Objective Exploring the design and optimizing factors of picture archiving and communication system (PACS) network architecture. Methods Based on the PACS of shanghai first hospital to performed the measurements and tests on the requirements of network bandwidth and transmitting rate for different PACS functions and procedures respectively in static and dynamic network traffic situation, utilizing the network monitoring tools which built in workstations and provided by Windows NT. Results No obvious difference between switch equipment and HUB when measurements and tests implemented in static situation except router which slow down the rate markedly. In dynamic environment Switch is able to provide higher bandwidth utilizing than HUB and local system scope communication achieved faster transmitting rate than global system. Conclusion The primary optimizing factors of PACS network architecture design include concise network topology and disassemble tremendous global traffic to multiple distributed local scope network communication to reduce the traffic of network backbone. The most important issue is guarantee essential bandwidth for diagnosis procedure of medical imaging.

Objective To discuss the scheme and implementing for workstation configuration of medical imaging information system which would be adapted to the practice situation of China. Methods The workstations were logically divided into PACS workstations and RIS workstations, the former applied to three kinds of diagnostic practice: the small matrix images, large matrix images, and high resolution grayscale display application, and the latter consisted of many different models which depended upon the usage and function process. Results A dual screen configuration for image diagnostic workstation integrated the image viewing and reporting procedure physically, while the small matrix images as CT or MR were operated on 17 in (1 in =2.54 cm) color monitors, the conventional X ray diagnostic procedure was implemented based on 21 in color monitors or portrait format grayscale 2 K by 2.5 K monitors. All other RIS workstations not involved in image process were set up with a common PC configuration. Conclusion The essential principle for designing a workstation scheme of medical imaging information system should satisfy the basic requirements of medical image diagnosis and fit into the available investment situation.

Objective To explore the management model and realizing of PACS image data flow. Methods Based on the implementing environment and management model of PACS image data flow after full digital reengineering for radiology department in Shanghai First Hospital was completed, analysis on image data flow types, procedure, and achieving pattern were conducted. Results Two kinds of image data flow management were set up for the PACS of Shanghai First Hospital, which included image archiving procedure and image forward procedure. The former was implemented with central management model while the latter was achieved with a program that functionally acted as workflow management running on the central server. Conclusion The image data flow management pattern, as a key factor for PACS, has to be designed and implemented functionally and effectively depending on the performance environment, the tasks and requirements specified to particular user.

Objective To evaluate the value of dynamic susceptibility-contrast (DSC) MR perfusion imaging in differentiating benign and malignant meningiomas on the basis of differences in their vascularity in both tumor parenchyma and peritumoral region. Methods 33 patients with pre-operation meningiomas(25 benign and 8 malignant) underwent conventional and DSC MR perfusion imaging. Maximum relative cerebral blood volume (rCBV) and corresponding relative mean transit time (rMTT) values of the same part in both tumor parenchyma and peritumoral region were calculated (compared with contralateral normal white matter). The peritumoral region was defined as the area immediately adjacent (0.05) in parenchyma part and both were statistically significant (t test, ?

Objective To evaluate the clinical effectiveness of the treatment for the intramedullary broad dissemination of the malignant bone tumor of limbs by microwave heliotherapy combined with prosthesis replacement.Methods From June 2001 to April 2012,19 patients with intramedullary broad dissemination of malignant bone tumor of limbs were treated with microwave heliotherapy combined with prosthesis replacement.There were 12 males and 7 females,47 years old on the average (ranging from 11 to 65 years).The tumors involved:primary malignant tumor 11 cases,metastases of the scapula 8 cases.Locations of tumors involved:the distal femur 8 cases,the proximal tibia 6 cases,the proximal humerus 3 cases and the proximal femur 2 cases.After the patients were examined with MRI and the level of osteotomy was determined,the prostheses were custom-made.The exposures of the all tumors were via the conventional surgical approach.The lesions were heated at 50 ℃ for 20 min by 2 450 MHz microwave,with surrounding soft tissue protected by copper mesh.The level of osteotomy was determined by the result of preoperative imaging measurement.The prosthesis was installed after the microwave heliotherapy.Results The duration of surgery was from 60 min to 150 min (100 min on average).The blood loss was from 300 ml to 1200ml (600 ml on average).All patients were followed-up for 10 months to 5 years (2.7 years on average).1 case with chondrosarcoma relapsed 18 months after surgery,and survived with tumors.1 case with malignant fibrous histiocytoma died due to multiple metastases 8 months after surgery.1 case with Ewing sarcoma died due to pulmonary metastases 23 months after surgery.The remaining 7 cases with the primary malignant bone tumors did not recur or transfer during the follow-up period.6 cases with the metastases died due to metastases 5 to 20 months after surgery.The functions of shoulder joint of 3 proximal humerus tumor patients were restricted,while 16 patient's function weren't restricted.Conclusion The clinical results demonstrated that the microwave heliotherapy combined with prosthesis replacement was an ideal treatment for the intramedullary broad dissemination of the malignant bone tumor of limbs.

