocortisone,methotrexate and infliximab.(2) Follow-up situation:68 patients with initial surgery were followed up for 5-61 months,and 22 had postoperative complications.Of 9 patients with anastomotic fistula,6 had enterocutaneous fistula (5 patients with enterocutaneous fistula were improved by selective surgery,and the other patient was progress to acute diffuse peritonitis and then was improved by peritoneal lavage,adequate drainage and nutritional support therapy after emergency surgery).Three patients with anastomotic abscess were improved by adequate drainage.Six patients with secondary intestinal obstruction were improved by conservative treatment.Three patients with abdominal abscess were improved after antiinflammatory treatment and adequate drainage.Two patients with wound infection were improved by regular dressing change.Two patients with pulmonary infection were improved by anti-inflammatory and phlegm conservative treatment.(3) The related factors analysis affecting initial surgery of patients with CD.The results of univariate analysis showed that age of diagnosis,smoking history and behavior of disease were the related factors affecting initial surgery of patients with CD (Z =-2.120,x2 =5.082,50.512,P＜ 0.05).The results of multivariate analysis showed that A3 of age of diagnosis,B2 and B3 of pattern of disease were the independent risk factors affecting initial surgery of patients with CD [OR =15.624,10.535,28.509,95％ confidence interval (CI):4.856-29.375,3.609-17.637,8.526-79.228,P ＜ 0.05].(4) The related factors analysis affecting postoperative complications of patients after initial surgery for CD.The results of univariate analysis showed that preoperative levels of albumin (Alb) and hemoglobin (Hb),emergency surgery,operation time and anastomotic method were the related factors affecting postoperative complications of patients after initial surgery for CD (x2 =10.757,7.639,6.773,4.309,16.346,P ＜ 0.05).The results of multivariate analysis showed that preoperative Alb≤28 g/L,Hb≤ 100 g/L,emergency surgery and non-side-to-side anastomosis were the independent risk factors affecting postoperative complications of patients after initial surgery for CD (OR =9.592,8.849,6.538,12.645,95％CI:2.209-25.235,2.034-24.773,1.846-15.893,3.935-38.873,P ＜ 0.05).Conclusions The age of diagnosis ＞ 40 years,B2 and B3 of CD are high risk group of initial surgery.The poor preoperative nutritional status,emergency surgery and non-side-to-side anastomosis are independent risk factors affecting postoperative complications of patients after initial surgery for CD.

Objective To explore the clinical significance of the disagreement between transmitral pulsed wave Doppler (PWD) and mitral annulus Doppler tissue imaging (DTI) in the estimation of left ventricular (LV) filling pressures. Methods One hundred and eighty-two sinus rhythm patients without arrhythmia, congenital heart disease and valvular disease underwent routine echocardiography and synchronous electrocardiogram for assessment of LV function. Early and late diastolic velocities of LV, which were composed of e and a waves, were recorded using DTI at the mitral annulus. Six sites at the mitral annuli were selected corresponding to the septal, lateral, anterior septal, posterior, inferior, and anterior walls of LV from apical 4-, 3-and 2-chamber views. Transmitral diastolic flow velocity, which was represented by E and A wave, was measured with PWD from apical 4-chamber view. Ratio of early and late diastolic transmitral valve (MV-E/A), ratio of DTI-e/a-ann and ratio of E/e-ann were calculated, respectively. The mean value of e-ann from the above 6 sites was selected to describe the early diastolic velocities of mitral annular. Results According to the results of MV-E/A ratio and DTI-e/a-ann ratios of the 6 sites, these 182 patients were divided into 4 groups: groupⅠ(n=68): MV-E/A＜1.0, DTI-e/a-ann＜1.0 at all the 6 sites at the same time, with mean MV-E/A ratio being 0.71±0.16 and mean E/e-ann ratio 15.91±6.78; groupⅡ(n=38): MV-E/A＜1.0, DTI-e/a-ann≥1.0 at 1-6 sites among the total sites, with mean MV-E/A ratio being 0.76±0.12 and mean E/e-ann ratio 10.37±2.63; group Ⅲ(n=23): MV-E/A≥1.0, DTI-e/a-ann≥1.0 at all the 6 sites at the same time, with mean MV-E/A ratio being 1.74±0.42 and mean E/e-ann ratio 9.57±2.39; group Ⅳ(n=53): MV-E/A≥1.0, DTI-e/a-ann＜1.0 at 1-6 sites among the total sites, with mean MV-E/A ratio being 1.31±0.31 and mean E/e-ann ratio 13.27±9.46. The mean ages of group Ⅰ, Ⅱand Ⅳ were older than that of group Ⅲ. Although there was no obvious difference between group Ⅰand groupⅡ in the mean age and mean MV-E/A (P＞0.05), the mean E/e-ann was much higher in group Ⅰthan that in groupⅡ (P＜0.05). The mean MV-E/A was similar in group Ⅲ and group Ⅳ (P＞0.05), but the mean age and mean E/e-ann in the latter were older and higher than those in the former (P＜0.05), respectively. The mean age in group Ⅳ was younger than that in group Ⅰand Ⅱ, while the mean E/e-ann in group Ⅳ was higher than that in group Ⅱ, but lower than group Ⅰ (P＜0.05). Conclusion ①Ratio of MV-E/A ＜1.0 and ratios of DTI-e/a-ann ＜1.0 at all the 6 sites indicates increasing LV filling pressures; ②MV-E/A≥1.0 and DTI-e/a-ann＜1.0 at 1-6 sites among the total sites predicts a tendency of high LV filling pressures; ③Wide variability may present in those with MV-E/A＜1.0, DTI-e/a-ann≥1.0 at 1-6 sites among the total 6 sites or MV-E/A≥1.0, DTI-e/a-ann≥1.0 at all the 6 sites at the same time; ④Age of the patient has great influence on the measurement of MV-E/A ratio and DTI-e/a-ann ratio.

Objective:To investigate the expression status of Sonic Hedgehog signaling genes and molecules in human hepatocellular carcinomas(HCC),and to explore the relationship between these genes and clinical prognosis.Methods:HCC tissue and adjacent normal tissue from 29 HCC patients were assayed for the expression of hedgehog signaling genes by reverse transcription-polymerase chain reaction chain reaction(RT-PCR) techniques and for the expression of hedgehog signaling molecules by immunohistochemistry.The expressions of Shh,Ptch,Smoh,Gli-1 mRNA were assayed as well as Shh,Ptch proteins in 29 cases of HCC and in 29 liver tissues adjacent to the tumor.Results:Expression of Shh mRNA was detectable in about 51% of HCCs examined.Consistent with this,hedgehog target genes Ptch,Smoh and Gli-1 mRNA were expressed in over 68%,48% and 62% of the tumors,respectively,and the expressions of Shh and Ptch proteins in HCC tumor tissues correlated with those of Shh and Ptch mRNA in tumor tissues(P=0.041 and P=0.035).This suggested that the hedgehog pathway was frequently activated in HCCs.The simultaneous expression of Gli-1 in HCC and liver tissues adjacent to the tumor had significantly relationship with poor prognosis.Conclusion:Hedgehog signaling activation is an important event for development of human HCCs.It also suggests that markers for hedgehog signaling activation may be useful for the determination of prognosis.