Objective To explore the application value of diffusion-weighted imaging(DWI) in distinction of skull base chordoma from chondrosarcoma.Methods The clinical data and imaging findings of basicranial tumor confirmed by pathology,including 14 patients with classic chordoma,9 with poorly differentiated chordoma and 18 with chondrosarcoma were analyzed retrospectively.The lesion location,enhancement patterns,signal intensity on T2 WI relative to gray matter,and apparent diffusion coefficient (ADC) values were reviewed.The enhancement pattern was scored as 0 (little or non-enhancement),1 (heterogeneous enhancement),or 2 (homogeneous enhancement in ≥90％area).The data were analysed by Kruskal-Wallis test.Results There were significant differences in the mean,minimum and maximum ADC values,the intensity on T2 WI and the enhancement pattern among the three tumor types (P ＜0.05).However,the differences in the score of enhancement pattern and lesion location were not found (P＞0.05).Conclusion DWI may be helpful for the diagnosis of skull base chordoma from chondrosarcoma,and the accuracy rate will be improved when combined with T2WI intensity.

Objective The purpose of this study is to evaluate the safety and effect of the homemade wrist restraint belt in postoperative patients during anesthesia recovery period.Methods Three hundred postoperative patients were randomly assigned into two groups,patients in the control group(n =150)were constrained with traditional restraint belt while patients(n =150)in the observation group were constrain-ed with homemade wrist restraint belt before recovered from general anesthesia in the post anesthesia care unit (PACU).The effectiveness of constraint,patients comfort,constraint related complications,PACU faculty responses on the satisfaction were recorded during anesthesia re-covery period.Results The complications in the observation group were lower than those in the control group (P <0.05).Compared with con-trol group,the patient satisfaction,patient comfort,PACU faculty satisfaction were significant higher in the observation group (P <0.05).Con-clusion The homemade wrist constraints could increase the patient’s safety and comfort,reduce restraint belt related complications during anesthesia recovery period.It revealed more effectiveness than the traditional restraint belt.

Purpose To investigate the value of dual-source CT with dual-energy virtual non-contrast imaging in the diagnosis of cervical lymph node disease. Materials and Methods The dual-energy scan data of 126 lymph nodes from 50 patients confirmed pathologically were reviewed. The difference of average CT value, signal to noise ratio, contrast to noise ratio, image subjective assessment and lesion detectability between virtual non-contrast imaging and conventional non-contrast scan were analyzed. The radiation dose of virtual non-contrast imaging and real non-contrast imaging of cervical lymph node were also compared. Results ①The consistency of virtual plain scan combined with dual-energy contrast imaging in the diagnosis of six typical pathological types were all satisfactory (Kappa>0.7, P<0.01), and the detection rate of non-specific lymphadenitis, lymphomas and lymph node metastasis of thyroid carcinoma was higher among the six types (93.1%, 86.7% and 100.0%, respectively, Kappa=0.983, 0.893; P<0.01), and had the highest detection rate of lymph node metastasis of thyroid carcinoma (100.0%, Kappa=1.000, P<0.01). ②There was no significant difference among the average CT, signal to noise ratio and contrast to noise ratio of conventional scan and virtual non-contrast imaging during arterial phase and venous phase (H=3.125, 4.374, 4.037;P>0.05).③ Compared with conventional enhanced scan, dual-energy phases reduced radiation dose by about 19%. Conclusion Dual-energy virtual non-contrast imaging combined with contrast imaging can provide clear images in the diagnosis of enlarged cervical lymph nodes and reduce radiation dose of subjects, thus can be expected to replace real scan.

Objective To explore the value of spectral imaging technique in dual-energy CT in differential diagnosis of the metastatic lymph nodes in thyroid carcinoma,squamous cell carcinoma metastatic lymph nodes and lymphoma in the neck.Methods In 30 patients with pathologically confirmed with a total of 79 cervical lymph nodes enlargement which were using dual energy scan .Then observed the change trend of the spectrum curve and comparison the three kinds of lymph node energy spectrum curve’s slope.Results In the 79 lymph nodes,the metastatic lymph nodes in thyroid carcinoma were twenty-three,squamous cell carcinoma metastatic lymph nodes were twenty-four and lymphoma were thirty-two.From 60 to 180 keV,with the increase of keV values,the three kinds of malignant lymph nodes of the corresponding CT value decreasing and the higher the keV value,the CT value decrease magnitude was small,and the spectrum curve was〞drop type〞.The slope spectrum curve of the metastatic lymph nodes of thyroid carcinoma in arterial phase and parenchymal phase were maximum,which were 1.23±0.41 and 0.85±0.33,respectively.The slope spectrum curve of lymphoma in arterial phase and parenchymal phase were least,whcih were 0.40±0.16 and 0.47 ±0.09.The slope spectrum curve of the squamous cell carcinoma metastatic lymph nodes in arterial phase and parenchymal phase were 0.88±0.10 and 0.62±0.28.The energy spectrum curve slope of the three kinds of malignant lymph nodes have statistical significance.Conclusion The energy spectrum curve slope of arterial phase and parenchymal phase has some significance lymph node metastasis of in thyroid carcinoma,the metastatic lymph nodes and lymphoma in the neck.

