OBJECTIVE: Controversy over the presence of neuronal apoptosis in acute brain injuries has not been resolved due to the lack of direct evidence. In this article, the authors briefly review the current research progress of apoptosis and discuss the relationship between acute brain injuries and neuronal apoptosis.DATA SOURCES: A computer-based retrieval for relevant papers with abstracts indexed in Medline database published in English full text between January 1995 and February 2005 was conducted using the key words of "acute brain injuries" and "Neuronal apoptosis". Related articles in Chinese full text published between January 2000 and December 2004 were also searched in Chinese periodical full text database, Wanfang databases with key words of "acute traumatic brain injury, neuronal apoptosis".STUDY SELECTION: The retrieved articles were first examined to exclude review articles and repetitions, and only randomized and non-randomized controlled experiments or clinical trials on acute traumatic brain injury and neuronal apoptosis were included.DATA EXTRACTION: Altogether 136 articles directly related to acute traumatic brain injury and neuronal apoptosis were collected, among which 19 met the inclusion criteria with the other 117 removed for repetition or irrelevancy.DATA SYNTHESIS: The valid articles were reviewed to identify the factors related to neuronal apoptosis, apoptotic network theory, detection methods of apoptosis, and the relationship between acute traumatic brain injury and neuronal apoptosis as well as the possible mechanisms.CONCLUSION: Neuronal apoptosis occurs after acute traumatic brain injury, which induces intrinsic and extrinsic neuronal environment changes including increased extracellular excitatory amino acid content, massive free radical production and abnormal gene expression. These factors interact with each other and modulate neuronal apoptosis through multiple pathways.

OBJECTIVE: To probe into the progression of biochemical study on caspase-3 and its functions in disorders of center nerve system.DATA SOURCES:The relevant papers were looked up on Medline database from January 1995 to February 2005 with the retrieved words as"caspase-3", "apoptosis", "center nerve system" and "emergency diseases" in combination, limited in English version.STUDY SELECTION: By initial checking,the papers on caspase-3 in molecular biology and randomized control experiments on caspase-3 and the disorders in center nerve system were collected.DATA EXTRACTION: Totally 156 papers were collected directly related to caspase-3 and center nerve system, of which, 25 papers were in conformity with the criteria and 131 papers were exuded because of repeated contents and indirect relation with this paper.DATA SYNTHESIS: To synthesize the relevant information from the retrieved papers and sum up that the activity of caspase-3 is increased after acute cerebral injury, acute spinal injury, cerebral ischemia and cerebral hemorrhage and broadspectrum caspase-3 inhibitor, Z-VAD-fmk can reduce significantly the activity of caspase-3.CONCLUSION: Caspase-3 is the most important protease in cell apoptosis, it is the component in downstream effect of coordination of various apoptotic approaches and is the only way in protease cascade of cell apoptosis. The activated caspase-3 can split the essential and protective enzymes in cell and result in the alternations of apeptosis in morphology and biochemistry. DNA segmentation is the important biochemical property of nerve cell apoptosis at early stage in acute cerebral injury and the formation of it is necessary.

