Objective To investigate the association between vascular risk factors and the location of intracranial artery stenosis (anterior versus posterior).Methods Magnetic resonance angiography(MRA) were examined in 374 acute stroke patients.It was divided into two groups (anterior and posterior intracranial artery stenosis group).Analyzed possible risk factors.Results Univariate analysis showed there were differences between anterior and posterior intracranial artery stenosis in systolic blood pressure,history of smoking,drinking and stroke status,and national institutes of health stroke scale (NIHSS) score at discharge,short-term prognosis,serum creatinine,triglyceride,low density lipoprotein cholesterol (LDL-C) (P ＜ 0.05).In multivariate logistic regression analysis,high blood sugar (OR =1.135,95％ CI:1.003-1.284),history of stroke(OR =1.133,95％ CI:1.007-1.276),good short-term prognosis (OR =5.987,95％ CI:1.441-24.873) were preferentially related to anterior intracranial artery stenosis,whereas history of smoking (OR =0.003,95 ％ CI:0.000-0.376),high serum creatinine values (OR =0.509,95 ％ CI:0.328-0.790),high triglyceride values (OR =0.054,95％ CI:0.004-0.645) and high LDL-C values (OR =0.096,95％ CI:0.015-0.608) were preferentially related to posterior intracranial artery stenosis.Conclusion Vascular risk factors appeared to exert different effects of risk for anterior and posterior intracranial artery stenosis.

Objective To introduce the clinical application of BHP9504 fluorescent analytic instrument.Methods The chemical immunofluorescent test was used in high-precision,high-stability photo-signal test by photon counting technology.Results Photo-signal test could examine strong photo-signals in dark background so that it was able to improve sensitivity of experiments.Conclusion This technique widens the range of application and reduces specimen amount.

This article analyzes the status quo of sales supervision on medical devices through some aspects, including the relevant regulation system, the standards of sales admittance, the supervision team and the approval of business license. According to the exiting problems, some improving countermeasures are proposed for reference.
Materials Management, Hospital ; organization & administration

Objective To analyze reasons for unplanned return-to-theater obstetrical surgery in patients with placenta previa, and to propose a strategy for prevention.Methods Among 571 patients with placenta previa in the Department of Obstetrics, First Affiliated Hospital of Nanjing Medical University from January 2010 to January 2015, ten cases (1.75％) who had an unplanned return-to-theater obstetrical surgery were retrospectively analyzed.Results Seven out of the ten cases returned to the theater due to severe hemorrhage after cesarean section and hysterectomy or uterine artery embolization was performed.The rest three pregnancies were terminated at mid-term with amniotic injection of rivanol, two of which developed severe infection after the induction combined with uterine artery embolization followed by cesarean section,and the other one finally had an emergent hysterectomy due to severe postpartum hemorrhage after cesarean section because of intrapartum hemorrhage.Severe postpartum hemorrhage occurred in eight out of the ten cases, with a mean volume of (4 212± 1 651) ml.Blood loss between the original and return-to-theater surgery was (2 206± 736) ml.In these eight cases, the mean volume of erythrocyte suspension transfusion was (23.7±9.0) U, and [M(min-max)] 1 845(390 3 960) ml for plasma transfusion.Platelet transfusion was performed in five cases, cryoprecipitate transfusion in eight cases, serum albumin transfusion in six cases, and fibrinogen transfusion in five cases.The interval between original and return-to-theater surgery was 2.0(0.5-19.0) h.After the return-to theater surgery, the time of antibiotic use was (9.2±2.3) d, and the duration of hospital stays was (10.6±2.5) d.No patient required further re-operation, and all were discharged without long-term sequelae.All seven neonates had a good prognosis.Conclusions Severe postpartum hemorrhage in patients after initial operation because of placenta previa is the primary indication for unplanned return-totheater surgery.Closed postoperative monitoring, early recognition and expedite return-to-theater surgery are crucial to stop bleeding and save lifes.

