A 61-year-old patient with type I diabetes, diabetic nephropathy, thyroid hypofunction, chronic renal insufficiency anemia period, class IV heart function. During kidney dialysis, a little bleeding when puncture needle punctured the right common carotid artery, bleeding stopped after compression hemostasis. One week later, the patient complained of swollen neck, pain and difficult breathing. Ultrasonic examination suggested that local eminence beside the right common carotid artery, echoless and vascular interlinked; CDFI blood flow signal appeared the artery frequency spectrum, eddy current. Enhanced CT prompted right common carotid artery pseudoaneurysm, the contrast medium extravasated. The patient was diagnosed right common carotid artery pseudoaneurysm.
Aneurysm, False ; surgery ; Carotid Artery, Common ; Humans ; Iatrogenic Disease ; Male ; Middle Aged

Objective To investigate the correlation of preoperative pain threshold and pain tolerance threshold with the intensity of stress reaction induced by endotracheal intubation and skin incision. Methods Fifty ASA Ⅰ or Ⅱ women, aged 20-55 yr, undergoing elective abdominal surgery requiring at least a 10-cm-long skin incision under general anesthesia, were studied. The electricity dolorimeter was used to measure the patients' pain sensitivity, including pain threshold and pain tolerance, and a State Trait Anxiety Inventory (STAI) was also used to examine the mental state the day before surgery. Total intravenous anesthesia was performed in all the patients.Anesthesia was induced with TCI of propofol 4 μg/ml (effect-site concentration). After patients lost consciousness,fentanyl 3 μg/kg and vecuronium 0.1 mg/kg were injected intravenously. Tracheal intubation was performed 3 min later and the patients were mechanically ventilated. MAP and HR were recorded and arterial blood samples were taken for determination of plasma concentrations of norepinephrine (NE) at 10 min after entering operation room (T1), immediately before intubation (T2), 2 min after intubation (T3), immediately before incision (T4) and 2 min after incision (T5). The differences in MAP, HR and plasma concentrations of NE before and after intubation and skin incision were calculated. SPSS 13.0 statistical software was used to analyze the correlation of STAI,pain threshold, and pain tolerance threshold with the differences in MAP, HR and NE before and after intubation and skin incision. Results Pain threshold was not correlated with the differences in MAP, HR and NE (P ＞0.05). Pain tolerance threshold was negatively correlated with the differences in MAP (r= - 0.766, r =-0.688,P＜0.05), HR (r=-0.703, r=-0.638, P ＜ 0.05) and NE (r=-0.781, r=-0.781, P＜0.05). The STAI score was not correlated with pain threshold and pain tolerance threshold (P ＞ 0.05) .Conclusion Preoperative pain tolerance threshold is negatively correlated with the intensity of stress reaction induced by endotracheal intubation and skin incision, but there is no correlation between pain threshold and the intensity of stress reaction.

Objective To investigate the prevalence,related factors and individualized health management strategy of female urinary incontinence.Methods Questionnaire survey has been adopted on 4105 female subjects in the east coastal,middle and southwest areas of Shandong Province from Jan.2011 to Dec.2011.Logistic regression model was used to analyze the influencing factors of urinary incontinence.The degree of risk was conducted according to the UI affected to the quality of life.Results The available questionnaires were 4105.Logistic analysis showed that age,delivery frequency,first delivery age,newborn birth weight,perineum injury history,chronic cough and constipation were risk factors of urinary incontinence.However,the protective factors of urinary incontinence included abdominal delivery and whitecollar worker.Mild,moderate and strong impacts of urinary incontinence on the quality of life were found 77.68％ (1079/1389),21.38％ (297/1389) and 0.94％ (13/1389) of the participants,respectively.Unfortunately,doctor's office visiting was as low as 1.08％ (15/1389).Along with the increase of age,parity,age of first time delivery,injury of perineum,chronic cough,constipation,may add the risk of incidence of urinary incontinence while caesarean section and brainwork may decrease the risk of incidence of urinary incontinence.Conclusions The overall of incidence of urinary incontinence in Shandong province is in a high level.Urinary incontinence may significantly reduce the quality of life of the patients.More investigation on individualized health management strategy for female patients with urinary incontinence should be needed in the future.

