Objective To summarize magnetic the resonance imaging (MRI) features of choledochal traumatic neuroma,and investigate the key points of diagnosis and differentiation.Methods This was a retrospective descriptive study.The clinicopathological data of 1 patient with choledochal traumatic neuroma who was admitted to the Yantaishan Hospital on 18 August,2015 were collected.The patient received pre-contrast and dynamic-contrast-enhanced MRI and MR cholangiopancreatography (MRCP).Observational indexes included:(1) imaging features:location,size,signal intensity and enhancement characteristics of the lesion;(2) treatment and prognosis:surgical treatment,pathological findings,results of immunohistochemical staining and clinical follow-up.After preoperative related examinations,the patient and relatives were willing to receive surgical therapy,and postoperative pathological examinations and immunohistochemical staining were conducted.The follow-up using outpatient examination was performed to detect the patient's recovery and clinical symptoms up to January 2016.Ultrasound and laboratory examinations [alanine transaminase (ALT),aspartate transaminase (AST),γ-glutamyl transpeptidase (GGT) and total bilirubin (TBil)] were also recorded.Results (1) Imaging features:pre-contrast MRI revealed a stricture and intra-lumen nodular in the middle portion of common bile duct.The nodular was measured 1.2 cm × 0.9 cm at maximum cross-section.The nodular was well-demarcated and homogeneous of hypointensity on T1-weighted image comparing to hepatic parenchyma,slight hyperintensity on T2-weighted image and slight hypointensity on fat-suppressed T2-weighted image.MRCP could demonstrate the nodular more clearly and dilation of distal bile duct and intra-hepatic bile ducts.The width of common bile duct was 1.4 cm.After administration of contrast materials,the nodular showed avid enhancement and delay enhancement,which was mild enhancement at the artery phase,and gradual increase at the portal vein phase and the delay phase.The length of central stricture of the common bile duct was 1.3 cm.There was no abnormal enhancement in liver,spleen and pancreas.No retroperitoneal lymphadenopathy could be seen.The imaging diagnosis was cholangiocarcinoma with dilation of bile ducts.(2) Treatment and prognosis:the patient received surgery for tumor resection and Roux-en-Y reconstruction.The removed gross specimen was a grey-white nodular measured 2.0 cm × 1.0 cm.The cute surface was grey-white and stiff.The microscopic evaluation revealed haphazard arrangement of nerve bundles within the hyperplasia fibrotic stroma.Normal biliary epithelial cells can be seen beside the nerve bundles.Immunohistochemical staining showed S-100 and Vimentin were positive.The index of Ki-67 was 5％.The patient was discharged at 14 days postoperatively with the good recovery.During postoperative 5-month follow-up,the patient had good recovery and jaundice seleras were disappeared.Ultrasound showed the bile ducts were not dilated.The results of laboratory examinations were normal.Conclusion MRI features of choledochal traumatic neuroma include an intra-lumen nodular with biliary stricture and avid and delay enhancement after contrast materials administration.

The enrollment of foreign medical students has expanded year after year.The education of foreign students becomes an important part of college education.In order to explore an effective method of medical education,the difference between Chinese students and foreign ones has been analyzed and the experience has been concluded according to the practice in teaching clinical diagnostics in recent years.

Objective:To explore feature of clinic and coronary angiography (CAG)of acute myocardial infarction (AMI)for young adults less than 30 years old.Methods:A total of 41 AMI patients,who were under 30 years old and hospitalzed in our hospital from 2004 to 2012,were enrolled as young group.Another 360 AMI patients >50 years were randomly selected as middle-aged group during the same time.Clinical features and CAG results were compared between two groups.Results:Compared with middle-aged group,there were significant rise in percenta-ges of male (68.1% vs.97.6%),smokers (50.6% vs.80.5%)and hypercholesterolemia (59.2% vs.65.9%)and body mass index [(22.3±6.6)kg/m2 vs.(26.3±9.6)kg/m2 ],and significant reduction in percentages of hyper-tension (63.1% vs.24.4%)and diabetes mellitus (30.6% vs.4.9%)in young group,P<0.05 or <0.01;for ex-citing cause,percentages of psychological factors such as tension and anxiety (29.3% vs.3.6%),staying up late (39.0% vs.2.8%)and heavy drinking (14.6% vs.4.7%)in young group were significantly higher than those of middle-aged group,while percentages of agitation (8.3% vs.0)in middle-aged group was significantly higher than that of young group (P<0.05 or <0.01).For CAG results,young group was mainly single vessel coronary disease (56.1%),which were mainly type A (53.7%)and type B1 (29.3%)lesions,while middle-aged group was mainly multi-vessel coronary disease (48.1%),which were mainly type B2 (29.7%)and type C (33.9%)lesions,and there were significant difference between two groups (P<0.05 or <0.01).Conclusion:Smoking,obesity and hy-perlipidemia are the most important risk factors for acute myocardial infarction;the major exciting causes are sta-ying up late,alcohol drinking and high mental stress etc.in young AMI patients;their coronary lesions are mainly single vessel coronary disease,and of type A and type B1 .

