Objective To explore application value of 16 detecter spiral CT angiography for dissecting aneurysm of aorta .Meth-ods Retrospectively analyzed 9 cases of patients with the dissection of superior mesenteric artery in admission from January 2010 to December 2012 ,the cases were diagnosized by 16 detecter spiral CT angiography for dissecting aneurysm of aorta .post-process-ing techniques such as maximum density projection ,multi-plane reorganization and curved surface reconstruction and volume were used analyzed and diagnosized .Results These pathological changes such as superior mesenteric artery sandwich of true ,false cavity and inner diaphragm ,broken mouth position ,sandwich cumulative range and whether merger thrombus ,branch vascular involve-ment could be displayed by 16 detector CT vascular imaging and post-processing technology .Conclusion 16 layer detector CT ima-ging and post-processing techniques of blood vessels could clearly show the mesenteric artery sandwich ,which might be play an im-portant role for timely and accurate diagnosis .

Objective To improve the quality,efficacy,and efficiency of health checkup by establishing and implementing total quality management system.Methods Routine physical examination data of 5955 individuals (from January 2007 to May 2007,when total quality management system was not implemented) were analyzed and compared with 7520 individuals (from January 2008 to May 2008.when the system was implemented).Results The report quality of routine physical examination was significantly improved,and the qualification rate was increased from 82.6% to 98.2%.The healthcare service procedure was optimized.The examination time for the essential items was shoaened from 51 to 35 minutes.The result report time was reduced from 5 to only 1 day.The customer satisfaction rate Was increased from 86.3% to 98.1%; however,the suing rate Was decreased from 0.05% to 0.01%.The examination efficiency was significantly improved.The growth rate of checkup recipients was increased from 7.22% to 26.38%.There Was statistical significance before and after the implementation of the total quality management system (P

Objective: To explore the effect of ultrasound on dentin smear layer's surface and bonding strength of the universal resin adhesive under self-etching mode. Methods: Forty mandibular third molars without caries were randomly divided into two groups; one was polished with silicon carbide sandpaper; the other was polished with silicon carbide sandpaper followed by ultrasonic treatment. Scanning electron microscope (SEM) was used to observe surface of the dentin. Treated teeth were bonded with two universal resin adhesives, Clearfil Universal Bond (pH=2.3) and All-Bond Universal (pH=3.1), and the penetration of the bonding interface was observed with a confocal laser scanning microscope (CLSM) after Rhodamine B staining. Finally, the micro tensile bond strength test was conducted to test the adhesion. Results: The SEM showed that after polishing with silicon carbide sandpaper, the smear layer of the dentin surface was scratched, and dentin tubules were almost completely blocked, with no obvious dentin tubules exposed. After ultrasonic treatment, the scratches were reduced, and a large number of dentin tubules were exposed. CLSM showed that both adhesives could penetrate the dentin along the dentin tubules more deeply after ultrasound treatment. Micro tensile bond strength tests showed that ultrasonic treatment could enhance the bonding strength of two universal resin adhesives. However, there was no statistical difference in bonding strength between these two universal resin adhesives under the same treatment. . Conclusion Ultrasound can partially remove the smear layer on dentin's surface, expose dentin tubules, and increase universal resin adhesives' penetration depth and bonding strength under self-etching mode

