Objective To analysis the imaging findings of tetralogy of Fallot and related pathological basis. Methods The clinical,pathologic and right ventriculography findings of 124 tetralogy of Fallot which were confirmed by surgery were retrospectively aralyzed. Results 124 tetralogy of Fallot were separated into type Ⅰ 62, Ⅱ 31, Ⅲ 6, Ⅳ 25 by Gray's classification,and slight,midrange,severe stenosis were 71 (0.51～0.6) ,33(0.41～0.5) ,20(<0.4) by Partiole's classcification. As to ventricular septal defect(VSD) ,infra-cristal ventricular septal defect were found in 116/124 in which crista supravcntricalaris appeared as girdle-shaped filling defect in lateral position, suprac-ristal ventricular septal defect were found in 8/124 in which crista supraventricularis appeared as round filling defect in orthophoric position. Conclusions Right ventriculography can precisely display stenosis of pulmary and ventricular septal defect(VSD). It has great valne in diagnosis and surgical therapy of tetralogy of Fallot.

Objective To probe the teaching method of application of problem-based learning (PBL)with computer aided technology in teaching of breast surgery clinical practice.Methods 48 students were randomly divided into two groups:control group(n=24) were taught by lecture-based learning(LBL),experimental group (n=24) were taught by method of application of problem-based learning(PBL)with computer aided technology.Questionnaire was provided to the students of experimental group to investigate the degree of recognition to the teaching method of problem-based learning (PBL)with computer aided technology.5 patients from experimental group and 5 patients from control group participating in teaching were given questionnaires to investigate if their right of privacy were violated.The theory examination score(out of 50) and comprehensive skills assessment score (out of 50) were compared between the two groups; the mean differences between the two groups were compared by t test.Result The teaching method of application of problem-based learning(PBL) with computer aided technology was recognition by 91.7 ％(22 persons) of students.20 percent(one person) of the experimental group patients felt their right of privacy violated; 60 percent(three persons) of the control group patients felt their right of privacy violated.The theory test scores of the experimental group and control group were (46.23 ± 2.45) and (45.52 ± 3.29).There was no statistical significance (t=1.230,P=0.225).The skill test scores of the experimental group and control group were(47.23± 2.45) and (36.52 t 3.29).There was statistical significance(t=12.791,P=0.000).Conclusion The teaching method of application of problem-based learning(PBL) with computer aided technology can help encourage the study interest of students,and cultivate their clinical thinking method and capacity,and protect the right of privacy of the patients,avoiding patient-hospital disputes.

Objective To evaluate 1*"H magnetic resonance spectroscopy (1H MRS) in the differentiating recurrent brain gliomas after radiation therapy from delayed cerebral necrosis. Methods Fifteen patients who had clinical and CT, MRI changes that suggested a diagnosis of delayed cerebral necrosis or recurrent brain tumor after radiation therapy and 5 patients who had a definite clinical diagnosis of delayed cerebral necrosis underwent single voxel MR spectroscopy simultaneously both in the lesion′s region and the contralateral side. Results Of the former 15 cases who proved by surgicopathology, 14 cases were gliomas,1case was delayed cerebral necrosis, and their etiologic diagnoses of 1*"H MRS were correct. (1)1H MRS in 14 cases with gliomas exhibited specific spectral peaks including prominent choline-containing compounds (Cho), decreased or absent acetylaspartate(NAA) and total creatine (Cr),and the metabolic ratios showed significantly increased Cho/Cr, decreased NAA/Cr. Twelve cases showed abnormal lactate (Lac). (2)Among 6 cases with delayed cerebral necrosis, 5 cases exhibited decreased or absent Cho, NAA, Cr, and abnormal Lipid, 1 case showed absent Cho, NAA, and Cr with a flat curve without Lac. Conclusion 1H MRS was positively claimed for differentiating recurrent brain gliomas after radiation therapy from delayed cerebral necrosis.