Objective To assay the protective effect of endothelial progenitor cells (EPCs) on acute lung injury (ALI) in rabbits.Methods Forty male New Zealand rabbits were divided into EPCs low-dose group,EPCs mid-dose group,EPCs high-dose group,ALI group,and control group according to the random number table,with 8 rabbits per group.Emulsified oleic acid was used to induce ALl.Instead,saline emulsion was injected to rabbits in control group.PBS containing 1 × 105,1 × 106,and 1 ×107 EPCs were respectively administered to rabbits in EPCs low-dose,mid-dose,and high-dose groups; on the contrary,blank PBS was injected to rabbits in ALI and control groups.Lung weight to dry ratio (W/D) and pulmonary permeability index (PPI) were detected before and after operation; protein expressions of TNF-α and IL-1 βby western blot,and mRNA expression of NF-κB by RT-PCR.Results PPI and W/D value lowered in EPCs low-dose group (15.0 ± 1.1,5.04 ± 0.11),mid-dose group (13.8 ± 0.7,4.80 ± 0.13),and high-dose group (13.7 ± 0.7,4.87 ± 0.08) when compared to 17.1 ± 1.5 and 5.21 ±0.05 in ALI group (P ＜0.05).EPCs low-dose,mid-dose,and high-dose groups showed decreased levels in NF-κB (0.75 ± 0.04,0.41 ± 0.05,0.42 ± 0.03),TNF-α (0.364 ± 0.020,0.312 ±0.015,0.310 ±0.013),and IL-1β (0.230 ±0.017,0.206 ±0.010,0.210 ±0.018) compared to ALI group (0.87 ±0.11,0.387 ±0.018,0.262 ±0.019,P ＜0.05).Moreover,all indicators were lowered significantly in EPCs mid-dose and high-dose groups when compared to EPCs low-dose (P ＜0.05),but the two groups themselves revealed no statistical difference.Conclusion EPCs protect ALI via improving pulmonary edema,pulmonary permeability,and inflammatory response in a dose-dependent correlation with EPCs,but ceiling effect is observed as well.

Objective To explore the causes of per-hospitalization high inpatient expenditure of a tertiary hospital in 2015,by analyzing the influencing factors.Methods We retrospectively studied 1 282 inpatient cases who cost more than 100 000 yuan per case at a tertiary hospital in 2015,analyzing statistically major influencing factors of such expenditure in variance analysis and multiple stepwise regression analysis.Results The average days of stay of these cases were 27.6 days,and the average medical cost of those cases was 149 153 yuan per person.Costs for medicines and material made up a large proportion of medical costs,respectively accounting for 33.38% and 31.98% of the total.The days of stay,prognosis of the patient,complications as well as hospital infection,surgeries,gender of the patients constituted major factors on inpatient medical expenditure.Conclusions Reducing the average days of stay,guiding reasonable applications of drugs and medical materials,strengthening management on operations and controlling excessive medical services are effective approaches to reducing excessive growth of medical costs.

AIM: To investigate the molecular mechanism of amylin in inducing apoptosis of human pancreatic islet ?-cells. METHODS: Human pancreatic islet cells were isolated and cultured. The cells were treated with amylin or amylin and aminoguanidine (AG group) for 24 h, respectively. Apoptosis of pancreatic islet ?-cells was studied by in situ TUNEL method combined with double staining for insulin and ELISA. The levels of insulin, NO 2 -/NO 3 - and glutathione (GSH), p53 mRNA and bcl-2 mRNA were also detected. RESULTS: (1) The enrichment factor and the apoptosis rate of pancreatic islet ?-cells in amylin group were markedly higher than that in control group and AG group ( P

Urinary excretions of transforming grow th factor-? 1 (TGF-? 1), laminin (LN) and type Ⅳ collagen were determined i n 182 type 2 diabetic patients. Urinary excretions of TGF-? 1, LN and type Ⅳ collagen were increased in type 2 diabetic patients, and these findings were fa irly well correlated with severity of diabetic nephropathy (DN). Urinary TGF-? 1 seems to be the early index of DN, urinary LN and type Ⅳ collagen appear to be the indices of DN severity.

