Objective To study the CT diagnosis and differential diagnsis of hypoxic ischemic encephalopathy (HIE)in neonates.Methods 55 cases who had clear history of asphyxia in perinatal period and had clinical symptoms were scanned with CT.The complete clinical materials and CT data were analyzed.Results The clinical and CT grades were conducted according to references.The results showed that there was difference between CT grades and clinical manifestation.Subarachnoid hemorrhage was the most common complication.The density of the lesions was significantly different from that in normal sites.Conclusion In the CT diagnosis of HIE,clinical data and anatomical structure of neonates are both critical for the correct diagnosis.

[Objective]To evaluate the clinical result of surgical treatment of coronal shear fracture of the capitellum humeri of adults.[Method]From January 2001 to July 2005,6 cases of 2 males and 4 females with coronal fractures capitulum humeri were chosen open reduction and internal fixation utilizing screws.The fractures were terated under direct vision and were fixed with screws.The left arms in 4,right in 2,the age of the group were from 27 to 48 years old,with the average of 38 years.The operative time was from 3 days to 9 days after injury.All cases were fresh and close fractures.[Result]All operations were successful,no nerves and blood vessels injury was found,the incisions were all healed by first intention.The X-ray films showed that the fractures were anatomic reduction.The healing time was 7 weeks in average with 6 to 9 weeks range.All cases were followed up from 12 to 52 months with an average of 32 months,no postoperative complications such as myositis ossificans or avascular necrosis of capitulum humeri was found.According to BrobergMorrey Scale,there were 5 caese of excellent,1case of good.[Conclusion]The coronal shear fracture of the capitellum humeri of adults are suitable for opening reduced direct vision and fixing with screws,prompt treatment with anatomic reduction and internal fixation and early rehabilitation could lead to excellent or good outcomes.

Objective To investigate the clinical characters of posturographic test in patients with sudden hearing loss.Methods The postural map and correlative parameters value were examined by dynamic posturography in 100 cases of normal subjects and 120 cases of sudden hearing loss.According to state of the vestibule function,120 patients were divided into normal(67 cases) and abnormal(53cases) groups.The parameters of the length,velocity and Romberg of postural sway were compared between two groups.Results The postural map was most prominent centre patten(51%) in normal subjects,the patient's map was most prominent diffuse patten(60.83%).Length,velocity and Romberg of postural sway of the patients were significantly increased in comparison with normal subjects(P0.05).Conclusion The results of posturographic test indicate that the vestibular system in patients with sudden deafness is damaged.

Objective To study the correlation between prognosis and vertigo and status of the vestibule functions with the patients of the sudden deafness (SD).Methods For 161 patients of the SD, the parameters of the hearing before treatment, vertigo and vestibule functions, were analyzed to establish a statistic model by means of Logistic regression with single factor analysis of variance, Logistic regression analysis and Chi square test.Results The single factor analysis of variance and Chi square revealed statistical differences between prognosis of the SD and hearing before treatment(P0.05).Conclusion If the patients with SD had more severe hearing loss, the prognosis would be less successful. The normal or abnormal caloric tests had influence for the prognosis of the SD, but vertigo showed influence on prognosis only when caloric test was abnormal. The degree of hearing loss was not related to that of vertigo or vestibule functions while the sudden deafness accompanied with vertigo was not due to the damage of vestibular functions.

Objective To explore the endoscopic features and careinoembryonic antigen (CEA) ex-pressions of colorectal serrated adenomas (SA). Methods From June 2005 to July 2008, 27 patients with colorectal polyps and 26 cases of advanced colorectal cancer (ACC) were enrolled in the study. The pit pat-tern of the suspected lesions were observed with 0. 4% indigo carmine sodium stain and classified according to Kudo classification. The polyps were removed by biopsy, high-frequency electrical excision or endoscopic mucosa resection and the samples of ACC were collected with biopsy forceps. All specimens underwent rou-tine pathological examination and CEA expression was detected by immunohistochemistry. Results There were 47 SAs and 27 other types of polyps in polyp group. Most SAs located in left-side colon and were char-acterized by the bulge semipedunculation. The diameters of 45 serrated adenomas ranged from 3 to 8ram, and the maximal diameter of other 2 were more than 10ram. The most common type of pit pattern in SA was mixed type Ⅱ and ⅢL, with type Ⅱ predominant in a certain percentage. Expression of CEA in SA glands was significantly higher than that in proliferative polyps (P < 0. O1). Candnsion SA is an unique type of colorectal adenoma, which is capable of expressing CEA, and displays malignant potential and deserves great attention.

