[Objectives] To evaluate characteristics of Kawasaki disease(KD) in children younger than 5 years old in comparison with older than 5 years old, and to improve the knowledge of clinicians on KD in older children. [Method] The clinical characteristics and treatment of Kawasaki disease from January, 2004 to May,2011 were analyzed retrospectively and summarized .[Results] A total of 158 patients were included in this study, 39 patients(24.7%) were ≥5 years old and 79 patients(75.3%) were<5 years old. The older children seemed to have longer total fever duration, pre-intravenous immunoglobulin(IVIG) and post-IVIG fever duration and higher coronary artery disease(23.08% vs.8.40%) than the younger children, and the incidence rate of incomplete KD was higher in younger infant. But there was no difference in effect of IVIG ,incidence of conjunctival hyperemia, extremity hardness, cervical lymphadenopathy and rash, etc(P>0.05). There was statistical difference in erythrocyte sedimentation rate(ESR), hemoglobin(Hb) and white blood cell(WBC) count between 2 groups(P<0.05).The expression of inflammation factor in acute phase of older children was higher than the younger children(P<0.05). [Conclusions] Older patients had a higher prevalence of KD and coronary artery abnormalities than the younger patients. The occurrence of coronary artery might be related to more marked inflammatory response.

Objective To evaluate the diagnosis and treatment of aortic dissection combined with chronic renal failure.Methods Ten cases were retrospectively analyzed who were diagnosed as aortic dissection combined with chronic renal failure between January 2012 and December 2014.The history of chronic renal failure was 1-6 years.According to Standford classification,one case was type A dissection and the other nine were type B.Results Seven type B dissection had endovascular stent implantation.Perioperative renal function monitor and hemodialysis was given.The other two patients with type B dissection had conservative treatment.One patient with type A dissection died in the day of diagnosis.Follow-up data showed seven patients with stent implantation were in good condition and two others with conservative treatment died due to dissection rupture three and eight months after diagnosis respectively.Conclusions The mortality of aortic dissection combined with chronic renal failure is high.For Standford B dissection,endovascular stent implantation is a reliable treatment method.

Objective To probe into the optimization of scanning parameters of chest with low-dose spiral CT.Methods The phantom was scanned with different scanning parameters.The image quality obtained with the standard dose parameters and the low-dose technique were compared to evaluate the spatial resolution,low contrast resolution,noise level field uniformity and radiation dose,then the optimal scan parameters were defined.The scanning parameters were 120 kV,0.75 s,Pitch 1.0,FOV 360,RF3 reconstruction model(standard filter).Different thickness and tube electricity were used and the data were analyzed with the statistical method.Results There was significant difference about the data of the CTDI between the 160 mA conventional spiral CT and the low dose groups(30 mA,50 mA,70 mA,90 mA).There was no significant difference about the CTDI between 30 mA and 50 mA,and between 50 mA and 70 mA.There was obviously significant difference about the image noise on 1 mm slice and 10mA with other groups.The spatial resolution and low contrast resolution increased along with the increase of tube electricity,and 50mA was a inflexion of low contrast resolution.Conclusion 50mA and 5mm slice are the best scanning parameters in low-dose lung scanning and adapt to routine screening and early lung cancer screening.

Objective To evaluate the diagnostic and therapeutic strategy of traumatic pulmonary pseudocyst (TPP).Methods Fifteen patients who were diagnosed and treated as TPP between January 2000 and November 2011 were studied retrospectively.Results Nonpenetrating chest trauma was the underlying cause in all cases.A typical sign shown on chest radiograph was a thin-walled cavitary lesion in 9 patients,6 patients accompanied by traumatic wet lung,with or without an air-fluid level.Serial radiological images of CT showed high resolution of the above lesions.Single TPP lesion occurred in 9 patients,and multiple TPP lesions in 6 patients.The size of the lesions was 5 -75 (32 ± 17) mm.The pseudocyst was located in the left lung in 5 patients(33％),located in the right lung in 7 patients (47％),located in bilateral lung in 3 patients (20％).All TPP patients were treated conservatively with no occurrence of complications.Conclusions TPP is an uncommon benign lesion secondary to thoracic trauma.CT scan is an optimal option for diagnosis and evaluation of TPP.Uncomplicated cases can take conservative treatment.For complicated patients,theraneutic strategy should be made individually.

