Objective To prospectively determine whether position and size of tumor region of interest (ROI) influence estimates of lung cancer vascular parameters at 256-slice CT perfusion study.Methods After institutional review board approval and informed consent,16 men and 11 women with lung cancer underwent 70-second CT perfusion study. Perfusion, blood volume, peak enhancement weredetermined for 60 or 120 mm2 circular ROIs placed at the tumor edge and center and around (outlining) visible tumor. ROI analysis was repeated twice by two observers in the same way to get the average values.The correlation between the measurements and microvascular density counts was determined in 19 patients with operation.Measurements were compared by using Pair-Samples t test,a difference with P≤0.05 was significant.Results Perfusion,blood volume,peak enhancement measurements were substantially higher at the edge than at the center for both 60 and 120 mm2 ROI. For 60 and 120 mm2 ROI,median of the three measurements were (M=15.40,9.50 ml · min- 1 · 100 ml - 1,M =35.60,25.40 ml · 100 g-1,and M=16.47,10.20 HU),respectively,at the edge versus(M =14.80,8.52 ml · min- 1 · 100 ml- 1,M =33.50,23.90 ml · 100 g- 1,and M =15.64,9.40 HU),respectively,at the center(t value was 10.95,9.80,7.06,2.93,7.74 and 10.09,respectively,all P ＜ 0.05 ). Measurements varied substantially depending on the ROI size,values for the ROI for outlined tumor were intermediate between those at the tumor edge and center.Perfusion(M=12.51 ml.min- 1 · 100 ml-1),blood volume(M=29.31 ml.100 g-1),peakenhancement (M =12.93 HU) for the ROI outlining tumor were intermediate between those at the tumor edge and center.There was a good correlation between perfusion,blood volume,peak enhancement for the ROI outlining tumor and microvascular density[ ( 19.43 ± 8.78 ) vessels/0.74 mm2 ],respectively ( r value 0.732,0.590 and 0.544,all P ＜ 0.05 ).Conclusions Position and size of tumor ROI substantially influence ultimate perfusion values.ROI for outlined entire tumor is more reliable for perfusion measurements and more appropriate clinically than use of arbitrarily determined smaller ROI.

Objective To study the value of MR diffusion tensor tractography(DTT) in evaluating the white matter(WM) tracts in cerebral neoplasm.Methods Fiber tractography was used in this study to assess tumour-induced changes in WM trajectories in three cases of cerebral neoplasm: glioblastoma multiforme, meningioma and anaplastic astrocytoma.Results Three patterns of WM alteration were identified:(1) disruption;(2) displacement and (3) infiltration. Tumor disruption of WM tracts was observed in glioblastoma multiforme, in which the terminated fibers could crossed the corpus callosum. In meningioma, DTT illustrated bulk displacement ,remnant and separation of WM tracts.In anaplastic astrocytoma,WM tracts were disrupted and infiltrated by tumors. Conclusion The changes of WM tracts on DTT are correlated with the clinical and histopathological features of the tumor.

Objective To investigate the effect of glutathione on serum IL-6, IL-8 and TNF-α levels in severe acute pancreatifis (SAP). Methods Thirty-six patients with SAP were randomly divided into glutathione treatment group and non-glutathione treatment group. Age-matched controls were enrolled from healthy volunteers. Serum levels of IL-6, IL-8, and TNF-α were measured within 24 h of admission and the seventh day after admission. Results The serum levels of IL-6, IL-8, and TNF-α in SAP patients were (81.34±5.99)ng/L, (97.81±15.61) ng/L and (28.21±1.53)ng/L, respectively, which were significantly higher than (16.69±2.86) ng/L, (26.42±1.59) ng/L and (15.89±1.41) ng/L in control group (P＜0.05). Seven days later, the serum levels of IL-6, IL-8, and TNF-α in glutathione treatment group were (31.21±3.88)ng/L, (35.51±1.27)ng/L and (16.15±1.31)ng/L, respectively, and those in non- glutathione treatment group were (53.88±6.21 ) ng/L, (51.91±9.88) ng/L, (17.88±1.51 ) ng/L, redpectively. The serum levels of IL-6, IL-8, and TNF-α at the seventh day after treatment were lower than those before treatment and the decrease in glutathione treatment group was more significant (P＜0.05). Conclusions Glutathione may reduce the serum levels of IL-6, IL-8, and TNF-＜ and may play a role in the treatment of SAP.