Objective To compare the changes in TLR4-NF-κB signaling pathway in infant and adult mice infected with influenza virus, and to provide experimental evidence for the study of immunopathological mechanism in pediatric respiratory virus susceptibility. Methods Immunohistochemistry and RT-PCR were applied to detect the expressions of lung TLR4 and NF-κB P65 mRNA and proteins in the infant and adult mice, and to compare the changes in TLR4-NF-κB P65 signaling pathway after infection with influenza virus.Results (1) The infant model group showed the strongest expression of TLR4 protein in the lung tissue, compared with that in the normal group and adult model group showing significant differences (P<0.05).(2) The expression of NF-κB P65 protein in the lung tissue was strongest in the infant model group, and it was gradually increased over time, showing a significant difference between each time point and the next time point (P<0.05).(3) The infant model group showed the strongest expression of TLR4 mRNA in lung tissue, significantly higher than that in the normal and adult model groups (P<0.05).(4) The expression of NF-κB P65 mRNA in the lung tissue was highest in the infant model group, and significantly higher than that in the normal and the adult model groups ( P<0.05) , and it was gradually increased with the time.Conclusions The over-activation of TLR4-NF-κB P65 signaling pathway may be one of the immunopathological mechanisms of serious injury in the lung tissue in infant rats.

Objective To summarize the clinical features,diagnostic and treatment experience of severe hand,foot and mouth disease(HFMD) cases receiving mechanical ventilation from Jan 1 to Sep 6,2009 in our hospital and provide reference for reducing the occurrence of neurogenic pulmonary edema(NPE) and mortality. Methods 147 severe HFMD who received mechanical ventilation were analyzed by a retrospective investigation. Results 85.0% children were less than 3 years old and 100% patients had a fever. The mechanical ventilation occurred within 1 to 4 days after fever (3.06 ± 1. 02) d. Neurological complications presented as bad spirit,easy surprised, involuntary movement of the extremities and lethargy. Respiratory system complication presented as polypnea, hypepnea and irregular rhythm. Circulatory system complication presented as heart rate increase or decrease, hypertension or hypotension, piebald skin and low limb temperature.Some of the children had high white blood cell counting,glucose and lactic acid of the blood. The EV71-PCR positive rate was 34. 7% for throat swabs,and 42. 2% for anal swabs. Chest X-ray presented as increased broncho vascular shadows, exudation or nonapparent abnormality. Only three children were dead, fatality rate was 2. 0%. Conclusion The HFMD cases in this outbreak are relatively more serious,and change rapidly. It's difficult to treat as soon as NPE appeared,and it has high fatality rate. Early recognition of critical patients,timely giving mechanical ventilation,and the comprehensive treatment can reduce NPE incidence and the mortality.