Objective To study the changes of iodine source and the nutritional status of iodine after termination of iodized salt supply in the areas with different water iodine concentrations in Shanxi province,in order to provide scientific bases for developing strategies on control and prevention of iodine deficiency disorders,and to study the cut-off value of water iodine level where iodized salt supply should be stopped.Methods In 2010 in Shanxi province,6 villages with 100％ of non-iodized salt consumption rate were selected as the survey spots based on the iodine concentration in drinking water of 0-,50-,100-,150-,300-,≥500 μg/L.Villages'iodized salt supply was terminated thoroughly.In each village,20 children aged 8 to 10 were selected.At the same time,women of childbearing age 18 to 50 years old and adult men aged 18 to 60 were selected from the same families as the children.Diet surveys were conducted by the method of 3 days recall on all subjects.Drinking water samples,staple foods,supplementary foods and urinary samples of all subjects were collected and the iodine concentration was determined by arsenic-cerium catalytic spectrophotometry.Results ①In the villages of water iodine 25.9,70.6 μg/L,the medians urinary iodine of children,women and men were all ranged from 100 to 199 μg/L,which meant their iodine nutrition levels were appropriate.In the village of water iodine 109.0 μg/L,the medians urinary iodine of children,women and men were all ranged from 200 to 299 μg/L,which meant their iodine nutrition levels were more than appropriate.In the villages of water iodine 225.8,430.0,581.2 μg/L,the medians urinary iodine of children,women and men were all ≥ 300 μg/L,which meant their iodine nutrition levels were too high.②)In all the 6 villages,the intaking amount of iodine met and exceeded the standard recommended intake of dietary iodine by ICCIDD/UNICEF/WHO (8 to 10-year-old children ≥ 120 μg/d,women of childbearing age and adult men ≥ 150 μg/d).But in the village of water iodine 581.2 μg/L,the iodine intake was exceeded the daily maximum safe intake (children aged 8 to 10 ≤800 μg/d,women of childbearing age and adult man ≤ 1000 μg/d).③The amount of iodine ingestion from drinking water was increased with the water content of iodine.When water iodine exceeded 100 μg/L,the amount of iodine ingestion from drinking water was higher than from food intaking,and became a main resource of iodine in the human body.Conclusions In the counties of iodine concentration in drinking water above 100 μg/L in high iodine areas of Shanxi province,the water iodine becomes the most important source of iodine,and iodine nutritional level is more than appropriate or possible excess.It is recommended that in areas of high water iodine of Shanxi province,the standard cut-point of water iodine value is set to 100 μg/L.

Objective To evalute the value of spiral CT in diagnosis and treatment of chronic suppurative otitis media.Methods Sixty-five cases including seventy-nine ears underwent the direct axial plane and coronal multiplanar reformation and three-dimensional reconstruction of auditory ossicular chain in chronic suppurative otitis media spiral CT imaging of temporal bone. Results The direct axial plane and coronal multiplanar reformation in diagnosing of the chronic suppurativeotitis media were correspondent,but in showing of the most middle ear structure were difference. Three-dimensional images was superior to axial and coronal MPR images in showing of the change of malleus and incus,the contrary situation in showing stapes. Only 3D image may not select application for definition.The rate of agreement between spiral CT diagnosis by combination of three different imaging methods and definition of chronic suppurative otitis media and operative findings(89.9%～97.5%) were higher, false positive rate(2.9%～6.0%) and false negative rate(0～14.6%) of the CT diagnosis were lower.Conclusion Combination of three different imaging methods(axial images, coronal MPR images and three-dimensional images of the ossicular chain) can improve the value of the spiral CT diagnosis and therapy of chronic otitis media.

Objective To determine the value of differential time to positivity ( DTTP ) of blood culture for the diagnosis of catheter-related bloodstream infection ( CRBSI ) in patients with solid tumors in intensive care unit ( ICU ). Methods A retrospective study was conducted. 615 pairs of peripheral vein blood cultures and instantaneous catheter tip blood culture of 615 patients admitted to ICU of Tianjin Medical University Cancer Institute and Hospital were collected from August 2011 to March 2014. The DTTP method and ( or ) semi quantitative culture of catheter tip were compared. CRBSI was diagnosed when both cultures were positive for the same microorganism and DTTP ≥2 hours ( 120 minutes ). The result of this procedure was compared with that of organism obtained using the semi quantitative culture of blood at catheter tip with≥15 cfu. Based on the clinical diagnosis, the reliability of two kinds of laboratory examination was compared for the diagnosis of CRBSI by plotting receiver operator characteristic curve ( ROC curve ). Results The result of 615 cases suspected of having CRBSI were analyzed during the study period. Of these, 440 episodes were excluded because cultures were negative for blood obtained through peripheral vein and central vein. Eight episodes were excluded because only peripheral vein blood culture was positive and 57 episodes were excluded because of only central vein blood culture was positive, 68 pairs of blood cultures were excluded due to the presence of multiple catheters and repeated blood withdrawals. Two cases of polymicrobial cultures were excluded from the final analysis due to the difficulty in determining the time of positive result for each individual microorganism. Ten cases in 42 cases of suspected cases of CRBSI were excluded from analysis because catheter was not removed, therefore culture from catheter tip could not be obtained. Using the DTTP method, 14 out of 17 CRBSI cases were diagnosed with DTTP≥120 minutes, while 3 cases were missed;the semi quantitative catheter tip culture was positive in 13 cases, and in 4 cases it was neglected. In 2 cases of CRBSI it was missed by both methods. The area under the ROC curve ( AUC ) of DTTP, catheter tip culture and the combination method was 0.912, 0.882 and 0.941 for diagnosis of CRBSI, respectively. Validity values for the diagnosis of CRBSI for DTTP were:sensitivity 82.35%, specificity 92.31%, positive predictive value 93.33%and negative predictive value 80.00%, and they were higher than those of the catheter tip culture method only ( 76.47%, 84.62%, 86.67% and 73.33%). The specificity and positive predictive CRBSI combination of the two methods in the diagnosis value were up to 100%, the sensitivity ( 88.24%) and negative predictive value ( 86.67%) was also increased, but no significant differences were found with DTTP method (χ2=0.00, P=1.00;χ2=0.00, P=0.98;χ2=0.00, P=0.98;χ2=0.00, P=0.98 ). Conclusions DTTP can be a valid method recommended for CRBSI diagnosis in critically ill patients with acceptable sensitivity, good specificity as well as positive predictive value. DTTP combined with other clinical symptoms can not only avoid unnecessary catheter withdrawal, but it also can help obtain the optimal treatment time and strategy.

