Objective To evaluate the therapeutic effects of noninvasive bi-level positive airway pressure (BiPAP) ventilation after extubation in chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure.Methods Forty-one intubated COPD eases with severe respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study.At the time of pulmonary infection control (PIC) window,the extubation was conducted and followed by BiPAP ventilation in 21 cases (the experimental group),while the other 20 COPD cases with similar clinical characteristics,as the control group,who continuously received invasive mechanical ventilation after PIC window.Outcomes including the duration of invasive ventilation,the total duration of ventilation support,success rate,the incidence of ventilator associated pneumonia (VAP) and mortality rate were observed and compared between the two groups.Results The two groups had similar clinical characteristics and gas exchange at the time of PIC window (P ＞ 0.05 ).Compared with the control group,the experimental group had shorter duration of invasive mechanical ventilation (6.9±3.0) d vs.(13.1 ±4.3) d,t=5.38,P＜0.001),lower rate of VAP (1/20 vs.8/20,x2 =5.51,P=0.02) andhigher extubation rate (20/21 vs.13/20,x2 =4.19,P =0.04).Conclusion In COPD patients with intubation and mechanical ventilation for respiratory failure,BiPAP ventilation after extubation at the point of PIC window may improve patients' prognosis.

Objective To discuss the value of radiation dose reduction with directed digital radiography application in chest X-ray. Methods Patients were in posterior-anterior standing posture for test. To compare DR exposure parameters with traditional roentgenography in the same exposure condition of 125 kVp, automatic mAs, 180cm focus-film distance. Patients' thoracic thickness was 22-25cm. Results DR can reduce exposure dose by 44.2%. Conclusion Directed digital radiography can improve the quality of chest images,make working flow more reasonable, enhance the working efficiency and reduce patient's x-ray dose as well.

Objective To explore the utilization and effectiveness of ultrasound screening for neural tube defects (NTDs),so that to provide scientific evidences for the secondary prevention of NTDs.MethodsFour hundred and fifty-nine women who delivered or gestated NTDs babies or fetuses were randomly selected from Shandong Province and Shanxi Province,and the related information was collected with structured questionnaire by trained interviewers.Results Of the 459 cases,the ultrasonography utilization rate was 98.7%,and 6 cases (1.3%) never took examinations by ultrasonography during the whole pregnancy period.The total diagnosis rate of ultrasound screening for NTDs was 85.9%,and those of anencephalus,spina bifida and encephalocele were 96.4%,79.6% and 73.8% respectively (P<0.05).The average diagnosis week of NTDs was 24.0 and those of anencephalus,spina bifida and encephalocele were 21.2,27.1 and 24.7 respectively (P<0.05).The detection rates of NTDs before 16 weeks,16-20 weeks,20-24 weeks,24-28 weeks and after 28 weeks were 14.1%,49.4%,46.3%,49.2% and 52.1% respectively (P<0.05).The detection rates of NTDs in hospitals,maternal and child care service centers and family planning centers were 46.4%,52.0% and 28.1% respectively (P<0.05).The detection rate of NTDs by two-dimensional ultrasound equipment was 41.3% and 83.3% by three-dimensional ultrasound equipment (P>0.05).Conclusions The detection rates of NTDs and the subtypes by ultrasonography are low at different pregnant periods and in different medical institutions.It is important to increase the utilization rate of ultrasound screening by pregnant women and improve the NTDs diagnostic level of primary health care institutions,so that to improve the efficacy of secondary prevention strategy for NTDs in China.