Background Diabetic retinopathy (DR) is a chronic inflammatory disease,with pathological changes of retinal microvessels.Studies demonstrated that sericin has anti-inflammation and anti-oxidation effects,inferring that sericin might play a protective effect on diabetic microangiopathy.Objective This study was to investigate the effects of sericin on intercellular adhesion molecule-1 (ICAM-1),vascular cell adhesion molecule-1 (VCAM-1) and Cx43 expressions in retina and explore the protection of sericin to retinal microangiopathy in diabetic rats.Methods Forty-eight specific pathogen free male SD rats were randomly divided into normal control group,diabetic model group,sericin-treated group and calcium dobesilate-treated group,with 12 rats for each group.The diabetic models were established by intraperitoneal injection of streptozotocin (STZ) for 3 consecutive days and feeding up with high lipid foods.Normal saline solution,2.4 g/(kg · d) sericin solution and 0.2 g/(kg · d) calcium dobesilate were used by gavage administration in the rats of the diabetic model group,sericin-treated group and calcium dobesilate-treated for 3 months group,respectively.The rats were sacrificed and retinal sections were prepared,and the retinal morphology was examined by hematoxylin-eosin staining.The expressions of ICAM-1,VCAM-1 and Cx43 proteins and mRNA in retinas were detected by Western blot assay and reverse transcription PCR.The use and care of the rats complied with Regulations for the Administration of Affairs Concerning Experimental Animals by State Science and Technology Commission and ARVO statement.Results The retinal structure was normal in the normal control group.The swell and rupture of inter limiting membrane (ILM),scatter vascular endothelial cell nuclei breakthrough ILM and decrease of retinal ganglion cells (RGCs) were displayed in the diabetic model group;while in the sericin-treated group and calcium dobesilate-treated group,the mild thickening of ILM and disorder of retinal cells were obtained.The relative expression levels of ICAM-1 and VCAM-1 were significantly raised and those of Cx43 were reduced in the diabetic model group,sericin-treated group and calcium dobesilate-treated group when compared with the normal control group (all at P＜0.05).Compared with the diabetic model group,the expressions of ICAM-1 and VCAM-1 proteins and mRNA in the sericin-treated group were significantly reduced (ICAM-1 protein:0.834 3±0.032 1 vs.0.918 9±0.042 4;VCAM-Ⅰ protein:0.726 4±0.011 2 vs.1.235 0±0.078 9;ICAM-1 mRNA:0.716 3±0.008 6 vs.0.956 8±0.012 5;VCAM-1 mRNA:0.393 7±0.035 0 vs.0.477 9±0.020 6) and those of Cx43 protein and mRNA were evidently elevated (Cx43 protein:0.133 1 ±0.015 3 vs.0.039 2±0.002 0;Cx43 mRNA:0.676 8 ±0.064 8 vs.0.430 8±0.111 3) (all at P＜0.05).Conclusions Sericin can relieve retinal microangiopathy and protect retina against the pathogenesis and development of DR by down-regulating the expressions of ICAM-1,VCAM-1 and upregulating the expression of Cx43 in retinas of diabetic rats.

Objective To verify the presence of anti-ovary antibodies in systemic lupus erythematosus (SLE) and its possible correlations with serum levels of hormone profile and menstrual disturbances in patients with SLE.Methods Clinical data of 78 consecutive paticnts who fulfilled 4 or more of the ACR 1997 revised criteria for SLE were studied and compared with 40 age-matched healthy controls,including anti-ovary antibodies.Results 27 (34.6％ ) patients with SLE,and 1 (2.5％) of the healthy controls tested positive of anti-ovary antibodies.The levels of E2 and T and P decreased[ E2:( 80.96 ± 36.2 ) ng/L vs ( 118.53 ± 42.4 ) ng/L; T:( 3.85 ± 1.18 ) nmol/L vs ( 6.43 ± 2.28 ) nmol/L; P:( 1.37 ± 0.59 ) μg/L vs ( 3.92 ± 1.23 ) μg/L],and the levels of FSH and LH and PRL increased in SLE patients when compared with healthy controls [ FSH:( 19.17 ± 9.26)IU/L vs (10.18 ±7.27 )IU/L; LH:( 21.19 ± 12.44)IU/L vs (13.79 ±8.27)IU/L;PRL:(6.18 ± 2.27 ) μg/L vs (2.37 ±0.63)μg/L,P ＜0.05 orP ＜0.01].The higher SLEDAI score,higher rate of menstrual disturbances (6.3 ±2.8 vs 3.5 ± 1.7,81％ vs 47％,P ＜0.05 or P ＜ 0.01 ) and decreased serum level of E2 [ (64.13 ± 26.36 ) ng/L vs ( 82.83 ± 28.71 ) ng/L,P ＜ 0.05 ]were found in SLE patients with anti-ovary antibodies positive than in SLE patients with anti-ovary antibodies negative.Conclusions The presence of anti-ovary antibodies was 34.6％ in SLE,and may correlate to decreased serum level of E2 and menstrual disturbance.

