5,6 or 7 respectively,the specificity became gradually higher.But the sensitivity and the diagnoses according rate became lower.Conclusion Holter is a simple shortcut useful tool as a non-invasive means of assessing and filtrating OSAS.

Objective To explore the role of apparent diffusion coefficient (ADC) value of diffusion-weighted imaging (DWI) in the differentiation between benign and malignant bone tumors. Methods Echo planar imaging DWI was performed in 18 patients with benign tumor or tumorous lesion and 26 patients with malignant tumor of bone. Three b-values (0, 500 and 1000 s/mm2) were applied. The lowest, highest, and whole ADC values were measured for each lesion, respectively. Results The lowest ADC values of benign bone tumor[ mean( 1.28±0. 49) ×10-3mm2/s ] were significantly higher than that of malignant tumor [ mean ( 0. 92±0. 35 )×10-3mm2/s, t = 2. 839, P < 0. 01 ]. The whole ADC values of benign bone tumor [ mean (1.62±0. 51 ) ×10-3mm2/s] were significantly higher than that of malignant tumor [ mean ( 1.21±0. 36) ×10-3mm2/s, t = 3. 092, P < 0. 01 ]. However, there were much overlapping between benign and malignant bone tumor in the lowest and whole ADC values. There was no significant difference for the highest ADC values between benign [. Mean ( 2. 02±0. 55 )×10-3mm2/s] and malignant bone tumor[ mean( 1.71±0. 65 ) ×10-3mm2/s, t = 1. 669, P > 0. 05 ]. Excluding cases of bone cyst and aneurismal bone cyst, the lowest, highest, and whole ADC values of benign bone tumor was (1.11± 0. 31 )×10-3mm2/s, ( 1.88±0. 49)×10-3mm2/s, and( 1.45±0. 35 )×10-3mm2/s, respectively. There was no significant difference for the lowest, highest, or whole ADC values between benign and malignant bone tumor (t = 1. 728, 0. 964, and 2. 012, respectively, P > 0. 05). Conclusion ADC value is useless for the differentiation between benign and malignant bone tumors.

OBJECTIVE To explore the reason and the nursing measure of the ventilator-associated pneumonia(VAP).METHODS Fifty five patients with VAP after mechanical ventilation were statistically analyzed and the pathogens were detected,at the same time to carry out comprehensive nursing measure.RESULTS After effective nursing measuring the motality due to VAP was decreased and the successful rescue rate was increased.CONCLUSIONS The VAP associates with various risk factors,but it can be prevented and controalled via overall reasonable and effective nursing measure.

Objective To investigate the value of CEUS quantitative analysis in diagnosis of different pathological stages of small hepatocellular carcinoma (HCC).Methods Data of 112 patients with HCC confirmed by surgical or biopsy were analyzed retrospectively.All the diameter of single tumor or the sum of the largest two lesions in multiple tumors were within 3 cm.Three groups were classified based on the Edmonson stage:High differentiation group (n=50,stage Ⅰ or Ⅱ),median differentiation group (n=30,stage Ⅲ),low differentiation group (n=32,stage Ⅳ).Qontraxt ultrasound imaging analysis software was utilized to measure CEUS parameters,including the maximum intensity of tumor (TMAX),nontumor's intensity (NT),maximum intensity of nontumor (NTMAX),appear time,time to peak,washout time,and the ratio of TMAX/NT and TMAX/NTMAX were calculated.The differences among the three groups was compared by statistics test.Results The values of TMAX,TMAX/NTMAX and washout time were statistically different among the three groups (all P＜0.05).The maximum values of TMAX,TMAX/NTMAX and the shortest washout time were found in the low differentiation group.And the minimum values of TMAX,TMAX/NTMAX and the longest washout time were found in the high differentiation group.There were no statistical differences of NT,NTMAX,TMAX/NT,appear time and time to peak among the three groups (all P＞0.05).Conclusion The quantitative parameters of CEUS is helpful in distinguishing different Edmonson stage of small HCC.

OBJECTIVE To discuss the liable episodes of the urinary tract infection with relation of catheter and propose the prevention measures.METHODS We radomly selected 536 patients with catheter.The urinary tract infection,as well as related factors were observed in patients with indwelling catheter.RESULTS The catheter replacement time interval as well as indwelling time were the risk factors,when the indwelling catheter time was 1-3 days,the CAUTI rate was 10.3%,if the time was ≥10 day,the CAUTI rate was 97.6%.Additionally the antibiotic use would cause dysbacteriosis which also easily caused the urinary tract road infection.CONCLUSIONS When taking care of the patients who had catheter,we should grasp the indications of catheterization,reduce the indwelling time,apply the effective nursing measures and correct choice of antibiotics,that can evidently control the infection.

