Objective To describe the MRI findings in patients with Acquired hepatiocerbral Degeneration(AHCD) and evaluate the role of MRI in dignosis of AHCD. Methods 26 patients with chornic hepatic failure under went brain MRI scan. Eight of these patients had abdominal MR digital subtract angiography(MRDSA) examnation. 25 patients had plasma ammonia levels test two weeks after MR exmnation. Results 22 patients had abnormal MRI findings, T 1WI demonstrated incresed signal in the globus pallidus (22/26), putmen (4/26), mesencephalon surrounding red nucleus(15/26),and in the anterior pituitary (12/26). While T 2WI demonstraied no corresponding alteration in signal intensity. Eight patients which had MRDSA showed obvious portal systemic shunts. There was positive correlation between plasam ammonia level and abnormal signal( r = 0.521 6, P

Objective To discuss the best method to treat deep perianal abscess and to investigate the clinical efficacy and value of the procedure of percutaneous catheter drainage guided by ultrasound in treatment.Ninteen patients with deep abscess underwent the procedure from Jan.2012 to May.2013.Methods Clinical data of 19 patients were analyzed retrospectively,including 16 male cases and 3 female cases.Results The average age is 39.8.All patients were cured without complications.The average length of stay is 7.8 days,a mean follow-up of 6.6 months after discharge,no patient with recurrence or fistula.Conclusion No specific performance of colorectal carcinoid,surgical resection is the most effective method of the treatment of colorectal carcinoid,the procedure should be individual treatment.However,the long term prognosis need to be explored in the future.

Peroxisome proliferator-activated receptors (PPARs) are a family of nuclear hormone receptors belonging to the steroid receptor superfamily. Three PPAR isoforms, PPAR?, PPAR? (also known as PPAR?) and PPAR? have been found in the mouse. They can activate expression of many genes, including those involved in lipidmetabolism. PPAR? is ubiquitously expressed, but the level of expression differs markedly between different cell types. PPAR? is expressed in skeletal muscle at 10- and 50-fold higher levels compared with PPAR? and PPAR?, respectively. A role for PPAR? in skeletal muscle is to increase the genes expression with relation to oxidative metabolism. In order to determine the molecular mechanisms governing PPAR? gene expression in muscle, a 2 kb 5′ flanking region was cloned and analyzed. The DNA fragment is able to transcribe GFP in COS7 cells. Dual luciferase assay is used to quantify promoter activity. Deletion analysis of the 2 kb PPAR? promoter fragment in COS7 and NIH 3T3 cells shows that the proximal promoter sequence, nt -197 to +120, confers basal transcriptional activity of the mouse PPAR? gene. Computational analysis of putative cis-acting elements located within the ～2.0 kb mouse PPAR? 5′-flanking sequence was performed using the TRANSFAC database and MatInspector software and 4 potential MEF2A binding sites were found. And there is a potential binding site sharing 100% identity with positive element of MEF2A in the proximal promoter (nt -261). Co-transfection experiments of the PPAR? promoter reporter and pMEF2A expression plasmid (pMEF2A) showed that MEF2A significantly enhanced transcription activity of PPAR? promoter in NIH 3T3. Moreover, the enhancive effect depended on the concentration of plasmid pMEF2A transfected into cells. The results suggested that MEF2A may enhance transcription activity of the PPAR promoter in muscle cells.

Objective To explore the application value of combined detection of serum hyaluronic acid(HA) ,procollagen type Ⅲ(PCⅢ) ,laminin(LN) and collagen type Ⅳ(CⅣ) .Methods Immunoradiometric analysis was conclucted to detet the index levels of serum HA ,PC Ⅲ ,LN and C Ⅳ in 81 patients with liver disease(24 cases in hepatitis group ,39 cases in liver cirrhosis group ,18 ca-ses in liver cancer group) and 40 healthy adult(control group) .Then compared the differences of 4 indicators among groups .Results Four index levels of serum liver fibrosis from liver disease patients were higher than those of control group(P< 0 .05 or P<0 .01) ,HA level of liver cirrhosis group and liver cancer group were significantly higher than that in hepatitis group (P<0 .05 ,P<0 .01)HA level of liver cancer group was higher than that of liver cirrhosis group(P<0 .05) ,liver cirrhosis was higher than hepati-tis group(P<0 .05) .Conclusion Combined determination of the serum HA ,PCⅢ ,LN and CⅣ has importantly clinical significance in early diagnosis and prognosis of hepatic fibrosis .

