Objective To evaluate the application of fast track surgery (FTS) in the rib internal fixation of multiple rib fractures. Methods Forty-eight chest trauma with multiple rib fractures patients from March 2008 to March 2010 were divided into FTS group and traditional care group randomly. Meanwhile two groups accepted FTS and conventional management of perioperative period respectively. The degree and duration of the chest pain, early exercise tolerance, intravenous infusion time, the length of postoperative hospital stay,chest scar and postoperative complications were observed and compared between the two groups. Results The duration of chest pain was significantly shorter in FTS group than in the traditional care group([ 112. 46 ±23. 24 ] mins vs [ 180. 23 ± 51.56 ] mins, t = 4. 23 ,P ＜ 0. 05); the early exercise tolerance was longer([ 68. 35 ±9. 30 ] mins vs [ 33.48± 5. 18 ] mins,t = 2. 87, P ＜ 0. 05) ;the intravenous infusion time was shorter ([ 10. 83 ±1.87 ] d vs [ 13. 30 ± 2. 12 ] d, t = 2. 38, P ＜ 0. 05); the length of postoperative hospital stay was shorter([ 12. 35 ± 2.03 ] d vs [ 16. 48 ± 3. 18 ] d, t = 3.04, P ＜ 0. 05); the less postoperative complications(8.3% vs 37. 5 %, x2 = 5. 005,P ＜ 0. 05); chest pain was relieved([ 3.43 ± 0. 45 ] cm vs. [ 6. 62 ± 0. 62 ] cm, P ＜ 0. 05);the scar healed well. All patients were successfully discharged. Conclusion The perioperative idea of fast track surgery was feasible and effective in the chest trauma with multiple rib fractures patients. FTS can improve the patients long term living quality.

OBJECTIVE:To provide the reference for verifying and improving the usage criteria and guidelines of compound oral contraceptives(COCs)in China. METHODS:The usage criteria and guidelines of COCs were introduced and compared issued by WHO,US and European Union(EU). RESULTS&CONCLUSIONS:WHO has established 4 standards and guidelines for COCs, i.e. Medical Eligibilitu Criteria for Contraceptive Use(MEC),Selected Practice Recommendations for Contraceptive Use(SPR), Decision-making Tool for Family Planning Clients and Providers,Family Planning:A Global Handbook for Providers. According to the specific circumstances of the user,MEC has been divided into 4 levels according to the situation of users,i.e. suitable for use,use cautiously,relative contraindication,absolute contraindication. SPR mainly describes the specific issues of how to use vari-ous contraception methods safely and effectively. The reading card mode for Decision-making Tool for Family Planning Clients and Providers can query specific methods and steps of contraceptive informed choice fast. Family Planning:A Global Handbook for Providers can provide practical guide for the family planning service providers in the first line. On the basis of WHO MEC and SPR,some projects are modified and added in the US MEC and SPR,including the classification of breast feeding,the risk grade of DVT/PE recurrence,etc. EU have formulated COCs criteria and guidelines earlier than WHO and US;the key points and specif-ic varieties of COCs are prompted and updated based on the latest evidence- based medicine,including a new assessment of the risk of thrombosis after using the COCs,the special safety tips for the use of Diane 35? and its generics. Concerning the optimal ev-idences of current COCs usage of WHO,US and EU,combined with domestic situation,our country may provide the clear and up-to-date usage criteria and guidelines of COCs for its users and medical staff.