Objective To evaluate the clinical effectiveness of the treatment for spinal metastases by cooled microwave ablation combined with percutaneous vertebro plasty(PVP).Methods From February 2014 to January 2017,24 patients with spinal metastases were treated with cooled microwave ablation combined with PVP,including 14 males and 10 females with an average age of 58.2 years (range,32 to 73).Preoperatively all the patients suffered with the local pain and the spinal cord or nerve root compression symptoms.The locations of the lesions included:14 in the thoracic and 10 in the lumbar.The primary tumors type:lung cancer 6 cases,breast cancer 3 cases,liver cancer 2 cases,kidney cancer 2 cases,gastric cancer 1 case,prostate cancer 1 case,ovarian cancer 1 case,osteosarcoma 1 case,fibrosarcoma 1 case,colon cancer 1 case,and unknown source tumor 5 cases.The preoperative Tomita score was 4-7 points (mean 6.3 points),and the Tokuhashi score was 8-11 points (average 9.3 points).23 patients with the spinal metastatic were treated with cooled microwave ablation combined with PVP.1 patient were treated with cooled microwave ablation only.The clinical outcomes were evaluated using visual analogue scale (VAS) and Frankel grading.The local control rate was evaluated by imaging.Resuits All cases were followed up for 5 to 36 months.The tumor volume size was 3.2-12.1 cm3 by preoperative measurement.Each lesion was heated to 3-7 hot zones.Each hot zone was heated for 5 minutes.The total heating time was 15-35 minutes (mean 22.1 minutes).The temperature inside the lesion was (56.2±5.83) ℃.The temperature inside the spinal canal was (33.6±5.14) ℃.The visual analogue scale (VAS) of the 24 patients at 24 hours and 3 months after operation was statistically different from the preoperative visual analogue scale (VAS).The Frankel grading of 19 patients had at least one grade improvement 3 months after operation.6 cases died due to systemic multiple metastases 5-8 months after surgery.9 patients had more than one organ metastasis or bone metastasis during follow-up,and survived with tumors.The remaining 9 cases did not recur or transfer during the follow up period.No nerve damage or other complications were observed in all patients.Conclusion The cooled microwave ablation combined with PVP could relieve the pain in spinal metastases,relieve the nerve compression,and reconstruct the stability,which is a safe and effective palliative surgical method.

BACKGROUND:Removing the posterior ligamentous complexes during posterior lumbar interbody fusion (PLIF) may influence motion and load bearing characteristics of the adjacent segments,contributing to the postoperative instability at the adjacent segment,which is one of the important factors for adjacent segment degeneration.OBJECTIVE:To evaluate the clinical effectiveness of the PLIF plus screw implantation preserving posterior ligamentous complexes under microscope.METHODS:Thirty-six patients with single-level lumbar degenerative disease were enrolled,which were allotted to experimental (n=17) and control (n=1 9) groups,followed by treated with PLIF plus screw implantation preserving posterior ligamentous complexes,and traditional PLIF plus screw implnatation,respectively.The Visual Analogue Scale scores and Oswestry Dysfunction Index at baseline and postoperative 3 months were assessed.The adjacent segment degeneration was observed through radiology during follow-up.RESULTS AND CONCLUSION:The Visual Analogue Scale and Oswestry Dysfunction Index scores in the two groups were significantly lower than those before treatment (P ＜ 0.01),and the postoperative scores in the experimental group were significantly lower than those in the control group (P ＜ 0.01).The adjacent segment degeneration occurred in two cases in the experimental group and 8 cases in the control group during follow-up.Radiology revealed that the internal fixative was stable,none of screw loosening,rupture or pullout.These results suggest that PLIF plus screw implantation with posterior ligamentous complexes can effectively relieve the pain and dysfunction in the lumbar degenerative patients,and reduce the incidence of adjacent segment degeneration.