Objective To investigate the interference effect of baicalin on acute brain injury induced by aconitine in rats and its mechanism. Methods A total of 200 Sprague-Dawley(SD)rats were randomly divided into five groups:normal control,baicalin control,aconitine poisoning,baicalin 15 mg/kg intervention and baicalin 30 mg/kg intervention groups(each,n=40). Aconitine(20μg/kg)was given via tail vein in aconitine poisoning group. The rats in the normal control group and baicalin control group were respectively injected with saline 2 mL/kg and baicalin 30 mg/kg via tail vein. The aconitine poisoning rats were given with baicalin at the dose of 15 mg/kg and 30 mg/kg respectively in the low and high dose baicalin intervention groups within 2-3 minutes after injection of aconitine. Rats in all groups in the study were anesthetized and sacrificed at 1,6,12,24 hours after various agents were respectively given in the groups,the rat cerebral cortex samples were collected,the histological changes in normal and baicalin control groups and pathological changes of the aconitine poisoning rats were observed,the levels of glutamate(Glu),aspartate(Asp),γ-aminobutyric acid(GABA),glycine(Gly)were detected and the apoptotic cells were determined at the above time points. Results Compared with the normal control group,the aconitine poisoning group had significantly higher levels of excitatory amino acids Glu and Asp and the number of apoptotic neurons. After exposure to aconitine for 1 hour, the levels of inhibitory amino acids of GABA and Gly were markedly decreased in the rat cortex in the poisoning group compared to the normal control group(both P<0.05),at 6 hours and 12 hours they were significantly increased and after 24 h,they began to decline,but still maintained at relatively high levels. Compared with the aconitine poisoning group, after baicalin intervention for 1 hour,in the 15 mg/kg and 30 mg/kg baicalin intervention groups,the levels of Glu and Asp were markedly decreased〔Glu(μmol/L):309.39±14.59,307.22±23.69 vs. 370.46±40.31,Asp(μmol/L):143.43±8.36,129.12±4.86 vs. 222.97±6.26〕,while the levels of GABA and Gly were increased〔GABA(μmol/L):55.91±4.76,59.61±13.11 vs. 32.05±2.20,Gly(μmol/L):32.33±1.85,33.90±0.66 vs. 21.96±4.75〕,and the number of neuronal apoptosis was obviously decreased(cell/mm2:18.65±4.10,14.80±1.89 vs. 58.15±3.68,both P<0.05). Under microscope and electron microscope,the pathological and ultrastructural changes indicated that the aconitine poisoning group had the most marked cerebral cortex damage at 12 hours after poisoning,while the two baicalin intervention groups showed milder damage than that in aconitine poisoning group. Conclusions The neural toxic effect of aconitine in rats may be related to the imbalance between the neurotransmitter contents of excitatory Glu. Asp and inhibitory GABA,Gly in the cerebral cortex. Baicalin can decrease the contents of excitatory amino acid and elevate the inhibitory amino acid,therefore it may ameliorate the cerebral injury of acute aconitine intoxication in rats.

Objective To analyze the risk factors for the failure of noninvasive mechanical ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and to help the clinical risk assessment and decision making.Methods A retrospective case control study was conducted.The patients with AECOPD undergoing NIV admitted to Kaifeng Emergency Center from June 2011 to March 2016 were enrolled,and they were divided into two groups according to whether NIV was successful or not within 12 hours.The nutritional status,blood gas analysis,serum electrolytes,D-dimer,renal function,serum pre-albumin,as well as kinetic vital signs,Glasgow coma scale (GCS) score,expression of respiratory distress,and spontaneous expectoration were recorded.Logistic forward stepwise regression analysis was used to analyze the factors for failure of NIV.Results 122 patients.with the initial NIV were enrolled,with NIV failure in 41 patients within 12 hours,accounted for 33.6％.Compared with NIV success group,the percents of respiratory rate ≥ 25 breaths/min (75.6％ vs.17.3％),expectoration disorders (78.0％ vs.19.8％),circulatory disorders (61.0％ vs.18.5％),malnutrition (61.0％ vs.11.1％),decreased serum pre-albumin (58.5％ vs.17.3％),and GCS score ＜ 12 (75.6％ vs.28.4％) in NIV failure group were significantly increased (all P ＜ 0.05).But there were no significant differences in gender,age,body temperature,blood gas analysis,D-dimer,serum creatinine between two groups.It was shown by the results of binary logistic regression analysis that respiratory rate,expectoration disorders,circulatory disorders,malnutrition,serum pre-albumin,and GCS score were the factors of NIV failure [odds ratio (OR) values were 10.879,6.338,9.860,23.273,8.862,6.774,and P values were 0.011,0.038,0.024,0.003,0.015,0.041,respectively].It was shown by the results of logistic stepwise regression analysis that respiratory rate ≥ 25 breaths/min,expectoration disorders,circulatory disorders,malnutrition,decreased serum pre-albumin,and GCS score ＜ 12 were independent risk factors of NIV failure (OR values were 6.610,5.403,5.138,8.153,4.979,5.100,and P values were 0.007,0.013,0.023,0.007,0.027,0.023,respectively).Conclusions The multiple independent risk factors can induce NIV failure within 12 hours in emergency patients with AECOPD,i.e.increased respiratory rate,expectoration dysfunction,circulatory disorders,malnutrition,decreased serum pre-albumin,and decreased GCS score.Emergency physicians should pay attention to these early risk factors in AECOPD patients,which can be taken as correct judgment and guide.

