To study the significance of the pathological changes of axon and myelin sheath in injured brainstem.The neurofilament and myelin basic protein was demonstrated immunohistochemically,and the pathological changes of axons and myelin sheathes in human brainstem following trauma were observed.In the injured brainstem,irregular swelling and disconnecting axons could be found as early as 0 5h after injury, while pathological changes in myelin sheaths such as tortuous change,partial peeling off from axon and intermittent disappearance could be observed at 19～22h after injury.However,in the normal brainstem,there were no evident changes in axons and myelin sheaths.Pathological changes of axon and myelin sheath in brainstem would occur after trauma,which could be used for postmortem diagnosis of brainstem injury.

AIM: To explore the effect of nuclear factor-?B (NF-?B) on the anti-apoptosis induced by brain ischemia preconditioning (IP). METHODS: Temporary middle cerebral artery occlusion for 20 min followed three days reperfusion before 6 hours middle cerebral artery occlusion (MCAO) trancranially was used as preconditioning in Wistar rats. The protective role was evaluated by analyzing the infarct volume. The status of neuronal apoptosis was observed by TUNEL. The expression of NF?B p65 protein, the assay of SOD activity and MDA concentration were analyzed by using the methods of immunohistochemistry and cytochemistry. RESULTS: Compared to the control group, 20 min ischemic preconditioning, which did not produce neuronal damage obviously, reduced the infarct volume significantly after MCAO 6 h and obviously decreased the number of neural cell apoptosis in penumbra (P

Objective To evaluate the low-dose dual-source whole-body CT angiography in assessing the arteries of Takayasu’s arteritis (TA).Methods Low-dose whole-body CT angiography(CTA)was performed in 57 consecutive patients with suspected TA. The scanning parameters were performed with tube voltage 80 kV and attenuation-based tube current modulation with a referenced tube current at 300 mAs.The volume CT dose index (CTDIvol)and dose-length product (DLP)were obtained for all scans.Subjec-tive and objective image quality of different arteries were assessed in seven anatomic territories,including intracranial,cervical,tho-racic,abdominal,upper extremity,thigh and shank.In addition,CT findings of whole-body arteries were recorded.Results Forty out of fifty-seven patients with definite diagnosis of TA enrolled in this study.Mean CTDIvol and DLP for all patients were (2.5± 0.9)mGy and (403.7±91.4)mGy·cm,respectively.The scoring order of subjective and objective iamge quality was neck,chest, abdomen,thigh,upper extremity,head and shank.5.9% of intracranial arteries,3.3% of lower extremity arteries and 0.5% of upper extremity arteries were extra detected.Conclusion The extra CT findings of intracranial,lower extremity and upper extremity arter-ies provides a more comprehensive evaluation of whole-body arteries involvement.

Objective To study the imaging features of sacroiliac joints(SIJ) in patients who were misdiagnosed as spondyloarthritis(SpA).Methods A total of 34 patients with chief complaint of back pain and misdiagnosed as SpA from January 2007 to April 2013 in Department of Rheumatology Chinese PLA General Hospital were enrolled.The imaging,clinical manifestations,laboratory examinations data were analyzed.Result The main reason for misdiagnosis as SpA was because of sacroiliitis presenting on imaging.The final diagnoses included 24 patients as SIJ infection,4 patients as neoplastic diseases,2 patients as metabolic bone diseases,2 patients as sacroiliac joint degeneration,1 patient as gout of sacroiliac joint,1 patient as diffuse idiopathic bone hypertrophy.For patients with infection,there were 10 patients receiving X-ray and 22 patients receiving CT of SIJ.However,5 and 7 patients had negative results respectively.These patients with infection had abnormalities in MRI including all with bone marrow edema,21 patients with erosion of bone and joint,22 patients with muscle involved.As to the patients with malignancies,SIJ CT scan appeared normal.Bone marrow edema and erosion in MRI were found in all neoplasm patients expect one as ependymoma.Adjacent muscles were involved in the patient with Ewing's sarcoma.Either X-ray or CT in other patients demonstrated obvious abnormalities,but only mild erosion of bone was found in MRI.Conclusion Bone marrow edema of SIJ in MRI represented not only in patients with SpA.Rheumatologists should analyze the clinical manifestations and laboratory examinations comprehensively in order to avoid the misdiagnoses.