Objective To compare the effect of naive porto-azygous devascularization and that as a remedy therapy after a failed endoscopy for the treatment of bleeding portal hypertension.Method From June 2005 to June 2010,230 portal hypertension patients were treated with porto-azygous devascularization,among them,202 cases were of portal hypertensive cirrhotics,28 cases of alcoholic cirrhosis.Group A (16 patients)received remedial porto-azygous devascularization after endoscopic treatment failed (esophageal variceal ligation,esophageal variceal selerotherapy).Group B(214 patients)received naive porto-azygous devascularization.Results The average operation time in group A was 198 min(115-335)min,mean bleeding amount was 750 ml(300-2000)ml,average post-operative hospital stay was 11 days (8-15)days.The average operation time in group B was 120 min(90-190)min,mean blood loss was 250 ml(150-500)ml,average post-operative hospital stay was 7 days(6-9)days.The average operation time,bleeding amount and post-operative hospital stay was significantly different between the two groups (P＜ 0.05).212(92.2％)patients were followed up,and the mean follow-up time was 2.5 years (1-6)years,mortality rate was 4.2％,rebleeding rate was 5.7％.Conclusions Surrounding the perioesophageal and gastric tissues were fibrotic and hard after the endoscopic treatment,this significantly increased the difficulty of surgery,therefore,porto-azygous devascularization is the choice of therapy for portal hypertension patients.

ObjectiveTo investigate the effects of nicotine exposure and ethanol-preferring behavior on mRNA expression of some nAChR subunits in the rat ventral tegmental area(VTA) and to explore possible mechanisms of dependence on tobacco and alcohol.Methods39 male Wistar rats,35-day-old,were randomly divided into an experimental group (group N,n=20) and a control group (group C,n=19).Rats in group N were treated with nicotine ( 1.0 mg · kg -1 · d -1 ) by subcutaneous injection while in group C with saline both for 10 days,after which 6 rats (respectively group NE,n =6,group CE,n =6 )were drawn randomly from each group and killed by cutting off the head.mRNA was extracted from the VTA tissue,and the expression of nAChR subunits,including α4,α5,α7 and β2,were examined by Real Time-PCR.Other rats both in groups N and C ( respectively group NA,n=14,group CA,n=13) were induced for 69 days to establish two-bottle free choice alcohol-preferring behavior model by Samson sucrose fading program from 60-day-old on.The same indexes mentioned above were detected by the same methods in the VTA tissue.Results① The factor analysis showed that both the two factors,nicotine and alcohol-preferring behavior,showed regulating effects on the expression of nAChR subunits α4 and α5 ( respectively F was 6.13,5.407,5.186,7.132,P ＜ 0.05 ),and the factor,alcohol-preferring behavior,on subunit β2 (F =5.896,P＜0.05) ; the two factors exhibited strong interaction on the expression of subunit α7 (F=13.894,P＜0.001 ),and some interaction on subunits α5 and β2 (respectively F was 6.149,4.222,P＜0.05 ).② The mRNA expression of nAChR subunits α4,α5,α7,and β2 were significantly up-regulated by different degrees in group NA compared to group CA ( respectively Fwas 7.941,13.517,17.438,9.272,respectively P ＜ 0.05,P ＜ 0.05,P ＜ 0.01,P ＜ 0.01 ),the expression level of subunits α4,α5,α7 and β2 were significantly higher in different degrees in group NA than in group NE( respectively F was 5.293,8.500,6.149,4.837,P ＜0.05) ; while subunit α7 was significantly down-regulated in group CA compared to group CE (F =12.750,P ＜0.01 ).ConclusionNicotine and ethanol co-affect on the nAChR subtype comprised of subunits α4,α5,α7 and β2.

