Objective To analyze the condition, distribution, constituent ratio, main symptoms, laboratory examination and other clinical features of juvenile rheumatic disease (JRD) in order to enhance theunderstanding of it. Methods Five hundred and sixty-one cases of JRD treated in the Department of Pediatrics of Henan Provincial People′s Hospital were analyzed retrospectively from January 1990 to August 2003. Results Henoch-Schonlein purpura (HSP), juvenile idiopathic arthritis(JIA), rheumatic fever (RF), systemic lupus erythematosus (SLE) occurred more in rural area than in urban. Mucocutaneous lymphnode syndrome (MCLS) occurred more in urban than in rural area.The initial symptoms of JRD were arthralgia, skin rashes and fever. The frequently involved organs were kidney, lymphnode, heart and liver. White blood cell count and erythrocyte sedimentation rate raised in 43.1% and 61.6% patients with JRD respectively. Rheumatoid factor was mostly positive in JIA. Three patients died. Conclusion 2.9% patients with JRD have been admitted to Department of Pediatrics. The most common diseases are HSP, JIA, MCLS, RF, SLE. The morbidity of HSP shows an increasing tendency and RF shows decreasing tendency. It is suggested to enhance the understanding of JRD. Improve the diagnostic and treatment level is the key to control disease and reduce complications.

Osteoporosis is a systemic metabolic degenerative skeletal disease, characterized by reduced bone mass and disrupted bone microarchitecture, leading to enhanced bone fragility, decreased bone strength and increased susceptibility to frac?tures. Its occurrence and development is an extremely complex biological process, which is a multi factor, multi gene and multi stage experience. Osteoporosis is the fourth chronic disease in our country, which mainly affects postmenopausal women and the el?derly. Bone mass is jointly maintained by the action of bone resorption by osteoclasts and bone formation by osteoblasts. If the im?balance between the two occurs, resulting in reduced bone formation and increased bone resorption, bone homeostasis is changed to cause osteoporosis. Traditional treatment for osteoporosis are drugs which just to depress bone resorption (such as bisphospho?nates and estrogen), or just to promote bone formation (such as PTH and statins), or just to supply the source of calcium. This sin?gle point of local treatment is clearly difficult to play a long?term part in complex lesions of osteoporosis. In recent years, research?ers have studied the molecular signaling pathways related to osteoporosis. The current studies reveal that signaling pathways in os?teoporosis include MAPK, PI3K/Akt, Wnt/β?catenin, RANKL/RANK/OPG, Hedgehog and Notch signaling pathways. These signal?ing pathways play an important role in the molecular pathogenesis of osteoporosis. In addition, there are GH/IGF?1, PPAR?γ, PTH signaling pathways and so on. Taking these signaling pathways as targeting points is a new strategy for the development of new anti osteoporosis drugs or the prevention of osteoporosis. But there are cross?talks and/or interactions between these signaling pathways related to osteoporosis and the pathogenesis of osteoporosiswhich make its therapy more difficult. This paper reviews the research progress of signaling pathway in osteoporosis in order to explore the molecular mechanism of its occurrence. Thus these signaling pathways can be taken as new targets to develop safer and more effective anti?osteoporosis drugs.

Objective To investigate the 64-slice spiral CT angiography combined with negative contrast CT cholangiography in the evaluation of resectability of hilar cholangiocarcinoma.Methods The clinical data of 46 patients with hilar cholangiocarcinoma were analyzed.The resectability was observed by the 64-slice spiral CT angiography combined with negative contrast CT cholangiography,and compared with the postoperative results.Results Preoperative CT Bismuth-Corlette classification and postoperative results showed no significant difference (x2 =0.00,0.53,1.96,0.59,2.63,all P ＞ 0.05).Preoperative CT assessed the resectability of 26 cases with hilar cholangiocarcinoma,The intraoperation evaluated resectable 22 cases,the difference was not significant (x2 =1.51,P ＞ 0.05).Conclusion 64-slice spiral CT angiography combined with negative contrast CT cholangiography can make a good evaluation of hilar cholangiocarcinoma involving the degree of blood vessels and bile ducts,provide an important basis for the selection of clinical protocols.