BACKGROUND: Connective tissue growth factor (CTGF) has very strong regulative effect on the differentiation and proliferation of renal cells as well as the synthesis and degradation of extracellular matrix. Its abnormal expression plays a key role in the process of fibrous degeneration of various renal diseases including diabetic nephropathy.OBJECTIVE: To observe the protective effect ofjiedu tongluo baoshen gelatin capsule on renal disease in rats with diabetes mellitus and its effect on the expression of renal CTGF mRNA.DESIGN: A randomized controlled experiment taking animals as subjects.SETTING: Institute of Traditional Chinese Medicine, Changchun College of Traditional Chinese Medicine; Department of Pathology, Institute of Regenerated Medical Sciences, Jilin University MATERIALS: Totally 46 Wistar rats, of clean degree, male and female in half, weighing 150 to 200 g, were used in the experiment. Jiedu tongluo baoshen gelatin capsule was provided by Preparation Room, Traditional Chinese Medicine Hospital of Jilin Province (Batch No. 2002101, composed of Renshen, Huangqi, Shengdi, Gouqizi, Zhimuv Digupiv Huanglian,Zhenhua, Jinyinhua, Dahuang, Danshen, Yimucao and so on, 0.25 g/pill)and benazepril (Provided by Beijing Nuohua Pharmaceutical Company,Batch No. 01046) were used in the experiment.METHODS: This experiment was carried out in the Department of Pathology, Institute of Regenerated Medical Sciences, Jilin University from May 2002 to January 2003. ① Totally 46 Wistar rats used in the experiment were randomly divided into 4 groups: normal control group (n=10), model group (n=12), benazepril-treated group (n=12) and traditional Chinese medicine-treated group (n=12).Rats of normal control group were intraperitoneally injected of natrium citricum buffer solution of same volume; Rats of other groups were intraperitoneally injected of 50 mg/kg streptozotocin which was dissolved by 0.1 mol/L citric acid buffer solution before use(pH 4.2). Seventy-two hours after modeling, venous blood was collected from the tails to measure the levels of fasting blood glucose and urine glucose.Blood glucose ≥ 16.7 mmol/L and urine glucose over 卅 suggested diabetic models were successful. Rats of benazepril-treated group were performed intragastric administration of benazepril suspension of 15 mg/(kg·d);Rats of traditional Chinese medicine-treated grou p were performed intragastric administration ofjiedu tongluo baoshen gelatin capsule suspension of 5 g/(kg ·d); Rats of normal control group and model group were performed intragastric administration of the same volume of running water on each morning, once a day, 12 weeks in total. ② Levels of blood glucose,urea nitrogen, serum creatinine and urinary albumin excretion rate were measured 12 weeks after administration; Level of angiotensin Ⅱ of renal tissue was measured with radioimmunoassay; Levels of renal fibronectin and type Ⅳ collagen protein expression were measured with immunohistochemical method; Connective tissue growth factor gene expression of renal cortex was measured with reverse transcription-polymerase chain reaction and renal histological observation was also performed. ③ Analysis of variance was used in the intergroup comparison.MAIN OUTCOME MEASURES: Biochemical index of blood and urine,level of angiotensin Ⅱ of renal tissue, pathological morphology, expression of fibronectin and type Ⅳ rabbit anti-rat collagen protein and expression of connective tissue growth factor mRNARESULTS: Five, four and three rats died in the process of experiment respectively in model group, benazepril-treated group and traditional Chinese medicine-treated group, finally, 10,7,8 and 9 rats entered the stage of result analysis respectively in normal control group, model group, benazepril-treated group and traditional Chinese medicine-treated group. ① The ratio between body mass and renal mass was significantly higher in the model group than in the normal control group (P ＜ 0.05),but was significantly lower in the benazepril-treated group and traditional Chinese medicine-treated group than in the model group (P ＜ 0.01). ② Fasting blood glucose was significantly higher in the model group than in the normal control group (P ＜ 0.01),but was significantly lower in the traditional Chinese medicine-treated group than in the model group and benazepril-treated group (P ＜ 0.01). ③ Levels of urea nitrogen, serum creatinine, creatinine clearance, urinary albumin excretion rate and angiotensin Ⅱ of renal tissue were significantly higher in the model group than in the normal control group (P ＜ 0.01), but significantly lower in the benazepril-treated group and traditional Chinese medicine-treated group than in the model group (P ＜ 0.05-0.01 ). ④Pathomorphological change of renal tissue was very severe in the model group,but very mild in the benazepril-treated group and traditional Chinese medicine-treated group. ⑤Fibronectin and type Ⅳ rabbit anti-rat collagen protein expression were significantly higher in the model group than in the normal control group (P ＜ 0.01), those were significantly lower in the benazepril-treated group and traditional Chinese medicine-treated group than in the model group, but higher than normal control group (P ＜ 0.01). ⑥Expression of CTGF mRNA of renal cortex of model group was 2.65 times that of normal control group. Expression of CTGF mRNA of benazepriltreated group and traditional Chinese ine-treated group was decreased by 23.68% and 26.32%, respectively (P ＜ 0.05 or 0.01).CONCLUSION: Jiedu tongluo baoshen gelatin capsule has protective effect on diabetic nephropathy, which might be implemented by reducing the level of angiotensin Ⅱ of renal tissue and down-regulating the expression of CTGF mRNA of renal cortex of rats with diabetes mellitus, so as to reduce the deposition of extracellular matrix.