Objective To investigate the imaging features of surgical complications of Crohn's disease (CD).Methods The retrospective cross-sectional study was conducted.The clinical data of 128 CD patients with surgical complications who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from January 2014 to December 2015 were collected.All the patients underwent computed tomography enterography (CTE),magnetic resonance enterography (MRE),magnetic resonance imaging (MRI) of anal tube and X-ray examination.The patients underwent surgical therapies after examinations.Observation indicators:(1) clinical characteristics of surgical complications of CD:occurrence of surgical complications of CD,correlation between preoperative complications and Montreal types of CD,(2) diagnostic accuracy of surgical complications and perianal lesions through CTE,MRE and MRI of anal tube,(3) imaging findings of preoperative complications of CD,(4) treatment and follow-up situations.Follow-up using telephone interview and outpatient examination was performed to detect the postoperative recovery and reoperations of patients up to March 2016.Count data were represented as frequency or percentage.The correlation between preoperative complications and Montreal types of CD was represented as the odds ratio (OR) and 95％ confidence interval (CI).The features of diagnostic indexes were described as the sensitivity and specificity.Results (1) Clinical characteristics of preoperative complications of CD:all the 128 patients had preoperative complications,including 71 with anal fistula or anal fistula combined with perianal abscess,26 with intestinal fistula,24 with intestinal obstruction,23 with abdominal abscess,3 with digestive tract perforation,1 with kidney stone and 1 with hydronephrosis.Of 128 patients,12 had intestinal fistula combined with abdominal abscess,1 had intestinal fistula combined with intestinal obstruction,3 had intestinal fistula combined with abdominal abscess and intestinal obstruction,1 had intestinal fistula combined with digestive tract perforation and 1 had intestinal fistula combined with hydronephrosis.There was a correlation between lesion location of CD and type of complications.Thirty-five of 51 patients had strictures or penetrationtype lesions,with a correlation between strictures or penetration-type lesions and ileal CD [OR =6.23,95％ confidence interval (95％ CI):2.86-13.61,P ＜ 0.05].Fifty-six of 77 patients had anal fistula,showing a correlation between combined anal fistula and colonic lesions of CD (OR =6.40,95％ CI:2.92-14.01,P ＜ 0.05).(2) Diagnostic accuracy of CTE,MRE and MRI of anal tube:with intraoperative exploration findings as the standard,the sensitivity and specificity of surgical complications of CD were 84％ and 95％ through CTE or MRE,and the sensitivity and specificity of anal fistula were 100％ and 100％ through MRI of anal tube.(3) Imaging findings of surgical complications of CD.① Of 71 patients with anal fistula,65 had 2 or more internal openings or fistula tract of complex anal fistula.The internal opening was a starting point of the fistula tract,and enhanced scans of MRI displayed punctate,shredded or small round abnormal strengthening signals between under mucous membrane of the anal canal and sphincter.The tubular and striped fistula tract was horizontal or vertical distribution,with a lightly high-high signal on T2 weighted-images (WI).The results of enhanced scans of MRI showed that there was an obvious homogeneous enhancement in the fistula tract or enhancement in the fistula tract wall,and no enhancement in the cavity of fistula tract.MRI findings in 38 patients combined with perianal abscess included a obvious high-signal on T2WI,and enhanced scans of MRI showed circular enhancement and no internal enhancement.② Of 26 patients with intestinal fistula,17 had intestinal fistula,imaging findings included multiple thickened intestinal walls and more obvious enhancement compared with normal intestinal canal.There was gathering and adhesions among intestinal canals,showing mash connections and petal-like changes.Fourteen patients had enterocutaneous fistula (6 combined with intestinal fistula and 1 patient combined with intestinal fistula and intestine-bladder fistula).Four patients had intestine-bladder fistula (2 combined with intestinal fistula and 1 combined with intestinal fistula and enterocutaneous fistula).One patient had intestine-vagina fistula.The results of CTE and MRE examinations showed that thickened intestinal canals and intestinal walls in the lesions,and shadows of intestinal canals communicated with the abdominal,bladder wall and vagina,with a high signal on T2WI and enhancement of intestinal wall by enhanced scan.The partial intestinal canals were physically close to other organs,without a connection between them,and anomalous enhancement or local pneumatosis among the adjacent organs were detected.③ CTE findings of intestinal obstruction included constriction of intestinal canal combined with dilatation of proximal intestinal canal.There were 3 enhancement methods of thickened intestinal wall in 24 patients with intestine obstruction.Imaging findings of 12 patients included enhancement in the intestinal mucosa and no enhancement in the submucosa and muscularis mucosa.Imaging findings of 4 patients included enhancement of intestinal mucosa and muscularis mucosa and no enhancement in the submucosa.Imaging findings of 8 patients included homogenous and heterogeneous enhancements in the intestinal walls.④ Twentythree patients were complicated with abdominal abscess,including 15 combined with intestine fistula.The scans of CTE showed that there was a round-like or oval mass in the abdomen,with a high signal on T2WI,fluid-dominated inflammatory exudation around the mesentery,the enhancement of annular wall of mesentery and no enhancement of pus within the mesentery.⑤ Three patients were combined with digestive tract perforation,including 1 combined with intestine fistula.CTE and X-ray detections showed there was a shadow of free gas in the intestinal mesentery and under abdominal diaphragm.⑥ Two patients were combined with kidney stone and hydronephrosis.X-ray findings of kidney stone included the deposition of multiple and sharp-edged dense shadows within the renal calices.CTE findings of hydronephrosis included inflammatory thickening of ureteric wall with proximal ureter dilatation.(4) Treatment and follow-up situations:128 patients underwent successful operation and were followed up for 4-27 months.Of 10 patients undergoing reoperations due to postoperative complications,MRI detection of 7 patients with recurrence of anal fistula showed fistula tract or abscess located at the previous loci was incompletely healed or progressed,morphous and location of lesions were roughly the same as the preoperative situations.The scans of CTE in 2 patients with anastomotic stricture showed that there were the thickening of intestinal wall and obstruction and dilatation at the proximal anastomotic-site.The enhanced scan of CTE in 1 patient with anastomotic fistula showed that there were irregularly cavity-like lesion beside the metal anastomotic ring,and effusion was seen within the lesions,with an edge enhancement.The other 118 patients recovered well without intestinal fistula or intestinal obstruction on CTE or MRE examination.Conclusions Anal fistula is the most common surgical complication of CD,and intestinal fistula,intestinal obstruction and abdominal abscess are also relatively common.The early postoperative complications consist of the recurrence of anal fistula.Location of lesions in CD is associated with the type of complications.CTE or MRE and anal MRI findings have different imaging characteristics for CD combined with different complications,with a certain value in the assessment of abdominal and perianal complications.