Objective To detect the expression and effect of human tumor necrosis factor related apoptosis-inducing ligand (hTRAIL) in vivo,by using a novel double expressing adenoviral vector encoding hTRAIL and firefly luciferase ( luc ) gene ( ad -luc-hTRAIL),in which luc was used as reporter gene.Methods Lung cancer A549 cell xenografts in 16 nude mice models were established in subcutaneous inoculation way,the adenovirus vectors ( ad-luc-hTRAIL,ad-hTRAIL,ad-luc) and phosphate buffer saline (PBS) (n =4) as control were injected into tumor respectively.The size of the tumor was measured at different time points (4,7,10,14,21,28 d)after injection.The activity of luciferase in surface of the tumor was detected in vivo by using high-sensitivity cooled-charged coupled device(CCD) camera.The expression of hTRAIL was demonstrated by immunohistochemistry staining after sacrificing the animals at different time points,and immunohistochemical scores (IHS) were measured. The apoptosis rate of tumor cells was detected by using TUNEL and calculated. Analysis of variance,the paired t test and linear correlation analysis was used for the statistics. Results The growing speed of tumour xenografts was more slowly in ad-luc-hTRAIL and ad-hTRAIL groups than PBS group (t =2.71,2.72,P ＜ 0.05 ).The tumor volumes of ad-luc-hTRAIL,ad-hTRAIL,ad-luc and PBS groups 28 days after injection were (208.4 ± 42.3 ),( 181.5 ±23.9),( 403.1 ± 54.0 ) and ( 427.0 ± 59.3 ) mm3, respectively. There was no significant difference between ad-luc group and PBS group(t =2.07,P ＞ 0.05).The expression of luciferase in ad-luc-hTRAILgroup reached its peak at 7th day ( 1.37 ± 1.04),and then decreased quickly.The IHS and apoptosis rate in ad-luc-hTRAIL and ad-hTRAIL groups reached their peaks at 7th day,the peak values of IHS were 6.25 ±2.06 and 6.5 ± 2.89,the peak values of apoptosis rate were (60.75 ± 8.06 ) ％ and ( 61.50 ± 8.47 ) ％,respectively.The amount of luciferase expression ( absolute number of photons detected by CCD camera)was linear positive correlated with IHS and apoptosis rate ( rphotons/IHs =0.942,rph /rate =0.842,rIHs/rate =0.887,P ＜ 0.05 ).Conclusion The target gene hTRAIL can be transfected into lung cancer A549 cell xenografts nude mice models efficiently with a high level expression,and the therapeutic effect of hTRAIL can be monitored by detecting the expression of luc.

Objective To detect the expression and effect of human tumor necrosis facctor related apoptosis-inducing ligand(hTRAIL)in vitro by using a novel double expressing adenoviral vector encoding hTRAIL and firefly lueiferase (luc) gene (Ad-hTRAIL-luc),in which luc wag used, as reporter gene.Methods A549 cells were transduced with the adenoviral vector encoding enhanced green fluorescent protein (EGFP) gene(Ad-EGFP)at variable multiplicity of infection(MOI).Adenoviral transducfion efficiency wag determined 48 h later.A549 cells were transduced with Ad-hTRAIL-luc at variable MOI.and the following tests were performed 48h later,respectively:the expressive ratio of hTRAIL and the apeptotic ratio of A549 cells were meagnred by flow eytometer;counts per minute(cpm)of luminescence were measurde by scintiUation counters. A549 cells were transduced with Ad-luc at variable MOI, and cpm of luminescence was measured by scintillation counters 48 h later. After A549 cells were transduced with AdhTRAIL-luc,the expressive ratio of hTRAIL,the apoptotic ratio of A549 cells and cpm of luminescence were analyzed by one-way ANOVA.The positive ratio of EGFP and cpm of luminescence (Ad-luc) were analyzed bv nonparametric ANOVA.Results After A549 cells were transfected with Ad-hTRAIL-luc,the expressive ratio of hTRAIL on the cell membrane of the groups were(2.37±0.04)/,(3.16±0.03)/,(3.64±0.03)/,(3.96±0.02)/,(4.24±0.02)/,(4.34±0.02)/ respectively,which showed significant difference between each other (P＜0.01);and the apoptotic ratio of A549 cells were (1.52±0.04)/,(2.93±0.02)/,(3.39±0.02)/,(3.64±0.02)/,(3.86±0.02)/,(4.08±0.02)/,(4.20±0.02)/,respectirely,and it showed significant difference between each other (P＜0.01);cpm of luminescence were 465 561±26 801,1 038 576±29 417,937 655±23 197,786 432±20 028,524 288±16 338,401 566±15 961,respectively,and it also showed significant difference between each other(P＜0.01).There was a positive relationship between the expressive ratio of hTRAIL and cell apoptotic ratio of A549 cells (r=0.984,P＜0.01).Conclusion The double expressing adenoviral vector Ad-hTRAIL-luc can transfer luc and hTRAIL gene to A549 cells efficiently,and the activity of luc may reflect the effect of hTRAIL as well as the expression of hTRAIL.

