CT perfusion (CTP) has provide a novel approach for the diagnosis of ischemic cerebrovascular diseases. The evaluation indices include cerebral blood flow, cerebral blood volume, time to peak, and mean transmit time. These semi-quantitative indices used for evaluating cerebral blood perfusion have very important significance for the guidance of choosing the best treatment protocol and efficacy observation. CTP is mainly used in acute ischemic stroke to identify penumbra and infarct, as well as predicting hemorrhagic transformation in combination with other means and choosing thrombolytic candidates. In addition, CTP is also used to assess cerebrovascular reserve capacity in patients with chronic ischemic diseases and diagnose cerebral vasospasm in patients with subarachnoid hemorrhage and their efficacy evaluation.

Objective To evaluate the expressions of hypoxia-inducible factor-1α(HIF-1α),vescular endothelial growth factor(VEGF)and survivin in developing colorectal cancer,and the association among them.Methods The protein expressions of HIF-1α,VEGF and survivin were detected in specimens obtained from 69 patients with colorectal cancer and 20 normal controls by immunohistochemistry.The correlations of HIF-1α,VEGF and survivin with clinicopathologic features were analyzed.Results The expression of HIF-1α,VEGF and survivin proteins in patients with colorectal cancer were 56.52%,66.67% and 46.38%,respectively,and little expressed in normal controls(P＜0.01).The expressions of HIF-1α,VEGF and survivin were closely related to the differential grade of adenocarcinoma,he in volvment of penetration,lymph node metastasis and Dukes stage(P＜0.05).In addition,HIF-1α protein expression had positive correlations with both VEGF and survivin(P＜0.05),and the expression ofVEGF also had positive correlation with survivin(P＜0.05).Conclusions HIF-1α may involve in thepathogenesis of colorectal cancer through up regulating the expressions of VEGF and survivin,which mayhave synergetic effects in the pathogenesis of colorectal cancer.

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Objective To evaluate the clinical efficacy of emergent endoscopic injection of tissue adhesive (N-oclyl-a-cyanoacrylate) combined with endoscopic variceal ligation (EVL) for esophageal and gastric varices bleeding. Methods Data of 21 patients with acute esophageal and gastric varices bleeding who received emergent endoscopic injection of tissue adhesive and EVL were retrospectively studied. Results The instant hemostatic rate was 95% (20/21) with no severe complications. Conclusion Emergent endoscopic injection of tissue adhesive combined with EVL is an effective and safe therapy for esophageal and gastric varices bleeding.

Objective Study the diagnostic value of CT to assess the transfer of right recurrent nerve nodes(RRNN) on the thoracic esophageal squamous carcinoma,so as to provide reference for thoracic segment esophageal surgery way.Methods A retrospective analysis from January 2011 to February 2014 in the first affiliated hospital of zhengzhou university at the records of 132 cases of thoracic segment esophageal thoracic surgery with preoperative CT image data,recorded each patient's right recurrent nerve nodes in the largest length to diameter and the average CT number,and compared with postoperative pathologic results.Results With the ROC curve analysis,considering transfer when the length of RRNN' s diameter 8.5 mm or more in CT,the area under the curve is 0.911,the sensitivity is 85.7％,specificity is 78.8％.Considering transfer when the RRNN average CT number acuity 32.50 HU,the area under the curve is 0.815,the sensitivity is 85.7％,specificity is 76.9％.Whether RRNN transfer has significant correlation(P ＜ 0.05) with the length of tumor,tumor location and whether lymph node of other station transfer,doesn' t have significant correlation (P ＞ 0.05)with patients'age,sex,tumor differentiation degree and the T stage.Conclusion When the RRNN length to diameter 8.5 mm or RRNN average CT numberr acuity 32.50 HU,right recurrent nerve nodes should be considered lymph node metastasis,and choose chest conclusion laparoscopic radical prostatectomy.The upper thoracic portion esophageal tumor's length is 5 cm or more,or clinical suspected lymph node metastasis of other station is the risk factor for metastasis of RRNN.

