Objective To investigate the relationship between the different deep venous drainage patterns in the brain and the perimesencephalic subarachnoid hemorrhage (PMSAH).Methods From January 2014 to January 2017,the clinical data of 90 patients with subarachnoid hemorrhage (SAH) diagnosed and treated in the Second Affiliated Hospital of Anhui Medical University were analyzed retrospectively.Thirty patients with PMSAH were in a PMSAH group and 60 patients with aneurismal SAH were in a control group.Unilateral cerebral hemisphere venous drainage was divided into type A (normal continuous):the basilar vein had deep middle cerebral vein drainage and was drained into the great cerebral vein of Galen;type B (normal discontinuous):there was discontinuous venous drainage between the basal vein and the anterior uncal vein and the posterior Galen vein;type C (primitive variant):did not drained into great cerebral vein of Galen,perimesencephalic vein was drained into the superior petrosal sinus or basal vein was directly drained into the transverse sinus or straight sinus.The different combinations of bilateral cerebral hemisphere venous drainage were divided into normal type drainage (typeⅠ:AA),discontinuous type drainage (types Ⅱ:AB or BB),and primitive type drainage (types Ⅲ:AC,BC,or CC).The differences of venous drainage between the two groups were compared.Results In the PMSAH group,both types Ⅰ and Ⅱ drainages accounted for 26.7％ (n=8 in each type) and type Ⅲ accounted for 46.7％ (n=14).In the control group,typeⅠaccounted for 48.3％ (n=29),type Ⅱ accounted for 28.3％ (n=17),and type Ⅲ accounted for 23.3％ (n=14).There were no significant differences in the distribution of three venous drainage patterns between the two groups (χ2=5.804,P=0.055).However,there was significant difference in the types Ⅲ venous drainage between the two groups (χ2=5.081,P=0.024).Conclusion Most of the deep cerebral venous drainage in patients with PMSAH showed basilar venous drainage into the venous sinuses of dura mater,but not to the large cerebral vein drainage,suggesting the way of primitive drainage into the dural sinus was more prone to rupture compared with that of drainage into large cerebral veins.

Objective To observe the clinical sedativelefficacy of Tianwang-Buxin Dan treating chronic obstructive pulmonary disease patients undergoing mechanical ventilation.Methods 97 patients with chronic obstructive pulmonary disease undergoing mechanical ventilation were randomly recruited into a treatment group (47 cases) and a control group (50 cases).The control group was treated with midazolam and fentanyl,and the treatment group were treated by Tianwang-Buxin Dan on the basis of the control group.The amount of medazolam and fentanyl,duration of MV,and incidence of side-effects such as hypotension,bradycardia,delirium,nausea,etc were observed in both groups.Results The expected sedative and analgesia scores were obtained in patients of both groups.Compared with the control group,the patients in the treatment group were easier to be aroused and be kept in sedation and analgesia state,besides the dose of midazolam (μg/kg·h-1) (9.51 ±5.87 vs 20.01 ±6.24,P＜0.01)and fentanyl (μg/kg·h-1) was significantly fewer (0.22 ±0.13 vs 0.32±0.12,P＜0.05),duration of MV (days) was shorter(7.13±6.25 vs 12.85±9.13,P＜0.01),duration of disable sedatives for extubating (hours)was shorter (4.35 ± 2.57 vs 8.79±4.02,P＜0.01),the rates of hypotensionand brdycarcardia were significantly lower,the rates of delirium and nausea were clearly lower(both P＜0.05)in the treatment group.Conclusion Sedative effect of Tianwang-Buxin Dan is satisfactory for patients with chronic obstructive pulmonary disease undergoing mechanical ventilation,with the property of easier arousal,lower hypotension rates,lower brdycarcardia rates,lower delirium rates nausea rates,and fewer dosage of midazolam (by 50％) and fentanyl (by 30％) administration.

Objective To investigate the prevalence of latent tuberculosis infection(LTBI),and to identify the risk factors in primary schoolchildren from Shanghai through the population-based field investigation combined with the tuberculosis infection enzyme-linked immunospot assay(T-SPOT.TB)assay.Methods The children in grade 4 and 5 were enrolled from four primary schools in Pudong new district and Yangpu district of Shanghai.Questionnaire interview was applied to investigate the soeiodemographic and clinical information related to LTBI.The T-SPOT.TB assay was used to detect LTBI in the enrolled subjects.Univaitate and multivariate analyses were used to identify the risk factors associated with LTBI among the primary schoolchildren.Results Totally 472 schoolchildren were enrolled in the present study,with 439(93.0%)being vaccinated with bacillus calmette-guerin (BCG) and ten (2.1%) having contact history with tuberculosis (TB) patients.Among the 472 eligible subjects,16(3.4%) children were T-SPOT.TB positive,who had no clinical symptoms andsigns relevant to TB and were defined as LTBI.The LTBI prevalence in BCG vaccinated and unvaccinated children were 2.7% and 12.1%,respectively (OR:6.972;95%CI:1.834-26.500);those in TB contacts and children without TB contact history were 30.0% and 2.8%, respectively (OR: 16. 38; 95% CI: 3. 692-72. 700). Conclusions The prevalence of LTBI among senior schoolchildren in Shanghai is 3.4%. BCG vaccination is protective for children from LTBI, while daily contacts with TB patients increases the risk of LTBI in schoolchildren.