Objective To explore the risk factors for childhood death from pneumococcal meningitis.Methods The data of 32 hospitalized children were retrospectively analyzed,who were diagnosed as pneumococcal meningitis and enrolled in the Affiliated Children′s Hospital of Soochow University from November 201 0 to December 201 5.The subjects were divided into the death group and survival group according to their prognosis.The clinical characteristics and laboratory data were compared between 2 groups.Results Between the death group and survival group,there were significant statistically differences in shock within 24 hours after admission(63.6% vs 1 4.3%,P =0.01 3),as well as endotracheal tube intubation(1 00.0% vs 23.8%,P <0.001 ),the levels of cerebrospinal fluid(CSF)IgG[(491 .27 ± 203.53)mg/L vs (267.24 ±1 88.07)mg/L,P =0.006],IgM[(1 1 5.72 ±79.1 9)mg/L vs (32.80 ±28.52)mg/L, P =0.006],IgA[59.52(1 5.51 ,75.69)mg/L vs 1 8.77(9.33,27.54)mg/L,P =0.023],CSF leukocyte[330.00 (1 50.00,380.00)×1 06 /L vs 870.00 (403.00,6 1 60.00)×1 06 /L,P =0.009 ],CSF protein [(4 047.00 ± 1 942.1 6)mg/L vs (2 470.62 ±1 259.94)mg/L,P =0.009],CSF adenosine deaminase (ADA)[35.20(1 8.90, 87.20)U /L vs 8.80(3.05,23.78)U /L,P =0.001 ],serum sodium[(1 30.21 ±2.85)mmol/L vs (1 32.83 ±3.69) mmol/L,P =0.049],serum lactic acid (LA)[4.40 (2.60,5.70)mmol/L vs 2.40 (1 .75,4.50)mmol/L,P =0.01 3],serum C -reactive protein (CRP)[(95.87 ±65.40)mg/L vs (1 65.61 ±83.05)mg/L,P =0.022],serum lactate dehydrogenase (LDH)[81 3.40(465.20,2 31 0.70)U /L vs 359.20(257.85,405.90)U /L,P =0.001 ], platelet[(1 63.82 ±1 64.86)×1 09 /L vs (295.71 ±1 30.29)×1 09 /L,P =0.01 9]and positive rate of blood culture (90.9% vs 47.6%,P =0.023)between the death group and survival group.Conclusions The risk factors associated with mortality in pediatric SPM include shock within 24 hours after admission,endotracheal intubation,hyponatremia, thrombocytopenia,as well as high serum LA level,high serum LDH level,lower serum CRP level or cultures of blood and CSF double positive.

Objective To explore the effect of treating posterolateral tibial plateau fractures via the fibular osteotomy approach.Methods From August 2009 to August 2011,17 patients with posterolateral tibial plateau fractures,including 12 males and 5 females,aged from 24 to 76 years (average,37.8 years),were treated via the fibular osteotomy approach in our hospital.According to the Schatzker classification,8 cases were type Ⅱ,3 cases were type Ⅲ,6 cases were type V.After operation,X-rays were taken in all patients,and Rasmussen's radiological and functional gradings were used to evaluate radiological and functional outcomes of knees.Results All patients obtained follow-up,ranged from 9 to 35 months (average,18months).The healing time of the fracture ranged from 10.0 to 18.0 weeks (average,13.5 weeks).During the period of followed-up,there was no loss of reduction; one case presented with symptoms of common peroneal nerve injury,such as local hypesthesia in distal lateral lower leg and dorsi pedis,which recovered two weeks postoperatively.According to Rasmussen's radiological grading,the mean score of the knee joint was 17.5(range,14.0 to 18.0).The range of motion of the knee joint ranged from -5°to 135°(average,123.5o).According to Rasmussen's functional grading,the mean score of the knee joint was 26.9 (range,22 to 30).Conclusion Treating posterolateral tibial plateau fractures via the fibular osteotomy approach can obtain sufficient exposure,good reduction and fixation,and avoid flexion contracture of the knee and peripheral vascular nerve injury.Moreover,postoperative function and stability of the knee joint recover well.

Objective To evaluate the effectiveness of swallowing training supplemented with neuromuscular electrical stimulation to provide a reference for clinical treatment and further study.Methods Reports of randomized and controlled trials of surface neuromuscular electrical stimulation in treating post-stroke dysphagia were sought in the Cochrane library,the PubMed and Embase databases,the Cumulative Index to Nursing and Allied Health Literature (CINAHL),and also in the ProQuest,PsycARTICLES,CBMdisc,China National Knowledge Infrastructure (CNKI),CQVIP database and Wanfang databases.All of the literature found was evaluated by 2 researchers according to predefined inclusion and exclusion criteria and the data were extracted and combined.Then meta-analysis was performed using version 5.3 of the RevMan software package.Results Eleven randomized and controlled trials involving 576 patients were included in the meta-analysis.Together,the data showed that swallowing training supplemented by neuromuscular electrical stimulation is significantly more effective than swallowing training alone in improving swallowing function.It reduces the risk of aspiration and improves quality of life.It does not,however,generally shorten the pharyngeal transmit time.Conclusions Swallowing training supplemented with neuromuscular electrical stimulation is a promising approach for treatment of post-stroke dysphagia and warrants further study.