Objective To develop a kind of medical rescue vest which is suitable to single pawn in emergency mission. Methods According to the rescue mission of single pawn and medical soldier in the early stage, the quantity and species of rescue equipment in medical rescue vest are studied to meet the medical needs of rescue mission; the determine ways of recovery effect are researched to ensure the adaptation of personnel and equipment; the vest structure is designed by people somatotyoe, the principle of human work efficiency and combination of disaster field characteristics. Results In the course of rescue drilling and rescue practice, the rescue vest is convenient and practical and meets the technology needs of war injury cure such as hemostasis, bandaging, fixing, handling, ventilation and basic life supporting etc. Conclusion The lightweight and practical medical rescue equipments are provided for single pawn and health soldiers to improve the ability of complete rescue mission.

Objective To evaluate the effectiveness of a insulin regimen for the management of stress hyperglycemia induced by head injury.Methods Eighty patients (64 male, 16 female) admitted to the hospital within 24h after head injury were enrolled in the study. The age ranged from 16-75 yr. The patients were divided into 3 groups according to the numeric values of Glasgow Coma Scale (GCS) : group Ⅰ 0, the step Ⅲ was taken to maintain blood glucose at normal level using formula Ⅱ : the maintenance dose of insulin = (last blood glucose ? 18) / 150 U?h-1 .Results The blood glucose levels before anesthesia were (12 ? 7) mmol (group Ⅰ ), (9 ? 3) mmol (group Ⅱ ) and (8 ? 5) mmol (group Ⅲ ) . The differences between the two groups were significant ( P

Objective To compare the low- and standard-dose protocols in the evaluation of coronary artery calcification (CAC) scores and in image quality,and to assess the accuracy of low-dose prospective ECG-gated helical CT in CAC measurements.Methods Forty-three patients with CAC were scanned twice using a tube current setting of 100 and 55 mA retrospectively.CAC scores (Agatston) of different branches of coronary artery were recorded.The mean and SD of the CT attenuation values in regions of interest in the aorta were measured,and the value (mean + 2 × SD) were obtained.Results Calcification plaques were found in 105 of the 172 vessels in the 43 subjects.The radiation dose of the 50 mAs group was (0.72 ± 0.04) mSy,significantly lower by 0.6 mSv than that of the 100 mAs group [(1.32 ± 0.08) mSv,P ＜ 0.05].The total calcification score of the 55 mAs group was significantly positively correlated with the routine dose group after performing the square root transformation (r =0.998).A signficant correlation existed in vessel-based calcification between these 2 groups (r= 0.997).Conclusions Low-dose prospective ECG-gated 64-slice CT yields high accuracy on CAC scoring while maintaining the image quality needed to measure CAC.

Objective To discuss the clinical characteristics for central compartment lymph node metastasis in stage cNO papillary thyroid microcarcinoma and significance and feasibility of preventive dissection,aimed to provide reference for clinical treatment.Methods Reviewed the clinical data of 277 patients with stage cNO papillary thyroid microcarcinoma from Jul.2011 to Dec.2015 underwent surgery in the Department of General Surgery of Lianyungang East Hospital.Evaluated the necessity of prophylactic central lymph node dissection.Adopted chi square test and Logistic regression to analyze its relationship with patients' gender,age,tumor number,tumor size,enveloped infiltration,single and bilateral tumor.All 277 patients underwent primary radical resection with ipsilateral central lymph node dissection.The specimen of resection was analyzed by routine pathology.Results The positive rate of thyroid papillary microcarcinoma lymph node metastasis was 36.8 ％ (102/277).The elements of male patients (P =0.023),age ＜ 45 years (P ＜ 0.001) and tumor diameter ＞ 0.5 cm (P =0.019)had high positive rate.The multivariable analysis showed that male patients (OR =2.63,P ＜ 0.001),age ＜ 45 years (OR =2.25,P =0.016),tumor diameter ＞ 0.5 c m (OR =2.13,P =O.009) were independent risk factors for CLN metastasis.Forty-three (15.5％) cases had transient parathyroid function.No Permanent recurrent nerve paralysis and hyperparathyroidism occurred in this group.Conclusions Prophylactic central lymph node dissection is helpful for accurate staging of tumor classification and risk assessment,has important significance,on the follow-up of patients after treatment of choice.For male patients,age ＜ 45,tumor diameter ＞ 0.5 cm,enveloped infiltration,the central compartment lymph node dissection may be necessary.