Objective To compare the outcomes of arthroscopic single-row and suture-bridge repair of medium-sized rotator cuff tears through clinical and MRI assessment.Methods Forty-five patients with medium-sized rotator cuff tears who underwent arthroscopic repair using single-row (SR,n=29) or suture-bridge (SB,n=26) technique between July 2014 to June 2015 in our hospital,were retrospectively enrolled in this study.All surgeries were performed by the same senior doctor.The functional outcomes were assessed using the rating scale of the University of California at Los Angeles (UCLA),American Shoulder and Elbow Surgeons shoulder index (ASES),Fudan University Shoulder Score (FUSS),visual analog pain scale score (VAS),and range of motion (ROM) before the operation and at the last follow-up.MRI examination was performed at the final follow-up.Results Finally 50 patients were followed up successfully,24 in SB group and 26 in SR group.There were no significant differences between the two groups in terms of age,sex,follow-up duration,and the affected side.Before the operation,no significant differences were observed between the 2 groups in all the measurements.After more than 1-year follow-up,significant improvement was found in all measurements for both groups,but without significant differences between them.MRI examination showed no re-tears in either group.According to the Sugaya's classification,there were more type Ⅰ patients in SB group than SR group (83.3％ vs 61.5％),but the difference was not significant.Conclusion Arthroscopic suture-bridge repairing of medium-sized rotator cuff tears results in safe and good early clinical outcomes.However,compared with the single-row technique,there was no significant advantage.Although the MRI examination showed a better result of rotator cuff healing in the early stage,its long-term outcomes need further studying.

PurposeTo explore the significance of dual energy CT in differential diagnosis of squamous cell carcinoma metastatic lymph nodes and lymph node tuberculosis in the neck.Material and Methods Twenty-five patients with a total of 62 cervical enlarged lymph nodes confirmed with squamous cell carcinoma metastasis or lymph node tuberculosis by pathology underwent dual energy enhanced CT scan. Iodine coverage value of two different kinds of pathological properties of lymph nodes was measured. The trend of the spectrum curve was observed and the energy spectrum curve slope of two kinds of lymph nodes were compared. The sensitivity, specificity and accuracy of energy spectrum curve slope in differential diagnosis were analyzed. Results Of all 62 lymph nodes, there were 32 squamous cell carcinoma metastatic lymph nodes and 30 lymph node tuberculosis. There were statistic significance in the iodine coverage between the squamous cell carcinoma metastatic lymph nodes and lymph node tuberculosis (t=3.806 and 3.698,P<0.05). In the range from 60 keV to 180 keV, CT value of the two kinds of lymph nodes decreased with increase of keV value. It showed the higher the keV value the less CT value decreased, with the energy spectrum curve of drop type. The area of the iodine coverage was 0.756 with the differential diagnostic sensitivity of 56% and the specificity of 80%. The area of energy spectrum curve slope was 0.898 with the differential diagnostic sensitivity of 76% and the specificity of 85%.Conclusion The iodine coverage value and the energy spectrum curve slope have significance in differential diagnosis of the cervical squamous cell carcinoma metastatic lymph nodes and lymph node tuberculosis. The energy spectrum curve slope is superior to the iodine coverage value in differential diagnosis.

Objective To evaluate the efficacy of parecoxib sodium for prevention of post-thoracotomy pain syndrome.Methods Ninety ASA physical status Ⅰ or Ⅱ patients,aged 40-64 yr,weighing 50-80 kg,scheduled for elective thoracotomy,were equally and randomly divided into 3 groups using a random number table:control group (group C) and two different treatments with parecoxib sodium groups (P1 and P2 groups).At 20 min before skin incison,parecoxib sodium 40 mg was injected intravenously in P1 and P2 groups,while the equal volume of normal saline was given in group C.An increment of parecoxib sodium 40 mg was given every 12 h for 6 times after surgery in group P2.General anesthesia combined with epidural anesthesia was used during surgery and patient-controlled epidural analgesia was used for postoperative analgesia in the three groups.Morphine was used as rescue analgesic to maintain VAS score ≤ 3.The consumption of morphine within 72 h after operation,development of adverse effects and development and duration of pain (VAS score ＞ 3) within 6 months after operation were recorded.The blood coagulation was measured at 72 h after operation.Results Morphine was not used within 72 h after operation in P2 group.The abnormality of blood coagulation at 72 h after operation was not observed in the three groups.Compared with group C,no significant changes were found in the incidence and duration of pain within 6 months after operation in P1 group (P ＞ 0.05),the incidence of pain was significantly decreased and duration of pain was shortened within 6 months after operation in P2 group,and the incidence of nausea,vomiting and pruritus was decreased in P1 and P2 groups (P ＜ 0.05 or 0.01).The incidence of nausea,vomiting and pruritus was significantly lower in P2 group than in P1 group (P ＜ 0.01).Conclusion Continuous application of parecoxib sodium for 72 h can decrease the development of post-thoracotomy pain syndrome without increasing the incidence of adverse effects.