Objective To determine the characteristics of paresteal lipomas with hypemstosis (esteochondromas or osseous protuberances)on CT images and to improve the knowledge of diagnosis and differential diagnosis of the disease.Methods CT images and clinical history of 6 patients with pathologically confirmed parosteal lipemas with hyperostosis were retrospectively reviewed.All of the 6 patients underwent plain CT scans.Results CT images clearly show lipomas and osseous projections or osteochondroma in the 6 cases.Parosteal lipomas were found with osteochondronms in 2 cages(1 at the isehium.and the other 1 at the femoral trochanter)and willl osseous protuberances in 4 cases(2 at the diaphysis offemurs.1 at the diaphysis oftibia and the other 1 at the sternum).These osteochondromas and ossous protuberances were surrounded by the adipose component of the neoplasm and had a firm attachment oftlle neoplasm to the underlying bone.The size ofthe osseous projections varied from 0.3 cm x1.2 cm to 6.0 cm x 4.0 cm.The shape of the osgeous projections was various.Osteochondromas found in 2 cases showed cortical continuity with the adjacent bone together with marrow continuity with tlle adjacent bone marrow.In the 4 cages of parosteal lipama with osseous protuberances,2 to 4 osseous protuberances were found in 2 case8 and solitary osseous protuberance were found in the other 2 cases.The lipomatoas companent showed typical features of adipose tissue on all images.The size of the lipomas varied from 3.0 cm ×2.0 cm to 11.0 cm×10.0 cm with clear border.Fibrous septa of different thickness were found within the adipose tissue.There was essification and (or) calcification in 1 case and muscle atrophy in 2 espies.Conclusions CT scan is useful in the presurgical evaluation of parosteal lipomas witll osteochondromas or osseous protuberances became it can demonstrates the morphology,location and extent of the lesions.and it can show their relationship to the surrounding structures. It is important for differential diagnosis and preoperative assessment of the lesion.

Objective To investigate the effects of N - acetylcysteine (NAC) on apoptosis and the expressions of Fas/FasL mRNA in lung tissue of rats with paraquat - induced acute lung injury.Methods Forty five male SD rats were randomly (random number) divided into normal control group,paraquat (PQ) group,and NAC treatment group.The rat model of acute lung injury was made with 2％ PQ induction in dose of 25 mg/kg injected,and NAC was injected into the PQ poisoning rats (200 mg/kg) 30 minutes after PQ administration in NAC treatment group.In the control group,equal amount of saline instead was injected into the rats.Apoptosis was detected by using TUNEL method and the expressions of Fas/FasL mRNA were evaluated by using reverse transcription polymerase chain reaction (RT- PCR),and the levels of Fas/FasL protein were detected by using western blot analysis.Results Compared with control group,cell apoptosis and expressions Fas/FasL mRNA in PQ group were significantly different ( P ＜ 0.05 ).Compared with PQ group,cell apoptosis and expressions Fas/FasL mRNA in NAC group were significantly decreased,were significant lower (P ＜ 0.05).Conclusions NAC inhibited apoptosis in lung tissue of rats with paraquat induction by regulating the activation of Fas/FasL systems.

Objective To evaluate clinical significance of the grade of ischemia by QRS complex on the admission electrocardiogram(ECG)to predict severe arrithmia in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Patients with acute ST-segment elevation myocardial infarction(STEMI)admitted to emergency department from July 2003 to April 2008 were enrolled.A total of 223 patients met the criteria(ischemic chest pain ≥ 30 min,2 or more adjacent leads of ST segment elevation and onset time within 12 h).Exclusion criteria were bundle branch block and left ventricular hypertrophy.All enrolled patients were divided into two groups based on the enrollment electrocardiogram:grade 2 ischemia(ST elevation without terminal QRS distortion; n =134)and grade 3 ischemia(ST elevation with terminal QRS distortion; n =89).Patients of the two groups had comparable genderproportion,average age and coronary heart disease risk factors etc.All patients received thrombolytic therapy.The incidence rate of ST segment resolution(STR)and severe arrithmia in hospital stay were observed.Numerical variables were expressed mean ± standard deviation and compared by unpaired Student't test,Categorical variables were expressed percentage and compared by chi square test.Multiple logistic regression analysis was used to determine independent predictors of severe arrithmia.Results Patients with grade 3 ischemia had greater Σ ST on admission and 2 h after thrombolysis ECGs(P ＜ 0.01),the incidence rate of STR in patients with grade 3 ischemia was lower than that in patients with grade 2 ischemia(P ＜0.01).The peak creatine kinase MB fraction was higher in patients with grade 3 ischemia than that in patients with grade 2 ischemia(P ＜ 0.01).There was no significant difference of the incidence of severe arrithmia,such as ventricular premature beat,ventricular tachycardia or fibrillation,second-degree or third-degree atrioventricular block,and sinus arrest between the two groups(P ＞ 0.05),but there was a trend of higher incidence of severe arrithmia in patients with grade 3 ischemia compared with that in patients with grade 2 ischemia.Multiple logistic regression analysis demonstrated that the independent predictors of severe arrithmia were duration from symptom to thrombolysis and initial.Σ ST,whereas grade 3 ischemia remained a strong predictor of severe arrithmia.Conclusions Grade 3 ischemia on admission is associated with lower incidence of STR in patients with ST-segment elevation myocardial infarction(STEMI)after thrombolysis and a strong predictor of severe arrithmia.