Objective To investigate the effect of early application of clean intermittent catheterization(CIC) in infants with neurogenic bladder(NB).Methods Eighty-seven children with NB diagnosed in our urodynamic center were less than 1 year old when they first came to hospital from January 2007 to January 2010, and CIC was carried out at different age.Sixty-four patients were followed up for a long time and divided into early CIC group(less than 1 year old children) and late CIC group(more than 3 years old children) according to the treatment time.Early CIC group included 29 patients [19 boys and 10 girls with the mean age of (7.5 ±2.8) months].And 4 cases were suffering from postoperative spina bifida manifesta;22 cases with spina bifida occulta;2 cases with sacral dysplasia;1 case with meningitis.Late CIC group included 35 patients [20 boys and 15 girls with the mean age of (8.0 ±2.9) months].2 cases were suffering from postoperative spina bifida manifesta;28 cases with spina bifida occulta;4 cases with sacral dysplasia;1 case with postoperative pelvic surgery.Before the treatment, there were no significant differences of the bladder compliance (BC), the maximum cystometric capacity (MCC) and the safety bladder capacity (SBC) between two groups.Urodynamic parameters and complications of 64 patients who were successfully followed up for 6 years were compared.Results After 3 years follow up, BC, SBC and MCC in early CIC group [(8.5 ± 1.9) ml/cmH2O, (140 ±25) ml, (142 ±29) ml]were significantly higher than those of late CIC group [(7.0 ± 2.2) ml/cmH2O, (110 ± 31) ml, (120 ± 28) ml;all P ＜ 0.05].After 6 years follow up, BC, SBC and MCC in early CIC group [(12.0 ±2.5) ml/cmH2O, (210 ±26) ml, (230 ±30) ml] were significantly higher than those of late CIC group [(9.3 ± 2.3) ml/cmH2O, (192 ± 31) ml, (205 ± 35) ml;all P ＜ 0.05], and the vesicoureteral reflux rate [24.1％ (7/29)] in early treatment group was significantly less than that in late treatment group [54.3％ (19/35), P ＜ 0.05].Increases in BUN and serum creatinine were found in 6 cases (20.7％) in early CIC group and 17 cases (48.6％) in late CIC group, the difference was significant (P ＜ 0.05).Conclusion For NB patients, the effect of early CIC is better than that of late CIC.

Objective In children with neurogenic bladder and secondary vesicoureteral reflux , we ex-plore the differences of urodynamics between the children with and without detrusor overactivity (DO). The study is in order to provide theoretical support for clinical practice. Method From January 2013 to March 2016, 110 children with NB vesicoureteral reflux diagnosed by videourodynamics were recruited. There are 63 boys and 47 girls aged 4-12 years with mean of 7.5 years. According to presence of DO during the filling phase, the patients were divided into DO (n=32) and non-DO groups (n=78). The time of bladder ureter reflux perfusion and detru-sor pressure were recorded for calculation of bladder compliance when the reflux occurs in the two groups. Maximum cystometry capacity and maximum detrusor pressure were recorded for calculation of the bladder compliance at the end of filling in the two groups. According to the reflux flow level, patients were divided into mild reflux (Ⅰ-Ⅱdegrees), severe reflux (Ⅲ-Ⅴdegrees). The difference of reflux side of the two groups and reflux degree were an-alyzed. Result In DO group, bladder capacity and compliance were (107.5 ± 21.3) mL and (5.6 ± 1.8) mL/cmH2O, respectively, when bladder ureter reflux occurs. In non-DO group, the bladder ureter reflux bladder capac-ity and compliance were (124.7 ± 35.6) mL, (6.7 ± 2.3) mL/cmH2O. The two parameters were significantly differ-ent in both groups. In DO and non-DO groups, the detrusor pressure were (21.7 ± 8.3) cmH2O and (19.6 ± 9.2) cmH2O, respectively, which does not have any significant statistical difference. At the end of filling, bladder capac-ity and compliance in DO group were (198.7 ± 36.5) mL, (5.8 ± 1.9) mL/cmH2O. In non-DO group, bladder ca-pacity and compliance were (223.8 ± 40.2) mL and (6.5 ± 1.4)mL/cmH2O. In both group, there are difference. In DO group, there are 20 cases of unilateral reflux (63%) and 12 cases of bilateral reflux (37%). In non-DO group, there are 31 cases of unilateral reflux (40%) and 47 cases of bilateral reflux (60%). The reflux of the two groups are also serious. Conclusion Small bladder capacity and poor bladder compliance are the urodynamic characteris-tics of children with NB and secondary vesicoureteral reflux when DO occurs.