Objective:To analyze risk factors of cancer patients with Pseudomonas aeruginosa bloodstream infections and drug resistance. Methods:Clinical data of 30 cancer patients with P. aeruginosa bloodstream infection and 90 without infection who were ad-mitted in the Tianjin Medical University Cancer Institute and Hospital between January 2010 and December 2012 were retrospectively analyzed. Whonet 5.6 and SPSS19.0 software were used for statistical analysis of the data. Results:The infection group consisted of 20 male and 10 female patients with a mean age of 60.9±11.2 years. The control group consisted of 60 males and 30 females with a mean age of 51.3 ± 15.9 years. Multivariate logistic regression analysis showed that the number of hospitalization, combined with infection of other sites, and more than two types of antibiotics were independent risk factors of cancer patients with P. aeruginosa bloodstream infec-tions. P. aeruginosa showed high sensitivity(>80%) to carbapenems, ceftazidime, cefepime, aminoglycosides, and fluoroquinolones. The mortality rate of cancer patients with P. aeruginosa bloodstream infections was 60%. Conclusion:Cancer patients with P. aerugino-sa bloodstream infections have high mortality. Therefore, comprehensive prevention and control measures must be implemented in clini-cal practice to reduce P. aeruginosa bloodstream infections.

OBJECTIVETo compare the effects of dexmedetomidine and midazolam with fentanyl with anticipated difficult intubation during awake blind nasal intubation on respiration and hemodynamics of patients.

METHODSForty patients (ASA class I to II) undergoing selective oral and maxillofacial surgeries with anticipated difficult intubation were enrolled in the study. The patients were randomly assigned into two equal groups. Experimental group received dexmedetomidine, control group received midazolam and fentanyl. The Ramsay sedation scores, mean artery pressure (MAP), heart rate (HR), respiratory rate (RR) and blood oxygen saturation of pulse (SpO2) were recorded at baseline (TI), beginning to intubate (T2), 10 min after beginning to intubate (T3), 20 min after beginning to intubate (T4), and after intubation (T5). The operative time for intubation, intubation times, success rate of intubation, the anesthetic effects and complications were recorded.

RESULTSThe success rate in the experimental group was significantly higher than that in the control group (P<0.05). Intubation times in the experimental group was less than that in the control group (P<0.05). The incidence of complications such as nausea, vomiting, cough and throat unwell in the control group was higher. Compared with the T1, RR decreased at T2 in the control group, but RR increased significantly at T4 and T5. RR and SpO2 had no significant change in the experimental group. Compared with T1, MAP and HR increased at T3, T4 and T5 in the control group (P<0.05). MAP and HR showed no significant variations in the experimental group (P>0.05). The Ramsay sedation scores in the control group were lower than those in the experimental group (P<0.05).

CONCLUSIONAppropriate application of dexmedetomidine can be safer and more effective than midazolam with fentanyl for awake blind intubation.

ObjectiveTo evaluate the treatment efficiency of Au nanoparticles enhanced photosensitizer using near-infrared illumination.MethodsSpecific length-diameter-ratio Au Nanorods (AuNR) was coated with traditional photosensitizer indocyanine green (ICG),producing the novel photosensitizer ICG-AuNR.In order to evaluate the treatment efficiency,in-vitro near-infrared phototherapy experiments were performed on 4T1 mouse breast cancer cells.ResultsThe fluorescent intensity of ICG-AuNR is three times stronger than that of free ICG of the same concentration.Compared with free ICG of the same concentration,cell viability of 4Tl cells reduced in the near-infrared illumination treatment with the novel photosensitizer ICG-AuNR.ConclusionIn comparison with free ICG of the same concentration,the novel photosensitizer ICG-AuNR proves to be more effective on growth inhibition of cancer cells using near-infrared illumination treatment.