BACKGROUNDLung cancer is one of the most common malignant tumors in China. Surgical resection is still the first choice of treatment for most lung cancer patients. The prognosis of lung cancer after surgical treatment is correlated to many factors. One of them is nosocomial infection. This study is to investigate the distribution of the pathogens causing nosocomial infection and its correlative factors in patients with lung cancer.

METHODSOne hundred and thirteen cases that had hospital-acquired infection out of 1227 surgically treated patients with lung cancer were analyzed statistically.

RESULTSOf all the pathogenic species, the most prevalent species were Gram-negative bacteria with average positive detection of 64.03% (299/467). The second were Gram-positive bacteria (145/467, 31.05%) and the third were fungi (23/467, 4.92%). The results of drug sensitivity tests showed that all of strains had higher resistance rate. The rate of extended spectrum β-lactamases (ESBLs) and meticillin-resistant Staphylococcus (MRS) was very high. The incidence of nosocomial infection was seriously correlated with age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours.

CONCLUSIONSThe nosocomial infection of lung cancer patients after surgical treatment is seriously correlated with patient's age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. More attentions should be paid to the pathogenic species and its correlative factors of nosocomial infection in lung cancer patients. The resistance of bacteria to the commonly used antibiotics is produced in various degrees. During clinical therapy with antibiotics, antibiotics should be selected according to the results of drug sensitivity tests. In order to reduce the production of drug-resistance, the appropriate use of antibiotics must be strengthened.

Pan-vascular medicine is an emerging discipline focusing on atherosclerotic diseases,with the concept of multidisciplinary integration,emphasizing on exploring the mechanism of disease development from the whole of the organism's structure and function.At present,the basic mechanism system of pan-vascular diseases has yet to be perfected.The pan-vascular concept is highly compatible with the idea of Chinese medicine that focuses on the overall view.Deficiency of all qi is the root cause of pan-vascular diseases,while phlegm,blood stasis,and water-dampness and other tangible evils stagnate in the veins and channels as the symptoms of the disease,therefore,the disease mechanism can be highly summarized as"stagnation due to qi deficiency".Deficiency leads to the stagnation,blocking the veins and channels,and the deficiency worsens due to the stagnation and then damages the veins and channels,thus,it develops into a disease.Based on the theory of"stagnation due to qi deficiency",this paper takes endothelial cell dysfunction as the entry point of pan-vascular diseases,and considers that low endothelial cell immunity is the initiating factor of pan-vascular diseases,and that the widespread persistence of microinflammatory state is the key pathology to pan-vascular diseases.

Objective To observe the application value of PET glucose metabolic imaging and MR structural imaging in diagnosis of Alzheimer disease (AD) and mild cognitive impairment (MCI).Methods Totally 18 patients with AD (AD group),6 patients with MCI (MCI group) and 10 healthy volunteers (HC group) were enrolled.There were 11 cases of moderate or severe AD and 7 cases of mild AD in AD group.PET and structural MR imaging of the brain were performed.The radioactivity distribution in the brain and the hippocampal atrophy were observed through visually evaluation and quantitative analysis.Results The glucose metabolism reduced in certain regions of the brain in all AD patients (18/18,100％).Among them,11 patients with moderate or severe AD accompanied hippocampal atrophy,while 3 of 7 patients with mild AD showed hippocampal atrophy.No hippocampal atrophy was found in 5 patients with MCI (5/6,83.33 ％),but 2 of them showed decreased radioactivity in the brain.The symmetric mild diminution of radioactivity distribution without hippocampal atrophy was found in all subjects in HC group (10/10,100％).Two cases in HC group showed mild encephalanalosis.Conclusion Both of PET glucose metabolic imaging and MR structural imaging can be used to diagnose AD or MCI with different focus.Combination of these two techniques is helpful to improving diagnostic accuracy.