Objective:Based on the clinical indicators of severe community-acquired pneumonia in emergency department, the early warning indicators of critical condition were constructed.Methods:The general information, vital signs before entering ICU, laboratory indexes and the survival rate in 30 days of 118 patients with community-acquired pneumonia were retrospectively collected in the emergency care unit of Peking Union Medical College Hospital from January to December 2018. The indexes of death patients (24 cases) and alive patients (98 cases) underwent comparative analysis, using ROC curve to predict the clinical outcome and reliable parameters of emergency patients with community-acquired pneumonia. The best cutoff value was determined according to Youden index and then undergoing multiple factors Logistic stepwise regression analysis. Then early warning model of critical degree was finally built.Results:Eleven indicators were used to predict the criticality of patients with acute community-acquired pneumonia, including AVPU (alert, voice, pain, unresponsive) score, Glasgow Coma Scale(GCS), heart rate, pulse oxygen saturation (SpO 2), fraction of inspiration O 2, oxygenation index,potential of hydrogen, blood potassium (K +), bilirubin, urea nitrogen, and C reactive protein, the optimal cutoff values were 2 points, 8 points, 91 times per minute, 0.94, 41%, 81.20%, 7.38, 4.0 mmol/L, 10.90 μmol/L, 2.23 mmol/L, and 41.5 mg/L. Multiple Logistic stepwise regression showed that the independent factors for predicting death were GCS score, SpO 2 and urea nitrogen, and the predictive ability of the early-warning model was 83.7%. Conclusions:GCS score, SpO 2 and urea nitrogen are effective early warning indicators for the severity of severe community-acquired pneumonia in emergency department, which are conducive to the rapid and efficient early identification and treatment of critically ill patients. Therefore, they are worthy of promotion and application in clinical practice.

The occlusal interference model in rats was established. In the masseter the level of MDA was increased, but both SOD and GPX were decreased in the presence of the occlusal interference, while the expression of UCP3 was higher than that in the control group (P ＜ 0. 05) .The findings indicate that the occlusal interference can induce the oxidative damage of masseter in rats, which has a correlation with UCP3.

Objective To explore the correlation between serum growth differentiation factor‐15(GDF‐15) level and acute myocardial infarction(AMI) to provide a basis for the prognostic evaluation of AMI .Methods Totally 192 Han patients with AMI (AMI group) and non‐coronary heart disease (NCHD ,NCHD group) diagnosed in Chengde Municipal Central Hospital from Sep‐tember 2013 to January 2015 ,were selected and their clinical data were collected .The biochemical markers and serum GDF‐15 level were detected .Results Comparing the AMI group with the NCHD group ,differences in the patients′age ,smoking ,blood glucose (Glu) ,TC ,TG ,LDL‐C levels had statistical significance (P<0 .05);the serum GDF‐15 level in the AMI group was significantly higher than that in the NCHD ;serum GDF‐15 level was positively correlated with TC ,LDL‐C ,hs‐CRP and Glu in the AMI group . Conclusion The increase of serum GDF‐15 level is obviously correlated AMI ,therefore GDF‐15 can serve as an indicator for moni‐toring myocardial infarction .