Objective To evaluate the effects and safety of closed tracheal suction system(CTSS)versus open tracheal suction system (OTSS) for mechanically ventilated patients.Methods All randomized controlled trials (RCTs) comparing CTSS with OTSS for mechanically ventilated patients home and abroad were identified via manual and computer retrieval.All related data were extracted.Meta analysis was conducted using the statistical software RevMan 5.1 on the basis of strict quality evaluation with the methods recommended by the Cochrane Collaboration.Results Fifty-one related papers were found and 12 RCTs involving 1205 patients in CTSS group and 1179 patients in OTSS group were included.The results of meta analysis showed that CTSS was associated with a significant reduction in the duration of mechanical ventilation (WMD =-0.73,95％ CI-1.07--0.40,P＜0.0001),but the incidence of ventilator associated pneumonia and microbial colonization,mortality and length of ICU stay exhibited no difference between the two groups (P ＞ 0.05).However,compared with OTSS,CTSS reduced the incidence of arrhythmia (RR =0.23,95％ CI 0.07-0.74,P =0.01) and minimized the disturbance to heart rate (WMD =-1.97,95％ CI-3.03--0.91,P =0.0003),mean arterial pressure (WMD =-2.01,95％ CI-3.02--1.01,P ＜ 0.0001) and oxygen saturation (SpO2) (WMD =-1.00,95％ CI-1.14--0.86,P ＜ 0.000 01).Conclusions Compared with OTSS,CTSS could reduce disturbance to respiratory and circulatory system by sputum suction and shorten the duration of mechanical ventilation.However,CTSS has no advantage in prevention of ventilator associated pneumonia or microbial colonization,nor does it shorten the length of ICU stay or improve the outcome of mechanically ventilated patients.

Objective To investigate the treatment of Pipkin fractures and curative effect. Methods From January 2003 to November 2009, we treated 19 cases of posterior dislocation of the hip with fracture of the femoral head,with type Ⅰ 8 cases, type Ⅱ6 cases, type Ⅲ 1 case, type Ⅳ4 cases. Seventeen patients were treated according to the illness with internal fixation treatment. Results Among type Ⅰ 8 cases, 2 cases were good with conservative treatment, 3 were excellent and 3 were good with surgical treatment;Among type Ⅱ6 cases, 3 were excellent, 2 were good, 1 was fair; 1 patient of type Ⅲ was fair; In 4 cases of type Ⅳ, 1 case was excellent, 2 cases were good, 1 case was fair. Conclusions Surgical treatment as soon as quickly is preferred for posterior dislocation of the hip with fracture of the femoral head( Pipkin fractures) , but the surgical time and methods should be chosen according to patients' detailed illness. It is important reserving the hip bone for preventing traumatic arthritis, and surgical skills to protect blood supply should not be ignored.

The smoke of anti-infrared smoke agent in a self-made miniature smoke chamber was determined by using Forier transform infrared spectrometer. The smoke changing and settling regulation with time were obtained by measuring the IR spectra of smoke at different time dynamically. Through testing the smoke of different quantity of the same smoke agent, it was found that the relationship between the concentration of the main smoke products and the absorbance obeyed Lambert-Beer′s Law. Finally, the relationship between the smoke screening ability and reactant agent amounts was obtained by calculating the screening ability of different amounts of reactant agent in three “atmosphere windows”.

Objective To systematically review the efficacy of dexmedetomidine or midazolam for sedation in critically ill patients. Methods We searched the PubMed, EMBaes, Cochrane Library, Wanfang Database,CNKI and VIP for all randomized controlled trials (RCTs) about the efficacy of dexmedetomidine versus midazolam for sedation in severe cases. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software. Results Six RCTs involving 613 patients were included in our Meta-analysis. The results of Meta-analysis showed that the length of ICU stay was significantly shorter in group dexmedetomidine than in group midazolam. There were no significant differences in the duration of mechanical ventilation, incidences of bradycardia, hypotension and delirium and mortality rate between the two groups. Conclusion Dexmedetomidin can shorten the length of ICU stay and is beneficial for the outcome in critically ill patients.