BACKGROUNDLymphatic dissemination is the main approach of metastasis in lung cancer, and it is also an important prognostic factor. The aim of this study is to explore the relationship between tumor size and lymph node metastasis in squamous cell carcinoma and adenocarcinoma of the lung.

METHODSA total of 240 patients diagnosed as squamous cell carcinoma and adenocarcinoma were studied. The relationship between tumor size and lymph node metastasis was analyzed.

RESULTSLymph node metastasis rate in maximum diameter (d)≤2cm, 2cm < d≤3cm, 3cm < d≤6cm, 6cm < d≤10cm, and d > 10cm groups was 50.0%, 35.1%, 52.8%, 52.1% and 71.4%, respectively. There was no correlation between tumor size and lymph node metastasis (r=0.10, P > 0.05). Lymph node metastasis occurred more frequently in adenocarcinoma (58.8%) than that in squamous cell carcinoma (42.9%) (P < 0.05). Mediastinal lymph node metastasis was found in 7 patients (16.3%) with d≤3cm, who were all diagnosed as moderate or poor differentiation.

CONCLUSIONSLymph node metastasis is not related to tumor size. Lymph node metastasis occurs more frequently in adenocarcinoma than it does in squamous cell carcinoma. Mediastinal lymph node metastasis can be found in tumor with d≤3cm, and differentiation grade may play an important role in lymph node metastasis.

Objective To summarize the characteristics and management of pregnancy complicated with aortic dissection, and to explore the reasonable diagnosis and treatment plan. Methods The clinical data of 10 patients of pregnancy complicated with aortic dissection in Wuhan Tongji Hospital from January 2011 to June 2017 were collected. Their age was 25.2 (21-29) years. Results In the 10 patients, the majority (8 patients) were primipara, and most of them were in the late stages of pregnancy (5 patients) and puerperal (4 patients). Among them, 1 patient had gestational hypertension, and the blood pressure of the left and right upper extremities was significantly abnormal (initial blood pressure: left upper limb blood pressure: 90/60 mm Hg, right upper limb blood pressure: 150/90 mm Hg). The major clinical manifestations were severe chest and back pain which happened suddenly, with D-dimmer and C-creative protein increased which may be associated with inflammatory reaction. All patients were diagnosed by thoracoabdominal aortic CTA, including 5 patients of Stanford type A dissection and 5 patients of Stanford type B dissection. In the 10 patients, 1 patient refused surgery and eventually died of aortic rupture with the death of fetus before birth. And the remaining 9 patients underwent surgical treatment, 3 patients of endovascular graft exclusion for thoracic aortic stent graft, 2 patients underwent Bentall operation, 1 patient with Bentall + total aortic arch replacement + vascular thoracic aortic stent graft, 1 patient with Bentall operation combined with endovascular graft exclusion for thoracic aortic stent graft, 1 patient with Bentall + coronary artery bypass grafting, 1 patient of thoracoabdominal aortic vascular replacement. Among them, 1 patient underwent endovascular graft exclusion for thoracic aortic stent graft died of severe postoperative infection, and the remaining 8 patients were discharged from hospital. Nine patients were single birth, among them 5 newborn patients had severe asphyxia, 4 patients had mild asphyxia. Finally, 3 neonates died of severe complications, and the remaining 6 survived. Conclusion The ratio of pregnancy with Stanford type A aortic dissection is far higher than in the general population, the possibility of fetal intrauterine asphyxia is larger, but through active and effective surgical and perioperative treatment, we can effectively save the life of mother and fetus.