ObjectiveTo compare the accuracy of the four sequences of MRI in the diagnosis of articular cartilage injury of the knee and to investigate the advantage and shortage of the four sequences. In order to evaluate the most adequate sequence in detecting articular cartilage injury of the knee. Methods36 knee joints of 31 patients,underwent MRI scanning prior to arthroscopy included T1WI-TSE,T2 WI-TSE-SPIR, PDW-TSE-SPIR,3D-WATSC. Divided each knee side of every cartilage into five parts. Investigated and diagnosed the 180 articular cartilage surface according to Recha criteria by detecting and compared with arthroscopic examination respectively. The accurate criteria of the four sequences of MRI was sensitivity, specificity, accuracy. The criteria of correlation was the value of Kappa.ResultsCompared with the arthroscopic result which was the gold standard, the sensitivity, specificity, accuracy and Kappa value of the T1 W-TSE sequence was 63.8％ ,95.3％ ,78.8％ and 0. 403 respectively;The sensitivity,specificity ,accuracy and Kappa value of the T2WI-TSE-SPIR sequence was 56.3％ ,97.6％ ,76.1％ and 0. 353 respectively.The sensitivity,specificity,accuracy and Kappa value of the PDW-TSE-SPIR sequence was 79. 8％, 93.0％ ,86. 1％and 0. 642 respectively; The sensitivity, specificity, accuracy and Kappa value of the 3D-WATSC was 96. 8％,88. 3％ ,92.8％ and 0. 812 respectively. ConclusionThe accuracy and Kappa values of Fat-suppressed three-dimensiunal fast spoiled gradient-echo sequence (3D-WATSC)was superior to other sequences in the diagnosis of articular cartilage injury of the knee. The correlation between 3D-WATSC and arthroscopy in detecting cartilage injury was remarkable. 3D-WATSC had been deemed the most adequate sequence in detecting articular cartilage injury of the knee.

Objective To explore the impact of pre-setted generation adaptive statistical iterative reconstruction Veo (ASiR-V) on chest CT radiation dose and image quality.Methods The chest model and 120 patients (divided into 6 groups,each n=20) were scanned by GE Revolution CT under the condition of pre-setted ASiR-V weights for 0,20％,40％,60％,80％ and 100％ respectively.The tube voltage was 120 kV,the tube current was automated mAs (Smart mA10-500) technology,the noise index was 11.The dose-length product of each chest model group and patients group were record,the effective dose (ED) of each group was calculated and compared.The image quality among groups through combining the objective CT and standard deviation (SD) values of different organizations (lung tissue,the soft tissue near by spine,the aorta and vertebral body) in chest model and the image subjective rating of patients were compared,and the subjective score of patients' images was also compared among groups.Results With the increase of pre-setted ASiR-V,the ED of chest model and patients reduced as a logarithmic fitting,there are no obvious changes of the CT value and image noise SD value of different organizations in model.The subjective score of mediastinal and pulmonary window was begin to decline at 40％ weighted ASiR-V.The subjective score of mediastinal and pulmonary window descend obviously at 60％ weighted ASiR-V compare to 40％ (P＜0.05).ED of pre-setted 40％ weighted ASiR-V reduced to 57.21％ compared to that of 0 weighted ASiR-V.Conclusion The pre-setted ASiR-V can reduce the radiation dose,and does not affect the objective image quality at the same time.The pre-setted 40 ％ weighted ASiR-V has the highest clinical application value due to the radiation dose can be obviously reduced with ensuring the image quality,which can meet the demand of diagnosis.

Objective To assess the clinial application of 3D reconstruction with MSCT for acetabular fractures.Methods Volume scanning was performed in 20 patients with acetabular fractures,all data sets were transferred to workstation.Reconstruction were done with more thinner slices.Results Acetabular frature 3D images went all the way with the results of surgery in 17 cases.Conclusion MSCT 3D images can compare beauty with gross specimen,which could be propitious to the subtype of acetabulum fracture and have an advantage in the application.

OBJECTIVETo explore the anatomic basis and clinical application of the horn shaped perforator flap pedicled with the angular artery for the reconstruction of midface defect.

METHODS(1) 10 fresh cadavers were perfused with a modified guiding oxide gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise' s interactive medical image control system, MIMICS). The origin and distribution of the angular artery perforator were observed. (2) Between July 2012 and July 2014, twenty-one patients underwent operations for the reconstruction of midface defect. Ten patients had squamous cell carcinoma, nine patients had basal cell carcinoma and two patients had nevus. The flaps' size ranged from 1.5 cm x 3.5 cm to 2.5 cm x 5.0 cm.