Objective To evaluate the clinical effectiveness of the treatment for the proximal femur malignant bone tumor by conducting intercalary diaphyseal endoprosthetic reconstruction.Methods Form June 2011 to July 2014,7 patients who had proximal femur malignant bone tumor were treated with intercalary diaphyseal endoprosthetic reconstruction.There were 3 males and 4 females,61.8 years old on the average (ranging from 28 to 76 years).The tumors involved:4 case of the limbs primary malignant tumor,1 case of osteosarcoma,1 case of juxtacortical osteosarcoma,1 case of malignant lymphoma with pathological fracture,and 1 case of malignant fibrous histiocytoma with pathological fracture,as well as 3 cases of the Metastatic breast cancer of the proximal femur.All patients were evaluated by plain radiography,CT and MRI before operation.After these 7 patients were examined with MRI and the level of osteotomy was determined,prosthesis fitting is ready.The exposures of all the tumors were via the femur lateralis surgical approach.According to the general principles of tumor surgery,expose the tumor segment and soft tissue tumors.The segment of involved bone was then removed,with a surrounding cuff of normal tissue overlying the tumor.The level of osteotomy was determined as the result of preoperative imaging measurement.The proximal and distal femur intramedullary canals are reamed.The prosthesis is assembled and installed after the cement used.Results The duration of surgery was from 45 min to 120 min (90 min on average).The blood loss was from 200 ml to 800 ml (400 ml on average).All patients were followed-up for 6 months to 2 years (14 months on average).1 case with osteosarcoma died due to pulmonary metastases 18 months after surgery.The remaining 3 cases with the primary malignant bone tumors did not recur or transfer during the follow-up period.1 case with the metastases was comprehensive treated in another hospital,and survival with tumors.The remaining 2 cases with the metastases did not recur or transfer during the follow-up period.Conclusion The clinical results demonstrated that the intercalary diaphyseal endoprosthetic reconstruction was an ideal treatment for the proximal femur malignant bone tumor.

BACKGROUND:Segmental bone defects resulting from osteoporotic fractures, trauma, congenital bone dysplasia and progressive bone disorder are very common, and bone tissue engineering provides a new approach to bone defect repair. Growth factors related to bone tissue engineering bone have been reported a lot and have achieved some results. How to mimick the natural timing of different growth factors with different bioactivities has become the current hotspot in bone repair. OBJECTIVE: To review the new developments in vascular endothelial growth factor and bone morphogenetic protein in bone tissue engineering. METHODS: The first author searched CNKI (1990/2015) and Medline database (1990/2015) for related articles using the key words of “osteogenic factors, angiogenic factors, tissue engineering bone, bone repair, vascularization, vascular endothelial growth factor, bone morphogenetic protein, sequential release, seed cels, cytoskeleton” in Chinese and English, respectively. Mechanism of action and research direction about vascular endothelial growth factor and bone morphogenetic protein were summarized. RESULTS AND CONCLUSION:Totaly 313 papers were searched initialy, and finaly 87 papers were enroled in result analysis. The results show that different growth factors play different roles in bone repair. Vascularization and osteogenesis are the most important processes in bone repair. The osteogenic factors play an important role in maintaining bone structure and bone formation. The angiogenic factors can provide oxygen and nutrients for tissue growth, differentiation and functionalization. The combination of osteogenic and angiogenic factors has a better osteogenic effect than osteogenic or angiogenic factors used alone. However, the most important problem is how to control the exogenous osteogenesis and the release dosage of angiogenic factors in bone repair.