Objective To investigate the expression ofpodocalyxin(PCX) in patients with diabetic nephropathy (DN) and its clinical significance.Methods A total of 68 patients with DN were enrolled as DN group.Another 20 healthy person were selected as control group.The patients with DN were divided into three sub-groups:normal albuminuria group(＜ 30 mg/g,group A),microalbuminuria group(≥30 mg/g but ＜ 300 mg/g,group B) and macroalbuminuria group (≥ 300 mg/g,group C).The level of urinary PCX was measured with enzyme-linked immunosorbent assay.Results The level of urinary PCX,serum creatinine and blood urea nitrogen in DN group was higher than that in control group [(27.44 + 6.87) μ g/L vs.(3.52 +1.13) μ g/L,(154.82 ± 11.54) μ mol/L vs.(82.56 ± 5.71) μ mol/L,(8.79 ± 0.58) mmol/L vs.(4.23 ± 0.34)mmol/L,P ＜0.01].The level of urinary PCX in group A,B,C was (18.04 ±4.12),(23.58 ±5.43),(32.18 ± 6.05) μ g/L,and there was significant difference among three groups (P ＜ 0.05).The level of serum creatinine and blood urea nitrogen was (138.54 + 8.66),(142.16 ± 11.74),(165.13 ± 12.85) μ mol/L and (8.48 ± 0.43),(8.56 ± 0.61),(10.04 + 1.17) mmol/L in group A,B,C,there was no significant difference between group A and group B(P＞ 0.05),but there was significant difference between group A and group C,or between group B and group C (P ＜ 0.05).Conclusion The high-level expression of urinary PCX is found in DN patients,which maybe play a key role in the early diagnosis and assessment of the progression of DN.

Stigma is demeaning,insulting social psychology mark.In A dream of red mansions,there are a lot of description about stigma and its psychological effects.Stigma effect not only influences many people's daily life,but also determines the fate of the key figures.The stigma effects also has obvious interference on the patients' psychology during the medical treatment.Moreover,stigma also influences the effects of clinical treatment.Therefore,hospitals should create an equal,united,tolerant medical environment and atmosphere of doctor-patient communication,and promote the government and the public health system to take corresponding policy measures to improve the living conditions of persons of stigma.

Objective To evaluate and improve the geometrical accuracy of the magnetic resonance imaging used for gamma knife radiosurgery localization. Methods Four common MRI scan programs were used in this study. The images were transferred to the Gamma Plan treatment planning system.Deviations between stereotactic coordinates based on MR images and real geometrical positions given by the construction of the phantom insert were evaluated for each study.The deviations were further investigated as a function of the spatial position of measured points in the investigated volume.Results The geometrical coordinate errors for axial and coronal images of the selected scan programs were all less than 1 mm.Optimal imaging procedure in terms of geometrical accuracy was observed using spin echo T1 and 3D FSPGR MRI sequences in the unit.Statistically significant differences were found in axial images amongSE T1,FSE T2,FRFSE Pd,FSPGR 3D sequences (F=1497.51,1873.63,2.87,3.00,P ＜0.05).The error increased along with the increase of the distance between node point and centricity.Conclusions The geometrical coordinate errors is related with the imaging program in M(il)l. Proper imaging programs and parameters should be selected according to the imageology character of patients' lesions when the radiosurgery is performed.

Objective To determine the utility of apparent diffusion coefficient (ADC) values as an objective method of early detection of traumatic brain injury of the mice models in hippocampus injury.Methods A total of 18 healthy male adult C57/BL6 mice were randomly divided into three groups according to the degree of injury:the mild group,severe group and control group.Conventional images,diffusion-weighted images,ADC were studied.The hippocampal were selected as the interesting area.ADC values were calculated and compared with those in control subjects after 6 h,12 h and 24 h.Student t test was performed for each region to compare the injury groups and the control.Results In control group both sides hippocampal ADC values had no differences(8.65±0.26 and 8.77±0.12) × 10-4 mm2/s,P＞0.05.Abnormalities were detected on ADC values,compared with conventional images in the injury groups.ADC values in mild group and severe group were significantly different from those of control group(6 h ADC values were (8.70±0.50) × 10-4 mm2/s,(6.13± 0.11) × 10-4 mm2/s,and (3.16±0.78) × 10-4 mm2/s in control,mild and severe group respectively),(12 h ADC values (8.23±0.61)× 10-4 mm2/s,(5.92 ± 0.27) × 10-4 mm2/s and (2.64±0.65) × 10-4 mm2/s) and (24 h ADC values (9.01±0.14) × 10-4 mm2/s,(5.99± 0.13)×10-4 mm2/s and (2.58±0.42)×10-4 mm2/s),P＜0.05.Conclusion There are differences among the ADC values on differcnt types of hippocampal brain injury mouse-model.ADC values can identify the degree of damage on brain injury and can detect early craniocerebral injury.