RESULTSThe facial artery branches the lateral nasal artery 1 cm from the outside corner of the mouth, subsequently strenches to inner canthus continuing as the angular artery. The angular artery anastomoses extensively with the dorsal nasal artery and the infraorbital artery. All the flaps survived. The patients were satisfied with the final aesthetic and functional results.

CONCLUSIONSThe flap can be designed flexibly and simply with reliable blood supply. The donor sites could be closed directly without skin graft, it is a simple and fast method for the reconstruction of midface defect.

Anastomosis, Surgical ; methods ; Arteries ; anatomy & histology ; Cadaver ; Carcinoma, Basal Cell ; surgery ; Carcinoma, Squamous Cell ; surgery ; Face ; blood supply ; Facial Neoplasms ; surgery ; Humans ; Nevus ; surgery ; Nose ; blood supply ; Perforator Flap ; blood supply ; transplantation ; Skin Neoplasms ; surgery ; Skin Transplantation ; Software ; Tomography, Spiral Computed

Objective To evaluate the effectiveness of regional electrocardiographic consultation network for primary medical institutions.Methods A distance electrocardiographic ( ECG ) consultation center was established in Yuyao People′s Hospital in September 2012, which was connected to 56 regional primary medical through internet.The online consultation was provided by ECG specialists in the center for general practitioners in regional primary health care institutions.Additionally, the ECG training course was also conducted monthly for general practitioners.The 2-year data of ECG consultation were retrospectively reviewed and the effectiveness of the consultation network was evaluated.Results During the past two years, 86 593 electrocardiograms were uploaded by primary medical institutions, in which 3 976 were required for consultation. The monthly number of electrocardiograms sent by general practitioners was increased from 3 269 ±290 in the first year to 3 947 ±376 in the second year ( P<0.01 ) .However, the requirements of ECG consultation were not significantly different between two years.Compared to the first year, the rates of consultation requirements, misdiagnosis and missed diagnosis for ECGs of atrial and ventricular premature beats, atrial fibrillation, supraventricular tachycardia, left and right bundle branch blocks,ⅠandⅡdegree atrioventricular blocks and myocardial infarction were significantly decreased ( all P<0.05) in the second year;meanwhile there was a tendency towards the reduction for ECGs of atrial flutter and Ⅲ degree atrioventricular block in the second year.Conclusion The regional electrocardiographic consultation network is effective to improve the capability of primary medical institutions in electrocardiographic diagnosis.

Objective An attempt to develop a patient survey questionnaire on the public benefit nature of medical institutions as seen by patients,along with an evaluation of its reliability and validity.Methods A field survey was conducted among the patients visiting these institutions.The Cronbach's α coefficient was calculated to test the reliability.Factor analysis and spearman correlation analysis were applied to test the validity.The validity was also tested by analyzing the demographic factors and comparing the results between different kinds of medical institutions.Results The Cronbach's α coefficient of the questionnaire was 0.853,meanwhile the Cronbach's α coefficient of the three items was 0.845(quality of care),0.845 (suitability of services) and 0.752 (professional ethics).Three common factors were extracted,which coincided with the three items-quality of care,suitability of services and professional ethics.And the results are hardly affected by common demographic characteristics.Condusion The reliability of the questionnaire was acceptable,and the items were reasonably divided in the questionnaire with good structural validity.The questionnaire can be widely applied to evaluate the public benefit nature of medical institutions.

Objectives:Economic growth and rapid development of health technology in China have created opportunities to strengthen health technology assessment (HTA) capacity.Over the time,HTA institutions have been established to conduct HTA related work.This study reviewed the current status of HTA in China and analysed the challenges of HTA development in the context of health reform under"new normal"economy.Methods:Literature review and webpage searches were used to document the development of HTA in China.An institutional survey has also been conducted to collect information on the HTA research institutions in China.Results:The number of articles and research projects on HTA were rising and are continuing to rise.HTA development has made substantial progress in China in terms of growing number of research institutions and qualified HTA workforce.However,HTA has notable weaknesses such as low capacity for conducting HTA research,limited experience in HTA researchers,and lack of knowledge translation.Conclusion:Currently,the translation of HTA findings to policy-making is limited and the integration of HTA in the policy-making processes is still in its infancy.The HTA development in China has had opportunities due to demands of health care,health insurance,and health technology as a result of health reform.Capacity building and institutionalization of HTA are urgently needed for further development of HTA in China.