Objective Based on the theory of "lung and large intestine form", to observe the improvement of gastrointestinal function and pulmonary symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease with phlegm heat accumulation and find the best meridians and acupoints. Methods A total of 120 patients with acute exacerbation of chronic obstructive pulmonary disease with phlegm heat accumulation and gastrointestinal dysfunction were randomly divided into intervention 1 group (lung meridian group), intervention 2 group (large intestine meridian group) and intervention 3 group (lung meridian and large intestine meridian group) and control group. There were 30 cases in each group. The control group was given conventional treatment and nursing. The intervention group was treated with acupoint massage along meridians, 1 times a day for 20 minutes, and the intervention lasted for 10 days. The scores of gastrointestinal symptoms, clinical symptom scores and C reactive protein among 4 groups were compared. Results The scores of gastrointestinal symptoms, clinical symptom scores and C reactive protein were decreased in all groups after intervention compared with those before intervention, and the difference was statistically significant (F=9.736, 2.980, 0.894, P<0.01 or 0.05). After intervention, the difference of the scores of gastrointestinal symptoms among four groups were statistically significant (Ftime=213.423, F interaction =2.540, Fgroup =3.184, P<0.01 or 0.05). The difference of the scores of clinical symptoms among four groups were statistically significant( Ftime =337.859, P<0.01). The difference of C reactive protein among four groups was statistically significant (F=0.894, P<0.05). Conclusions Acupoint massage can effectively reduce the score of the symptoms of the gastrointestinal tract, the integral of clinical symptoms and the C reaction protein, and the effect of the massage of the meridians and collaterals. The effect of massage in the lung and the coliform meridian acupoint group is the best.

Objective:To explore the value of Hong′s single-stitch duct to mucosa pancreaticoenterostomy(HSDMP) in laparoscopic pancreaticoduodenectomy(LPD).Methods:The perioperative clinical data of 300 patients undergoing LPD admitted to the Second Department of Hepatobiliary Surgery in the First Hospital of Jilin University from April 2015 to March 2019 were retrospectively analyzed. The patients were categorized into pancreatic fistula group( n=43) and non pancreatic fistula group( n=257). according to the presence or absence of postoperative pancreatic fistula. Among them, pancreaticojejunostomy was performed with HSDMP in 210 patients, and 90 patients underwent traditional pancreaticoenterostomy. Univariate and multivariate logistic regression were used to analyze the risk factors for the development of pancreatic fistula after LPD, and the difference on the time of pancreaticojejunostomy and the incidence of postoperative pancreatic fistula were compared between HSDMP and traditional pancreaticojejunostomy. Results:Univariate analysis showed that the differences on BMI, abdominal operation history, pancreatic texture, and pancreatic duct diameter were statistically significant compared with non-pancreatic fistula group (all P value <0.05). Multivariate logistic regression showed that BMI ( OR1.180, 95% CI1.047-1.338, P=0.008) and pancreatic texture( OR=0.375, 95% CI 0.135-0.861, P=0.036) were independent risk factors for pancreatic fistula after LPD. Compared with traditional pancreaticojejunostomy, HSDMP was associated with shorter anastomosis time and low incidence of postoperative pancreatic fistula, but there was no statistical significance between the two groups. Conclusions:The independent risk factors for pancreatic fistula are high BMI and soft pancreatic texture. Compared with traditional pancreaticojejunostomy, HSDMP does not prolong LPD time and increase the incidence of postoperative pancreatic fistula.