Objective:To investigate the relationship of papillary thyroid microcarcinoma (PTMC) with serum thyroglobulin.Methods:Data of 539 patients with papillary thyroid nodule (≤1cm) in Department of Thyroid and Breast Surgery of the Second Hospital of Anhui Medical University and the Department of Oncology Surgery of Suzhou Municipal Hospital for thyroidectomy were retrospectively analyzed. All of the nodules were classified as TI-RADS 4b with ultrasound. According to the postoperative pathological results, patients were divided into PTMC group (experiment group) and benign tumor group (control group) . The PTMC patients were also divided into lymph node metastasis group (experiment group) and no lymph node metastasis group (control group) based on the cervical lymph node metastasis. Then we analyzed the relationship between thyroid stimulating hormone (TSH) , thyroglobulin antibody (TgAb) , thyroid peroxidase antibody (TPOAb) and thyroglobulin (Tg) with PTMC and lymph node metastasis by SPSS.Results:Age, TSH, Tg and TgAb were independent risk factors for PTMC, B: -0.020, 0.192, 0.026, 0.008, 95% CI: 0.962-0.998, 1.045-1.404, 1.015-1.038, 1.003-1.014, both P<0.05. The relations between PTMC and TSH, Tg and TgAb were positive, while age was in negative correlation with PTMC. Meanwhile, age and thyroglobulin (Tg) were also independent risk factors for lymph node metastasis in PTMC patients, B: -0.025, 0.014, 95% CI: 0.957-0.994, 1.008-1.021, both P<0.05. Age was negatively correlated with lymph node metastasis and Tg was positively correlated with lymph node metastasis. Tg level higher than 26.520 ng/ml indicated that the nodule was PTMC (sensitivity: 0.560, specificity: 0.719) , and Tg level higher than 36.695 ng/ml predicted lymph node metastasis in PTMC patients (sensitivity: 0.532, specificity: 0.788) . Conclusion:Tg is a sensitive serum index for identifying PTMC from benign thyroid nodule, and it is also related to lymph node metastasis in PTMC patients.

Objective To evaluate the safety and efficacy of carbon dioxide (CO2) used as an alternative to air in the gastric endoscopic submucosal dissection (ESD). Methods 80 cases underwent ESD treatment were randomly as-signed to two groups, 40 cases in CO2 group and 40 in air group. Arterial blood CO2 partial pressure was measured preoperative, intraoperative and postoperative respectively. Visual analog scale (VAS) was used to record patients the degree of abdominal pain and distention at 1 h, 6 h and 24 h after operation in each group. The incidence of com-plications were evaluated. Regular follow up were scheduled in all the patients. Results There was no significant dif-ference in degree of abdominal pain score and the CO2 partial pressure between the two groups. The abdominal dis-tension scores of CO2 group were significant lower than air group at 1 h, 6 h after the ESD procedure. There were no statistically significant difference in the incidence rate of complications. Conclusion The utilization of CO2 in gas in-sufflation during gastric ESD is safe. CO2 insufflation can significant reduce the postoperative abdominal distension and improve the quality of postoperative recovery.