Objective Explore the diagnosis experience of sarcomatoid renal cell carcinoma (SRCC).Method There were 5 cases of SRCC from April 2011 to June 2013,3 of them were females and 2 were males,with a mean age of 49 (27-71).All the patients were presented with pain accompanied with other symptoms such as hematuria,fever and polyuria.CT urography suggested renal occupied lesions,withuneven density and enhancement,and malignancy was highly suspected.The mean diameter of tumors was 9.2 cm(4-18 cm).Radical nephrectomy was performed on all patients,tumors were located in renal parenchymal,and with adherence to other tissues.One patient with lung metastasis was found before surgery.Result Pathologic findings of the resected tissues after operation noted SRCC.Under the microscope,a large number of spindle shaped cells were seen,and Vimentin and PCK were all positive in immunohistochemical.Three patients with metastases were found after surgery (adrenal gland,liver,pancreas).Postoperative pathological stages were one T2N0M1,three T4N0M1 and one T3N0M0.One patient received IL-2 immunotherapy.All patients died within 9 months after surgery with a median survival of 3.8 months.Immunohistochemistry in the postoperative,there were four patients with the level of Ki-67 LI ＞ 50％,with distant metastasis and survival time was 1-4 moths.Conclusion The disease develops rapidly,and the prognosis of the patients is very poor.The Ki-67 LI may be considered as a prognosis marker and the patients with sarcomatoid differentiation can benefit little from surgery alone.

ObjectiveTo assess fine needle aspiration (FNAC) in the early diagnosis for auto immune thyroid disease (AITD) in adolescent.Methods Seventy-one patients, age ranging from 9 to 23 years with thyroid enlargement underwent FNAC. Their smears were classified into 4 types according to the degree of degeneration of adenoidal cell and lymphocyte invasion by HE combining with rapid staining.The results were compared with B ultrasound and serum thyroid auto antibody measurement.ResultsB ultrasound showed hyperthyroidism in 12 cases, inflammation in 53, nodule change in 5, normal in 5. Thyroid function examination demonstrated hyperthyroidism in 22 cases, hypothyroidism in 9 cases, and euthyroidism in 40 cases. Auto thyroid antibody (TGAb,TMAb) were all beyond normal range except in 1 case, and TPOAb elevated in 37 cases. FNAC identified Grave′s disease in 14, Hashimoto′s diseases typeⅠ( HT-Ⅰ) in 35 cases,HT(Ⅱ) in 13,HT(Ⅲ) in 3, and HT(Ⅳ) in 6 cases. ConclusionsFNAC contributes to early diagnosis of AITD in adolescent for its safety, simplicity, rapidity and accuracy.

Objective:To investigate the differentiation of human neural stem cells(hNSCs) in vitro and to assess the potential of hNSCs transplanted into the pylorus of nude mice.Methods:Central nervous system-derived hNSCs(CNS-hNSCs) were obtained from the subventricular zone of aborted fetus brain(10weeks),suspension cultured,passaged and induced to differentiate in vitro.Stem cell marker neuroepithelial stem cell protein(nestin),enteric neuronal marker protein gene production 9.5(PGP9.5) and glial cell marker glial fibrillary acidic protein(GFAP) were detected by immunofluorescence method.CNS-hNSCs(cultured for 3 months) were transplanted into the pylorus of nude mice and followed by immunofluorescence method.Results:Using the immunofluorescence method,nestin could be identified and the induced cells expressed PGP9.5 and GFAP.After being transplanted into the pylorus of nude mice,CNS-hNSC could be detected to survive at least for 6 weeks.Conclusion:CNS-hNSCs could be cultured,passaged and induced in vitro successfully;transplantation of CNS-hNSCs into gastrointestinal tract could be a potential cellular replacement strategy for gastrointestinal motility disorders.

Objective To explore the pathogenesis of invasive pituitary adenomas,and to improve the effect of clinical treatment.Methods 15 pairs of invasive pituitary adenoma tissues and noninvasive pituitary adenoma tissues were selected from 114 specimens collected and the Id1 gene expression and Id1 protein expression in invasive pituitary adenoma tissues and noninvasive pituitary adenoma tissues were tested by quantitative RT-PCR,Western blot and immunohistochemical methods;Then small interfering RNA (siRNA) was used to interfer Id1 gene expression in NQ-04 cells.Results The Id1 gene expression in invasive pituitary adenoma tissues was significantly higher than that in noninvasive pituitary adenoma tissues(n =15,t =2.725,P =0.013) ;The migration of pituitary adenoma cells interfered was significantly reduced.Conclusion The invasive pituitary adenoma tissues has high level of Id1 gene expression,which may be correlated with its invasion.And Id1 is expected to become a biological marker of diagnosis and determination in the prognosis of pituitary adenoma.