ObjectiveTo evaluate the feasibility and outcome of overnight laparoscopie cholecystectomy (OLC).MethodsThe clinical data of 149 patients with cholecystolithiasis or gallbladder polyps who were admitted to the Tianjin People's Hospital from October 2008 to December 2010 were retrospectively analyzed.All the patients underwent LC in the morning and were discharged 24 hours later.Modified Aldrete scoring was done 4-6hours after LC.Patients were contacted by telephone 3 days after LC and reexamined in the out-patient department 7 days after LC.The hospital cost of patients who underwent OLC or LC was compared using the t test.Results OLC was successfully performed on 149 patients,and the modified Aldrete scores of 130 patients were above 9.The visual analogue scale (VAS) of 118 patients were under 4,and the VAS of 31 patients were above 4.The condition of the 31 patients were closely monitered,and were administered morphine.Of the 149 patieuts,144were discharged 24 hours after operation,and the remaining 5 patients were admitted to general ward because of fever,peritoneal effusion or abdominal pain.The incidence of postoperative complication was 2.0％ (3/149) and the mortality was 0.All the patients were followed up,and none of the patients had an emergency readmission.The duration of incapacity was 5.2 days (range,2-7 days).The mean hospital cost of patients who received OLC was ( 7888 ± 396 ) yuan,which was significantly lower than ( 12121 ± 960) yuan of patients who received LC ( t =38.97,P ＜ 0.05 ).ConclusionOLC is effective and safe,and meets the requirement of health insurance policy.

Objective To investigate the outcome of damage control sugery in patients with acute superior mesenteric occlusion (ASMO).Methods Seventeen patients with acute superior mesenteric occlusion from June 2008 to May 2012 were reviewed retrospectively.Diagnosis was confirmed by CT and/or DSA.Patients were divided into two groups:seven patients in damage control group (shortening surgical time,bowel exteriorization,temporary abdominal closure) ; ten patients in conventional surgical treatment group.The treatment outcomes of the two groups were compared.The survival of all patients was followed up for 6 months to 5 years at outpatient clinic.Results The overall mortality rate was (5/17) and surgical complications rate was (8/17).Operation time was (97 ±42) min and (236 ± 137) min(t =-4.72,P ＜0.01,P ＜ 0.05) respectively in damage control group and conventional surgical treatment group.Intestine resection length was (114 ± 94) cm and (229 ± 93) cm (t =-2.49,P =0.03,P ＜ 0.05) respectively.Complications rate was (1/7) and (7/10) (Fisher's dxact test P =0.05,P ≤0.05) respectively; mortality was (1/7) and (4/10) (Fisher's dxact test P =0.34,P ＞ 0.05) respectively.Conclusions Although damage control does not significantly reduce mortality,but the rational use of damage control can effectively reduce operation time,shorten intestine resection length and decrease surgical complications.

Objective: To investigate the relationship of loss of P16 expression with biologlical behaviors and prognosis of gastrointestinal stromal tumors(GISTs). Methods: The expression of P16 protein and mRNA was detected in GISTs tissues by immunohistochemistry,Western blot and RT-PCR.The prognosis was evaluated through follow up. Results: The expression rates of P16 protein and mRNA in GISTs were 53.8%(21/39，Frozen tissue)，51.3%(20/39，Frozen tissues)and 51.4%(37/72，Paraffin-embedded tissues)，respectively.The expression of P16 was significantly different among GISTs of different aggressive risk(P<0.05).With the incease of aggressive risk，the expression of P16 was deceased.The expression of P16 was negtively correlated with Ki-67 and patient survival(P<0.05). Conclusion: The loss of P16 expression has a positive correlation with the infiltration and progression of GIST.Detection of P16 protein and mRNA is helpful for the evalutaion of biological behaviors and prognosis of gastrointestinal stromal tumors.