Objective:To elucidate the changes in apparent diffusion coefficients(ADC)by quantify diffusion weighted (DW)magnetic resonance imaging(MRI)in patients with Alzbeimer's disease(AD),and the relationship between micro-structure changes of white matter(WM)and the cognitive impairment thereof.Methods:The DW-MRI was performed in 30 probable AD patients and 30 normal controls with normal-appearing white matter(NAWM).The ADC was measured in different WM areas.The neurologic and neuropsychological assessments were examined with mini-mental state examination(MMSE)in patients.The ADC were determined in standard regions of the frontal,temporal,occipital and parietal white matter,genu,splenium of the corpus callosum.Results:The value of ADC was higher in frontal,splenium corpus callosum,temporal,and parietal white matter of AD group than that of control(P ＜ 0.01).There was no significant difference in the ADC value of genu and occipital white matter between AD and control groups(P＞ 0.05).The score of MMSE was 24.1±0.8 in AD group.The ADC values of parietal,splenium of the corpus callosum and frontal white matter were significantly negatively correlated with MMSE scores in AD group(P ＜ 0.05 or P ＜ 0.01).There was no correlation between the ADC values of genu of the corpus eallosum,temporal and occipital white matter with the MMSE score(P ＞ 0.05).Conclusion:The quantitative DWI analysis of MRI DWI may be helpful in assessing WM abnormalities in AD.The parietal WM abnormalities may play an important role in the development of dementia.It was showed that Alzheimer's cognitive decline with ADC value and micro-structure of white matter was closely related.

Objective Applying diffusion weighted image (DWI) and apparent diffusion coefficient (ADC) to analyze brain injury caused by hypoxic-ischemic encephalopathy (HIE) in term neonates.Methods From June 1,2010 to January 5,2011,thirty-eight full term neonates with HIE were hospitalized in the Second Hospital of Tianjin Medical University.Those with nervous system diseases were excluded.The 38 cases were divided to mild HIE group (n=24) and moderate-to-severe HIE group (n=14).The control group included 10 normal full term neonates without history of asphyxia.All babies were scanned by magnetic resonance imaging (MRI).Spin echo-echo planar imaging sequence was used for DWI images.ADC values of nine regions (frontal lobe gray matter,frontal white matter,parietal gray matter,parietal white matter,corona radiata,caudate nucleus,putamen,posterior limb of the internal capsule and thalamus) were measured.MRI and DWI images were compared.ADC values were compared by analysis of variance and Student-Newman-Keuls test.Results ADC values of the nine indicated regions (frontal lobe gray matter,frontal white matter,parietal gray matter,parietal white matter,corona radiata,caudate nucleus,putamen,posterior limb of the internal capsule and thalamus) were (1.37±0.07),(1.81±0.12),(1.35±0.10),(1.84±0.09),(1.23±0.11),(1.28±0.09),(1.18±0.08),(1.05±0.07) and (1.15±0.08) ×10-3 mm2/s in control group,(1.28±0.11),(1.60±0.15),(1.27±0.09),(1.59±0.20),(1.19±0.15),(1.19±0.13),(1.11±0.09),(0.97±0.11) and (1.06±0.12) ×10-3 mm2/s in mild HIE group,and (1.18±0.14),(1.51±0.22),(1.19±0.09),(1.56±0.19),(1.03±0.16),(1.08±0.07),(1.02±0.07),(0.87±0.09) and (0.96±0.12) × 10-3 mm2/s in moderate-to-severe HIE group.ADC values among the three groups had statistical difference (F=3.89,3.21,4.05,3.30,3.28,3.27,4.12,4.75and 4.72,all P＜0.05).ADC values of frontal lobe gray matter,frontal white matter,parietal gray matter,parietal white matter,putamen,posterior limb of the internal capsule and thalamus in mild HIE group were lower than those in control group (all P＜0.05).All of the ADC values of nine regions in moderate-to-severe HIE group were lower than those in control group (all P＜0.05).ADC value of frontal lobe gray matter,parietal gray matter,corona radiata,caudate nucleus,putamen,posterior limb of the internal capsule and thalamus in moderate-to-severe HIE group were lower than those in mild HIE group (all P＜0.05).Conclusion DWI and ADC values could reflect brain injury caused by HIE,and ADC values can be used to quantitatively analyze the degree of hypoxic-ischemic injury.