Objective To investigate influences of nasal continuous positive airway pressure to sleep architecture of obstructive sleep apnea syndrome and the reason of daytime sleepiness. Methods 34 patients with severe OSAS were monitored with polysomnography (PSG) before and after nCPAP treatment. Results Apnea hypoventilation index (AHI) decreased and the lowest SaO2 increased and sleep architecture was improved in all patients. Conclusion The nCPAP therapy can effectively improve the disturbances of sleep architecture and respiratory parameters.

Objective To investigate the testing capabilities of clinical transfusion laboratories in medical institutions in Beijing for the regulatory authorities to formulate administrative policies in this regard.Methods Experts assigned by Beijing Clinical Transfusion Quality Control Center made on-site inspections at the transfusion laboratories in medical institutions using quality control products.They recorded the complete testing process of the operators as well as the instruments,detection reagents in use and the testing results,with statistics and analysis made to the data so collected.Results The pass rate of these on-site inspections was lower than that of the external quality assessment.Some laboratories failed to complete the testing of the quality control products in time and the actual operations in some laboratories were inconsistent to the guidelines.55.9％ of level Ⅰ hospitals and 25.6％ of level Ⅱ hospitals were found with insufficient and inadequate instruments and process layout to meet the needs of clinical blood transfusion.Some of the technicians were found without sufficient trainings in their professional knowledge and basic skills,resulting in their poor competence against emergency cases and weakness in independent problem solving.In addition,the records of detection process and results were found to be substandard.Conclusions Transfusion laboratories in Beijing need to improve their testing capabilities in general.

A total of 58 patients with simple septic shock were recruited from intensive care unit and divided into control group (n =28) and treatment group (n =30) according to treatment modalities.The control group was routinely treated.The treatment group received continuous veno-venous hemofiltration (CVVH) for 10-14 days plus routine measures.After 3 days,the score of acute physiology and chronic health evaluation-Ⅱ (APACHE-Ⅱ) of the treatment group was better than that of the control group (P ＜ 0.01).And sequential organ failure assessment (SOFA),left ventricular end diastolic diameter (LVEDD),left ventricular end systolic diameter (LVEDS) and left ventricular ejection fraction (LVEF) improved significantly (P ＜ 0.05).And the relevant blood biochemical parameters improved significantly better than the control group (P ＜ 0.05).In the group CVVH,there were mortality (n =7,23％) and multiple organ failure (MODS) (n =6,20％) ; In the control group,mortality (n =14,50％) and MODS (n =13,46％).The mortality rate had inter-group differences of statistical significance (x2 =4.38,P ＜0.05).Thus early volume resuscitation plus CVVH had excellent curative efficacies for septic shock.