Objective To compare the usefulness of contrast-enhanced T1 high resolution isotropic volume excitation (THRIVE) sequence and fat-saturated TSE sequence in detection of spinal metastases.Methods Thirty-one consecutive patients with spinal metastases were recruited.All patients received post-contrast TSE T1WI followed by a fat-suppressed THRIVE sequence.The number of lesions,SNR and CNR for both sequences,and the scoring of image quality concerning motion-artifact and tumor conspicuity were compared.Results Acquisition time of the post-contrast TSE T1W sequence and the THRIVE sequence was 2 min 55 s and 33 s,respectively.No significant difference was found in the number of lesions detected between the two sequences (Z=-0.816,P=0.414).The SNR (432.54±271.60) and CNR (233.27± 197.65) of the THRIVE sequence were significantly lower than the SNR (674.32±375.79) and CNR (312.38±207.49) of the TSE T1W sequence respectively (t=-4.366,-2.660,P＜0.001,0.012).Tumor conspicuity of the post-contrast TSE sequence was better than that of THRIVE sequence (Z=-4.082,P＜0.001),while the motion-artifact in TSE sequence was more severe (Z=2.291,P=0.022).Conclusion The post-contrast THRIVE sequence is capable of decreasing acquisition time and motion-artifact.Besides,its detected efficacy is equal to that of TSE sequence.There is practical possibility to replace the conventional post-contrast TSE T1WI sequence with the THRIVE sequence in the imaging of spinal metastases.

Objective To evaluate graft regeneration and influencing factors after right lobe adult living donor liver transplantation (LDLT) using MSCT.Method Sixty-three living recipients were included in this study.We measured graft volume periodically by using MSCT and IQQA-Liver workstation.The liver regenerative ratio (LRR) of different stages of recipients after LDLT was calculated and compared,and stepwise regression analysis was done to set up the regression equation.Result Within 0.5 month after LDLT,graft volume was increased rapidly,and LRR reached maximum [(106.11 + 30.90)％],then decreased slowly.There was significant difference in LRR among 0.5,1 month and 3,6 months after LDLT (P＜0.05).The following factors,including whether the graft containing middle hepatic vein or not,age and sex of recipients,had no significant influence on LRR after LDLT (P＞0.05).The status of liver function of recipients preoperatively had significant influence on LRR 0.5 month after LDLT (P＜0.05).There was significantly negative correlation between the graft volume and LRRs of recipients at different stages after LDLT (P ＜ 0.05).Regression equation could be derived.Conclusion Most evident graft regeneration occurs in early stage after adult LDLT.There are many and different factors influencing graft regeneration at the different stages after LDLT.Graft volumetric measurement by using MSCT is a valid modality to evaluate graft regeneration after LDLT.

Objective To investigate treatment effect of the type of foot drop in patients with lumbar disc herniation.Methods Clinical data of 34 patients with foot drop in lumbar disc herniation who were treated in Spinal Surgery Department of Shunyi District Hospital of Beijing from January 2006 to December 2013 were retrospective analyzed,all patients were treated by operation.After 24 months of follow-up,the effect was observed,the prognosis and related factors were analyzed.Results Two years after operation,the recovery of the patients was excellent in 4 cases and good in 19 cases,common and poor in 11 cases,and the excellent and good rate was up to 67.6%(23/34).Analysis results showed that after 3 to 24 months after surgery,the anterior tibial muscle strength grades(grade 0-5) corresponding score were 28 points preoperatively,59 points at 3 months after surgery,69 points at 6 months after surgery,92 points 1 year after surgery,reached 95 points 2 years after surgery.Muscle strength score of patients with an increasing trend,especially after 3 months to 12 months after the operation.Conclusion The drop occurred should be operated as soon as possible,recommendations for open surgery,complete decompression,avoid injury.Three months to 1 years after operation is the key period of recovery.