Objective To investigate the medium- and long-term effects and safty of Pipeline embolization device ( PED) for the treatment of large and giant intracranial anterior circulation aneurysms. Methods From December 2014 to December 2016,the data of 36 consecutive patients with large and giant aneurysm ( 36 large and giant intracranial anterior circulation aneurysms ) treated with PED in Donglei Brain Doctor Group were analyzed retrospectively. The diameter of the aneurysms was 12 -33 mm, (mean16.6±4.5mm),andthenecksizewas4-10mm(mean6.1±1.5mm).Eightaneurysmswere located in the carotid cavernous sinus segment,22 in the ophthalmic artery segment,5 in the internal carotid artery posterior communicating segment, and 1 in the M1 segment of middle cerebral artery. Seven aneurysms were only treated by PED,28 aneurysms were treated by PED in combination with coil embolization,and 1 aneurysm was treated by double PEDs. The modified Rankin scale ( mRS) score was used to evaluate the prognosis of the patients. Results (1) The clinical prognosis of the patients was followed up by telephone and outpatient department for 6-33 months. Twenty-five patients were followed up by DSA,23 aneurysms (92%) were occluded totally (Raymond gradeⅠ) and 2 (8％) were occluded near totally ( Raymond grade Ⅱ) . ( 2 ) Seven patients were treated with PED alone. Four patients were cured totally after 6 months follow-up,1 was occluded subtotally,2 were not cured;6 were cured in the last follow-up (33 months),and the other aneurysm was gradually reduced;17 of 28 patients treated with PED in combination with coils received DSA follow-up. They were followed up for 6-8 months. All the aneurysms were totally occluded ( Raymond grade Ⅰ) . 1 aneurysm was treated by 2 PEDs, DSA revealed micro-aneurysm-like development at 8 months after procedure. The aneurysms were basically occluded after 15-month follow-up. (3) MRI confirmed after operation that 10 patients had asymptomatic scattered spotted ischemic foci,4 had cerebral parenchymal hemorrhage,1 of them died,1 recovered well after treatment (mRS 1),and the other 2 were asymptomatic cerebral hemorrhage. The occupying effect of 24 cases disappeared, 8 had obvious improvement,and 3 did not have any obvious change. Conclusions The occlusion rate of the treatment of large and giant intracranial aneurysms with PED was high. The results of medium-term follow-up showed that the occlusion rate of PED in combination with coils in the treatment of aneurysms was higher than that of PED alone. The long-term follow-up results showed that the occlusion rate of patients treated with PED alone (including one or more) was gradually increased with time. The safety of the surgery needs to be further confirmed by a large sample study.

Objective To investigate the construction of outpatient quality care services and the needs of patient for outpatient service,and to explore the relevance of the two projects.Methods A total of 152 cases of outpatient department registered nurse of Beijing Union Hospital and 281 cases of hospitalized patients on May,2017 were selected,and then developed the Content Questionnaire on Quality Nursing Work of Outpatient Nurse and the Questionnaire on Outpatient Needs Status to carry out investigation.Results This kind of hospital patients with college or university in 216 cases(76.9%,216/281),personal monthly income of 5.0-10.0 thousand accounted for 44.8%(126/281);outpatient nurses aged ≥46 in 83 cases(54.6%,83/152),the working time≥20 years in 120 cases(78.9%,120/152),college degree or above in 137 cases(90.1%,137/152),97 nurses(63.8%,97/152)in charge.The clinic nursing work relates to the rate of above 85%for disease treatment and consultation,health education,guidance service,self-service system services,on-site inspection,consulting room environment,and the cost of nurses working hours and the most frequent content for the on-site inspection and diagnosis of diseases,counseling,health education,medical order service.The order of patients' needs from high to low was disease and consultation,health education,guidance service,order service,on-site inspection,self-service system,registration service,waiting environment and consulting room environment.There was no correlation between the patient's needs and the rate of nursing,the length of work,and the frequency of work(P＞0.05).There were significant differences in the demand for health education on each department(F =3.047,P ＜0.05),education level,medical order service and on-site inspections have significant difference on demand(F=3.809,3.409,P＜0.05),family income,sources of patients were not statistically significant in the comparison(P＞0.05).The outpatient quality care services had lower improved demand(≤26%),and the first six item that needed to improve are disease and medical consultation,self-service system,treatment order service,waiting environment,health education,guidance services.Conclusions In view of the characteristics of outpatient medical staff and patients in large general hospitals,we will improve the quality of outpatient service and meet the needs of patient outpatient service,which will help to deepen the medical reform and improve the quality of medical service.