AIM: To investigate the effect of single immunoglobin IL-1 receptor related protein (SIGIRR) on damage of alveolar epithelial cells in acute lung injury induced by lipopolysaccharide. METHODS: The acute alveolar epithelial cell injury model was constructed by stimulation of A549 cells with LPS. In order to over-express SIGIRR, the A549 cells were transferred with eukaryotic expression vector containing full length SIGIRR cDNA. The transcriptional activity of NF-κB was measured by dual-luciferase reporter assay system. The concentrations of IL-1β, TNF- α and IL-6 were detected by ELISA. The levels of these inflammatory factors between the transfected cells and untransfected cells were compared. RESULTS: The over-expression of SIGIRR inhibited the transcriptional activity of NF-κB. The increases in IL-1β, TNF-α and IL-6 concentrations in alveolar epithelial cells induced by LPS were observed. CONCLUSION: SIGIRR in alveolar epithelial cells inhibits TLR4 signals triggered by LPS and attenuates the inflammatory reactions in alveolar epithelial cells, which plays a protective role against the acute damage of the alveolar epithelial cells.

BACKGROUND:Interlocking intramedul ary nail complications contain nail bent or broken, exit, re-fracture at spiketail or nail hole. Thus, our team designs a novel intramedul ary control ed dynamic nail.
OBJECTIVE:To evaluate the rationality and safety of intramedul ary control ed dynamic nail design and strength, and to give rational proposal for its clinical application.
METHODThe three-dimensional finite element models of composite femur, transverse fractures of the femoral shaft were constructed with intramedul ary control ed dynamic nailing. The stress and strain were detected under vertical loads and gait cycle.
RESULTS AND CONCLUSION:The maximum stress of the intact femur under the compression load was at femoral neck and the medial and lateral aspects of the femoral shaft;while the stresses of fractured femur were at the interface between screw and screw hole. In gait cycle, in case of intact bone, large stresses were found in the distal 1/2 of anteriomedialis of femoral shaft;while the stress distribution in fractured femur was similar with the 
former. Intramedul ary control ed dynamic nailing has the ability of generating compression between fragments. These suggest that intramedul ary control ed dynamic nailing is rational and good at design and biomechanical properties.

Objective:To explore the changes of NK and NKT cells and the expression levels of their activated, inhibitory receptors in the peripheral blood of patients with newly diagnosed rheumatoid arthritis ( RA), and to reveal the potiential role of NK and NKT cells played in the pathogenesis of RA.Methods:32 patients with new onset RA and 15 healthy controls were recruited.Activated and inhibitory NK and NKT cells in peripheral blood were quantified by flow cytometry.The frequency of spontaneous and stimulated IFN-γ+NK and NKT cells and CD107aγ+NK cells were examined.Finally,the potential relationship between the frequency of NK and NKT cells subsets and clinical indexes were analyzed.Results:The frequencies of NK cells in peripheral blood in RA patients were sig-nificantly lower than those in the controls ( P=0.026 ).The frequencies of NKG2D+, NKP46+activated NK cells and NKG2C+, NKG2D+,NKP46+activated NKT cells in RA patients were significantly higher than those in the controls (P=0.011,P=0.010,and P<0.001,P=0.032,P=0.001,respectively),whereas the frequencies of KIR2DL3+,KIR3DL1+and NKG2A+inhibitory NK cells and KIR2DL3+,NKG2A+inhibitory NKT cells in RA patients were significantly lower (P=0.002,P=0.002,P=0.014,and P=0.027,P=0.002,respectively).Moreover, the frequencies of stimulated IFN-γ+NK cells and IFN-γ+NKT cells, spontaneous and stimulated CD107 aγ+NK cells in RA patients were significantly higher than that in the controls ( P=0.037, P=0.004 and P=0.001, P=0.001, respectively).Furthermore,the frequencies of NK cells,NKG2Aγ+and KIR2DL3γ+inhibitory NK cells were correlated significantly with the values of DAS28 in RA patients (r=0.357,P=0.045;r=0.399,P=0.024;r=0.468,P=0.021,respectively).Conclusion:Lower frequencies of NK cells, higher frequencies of activated NK cells and activated NKT cells, lower frequencies of inhibitory NK cells and inhibitory NKT cells, and higher NK cell activity may induce the autoimmune reaction involved in the pathogenesis of RA.

Postoperative ileus( POI)is a temporary impairment of coordinated gastrointestinal motility that develops as a consequence of abdominal or non-abdominal surgery and is a major factor contributing to the prolonged hospitalization of patient. In recent years,because of the widespread use of opioid analgesics,morphine induced POI is common. This article reviewed the progress in study on mechanism and management of POI caused by morphine.