Objective To evaluate brush cytology under endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary strictures, and to analyze the factors influencing the diagnosis yield.Methods Brush cytology was applied in 144 patients with suspected malignant biliary strictures at ERCP.Brushing in bile duct was performed for 10 times from 2004 to 2006, while at least 20 times of brushing and repeated manipulation were performed at biliary strictures from 2007 to 2009. Cytological samples were processed immediately after brushing and analyzed by the same pathologist. Efficacy of brush diagnosis was evaluated based on reference to histopathology after surgery and/or clinical diagnostic criteria. Results Malignant stricture was finally diagnosed in 96 patients, and benign diseases in other 48. Brush cytology was positive in 78 of 96 patients with malignant stricture ( sensitivity 81.3% ), and negative in all patients without malignancy ( specificity 100. 0% ). Overall accuracy of diagnosis was 87.5%. Positive rate of malignancy by brush between 2007 and 2009 was 87.7% (50/57), while that between 2004 and 2006 was 71.8%, which were significantly different ( P ＜ 0. 05 ). The positive rate was not correlated with stricture location or tumor type. No major complications occurred, except for 4 moderate acute pancreatitis, 3 cholangiolitis and 2 biliary bleeding. Conclusion Brush cytology is of high sensitivity and specificity for malignant biliary stricture.Repeated brushing and manipulation can facilitate diagnosis yield.

Objective To observe the expression of heparanase(HPA)in kidney of diabetic nephropathy(DN)rats and to investigate the role of HPA in the pathogenesis of proteinuria in DN rals. Methods DM rat models induced by intraperitoneal injection with streptozotocin were constnmted.Twenty-six rats were randomly divided into heahhy control group(n=6),DM6-week group(n=10)and DM 12-week group(n=10).Relative kidney weight(RKW),blood glucose,BUN,Scr,24-hour urine volume and(t 24-hour proteinuria quantilation were measured,and renal morphology was observed after 6 and 12 weeks.The expression of HPA was examined by immunohistochemistry and reverse transcription PCR. Results (1)Conq)ared with the control group,RKW,blood glucose,BUN,24-hour urine volume and 24-hour proteinuria quantitation of DM groups increased markedly(P＜0.05 orP＜0.01).(2)Compared to the control group,the expression of HPA mRNA and protein in DM groups increused significantly(P＜0.01).(3)HPA protein and mRNA were positively correlated with the quantification of urinary prolein (r=0.783,P＜0.01;r=0.793,P＜0.01). Conclusion The increased expression of HPA maybe parlicipate in the pathogenesis of proteinuria in DN.

Objective To identify and rename one strain stored in National Center for Medicine Culture Collections ( CMCC) and used for tracheitis vaccine production. Methods The test strain CMCC (B)29108 and the type strain DSM30007T were cultured on NA medium. Characteristics in morphology, physiology, biochemistry and fatty acid profile were compared between the two strains. Phylogenetic analysis was based on 16S rRNA and rpoB gene sequences, together with the DNA-DNA hybridization assay. Results A Comparative analysis of a partial sequence of the 16S rRNA gene sequence revealed that the CMCC( B) 29108 strain was closed to the Acinetobacter species and showed the highest similarity with the type strain Acinetobacter baumannii DSM30007T. Moreover, the CMCC(B)29108 strain was highly similar to type strain DSM30007T in morphology, physiology, biochemistry and fatty acid profile. On the phylogenetic tree based on 16S rRNA and rpoB gene of all Acinetobacter members, the CMCC(B)29108 strain steadily clustered into one independent branch only with the DSM30007 T strain with a DNA-DNA hybridization value of 100%. Conclusion The CMCC(B)29108 strain that is one of the strains used for the production of tracheitis vac-cine should be assigned to the species of Acinetobacter baumannii based on its phenotypic, phylogenetic and chemotaxonomic characteristics.