Objective To understand the current situation and characteristics of occupational exposure(OE)among health care workers(HCWs),and provide basis for making preventive measures.Methods Self-designed question-naire about OE was adopted,OE among all HCWs in a hospital in January-December 2015 were surveyed and statis-tically analyzed.Results A total of 1888 HCWs were surveyed,there were 304 cases of OE,the mean OE rate in the whole hospital was 16.10%;OE occurred 370 times(19.60%).Doctors,trainees,and HCWs who worked for≤1 year had relatively higher OE rates,which were 23.18%(102/440),17.88%(49/274),and 18.34%(95/518) respectively.Sharp injury is the main OE mode,accounting for 83.24%(n=308),sharp injuries mainly occurred before disposing the used devices and during the process of use,accounting for 37.99%(n=117)and 36.69%(n=113)respectively.Among 370 times of OE,315 could be traced to the sources of exposure.Among the known ex-posure sources,OE of bloodborne pathogens accounted for 24.13% (n=76).59 of 370 times of OE implemented complete local treatment and reporting procedures,reporting rate of OE was 15.95%.Conclusion Hospital should take comprehensive measures to promote occupational safety precaution,and reduce the incidence of OE.

Klotho protein is an anti-aging gene product, which is involved in the regulation of calcium, phosphate and vitamin D metabolism together with fibroblast growth factor 23 (FGF23). In recent years, studies have found that Klotho/FGF23 is closely related to the growth and development of children and newborns. This paper summarizes the role of Klotho/FGF23 in the occurrence and development of infants small for gestational age, in order to provide further understanding and inspiration for the prevention and treatment of SGA complications.

Objective:To explore the correlation between glycemic control of type 2 diabetes mellitus (T2DM) patients and brachial-ankle pulse velocity (baPWV). Methods:A community-based cross-sec-tional study was conducted in Beijing, China. Every subject underwent physical examinations, glycated hemoglobin ( HbA1 c ) , blood lipid and baPWV measurements and completed a standardized question-naire. T2DM patients were divided into well controlled and poorly controlled groups according to HbA1c levels. The correlation between glycemic control of T2DM patients and baPWV was analyzed. Results:In this study, 1 341 subjects were recruited, including 733 T2DM patients and 608 non-diabetes sub-jects. Compared with non-diabetes subjects, abnormal baPWV ( baPWV≥1 700 cm/s) rate for T2DM patients was higher (40. 8% vs. 26. 8%, P<0. 001). With HbA1c<6. 5% or <7. 0% as the aim of glycemic control in T2DM patients, the abnormal baPWV rates for non-diabetes subjects, well controlled and poorly controlled T2DM patients were significantly different (non-diabetes vs. HbA1c<6. 5% T2DM vs. HbA1c≥6. 5% T2DM: 26. 8% vs. 32. 8% vs. 42. 6%, P <0. 001; non-diabetes vs. HbA1c <7. 0% T2DM vs. HbA1c≥7. 0% T2DM:26. 8% vs. 36. 1% vs. 43. 4%, P<0. 001). After being ad-justed for gender, age, smoking status, diabetes mellitus family history, T2DM duration, cardiovascular diseases ( CVD ) , waist hip ratio ( WHR ) , systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP) , total triglycerides ( TG) , high density lipoprotein cholesterol ( HDL-C) , and low density lipo-protein cholesterol ( LDL-C ) , the Logistic regression models suggested that glycemic control status of T2DM patients was associated with abnormal baPWV. Compared with non-diabetes subjects, the ORs for abnormal baPWV in HbA1 c <6 . 5% T2 DM patients and HbA1 c≥6 . 5% T2 DM patients were 0 . 927 (95%CI 0. 560-1. 537) and 1. 826 (95%CI 1. 287-2. 591). Compared with non-diabetes subjects, the ORs for abnormal baPWV in HbA1c<7. 0% T2DM patients and HbA1c≥7. 0% T2DM patients were 1. 210 (95%CI 0. 808-1. 811) and 1. 898 (95%CI 1. 313-2. 745). Conclusion:The glycemic con-trol status of T2DM patients from communities is significantly associated with baPWV. Poor glycemic con-trol is a risk factor for abnormal baPWV. Keeping HbA1c under control might lower the risk of cardiovas-cular diseases in T2DM patients.