Objective To study Twist,E-CD expression in colorectal cancer tissues and its relationship with colorectal cancer invasion,metastasis and prognosis.Methods Immunohistochemical staining (EnVision) was used to detect E-CD,Twist expression of normal colon mucosa in 30 cases,colorectal adenoma in 30 cases and colorectal cancer tissues in 142 cases.Chi-square、Fisher's and Spearman test were used to analyze E-CD and Twist protein expression,Kaplan-Meier survival analysis and multivariate COX regression were used to analyze prognosis of patients.Results E-CD in the normal mucosa were positively expressed in 90％ cases,which was significantly higher than that in colorectal adenomas (63％) (P =0.046) and colorectal cancer tissues (42％) (P =0.000).E-CD expression was related to tumor differentiation (P =0.048),invasion depth (P =0.000),vein (P =0.000) and lymph vessel invasions (P =0.030),lymph node metastasis (P =0.001) and Dukes' stage (P =0.016),but not related to patient's age(P =0.174),gender(P =0.159),tumor size (P =0.628) and tumor histological type (P =0.153).1,3,5 year survival rate in patients with positive E-CD expression was significantly higher than that in patients with negative expression (P =0.000).Positive expression rate of Twist in colorectal cancer tissues (68％) was significantly higher than that in normal mucosa (20％,P =0.000) and colorectal adenomas (30％,P =0.000).Twist expression was related to tumor histological type (P =0.000),differentiation(P =0.000),invasion depth(P =0.000),vein(P =0.000) and lymph vessel invasions(P =0.000),lymph node metastasis(P =0.010) and Dukes' stage(P =0.000).1,3,5 year's survival rate of Twist-negative expression patients was significantly higher than that in patients with positive expression (P =0.000).E-CD and Twist in colorectal cancer tissues were negatively correlated (r =-0.530,P =0.000).COX multivariate analysis shows that vein invasion (P =0.045),lymph node metastasis (P =0.040),Dukes' stage (P =0.000),E-CD (P =0.003) and Twist (P =0.031) were independent prognostic indicators.Conclusions E-CD and Twist expression in colorectal cancer are related to tumor invasion,metastasis and prognosis.Low E-CD expression and high Twist expression are related to poor prognosis of colorectal cancer patients.

Objective To summarize the characteristics of epidemiology,clinic and radiography of mycoplasma pneumoniae pneumonia(MPP) in children.Methods Two hundred and one MPP patients were selected as our subjects who hospitalized in Kailuan General Hospital Affiliated to Hebei United University from Jan.to Dec.2013.All clinical data were recorded.Results Of 412 children with pneumonia,201 children were developed MPP(48.97％).There was significant difference among different age groups regarding of MPP incidence rate(x2 =62.04,P ＜ 0.05),and the highest incidence was in school-age group(71.59％).There was significant difference among the different month,and the MPP cases were more occurred at January,July,September,October and November.The main clinical manifestations were cough (201cases,100％),fever(136 cases,67.66％),moist rales (168 cases,83.58％),breathing (58 casses,28.86％).And parts of children (23.38％) were complicated with extra pulmonary symptoms.The blood WBC of most MPP patients were without obvious increase and blood WBC of 136 cases(67.66％) was less than 10 × 109/L.The cases with hsCRP (＜ 5 mg/L or-10 mg/L) accounted for 36.32％ or 22.39％.Imaging examination results showed that 64 cases were with bronchovascular shadow,73 cases with spot and schistic shadow,64 cases with lobar pneumonia and 3 cases with pleural effusion.Conclusion Clinicians sholud make the early diagnosis and treatment of MPP based on epidemiology,clinical and image comprehensive characteristics of MPP.