Objective To investigate influencing factors of disability after craniocerbral injury caused by road traffic accident.Methods We collected 486 cases with craniocerebral injury caused by traffic accident,and conducted analysis.Factors related to disability were found by univariate analysis,and multivariate logistic regression analysis was conducted to filter the most important factors.Results Degrees of brain injury,drunk driving,age and types of accident were the major influencing factors.Drunk driving and age were positively related with disability grade while the degree of brain injury and type of accident were negatively related.Concuusiorn It is helpful to reduce disability and the burden on society by taking intervening measures on the related factors of disability after brain injury in road traffic accident.

This paper collected the case and interview data in the hospice wards of X Community Health Service Center in Harbin with the method of participant observation and in-depth interview.It sorted and analyzed the disease narrative,psychological experience and social-cultural significance of terminal stage patients.Through describing three field cases,this paper analyzed the depressed-helpless and request-desire pain experience in terminal stage patients.It emphasized the cultural narrative research in this special group,terminal stage patients,and further to provide realistic basis for the improvement of hospice care in China.

Objective:To explore the effect of the "trinity" training mode with curriculum training as the core, lecture training as supplement and community training as reinforcement, and to improve the health education ability of higher vocational nursing students.Methods:A total of 209 nursing students were selected as the research objects by random cluster sampling, and they were randomly divided into experimental group and control group. The experimental group adopted the "trinity" system to improve the health education ability of higher vocational nursing students, while the control group carried out the routine teaching. The health education ability of nursing students was evaluated by using the health education ability scale of nursing staff, and the nursing students of the experimental group were investigated by questionnaire. Statistics analysis was made by SPSS 15.0 software, the t test was conducted for analysis of measurement data, and Z test was used for counting data. Results:The health education ability of the nursing students in the experimental group was significantly higher than that of the control group ( P < 0.001). Nursing students in the experimental group generally had high recognition of the training mode of "trinity" system. The pass rate was 98.13%. Among them, 68.87% of the nursing students thought it would be a big gain to attend the special lectures; 69.81% of the nursing students thought it would be a big gain to participate in the community activities. Conclusion:The "trinity" health education ability training model can significantly improve the health education ability of higher vocational nursing students.

Objective To investigate the efficiency and safety of endoscopic submucosal dissection (ESD)for rectal neuroendocrine neoplasm(NEN). Methods A retrospective analysis was performed on data collected from 58 consecutive patients with rectal NEN,who underwent endoscopic ultrasonography and followed by ESD from January 2006 to January 2016 at Peking University First Hospital. Patients′endoscopic and pathological features, clinical manifestations, R0 resection rate and follow-up results were studied. Results En bloc resection was achieved for all of the 58 lesions with a mean diameter of 7.6 mm(range 3.0-18.0 mm). The complete resection rate was 94.8%(55/58). One patient showed postoperative bleeding. The diameter of lesion more than 15 mm increased the risk of non-R0 resection(P<0.05). During the mean follow-up of 3.2 years(range 1.2-11.2 years), all patients remained free from local recurrence. However,distant metastasis was detected in 1 NEN G2 patient with lymphatic invasion(1.7%). Conclusion ESD is effective for treatment of rectal NEN with diameter less than 15 mm and causes less complications. Tumor features and stage determine the risk of distant metastasis,so long-term follow-up is essential.