Aim To study protective effects of ulinastatin on injury of organs in rats induced by endotoxin.Methods 36 Wistar rats were divided into 3 groups: control group,model group and treatment group.The model of injury of organs were induced by injecting lipopolysaccharide(LPS) through the sublingual vein into rats.Ulinastatin was injected into the sublingual vein of rats in treatment group,LPS was injected into rats in the same way after 10 minutes.At the second hour or the sixth hour after treatment,serum and lung,liver and renal samples were cellected from rats to determine levels of TNF-?,IL-6,IL-1?and iNOS by RIA.Pathologic changes of lung,liver and renal organ were examined.Results Levels of TNF-?,IL-6,IL-1?,iNOS of serum and renal organs in treatment group were obviously reduced than those in model group(P

Objective To investigate the risk factors of worsening renal function (WRF) in patients with chronic heart failure ( CHF) and WRF influence on prognosis. Methods A case-control study were undertaken to analyze independent risk factor statistically related to incidence of WRF, and to assess the influence of WRF on prognosis. Results The independent predictors of WRF were creatinine level at admission (OR 2.248,95% CI 1.088-4.647, P = 0.029) and NYHA class on admission ( OR 2.485, 95% CI 1.3854. 459, P = 0.002). The mortality of patient with WRF was obviously higher than that of control group during hospitalization( OR 3. 824,95% CI 2. 452-5. 637 ,P ＜0.015). Conclusions WRF is a common complication among patients hospitalized for CHF, and is obviously associated with mortality during hospitalization. Higher creatinine level and weak heart function are independent risk factors for incidence of WRF of patients with CHF.

Objective To explore the diagnostic values of dual energy lung perfusion in the diagnosis of pulmonary embolism by using dual-source CT (DSCT). Methods Thirty patients with clinically suspected pulmonary embolism underwent dual-energy scanning with dual-source CT. The scanned data were integrated into three groups including 140, 80 kV and coefficient of 0.3. According to the CT pulmonary angiography (CTPA) of the fusion data, the patients were divided into pulmonary embolism group and normal group. The thin-slice reconstruction of data was analyzed using dual-energy perfusion imaging analysis software. The lung field was divided into upper, middle and lower part to make quantitative analysis of lung tissue perfusion. Paired t-tests were used in the normal patients to compare bilateral lungs, and independent samples t-tests were applied to compare the embolism group and normal group, while minimum intensity projection images (MinIP) were utilized in the assessment of lung ventilation. Results Dual energy CT showed symmetrical homogeneous perfusion in 16 normal cases, without significant perfusion defects. Quantitative analysis showed that left and right lung perfusion were (27 ± 7) and (28 ± 8 ) HU respectively, and no significant difference was found between the two sides ( t=-1.73, P ＞0.05 ).Perfusion of the left upper, middle and lower lung was ( 23 ± 6), (24 ± 6), and (28 ± 8) HU respectively, while the perfusion of right upper, middle and lower lung was (26 ±8), (27 ±8), and (28 ±9) HU respectively, showing no statistical significant difference between the two sides (t=-1.91, -1.96,-1.73 ,P＞0.05 ). Angiography of pulmonary embolism group(14 cases)showed filling defects in the pulmonary trunk, segments and sub-segments. Pulmonary perfusion imaging showed low perfusion or defectsin lung field that dominated by embolic vessels. Quantitative analysis showed that the perfusion of the whole lung and the middle and lower lung were (22 ±5), (22 ±8), and (21 ±8) HU in the embolism group,which were significantly different from the normal group (t=-2. 10, -2.32, -2.63, P＜0.05).Minimum intensity projection images showed a good consistency of abnormal ventilation zone area and perfusion abnormalities. Conclusions Pulmonary perfusion status, especially pulmonary embolism, can be analyzed by dual energy CT scanning. It helps to early discover and precisely locate the embolism.