Objective To investigate the metabolism change of intestinal flora due to chronic hypoxia in infants. Methods Ten infants with tetralogy of fallot were considered as the chronic hypoxia group,10 healthy infants were regarded as the control group. The urine concen-tration of hippurate in the morning with fasting was detected by 1 H nuclear magnetic resonance. Results The concentration of hippurate was decreased in hypoxia group compared with the control group,(47. 15 ± 32. 88) mg/L vs (346. 698 ± 13. 555) mg/L,with significant differ-ence,P=0. 002. Conclusion Chronic hypoxia alters metabolism of intestinal flora in infants.

Objective To investigate the early diagnostic value of EBV-DNA load in Plasma and peripheral blood mononuclear cells (PBMCs) for Children′s Primary Infectious Mononucleosis(IM).Methods The plasma and PBMCs samples were collected from children of 67 cases with primary IM (IM groups) and 75 healthy cases (H groups) during April, 2015 to March, 2016 in our hospital. The EBV-DNA load in PBMCs and plasma samples were quantified by Real-time PCR. Statistical differences between two groups were analyzed by using Mann-Whitney Test. Receiver operating characteristic curves (ROC) were analyzed to assess the early diagnostic value of EBV-DNA load for primary IM.Results Levels of EBV-DNA in the samples of plasma were significantly higher in the IM groups (median, 380 IU/ml) compared to the H groups (Z=-9.332,P<0.01), and levels of EBV-DNA in the PBMCs samples were also significantly higher (median, 2.51×105 IU/ml, Z=-9.194,P<0.01). According to ROC curve analysis, the AUC of EBV-DNA load in plasma was 0.908, the most appropriate cut-off value was 12.5 IU/ml (sensitivity: 83.6% and specificity: 94.7%),the AUC of EBV-DNA load in PBMCs was 0.944, the most appropriate cut-off value was 2.19×104 IU/ml (sensitivity: 89.6% and specificity: 82.7%), the AUC of combined testing(plasma and PBMCs) was 0.967(sensitivity: 98.3% and specificity: 99.0%).Conclusions Combined testing of plasma and PBMCs have better clinical value, it may be useful for the diagnosis of early stage of Children′s Primary Infectious Mononucleosis.

Objective To analyze the distribution and antimicrobial resistance situation of pathogens isolated from blood culture to provide the scientific basis for the accuratel use of antibacterial drugs and preventing and controlling nosocomial acquired blood‐stream infection .Methods The US BACTEK‐FK automatic blood culture instrument and the French VITEK 2 COMPACT auto‐matic bacteria identification/susceptibility system were used to conduct the culture ,identification of blood culture isolated bacterial strains and drug susceptibility test .The results of drug susceptibility test were judged by adopting the 2011 criteria of the Clinical Laboratory and Standards Institute(CLSI) .Results The main isolated bacteria from blood culture for the recent three years were E coli ,staphylococcus aureus and klebsiella pneumonia bacteria ,coagulase negative staphylococcus(CNS) ,etc .The proportions of hos‐pital‐acquired bloodstream infections during these period were 42 .2% ,46 .9% and 54 .1% respectively .The detection rate of methi‐cillin‐resistant staphylococcus aureus (MRSA) was 18 .8% ,which of multiple drug resistant acinetobacter baumannii (MDRAB) was 42 .9% ,which of producing extended spectrum beta lactamase (ESBLs) in E .coli and klebsiella pneumoniae were 71 .8% and 69 .8% respectively .Conclusion The bloodstream infections pathogens in this hospital are mainly Enterobacteriaceae bacteria ,the proportion of hospital‐acquired bloodstream infections increases year by year ;the detection rate of multi‐drug resistant Acinetobact‐er baumanni (MDRAB) is higher ,clinic should pay more attention to the change of blood culture pathogens and their drug resist‐ance trend ,meanwhile nosocomial bloodstream infection should be prevented and controlled .