Diabetes mellitus ( DM) is widely considered to be associated with pancreatic cancer ( PC) .Some studies have shown that DM has been recognized as a risk factor for PC and the early clinical manifestation of PC , however the exact relationship re-mains unclear .The conventional imaging techniques and molecular imaging techniques can evaluate the abnormal condition during the occurrence and development of PC and diabetes .This article will review the correlation between PC and DM and the potential molecular mechanism, such as hyperglycemia, insulin-like growth factors, oxidative stress, islet amyloid polypeptide and Kruppel sample factorⅡgene mutations, etc.In addition, the value of imaging diagnosis for PC and DM is also reviewed .

Objective To propose an extraction algorithm for extraction of breast tumor boundary in its ultrasonic image. Methods A novel Global-Local Energy function was proposed in the variational Level Set formulation for the curve evolution. By enhancing the intensity of local information, the breast tumor boundary was obtained from ultrasonic images accurately. Results Experiments on a synthetic ultrasound image showed that this method was more accurate at segmenting the object from the background than the Chan-Vese algorithm based on the global optimization. Experiments on 103 ultrasonic breast tumor images also showed that the boundaries were extracted accurately with this method without any pre-processing step. Conclusion This proposed method is expected for the fast and accurate boundary extraction of ultrasonic breast tumor boundary from ultrasonic image.

Objective To investigate the correlation between the red blood cell distribution width (RDW) with risk and and severity of noncardiac ischemic stroke.Methods The patients with acute noncardiac ischemic stroke were enrolled retrospetively and were used as a case group,and the non-stroke patients admitted to the Department of Neurology at the same period were served as a control group.The National Institutes of Health Stroke Scale (NIHSS) was used to assess the baseline neurological deficits.The NIHSS score ＜ 8 was defined as mild stroke and ≥ 8 was defined as moderate to severe stroke.The demographics,clinical data,and RDW were collected and compared.Multivariate logistic regression analysis was used to identify the independent risk factors for the risk of disease and severity of stroke in noncardiac ischemic stroke.Receiver operator characteristic (ROC) curve was used to analyze the predictive value of RDW for acute noncardiac ischemic stroke and its severity.Results A total of 1 173 patients with acute noncardiac ischemic stroke were enrolled.Over the same period,996 non-stroke patients were hospitalized in the Department of Neurology.The RDW in the case group was significantly higher than that in the control group (13.1％ ± 1.0％ vs.12.7％ ±0.7％;t=9.545,t ＜0.001).Multivariatelogistic regression analysis showed that RDW (odds ratio [OR] 9.920,95％ confidence interval [CI] 6.286-15.655,P＜ 0.001) was an independent risk factor for acute noncardiac ischemic stroke.ROC curve analysis showed that the RDW cutoff value for predicting acute noncardiac ischemic stroke was 12.55％,the area under the ROC curve was 0.611 (95％ CI 0.588-0.635),the sensitivity was 73.3％,the specificity was 43.7％,the positive predictive value was 60.5％,the negative predictive value was 58.2％,and the accuracy was 59.7％.RDW in the moderate to severe stroke subgroup was significantly higher than that in the mild stroke subgroup (13.7％ ± 1.6％ vs.12.9％ ± 0.6％,t =-13.794,P＜ 0.001).Multivariate logistic regression analysis showed that RDW (OR 3.835,95％ CI 3.002-4.899,P ＜ 0.001) was an independent risk factor for the severity of acute non-cardiac ischemic stroke.ROC curve analysis showed that the RDW cutoff value for predicting moderate to severe non-cardiac ischemic stroke was 13.45％,the area under the ROC curve was 0.713 (95％ CI 0.674-0.752),the sensitivity was 47.7％,the specificity was 86.1％,the positive predictive value was 49.8％,the negative predictive value was 85.1％,and the accuracy was 77.6％.Conclusions RDW is an independent risk factor for acute non-cardiac ischemic stroke.Increased RDW is associated with the severity of acute non-cardiac ischemic stroke.