Objective To evaluate the use of nasojejunal tube in early enteral nutrition in severe traumatic brain injury (STBI) patients under mechanical ventilation.Methods STBI patients requiring mechanical ventilation in intensive care unit (ICU) of the First Affiliated Hospital of Bengbu Medical College admitted in 2013 were randomly divided into the jejunal tube group (n =15) and gastric tube group (n =19).We compared the 2 groups in terms of the tolerable beginning time of enteral nutrition (EN),the time before reaching target feeding volume,the incidences of gastrointestinal complications and ventilator-associated pneumonia (VAP) during EN,mechanical ventilation time,ICU hospital stay,and 28-day mortality rate.Results The tolerable beginning time of EN [(51.73 ± 9.16) hours vs.(81.11 ± 11.82) hours,t =7.920,P ＜0.05] and the time required to reach target feeding volume [(87.27 ± 9.99) hours vs.(152.05 ± 28.74) hours,t =8.320,P ＜ 0.05] in the jejunal tube group were significantly shorter than those in the gastric tube group.In the process of EN,compared with the gastric tube group,the incidences of gastric retention (6.7％ vs.57.9％,x2 =10.937,P ＜ 0.05),reflux (0％ vs.36.8％,x2 =9.566,P ＜ 0.05),vomiting (20.0％.vs.63.2％,x2 =6.642,P＜0.05),aspiration (6.7％ vs.42.1％,x2 =6.087,P＜0.05),VAP (33.3％ vs.73.7％,x2 =5.536,P ＜ 0.05) in the jejunum tube group were significantly lower.The mechanical ventilation time [(10.73 ± 4.68) days vs.(15.74 ± 2.54) days,t =3.730,P＜0.05] and the ICU hospital stay [(13.60 ± 4.80) days vs.(17.42 ± 4.05) days,t =2.497,P ＜0.05] of the jejunum tube group were significantly shorter than those of the gastric tube group.Comparison of 28-day mortality rate between the two groups revealed no statistically significant difference.Conclusion Early implementation of EN via nasojejunal tube in mechanically ventilated STBI patients can alleviate feeding intolerance,shorten the beginning time of EN and the time required to reach target feeding volume,reduce the incidence of complications,and shorten mechanical ventilation time and hospital stay in ICU.

Objective To study direct economic loss of healthcare-associated infection (HAI)in hospitalized children with acute respiratory infection (ARI),and the influence in satisfaction degree of children’relatives.Methods Clinical data of 1 039 children with ARI in a pediatrics ward between April 1,2012 to March 31,2013 were analyzed retrospective-ly.50 patients with HAI were in case group and 50 patients without HAI were in control group.The difference in medical cost and the degree of satisfaction of children’s relatives were compared between two groups.Results Medical cost of pa-tients in case group was significantly higher than control group([P 25 - P 75 :￥3 095.54 - ￥4 779.48]vs [P 25 -P 75 :￥1 744.14-￥2 382.07],Z =5.89,P <0.01).The expenses in medicine,laboratory examination,diagnosis and treatment,and nursing in case group were all higher than control group,there were significant differences between two groups(all P <0.01 );Hospitalization day of case group was significantly longer than control group ([P 25 -P 75 :9 d-15 d]vs[P 25 -P 75 :6 d-8 d],Z =5.79,P <0.01 ).Satisfaction degree of patients’relatives in case group was significantly lower than control group (Z =8.22,P <0.01).Conclusion HAI occurred in ARI children can increase medical cost,prolong length of hospital stay and decrease satisfaction degree of patients’relatives.

ObjectiveTo evaluate the diagnostic value of CT in adults with midgut malrotation.MethodsThe CT and clinical findings of 13 cases confirmed by surgery were analyzed retrospectively.ResultsCT found “whirl sign” in 9 cases,“transposition sign” in 5 cases,and the superior mesenteric vein located in right lower abdomen in 4 cases.At the same time,duodenum and upper jejunum located in right upper abdomen.Conclusion“Whirl sign” and “transposition sign” were the typical CT findings of midgut malrotation in adults.Ectopic superior mesenteric vein highly indicated slight midgut malrotation in adults.