Objective To explore radiographic and MRI features of the hemangiomas and vascular malformation in the deep soft-tissue of the extremities.Methods 89 cases confirmed by surgical pathology and angiography were analyzed retrospectively with clinical data and radiological findings.Imaging exams included plain X-ray performed in all patients,and MRI scan in 33 patients.Results On X-ray plain film,there was normal bone and soft tissue in 54 cases(60.7%),soft tissue abnormalities in 14 cases(1 5.7%),and phleboliths in 30 cases(33.7%).Also,plain X-ray film studies demonstrated bone changes adjacent to the deep soft tissue in 32 cases(36.0%), including periosteal reactions(13 cases),cortical erosion (1 6 cases),involvement of the bone marrow (10 cases)and 7 diffuse lesions with all above changes.On MRI,lesions were similar to honeycomb or sponge,and T1 WI showed isohypointense signal in 25 cases (75.8%),hypointense in 5 cases (1 5.2%),inhomogeneous slightly hyperintense in 3 cases (9.0%).On T2 WI,all lesions were well defined and showed hyperintense signals with hypointense septation,of which there were 9 cases with nodular hypointense areas and vascular flow effect.Hypointense phleboliths were showed in 10 cases(30.3%).Following injection of the contrast medium,all lesions had heterogeneous enhancement patterns.Of the 33 patients studies with MRI,lesions of 18 cases(54.5%)had bone changes which were adjacent to or partially or fully wrapped by neighbouring soft tissue lesions,in which lesions of 12 cases showed abnormal signal within bone marrow and lesions of 3 cases with vascular flow void phenomenon.In 15 cases (45.5%)without osseous change,lesions of 3 cases were adjacent to bone,and lesions of 12 cases were with fat and muscle septum between the bone and lesions.Conclusion The hemangiomas and vascular malformation in the deep soft-tissue of the extremities may cause changes in adjacent bones.Familiarity with the performance of reactive bone changes on X-ray and MRI may help to improve the diagnosis and avoid misdiagnosis.

Objective To investigate the value of MR perfusion-weighted imaging(PWI)in the evaluation of therapeutic effect of brain metastases with gamma knife.Methods Treatment by gamma knife before and after that 3 months or 6 months PWI studies were penformed respectively in 22 patients with brain metastases .Maps of relative regional blood volume(rCBV)and mean transit time(MTT)were obtained.The ratios of rCBV and MTT of lesions were analyzed.Results rCBV of tumors in 22 cases was increased.The ratios of maximum rCBV of the lesions and opposite side were 6.16?3.12 and 1.18?0.17 respectively.The ratios of MTT of the tumors was 1.44?0.53.After gamma knife treatment,9 of 22 cases appeared decreased rCBV,but the ratios of MTT were no changing,of them,3 cases presented cerebral necrosis.13 of 22 cases,the ratios of rCBV were increased in varied degree after treatment by gamma knife,and 6 cases presented brain radionecrosis.Conclusion PWI is a significant method in evaluating the therapeutic effect of brain metastases with gamma knife

AIM: To investigate the mutatation type and polymorphism site in the ?-L-iduronidase (IDUA) gene of Liaoning district MPS-I patients. METHODS: The mutation type and polymorphism site in the IDUA gene of Liaoning district mucopolysaccharidosis type I (MPS-I) patients were detected by PCR-SSCP and DNA sequencing. RESULTS: ① 2 new mutations: R363H, 880+g-c in the IDUA gene of Liaoning district MPS-I patients were found. ② There were 3 polymorphism sites: R105Q、L118 and A361T in the IDUA gene of Liaoning district MPS-I patients. CONCLUSIONS: The mutation type in the IDUA gene of Liaoning district MPS-I patients is different from that of other countries and districts, while the polymorphism site in the IDUA gene of Liaoning district MPS-I patients is the same as that of other countries. [