Hemolysis caused by blood pumps is a very important characteristic. In vitro hemolysis test circuits were constructed to operate the model I centrifugal pump, the model II axial flow pump, the magnetic coupling pump and the model I & II spiral mixed pump. The output of all pumps was set at flow 5 L/min, an average pressure of 100 mmHg. Experiments were conducted for 4 hours at room temperature(25 degrees C) with 500 ml fresh anticoagulant sheep blood. Blood samples were taken for plasma free-hemoglobin measurement, and the change in temperature at the pump outlet port was measured during the experiment. Calculate the normalized index of hemolysis (NIH). The results showed that there was no relationship either between the pump rotational speed and the NIH in five types of blood pumps, or between change in temperature at the pump outlet port and NIH. The dynamic fluid field caused by pump design and structure could be the main cause of blood damage.
Animals ; Blood Flow Velocity ; Evaluation Studies as Topic ; Heart-Assist Devices ; adverse effects ; Hemolysis ; In Vitro Techniques ; Sheep ; Temperature

Objective: To explore the association between the accumulation of metabolic syndrome (MS) components and abnormal brachial ankle pulse wave velocity (baPWV), and to investigate the effect of accumulation of abnormal metabolic components on abnormal baPWV among adult individuals undergoing routine health examination. Methods: It's a cross-sectional study. Data from 9 201 stratified sampled subjects, aged between 25 to 75 years old, who took part in the annual health checkups in 11 cities of Zhejiang Province from January to December 2016, were analyzed. Blood pressure(BP), fasting plasma glucose(FPG), waist circumference(WC), triglyceride(TG), high-density lipoprotein cholesterols(HDL-C) were defined as MS components. The baPWV was measured by VP-1000 (BP-203RPE Ⅲ) and ΔbaPWV (measured baPWV-reference baPWV/reference baPWV) ×100 (%)> 10% was defined as abnormal. The relationship between MS components and ΔbaPWV was analyzed by linear regression, and impact of accumulation of MS components on ΔbaPWV was analyzed by logistic regression, and the ΔbaPWV in subjects with different levels of MS components were analyzed by analysis of variance. Results: (1) The linear regression analysis demonstrated a positive correlation between ΔbaPWV and MS components including systolic blood pressure, diastolic blood pressure, WC, FPG, TG, while ΔbaPWV was negatively correlated with HDL-C. The β values were 0.518, 0.616, 0.208, 2.778, 1.862, -1.339, respectively (all P<0.001), indicating a strong association between ΔbaPWV and systolic blood pressure, diastolic blood pressure, and FPG. (2) The logistic regression analysis showed that the proportion of abnormal ΔbaPWV was 2.595 times higher in MS individuals than in non-MS individuals (P<0.001). Abnormal ΔbaPWV increased in proportion with increase in numbers of the metabolic components (OR=1.913, 2.884, 3.833, 6.161, 11.176 in individuals with 1,2,3,4,5 metabolic components, respectively, all P<0.001). (3) The logistic analysis suggested that each component of MS could affect baPWV,and OR was 4.68, 2.45 for systolic blood pressure and/or diastolic blood pressure and FPG. All combinations of 2 components of MS also significantly affected baPWV,and OR value was the highest (5.104(95%CI 4.281-6.085), P<0.001) for FPG+BP. All combinations of 3 components of MS significantly affected baPWV,and OR value was the highest(5.385(95%CI 4.245-6.831), P<0.001) for BP+FPG+TG. All combinations of 4 components of MS affected baPWV,and OR value was the highest (6.519(95%CI 4.731-8.984), P<0.001) for BP+FPG+WC+TG. (4) Finally, every component of MS was divided into 3 levels, their impact on abnormal ΔbaPWV was analyzed. Prevalence of abnormal ΔbaPWV significantly increased with the increasing levels of the metabolic components expect for HDL-C, the F values were 1 224.66, 832.89, 192.72, 112.79 and 56.22, respectively (all P<0.001), indicating that higher levels of metabolic components significantly affected the ΔbaPWV. Conclusions MS and accumulation of abnormal MS components are closely related with abnormal ΔbaPWV, and the combination of BP and FPG have the greatest impact on the abnormal ΔbaPWV. Analysis on the accumulation of MS components might serve as an early indicator of arteriosclerosis.

Although a key tenant of the Sustainable Development Goals is to achieve universal health coverage,the global drug gap persists—over a third of the global population lack access to essential medicines.Without access to affordable drugs,people have worse health outcomes,higher medical expenses,and productivity loss,pushing them into poverty.Health technology assessments (HTAs) offer an opportunity to decrease the global drug gap and increase access to essential medicines by overcoming barriers to medicine access.These barriers include drug procurement,drug affordability for payers and patients,a patient's ability to obtain essential medicines,and health system capacity.Using HTAs can therefore close the global drug gap by increasing access to affordable essential medicines.In turn,people have better health outcomes,spend less money on medical care,and can have better productivity.Ultimately,use of HTAs can lift the population out of poverty and force fewer people into poverty by creating better health outcomes at affordable prices.