Objective To explore the value of dual-source dual-energy CT (DSDE-CT) in differentiating extravasation of iodine contrast agents from secondary hemorrhage after revascularization in acute ischemic stroke. Methods 46 acute ischemic stroke patients following intra-arterial thrombolysis were examined with DSDE-CT within 2 hours after the procedure. Simultaneous imaging at 80 kV/392 mA and 140 kV/196 mA was employed, and then mixed images, virtual unenhanced non-contrast images and iodine overlay maps were calculated. Mixed images alone, as conventional CT, and DUDE-CT interpretations were assessed separately by two radiologists and compared with follow-up CT. Results 6 of 34 patients were negative cases proven by CT without high density, and another 28 cases were proven positive cases with 3 cases of cerebral hemorrhage, 21 cases of contrast agent extravasation, and the remaining 4 cases of combined cerebral hemorrhage and contrast agent extravasation. The sensibility, specificity, positive predictive value, negative predictive value and accuracy of mixed imaging alone in diagnosing hemorrhage was 66.67%, 100%, 1005, 96.15% and 96.43%, while the sensibility, specificity, positive predictive value, negative predictive value and accuracy of hemorrhage with DUDE-CT was 100%, 96%, 75%, 100% and 96.43% . The diagnostic accuracy of superimposed fusion images for intracranial hemorrhage, extravasation of contrast agent and hemorrhage with extravasation of contrast agent was relatively high, and the difference was statistically significant (P < 0.05). The diagnostic accuracy of superimposed fusion images consistent with clinical follow-up was significantly higher (Kappa=0.815),as compared with that of mixed imaging alone (Kappa=0.0.564). Conclusion DUDE-CT has great value in differentiating hemorrhage from iodinated contrast after intra-arterial thrombolysis in acute ischemic stroke.

Objective To develop a fluorescence signal activatable multifunctional molecular probe with theranostics function through combining ultrasmall gold nanorods(UGNRs) with fluorescein,and to evaluate its therapeutic effect on photothermal therapy (PTT) in breast cancer cells.Methods The UGNRs were synthesized by the one-pot seedless method,then the functionalized modification of UGNRs were conducted using cysteamine.Finally,the activatable ultrasmall gold nanorods (AUGNRs) were synthesized by amide condensation of —NH2 of cysteamine and —COOH of carboxylated fluorescein CyS.The cell uptake ability and GSH-mediated imaging ability of AUGNRs were studied using breast cancer 4T1 cells.4T1 cells co-cultured with AUGNRs were irradiated with 808 nm excitation light,and the PTT effects were assessed by MTT colorimetric staining and calcein-AM/PI staining.Results The AUGNRs were synthesized successfully,which could be uptaken by 4T1 cells quickly and efficiently,and could achieve intracellular glutathione (GSH) triggered fluorescence recovery.No obvious cytotoxicity of AUGNRs to 4T1 cells was observed in the co-cultivation.Moreover,obvious PTT effects could be induced by 808 nm laser,which could effectively kill 4T1 cancer cells.Conclusion The fluorescence signals of AUGNRs can be induced by intracellular GSH,and tumor cell destruction can be achieved by 808 laser-excitated PTT effects.