Objective To explore the value of diffusion kurtosis imaging (DKI) histogram analysis for differential diagnosis of prostate cancer and noncancerous foci and the correlation between histogram parameters and Gleason score. Methods Twenty?one patients were retrospectively enrolled in Beijing Hospital from May 2017 to May 2018. All subjects underwent Philips 3.0 T MR scanning. The pathologies were confirmed by in?bore MR?guided biopsy. Finally, 31 lesions were collected (two lesions each from 10 patients), including 15 prostate cancer and 16 noncancerous foci (benign prostatic hyperplasia and prostatitis). ROI was drawn manually by two experienced radiologists. All the lesions were measured mean apparent diffusion coefficient (Dapp), mean apparent kurtosis coefficient (Kapp) and their histogram parameters, the averages of two measurements were used to be calculated. The values of these parameters in cancer and noncancerous foci were compared using independent?samples t test. The Spearman test was used to evaluate the correlation of these parameters and Gleason scores of prostate cancer. Results Mean Dapp, 10th Dapp, 25th Dapp, 50th Dapp, 75th Dapp, 90th Dapp, minimum Dapp, maximum Dapp, mean Kapp, 50th Kapp, 75th Kapp, 90th Kapp, maximum Kapp between prostate cancer and noncancerous foci were statistically significant (P<0.05). 90th Kapp (r=0.630, P<0.05) and maximum Kapp (r=0.565, P<0.05) increased with the Gleason scores increasing. Conclusion Histogram analysis of DKI model is valuable for diagnosing and assessing aggressiveness of prostate cancer.

Objective: To investigate the value of zTE ASL MRA in the follow-up of interventional treatment of intracranial aneurysm at 1.5 T, using DSA as gold standard. Methods: Patients with intracranial aneurysms who underwent coil embolization with or without stent were enrolled in this study. Both TOF MRA and zTE ASL MRA were performed on a 1.5T whole body scanner (MR360, GE, USA) equipped with an 8 channel head coil, and DSA was performed within one week of the MR examinations. Aneurysmal remnant and intra-stent opacity were analyzed. SE, PE, PPV, NPV of two MRA modalities in aneurysm recanalization detection were calculated. Kappa coefficient was used to determine the inter-reader and intra-reader reproducibility. Paired t test was used to test the visibility of in-stent lumen on two kinds of MRA. Results: A total of 24 patients (27 aneurysms) were included in this study, 23 aneurysms were treated with stent assisted embolization, four coil embolization. Thirteen cases of aneurysm remnant were detected by DSA, 15 by zTE ASL and 11 by TOF MRA. zTE ASL MRA had a relatively higher SE (100%) and NPV(100%) as compared with TOF MRA. The Kappa value in identification of aneurysm remnant was 0.85 between zTE MRA and DSA and 0.70 between TOF MRA and DSA, respectively. The inter-reader reproducibility was good (Kappa 0.70), while the intra-reader reproducibility was excellent(Kappa 0.85). There was statistical significance in the scoring results of the in-stent lumen visibility. Conclusion zTE ASL MRA proved to be a better imaging modality as compared to TOF MRA to evaluate the endovascular treatment effectiveness of intracranial aneurysms, especially for assessing the aneurysmal recurrence and in-stent lumen visibility.

Anxiety disorders,dopaminergic neurons and ventral tegmental area(VTA)are related closely.VTA dopaminergic neurons play an important role in the regulation of anxiety.Numerous research results in animals indicated that the VTA dopaminergic neurons,involving in multiple neural pathways,respectively regulate anxiety-like behavior in physiological or pathological condition.Dopamine,the main neurotransmitters in VTA regulates anxiety through dopamine D1 and D2 receptors.In addition,the VTA glutamate,GABA and acetylcholine also play directly or indirectly roles in regulating anxiety.The clinical imaging research showed that the integrity of dopaminergic VTA structural of anxiety disorder group is lower than healthy control.Current researches of VTA dopamine neurons involving in the regulation of anxiety-like behavior is developing at a high speed and deserving further exploration,which will further elucidate the pathogenesis and provide new ideas for prevention and treatment of anxiety disorders.