Objective To investigate the effects of angiotensin Ⅱ (Ang Ⅱ) or high glucose on the toll-like receptor 4 (TLR4) expression,inflammatory cytokines and fibrotic factors in human tubular epithelial cells (HK-2),revealing the innate immune-related pathogenesis of diabetic nephropathy (DN) which may have clinical implications.Methods Three TLR4 siRNA sequences were designed and synthetized.After transfection,the most effective siRNA was selected to use for further expriments.The experiment consisted of 2 parts.Part 1:Cells were divided into three groups:normal-glucose group (NG,5.5mmol/L glucose),mannose group (M,5.5 mmol/L glucose + 19.5 mmol/L mannose),High-glucose group (HG,25 mmol/L glucose),preliminary validated the effects of high glucose and high osmotic pressure.Part 2:Cells were divided into seven groups:NG group,HG group,Ang Ⅱ group,Ang Ⅱ + negative group,HG+ negative group,Ang Ⅱ + siRNA group and HG+ siRNA group.Real time PCR was used to analyze the mRNA expression of TLR4,myeloid differentiation factor 88 (MyD88),heat shock protein 47 (HSP47).Western blotting was used to observe the protein expression of TLR4,MyD88,HSP47,NF-κB,type Ⅳ collagen (ColⅣ).ELISA was used to detect the expression of monocyte chemotactic protein-1 (MCP-1) and interleukin-6 (IL-6).Results Compared with NG group,TLR4,MyD88,HSP47 mRNA and TLR4,MyD88,NF-κB,ColⅣ,HSP47 protein were highly expressed under high glucose or Ang Ⅱconditions (P ＜ 0.01),and the expression levels of MCP-1 and IL-6 also increased significantly (P ＜ 0.01).Compared with HG or Ang Ⅱ group,the above indicators were obviously inhibited in the TLR4 siRNA groups (P＜0.01).Comparison between blank vector transfected groups and HG group as well as Ang Ⅱ group indicated no statistic significance (P ＞ 0.05).Conclusions Both Ang Ⅱ and high glucose stimulate TLR4 expression,which result in the up-regulation of inflammatory and fibrotic factors in HK-2.Specific target of TLR4 gene silencing can block the TLR4 pathway that is activated by high glucose and Ang Ⅱ,and thus reduce the inflammatory and fibtogenic factors' release.TLR4 signal is the common innate immune response pathway which induces the release of inflammatory and fibrotic factors in HK-2 under high glucose or high angiotension conditions.

Objective To observe the parameters and effect of endocardial pacing by steel wire electrode cardiac puncture on heart with normal beat in living animal, and evaluate its safety.Methods After anaesthesia and thoracotomy in 6 living dogs with normal heart beat, the pericardia were excised. Steel wire electrodes with annular or hook tips were used respectively at right ventricular 4 corresponding spots to perform cardiac puncture endocardiac pacing (each dog experienced 8 times of puncture); the time from puncture to effective pacing, pacing parameter and puncture complication (time and quantity of bleeding) of each electrode at each spot were recorded. Finally, the two types of electrode completed 24 times of manipulation respectively; the data collected of the two types were compared. Results The cardiac pacing successful rates in the two groups were 100%; the time taken from the beginning of heart puncture to effective pacing in annular tip group was less than that in hook tip group, but the time difference between the two groups showed no statistical significance (s: 18.4±2.3 vs. 19.6±4.1,P > 0.05). The parameters of pacing in the annular tip group, such as operation time (s: 18.4±2.3 vs. 19.6±4.1), the threshold value of pacing (V: 2.1±0.2 vs. 2.2±0.8), the amplitude of R wave sensed (mV: 11.3±3.2 vs. 12.6±4.1) and the impedance of electrode (Ω: 674.2±89.7 vs. 668.5±101.3) were not significantly different compared with those in the hook tip group (allP > 0.05). Either after puncture or after the electrodes were taken out, the time of bleeding [after puncture (minutes): 4.4±2.3 vs. 4.5±3.1, after the electrodes taken out (minutes): 4.1±2.2 vs. 4.8±2.5] and the volume of bleeding [after puncture (mL): 2.8±2.4 vs. 3.2±3.5, after the electrodes taken out (mL): 3.3±1.7 vs. 3.5±2.6] were not significantly different between the two groups (allP > 0.05).Conclusions In living dogs with normal heart beat, the manipulation and function of endocardiac pacing by cardiac puncture with either steel wire annular or hook tip electrode are well and effective, and the performance is simple and safe without any serious myocardial injury and complication. Thus, it is helpful to quickly establish efficient endocardiac pacing in emergency cases.