Objective To study the damage of hyperhomocysteinemia (HHcy) and asymmetric dimethylarginine (ADMA) on the structure of rats cerebral vessels,and to explore the treatment effect of probucol,folic acid and vitamin B12.Methods Totally,70 male Sprague-Dawley(SD) rats were randomly divided into seven groups:normal control (A),HHcy model (B),low-dose-probucol (C),middle-dose-probucol (D),high-dose-probucol (E),folic-acid plus vitamin B12 (F),folic-acid plus vitamin B12 plus probucol(G)group.Group A was fed plain feedstuff and water.Other groups were fed homomethionin feedstuff and water,probucol (340,510,680 mg· kg-1 · d-1),folic acid and vitamin B12,folic acid plus vitamin B12 plus probucol respectively.The plasma concentrations of homocysteine(Hcy) and ADMA were assayed by high-performance liquid chromatography method (HPLC) at the beginning,and at the end of 8 and 12 weeks.The analysis of rats cerebral vessels was performed with electron microscope at the end of 12 weeks.Results (1) After adding high concentrations of methionine feedstuff for 8 weeks,the levels of Hcy in group B (60.4±11.9) μmol/L were significantly raised compared with group A(7.1±1.4) μmol/L.Meanwhile,ADMA levels in group B(1.3±0.4)μmol/L were higher than group A(0.4±0.1) μmol/L.At the end of 12 week,the levels of Hcy and ADMA were lower in groups C[(49.9±11.4)μmol/L,(1.0±0.2)μmol/L],D [(46.8± 10.9)μmol/L,(0.9±0.1)μmol/L],E[(44.3±11.4)μmol/L,(0.9±0.1)μmol/L],F [(16.3 ± 4.9)μmol/L,(0.7 ± 0.2)μmol/L] compared with group B [(69.5 ± 11.4)μmol/L,(1.6 ±0.5)μmol/L],but higher than group A[(6.7±1.3)μmol/L,(0.5±0.1)μmol/L].The levels of Hcy and ADMA in group G[(8.9±1.9) μmol/L,(0.6±0.2) μmol/L]were also lower than those in group B (P＜0.05],but they did not show statistically significant differences compared with group A(P＞0.05).(2) According to correlative analysis,Hcy levels were positively correlated with ADMA levels (P＜0.05).(3) On electron microscope,we observed that the cerebral artery and cerebral cortex of group B were seriously damaged.After the intervention with probucol,folic acid and vitamin B12,the structure of rats cerebral vessels were improved in group C,D,E,F and G as compared with group B,and group G were especially improved more obviously.Conclusions The HHcy and ADMA could damage the structure of rats cerebral vessels.Probucol,folic acid and vitamin B12 may alleviate the cerebral vascular damage by decreasing the levels of Hcy and ADMA,and the effect is more significant by the combined drug regimens of Probucol,folic acid and vitamin B12.

Objective To analyze the MRI characteristics of cavernous angioma of the epidural space in spine.Methods MR imaging features of cavernous angioma of epidural space in 3 cases confirmed by surgery-pathology were analysed with literature review . Results Among the three cases,the tumors located in the lumbar spine in one and in the thoracic spine in 2.The tumors were all at posterior to the spinal cord and shuttle-shaped,the major axis was consistent with the spinal ordinate axis,the corresponding plane spinal cords were compressed and resulting in distortion and shift.The tumors were high signal intensity on T_2WI,and obviously homogeneous enhanced after Gd-DTPA administration. Conclusion MRI examination is the best method to diagnose this kind of disease.

Objective To know about the current status of the work engagement of the clinical nurses and its influencing factors,to explore the influencing factors of work engagement of clinical nurses so as to provide basis for improving the level of the work engagement of the clinical nurses.Methods The work engagement scale,hardiness scale,role pressure scale,perceived organizational support scale and questionnaire of family care index were used to investigate a total of 630 clinical nurses.The results were analyzed.Results The average score of work engagement,hardiness,role pressure and perceived organizational support were showed respectively as following:(3.28±0.51),(2.60±0.53),(3.00±0.50),(3.43± 1.04) scores.Clinical nurses number of the total point between 7 and 10 of family support accounted for 70.9％(447/630).Hardiness,perceived organizational support,family support and work engagement were in obvious positive correlation,whereas role pressure was in obvious negative correlation with work engagement.Hierarchical regression analysis showed after the variable of demographic was controlled,the hardiness and perceived organizational support respectively had significant positive predictive function on work engagement as respective independent variables.Role pressure had obvious negative predicative function on work engagement.Conclusions Hospital managers should create a good working environment for clinical nurses,measures should be taken from individual and organizational aspects so as to improve the hardiness and perceived organizational support,reduce role pressure and the work positivity of the clinical nurses,so that the nurse more positively devoted to their work.It has important practical significance to improving the quality of their services and stabilizing nursing troop.