Objective To evaluate the robustness of body mass index (BMI) adapted tube current selection method for obtaining consistent image quality in MSCT coronary artery imaging Methods Initially one hundred patients in the control group ( C group) underwent cardiac scans using GE 64-row VCT with standard scan protocol (640 mA, 120 kV, 0.35 see, body bewtie, C2 filter). Noise measurement was obtained for each patient using the average of three consecutive slices in the ascending aorta with ROI of 10 mm×10 mm to establish the relationship between BMI, desired image noise (IN) and required mA. An excel table was established to predict the required mA to achieve a desired IN for each patient with different BMI. A second group of one hundred cardiac patients (L group) was scanned with BMI-aclapted mA from the table to evaluate the practicability of this method. BMI, IN, CT dose index(CTDI),effective dose (ED) were all recorded. Results For the control group of 100 patients, the mean values and standard deviations of image quality score (IQS), BMI, IN and ED were 3.71±0.54, 25.08±2.63, 24.56±5.03 and (17.63±1.68 ) mSv (with range of 15-22 msy). Regression analysis indicated linear relationship between BMI and image noise with fixed mA. Using the relationship between tube current and image noise and noise ratio between large bowtie and cardiac bowtie, the following equation for the required tube current Xma to achieve present image noise of Ins for patient with certain BMI value when using cardiac bowtie could be then obtained: Xma = Fma×( k1 x BMI + c1 )/Ina]2, where Fma = 640 mA, k1 = 1. 033, c1 = - 3.2, Ins = 27 in the study. (2) For the patients in L group, the mean values and standard deviations of IQS, BMI, and IN were 3.69±0.53, 25.07±2.91, and 26.61±3.44, respectively. The average tube current used was (469.95±113.45) mA, depending on patient's BMI values. The average effectively dose was(9.08±2.25) mSv. There was no statistically difference between the two groups in image quality( F= 0.068,P=0.794). Conclusions In 64-MSCT cardiac imaging, the use of BMI dependent tube current selection method, in conjunction with dose reduction techniques, can provide individualized scan protocol to obtain consistent image quality across patient population and to optimize dose delivery to patients.

Objective To investigate the feasibility of measuring liver volume with Argus methoct Methods Thirty-two healthy liver transplant donor candidates underwent liver MRI on a 3.0 T MR unit.Volume interpolated body examination(VIBE)was performed after the administration of gadobenate dimeglumine.The VIBE data was transferred to the diagnostic workstation,and then multiple planar reconstruction(MPR)images were acquired.Firstly.two observers manually drawn the liver shape and calculated three volumes:the whole liver volume and right lobes volumes include middle hepatic vein (MHV)and exclude MHV,respectively.Secondly,the same data was transferred to Argus software.calculated that three volumes.Each measurement time was recorded.Actual graft volume(the right lobe)wag measured during surgery.The correlation between right lobes volume of two measurements and actual graft volume was analyzed.The time needed for Argus and that needed for manual method were compared with paired t test.Results The right lobe volumes measured by Argus,manually and surgery method were (813±187),(807 ± 181)and(713 ± 137)mm3,respectively.Argus method and manual method showed good correlation with surgery method,and the correlation coefficients were 0.897(Argus method)and 0.884(manual method),respectively.The time for manual method and Argu8 method were(44.3 ±2.7)and(12.2.±1.0)min,respectively.There was significant difference between Argus and manual methods (t=76.39,P＜0.05).Conclusion Compared with manual method,use of the Liver volumetric measurement by Argus software not only correlated well with Actual graft volume,but also saves time.Argus has potential clinical value for volumetric measurement in living liver transplant donors.

With the continuously exploration,in recent years,further understanding of anatomical characteristics of the cervical pedicle brings great breakthrough in cervical pedicle screw implantation.In addition,pedicle screw implantation in cervical spine is considered as a technique with high safety and reliability,which can be widely used in cervical trauma fracture,cervical instability,degenerative,inflammatory,benign or malignant tumor,deformity and other neck diseases.Because of the tremendous differences between upper cervical spine (C1,C2) and lower cervical spine (C3-7) in anatomical morphology,cervical pedicle screw implantation in C1 and C2 differs from in lower cervical spine.Due to the similar structure of C3-7,pedicle screw implantation methods are based on the same principle and sharing a few points in common.The pedicle screw technique can be classified in two groups according to the practice methods:navigation technology and manual placement of cervical pedicle screw.Navigation nailing is considered as reliable,easy handing,and with clear operative vision,however,with disadvantages as complex procedures,highly cost operation equipment,and risk in navigation draft.Therefore,manual placement of pedicle screw is more reasonable and practical comparing with the former.In this study,it analyzed anatomical characteristics of lower cervical pedicle and the measurement of pedicle structure,discussed technique of manual placement of pedicle screw in lower cervical spine and biomechanical study of pedicle screw,and summed up the comparison of the advantages and disadvantages of current representative manual placement technology.