ObjectiveEvidence-based medicine was used to make an individualized treatment plan for rare solitary splenic metastasis of an ovarian carcinoma in a female patient. MethodsAfter clinical problems were discovered, evidence was collected from the Cochrane Library, PubMed, EMBASE, ScienceDirect, CNKI and Wanfang databases according to our predefined search strategy. The search was done until October, 2009. The validity of the evidence was assessed. The evidence, combined with the doctor experience and the patient value, was applied to the patient. ResultsA total of 15 English literature and 11 Chinese literature were identified. A rational treatment plan was made upon a critical evaluation of the data. There were 5 review articles in PubMed, EMBASE and ScienceDirect databases and no RCT in the Cochrane Library. And there was one retrospective cohort study inCNKI and Wanfang databases. The others were all case reports. After 20 month follow-up, the treatment protocol was proven correct. Conclusion The patient has rare disease, and the evidence intension for the evidence-based medicine was low. It can not present the efficacy of the evidence-based medicine treatment sufficiently, though it could provide some suggestion for rare disease which was lack of large RCT for evidence-based Methods .

ObjectiveTo explore the efficacy of an antibiotic ertapenem for the treatment of bacterial liver abscess. MethodThe clinical data of 134 hospitalized bacterial liver abscess patients were retrospectively analyzed to evaluate the clinical and bacteriological efficacy of ertapenem from March 2009-2011in our hospital. ResultFever was present in 122 (91％)cases,abdominal pain was complained in 70 (52.2％ ) cases and rigor in 66 (49.3％ ) cases.In 92(68.7％ ) cases the abscess was located in the right lobe of the liver.Leukocytosis and liver dysfunction were found in 73 cases(54.8％ ) and 84 cases (62.7％ ),respectively.Ultrasonography was the most effective diagnostic means for liver abscess.Fortyone cases(30.6％ )were treated conservatively with ertapenem and 82(61.2％ )were treated with ertapenem associated with percutaneous liver puncture aspiration and 11cases (8.2％ )were treated with ertapenem associated with surgery.The clinical success rate was respectively 89％,87.8％,90.9％.The average duration of medication and length of stay were respectively ( 7.0 ± 2.4 ) d and 14.2 d.Ninety-seven pathogens were isolated from samples and predominant strains were Klebsiella species.Bacterial eradication rate was 92.8％.The sensitivities of isolated bacteria to ertapenem were 94.8％.ConclusionsErtapenem administration is effective therapy for bacterial liver abscess.

Student evaluation is an important part of the teaching process.The Children's Hos-pital of Chongqing Medical University focused on the characteristics of individual child's growth and overall development according to the own condition and integrated formative assessment and summa-tive evaluation in the classroom teaching and clinical internship process. All the measures mentioned above not only help promote students' learning interests,master of knowledge and clinical skills but also exert positive effect on the improvement of teaching level.

Objective This study explored the expression of polyclonal protein SUZ12 in patients with intrahepatic cholangiocarcinoma(ICC),and its role in predicting the survival and treatment of ICC patients.Methods The expression of SUZ12 and p16INK4a was detected by immunohistochemical assay in 207 liver tissue samples including ICC patients,BilIN-1,-2,-3 and non-tumor-like cholangiocarcinoma.The expression of these proteins was assessed to be related to the pathological characteristics of the ICC patients receiving chemotherapy and the outcome of survival as well as the subsequent chemotherapy response.Results The expression level of SUZ12 was gradually increased from non-neoplastic bile duct tissue to BilIN-1,-2,-3 and ICC.The expression of p16INK4a protein was expressed in non-neoplastic-like cholangiocarcinoma,but it decreased gradually in BilIN-1,-2,-3 and ICC tissues.SUZ12 expression was associated with undifferentiated ICC,lymph node metastasis and advanced cancer.Kaplan-Meier curve analysis showed that ICC patients with high expression of SUZ12 had a significant reduction in overall survival and disease-free survival in comparison with ICC patients with the low expression of SUZ12.SUZ12 expression was significantly associated with overall survival of patients receiving adjuvant gemcitabine-based chemotherapy(AGC).Conclusion SUZ12 expression is able to predict the overall survival and disease-free survival of ICC patients with adjuvant gemcitabine-based chemotherapy.