Objective Investigating the relationship between the incidence of Primary Acute Cerebral Infarction (PACI) and seasonal variation to employ measures to prevent PACI with climate change. Methods A retrospective analysis of patients diagnosed with PACI between 2009 and 2013 in the department of Neurology of Second hospital of Tian Jin Medi-cal University (n=1 198 patients) was carried out. Combined with the general clinical data, we analyzed seasonal, monthly and weekly variation among PACI incidents. Results The incidence of PACI increases over years between 2009 to 2013 (P ＜ 0.01). Significant difference of incidents of PACI was observed between each season (P=0.047). Incidence of PACI peaked in winter(30.33 ± 9.63/month), while bottomed in spring(21.83 ± 5.36/month). Significant difference of incidents of PACI was also observed between each months(P=0.010). The monthly incidence was highest in January and February (33.25 ± 9.62/month)and lowest in March and April(20.75 ± 4.89/month). The seasonal variation was only found in the pa-tients who are complicated with pulmonary infection (P＜0.01) regardless of the presence or absence of other risk factors, such as smoking, drinking ,hypertension, coronary heart disease, and diabetes mellitus. The weekly variation of PACI was on-ly significant in patients younger than 65 years old(P=0.043). The peak incidence among a week was Monday(17.86%),and incidence bottomed on Friday (13.36%). Conclusion Our study revealed that the incidence of PACI increase over year be-tween 2009 to 2013 and it shew a characteristic variation with respect to season, month and week. Based on these results, we can formulate prevention measures accordingly.

10.3969/j.issn.2095-4344.2013.24.018

Objective To explore the characteristic findings of 1H-MR spectroscopy(1H-MRS) in the prefrontal cortex and amygdala of patients with heroine dependence(HD), and the relationship to total cumulative dose of inhaled heroine.Methods Fourteen male HD patients and 12 healthy controls (HC) underwent 1H-MRS at the prefrontal cortex and amygdala regions.The total cumulative in haled heroin dose was (852±341) g in HD.Ratios of N-acetylaspartate/creatine(NAA/Cr) and choline/creatine (Cho/Cr) were respectively measured in the prefrontal cortex and bilateral amygdale regions.The student's t test and the linear correlation were employed for statistical analysis.Results Compared to HC group, HD patients had a significant lower ratio of NAA/Cr in the prefrontal cortex (1.44±0.46 vs 1.50±0.75, t=1.77 ,P <0.05), left amygdala region (1.32±0.08 vs 1.42±0.08, t=3.41, P < 0.05), and right amygdala region (1.34±0.09 vs 1.44±0.10, t=2.63, P <0.05), the HD patients had a significant increased ratio of Cho/Cr in the prefrontal cortex (0.92±0.06 vs 0.86±0.08, t=2.31, P < 0.05), left amygdala region (1.20+0.12 vs 1.07±0.04, t=3.60,P<0.05) and right amygdala region(1.26±0.15 vs 1.12±0.11,t=2.60,P <0.05).There was a negative linear correlation between the total cumulative inhaled heroine dose and the ratio of NKA/Cr in the prefrontal cortex (r=-0.9159, P < 0.01), left amygdala region (r=-0.8756, P < 0.01), and right amygdala region (r=-0.9399, P < 0.01) respectively.Conclusions The study indicates that neuronal damage and glial proliferation may occur in the prefrontal cortex and amygdala region, which suggests the abnormalities of executive function and emotion in patients with HD.A relationship exists between the heroin-induced metabolic abnormality and the total cumulative dose of inhaled heroine.

Objective To study the value of~1H-magnetic resonance spectroscopy(~1H-MRS) and diffusion weighted imaging(DWI) in evaluating the changes of pathological structures of hippocampal sclerosis.Methods Twelve normal controls and twelve cases with temporal lobe epilepsy were examined by conventional MRI,~1H-MRS and DWI.The NAA/(Cr+Cho) ratios and ADC values in the hippocampus were measured and compared between patients and normal controls.Results The NAA/(Cr+Cho) ratios of hippocampus in patients with hippocampal sclerosis were significant decrease in comparison with controls and the contralateral side,and the ADC values were also significant increase.There was correlation between the NAA/(Cr+Cho) ratios and ADC values in the disordered hippocampus(r=-0.79,P=0.002).Conclusion There is a significant correlation between the NAA/(Cr+Cho) ratios and ADC values in the hippocampal sclerosis.~1H-MRS and DWI capture partially complementary aspects of hippocampal pathology noninvasively in vivo.